Five Changes to Pharmacy Operations

Susan Jackson
Director of Pharmacy, Wellstar Health System

I hope a few things on this list of operational changes might be of value to help others find solutions that work best for them.

Minimize personal contact within the department

• Remote pharmacy services (as governed by your state)
  • Determine IT hardware needs and remote access feasibility
  • Work with HR to identify eligible employees
  • Develop staffing models that allow some of the clinical and order verification functions to be performed from remote locations
  • For systems, consider leveraging remote functionality across several facilities. For example, one pharmacist may verify orders at multiple sites
• Use visual queues to distance employees in congested areas

Deploy innovative inventory management tools

• Coordinate supply conference calls on a routine basis to review items and identify critical needs
• Prepare a shared spreadsheet for inventory of critical items
• Use days on hand methodology vs. quantity to level the playing field when sharing inventory information across facilities
• Use automation functionality to help control dispensing of medications that are high in demand (i.e. hydroxychloroquine) to prevent diversion from your facility
• Leverage ADM reports to maximize par levels and minimize trips to the floor for refills
• Consider dispensing IV drips like fentanyl, midazolam, and cisatracurium in smaller volumes to conserve supply – especially for non-COVID-19 patients or patients requiring lower doses

 Work with providers and nursing to minimize entry into COVID-19/PUI patient rooms

• Use EMR technology for pharmacy communications to nursing to minimize interruptions
• Work with your IV pump provider to determine if extended tubing can be considered to allow the IV pumps to stay outside the room
  • Evaluate your process for keeping materials and medications outside of the room
  • Place a starter kit of code medications with the RSI kit in the OmniCell for quick access
  • Use virtual kits or plastic bags
  • Establish a process for cleaning anything that can’t be disposed of and identify an area to sequester these items in the pharmacy.

Establish bi-directional communications with clinical teams

• Develop a panel of physicians, pharmacists, respiratory therapists, nursing, etc. to meet routinely to review best practices in literature
• Communicate practice and treatment protocol changes rapidly to pharmacy. We have a liaison on the clinical committee to relay issues back and forth.
• Make sure that they are aware of any issues with procuring targeted medications. The current supply on hand is updated regularly on a shared spreadsheet and reported back to the clinical team.

Adopt a PPE conservation strategy early

• Consider a PPE “will call” rack for paper bags with employee specific masks, etc. as they are rotated for re-use
• Cohort batching times and types to reduce PPE waste
• Adjust medication administration times to reduce trips into the room for nursing

DISCLAIMER

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.