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April 08, 2020

Tips from Maryland and Delaware

Dennis Killian
VP of Clinical Operations, Peninsula Regional Medical Center

In collaboration with regional health system pharmacy directors in Maryland and Delaware (noted below), Dennis Killian, VP of Clinical Operations, Peninsula Regional Medical Center, provides recommendations ranging from staffing and medication handling to technology and treatment protocols.

Staffing

  • Cross-training
    1. Pharmacist cross-training with technicians to learn workflow
    2. Clinical pharmacists shadowing central pharmacy operations
  • Decentralized and home medication list collection (HMLC) services
    1. Dctrl/patient counseling transitioned to phone-based
    2. HMLC transitioned to phone-based service
  • Remote clinical services
    1. Internal medicine rounds via ‘tele-rounds’
    2. Consult service via home
    3. ED services, Behavioral Health, ICU rounds difficult to transition to home
    4. Considering AMS migration to home
  • Teams/Shifts
    1. Mocked up Team A and Team B; not implemented
    2. Some shifts are already 7on/7off
  • Work from home
    1. 340B personnel, planning for certain clinical/staff function, like IT/AMS etc
  • Sick leave
    1. Need to have an on-call strategy if someone gets sick or gets screened positive during arrival
  • Vacation
    1. PTO caps increased
  • Remote pharmacy services
    1. Utilized existing service – no additional volume due to decreased patient census
  • Hospital staffing center
    1. Redistribute staff as needed

Policies

  • Employee screening protocol
    1. Restricting entrances
    2. Screening for temperature, symptom questionnaire
  • PPE/Deliveries to COVID-19 units
    1. COVID dedicated units
      1. Do not use tube system
      2. Don/Doff gown, glove, mask (cone) in ante room
      3. Process for CS delivery – in ante room
      4. Link to COVID-19 Unit Delivery Procedure and use of PPE
    2. 1/day cart fill to 2/day cart fill for whole hospital to minimize medication returns
  • Medications returned from COVID-19/PUI – decontamination
    1. Bagging meds from COVID areas, sealed (see P&P); decontamination process for emergency boxes/trays. Link to Return to Stock of Medication etc.
  • Patient own medications (COVID/PUI)
    1. Trying to avoid POM for COVID/PUI
  • Crash carts/Anesthesia Carts/Medication Boxes
    1. Using a ‘Code Bag’ with emergency medications
      1. Link to COVID Code Bag Policy
    2. Created ‘COVID boxes’ (share list)
    3. Don’t bring crash cart into the room

Technology/Equipment

  • ADC in new units
    1. Using ICU inventory as an initial list and modifying accordingly
  • IV pumps
    1. Putting pumps outside the room to limit access
  • 340B
    1. Making sure new COVID/PUI areas are on the split-biller report

Medication Supply Chain

  • Beta 2 agonist MDIs
    1. Conserve use; nebs throughout hospital, even PUIs
    2. Adapter to use both ProAir and Ventolin
  • Propofol
  • Fentanyl
  • Perpetual inventory
    1. Hydroxychloroquine
      1. Link to Hydroxychloroquine oral suspension
    2. MDIs, others
  • NMBs
    1. Cisatracurium
    2. Vecuronium
    3. Considering using rocuronium

Treatment Protocols

Online Resources

Open Discussion

  • Stress management
    1. Open communication
    2. Listen to employees
  • Links
    1. AuntMinnie.com

Contributors

    John T. Jordan, Jr., Pharm.D.
    BCPS Senior Director of Pharmacy Services
    Residency Program Director
    Peninsula Regional Health System
    Office (410) 543-7054
    Mobile (443) 397-3834
    john.jordan@peninsula.org

    George B. Schwobel, Pharm.D.
    Manager of Pharmacy Services
    Nanticoke Memorial Hospital
    801 Middleford Road Seaford
    Delaware 19973
    Office (302) 629-6611 x2090
    schwobelg@nanticoke.org

    Joshua Coffield, PharmD, MBA
    Director of Pharmacy
    Beebe Healthcare
    424 Savannah Road
    Lewes, DE 19958
    Phone (302) 645-3559
    jcoffield@beebehealthcare.org

    Dennis M. Killian, Pharm.D., Ph.D.
    Vice President of Clinical Operations
    Peninsula Regional Health System
    Office (410) 543-7048
    Mobile (443) 523-7987
    dennis.killian@peninsula.org

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.