Each patient represents a unique set of challenges that requires focus and knowledge.
The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on the United States’ health care system and its workers. During this pandemic, I have had the opportunity to practice pharmacy in a dedicated COVID-19 treatment facility. This facility is a converted suburban hospital that only admits patients diagnosed with COVID-19. Practicing pharmacy in this unique environment poses multiple challenges.
I am sharing some insight regarding pharmacy practice in a dedicated COVID-19 treatment facility for 2 reasons. The first is to contribute to the conversation regarding the role of pharmacists during the COVID-19 pandemic. The second is to give those interested in a similar role some information and context based on my experience. It is my hope that we can all utilize our talents and expertise to help patients in these historic times.
My first observation is that the treatment paradigms for COVID-19 are constantly changing. This is a new disease with many unknowns. While there is often little consensus on the best treatment, there is a near constant flow of new discoveries being published. As pharmacotherapeutic strategies are being intensely studied, it is imperative for pharmacists to stay up to date on these latest findings. Now, more than ever, critically analyzing primary scientific research is imperative to implementing the best patient care. Traditionally, pharmacists have been curators of pharmacotherapeutic modalities and information. For pharmacists to continue in this role, we need to be updating ourselves on the best practices regarding COVID-19 therapy.
Beyond rapidly changing pharmacotherapeutic approaches to the disease, the logistics of caring for these patients necessitates new institutional policies. COVID-19 is highly infectious, requiring structural and policy adaptations to suit this reality. Just as our knowledge of COVID-19 treatments is constantly evolving, so is our understanding of the virus itself. This leads to internal policies that require constant adaptation. These updates need to be disseminated to relevant departments quickly and efficiently. This can lead to some confusion between (and within) various services and departments. Email fatigue can make communicating new policies difficult; however, organization-wide efforts that keep all relevant parties informed multimodally does work.
While COVID-19 is often the immediate threat to patients admitted to a dedicated treatment center, it is rarely the only condition that requires attention. Pharmacists in COVID-19 treatment centers should not overlook other conditions that may require pharmacotherapeutic intervention. These other health conditions, such as heart failure, diabetes mellitus, and convulsive disorders, can still require a thorough work-up to ensure optimal pharmacotherapy for the entire patient. Treating the whole patient, rather than just the COVID-19, is critical in a dedicated treatment center. This also necessitates a more ‘typical’ pharmacy operations architecture with regards to order entry, therapeutic drug monitoring, and formulary interchanges to remain intact. Given this reality, secure remote order entry has the potential to minimize the number of centrally located personnel in the pharmacy and reduce pharmacist fatigue. With existing technology, it is possible to perform many pharmacy operations from a distant site, including the home. This technology should be considered, when appropriate, in inpatient facilities with high COVID-19 patient populations.
COVID-19 is a resource-intensive disease to manage. Multiple health care professionals are needed to care for these patients safely and effectively. It is not uncommon for these individuals to work multiple shifts back-to-back, which can go beyond 8 hours each. This can lead to pharmacist fatigue and burnout. Burnout, as well as multiple novel drug combinations and treatments, can make for an environment that is conducive to making medication errors.
With regards to novel agents currently being utilized, most have not been thoroughly studied for this application, if at all. It is imperative to attain a good working familiarity with drugs that are being used in this population to minimize drug interaction, adverse drug events, and errors related to dose or administration.
A dedicated COVID-19 treatment facility requires excellent teamwork to operate effectively. Pharmacists play a crucial role coordinating with other members of the health care team to deliver the best pharmacotherapy possible. Understanding the current institutional policies, the up-to-date scientific consensus on pharmacotherapeutic strategies, and medication delivery logistics within the building is necessary for a pharmacist in a COVID-19 treatment facility.
We, as pharmacists, must be aware that our purpose is to optimize care for patients, not just COVID-19. Each patient represents a unique set of challenges that requires focus and knowledge. Pharmacists are up to this challenge and are indispensable members of the team in a dedicated COVID-19 treatment facility. I am privileged to have the opportunity to contribute to such an important mission.