COVID-19 has kept the Pharmacy staff busy and engaged. Weeks before the coronavirus struck this area, Southcoast Pharmacy Services had already begun preparing to meet the crisis. (IV Tech, Jessica Griffith, pictured above)

“Back in February, we knew there could be a potential problem with the drug supply for specific medications during the COVID-19 pandemic,” says Jack Evans, Executive Director, Pharmacy Services.

The hospitals would need an additional supply of certain medications to meet the needs of COVID-19 patients. These include analgesics for pain, paralytics for sedation for patients on ventilators, respiratory inhalers as well as an antiviral and anti-inflammatory medication.  

Pharmacy Services began closely monitoring COVID-19 incidence and prevalence in Massachusetts, especially Plymouth and Bristol Counties. They paid close attention to information coming out of the metropolitan NYC area that gave us a roadmap to what would be needed for drugs and supplies and what to expect as COVID-19 spread to our area. The Mass.gov, New York Times, and professional pharmacy organization websites were tapped; together they provided the data needed to forecast and prepare for what might happen in the South Coast region.

“The pharmacy management team meets virtually mid-mornings and focuses on COVID-19-related matters. Topics discussed include COVID-19 prevalence at Southcoast, staffing, safety, operational and supply issues, and stats, which are shared within the pharmacy and other departments as needed to keep everyone in the loop,” Evans says. 

“One of our initial concerns was medication supply, a concern in NYC.  We established a medication watch program that continually tracks our medication inventory each weekday and monitors changes over the prior seven days. This program detects utilization changes and serves as an early warning about shortages in the market.”

Fortunately, with the information, the Pharmacy Purchasing staff made certain that we obtained all needed medications and adequate inventory has not been a problem. Their diligence paid off.

However, there were other challenges. Pharmacy Services staff stepped up in many additional ways to keep service quality high and patients safe. And they continue to do so, even as Southcoast reopens more patient care services.

To begin with, Pharmacy Services had its own supply of PPE, which they shared as needed with other hospital departments. When replacement wall-mounted hand sanitizing solution containers became unavailable to purchase, they were called on to wash, sanitize and refill all dispensers at all three hospitals.  Facilities and Clinical Engineering Departments moved shipments of large seven-gallon drums of hand sanitizer to the Charlton Memorial Pharmacy Services; the Pharmacy staff refilled the dispensers, which were then re-distributed.

Pharmacy Services also centralized the medication order verification process. This enabled any one of the inpatient pharmacies to review and verify our physician’s medication orders for any patient at any of our three hospitals, assuring timely response and providing support should backup be needed at one of the Southcoast hospitals. This operational change was key to improving efficiency and ensuring continuity of service in case of any staff shortage.

Evans noted that in May, Charlton Memorial was one of four Massachusetts hospitals that received a large shipment of remdesivir, a new antiviral medication given emergency use authorization by the FDA, that was showing positive results in treating certain COVID-19 patients. The Pharmacy worked in conjunction with Chief Clinical Officer Dr. Dani Hackner and the Massachusetts Department of Public Health to quickly distribute the drug to other Massachusetts Hospitals in Boston and other areas.

“Our Antimicrobial Stewardship pharmacists coordinated with medical staff leadership, our infectious disease physicians and nursing to quickly utilize the medication at Southcoast,” says Evans.

Southcoast has more than 140 Pharmacy Services staff, including Hospital Pharmacists, Clinical Pharmacists, Retail Pharmacists, Certified Pharmacy Technicians, Pharmacy Purchasers, Antimicrobial Stewardship Pharmacists, support staff and pharmacy students. They work as part of the healthcare team at Southcoast at our three inpatient hospital pharmacies, our two oncology pharmacies at Charlton Memorial and Fairhaven, our three retail pharmacies at Charlton Memorial, St. Luke’s, and Fairhaven and our specialty pharmacy in Fairhaven.

“Our clinical pharmacy staff serve the needs of all inpatients. They work closely with the doctors, nurses and other staff on all the med/surg floors and our ICUs,” says Rachel McGarty, Pharmacy Manager at Charlton Memorial. “We’ve stayed on top of rapidly changing circumstances. There’s always new information and new guidelines coming out – on the use of off label meds, on the effects of the disease and medications that can help with these varying conditions, on possible new treatments.”

Last week there was some new promising information about using dexamethasone in certain COVID-19 patients. “It’s our responsibility to be a helpful resource to other clinical staff so that patients receive the best and safest care possible.”

Caring for seriously ill patients with COVID-19 is challenging – physically, professionally, and emotionally. But incidence in the region is decreasing and many, many patients have recovered. And there’s another reason for optimism.

“Anecdotally, we’re seeing good results using remdesivir and with COVID plasma treatment,” says Katie Akley, Clinical Pharmacist at Tobey. “We get very attached to patients. I’m feeling more hopeful now that we can offer more in the way of treatment.”

Kasey L’Heureux, Team Leader, Tobey Inpatient Pharmacy Services, says she’s been very gratified that despite the challenges brought by COVID-19 “the staff has provided the same level of care the whole time that we always do, without missing a beat.”

She also adds that it’s important for patients and families to know that Pharmacy is a resource for patients. “Sometimes patients don’t realize that if they have questions about their medicines they can always ask to see a pharmacist, we’re here for them as part of the clinical team.”

Apryl Arruda, Certified Pharmacy Technician at St. Luke’s, emphasizes the intra-departmental teamwork involved with caring for patients.

“We work closely with nurses and doctors. That’s important. They know who we are, and they always know where to find us,” she says. “My colleagues have been amazing under stress. COVID-19 has made us more understanding of one another’s challenges. At the end of the day, quality patient care is the goal. This is why we’re here.”

She also explains how Pharmacy keeps patients safe. “We’re a well-oiled machine. We make sure people get the right medication at the right dosage at the right time.”

There’s a check-and-balance system in place in which multiple Pharmacy staff must check and verify medicines ordered and administered. Additionally, some medications are mixed on-site, particularly those being given by IV. “The USP 797 Clean Room where we mix the meds is a sterile environment. We sanitize and test the room constantly,” says Arruda.

Deb Nery, Clinical Pharmacist at Charlton Memorial, attests to the measures taken to keep patients and staff safe from COVID-19 transmission. “When medications are returned to us centrally from the Omnicell Machines, where they are stored on each floor, we quarantine them for 72 hours. We don’t send any medication back to a floor without quarantining them first. We do a lot of cleaning as well. We wipe everything down. Any big bulk item that comes to us gets sanitized.”

“The Clinical Pharmacists don’t normally go into rooms where people have COVID-19 to minimize risk of transmission. When we see patients without COVID-19, we still take precautions. We gel in and gel out. Wear protective equipment – masks, goggles, face shields,” she says.

There are many other things that the Pharmacy staff do, as well. “Most patients come into the hospital already on medications. Typically, they need new medications as well,” says Nery. “We check the current and new medications to make sure the combination is safe and appropriate.”

When it comes to patient safety and quality of care, Nery says, “The Pharmacy staff are united and collaborative, and they do whatever it takes.”

Patients need not worry unnecessarily if they need medical attention, Akley says.

“I live in the community. I have family and friends in the community. I tell them we can protect you. We have policies and procedures in place. We’re organized. You need to come in and be seen.”

Click here to learn more about Southcoast Health’s exceptional staff and their response to COVID-19.