A Study On The Cross-sectional Survey Of The Capabilities Of Emergency Preparedness Of Hospital Pharmacies And The Managerial Countermeasures In China

Objective: To understand the current situation of emergency preparedness of hospital pharmacies in China,to evaluate the differences of the capabilities of emergency preparedness between different regions and different level hospitals,to analyze the degree of availability and shortage obstacles of emergency drugs,and to provide the data support and reference recommendations for improving the emergency preparedness system of hospital pharmacies in China.Methods: Through the literature study and typical case analysis of sudden disaster events,the evaluation indicators of emergency preparedness capabilities of hospital pharmacy were constructed.The self-filling questionnaire was used to investigate the current situation of emergency preparedness,drug types of shortage and obstacle factors of drug shortage in China’s hospital pharmacies.Based on the binary logistic regression model,odds ratio(OR)was used to analyze the differences of emergency preparedness capabilities and obstacle factors of drug shortage in the hospital pharmacies between the high-and low-incidence areas of geological disasters.By means of nonparametric test method,we evaluated the differences of emergency preparedness capabilities and obstacle factors of drug shortage in three levels hospitals;We have established a list of emergency drugs to evaluate the availability of these drugs at the level of national and hospitals;Finally,the cohesive model of emergency medicine reserve and supply management of hospital and national emergency system were discussed.Results: There were 48 secondary evaluation indicators of the command decision-making,early warning and emergency medicine reserves and supply capacity of emergency preparedness in hospital pharmacies.Through online surveys and on-site survey,a total of 354 valid questionnaires were collected.The questionnaire results were as follows:(1)Overall,the command decision-making capability of emergency preparedness of hospital pharmacies includes 9 indicators.The rate of all 9 indicators covered by hospital pharmacies accounted for 13.84% of the total.The top two rates of the establishment of the personnel working system of emergency preparedness and the establishment of the provisions on temporary arrangements for emergency medical personnel and infrastructure in the hospital pharmacies were 76.55% and 71.75%,respectively.In terms of the early warning capacity,including 4 indicators,the rate of all 4 indicators covered by hospital pharmacies accounted for 36.72% of the total.The top two rates of the establishment of the emergency preparedness funds and the establishment of the emergency drill system in the hospital pharmacies accounted for 71.75% and 66.95% of the total,respectively.For the capacity of reserves and supply of emergency drugs,a total of 21 indicators,the rate of all 21 indicators covered by hospital pharmacies accounted for 8.47% of the total.The top two rates of the emergency drug reserves in accordance with the list of storage drugs and specification and the establishment of demand and consumption records system of emergency drugs in the hospital pharmacies were 86.12% and 77.40%,respectively.Among the 13 obstacle factors,it is the most important reason of emergency drug shortages that pharmaceutical distributors are reluctant to supply low-margin emergency drugs.(2)Logistic regression analysis found that there was a significantly statistical difference of the command and decision-making capability of emergency preparedness for the hospital pharmacies in the high-incidence areas of geological disasters compared to the low-incidence areas(P <0.10),OR=1.062.(3)Chi-square test results show that there were significantly statistical differences in the aspects of emergency command and decision-making and early warning(P <0.05)among three levels hospitals.In the pharmacies of tertiary hospitals,the rate of all capacity indicators involved in emergency command and early warning system accounted for 16.39% and 42.08%,which were higher than the level of secondary and tertiary hospitals.(4)Among 90 kinds of emergency drugs,10 drugs have only domestic production enterprises,7 kinds of drugs without domestic production enterprises.8 out of 15 kinds of biological emergency drugs have only 0 or 1 production enterprises.At the level of hospitals,there are 41 kinds of emergency drugs in shortage supply.Of these drugs, nly one does not have domestic production enterprises,the rest have two or more domestic production enterprises.Most of the shortage drugs were antiviral drugs(41.53%),and the most frequent shortage of drugs was the Protamine Sulfate Injection(27.40%).(5)Government can select a number of large-scale hospital pharmacies as national emergency drug storage stations.These hospitals need to establish the mechanism of the daily and emergency reserve and supply system of emergency drugs.Conclusion: Overall,the emergency preparedness system of hospital pharmacies is not comprehensive enough in China.The capacity of emergency reserve and supply of emergency drugs is the lowest level of the hospitals.The command and decision-making capability of emergency preparedness of hospitals in the high-incidence areas of geological disasters is higher than that in the low-incidence areas.Tertiary hospitals have relatively the most advanced emergency preparedness management system.Biological products as emergency drugs have the poor availability at the national level.The shortage of emergency drugs in hospitals is not due to a shortage of production,but due to barriers of the drug supply path.The reserve and supply system of emergency drugs in hospital pharmacy may be integrated into the national emergency system so as to save funding and improve the efficiency of emergency rescue.