(1274) Development of a Pharmacy Point-of-dispensing Toolkit for Anthrax Post-exposure Prophylaxis for United States Postal Workers

Objectives: The objective of this project was to develop a Pharmacy Point-of-Dispensing (POD) toolkit and response plan for use by the local health department following a mass Anthrax exposure at a United States Postal Service (USPS) sorting facility. It is the responsibility of a local county health department pharmacy in western Pennsylvania to respond to anthrax exposure events, including the provision of an initial 10-day supply of antibiotics for post-exposure prophylaxis (PEP). A team of health department pharmacists identified the need to update the local health department’s USPS anthrax response plan to include development of a POD toolkit.

Methods: The process to develop a Medical Countermeasures Response Plan and Implementation toolkit for mass POD was guided by both the Centers for Disease Control and Prevention (CDC)’s Public Health Preparedness Capabilities: National Standards for State and Local Planning framework and input from an interprofessional stakeholder team. This process was led by a team of pharmacists. Phase 1 included a local needs assessment for anthrax exposure medical countermeasures planning. This needs assessment was guided by: (1) a literature review including past national anthrax response efforts in 2001, other state anthrax response plans; and clinical recommendations/guidelines for anthrax PEP medication administration and vaccination; (2) existing county health department anthrax response plan; and (3) a series of interprofessional fact-finding stakeholder meetings. This was followed by Phase 2, the development of the Policies and Procedures and the Implementation toolkit. The final phase, Phase 3, involved ongoing education and training for the health department pharmacy staff and other health department staff members, as well as revisions to the toolkit.

Results: The Phase 1 review of the 2001 anthrax response revealed antibiotic nonadherence as one of the most reported findings due to a lack of consistent and clear patient education about the medications. Five stakeholder meetings were held between January-June 2022. Stakeholders were engaged throughout all three phases of the planning process to provide feedback on the toolkit contents. The interprofessional stakeholder team included both clinical and non-clinical staff from the local health department and a USPS sorting facility in western Pennsylvania. Toolkit contents developed include: (1) Anthrax PEP POD Policy and Procedures; (2) Antibiotic Standing Order; (3) Patient Intake and Consent Form; (4) Medication Dispensing Record; (5) Ciprofloxacin Drug-Drug Interaction Quick Reference; (6) Doxycycline Drug-Drug Interaction Quick Reference; (7) Provider Letter; (8) Recommended “To-do” List for patients; (9) POD Flow Plan; (10) Antibiotic Dispensing Algorithm; (11) POD Pharmacy Supply List; (12) Response POD Call List; (13) CDC Patient Anthrax Fact Sheet: Ciprofloxacin; (14) CDC Patient Anthrax Fact Sheet: Doxycycline; and (15) Medication bottle/vial labels. The toolkit and standing order are now implemented at the local health department and are reviewed and updated on a yearly basis by the health department pharmacy team and leadership.

Conclusions: Development of this toolkit and response plan highlights the expertise pharmacists bring to medical countermeasures planning. This toolkit adds important patient-facing resources that address patient concerns regarding medication adherence, patient safety, and patient education which were issues during the 2001 events. The toolkit was created with adaptability in mind. Content of this toolkit can easily be revised for mass antibiotic dispensing due to other Category A bioterrorism agents such as Plague (Yersinia pestis) or Tularemia. This work highlights the importance of engaging pharmacists in emergency response and medical countermeasures planning that involve medications.