Pharmacist in Action: COVID-19 Preparedness

Curtis E. Haas, PharmD, FCCP, editor-in-chief of Pharmacy Times: Directions in Health-System Pharmacy, and chief pharmacy officer for the University of Rochester’s health care system, discusses preparation for potential patient surge due to COVID-19.

Curtis E. Haas, PharmD, FCCP: My name is Curtis Haas. I am the editor-in-chief for Pharmacy Times’ health system edition. I am also the chief pharmacy officer for the University of Rochester health care system in Rochester, New York.

I've been asked today to speak a little bit about some of our planning, and what we're doing around preparation for COVID-19, and the potential patient surge that we'll need to deal with. I'm sure all of you are equally focused on addressing this issue, and I wanted to just share some of our thoughts, and maybe they'll give you some ideas as well.

When we first started recognizing the pandemic potential of the coronavirus, we were initially focused on drug shortage concerns and what we would do as active pharmaceutical ingredient challenges started reducing the amount of finished dosage forms that we could acquire. Now, of course, like everyone else, we're much more concerned with workload, as well as workforce issues, as this is a growing pandemic here in the United States.

We needed a plan that would deal with patient surge, while also dealing with what we anticipate will be significant workforce shortages. I wanted a plan for dealing with 25%, 40%, and 60% absenteeism rates, hopefully worst case scenario. In the process, we established a daily contingency planning meeting for all members of the pharmacy management team, including the leadership from the pharmacy departments our affiliate hospitals. Of course, this was mostly remote attendance in this era of social distancing.

We started out by defining what we consider core pharmacy services: the things we absolutely, positively must do as a department of pharmacy to provide care for patients in our hospitals. The director of acute care pharmacy services and his team then categorized all of the other services that we provide as a department by yellow, orange, and red levels of staffing crises—that is the 25%, 40%, and 60% absenteeism—and basically deciding what you stop doing first, and then how do you progressively pull back from other things that you no longer have the staff to support.

The other thing that we did is we established a grid including all pharmacists, and all technicians with columns next to each person representing different skills and training, and those are checked off for each individual. This really serves 2 purposes for us. First, it allows us to match assignments with skills as we start to move people around in the department, and it also identifies training gaps that need to be addressed to increase the resilience of the department, so that we can use people more effectively across our organization. While we have the time and the staffing, we developed a training schedule to close some of those skill gaps that were identified. Basically, we want more people that can do basic support in more areas of the department, as we start seeing the potential for declining staffing.

As the hospitals have also developed bed expansion plans, we have created a detailed checklist of everything that needs to be done, whether that be an IT dispensing logistics order verification activities, etc., in order to support each of those new, what I refer to as, ectopic patient care areas that we're developing to potentially deal with significant patient surge.

We've also worked with our rural affiliates to develop support plans for each of these smaller institutions, which have very small staffs, and can be decimated very quickly by absenteeism. This involves the ability to consolidate services across hospitals, and have multiple hospitals served from a single department of pharmacy within 1 of the hospitals. We also look at ways that we can support these institutions from our main hospital.

Lastly, we also looked at ways to develop detailed plans for sustaining our outpatient pharmacy, of which we have 12, and our home infusion programs, and looking at how we may have to consolidate some of those services, how we've increased our delivery capabilities, and also developed ways of supporting our emergency department without having patients traveling through the hospital to get to our outpatient pharmacy. Fortunately, at our main hospital we have a 24/7 outpatient pharmacy which will give us a lot of capacity to help support the other programs as needed.

Lastly, of course, like everyone else, we identified everybody that we could possibly assign to work remotely, and have created the technological platforms, and other things that are needed in order for those folks to be able to work from home or other remote locations.

So, again, I'm sure what we're doing here is not very much different from what you're doing at your institutions across the country, but I just wanted to share some of the things that we've been thinking about, and implementing over the past several weeks.

I wish everybody the best, and stay healthy, and we'll all get through this. Take care now.