1. Just in Time POD Training Part 2 Roles and Responsibilities

2. Facility Manager Employee of the physical facility (e.g. school system employee) with adequate knowledge of building layout and access to available equipment, systems and utilities.

3. POD Manager Coordinates and manages all functions required to set-up, operate and demobilize a POD through the Department Operations Center at JCDH

4. POD Manager Duties include but are not limited to: Staff direction Coordination with EMA and JCDH management Coordination of support services (food, supplies) Working with facility owner/manager Maintain client throughput by adjusting POD flow as needed News media (as directed by PIO)

5. Triage Clinicians Every client/representative must go through Triage to determine where medication will be dispensed MD/CRNP/RPh will triage and mark/initial appropriate drug for Express dispensing DUR, Family and Support Services will be referred to expedite the triage process

6. Clinician in Charge Duties include but are not limited to: Staff assignments, orientation and JITT (Just in Time Training)for triage clinicians Communicates staffing and supply needs to POD manager Functions as Triage Clinician if needed Maintains smooth flow of operations Makes appropriate referral if client cannot receive medications available at the POD Functions as First Aid/Emergency medical services if needed Assists with demobilization

7. Team Leader-Clinician Duties include but are not limited to: Assist Clinician in Charge with staff assignments, orientation and JITT for triage clinicians Communicates staffing and equipment needs to Clinician in Charge Maintains smooth flow of operations for the team Functions as Triage Clinician Monitors team for S/S (signs/symptoms) of stress and fatigue Coordinates breaks and lunch with Clinician in Charge Assists with demobilization

8. Clinician Reviews client history form for completeness Determines and documents what dispensing line client should be directed to If EXPRESS-determines, documents and initials medication(s) to be dispensed according to the ADPH Algorithm and directs client to a Guide If Support Services, Family or DUR- marks form and directs client to a Guide

9. Nurse in Charge Coordinates with the POD manager and EMA to help prepare the site for client assessment and dispensing operations-may also function in a regular nursing role

10. Nurse in Charge Duties include but are not limited to: Staff assignments, orientation and JITT including appropriate labeling and documentation of medication dispensed Communicates staffing and equipment needs to POD manager Maintains smooth flow of operations Monitors nursing staff for S/S of stress and fatigue Schedules breaks and lunch Fills in as needed in any other nurse position Assist with demobilization

11. Team Leader-Nurse Duties include but are not limited to: Functions in the nursing role Assists Nurse in Charge with staff assignments, orientation and JITT including appropriate labeling and documentation of medications dispensed Communicates staffing and equipment needs to Nurse in Charge Monitors team for S/S of stress and fatigue Coordinates breaks/lunch with Nurse in Charge Assists with demobilization

12. Dispensing Nurses-Express Reviews client history form and determines if antibiotic chosen is appropriate (e.g. Client has marked allergy to Cipro and Cipro has been ordered-take the client history form to the Nurse Team Leader) Provides abbreviated counseling to client and reinforces verbally the importance of completing the entire regimen and follow-up instructions

13. Dispensing Nurses-Express Answers any client questions Instructs the client to sign the client history form Completes documentation and labeling including BCP precaution sticker Dispenses medication, drug information sheet and PCP referral form (green form) Requests supplies as needed using “Supplies Needed” Sign

14. Dispensing-Family Client history form will be reviewed by Pharmacist/Pharmacy Student and appropriate medication determined Review Doxy crushing instructions and dosing chart based on weight for children. If weight is unknown, estimate. Mark appropriate dosage on the instruction sheet and include each child’s name Provide abbreviated counseling to client and reinforce verbally the importance of completing the entire regimen and follow-up instructions

15. Dispensing-Family Answer any client questions Instruct client to sign client history form Complete documentation and labeling Dispense medication with drug information sheet and PCP referral form (green form) at Pharmacist’s direction

16. Dispensing-Support Services Social Worker, Interpreter or other POD worker may provide assistance as needed in this area (such as completing client history form, assisting with translation or help with unaccompanied minors) Client history form will be reviewed by Pharmacist or Pharmacy Student and appropriate medication determined Provide abbreviated counseling to client and reinforce verbally the importance of completing the entire regimen and follow-up instructions

17. Dispensing-Support Services Answer any client questions Instruct client to sign client history form Complete documentation and labeling Dispense medication with drug information sheet and PCP referral form (green form) at Pharmacist’s direction

18. Clinical Supply Coordinator Answers directly to POD Manager Supervises runners Establishes separate storage area for supplies In charge of all drugs, forms, supplies and equipment Receives, organizes and documents drugs/supplies Maintains adequate security in drug/supply area Coordinates replenishment orders Coordinates breaks and lunch for supervised staff Assists with demobilization

19. Runners Watch for “Supplies Needed” signs to be displayed at any station Provide supplies as requested Recycle POD items as needed Report any problems with supplies to Coordinator Assist with any additional needs identified including the Support Services area

20. Social Worker in Charge Responsible for JITT and supervision of non-medical staff, including volunteers if utilized Monitor individuals exhibiting extreme signs of distress, including staff Make appropriate referrals if needed Provides assistance with support services Assist with client flow if needed Provide staff support if needed Coordinates breaks and lunch with supervised staff

21. Social Worker Monitor individuals exhibiting extreme signs of distress, including staff Make appropriate referrals if needed Provides assistance with support services Assist with client flow if needed Provide staff support if needed Coordinates breaks and lunch with supervised staff

22. Clerk in Charge Coordinates POD worker registration process (this includes sign in/sign out and vest pick up/return) Responsible for JITT and supervision of clerks in all areas of the POD Maintains clerical supplies (clipboards, forms, pens, etc.) Ensures signage is properly displayed Maintains staffing/shift rosters Observes clerks for signs of stress/fatigue Schedules regular breaks Assists with demobilization

23. Team Leader-Clerk Assists Clerk in Charge with POD worker registration process Maintains clerical supplies (clipboards, forms, pens, etc.) Ensure signage is properly displayed Observe clerks for signs of stress/fatigue Coordinate breaks and lunch for clerical staff with Clerk in Charge Functions as a Clerk

24. Clerk Assists with POD worker registration process Assist clients with the registration process-this includes forms, educational material, pens, labels for medication May assist clients with completion of form Directs clients to Greeter and POD entrance Maintain clerical supplies-request additional supplies from runner as needed

25. Greeter in Charge Duties include but are not limited to: Staff assignments, orientation and JITT for Greeter staff and Team Leaders Communicates staffing and equipment needs to Social Worker in Charge Maintains smooth flow of operations (this may include areas outside of the POD) Coordinate breaks and lunch for supervised staff Fill in as needed in Greeter position Assist with demobilization

26. Greeter in Charge *Note: For this exercise only, the Greeter in Charge will be responsible for Traffic Control and will answer directly to the POD Manager. In a real event, traffic control would be the responsibility of the Local Law Enforcement Agency.

27. Team Leader-Greeter Duties include but are not limited to: Assisting Greeter in Charge with staff assignments, orientation and JITT for Greeter staff Communicates staffing and equipment needs to Greeter in Charge Maintains smooth flow of operations (this may include areas outside of the POD) Functions in the Greeter position Assists with demobilization

28. Greeter Greet clients as they arrive and answer any initial questions Direct client flow to appropriate areas (may include areas outside of the POD) Identify any issues or needed assistance that may need to be addressed Assist in any other area as directed by Greeter in Charge

29. Guide in Charge Duties include but are not limited to: Staff assignments, orientation and JITT for Guide staff and Team Leaders Communicates staffing and equipment needs to Social Worker in Charge Maintains smooth flow of operations-(this may include areas outside of the POD) Coordinate breaks and lunch for supervised staff Fill in as needed in Guide position Assist with demobilization

30. Team Leader-Guide Duties include but are not limited to: Assists Guide in Charge with staff assignments, orientation and JITT for Guide staff Communicates staffing and equipment needs to Guide in Charge Maintains smooth flow of operations-this may include areas outside of the POD Coordinate breaks and lunch for supervised staff Functions in Greeter position Assists with demobilization

31. Guide Serves as gatekeeper and admits clients into appropriate areas as they become available Assists with client flow-notifies Guide in Charge of any problems (bottleneck) May escort clients needing assistance to the appropriate area

32. Forms

33. Client History Form This form is available at http://adph.org/CEP/assets/SNS_NAPH_Form.pdfhttp://adph.org/CEP/assets/SNS_NAPH_Form.pdf

34. Forms Review Flow Chart

35. Notification to Primary Care Provider

36. Referral Form

37. Doxy client Information Sheet

38. Cipro client Information Sheet

39. Doxy Crushing Instructions

40. Labeling and Documentation

41. Doxycycline 100mg SNS label includes: Name of Drug Strength Dosage Quantity

42. Doxycycline 100 mg SNS tear off label for client History Form Includes: Name of Drug Quantity Dispensed Lot Number Expiration Date Prescription Number National Drug Code

43. For this exercise…. Colored-coded labels (shown below) will be used to simulate the SNS tear off label. * Do not tear off SNS label. Doxycycline 100 mg #20 tabs Ciprofloxacin 500 mg #20 tabs

44. Labeling for Dispensing ADPH-Donald Williamson, MD Emergency Prescription-June 5, 2014 For questions call 1-866-543-9899 client________________________ This label will be provided at registration-client will write in name. In a real event, this label would be affixed to the medication bottle, but not for this exercise.

45. This Antibiotic may decrease the effectiveness of birth control pills This sticker will be added to medication if client marks “Yes” to Birth Control Pills Labeling for Dispensing

46. Documentation C lient history should be completely filled out. This includes client name, address, phone number and medical history on each person represented on the form. Weights and birthdates for children may be estimated. Forms should be checked at every step of the POD process for completion. Form must be authorized and signed by the client picking up the medications at the time of dispensing.

47. At Triage, the Clinician will determine if the client and all household members are eligible to receive medication through EXPRESS dispensing. If so, the clinician will determine the medication to be dispensed, circle it and initial. Then he/she will circle EXPRESS at the bottom of the form and send the client to a Greeter. Clients not eligible for EXPRESS dispensing will be sent to the appropriate line for dispensing by a Pharmacist. Documentation

49. The Dispensing Nurse or Pharmacist will have the client sign the form, apply the appropriate label for the medication dispensed, print and sign his/her name, fill in POD location and date.

53. Questions? Call or email: Julie Cobb, RN Jefferson County Department of Health Emergency Preparedness and Response 205-558-2124 Julie.cobb@jcdh.org