The coronavirus pandemic continues to present new challenges for all hospital departments — and the pharmacy is no exception. Whether it is overcoming staffing challenges from increased or decreased patient volumes, protecting personnel or establishing processes for the procurement, storage and delivery of medications, the hospital pharmacy has had to quickly adapt.
The demands of the pandemic have not eased since March of this year for many hospitals, and now experts are predicting the combined events of the coronavirus and the upcoming flu season may have a particularly significant impact on our health system. Michael D. Brown, RPh, vice president of Managed Services at Dublin, Ohio-based Cardinal Health, cautions hospitals that they should plan for these events now and consider lessons already learned about medication delivery processes to best protect staff and patients.
At Cardinal Health, Mr. Brown is responsible for pharmacy operations and performance for about 200 U.S. hospital pharmacies. In this piece, Mr. Brown describes how hospital pharmacies can benefit from best practices based on other hospitals’ experiences with the pandemic thus far and how pharmacy leaders can stay on top of the ever-changing information about the coronavirus.
Editor's Note: Responses were lightly edited for length and clarity.
Question: What lessons can leaders apply now to the hospital pharmacy to prepare for future pandemic challenges?
Michael Brown:I think there are two key lessons that hospital leaders should consider.
First, hospital pharmacy leaders need to consider the medication delivery process ahead of a potential spike in cases. It is vital that the team knows how they will secure medications and deliver them safely in new environments. For example, we have seen some hospitals increase patient capacity by adding patient care areas in spaces such as cafeterias or closed-off floors. In these situations, having the processes and equipment needed to secure and deliver medications is essential – and requires planning ahead.
Secondly, hospital pharmacies should review and update contingency plans now, including how your organization will conduct contact tracing and how the process will work in the event staff need to self-quarantine or contract the virus.
To ensure pharmacy service levels are adequately supported, leaders should plan how to staff the pharmacies in the event an employee tests positive and must quarantine. This is particularly important for hospitals in COVID-19 hot spots. One option is to use remote pharmacy services, so that staff won't have to come on-site. Another suggestion is to adjust staffing patterns. I’ve seen some pharmacies move from traditional shifts to seven days on and seven days off to allow more time for symptoms to manifest in cases where staff may have been exposed. Hospitals that are not in COVID-19 hot spots may also be seeing changes in staffing patterns because of a decrease in elective surgeries. In these cases, hospitals will need to plan for how to deal with potential staffing decreases or shifting staffing patterns to maximize staff time and competencies.
Q: How can pharmacy leaders ensure that they are updated with the latest coronavirus news, best practices and medication treatment therapies?
MB: This pandemic is a highly complex situation—information is coming out rapidly and is ever-evolving. We see firsthand how important it is for pharmacy leaders to stay informed on the latest studies and treatment recommendations to remain trusted partners for physicians as they begin ordering these new drugs or therapies.
To help with this, Cardinal Health has assembled a team of clinicians to serve as coronavirus experts who provide education and key learnings on an ongoing basis to our managed hospital pharmacies. This team meets weekly to assess the latest studies and therapies and provide counsel. We also publish a weekly newsletter with this important information for our clients. So instead of pharmacy directors spending their valuable time researching this information independently, we’re able to help equip pharmacy staff with the necessary information to make informed decisions using evidence-based literature—allowing them to remain focused on the frontlines to serve patients.
Q: How can hospital pharmacy leaders minimize the risk of infection in the facility and keep staff safe?
MB: Pharmacy teams should start by following basic, best-practice procedures, like handwashing and wearing face and body coverings. In addition, hospitals may wish to consider other policy areas that could help minimize contamination risk. These include:
- Managing all equipment in hospital “hot zones:” For example, it’s important to consider an employee cellphone policy, and determine if they should mandate that personal cellphones remaining outside of the pharmacy, and other areas, to prevent the threat of contamination. Additionally, pharmacy leaders should evaluate the location of crash carts, as those located inside infected patient rooms need to be sequestered. The alternative is to weigh the risk of potential delays to medication access by keeping a crash cart just outside the infected patient rooms, so that its contents are more protected from possible infection.
- Automated dispensing cabinet processes: On floors with COVID-19 patients, standard processes may need to be re-considered. The typical process is that nursing pulls medications from a centrally located cabinet on the patient floor and then brings medications to and from patient rooms. However, when engaging with highly infectious patients, this may cause unnecessary trips to and from the infected patient rooms. Pharmacy leaders may want to carefully consider the benefits and risks of implementing a cart-fill approach, with individual bins stored in the patient rooms, containing drugs specific to each patient.
Overall, hospital and pharmacy leaders need to evaluate processes impacting pharmacy staffing and safety, as well as the procurement, storage and delivery of medications. While every hospital is unique and needs to assess their specific situation, now more than ever, every hospital needs a thorough, expert-guided plan to help serve staff and patients.
To learn more about Cardinal Health pharmacy resources, visit cardinalhealth.com/pharmacyservices. To learn more about Cardinal Health’s response to the coronavirus, click here.