May 14, 2020

Answering the Call

Linda Barcelona, RPh
Health System Executive - Strategic Solutions Group
Omnicell

When the pandemic first began to impact us, I had reached out to a few of my customers to provide them with information which I thought may be helpful (reports, guidelines, regulatory changes, etc.) for inventory management.  I had also added that they please reach out if I could assist with anything else. Shortly thereafter, I received a phone call from the Corporate Pharmacy Director at LCMC Health, a six-hospital system in the New Orleans metro area.

The Corporate Pharmacy Director, Danny Jackson, asked if I would be able to help one of their smaller facilities (New Orleans East Hospital, aka NOEH), as their census had quadrupled and they did not have the staff to support this increase. I had a second phone conversation with NOEH Pharmacy Director Brandon Nguyen, who asked if I could please come and work with them as a pharmacist in the evenings to help support staff and to care for patients. 

I had watched as my clinical peers struggle to care for the influx of patients and felt frustratingly helpless knowing that I had a valid pharmacy license and could help provide some relief. It was a blessing and an honor when I received the call to join the NOEH team. I was thrilled to finally be able to run into that fire.

Following a very rapid onboarding process, I began working in the NOEH pharmacy in late March, supporting their staff 2-4 evenings a week. I helped them validate physician orders, prepare and check IV medications, deliver medications to the ICU/COVID units, and stock medications in the Omnicell cabinets. 

It was a strange feeling when I first arrived at the hospital. There were tables set up by every entrance that were staffed with both nurses and security guards. Everyone who entered received a mask, sanitized their hands, had their temperatures taken, answered a few health-related questions, and received a wristband to show they had gone through these initial screenings. There were no families sitting in waiting rooms, no one wandering the halls, no one in the cafeteria. It was eerily desolate. After I had completed my onboarding with HR, I was brought to a clinic room (since converted into a COVID-19 ICU unit) to be fitted for an N95 mask. Masks, glasses, and gloves would be worn the entire time while inside the hospital. 

During this time, NOEH hired a newly graduated pharmacist who was going through her training period. I was able to assist in her training relating to IV preparation and sterile technique, regulatory compliance, as well as provide an in-depth tutorial on the operation of Omnicell cabinets.

The routine in the pharmacy was somewhat typical to what one would expect with subtle differences. The drug mix was very COVID-oriented and the volume of IV drips were high. With roughly 90% of the inpatients COVID positive, and approximately 50% of those on ventilators, it was to be expected. There was constant attention placed on maintaining stock levels in the Omnicell cabinets and the ordering and tracking of high-utilization medications. The mood was somewhat anxious and solemn. No one was sure when the chaos would begin to ease.

The lead pharmacist I worked with during the majority of my time, Peter Tran, was remarkable. He was frequently on phone calls with both nurses and physicians helping them modify medication regimens to be either more clinically appropriate, or to recommend changes to adapt to medication shortages. Continuous contact with the ICU nurses was critical as drip rates could change quickly for these patients, and it was imperative to ensure they had all medications needed to care for these critical patients. Visits to the ICU units (in full PPE garb) helped show the other clinicians that pharmacy was by their side and committed to provide help whenever needed. 

Walking through an ICU unit only feet away from COVID patients is an intense task that requires a great deal of focus. Proceeding cautiously so as not to risk contact and contamination, I also needed to employ a skill I had used in my ICU days at Children’s Hospital New Orleans. It’s the ability to see without seeing. You train yourself to look at the critical, the nurses and the medications, to notice the patients in beds, but to remain emotionally “distant.” The heartbreak of this situation can quickly distract you from the focus that is required to provide care.

With the census beginning to normalize, and their new pharmacist trained and ready, I have been able to scale back to an on-call/as-needed role with NOEH. They were extremely thankful for the assistance I was able to provide during their time of great chaos and uncertainty. They also indicated that they were anticipating another surge later this year, and that they would be reaching out again if I was in a position where I could help once more. 

The hospital staff was amazing, and I’m honored to have had the opportunity to work alongside them. I hope another surge never happens. I hope that everyone follows guidance and best practice. However, I will always be ready to run into the fire again.

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.