Caitlin Mollison, Managing Editor

Safety within pharmacies is a priority in the best of times, but it has become essential to ensure that pharmacies and pharmacists do not spread coronavirus disease 2019 (COVID-19) during the pandemic.

To that end, the Pharmacist Moms Group, the largest group of female pharmacists in the United States with more than 31,000 members, set up a special task force that has issued guidelines for pharmacists working in community pharmacies. 

 cover operations, personnel, recommendations for patients, end-of-workday procedures, additional tips, and national resources.

“Pharmacist Moms wanted to help prepare pharmacists and pharmacy technicians who may be exposed and provide them with proper support. We need to be proactive as pharmacists to protect ourselves,” Suzanne Soliman, PharmD, BCMAS, chief academic officer at the Accreditation Council for Medical Affairs and the founder of Pharmacist Moms Group, said in an email interview.

Important safety measures for pharmacy staff members addressed by the guidance include, “washing hands frequently with soap and water for at least 20 seconds, avoiding touching the face, and wearing personal protective equipment such as gloves and masks if available,” task force member Jennifer Gershman, a drug information pharmacist in South Florida, said in an email interview.

“Providing drive-through services and limiting the [number] of patients inside the pharmacy is also important to protect the staff,” she said. “Credit card machines, counter tops, and door handles should also be cleaned frequently.”

Another member of the task force, Hillary Blackburn, PharmD, director of pharmaceutical services at Dispensary of Hope in Nashville, Tennessee, which donates and dispenses medications philanthropically, said that she has been heavily involved in developing the distribution center staff employee wellness screenings for onsite workers and cleaning procedures for them.

Procedures at the distribution center include checking employee temperatures each day, hand-washing and sanitizing, cleaning workstations, surfaces, and other high-touch areas.

There is also a checklist for employees to make sure that they and anyone living in their homes are not experiencing a fever, new cough, or shortness of breath, as well as guidelines for what employees should do if they test positive for COVID-19 or live with someone who has.

“The safety of our employees is of the utmost importance to us,” Blackburn said in an email interview.

Travis Wolff, PharmD, owner of Med-World Pharmacy in Sapulpa, Oklahoma, said in an email interview that his pharmacy is taking similar precautions.

“We have timers set and signature logs, requiring us each to wash our hands for 20 seconds once per hour, as well as disinfect patient care workspaces. If [there is] no visible sickness, we are disinfecting with Lysol/bleach/regular protocol stuff, but if [someone is] visibly sick or [there is] reported exposure to a patent, we clean with a viral germicidal agent with known antiviral activity (currently using Citrus II),” Wolff said.

In terms of direct patient care, the pharmacy’s staff members are offering service via drive-through window and are wearing N95 masks and using gloves when anything is received or given to a patient, including cash, credit and insurance cards, hard-copy prescriptions, and identification, he said.

The pharmacy asks delivery drivers about illness or exposure to illness over the phone and collects payment over the phone, Wolff said. The drivers give exact delivery times to patients and leave medications on their doorstep, watching from their cars to make sure they pick up what is dropped off. These drivers, who have Citrus II spray, gloves, and N95 masks, are not allowed to enter homes or take anything from patients, including cash.

In addition, Wolff said that the state board of pharmacy has mandated that all pharmacy benefit managers accept “CV19” or “COVID-19” for all signatures, so that “we are not sharing ink pens both on deliveries or at the drive-through.”

Med-World is continuing its clinical management programs but has switched over to the Zoom video conferencing service for most consultations and is doing immunizations and point-of-care testing curbside, he said.

The pharmacy has educated all staff members about the likelihood of being an asymptomatic carrier, so they are practicing social distance, including grocery deliveries to their homes.

“We have even offered childcare in the back if anyone needs it, hiring a school aide who otherwise is not going to work anyway,” Wolff said.

He recommends that pharmacies also assess the health status of their employees, including taking their age, disease states, and medication profiles into consideration.

“We have an employee on a specialty medication for psoriasis, who, while otherwise healthy, cannot afford to be exposed. So we have given her some case management duties in an office, not in direct patient care,” Wolff said.

At the end of the day, “our staff are like family,” Wolff added. “It is important being [on] the frontline that we are vigilant in our procedures and make sure our staff are equipped to be successful.”

Guidelines for pharmacists in community pharmacy. Pharmacist Moms. 

pharmacistmomsgroup.com/guidelines-for-pharmacists-in-community-pharmacy/

. March 17, 2020. Accessed March 20, 2020.

Articles

Pharmacy Moms Group special task force develops guidelines as precautions are implemented amid the COVID-19 pandemic. 

Pharmacies Step Up COVID-19 Safety Measures

As the novel coronavirus (COVID-19) crisis continues, one key issue for pharmacists, other health care professionals, and patients is the potential for drug shortages in the United States.

There is growing concern because although reserves exist, China experienced a drop-off in drug production during the height of its COVID-19 outbreak, though that is leveling off.

 And India, another big supplier, has also said that it will keep some of the medications it makes on reserve.

“We are now starting to see spot shortages for a few different products, in part due to disease progression around the world, especially across Europe, which is a large producer of drugs,” Soumi Saha, PharmD, JD, senior director of advocacy at Premier Inc in Washington DC, said in an email interview with 

. “Italy, for example, is the (number) 3 producer of active pharmaceutical ingredients behind India and China, so we’re keeping a close eye on the availability of raw ingredients from that region as part of our ongoing risk assessments.”

Premier is a health care improvement company that unites an alliance of approximately 4000 health systems and hospitals and more than 175,000 other organizations and providers. Saha said that Premier is also seeing an increase in the purchase of drugs that are expected to become frontline therapies for COVID-19.

For example, she said, “South Korea recently reported that certain anti-malarial drugs have positive outcomes in COVID-19 patients, and within 24 hours we saw a dramatic uptick in the purchasing of those drugs across the country.”

In terms of drug reserves, Premier is working with manufacturers to understand how much product is available to wholesalers, how much is in warehouses, or “how much could be on a barge coming across the Indian Ocean,” Saha said.

“We know that manufacturers of products for Premier’s drug shortage programs, including ProvideGx, have safety stock, and we are in discussions with suppliers, particularly for products that are in high-demand categories right now, such as metered dose inhalers and cholorquine, about ramping up production and ensuring adequate allocations in the supply chain,” Saha said.

Meanwhile, the FDA has announced a drug shortage caused by the COVID-19 outbreak but has not identified the drug or the country where it is made, in an effort to prevent hoarding and panic.

However, the agency “should be sharing this information with private sector partners to help address the situation and ensure additional supply is available as soon as possible. At organizations such as Premier, if we know which drugs are in potential shortage, we can leverage our ProvideGx drug-shortage subsidiary to incentivize manufacturers to enter the marketplace and manufacture the drug,” Saha said.

Receiving such information would help Premier to help prevent a drug shortage before it becomes widespread, she said, adding that the company is in discussions with the FDA to “release this critical information to us soon.”

pharmacists think that this is a good time to show their value

“We can help with therapeutic interchange while navigating the patient’s formulary better than anyone on the medical team. We should be proactive and jump in when we can, never contacting the physician without a solution to the identified shortage,” Travis Wolff, PharmD, owner of Med-World Pharmacy in Sapulpa, Oklahoma, said in an email interview with 

Although some pharmacies are marketing 90-day supplies to limit the number of patient visits, he said that pharmacists should discourage that practice.

“If an otherwise healthy patient gets new 90-day supplies, we will end up like toilet paper with empty shelves,” Wolff said. “We should screen and only grant 90 days or early fills to the most at-risk patients.”

Tara Fink, PharmD, pharmacy clinical services manager at Walmart Health & Wellness in Fort Worth, Texas, said in an email interview with 

that “we have been managing significant medication backorders, shortages, and recalls on a variety of medications for the last couple of years, more so than ever before” in the retail setting.

“COVID-19 is creating a paradigm shift, but I am confident that we will find a way to take care of our patients should a shortage arise, as we have always done,” she said. “I’m very proud of my colleagues and encouraged by the brave pharmacists stepping up to meet all the new challenges that are coming our way.” 

Another concern is a shortage of medical supplies, such as personal protective equipment (PPE). Premier’s surveys of supply inventories in the acute space and at senior living facilities show that some providers are running low on PPE, such as masks.

Many have initiated conservation strategies, and Premier is recommending that all providers immediately implement these strategies until manufacturing of these products ramps up, Saha said. Premier has compiled a one-page document of best practices during extended use of PPE, which it has distributed to its members, she said.

Saha remains optimistic about the drug supply, however, because she says that the pharmacy profession is accustomed to dealing with shortages.

“We’ve had over 100 drugs on the FDA shortage list and 200 on the [American Society of Health-System Pharmacists] shortage list for years. While pharmacy manufacturing is not resilient, the practice of pharmacy has become,” Saha said.

“Pharmacists are adept at finding alternatives when the ideal drug is not available,” she said. “If anyone knows how to handle shortages, it’s pharmacy.”

Lupkin S. How coronavirus is affecting the U.S. pharmaceutical supply. NPR. March 12, 2020. 

npr.org/sections/health-shots/2020/03/12/814623335/how-coronavirus-is-affecting-the-u-s-pharmaceutical-supply

Goel V. As coronavirus disrupts factories, India curbs exports of key drugs. The New York Times. March 3, 2020. 

nytimes.com/2020/03/03/business/coronavirus-india-drugs.html

FDA. Coronavirus (COVID-19) supply chain update. 

fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update

. Published February 27, 2020. Accessed March 19, 2020.

Premier Inc. survey finds 86 percent of health systems are concerned about personal protective equipment shortages due to coronavirus [news release]. Charlotte, NC; March 2, 2020: Premier Inc website. 

premierinc.com/newsroom/press-releases/premier-inc-survey-finds-86-percent-of-health-systems-are-concerned-about-personal-protective-equipment-shortages-due-to-coronavirus

Premier Inc. survey: more than two-thirds of senior living facilities say they can’t access personal protective equipment needed for COVID-19 containment plans. [news release]. Charlotte, NC; March 16, 2020: Premier Inc website. 

premierinc.com/newsroom/press-releases/premier-inc-survey-more-than-two-thirds-of-senior-living-facilities-say-they-cant-access-personal-protective-equipment-needed-for-covid-19-containment-plans

COVID-19 and PPE conservation. Premier Inc website. 

premierinc.com/newsroom/education/covid-19-ppe-conservation

. Published March 18, 2020. Accessed March 19, 2020.

As the COVID-19 pandemic continues, a key issue for pharmacists, other health care professionals, and patients is the potential for disruptions in the US medication supply chain.
 

Drug Shortage Concerns Are Top of Mind Amid COVID-19 Outbreak

Pharmacists should document all that they do to help transform their practices and attract payers.

That was the takeaway from the session, “Care Planning: The Key to Thriving and Surviving” at the National Community Pharmacists Association (NCPA) 2019 Annual Convention in San Diego, California, on Monday, October 28.

Pharmacy system vendors are making care planning and documentation easier than ever before, according to Mark McCurdy, RPh, owner of Mark’s Pharmacy in Cambridge, Nebraska, who told attendees that he is no different than they are, except that his pharmacy decided to adopt a community wellness mentality 4 years ago and start documenting patient interactions.

He provided an overview of how care planning can increase pharmacy profits through efficiencies and through new revenue from payers that value what pharmacists do for patients, if they see the documentation of what has been done.

McCurdy focused on 3 things during the session: the elements of a care plan to document interactions with patients; strategies for implementing planning into a pharmacy’s workflow; and identifying the types of interventions that can be documented in a care plan.

“Who are you telling that you’re providing this patient care? Are you able to prove it?” McCurdy asked.

“You need to be able to get credit for what you’re doing” on the medical side, he said.

The payers want to know what value they get from pharmacists providing patient care.

“If you don’t document it, it didn’t happen. You have to put down in code how you’re taking care of these people,” McCurdy said.

Pharmacists have been engaging in uncompensated care for a long time, so it is time to document that the services they offer to patients are cheaper than them visiting a doctor or emergency department, he said.

“We’re very convenient for patients,” McCurdy said. “We’re very available for patients.”

It is key to get buy-in from everyone who works in the pharmacy.

“You need to engage everyone in your pharmacy with care planning,” McCurdy told the audience. “This is going to take everyone in your pharmacy to make this happen.”

McCurdy advised that pharmacists use systematized nomenclature of medicine — clinical terms (SNOMED) codes. SNOMED is a vocabulary of clinical terminology that is used by health care providers for the electronic exchange of clinical health information.

“If you’re recording a blood pressure, there’s a code for that. If you’re giving an immunization, there are codes for that.” McCurdy said.

In terms of care planning, it takes time to set up patients, but it is worth it, said McCurdy, who added that pharmacists might want to use employees, such as pharmacy technicians, to do some of this work.

McCurdy recommends that pharmacies use cheat sheets, codes, and screen shots of care plans to move forward.

He also says that pharmacies can look into automation of their processes

“There are vendors that will help manage this,” McCurdy said, though some solutions can also be managed in house.

Some types of care plan activities that can be documented are disease and medication education, dosing and dosing changes, and vaccinations.

“You can no longer rely on dispensing alone,” he said.

McCurdy M. Care Planning: The Key to Thriving and Surviving. Presented at: National Community Pharmacists Association (NCPA) 2019 Annual Convention; San Diego, California; October 28, 2019.

Care planning can increase pharmacy profits through efficiencies and through new revenue from payers that value what pharmacists do for patients, if they see the documentation of what has been done.

Building Practices with Documentation for What Pharmacists Do

Two experts shared best practices for operating a pharmacy convenience packaging service with attendees of the National Community Pharmacists Association (NCPA) 2019 Annual Convention in San Diego, California, on Sunday, October 27.

During the session, “Expanding the Market for Your Packaging Services,” Susan Rhodus, RPh, senior vice president for contract administration at Gerimed, talked about the opportunities for pharmacists in the at-home-care market, which is growing dramatically, because baby boomers do not want to go into long-term-care facilities. At-home care is part of long-term care (LTC).

These at-home-care patients “are underserved from a pharmacy aspect. They need your care,” Rhodus said.

Five million people are homebound, she said, and 10,000 people are turning age 65 years each day.

Those confined to their homes “are the ones who are going to the hospital the most. They’re falling the most. They’re the ones who need extra services, and they aren’t getting them,” Rhodus said.

By law, a nursing home has to be affiliated with a pharmacy to get Medicare or Medicaid, and 97.2% are affiliated with a pharmacy, she said, citing CDC data.

But just 4.9% of home health agencies are affiliated with pharmacies, creating a huge opportunity for pharmacists in that segment, Rhodus said.

One of the biggest issues with medical at-home care, however, is determining who qualifies, according to presenter Steve Adkins, PharmD, owner of Health Park Pharmacy in Raleigh, North Carolina.

If a patient cannot walk into a pharmacy and get medications and take them appropriately themselves, cannot walk into a pharmacy unassisted and get the services provided, or has a caregiver administering their medications, he or she should qualify for medical at-home care, Adkins said.

“Have a checklist to figure out whether your patients are qualified,” Adkins added.

In addition, the Centers for Medicare and Medicaid Services (CMS) has a list of 10 services required for Medicare Part D LTC qualification, so it is important to make sure that a pharmacy can meet these requirements to serve these patients. One of the 10 requirements is providing special packaging.

The National Council for Prescription Drug Programs has added a new Level of Service code to support pharmacies providing special services to medical at-home patients. This level of service,  07, for medical at-home with special pharmacy services is identical to LTC beneficiaries, with the exception of emergency kits. Pharmacy benefit managers (PBMs) have to agree to adding this designation and any changes in contract payments for this new level of service. PBMs pay at retail rates for patients served in their homes.

Medical at-home pharmacy services are important, because of adherence, better quality of life, compliance, a decrease in admissions to hospitals and visits to emergency departments, a decrease in admissions to assisted-living facilities and nursing homes, and lower health care costs for complex chronic care patients.

Better quality of life is a way to reach patients.

“When you’re doing motivational interviewing with patients, you need to hone in on this,” Adkins said, adding that it is important to use a life event to light a fire with patients, such as being able to attend a child’s wedding.

In terms of packaging, “medical reconciliation is key,” Adkins said. “Med [synchronization] is a must. If you aren’t doing synchronization, there’s no way you can do packaging. Sync is the cornerstone of all this.”

Adkins said that once a pharmacy starts to market the packaging, bring in providers and communicate with them.

In addition, “I would never recommend doing this on a large scale without some kind of quality assurance” related to packaging, Adkins said.

Finally, it is important to work with community partners and ask them questions, such as how many employees they have, and what their pain points are, he said.

Adkins said he strongly recommends doing ride-alongs with nurses and members of the sales teams, sit in on clinical meetings, and be accessible if they need to reach out.

“Make it as easy as possible for them to get those patients to you.” he said.

Strategies for Operating a Long-Term-Care Pharmacy

Coverage of the NCPA 2019 Annual Convention & Expo

Adkins S, Rhodus S. Expanding the Market for Your Packaging Services. Presented at: National Community Pharmacists Association (NCPA) 2019 Annual Convention. San Diego, California; October 27, 2019.