Pharmacy leaders from hospitals across the nation are using what they've learned during the COVID-19 pandemic to develop pandemic preparedness models.
The challenges and lessons learned from the COVID-19 pandemic was one of the topics experts discussed during a session at the Becker's Healthcare Pharmacy Virtual Event on Sept. 22. The panel included:
- Onisis Stefas, PharmD, vice president and chief pharmacy officer at New Hyde Park, N.Y.-based Northwell Health
- Joseph Pinto, executive director of pharmacy operations at New York City-based Mount Sinai Health System
- Adrian Gonzales, PharmD, system director of central pharmacy services at Roseville, Calif.-based Adventist Health
Here's an excerpt from the conversation, edited for clarity. To view the full session on-demand, click here.
Question: Given the challenges or opportunities in pharmacy services that have been spotlighted by the COVID-19 pandemic, what changes can you foresee taking effect in health system pharmacy in the future to develop a pandemic preparedness model?
Joseph Pinto: The primary challenge initially was just understanding the virus and the treatment of it. We really had to be nimble in terms of addressing the different treatments that were coming up and what we were hearing, not only internally within our system, but from our colleagues throughout New York City, where we were at one point the epicenter. On a daily basis, I would have a call with colleagues in our area. The biggest challenge for us is knowing what approach to take in pharmacy and being directly involved with the clinicians, both operationally and clinically, to make that decision.
And then in addition to that was being able to access the medications for use. There were definitely some challenges in supply and being nimble and maneuvering through that and cooperating and coordinating with the providers was a big challenge for us. It sort of highlighted some of our challenges and weaknesses we needed to improve in terms of that communication. But as we went along, I think we managed it really well. Going forward, we definitely have a closer relationship with our emergency management team and have actually started a plan and are looking not just for the COVID pandemic but emergency management overall.
Dr. Onisis Stefas: At one point, we were treating the largest number of COVID patients in the country, and it was an unbelievable experience. Some of the challenges were really around supply chain. A lot of people were talking about vents, but people weren't talking about the medications required for the vents. And as we were all pulling from the same distributors in the same areas, it became very quickly apparent that we needed to come up with a different solution. So, we leveraged a lot of the relationships that we had with the various different pharmaceutical companies and set up contracts and relationships bypassing the wholesalers, who we were basically on allocation with, and getting direct shipments from the pharmaceutical companies directly into the organization. We also looked at our utilization rate and our burn rates. And then from there, we brought it into a central repository warehouse. We actually pushed it out to the various different locations based on need. This allowed us to build certain efficiency around the supply chain and get the crucial medications needed where it was needed most, which was extremely beneficial.
On top of that, as you can imagine, we were also having some staffing issues. Not only did we have our own staff that was impacted by COVID, we also had a surge in volume, and with that surge in volume, we needed additional resources. So once again, we strategically partnered, but this time, with the pharmaceutical schools. And we have a couple of schools in the New York metro area, and we hired 30 pharmacy interns within two weeks because all the schools were closed at that time. And then we deployed those pharmacy interns across our network in order to support the needs that we had, particularly as we were expanding that capacity during that time. I think we doubled that capacity at that time.
In addition, we also started to leverage our pharmacists remotely, where they were able to verify prescriptions from home and do things a little bit different than we normally do. And these instances where we're going direct to manufacturer, contracting, pushing out to the sites, hiring additional pharmacy students, those are all things now that we have in place that we're going to carry forward to continue to strengthen the pharmacy service line in the future, as well as support any resurgence activity that occurs.
Dr. Adrian Gonzales: When a pandemic or difficult circumstances comes our direction, it definitely opens up doors for innovation and doing things differently. Adventist Health has been on a path of shared services, and so this crisis actually helped fast track or solidify some of the shared services needs around gathering of information. Instead of having 20 different hospitals doing the investigative work of what's the latest literature reviews, guidelines, our system offices in our clinical content experts here, our system ID pharmacists, system critical care pharmacists, essentially created the guidelines and education for all of our sites. When we had our system and pharmacy therapeutics committee, we were able to make quick changes and disseminate that information quickly to all of our providers or nurses and pharmacies.
In addition to that, our central purchaser pharmacy buyer was able to have routine daily communications with all of our hospitals regarding some of the drug shortages with our neuromuscular blockers and just doing different things that were needed. It was really great to see how a central shared services was able to do a lot of the front-end work to allow some of our providers and frontline pharmacists to do what they needed.
Again, with telepharmacy, we're able to do shared staffing and really look at how we can flex up our labor pool and be creative and bring innovation into this. As additional crises come up, with the establishment of our command centers, the establishment of these shared services, we can learn from each other, and then disseminate that information in an accelerated format.