By Nishaminy Kasbekar, Chief Pharmacy Officer, Penn Presbyterian Medical Center
In November 2019, I was invited as a visiting speaker to China, including Wuhan. The populous capital of the Hubei province brought me many experiences of food, culture, and grandeur in terms of the architecture of temples and the Yangtze River. The trip allowed me to acclimate to a different culture and experience memories outside of my comfort zone – two thoughts that would hold me in the months to come.
I would never have predicted that such an extraordinary trip would have a lasting impact on me and the world. Words such as surreal, unprecedented, acclimate, quarantine, and social distancing became part of our new normal.
The daily news channels continued to inform of the disastrous impact of COVID 19 on morbidity and mortality in our world. The impact on society was personal and emotional, creating fear, panic, and uncertainty of the present and future.
COVID-19 created significant pressure and a state of overwhelm to the health care system. Increasing pressures regarding the capacity of intensive care units, hospital bed and resource availability such as ventilators, as well as overall well-being and resilience of staff became paramount issues. Normal operations were replaced with emergency preparedness, ceasing elective surgeries, and decreasing ambulatory visits allowed increased bed capacity and mobility of staff to most needed areas. The health care system and front-line workers were thrown into the forefront as essential and health care heroes with courage were created.
Pharmacy departments have always been at the forefront of medication use and medication safety, exhibiting versatility with ever-changing medications and technology.
The Department of Pharmacy is often observed as an ancillary service similar to Radiology and the Laboratory Departments, operational in nature and supporting the front lines. With the goal of providing safe and effective health care through the provision of promoting appropriate use of medications and innovative care delivery models, the Department of Pharmacy has emerged as a revenue-generating influencer. This dynamic time has brought a world of change and opportunity.
Pharmacy departments have always been at the forefront of medication use and medication safety, exhibiting versatility with ever-changing medications and technology. However, COVID-19 has created a versatility like no other. The ability to adapt to new formats such as drug shortages, staffing mobility, finding ways to generate revenue, and implementing a structure for COVID vaccine programs has been key challenges.
Pharmacy departments have previously adapted to drug shortages, but the degree of needs imposed by COVID-19 made managing ventilated patients a challenge. Critical shortages of analgesics, paralytics, narcotics, and antibiotics were noted early on in the pandemic and required full-time resources to manage. Our pharmacy department was nimble in efforts regarding the procurement of medications in different classes, educating front-line practitioners in choosing available medications and varying indications or safety concerns, and modification/implementation of utilization guidelines. We also created an internal calculator to give us internal analytics on burn rates of critical medications to ensure we had appropriate supplies.
As the rate of COVID positivity increased in the population, so did the rate of staffing exposures. With initial CDC quarantine requirements, Pharmacy departments had to meet a demanding workflow with fewer resources, and thus the emphasis on strategically positioning resources became apparent. Mobilization of flexible staffing allowed protection of the workforce and guaranteed skill set to manage the most critical patients. It also created teams of employees so if one set were exposed; another group was able to take over essential functions without incident.
Flexible training was also implemented as the changing logistics of medication delivery locations, schedules, and batching intravenous medications allowed demand to be met.
During COVID 19, we also saw a tremendous impact on patient interactions with our ambulatory environment. Decreased elective surgeries, decreased ambulatory visits, and decreased visits to retail pharmacies became a concern. As the unemployment rate increased, a patient’s ability to pay for their retail medications was also affected. We quickly implemented delivery and courier services to assist patients in obtaining their medications without coming on site. We noted payers approving 90 day COVID supplies as well for convenience and the ability of certain payers to relax prior authorization required for medications. Our pharmacy pivoted clinical pharmacists from being in clinics to virtual telemedicine visits, proactively assisting patients with prescription refills, medication assistance, financial assistance in terms of copay management, grant funding and medication education. This allowed our pharmacies to continue generating revenue despite the economic downturn.
COVID Vaccine Clinics
Very recently, our Pharmacy team has designed, strategized, and implemented Covid Vaccination clinics for employees and patients. Managing the subzero temperatures for storage and dispensing under the EUA guidance and reporting has been a challenging additional task in an already stretched COVID environment, but putting shots in arms has proved satisfying. We have also implemented equity and diversity strategies to address vaccine hesitancy and implemented weekend clinics for large volumes to optimize our community’s vaccination rates. In addition, we recently began a dispensing program for our bed-bound patients who are unable to visit a clinic in person.
Pharmacy practice has been revolutionized throughout the years morphing from a transactional model where providing medications to patients is a priority to transformational patient-centered model where the patient care quality is highest with appropriate medication use, medication safety, education, research, and innovation. Like other business models, COVID 19 has fueled a paradigm shift in the work of Pharmacy, providing leaders in the industry a unique opportunity to work in dynamic and novel ways. The pandemic has proven to the world that pharmacists play an integral role during challenging health care crises and has thrust pharmacists into the front line of essential health care workers.