Hospitals have had to adjust the way they operate at an unprecedented speed in response to the COVID-19 pandemic, and the pharmacy department is no exception.
Elie Bahou, PharmD, is the chief pharmacy officer of Providence St. Joseph Health, a health system based in Renton, Wash., that has 51 hospitals and 829 physician clinics in six states. He recently spoke with Becker's Hospital Review about how he's led his system's pharmacy department through all of the changes the pandemic has brought and gave advice to other pharmacy leaders facing similar challenges.
One of the biggest challenges Providence's pharmacy department faced when the pandemic began was having to work with and trust new partners very quickly without going through the traditional review processes. For example, when remdesivir was granted emergency use authorization from the FDA, Providence quickly had to start coordinating with AmerisourceBergen, the drug's wholesaler, to make sure all of its hospitals had access to the drug.
"Things are changing, honestly, every day. Two weeks ago, we thought hydroxychloroquine was going to be the drug of choice, so we ramped up on that, and it turned out all the studies are reflecting that it's really not the best drug of choice," Dr. Bahou said.
On a smaller scale, the pharmacy department had to adjust the types of drugs it was giving to patients to minimize the spread of COVID-19. Before the pandemic, Providence typically used a nebulizing solution to treat patients with asthma. But a nebulizing solution is an aerosol drug, which increases the chances of spreading particles through the air. So, Dr. Bahou's team decided to switch to using MDIs, or metered dose inhalers, which have less risk of transmitting the virus through the air.
While it may be a small change, switching from a nebulized solution to a metered dose inhaler alters the pharmacy's budget, so Dr. Bahou said his department set up a COVID-19-related cost center to soften the impact of nonbudgeted drug costs in the pharmacy departments.
The pharmacy department also created a list of the top 100 COVID-19 drugs, the drugs that are most important to treat COVID-19 and that they want to make sure they don't run out of. As new studies and data come out from clinical trials testing various drugs on COVID-19 patients, Dr. Bahou said the team will continue to adjust the list.
Providence's pharmacy staff also has had to adjust to remote working in some cases to make sure staff is staying safe and reducing the risk of spreading the virus. The pharmacy staff at several Providence hospitals is using telehealth visits as much as possible, a practice Dr. Bahou said he expects to become more commonplace when the pandemic ends.
"Telemedicine is really, really starting to pick up right now, and so is telerounding, as far as pharmacy is concerned. I think we're going to see that as a norm in the future," Dr. Bahou said.
Beyond increasing the use of telehealth, the COVID-19 pandemic will cause hospitals to develop new preventive measures to prepare for future pandemics, Dr. Bahou said.
"We're learning a lot. We're moving at the speed of light, and everything that we're learning right now will be applied in the future. The goal is really to have a template that says 'If this happens again, do one, two, three,'" Dr. Bahou said.
His team has set up a pharmacy command center to make sure all communications between team members are clear and understood between all regions.
When asked what advice he would give other pharmacy leaders in the middle of the pandemic, Dr. Bahou said: "Your team will work harder than perhaps they have ever worked. At times they will get tired and fatigued. Be there to cheer them on and help them problem solve. This unprecedented emergency has brought to the forefront the need to rethink how we deploy our resources and services and how we should prepare for emergencies with sustainability and resilience in mind."