Consulting Academy: Readjusting My Sails

Readjusting My Sails

Denise Robertson, P.D. Consulting Academy President

“It is not a failure to readjust my sails to fit the waters I find myself in.” - Mackenzi Lee

Ihave recently taken up sailing again, so this quote is quite timely. It also applies to navigating changes in pharmacy practice during this Covid-19 pandemic.

We find ourselves continuing to meet customer needs in spite of closed retail lobbies and drug, staff and PPE shortages. Consultant Pharmacists have had to address the challenge of serving their nursing home residents and facilities during the no visitation mandate that started on March 13th.

Communication has been the critical factor in managing these challenges. The APA board and staff have worked tirelessly in keeping its pharmacy members informed on issues of PPE procurement, Pharmacy Board directives and ways to navigate changing business protocol. The Arkansas Health Care Association (AHCA) has been essential in keeping long-term care facility owners, staff and contract personnel informed through weekly conference calls and updates. Each call provides the most recent governor’s update on Covid-19 statistics. Communications from the Office of Long-term Care are discussed, as well as those from other state and federal agencies. Changes in PPE protocol, family visitation protocol, staffing challenges, lab screening recommendations, required lab result reporting and CARES Act funds distribution are all addressed. AHCA was also essential in the coordination of the Governor’s

mandate to test all nursing home residents, staff and contract workers in June.

The restriction of nursing home entry to essential staff in order to protect our most vulnerable population was our main hurdle. Contract personnel such as nutritionists, physical therapists, medical directors and consultant pharmacists were not allowed in the facilities. Each group mentioned had to change the way they served their clients.

Consultant pharmacists collaborated with each other early on as to how they would proceed. Face to face meetings were replaced by virtual meetings and conference calls. Facility owners were consulted on their new protocols and precautions. We had to figure out how to continue to meet state and federal rules and regulations while committed to the protection of ourselves, residents and staff. Those facilities that use electronic health records were able to adjust well. Pharmacists were still able to do their medication regimen reviews off site. For those facilities that did not use electronic health records, it was more of a challenge. Monthly site visits were abbreviated or suspended depending on the presence of positive Covid-19 cases in the building. As a result, many phone calls were made with administrators and directors of nursing to address any issues that pertained to the usual site visit such as narcotic documentation, drug destruction and surrender, medication stock and glucometer maintenance.

The following are additional changes that were implemented during the pandemic. Routine pharmacy deliveries and reconciliations were conducted outside the facility. As restrictions eased and residents/staff tested negative, some pharmacists conducted “drive by” visits so that required documents could be signed outside the facility using proper PPE protection. Some facilities set up work stations outside their buildings so that contract workers would have access to the needed documents. As visitation restrictions eased in July for those facilities with negative resident/staff test results, the pharmacist site visit now involves screening at entry, washing of hands and masking up. Some facilities even require wearing full PPE as part of their protocol. Ever try to page through mounds of paperwork wearing gloves?

Strict adherence to policy and procedure recommended by officials from our state and federal agencies is significantly reducing the rate of Covid-19 spread amongst nursing home residents. We must keep doing our part. We must remain adaptable and readjust to fit the waters we find ourselves in. Stay Safe! §