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Medication and Pharmacy Best Practices Related to the COVID-19 Outbreak

As the Coronavirus (COVID-19) continues to spread to different regions around the world and across our industry, we want to assure you that Absolute Pharmacy is committed to customer, resident, and employee safety and well-being. This article provides medication considerations for your facility during the COVID-19 Pandemic from Susan Riggle, Consultant Pharmacist, at Absolute Pharmacy. Additionally, it outlines protocols Absolute Pharmacy has in place to protect and minimizes the spread of this virus.

 

LTC Facility Medication Considerations During the COVID-19 Outbreak

Reducing Pill Burden

Reducing the pill burden via discontinuing or holding a number of nonessential medications can assist a facility in various ways:

  1. Reduces caregiver burden by shortening the length of med pass.
  2. Reduces the length of time in each room, which reduces the chance of viral transmission from caregiver to resident AND from resident to caregiver.

The Sample Stop Order form below is an example of how this can be implemented at any time with the Medical Director. 

 

Reducing Risk of Transmission Via Nebulizer Treatments

There is valid concern for the risk of COVID-19 exposure when administering nebulized medications. It would be simple if we could convert everyone to metered dose inhaler (MDI) therapy. However, the drug supply for MDIs (especially Albuterol) has been inconsistent and is currently in very short supply. Additionally, not every resident is a candidate for MDI therapy.

Implementation of suggested measures below can support a facility in utilizing nebulizer treatment when appropriate:

 

  1. Discontinue as needed (PRN) nebulizers that have not been used for 2 weeks. This assists the supply chain and eliminates accidental use of a long-standing/unused PRN nebulizer treatment before a COVID-19 diagnosis is ruled out.
  2. Evaluate routine and frequently utilized nebulizer orders for alternative oral therapies such as antihistamines, guaifenesin, etc.
  3. Suggest high risk patients (i.e. those who leave the facility for dialysis or are new admissions to the facility) be evaluated for MDI and spacer. In addition, in the case of new admissions, discontinue PRN nebulizers unless there is a clear need AND a diagnosis that warrants its use.

If nebulizer treatment is needed in a suspected or confirmed COVID-19 case, all Personal Protective Equipment (PPE) requirements such as N95 mask, gown, gloves and eye protection should be utilized.

 

Other Facility Considerations

  1. Reduce or alter lab-drawing frequencies. Continue monthly warfarin labs but many others could be decreased/delayed/held if not tied to a specific drug for administration (i.e. Clozaril, Aranesp, Procrit, etc.).
  2. Decrease or discontinue the use of sliding scale insulins, with or without coverage, especially in those residents not on a basal insulin (i.e. Lantus, Levemir, Basaglar, etc.).
  3. Routine blood pressure and pulse monitoring for stable residents could also be put on hold for a finite time (if not tied to a specific drug order for hold parameters). Alternatively, especially in a staffing crisis, hold parameters could be suspended.

 

Sample form

Facility-Wide Stop Order Policy During Covid-19 Outbreak

To decrease the likelihood of viral transmission and decrease pill burden, this facility will implement an automatic stop/discontinuation of the following medication orders (check all that apply):

 

Acidophilus/Culturelle (in absence of antibiotic therapy) ___
Antihistamines___
Any herbal supplement ___
Artificial Tears (except for end of life comfort) ____
Calcium___
Fish Oil ____
Folic Acid/Folate (in absence of Methotrexate use)____
Multivitamins____
Statin therapy ____
Vitamin B-12____

 

If there are additional meds that should be discontinued, please add here:

_________________________________________________________

 

Nursing will then need to discontinue any patient specific orders that are included in the Stop Order Policy and send the discontinue order to pharmacy (if not using a pharmacy integrated eMAR system).

 

Implemented by this Facility:_______________________________________________________
Implemented by Medical Director on this date:________________________________________
Medical Director Signature:________________________________________________________
Director of Nursing Signature: ____________________________________________________

 

Pharmacy Protocols and Precautions

In accordance with Absolute Pharmacy’s Emergency Preparedness Policy, our goal is to communicate changes in pharmacy services as they arise during emergency/disaster situations to ensure the security and safety of employees and customers. Based on the COVID-19 pandemic infectious disease threat, Absolute Pharmacy is implementing measures to minimize contact and the spread of the virus.

 

Pharmacy Deliveries

  • Drivers are following their own screening process.
  • Drivers call before arrival to exchange deliveries and returns with facility personnel.
  • Deliveries are made in disposable packaging, when able.

Pharmacy Returns

Returns will be accepted from ALL facilities.

  • Normal return processes will remain for facilities without positive COVID-19 cases.
  • Additional steps will need to be taken by COVID-19 positive locations to send returns back.

Each situation will be reviewed on a case-by-case basis to ensure adequate safeguards are taken to minimize exposure and maintain the returns process.

 

Pharmacy Operations

  • Pharmacy technicians handling totes/returns from facilities will utilize appropriate Personal Protective Equipment (PPE).
  • All pharmacy totes utilized for deliveries will be sanitized prior to being used again.
  • Returns are processed as follows based on facility type (with and without positive COVID-19 cases):
    • Returned medications will be isolated before processing.
    • Totes are sanitized accordingly.

Employee Defenses

  • Constant communication through multiple channels about the importance of handwashing, social distancing, and proper hygiene measures.
  • Employees wear face coverings within the pharmacy.
  • Employees doing essential visits to facilities utilize appropriate PPE.
  • Employees are following self-screening processes.

 

In addition, Absolute Pharmacy is following the recommendations from the Centers for Disease Control and Prevention (CDC). We will continue to stay abreast of the situation as it unfolds and make any modifications necessary to our protocols to protect the health and well-being of our customers, their residents, and our pharmacy team.

 

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