In the nick of time Training for Point-of-Dispensing POD Staff: The NYC Experience

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Outline. Meaning of Just-in-Time (JIT) trainingOverview of NYC\'s POD format, operations, and staffing modelEvolution and segments of NYC\'s JIT preparing planResults from JIT preparing finished to dateImplications for arranging and future bearings. What is

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Without a moment to spare Training for Point-of-Dispensing (POD) Staff: The NYC Experience Anne Rinchiuso, MPH Medical Reserve Corps Coordinator/Emergency Planner New York City Department of Health and Mental Hygiene

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Overview Definition of Just-in-Time (JIT) preparing Overview of NYC's POD design, operations, and staffing model Evolution and parts of NYC's JIT preparing arrangement Results from JIT preparing finished to date Implications for arranging and future bearings

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What is "In the nick of time" (JIT) Training? Developing idea in HR/preparing writing "… constant production of learning and arrangements that can't be isolated from employment work." 1 For NYC, JIT Training alludes to preparing that POD staff will get at time of a crisis 1 Advances in Developing Human Resources Vol. 5, No. 3 August 2003 308-320

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NYC POD Layout *May be outside of the physical POD design

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Triage Station Use Triage script to recognize people who: Have contraindication to accessible prophylaxis taking drugs which collaborates with prophylaxis Have therapeutic conditions which require dosage conformity of prophylaxis or existing prescriptions If any of the above, send patient to Medical Evaluation If nothing from what was just mentioned, send patient to Dispensing to get prophylaxis

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Dispensing Station Provide anti-toxin or antibody to patients Direct open to Exit

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Medical Evaluation Station Evaluate people who: Have contraindications to prophylaxis Are on meds which cooperate with prophylaxis Have medicinal conditions influencing prophylaxis Determine: Which prophylaxis patient ought to get/if patient ought to get prophylaxis Send patient to Dispensing or Exit as proper

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Pharmacy Station Antibiotic or immunization is set up for Dispensing Station Re-bundling/shading coding of anti-microbial measurements Reconstitution of immunization, as suitable No open connection

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Exit Station Provide extra structures if necessary, and if accessible Informational signs about prophylaxis will be posted at ways out

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Flow Monitors Direct patients into, through, and out of the POD Provide data or potentially convey any accessible data sheets to patients holding up in line Critical to POD operations

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Medical Greeters Clinicians will be positioned outside of the POD to screen patients and allude people who might be sick with the infection for which we are giving prophylaxis to a doctor's facility

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Command/Personnel Stations Planning focuses of the POD Supplies Phones, faxes, PCs for correspondence Dedicated Personnel Officer to oversee staff assignments, breaks, and so forth

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POD Organizational Structure

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POD Resource Center Centralized POD war room Staffed and oversaw by DOHMH staff; situated at DOHMH All supply, office, and staffing demands from POD groups to come into Resource Center All information to be accounted for to, and gathered by, Resource Center Supply and staff landing times Supply and staffing levels Patient stream and throughput amid POD operation Significant issues experienced

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NYC's JIT Training Plan DOHMH representatives to make up Core Staff of main 6 initiative positions in POD Team Leader, Operations Chief, Logistics Chief, Flow Monitor Chief, Triage Chief, and Medical Evaluation Chief Core staff midway prepared and doled out by DOHMH "Ace Trainers" and Assignment Officers Approximately 2.5-3.0 hours

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NYC's JIT Training Plan (2) Core staff allots and prepares all other staff at POD destinations MRC volunteers, unconstrained wellbeing proficient volunteers, city specialists, and non-restorative volunteers through MOU with NY Cares Medical volunteers credentialed at 1 of 5 locales (1 for every district)

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Core Staff Training-Didactic Situation report/preparation General POD outline POD format POD stations and working methodology POD hierarchical graph Data accumulation and detailing conventions

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Core Staff Training-Practical Role-play triage and therapeutic assessment scripts Review solution prep for Pharmacy Station Color-code anti-toxins for simple apportioning Reconstitute immunization, if important Prepare syringes for administering, as fitting

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Core Staff Training-Practical (2) Review arrangement of Flow Monitors Discuss set-up of each station Demonstrate staff prophylaxis techniques Practice gone through of "patients" for all staff to watch/make inquiries Go over general staff task conventions for POD destinations

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Core Staff Responsibilities at POD Site Report into POD Resource Center upon entry Report entry times of therapeutic and non-therapeutic supplies, too Ensure appropriate physical set-up of POD Get the POD prepared for operation (i.e., put all calculations on tables, select secure therapeutic supply zone, and so forth.) Check ID and dole out all volunteers who touch base at POD Train all broad POD staff

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General POD Staff JIT Training: Shift 1 Arrive at POD site and get task from Personnel Officer Report to relegated Station for instructions and preparing Meet Station Chief and acquire staff ID apparel/materials JIT preparing led by POD Team Leader and additionally Station Chiefs Approximately 45 minutes

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General POD Staff JIT Training: Shift 1 (2) Didactic Situation report/instructions General POD diagram Practical Role-play triage and therapeutic assessment scripts Review pharmaceutical prep for Pharmacy Station Go over situation of Flow Monitors Discuss set-up of each station

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General POD Staff JIT Training: Shift 1 (3) A couple staff individuals gone through POD to pretend patients so all may watch Specific station-related inquiries tended to by Station Chiefs All staff individuals get prophylaxis before they start work Approximately 15-20 minutes

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General POD Staff JIT Training: Shift 2 Arrive at POD site and get task from Personnel Officer Report to Briefing Area for circumstance report and POD outline Report to Station for commonsense preparing Meet Station Chief and get staff ID dress/materials Partner with Shift 1 staff part to learn particular part When agreeable, assume control from Shift 1 laborer

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Why JIT Training? We will never have the capacity to pre-recognize or have the capacity to pre-prepare each of the 40,000 staff required for citywide enactment Turnover of DOHMH staff and volunteers prompts to loss of information Extensive and dreary pre-preparing can be exorbitant and tedious

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Why JIT Training? (2) Every staff part would should be re-prepared at the season of the crisis since it is not expected that they will hold the data over drawn out stretches of time without steady re-preparing Scenario-particular data will dependably should be given to staff

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Why JIT Training? (3) No matter how much pre-preparing you do, it is improbable that the majority of your pre-prepared volunteers will be accessible at the season of a crisis Spontaneous volunteers will unquestionably be utilized, and you should have a basic and productive method for preparing them when they answer to help you

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Trainings/Drills Completed to Date MRC Trainings (5) Citywide penetrate (4 PODs opened) CDC bore (1) Trainings with restorative understudies (2) DOHMH staff trainings (3) Participants substitute between being staff and being patients

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Trainings/Drills Completed to Date (2) Although these trainings were held with different populaces, they all have generally a similar precision rate Each likewise exhibited that we can give prophylaxis at the rate of ~1000/hour for anti-infection agents, and ~550/hour for smallpox antibody Our arrangements depend on these throughput numbers

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MRC Trainings 5 trainings held June 2004-February 2006 3 for anti-infection apportioning; 2 for smallpox immunization Volunteers assume all parts, according to licensures Additional POD preparing for smallpox inoculation got ready for Summer 2006

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JIT Training Results

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PODEX Citywide Drill 4 PODs opened all the while in Queens, NY-June 2005 DOHMH Medical-Clinical IMS area staffed administration positions (Core Teams) MRC staffed Medical Evaluation and Pharmacy Stations NY Cares and Red Cross volunteers, and in addition CERT groups, staffed every other position, including Triage Train-the-Trainer show utilized for 3 of 4 PODs

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JIT Training Results (2)

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CDC Drill POD bore held April 2004 at NYU College of Dentistry SNS receipt, stockpiling and organizing centered bore to which we included a POD DOHMH general wellbeing attendants staffed Triage Dental employees staffed Medical Evaluation Dental understudies staffed every other part

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JIT Training Results (3)

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Trainings with Medical Students Mt. Sinai School of Medicine-March 2004 SUNY Downstate Medical School-October 2004 Medical understudies staffed all positions

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JIT Training Results (4)

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DOHMH Staff Trainings School Health doctors and attendants April 2004 Physicians staffed Medical Evaluation; attendants staffed every other position Bureau of TB clinical staff-June 2004 Physicians staffed Medical Evaluation; adjust of center colleagues staffed every other position

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JIT Training Results (5)

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Flu POD Drill-November 2005 Tested strategies and move time for a move change "Prepare the-coach" demonstrate utilized for second move laborers Received preparation and task, then watched staff part they were assuaging carry out their employment, assuming control when prepared Evaluated specialist comfort level in regards to: directions, vitality level, capacity to perform work in view of move change and recommendations for development With POD satisfactorily staffed, quiet stream ~410/hour Multiple patient structures that we would not have amid citywide occasion

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Most Common Mistakes Observed Confusion between reactions and sensitivities Some genuine hypersensitivities not perceived (e.g., hives) S