Esther Brownrigg is the Clinical Pharmacy Development Lead at the South Eastern Health and Social Care Trust. She writes of the experience of hospital pharmacy during Covid-19.
As pharmacists, our work is dedicated to the optimal outcome for patients from their medicines – whether commencing new treatments, rationalising regimens, or optimising longer term treatments. Evidence based medicine underpins what treatments we use, the guidelines we follow and the procedures under which we operate. Yet at the start of 2020, the healthcare world faced the reality that a novel coronavirus was moving across the globe at such a pace that meant treatments and guidelines would have to evolve as rapid as the spread.
Adapting and adjusting to support surge
Throughout Covid-19 we have adjusted to new ways of working. We have adapted to evolving PPE requirements and considered how to best support our services to prepare for the surge of patients with COVID-19 presenting to hospital. Multiple wards became dedicated to the care of Covid-19 patients, with other hospital services “switched off” or redesigned to create capacity for an unknown number of infected patients expected to require high levels of acute or critical care.
To support critical care services, we skilled up extra pharmacists to help our sole specialist critical care pharmacist and assisted with the preparation of intravenous drugs. By preparing IV drugs in our aseptic units or in dedicated near patient IV preparation areas we released invaluable time back to nurses in the care of Covid-19 patients. Redeployed nurses and pharmacists worked in our near patient IV preparation areas in both the first and third surge. Rotational pharmacists who had experience in aseptic services as part of their foundation training were crucial in the day-to-day running of the near patient IV preparation areas, using their knowledge in aseptic technique of drug preparation.
Maintaining access to critical medicines and supplies
Global pressures on medicines used in the treatment of critical care patients saw colleagues in procurement and critical care collaborate regionally and nationally to safeguard access to critical medicines and maintain supplies throughout the surges. The Department of Health commissioned a rapid review of pharmacy services changed in response to Covid-19 where more detail on this work is captured. One of the most fundamental treatments that came under pressure in the third surge was oxygen. Pharmacists in collaboration with multi-disciplinary oxygen groups ensured oxygen demands were met by examining capacity and monitoring usage.
Medicine reconciliation is a key role for clinical pharmacists as patients’ cross primary and secondary care interfaces. Reconciling what patients take pre-admission facilitates informed decisions to continue, hold or stop those medicines during acute inpatient episodes. For our suspected or confirmed Covid-19 patients, pharmacists assisted infection control by reducing the footfall into patient rooms for face-to-face consultations by adapting how we interacted with our patients.
The RECOVERY trial has allowed multi-disciplinary clinical teams to contribute to the growing global evidence base and learn which treatments will most successfully assist in the clinical management of patients with Covid-19. Novel treatments such as remdesivir and tocilizumab were released for use out with the clinical trials they were originally trialled as evidence of their suggested beneficial role grew. The procurement, governance, management, and introduction of these drugs to clinical practice produced exceptional time critical pressures.
Gearing up for the biggest vaccination programme in our modern healthcare history
Vaccine development and authorisation by the MHRA brought the rollout of the biggest vaccination programme in our modern healthcare history. Respective CPOs and the MHRA designated pharmacists with the responsibility to oversee the complexities of the safe handling and administration of the vaccine, ensuring patient safety.
With the planning and organising of the SETRUST mass vaccination centre in the Ulster Hospital where I work, pharmacists commenced participation in a 12-hour day, 7 days a week rota as we started to vaccinate in line with the Joint Committee for Vaccination and Immunisation (JCVI). Alongside vaccinating staff, hospital pharmacy teams supported the deployment of vaccines to care homes and care home staff.
My experience working in the vaccination centre has been hugely rewarding. The collective feeling in the centre is optimistic and the sense of relief is palpable among those vaccinating and those attending for their vaccination. As the multi-disciplinary teams (having undertaken specialist training) became familiar with the processes, the centre has been able to achieve over 1,200 vaccinations per day. Currently the centre is approaching 100,000 vaccinations to those from the highest priority groups. The rollout through JCVI groups continues and will accelerate with the Greater Belfast Mass Vaccination Centre.
Covid-19 has highlighted how all sectors of pharmacy have risen to the challenge and showcased the capabilities of the profession which always prioritises our patients, their safety and the best outcomes. Throughout the pandemic all pharmacists have innovated and adapted both their roles and way of working. Our patients and communities have depended on the services we provide.
I am very proud to work among such dedicated professionals that have constantly sought to meet the demands placed on our services by the pandemic, overcoming challenges together as the capable and reactive teams of modern healthcare professionals that pharmacists are.