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April 22, 2020

Top 7 Insights

Jim Stevenson
VP Medication Systems Strategy,

As the COVID-19 crisis unfolds, hospitals and health systems across the country continue to navigate innumerable unknowns. At a time when it often feels as though all of us are flying the plane while we build it, coming together to share knowledge is an essential form of support.

That’s why we put out a call to our health system partners to share pharmacy best practices they’ve developed in response to COVID-19. These insights, especially from pharmacists working in major epicenters, are helping their peers better prepare as COVID-19 peaks continue to roll. The key takeaway we’re seeing - innovation and flexibility are the keys to safe pharmacy management when your health system becomes a “hot zone” for COVID-19.

1. Create new inventory processes for COVID-19 meds  

  • Identify a list of critical medications for treating COVID-19 patients and share it with all pharmacy staff.
  • Source additional refrigerators to store antivirals and neuromuscular blocking drugs that require refrigeration.
  • As your COVID-19 patient census increases, move to daily inventory checks of critical meds to ensure ongoing, adequate supply.

2. Put surge staffing policies in place

  • NYU Langone recommends developing compressed scheduling models for pharmacy staff. Shifting to a 10- or 12-hour shift model can extend the department’s operational coverage, while also giving employees larger blocks of time off.
  • Explore whether pharmacy residents can be tapped for assistance during a surge. Oregon Health & Science University has been able to get much-needed assistance with overnight support from its residents.
  • Prepare an on-call strategy that accounts for the possibility of staff members testing positive for COVID-19 or becoming sick with another illness.

3. Prepare medication cabinets for dedicated COVID-19 care areas

  • Take inventory of all the traditional medication cabinets available and begin identifying ways to transition them to units within the hospital where they will be needed.
  • Determine whether additional cabinets are needed to manage medications in nontraditional care areas.
  • Prioritize  Automated Dispensing Cabinets (ADCs) in COVID-19 care areas to safeguard your hospitals’ stock of PPE, as well as store, protect, track, and analyze COVID-19 medication data.

4. Establish safer ways of delivering medications to COVID-19 patients

  • From procurement of medications to their administration, pharmacists should start collaborating with hospital staff to put additional safety precautions in place.
  • Pharmacists should give recommendations to nursing staff—those administering medications —to reduce hand deliveries.
  • Implement new protocols for treating patients with respiratory illness (provide COVID-19 patients with MDIs to limit the spread, reserving nebulizers for non-COVID patients).

5. Protect medication that enters COVID-19 units from contamination

  • Institute a process for quarantining returned meds and med trays, placing them in a room away from COVID-19 areas for a few days.
  • Place the 3-4 most commonly used code meds in a Ziplock bag to avoid contaminating the crash cart for every single code.
  • Conserve space in the ADCs by leveraging separate medication units for a cart-fill process—stocking individual carts with up to a 24-hr supply of patient-specific medications.

6. Consider how pharmacy staff can contribute beyond their usual roles

  • Cross-train staff in different areas—for example, clinical pharmacists can pair up with technicians to learn workflow and pharmacy operations.
  • Advocate for pharmacists to take on expanded roles. The Department of Health and Human Services has authorized for licensed pharmacists to order and administer COVID-19 testing, which could lead to vital access for patients.
  • Consider how pharmacy can support virtual patient care services through telehealth initiatives.

7. Ensure pharmacy is part of the larger hospital-wide effort to keep staff and patients healthy

  • Give doctors and nurses recommendations for limiting the number of necessary touchpoints with COVID-19 patients related to medications (for example, move smart pumps outside of patient rooms, expand the window for medication administration, remove dual signature requirements).
  • Draft a plan for dispensing and delivering exposure prophylaxis and discharge medications to COVID-19 patients and exposed staff.
  • Make a plan to help discharged patients avoid making in-person visits to community pharmacies (for example, providing information about delivery or mail order services).

This list of top best practices for pharmacy is by no means comprehensive. Still, we hope that it paints a vivid picture of the challenges currently being faced during COVID-19 and the innovative ways pharmacy managers and staff have addressed them.

As we move forward and prepare for the future—whether it’s a second wave or the next global pandemic —these key learnings and others will be imperative for managing the next public health crisis that comes our way.

Want to share your best practices? Fill out this form to share your story.


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.