It’s two o’clock in the morning when your phone rings. It’s the on-call hospital administrator at your facility. A natural disaster has struck, and your hospital must remain fully operational for the next 72-96 hours with limited external resources. The 96-hour emergency management plan at your hospital is being activated, and a media press conference is set to take place at 5:00 a.m. The next question you hear is, “Do we have enough medications on hand to provide care to our patients for the next 3-4 days?” As the pharmacy director, which medications will you prioritize as the most medically necessary?

While this scenario might seem like something out of a blockbuster movie, you may have already faced it or addressed a similar question during your triennial accreditation survey preparation. At the core of this situation is the crucial question: Is the medication list in your emergency playbook robust enough to meet the challenge, or will it leave you scrambling?

If you haven’t created an essential medications list before, or are looking to revisit your current one, it’s important to start by defining your scope. According to the World Health Organization (WHO), essential medications are those that satisfy the priority health care needs of a population. Your scope consists of two main components: the setting you are covering and the types of medications you are including.

First, determine what your setting needs to plan for. Then, define which medications are essential for your patients. This should reflect the disease prevalence and public health relevance within your patient population, including common conditions, infrequent but possible scenarios, and rare but potential disease states. Both the identification of disease states and the selection of necessary medications should be approached in a multidisciplinary fashion, leveraging the expertise of specialists in each area to pinpoint the truly essential medications.

When creating a disease state-specific medication list, it’s helpful to identify primary and secondary alternatives when possible. For organizations that serve as centralized hubs within a larger health system, it might be most feasible to set a minimum reorder point at 7-8 days for each medication based on system-wide use. This strategy ensures the larger hub can maintain control over product availability during challenging times. However, given the diversity of your patients and the “rare or potential disease states,” this approach can lead to substantial costs and high levels of waste on seldom used but essential products.

For smaller or leaner facilities, establishing reduced reorder points for secondary agents or even a non-stocking status for infrequent secondary agents, when the primary medication is readily available, can help reduce carrying costs. This approach does require closer attention to stock levels to ensure availability and a commitment to daily ordering.

Regardless of the facility size, partnering with vendors to identify replacement product programs and collaborating with other hospitals in the area to understand each location’s stock can help cut costs and reduce waste.

Lastly, establishing a follow-up procedure to ensure the medications on your emergency list remain in stock is essential. If your automation or inventory management system allows you to set standard stock products in both decentralized and centralized inventory, you can align your inventory reports with cycle counts to ensure products are always replaced after expiration and never inadvertently removed.

For hospitals in regions where emergencies are more common, whether year-round or seasonally, consider creating more frequent automated dashboards to alert your buyer of stock issues. Additionally, revisiting your day’s supply based on current patient usage or embedding the emergency medication evaluation within the formulary approval process can help maintain the stability of your list as treatments and needs evolve.

Steps to Consider When Creating an Essential Medication List for Your 96-Hour Emergency Management Plan:

1. Form a multidisciplinary team.
   1. Include representatives from pharmacy, clinical departments, administration, inventory management, and key disaster management members.
   2. Ensure involvement of specialists for different disease states to get a comprehensive perspective.
2. Define essential medications.
   1. Prioritize medications based on disease prevalence, public health relevance, and patient needs within your specific setting. Identify primary medications and establish secondary alternatives for each condition.
   2. Validate the list with input from specialists and clinical teams to ensure completeness and accuracy.
3. Develop inventory management protocols.
   1. Set minimum reorder points based on medication use patterns. For centralized hubs, establish a minimum reorder point at 7-8 days for each medication. For smaller or leaner facilities, consider reduced reorder points or non-stocking status for infrequent secondary agents.
   2. Use automation and inventory management systems to track stock levels and align reports with cycle counts.
   3. Create automated dashboards to alert buyers of stock issues, especially in regions prone to emergencies.
4. Collaborate with vendors and other local hospitals.
   1. Collaborate with nearby hospitals to create a network of transparency and cost reduction by sharing information on high-cost, low-utilization medications.
   2. Work with vendors to identify product replacement programs or consignment opportunities to reduce costs and ensure supply.
   3. Explore options for emergency restocking and rapid replenishment.
5. Create a plan for ongoing monitoring and continuous improvement.
   1. Schedule regular reviews of the essential medication list to update it based on changing patient needs and treatment protocols. Revisit day’s supply based on current patient usage and embed the emergency medication evaluation within the formulary approval process.
   2. Maintain communication with clinical teams, administration, and other stakeholders to ensure the list remains relevant and effective.