(Management Case Study) What's Paper? Are You Prepared for a Technology Disruption?

Purpose: Cyberattacks in healthcare are increasing at an alarming rate across the United States. Current downtime procedures are usually designed for a single system being unavailable for a short period of time. While it is important to participate in organizational preparedness, pharmacy has a unique set of challenges due to specific systems and regulatory requirements. Since a cybersecurity incident can take down multiple systems on the server, our health system has challenged pharmacy to create a Business Continuity Plan to be prepared in the event of a technology disruption.

Methods: The pharmacy management team met to discuss the important elements to be included in the Business Continuity Plan that were specific to the pharmacy operation. An emergency readiness binder was assembled to address medication safety concerns during a technology disruption. The assumption when creating the plan is that all servers would be impacted for all locations within the system. Telephones, e-mail, electronic health records, and automated dispensing cabinets would not be available. The ultimate goal was to ensure patient care would not be interrupted during an extended downtime.

Results: Multiple medication safety scenarios were considered, and a detailed plan was established to address each of them. Topics included affected technology, transmission of orders, verification of orders, pharmacist consults, medication dispensing, controlled substance waste, medication administration documentation, medication reconciliation, pharmacy charges, surgery reconciliation, temperature monitoring, inventory management, medication recalls, allocation of resources, clinician education, and a well-coordinated recovery. Each topic was extensively researched and discussed to develop guidance for front line staff to continue to provide optimal patient care during an extended downtime. Since the pharmacy operation is highly reliant on technology, paper documents, labels, and logs were created to meet the needs of the department and ensure regulatory requirements are maintained. Successful planning and monthly exercises continue to establish a constant state of readiness.

Conclusion: A Business Continuity Plan that included detailed procedures was developed for the pharmacy department. Each facility will maintain an emergency readiness binder that includes the specifics of the plan and a starter supply of paper documents and labels. The binder will be stored in a strategic well-known location, and the contents will be reviewed at least annually for accuracy. After the development of this plan, pharmacy is better prepared to handle the transition to paper documentation during a technology disruption.