The Path Ahead in Reopening Community Pharmacies

As states begin to consider reopening businesses around the country, questions have been forming nationally regarding appropriate guidelines for a safe and healthy environment for store patrons and employees across industries. For pharmacies, these same questions remain regarding appropriate strategies to protect the communities they serve from coronavirus disease 2019 (COVID-19).

At the Pharmacy Quality Alliance (PQA) 2020 Annual Meeting last week, community pharmacist Benjamin McNabb, PharmD, who owns Love Oak Pharmacy in rural Eastland, Texas, explained plans for his pharmacy as many regions look to relax shelter-in-place guidelines.¹

“We foresee opening the pharmacy within the next 1 to 2 weeks, as long as cases stay down here in Texas. It’s certainly an interesting time for us, especially because we also have a restaurant and a frozen self-serve yogurt bar in the store. With a pharmacy in here as well, we need to think about how to make sure everyone wears masks as they enter the store,” said McNabb.¹

Currently, the existing guidelines for appropriate reopening strategies come from the CDC and the Occupational Safety and Health Administration (OSHA). In April, the CDC released updated guidelines advising that all people entering a pharmacy must wear a face covering, and that all pharmacists and pharmacy technicians must wear one as well.

Guidelines were also published by OSHA for health care workers during the COVID-19 pandemic that highlight the importance of providing partitions or physical barriers to support social distancing, following protocols for safe work practices, using personal protective equipment appropriately, and cleaning and disinfecting as necessary.

With both of these guidelines available to pharmacies, there are legal concerns to consider if the guidelines are not followed.

“Although a pharmacy does not need to incorporate every available guideline, a pharmacy should diligently review and adopt guidelines that fit it the best. Further, a pharmacy should cite within its protocol the source for an incorporated guideline. Citations to a reliable source provide a pharmacy with the argument that it took reasonable steps to protect patients and employees,” write Jeffrey S. Baird, Esq, and Bradley W. Howard, Esq, in a recent article on structuring COVID-19 protocols for pharmacies.²

Yet, there still remains flexibility in how pharmacies follow protocols and which protocols they follow due to the lack of strict uniformity in reopening procedures issued across the country. For businesses such as Love Oak Pharmacy, where there is more than just a pharmacy business to consider when reopening, considerations are also made to the state’s reopening procedures for restaurants as well.

“Texas restaurants are currently opening back up in phases. The first phase is at 25% building occupancy, then 50%, etc. That being said, we plan to monitor and limit our building occupancy. Also, restaurants must have a hand sanitizing station at the building entrance and must clean bathroom facilities after each use,” McNabb said.

He explained further that at Love Oak Pharmacy, while inside the store, customers and patients alike will be encouraged to follow floor markers that support social distancing while they wait in line. Employees will also enforce restricted restaurant seating to allow for the appropriate spacing between customers, and employees will operate the self-serve frozen yogurt bar because it will be off limits to customer use.

McNabb explained that, along with following state restaurant guidelines, he will also be sure to follow CDC guidelines for pharmacies in his store.

“Currently, the CDC recommends all persons entering a pharmacy should wear masks unless limited by age or other specific conditions. Considering these variables, we plan to position a greeter at the front door. Before entering the building, our greeter will ask basic screening questions, eg, have they been feeling sick (fever, cough, shortness of breath), have they been in contact with somebody with COVID-19, or have they traveled to high risk areas in the last 14 days. Our greeter will inform them of mask requirements, monitor our building occupancy level, and spray hands with alcohol before customers enter,” McNabb said.

However, for elderly customers and those with known preexisting conditions, the store will continue to encourage them to use touchless services via drive-through, curbside, and same-day home delivery options.

Recently, some have looked to countries such as China for guidance regarding safe reopening protocols, as restaurants in some cities have remained open during the COVID-19 pandemic with success. In these cities, employees have enforced similar guidelines to those reported by McNabb in order to support social distancing in a safe and healthy environment.³

However, the noted difference in China is its employment of temperature checks at restaurant entrances.³ In the United States, the National Restaurant Association released guidelines in April that suggested restaurants make the decision regarding temperature checks at the restaurant owners’ discretion, as it is not mandated by the CDC.⁴

This lack of uniformity regarding what restaurant and pharmacy owners should be doing to ensure a safe and healthy environment forces owners like McNabb to prepare for what may come on the horizon.

“One of our contingency plans includes splitting our pharmacy staff into 2 distinct teams. These teams will have zero overlap in work scheduling to help avoid exposure and risk quarantining the entire staff. This will only be implemented if an uptick in local COVID-19 cases is detected,” McNabb said.

With fears of a second wave of COVID-19 outbreaks looming following the reopening of many businesses nationally, a potential uptick in COVID-19 cases adds an extra weight to the shoulders of store owners and employees when considering an increase in patients entering a pharmacy.

“Employees are encouraged to follow social distancing best practices while not at work,” McNabb said. “They have an extra responsibility to keep not only their teammates but also their patients safe.”

REFERENCES

• Cranston L, Japsen B, McNabb B. General Session: The Business Impact of COVID-19. Presented at PQA 2020 Annual Meeting, May 13, 2020.
• Baird JS, Howard BW. Structuring COVID-19 Protocols for Pharmacies. Pharmacytimes.com. May 18, 2020. pharmacytimes.com/ajax/structuring-covid-19-protocols-for-pharmacies. Accessed May 19, 2020.
• Severson K. Safe Dining? Hard to Imagine, but Many Restaurants Are Trying. New York Times. May 15, 2020. nytimes.com/2020/04/26/dining/restaurants-open-coronavirus.html Accessed May 19, 2020.
• National Restaurant Association (NRA). COVID-19 Reopening Guidance. NRA website. drive.google.com/file/d/1LBAvtqsC5FVrDXIpN3ocgchkPGeKTm-V/view. April 22, 2020. Accessed May 18, 2020.