The Impact of Covid-19 on Hospital Medicines Information Services

Reflecting on a year of change

By Dave Abbott

Over the last year, much has been said about the impact of Covid-19 on the NHS and wider society. There probably isn’t an area that hasn’t been affected in some way by the restrictions that Covid-19 has made necessary, the changes to working practices to accommodate this, and the new and changed work that has developed from the need to respond to it.

Medicines Information services in the NHS were not exceptional in this respect, and many teams both inside and outside the NHS will have had similar or greater demands placed on them. However, there were some unique challenges for Medicines Information teams, both working in the NHS at a time of great service pressure, and working within an information service at a time when evidence was limited, but the demand for specific advice high.

Background

NHS Medicines Information services are based in most Trusts in the UK, and coordinate through the UK Medicines Information group (UKMI). Staffed predominantly by pharmacists and pharmacy technicians, Medicines Information services provide information and advice to healthcare professionals, patients and carers to support patients getting the greatest benefit from their medicines.

In early 2020, as the impact of Covid-19 could be seen approaching the UK, it became apparent that the work of hospital pharmacies would need to evolve. What new work needed to be picked up, and how could this be delivered when people were under increased pressure both inside and outside of work?

Logistics - dispersed workforce, dispersed enquirers

One of the first impacts noticed was the need for social distancing. As staff moved to remote working to support

this, new ways of maintaining connectivity with colleagues and enquirers had to be developed. Face-to-face contact was replaced by Microsoft Teams as the ubiquitous way of communicating. For those on site, accessing PPE and enabling social distancing introduced their own challenges. Moving around the NHS estate became more complex, with designated “hot” and “cold” areas, with different PPE requirements. This was particularly relevant to Medicines Information staff redeployed to “hot” areas for the clinical component of their work, with all the complexities this might cause. This all made the logistics of answering medicines questions more demanding, as enquirers worked in unfamiliar areas remote from their normal support networks, and Medicines Information teams also learned to work in a very different setting.

Information rich, answers poor

Covid-19 also affected the types of queries that Medicines Information services were asked. Some services noticed an increase in calls about care after patients had been discharged, as people tried to navigate new pathways of care without the normal routes for asking questions being open. However, almost all centres also began fielding calls about medicines to prevent or treat Covid-19 and later on questions about vaccines. The unique challenge with these calls was the lack of definitive answers and the rapidly evolving evidence base. As with all areas of medicine there is evolution of the evidence base and degrees of uncertainty around any advice provided, however the pace and scale of changes through Covid-19 was unprecedented. As the evidence base evolved and developed, more and more specialist areas published advice, and then updated their positions as more information became available. One of the roles of Medicines Information, through the national UKMI network and particularly the Specialist Pharmacy Service, was to corral and structure the waves of information coming out from a plethora of sources. This index of resources and summaries of advice was kept up to date through the “Do Once” SPS group via pages hosted on the SPS website (www.sps.nhs.uk). More locally, Medicines Information services were seen as ports of call for finding and assessing information on medicines, to turn it into advice for the care of patients - the primary skill set for professionals working in this area. This supported patient care in a variety of ways. For example, putting together information on which IV medicines could be given by bolus or under gravity rather than by pump allowed IV pumps to be moved to support the surge in demand from the expanded ICUs. Advising on potential alternatives to medicines suffering a critical shortage helped to support the ongoing care of patients when the volume of patients was increasing exponentially. Providing ready-to-use information on how to administer medicines and giving advice on medicines use helped to support other NHS colleagues who had been redeployed to other less familiar specialist areas, so helping to maintain patient safety. Then, as the acute pressures of Covid-19 patients in hospitals lessened, a new wave of questions developed with the roll-out of the vaccine programme. How do you manage products that need to be stored at extremes of temperature? Can people with particular medical histories have the vaccine? A particular recurring question was whether we could find out the excipients of vaccines that patients had had a reaction to in the past. For all these questions, the support provided by Medical Information teams in the pharmaceutical industry was invaluable.

What do we want to keep from our experiences?

So, as we approach what may potentially be an end to the acute pressures of Covid-19, what have we learned? Pleasingly, the skillset of Medicines Information professionals, of finding information and turning this into advice to support the care of individual patients has been recognised and appreciated. Remote working, once seen as an impossibility in the NHS, has become established practice. And for me most significantly, collaboration within and between NHS Trusts and between the NHS and the pharmaceutical industry has become much more common place. Whilst it will be nice to go back to a world of not wearing masks, goggles and edging down the side of hospital corridors to give everyone space, we must be careful not to slip back into our previous working silos, and realise that more is possible than we might think if we look for the opportunities rather than the barriers.

Dave Abbott

Highly Advanced Pharmacist - Medicines Advice Leeds Medicines Advice Service, Leeds Teaching Hospitals NHS Trust