By Helen Mcknight, Director of Pharmacy, Princeton Baptist Medical Center
Last year started with the promise of inventive health technology advances. Organizations actively researched innovative healthcare solutions such as 5G, Artificial Intelligence (AI), machine learning, and web-enabled devices to obtain information. The Internet of Things (IoT) seemed poised to cross over environments to connect “smart” devices and their human counterparts, moving health forward in ways that would enable revolutionary change. Over fifty percent of IT leaders expected their budgets to increase over the 2020-2021 calendar year.
In March 2020, Coronavirus Disease 2019 (COVID-19) radically shifted priorities. COVID-19 became a catalyst in an interconnected and interdependent global health care system. Pharmacy informatics, along with other associated supply chains, borne the brunt of the nimble switch. Business models abruptly changed from pushing innovation and competitive differentiation to cost control, expense management, system optimization, and efficiency.
The obstacles that pharmacy leaders faced over the last eighteen months have been overcome mainly with pharmacy informatics.
The obstacles that pharmacy leaders faced over the last eighteen months have been overcome mainly with pharmacy informatics. In Spring 2020, twelve American pharmacy organizations jointly released policymaker recommendations that aimed at expanding pharmacists’ role in combating the virus. The four measures recommended for immediate adoption were:
- Authorize Test-Treat-Immunize: Allow pharmacists to request and conduct tests, gather specimens, and interpret results; along with the expansion of immunization authority, especially in under-served areas.
- Ease Operational Barriers to Address Workforce and Workflow Issues: Permit pharmacy staff to operate across state lines using telehealth and remote prescription order verification.
- Address Shortages and Continuity of Care: Authorize pharmacists to independently conduct therapeutic interchange and substitution when product shortages arise; allow manufacturers to extend expiration dates; and increase the two-way communication on shortage causes and expected durations.
- Reimburse for Services and Remove Barriers: Provide coverage within scope pharmacist services; ensure continuous access when medication is in shortage; remove restrictions and cover home delivery.
Informatics systems have long been used to support clinical and operational advances within the healthcare institution. Informatics priorities that came to the forefront during the COVID-19 pandemic include:
(1) Boosted operational efficiency,
(2) Expanded customer experience,
(3) Optimized digital experience &
(4) Heightened cybersecurity.
In our community healthcare system, it was crucial to establish a tangible action plan. System-wide early-pandemic tabletop exercises focused each department head on potential unseen stumbling blocks and identified alternate strategies that might be required if systems to curb inappropriate drug utilization were insufficient. An incident command center was established to funnel all communication challenges through a few core leaders. Hospital managers designated a daily morning huddle to review daily priorities. A software platform was identified that allowed everyone in the hospital system to conveniently connect with limited entry technological barriers. The leadership huddle was deemed mandatory to all internal partners and was treated as the most important gathering of the day. In the pharmacy department, an afternoon safety huddle mirrored the system’s goals and objectives by identifying surge triggers and communicating new developments. The tight agenda addressed all major areas that require a decision, rapid progression, and innovation in a ten-minute timeframe. Those on the front lines were empowered to share success stories to keep worker recognition top-of-mind and decrease fatigue or burnout.
Hospital pharmacists evaluated emerging drug therapy options to rapidly make patient care decisions; monitored and adjusted medications to prevent side effects; resolved critical care medication shortages; ensured continuous controlled substance supply; petitioned supply chain warehouses to reserve personal protective equipment; and established new pharmacy services in temporary nursing units. From physician prescribing to order verification to preparation and dispensing activities, the entire pharmacy workflow was enhanced by technology. For example, smart infusion pumps, with their ability to store dosing guidelines in a drug library, were tethered outside of coronavirus patients’ room to ensure programming guidelines about potential unsafe drug therapy were available to key decision-makers. Drug libraries allowed the organization to enter various drug infusion protocols with hospital-defined upper and lower dosing limits stored in the pump’s memory. If a dose was programmed outside of established “guardrail” limits, the pump sounded an alert to inform the clinician that the dose was outside the recommended range. Institutional electronic health records (EHR) were updated to reflect the most up-to-date treatment protocols. Seasoned and new pharmacy practitioners played a role in ensuring the safety and accuracy of these systems.
Clinical and operational pharmacists worked together to create a priority list of COVID-19 treatments, including narcotics, sedatives, neuromuscular blocking agents, and vasopressors. A biweekly supply chain: healthcare system conference call ensured adequate wholesaler resources. It was critical to work with hospitalists and intensivist prescribers to prepare for the forecasted drug shortages and re-direct them towards suitable alternatives. Electronic health record treatment guidelines, medication use evaluations, and targeted prescriber conversations were used to emphasize the necessity of supportive care.
As patient volume diminished or surged, pharmacy leaders used spreadsheet data to adjust staffing plans. At first, weekend staffing grids were sufficient to meet demand. As the pandemic stretched on, attrition necessitated role deployment of technician staff to areas of greatest need. College of Pharmacy faculty members used teleconference platforms to permit fourth-year pharmacy students to complete their advanced pharmacy practice experience rotations.
To enhance customer experience, clinical pharmacists utilized their portable electronic tablets to discharge counsel patients and their family members. Pharmacists also applied their extensive knowledge and training in medicine use, organization, and problem‐solving to provide COVID‐19 health education to C-Suite members, physicians, and mid-level practitioners.
As we return to a new “normal”, healthcare informatic systems will need to concentrate their attention on collaborative data infrastructures to support COVID-19 patient care. Data interoperability, healthcare processes modeling, shared procedures for data privacy regulations, along with data stewardship and governance are seen as the most important next steps to boost collaborative practices.