We put out a call for pharmacy professionals across the country to share their stories of pharmacy practice during the COVID-19 pandemic. Below is a selection of those stories. If you would like to submit your story for consideration in a future issue, visit cpha.com/news/jcphp/jcphp-pandemic-stories.
Patterson Family Pharmacy
Ali Wright, RPh
COVID-19 offered an unexpected turn of events for businesses worldwide. Being a small business and independent pharmacy, closing our doors to the public was a frightening experience. With the fear of the coronavirus and stay-at-home orders, our staff knew we needed to take matters into our own hands. As a small-town pharmacy, we pride ourselves on going above and beyond for all our customers. Our motto at Patterson Family Pharmacy is “where you are known” and we can guarantee anyone who walks in our doors will be treated like family from the start! For the past two months we have been increasing our reminder calls for refills due, establishing a steady flowing drive-thru, and offering multiple deliveries a day to patients in surrounding areas. With the shortage of masks in our town we found a local seamstress willing to provide reusable masks to our staff and patients. In addition, our staff has been distributing goodie bags with multivitamins and alcohol pads to all patients as a token of appreciation for supporting our business during these troubling times. We understand the concerns associated with coronavirus and hope to ease the stress one patient at a time!
A New COVID-19-Specific Hospital in Georgia: Building an Interprofessional Staff in 2 Weeks
Trina J. von Waldner, PharmD
University of Georgia College of Pharmacy
One of the earliest COVID-19 hot spots was the rural community of Albany, Georgia. There were over 500 cases by early April, many traced back to a funeral in late February. Local hospitals were overwhelmed and requested support. The Georgia-3 Disaster Medical Assistance Team deployed mid-April. The interprofessional response was intensely interprofessional, including pharmacists. I was one of the pharmacists, and this emergency response initiative was like nothing I had experienced in a 34-year career that spanned hospital pharmacy administration, public health, and academia.
Our mission was to staff and prepare an alternate facility dedicated to COVID-19 patients. The first patients quickly arrived for the new ICU; many were DNR and had been hospitalized for a month or longer. Heartbreaking cases included much loved and respected family matriarchs, who for weeks had no visitors, save for their hard-working, PPE-clad nurses. Most patients were sedated and ventilated; many had multi-organ failure and secondary infections, requiring treatment with multiple pressors, high dose anticoagulants, and antibiotics. Pharmacists performed daily monitoring of drug therapy. Co-morbid conditions included diabetes, obesity, and cardiovascular disease.
The teamwork was impressive. Temporary nurses, physicians, respiratory therapists, and pharmacists were on-boarded in a matter of days. Managers were orienting new employees and expanding work schedules every shift. As I learned new systems, drugs, and coworkers, everyone worked together to provide the best care. I found my comfort level in helping train new people on computers and automated dispensing, moving pharmacy operations to 24-hour service, and bridging critical gaps as the hospital filled, floor by floor. In two weeks of 12-hours shifts, I saw changes in treatment that demonstrated how rapidly the pandemic was evolving. This public health challenge is far from over, but the dedication of everyone involved was a testament to the power of interprofessional collaboration and teamwork.
My COVID-19 Journey
Marilyn Stebbins, PharmD
UC San Francisco School of Pharmacy
Below is an excerpt from Dr. Stebbins' experiences as a COVID-19 patient. This piece was originally published on the UC San Francisco School of Pharmacy website. It can read in its entirety at pharmacy.ucsf.edu/news/2020/04/my-covid-19-journey.
Throughout this health episode and as a COVID-19 patient I saw the federal government downplay the COVID-19 threat. I saw a lack of readily available diagnostic testing, and no plans for patient isolation and testing after hospitalization. As an early COVID-19 patient, I experienced uncoordinated and sometimes differing guidance from the federal government and county public health departments, both of which health care providers rely on to make patient care decisions.
Once home, I felt disconnected. I wasn't contacted by the county public health department until I'd been home for four days. On my husband's need to quarantine, we received advice that made no sense in light of the fact that I was still positive. It would have been so much easier, and so much “healthier” for me, to have known before I came home from the hospital what my husband's COVID-19 status was. We may not have had to have isolated from one another in the same house once I was released from ICU, and I'd not have had the constant guilt and anxiety, as a known positive, about potentially infecting him.
After I returned home, I called my manicurist to explain how bad I felt that she'd been unknowingly exposed by me. The public health department had never contacted her.
I consider myself a well-informed health care provider, and even I felt somewhat abandoned by the larger health care system—and lost—once home. It was very difficult to find answers to my questions. Thankfully, I have a very committed primary care physician who continues reply to my questions with “let me find out for you.” She has been amazing.
In many ways, I was fortunate to be an early patient. Aside from the serious lack of COVID-19 testing, I needed care at a time when there were no shortages of hospital personnel or critical shortages of equipment. I had skilled, competent, and compassionate nursing care. My physicians were top-notch and always kept me informed. I saw the ICU pharmacist every day through the glass; she was my former student. I also knew I was being cared for from afar by our UCSF pharmacist alumni and faculty who practice at UC Davis Medical Center.
I saw exceptional patient care. I also saw—having moved horizontally, over, and through the system—a deeply uncoordinated system, however unintentional. And I committed to myself to do what I can, as one pharmacist, to change the status quo.
What did I learn?
Patients feel a sense of abandonment in times of uncertainty. Keeping patients well-informed at all times, even when it's only to say, “We don't have all the answers, but we're working on it,” is not only important, it's our responsibility as health care providers.
When patients are symptomatic, navigating the health care system can be an especially overwhelming challenge. It's our responsibility as health care providers to understand this and provide care from an empathetic as well as a clinical perspective.
The coordinated care of patients in and out of systems and across systems must be a priority. The provision of patient-centered care is the responsibility of health care providers. Coordinating patient-centered care is the responsibility of the larger health care infrastructure, working together and with providers.
Family members are a part of, not apart from, the care of patients. It's our responsibility as health care providers to consider family members in the patient's care plan.
What am I doing to help change the status quo?
I've donated blood for UCSF for several antibody studies and am hoping to donate my convalescent plasma as soon as I meet the criteria. I've also joined the UCSF COVID-19 Citizen Science Study, which is a surveillance study using an online app. I encourage each of you to do the same. Download the app or text COVID to 41411.
My UCSF virtual transitions-of-care team is now working with patients who've tested positive and negative for coronavirus and who have medication questions regarding COVID-19. It's important to provide evidence-based answers to patients and their families; knowledge is power. It's also important to validate their fears and frustrations with the ever-changing landscape of the COVID-19 treatment world. Fortunately, and because we practice at a health sciences university, my team is completely up-to-date on the latest science, patient care protocols, medication management protocols, and epidemiological outlook for COVID-19.
I'm gladly sharing my patient case with our PharmD students whose responsibility it will be, as future licensed providers, to advocate for patients; for an equitable health care system in which everyone has access to information, care, and testing when needed; and for the safety and protection of the entire health workforce.
Last, I'm raising my voice. Now is the time for pharmacists to step up, share the full extent of their expertise, and help identify and solve health system problems.
Pharmacists are on the front line in every community and could provide community testing when it becomes available, treatment options once these options are adequately studied, and vaccinations once developed.
Because of their access to the community, pharmacists are well positioned to help minimize the health disparities we're seeing so clearly in this pandemic.
Pharmacists have the expertise needed to leverage emerging models of telehealth and virtual clinics to ensure that each patient has an individualized, accurate medication list and takes their medications correctly and safely. Research suggests that medical errors are the third-leading cause of death in the U.S. and that many of these deaths are directly associated with medications.
We, as pharmacists, have the opportunity and the responsibility to change the health care system into one that gives us the ability to apply the full weight of our expertise. The status quo is not acceptable, and it's not in the best interest of our patients.
Update: May 7, 2020
I got my second negative. I'm now considered cleared of the virus and recovered!
It's been 77 days since my journey with COVID-19 began. My story was one of COVID-19 in the early days when we were all learning about this threat and how to deal with it. Everyone—my providers, the public health system, my friends and family—did their best to follow existing procedures at the time. Going forward, it's clear that we each—including me as a pharmacist and now a former COVID-19 patient—have to do our part to challenge this disease and use our expertise to prepare for whatever health threats of this magnitude we might face into the future. One of the ways pharmacists can serve the public is by ordering and administering FDA-authorized COVID-19 testing. Pharmacists are the most accessible health care providers in the community. I'm doing whatever I can to help inform decision makers about the potential of pharmacists to serve in this role.
Symba Center in Victorville, CA
Shawn R. Smith, PharmD
Western University of Health Sciences
As a new faculty member at Western University of Health Sciences College of Pharmacy I have spent most of my hours developing an innovative practice site, which is a nonprofit free clinic called Symba Center. Our clinic provides primary care services to uninsured and underinsured residents of Victorville, CA using a pharmacist-physician collaborative practice model with a focus on chronic disease management. In addition to pharmacist and physician clinicians, this multidisciplinary approach utilizes social worker and nurse community volunteers. During the COVID-19 pandemic, Symba Center partnered with City of Victorville's Homelessness Task Force to oversee operations and healthcare services at five homeless shelters throughout the city. Initiated on March 23, the pharmacist-led team developed written health policies and procedures, currently conducts staff and volunteer training, performs health screenings for residents, and provides COVID-19 testing services and personal protective equipment (PPE) to staff and residents. Symba Center clinicians intake and quarantine homeless persons through a triage process to minimize risk of COVID-19 spread and refer patients for emergency medical care as clinically indicated. The priority of this collaborative effort is to prevent the spread of COVID-19 in our community especially among the homeless who are disproportionately affected by chronic conditions that are known to put people at higher risk of poor outcomes if infected. Symba Center continues to provide these services to the City of Victorville and the homeless shelters in the area to ensure CDC infection control compliance in this vulnerable population.