Centralization of Services When do you Refer? Centralization of Services Chains may need to close some locations and set up hub stores Computer software Access patient profiles from remote location or DPIN remote profile Central fill Public has to be notified of any changes If staff are constantly sick it may be necessary to close some of the pharmacies and relocate staff to a restricted number of open locations. Which pharmacies are going to stay open, and which pharmacies will close? It is important that your computer software sets up your system so that you can access patient profiles from the computers at closed locations Notify the public should this occur . . . how?

How has the Pandemic Affected my Practice? When do you Refer?

How is the Pandemic Currently Affecting my Practice? When do you Refer? How is the Pandemic Currently Affecting my Practice? It already has! Increased public awareness More people asking about how to manage cold and flu symptoms Absenteeism Colleagues more aware of the need to stay home if sick No increase in antiviral medications Not prescribed unless high risk Testing for H1N1 not done routinely So far in my own practice, with H1N1 I have noticed an increase lately in cold and flu management, including which medications patients can purchase over the counter. People seem to be more aware of their environment, and it is safe to say that almost everyone has heard some sort of information about H1N1. Recently I have placed hand sanitizer at the drop off counter, pick up counter, and counselling area, and have noticed that people are using it quite frequently. Staff are also taking more sick days, which indicates they are aware of the situation and the appropriate protocols to stay home if you are sick. There hasn’t been an increase in the prescribing of antiviral medications thus far in the pharmacy I work in, but this can be attributed to the fact that antivirals are not routinely prescribed unless you are a patient who is at high risk of developing complications from the flu Testing for the H1N1 virus is not routinely done unless you are a patient at high risk.

Resources for Pandemic Planning When do you Refer? Resources for Pandemic Planning Review Emergency Preparedness Plans CPhA http://www.pharmacists.ca/content/hcp/resource_centre/practice _resources/pandemic2.cfm Manitoba Pharmaceutical Association Resource Kit Health Canada Preparedness Kit Handout: http://www.phac-aspc.gc.ca/alert- alerte/h1n1/guide/pdf/h1n1_preparedness_kit-eng.pdf Flu Prevention Checklist: http://www.phac-aspc.gc.ca/alert- alerte/h1n1/guide/pdf/h1n1_prevention_list-eng.pdf H1N1 Preparedness Guide: Order copies at 1-800-O-Canada (1- 800-622-6232) http://www.phac-aspc.gc.ca/alert- alerte/h1n1/guide/pdf/h1n1_guide-eng.pdf ‘Pharmacists are strongly encouraged to review their emergency preparedness plans. CPhA has developed an extensive pandemic guide for pharmacists that includes information on the role of the pharmacist, infection control, developing your plan, supply chain issues, business continuity, etc.’ 3CPHA has posted documents on their website which can assist you with infection control and personal measures that you can adopt as best practices that will increase the odds that you will stay healthy during this flu season. http://www.pharmacists.ca/content/hcp/resource_centre/practice_resources/pandemic2.cfm The Manitoba Pharmaceutical Association will be developing a Resource package for pharmacists in Manitoba which includes a useful Manager’s Checklist. This resource package will be mailed out to pharmacists, and is also accessible at their website, www.mpha.mb.ca. Health Canada: The following can be used as handouts for your patients Preparedness Kit: Highlights a home preparedeness kit for you to follow BEFORE you get sick. Flu Prevention Checklist: Highlights what you should do to prevent getting sick H1N1 Preparedness Guide: Useful information for everyone about H1N1

Resources for Pandemic Planning When do you Refer? Resources for Pandemic Planning Pharmacists should regularly visit the MHHL H1N1 Flu Information Site at http://www.manitoba.ca/flu/index.html Information changes all of the time so regularly update yourself Patient handouts/posters: http://www.manitoba.ca/flu/index.html Could it be the Flu? Handout/Poster for Patients Handwashing/Coughing Etiquette posters Video for kids about handwashing and coughing: http://www.manitoba.ca/flu/videos.html

Resources for Updated H1N1 Information Manitoba Health INFECTION PREVENTION AND CONTROL GUIDELINES: http://www.gov.mb.ca/health/publichealth/sri/doc s/ipcili.pdf Public Health Division: http://www.gov.mb.ca/health/publichealth/sri/inde x.html#guidelines

More Resources for Updated H1N1 Information When do you Refer? More Resources for Updated H1N1 Information Public Health Contact Information: Manitoba: 1-800-782-2437 www.gov.mb.ca/health/index.html H1N1 Flu Hotline: 1-800-454-8302 The Canadian Flu Guide: (FREE CEUs) www.CanadianFluGuide.ca Health Canada website: http://www.phac-aspc.gc.ca/alert- alerte/h1n1/faq_rg_h1n1-eng.php Centers for Disease Control and Prevention: http://www.cdc.gov/H1N1FLU/ Public Health Agency of Canada: http://www.phac- aspc.gc.ca/alert-alerte/h1n1/surveillance-eng.php MPhA H1N1 Flu Information site: http://napra.ca/pages/Manitoba/default.aspx?id=2411 Manitoba Health H1N1 Flu Information site: http://www.manitoba.ca/flu/index.html How to Prepare a Tamiflu Suspension: http://www.tamiflu.com/hcp/dosing/extprep.aspx

In Summary Understand your role as a pharmacist When do you Refer? In Summary Understand your role as a pharmacist Triage and patient referral, communication, planning Have a pandemic plan in place Consider prevention, public education, labour, communication, security, hours of operation, critical activities, inventory, vendors, centralization of services Resources for pandemic planning Patient handouts Many resources available for updated information – Use them! (Read slide)

References When do you Refer? 1. Key Facts on H1N1 Flu Virus – Public Health Canada. http:/www.phac-aspc.g.ca/alert- alerte/h1n1/fs-fr_h1n1—eng.php?option=print. Accessed 16/09/09 2. Public Health Agency of Canada: Frequently Asked Questions – H1N1 Virus. http://www.phac- aspc.gc.ca/alert-alerte/h1n1/faq_rg_h1n1-eng.php. Accessed 16/09/09 3. World Health Organization: Global Alert and Response: Pandemic (H1N1) 2009 Update 69: http://www.who.int/csr/don/2009_10_09/en/index.html. Accessed October 16, 2009 4. CHE Learning Module: http://www.canadianfluguide.ca/en/view.aspx?mid=H1N10101&sn=4&file=h1n1/h1n1_ch1_slides. swf 5. Guidance on H1N1 influenza vaccine sequencing, Public Health Agency of Canada H1N1 update, European Centre for Disease Control and Prevention (in .pdf format): http://www.phac-aspc.gc.ca/alert-alerte/h1n1/vacc/vacc-eng.php. Accessed October 2, 2009. 6. The Canadian Pandemic (H1N1) 2009 Flu Guide. Educational Program. http://www.canadianfluguide.ca/en/view.aspx?mid=H1N10101&sn=4&file=h1n1/h1n1_ch5_slides. swf 7. The Canadian Press: Lots of rest, fluids, chicken soup a recipe for toughing out Swine flu: doctors. Written by: Sheryl Ubelacker, Health Reporter Oct. 12, 2009: http://health.lifestyle.yahoo.ca/channel_health_news_details.asp?news_id=19528&news_channel_id =0&channel_id=0 8. Swine Flu FAQ: Msn source: http://news.ca.msn.com/world/cbc-article.aspx?cp- documentid=20546694. Accessed September 29, 2009. 9. The Benefit of Hand Washing – Health Canada. http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases- maladies/hands-mains-eng.php#how. Accessed September 29,2009 10. Health Canada. Symptoms of the Flu Virus (H1N1 and Seasonal) and Severity Indicators. http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/pdf/h1n1_guide-eng.pdf. Accessed October 20, 2009 Health Canada Website: Tools and Resources: http://www.phac-aspc.gc.ca/alert- alerte/h1n1/tools_outils-eng.php . Accessed October 20, 2009 Manitoba Health H1N1 Flu Information site: http://www.manitoba.ca/flu/index.html. Accessed October 20, 2009

When do you Refer? Questions?