With any introduction of automation or technology into the pharmacy, careful planning must be undertaken to prevent disruption of patient care during critical downtimes, including power outages. As manual methods for drug delivery and dispensing on patient care units have been replaced with automated approaches, this new automation is quickly becoming the standard of practice. Without proper planning, loss of power to these devices could create significant care delays and increase the risk of patient harm.
Acknowledging this new reality, The Joint Commission’s 2019 accreditation standards require the inclusion of written emergency backup policies for essential medication dispensing equipment.1 To achieve compliance with this requirement, each piece of pharmacy automation must be classified as essential or nonessential. Thereafter, pharmacy administration and facilities management must collaborate to identify which devices require emergency power, surge protection, or uninterruptible power supply (UPS), and ensure that each device has easily accessible written downtime procedures. (See TEXT BOX 1 for a definition of terms.)
Environment of Care Standards
The Joint Commission’s Environment of Care (EC) standards focus on the importance of managing risks within the environment of care. The main goal of these standards is to promote a safe, functional, and supportive environment within the hospital in order to preserve safety and quality. The EC standards apply to all hospitals regardless of their size or location.
The standard states that a written policy should be implemented outlining how the hospital will provide emergency power for essential medication dispensing equipment and essential medication refrigerators. In addition, the hospital should identify the dispensing equipment and refrigerators that fall under the essential category; specific examples are provided, including ADCs, medication carousels, medication robots, and medication refrigerators and freezers (see TEXT BOX 21).
In this endeavor, it is critical to consider the facility’s power infrastructure, as well as the types of automation and technology used in the pharmacy. Developing a policy and procedure (P&P) for pharmacy emergency power downtime is also required.
Facility Power Infrastructure
In recent years, there has been an evolution in hospital size and complexity. Regardless of the size of the hospital campus, health care facilities are mandated to provide reliable electrical power that is backed up with emergency and standby power systems. Emergency systems must be available during any crisis to ensure an uninterrupted flow of electricity to the entire health care campus.
Power interruptions may result from utility outages, equipment failures, testing procedures, and standard maintenance. Notably, those power outages that are due to natural disasters and other unexpected events are more difficult to address, particularly if they result in the entire facility relying on emergency and standby power to operate. Therefore, every health care facility’s contingency plan must encompass worst-case scenarios. During natural disasters, the availability of robust health care services is especially critical, so emergency systems must be maintained in a perpetual state of readiness.
In contrast to other commercial buildings, the provision of emergency and standby power to health care facilities is a major undertaking due to their complexity and size. Multiple systems are involved, and alternate power sources, switching equipment, different controls, and distribution equipment may be required.
In our health care facility, the 536-bed Moses H. Cone Memorial Hospital (MCMH) in Greensboro, North Carolina, a power blip—any failure that lasts more than 3 seconds— triggers our alternative power supply to engage. Automatic transfer switches re-route electrical power from normal sources to alternative sources, and a flow of emergency and standby electrical energy is immediately fed to our health care facility from emergency generators. The total duration of the experienced power loss should be less than 5 seconds.
Technology Use in Pharmacy
Pharmacy leadership must thoroughly evaluate the emergency and standby power needs of essential equipment used in pharmacy operations. Decisions as to what equipment requires emergency power access through emergency outlets (called red plugs at MCMH [see PHOTO 1]), and equipment that must be directly wired into the emergency electrical circuits (eg, carousels, air handler, security systems), must be made (see TABLE 1).
After these decisions are finalized, the next issue to address is dirty power—powerful electrical surges in the health care facility’s electrical grid, which can occur during the transition from normal to alternative power. Because dirty power has the capacity to damage essential equipment, the facility must determine which technologies should be protected by UPS devices.
UPS devices are designed to keep essential systems safe and operational. The basic standby UPS is an uninterruptible power source that delivers short-term, battery-sourced clean power—power that does not experience surges or power spikes during outages (see PHOTO 2). With a standby UPS, the hardware receives utility power under normal conditions through a direct AC connection. An uninterrupted power source is vital for the provision of clean power to mission-critical equipment.
Installation of a UPS can be beneficial in situations where items require additional time to be shut down properly to prevent damage to the hardware. The UPS allows appropriate time for critical jobs to finish, such as TPN formulation with multi-channel automated compounding devices, before shutting it down. At MCMH, the following technologies are protected by UPS devices: computers, the controlled substances safe, printers, automated compounding devices (multi-channel), and IV robots.
Finally, to prevent further damage to equipment, surge protectors are useful to protect hard-wired critical electronics, such as computers and printers. Surge protectors are also useful in situations where it is impractical to install a UPS device, such as automated dispensing cabinets, medical refrigerators, and unit-dose drug packagers.
Emergency power P&Ps should include comprehensive information that addresses which devices are controlled by a back-up source of energy. At a minimum, the governing P&P should include the essential equipment identified by the environment of care standards (ie, ADCs, medication carousels, refrigerators, and freezers). Additional information should encompass manual overrides in the event of unintentional downtime or emergency power failure (eg, for the carousel and C2 safe).
At the time of power loss, pharmacy personnel should inspect the essential equipment to ensure that the switch to emergency power was successful. Per National Fire Protection Association (NFPA) Code 99, restoration of critical loads is required within 10 seconds.2 Lastly, P&Ps should acknowledge the monthly and/or annual testing requirements for emergency generators as outlined by The Joint Commission.3
With our ever-increasing reliance on automation and technology in pharmacy, it is critical that advance planning addresses power failures. Each piece of electrical equipment owned by pharmacy should be designated as essential or non-essential. In addition, if emergency power is indicated, determine whether a UPS should be used, and establish the downtime procedures in the event of a power failure. Thoughtful planning and adaptation of P&Ps is necessary for compliance with The Joint Commission standard and will serve to ensure safe patient care can continue during power failures.
Moses H. Cone Memorial Hospital’s Pharmacy Emergency Power Policy is available in FIGURE 1.
Kevin N. Hansen, PharmD, MS, BCPS, the assistant director of pharmacy at Moses H. Cone Memorial Hospital (MCMH), provides oversight and leadership for pharmaceutical compounding and perioperative services pharmacy. He graduated from the Lake Erie College of Osteopathic Medicine with a Doctor of Pharmacy degree and received an MS in Pharmaceutical Sciences from the University of North Carolina Eshelman School of Pharmacy.
James Mundy, PharmD, is the assistant director of pharmacy operations at MCMH. Previously, he was the assistant director of pharmacy for sterile products, manufacturing, and perioperative services at MCMH. Jim received his PharmD from Campbell University.
Minh-Thi (Michelle) Ton is a fourth-year student pharmacist studying at the University of North Carolina Eshelman School of Pharmacy. She is currently completing her advanced pharmacy practice experience (APPE) at MCMH. Her interests include women’s health, psychiatry, and pediatrics.