Hospital pharmacy faces changes from COVID-19 [Sponsored content]

As CarolinaEast Medical Center shifted some of its focus to caring for COVID-19 patients, the hospital pharmacy was on the front line of change in the way drugs are purchased and delivered.

“Part of the problem with the COVID-19 pandemic is that a lot of our drugs are in short supply,” said Genelle Butz, director of pharmacy at CarolinaEast Health System.

To get what patients need, the hospital contacts suppliers and manufacturers directly, said Sandi Avery, pharmacy buyer and supply coordinator.

“We tell them what our needs are and they try to get us our meds,” Avery said. “We’re just trying to make sure we have enough to cover our patients and not take these drugs to areas that need them for COVID patients.”

Another obstacle is replacing drugs with those that are not available, she said.

“It’s not something we can do in five or 10 minutes,” Avery said. “It usually takes days to coordinate this. “

Butz said new drugs need to be entered into the hospital’s inventory tracking system and electronic medical records so that they are compatible with the bedside barcode systems used to keep patients safe.

“It’s difficult to bring something very quickly,” she said.

Avery said that now that people are receiving more products at their homes via UPS or FedEx, the hospital is seeing delays in receiving drug shipments. She said the hospital has started receiving deliveries on Saturdays to ensure needs are met.

Because manufacturers and suppliers are seeing unprecedented demands for certain products, it takes time for them to ramp up, Butz said. As a result, some providers have restricted access to certain drugs, including those commonly used in the hospital, she said.

“Depending on how they limit these drugs, we have to go back to them and say, ‘No, this is what we normally use. “We’re not trying to buy too much,” Butz said. “It’s been a lot of back and forth trying to make sure we’re getting what we need for our patients as well as trying to anticipate the needs of what a COVID outbreak looks like. “

As research indicates possible new drugs to fight COVID-19, demand for these drugs is increasing, she said.

One example is remdesivir, she said. A recent government-sponsored study found that remdesivir reduced recovery time from COVID-19 by 31% – an average of four days – for patients hospitalized with the virus.

“All of these drugs go to a wholesaler and the government identifies where they are going,” Butz said. The most recent information she received from the state showed the drug was going to seven hospitals in areas with a high volume of COVID-19 patients. New Bern is not one of these neighborhoods.

Critical care pharmacist Natalie Merrels said that as she and CarolinaEast Pharmacy Director Jeff Spray discussed treatment options for patients with COVID-19 early on, they saw the availability of hydroxychloroquine almost disappear in a day.

“Things changed very quickly and we had to adapt and manage an inventory as the evidence changed,” Merrels said. “It was a lot to watch. “

Senior clinical pharmacist Amy Copley said her mother was taking hydroxychloroquine, also known as Plaquenil, for lupus, an autoimmune disease that can cause severe fatigue.

“I was initially worried that she might not be able to get her maintenance supply that she takes all the time to control her lupus,” Copley said. “I think that’s a common theme with patients who have been doing it for some time. “

She said her mother was lucky enough to have access to her supply, although this often depends on the suppliers and wholesalers of the drug.

“This is a concern for patients who are at risk for flare-ups of their autoimmune disease if they don’t have their supply,” Copley said.

She said hospital pharmacists have spent hours trying to stay on top of clinical recommendations for treating COVID-19 patients, as the information came from hot spots like New York City.

“The last thing you want to do as a clinician is just sit back and watch someone die,” Copley said. “We’ve seen so many changes in terms of the initial recommendations to make hydroxychloroquine and then combine that with azithromycin. As clinical pharmacists, we are very concerned about drug interactions with these drugs and try to be careful and appropriate in their use. “

At first, even HIV drugs were considered for use against COVID-19, although this was quickly wiped out. Still, there was a rush for HIV drugs at the time, she said.

“So you are wondering if there were any HIV patients who couldn’t get their meds because of COVID,” Copley said.

Since the early days, organizations such as the Society of Critical Care Medicine and the Infectious Disease Society of America have issued recommendations that all new drugs considered for COVID-19 treatment undergo clinical trials before they are used. , she said.

Remdesivir appears to offer hope, Copley said, but data is still being collected on its effectiveness as a treatment for COVID-19.

“A lot of things have been tried, but the biggest concern is that we’re not doing any harm,” she said, “the first rule of medicine”.

Merrels said the biggest challenge has been trying to follow the latest medical recommendations for COVID-19 while staying on top of how the outbreak is personally affecting the community and staff.

“Security is one of our biggest concerns,” she said. “Safety, drug interactions, and thinking about how these new therapies, as we use them safely for other conditions, could have different effects in a COVID patient. Trying to balance all of these things has definitely been a challenge. “

As patients hear about treatments tried elsewhere in the media, Merrels said the reality is these are limited.

“You really want to do something for these patients, but we don’t have a lot of good options,” she said.

The pandemic has also affected the functioning of the pharmacy and hospital staff, Butz said.

“Jeff and I have worked to socially alienate our staff,” she said. “A hospital pharmacy is very different from a retail business. If someone brought COVID-19 and took one of our shifts, we wouldn’t be able to function. “

Butz said cross-training of staff has also increased so that shifts can be covered in the event of illness entering the pharmacy.

As the hospital reorganized to provide treatment for COVID-19 patients, the pharmacy needed to determine the best and safest ways to dispense the drugs and when to do so, she said.

“We want to expose our staff as little as possible,” said Butz.

The pharmacy also changed the way personal protective equipment was used in the sterile preparation room to maximize its use, she said.

“We really have to make sure that we can keep the PPE for the sterile preparation, because if we can’t make these drugs, then we’re not really good for anybody,” Butz said.

Merrels and Copley, who typically work in the intensive care unit and surgical care units, now work in isolated offices and consult with doctors via Skype.

“It certainly created challenges and removed some of the ease with which we could communicate our recommendations to suppliers,” Merrels said.

Isolation also creates social loneliness, she said.

“I’m used to being surrounded by intensive care nurses and doctors sitting in front of computers right next to me and we chat all day, sometimes about personal things – mostly patient care, but this ‘is a big social change, ”says Merrel.

Copley said she and some colleagues are now working in a loaned space in the attic of a hospitalist’s office across from the hospital.

“One of our colleagues is very, very pregnant and expecting a baby literally any day,” she said. “We were very, very grateful to be able to protect her and her unborn baby from this risk of exposure in the hospital.”

Although those in remote offices are only a few feet apart, they try to maintain social distancing.

“You kind of constantly feel torn between being grateful that you have reduced exposure to the virus – I’m less worried about bringing it home to my family, but it’s socially awkward,” Copley said. “Trying to do meetings via Skype is inconvenient at best.”

Avery said some pharmacy staff who have young children at home took time off to care for them when the hospital census was low, saving the hospital money. hospital and forcing others to take on more tasks.

“It helped the hospital and helped each other,” she said.

Critical care pharmacist Natalie Merrels has worked hard to make sure we are ready to meet the needs of COVID patients.

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