August 25, 2020
Dr. Deborah Wagner and collaborators drew on their experience planning for a field hospital in Ann Arbor, MI earlier this year.

Insights on developing a field hospital formulary and medication distribution process in preparation for a second surge of COVID-19 cases explores key considerations for the implementation of pharmacy operations and a field hospital formulary at an offsite location in a two-week period. Deborah Wagner, PharmD, Clinical Professor of Pharmacy and Anesthesiology, and collaborators drew on their experience planning for a field hospital in Ann Arbor, MI earlier this year. 

“I was appointed as the pharmacy lead for the development of the Michigan Medicine field hospital as a representative from senior University of Michigan healthcare leadership,” says Dr. Wagner. “This occurred as part of a four-phase engagement of Michigan Medicine to manage the COVID demands on the healthcare system.”

“Predictive modeling was used to anticipate a timeline for patient admissions based on the national data back in early March.  At that time, doubling was anticipated to happen every three days, which meant that all bed capacity in the central hospital would be met by April 9,” recalls Dr. Wagner. “At that time that was the target go live day to open a 500-bed field hospital.  Work began in mid-March to assess various campus locations that would meet the needs and have adequate beds.  After visiting dormitories and various athletic facilities, the University of Michigan Indoor Track and Field Building was determined to be the most suitable.”

Dr. Wagner has a wealth of experience in preparing pharmacy services for challenging situations, including work with county medical control boards, emergency management services, disaster preparedness committees (both internally and regionally), and as a representative on the State of Michigan Quality Assurance Task Force for Emergency Medical Services. According to Dr. Wagner, “my experiences have all provided me the necessary tools to develop limited drug formularies which I felt strongly were needed to manage medications in a remote field hospital.”  

“We enlisted the help of our medication use policy and informatics colleagues and the pharmacy practice administrative resident to gather together data that would help us develop such a plan,” notes Dr. Wagner. “I also performed medication chart reviews of current COVID patients in the hospital setting that potentially would have been candidates to move to a field unit.  Gaining relevant data as well as early engagement of physician leaders to support the formulary concept was key I believe to our success.  After that working closely with our inventory control folks and determining stocking, par levels, and restocking capacities as well as a discharge plan were important features as well.”

“One of our driving principles was keeping it as simplified as possible yet still meeting the needs of the patient populations that we anticipated seeing, allowing a process to obtain medications not on the formulary if absolutely necessary, and being nimble enough to adjust on the fly so to speak,” adds Dr. Wagner.

Although Michigan Medicine did not have to open the field hospital, the process used for developing the formulary and determining distribution models will allow for an immediate implementation if a second surge occurs.  The recently published paper outlines a methodical approach to developing limited formularies and pharmacy operations in a field hospital setting will allow health systems to establish efficient and effective medication distribution services in the event of a second surge of COVID-19 cases.