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A changing landscape: Hospital pharmacists adapt to COVID-19
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A changing landscape: Hospital pharmacists adapt to COVID-19

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For Elizabeth Clements and her staff at Community Hospital in Munster, patient interaction has always been a major part of their day-to-day roles.

As pharmacists at the hospital, they routinely perform rounds with physicians and other medical personnel, work with patients to improve adherence, and are often some of the final faces patients see before they are discharged.

Although their focus on providing patient care has not changed, the way they must now go about performing their duties has significantly been altered, at least temporarily.

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“Our primary pandemic response goal is patient and staff safety,” Clements said. “We have made significant changes based on COVID-19.”

Clements, who serves as director of pharmacy, says although the department has reduced presence on the hospital floors, it has remained fully engaged in the care of patients through other communication methods.

While patients are usually provided prescriptions before they leave the hospital, new protocols put into place have helped reduce contact while ensuring patients’ needs are met.

“With the safety of our patients in mind, we transitioned to curbside pickup for these prescriptions,” Clements said. “This allowed the patients or their caregivers to obtain the prescriptions easily without coming into the pharmacy and saved personal protection equipment for front line staff, as we would not be going into the patient rooms.”

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Pharmacy staff at the hospital have also begun drive-up care for patients who are being treated with anticoagulants, or blood thinners. These medications require routine blood tests to ensure proper dosages are being given.

“Our patients appreciated being able to continue their visits without the risks associated with contact with other patients or staff in the clinic,” Clements said.

Lindsay Koselke, an inpatient pharmacist at Franciscan Health Michigan City, says the hospital plans to offer a similar service to help alleviate the concerns of patients.

“Too many patients have been scared to come in,” she said. “So today we’re calling a lot of those patients and are going to trial lab levels taken in the parking lot.”

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Kevin Colgan, chief pharmacy officer with the University of Chicago Medicine, says 50% of the prescriptions staff members are filling are now mailed to help alleviate some of the same concerns patients are experiencing. Pharmacists are also performing more of their duties through telemedicine.

“For my clinical staff, we went to virtual rounds,” he said. “They’re used to rounds each day with attending physicians, med students and pharmacy students where they go in and see each patient. Because of social distancing, those have turned into virtual rounds.”

Through a secure Zoom meeting, pharmacists are still able to consult physicians and patients without in-person contact.

“They can also do this from home,” Colgan said. “If you look at the entire university’s workforce, 16% are working from home. This is how we are able to treat patients in the manner that is very much the same prior to COVID, but do it in a manner where there is social distancing.”

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In fact, only about 21% of clinical visits have been in person. The remaining number of visits has been through a form of telemedicine.

Adapting to these circumstances hasn’t been a complete overhaul, however. Colgan says pharmacists have long maintained relationships with patients over the phone, routinely contacting them to improve medication adherence and to answer any questions patients may have.

“We have a certain group of patients that the pharmacy follows, like hypertensive patients,” he said. “It’s a change, but an extension of what we already have done.”

Patients with hypertensive problems can monitor their blood pressure and report numbers to staff as well, something Colgan says he sees continuing even after COVID numbers have dropped.

“More at-home monitoring will be something we will see,” he said.

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One of the biggest challenges for pharmacists has been the continually changing landscape of care for COVID patients, Colgan said. Drug procurement has been a challenge and has involved finding creative solutions and a lot of teamwork.

“I’ve had to contact companies directly about what our specific needs are and why we need immediate service,” he said. “It’s been a time in health care where everyone has pulled together under one common cause to do this as safely as we can.”

Koselke says a major focus of her role has been on obtaining medications for patients fighting COVID-19.

“Not just the ventilator is important,” she said. “Once on the ventilator, there are medications you have to be on — sedatives and pain medications. We’ve had to keep our inventory levels up and constantly are monitoring these levels.”

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Pharmacists are routinely in contact with other hospitals in the Franciscan network to ensure each hospital has the needed medications in stock, she said.

“If they aren’t available, we have to come up with alternatives,” Koselke said. “We can’t say we don’t have it, and then give up. We have to come up with other options.”

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