Four priorities for pharmacy leaders in the Covid-19 pandemic

The Pharmacy Executive Forum recently hosted two virtual conversations with health system pharmacy leaders on the impact of the Covid-19 surge. Participants called in from across the country and represented a range of Covid-19 experiences: High impact areas, like New York, regions with moderate surge, and areas that may have avoided surge, but still felt the impact on their health systems.

Pharmacy leaders shared their experiences with the “total disruption and chaos” faced during the crisis and their insights on how to best prepare.

Use our briefing of these sessions to guide your Covid-19 pharmacy preparedness and response plan.

Jump to learn more about each priority:

1. Create a system-wide drug shortage plan
2. Tailor pharmacy education and communication strategies
3. Mitigate staffing challenges during the surge
4. Ensure support for ongoing patient prescription needs

Priority one: Create a system-wide drug shortage plan. This should be a pharmacy leader’s top priority due to the immediate threat to patient care.

• Assess resources and centralize inventory tracking across the organization to prevent hoarding at individual hospitals and facilitate resource redeployment. Organizations have used this opportunity to establish centralized purchasing in order to gain visibility into resources at each hospital.

• Health systems need solid projections about anticipated caseloads and drug needs to respond to the Covid-19 crisis.
  • Work closely with the planning department to understand caseload projections and use those projections to think through drug needs. It will be particularly important to account for the atypical length of stay and extended time on a ventilator required for Covid-19 patients.
  
  
  • Include two to three alternatives to each high-demand preferred medication when planning for medication stockpiles. Also take into account other medications and pharmacy supplies that may also experience shortages, such as metered-dose inhalers.

• Collaborate with suppliers, including manufacturers and wholesalers, to operationalize your drug shortage strategy.
  • Pursue a variety of partnerships to purchase in-demand drugs during an escalating crisis. It will quickly become clear who is willing to be a helpful partner and who does not have the flexibility to adapt to an escalating crisis.
  
  
  • Centralize purchasing at the system-level, instead of from each hospital, as this gives pharmacy teams more leverage and flexibility when working with supply chain partners to meet projected surge needs.
  
  
  • Depending on your health system’s footprint, consider working with your wholesaler to centralize distribution and storage of Covid-19 supplies at the wholesaler’s site instead of at health system locations. This leverages existing distribution channels and minimizes the burden on the health system.

Priority two: Tailor pharmacy education and communication strategies to current surge status for greatest impact among health system leaders and front line forces.

• Pre-surge: Establish your health system’s plan for drug alternatives.
  • Educate providers to anticipate certain changes in case of a Covid-19 surge.
  
  
  • Work with the IT team to build a Covid-19 order set in the EHR that includes your alternative drug plans.
  
  
  • Set up a dashboard for senior executives with daily drug updates, such as inventory volumes and burn rates.

• Moderate surge: Pharmacy needs to work closely with clinical leaders for the rapid implementation of changing medication recommendations.
  • Prepare for this stage by engaging early and often with physician and nurse leaders to ensure you have their confidence and buy-in to influence provider behavior during the crisis.

• Peak surge: Pharmacy needs to deploy real-time, on the ground resources to most effectively support appropriate care.
  • A severe surge demands physicians' and nurses' full bandwidth and makes it difficult for them to recognize and respond to the implications of rapidly evolving drug shortages and protocol changes.
  
  
  • Pharmacy leaders from New York hospitals reported that remote, virtual, and traditional education or communication methods failed in peak-surge circumstances. Instead, they recommended pharmacists be in the ICUs, working face-to-face with practitioners on the floor, comparing the work in such crisis conditions to “hand-to-hand combat.”

Priority three: Mitigate staffing challenges during the surge by planning ahead and using conservative staffing strategies throughout the crisis.

• Compile a list of licensed pharmacists at your organization whom you can redeploy during a surge. Don’t forget pharmacists from IT, ambulatory clinics, and supply chain.

• To ensure sufficient pharmacy staff remain healthy and available, implement distancing strategies at the start of a surge.
  • Conserve pharmacy leadership by ensuring that pharmacy managers do not work in the same place, at the same time. For example, if the pharmacy team has three managers, assign one each to day shift, night shift, and remote support.
  
  
  • Assign a portion of staff to remote tasks, such as order verification, to reduce the number of people in cramped pharmacy locations. Rotate pharmacy staff in 2-week shifts between remote and onsite tasks.

• Prepare a staffing plan for the “all-hands-on-deck” approach to care during peak surge; build in time for additional training to prepare staff to support intensive care units.

Priority four: Ensure outpatient pharmacy services can support ongoing patient prescription needs.

• Pharmacies should be prepared for an influx of retail pharmacy patients. Patients may be encouraged to engage primary care services, stock up on prescriptions and use mail-order or home delivery services to prepare for prolonged social distancing.


• Health systems should be ready to serve patients with specialty pharmacy needs. Many health system-owned specialty pharmacies saw increased volumes across March 2020 as payers relaxed prior authorization requirements and providers switched patients to oral therapies when possible.


• Ambulatory pharmacies should also take steps to maintain continuity of services, such as by identifying which tasks can be performed remotely and rotating staff through on-site and remote functions.