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Hospital pharmacies: how are they being reconfigured?

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The following comment came from the Associate Director of Allied Health: Patient Safety and Quality at Wellington Hospital. 

I'm noticing a national trend here in NZ for hospital pharmacy departments to significantly reconfigure their services in response to COVID-19. There are several key changes I'm noticing:

1. Moving from a ‘normal business hours plus on-call after hours and short-day weekend service’ to ‘a seven day service’ but I think these will mostly still be business hours with on-call only for AH.

2. Splitting teams into 'hot' and 'cold' teams and alternating on and off site, generally along lines of four days on/off to enable covering the 7-day service but also to reduce the risk of COVID sharing.

3. Reductions in clinical service in order to maintain supply services across seven days. This is happening in a variety of ways. Some are still doing medicines reconciliation with full patient interviews as before but to fewer areas, some are stopping the interviews for COVID patients and aiming to do these by phone consult (for patients who are admitted and able to communicate), and some are only doing clinical services remotely so as to not be going to and from the ward to the main department. This latter option is a high level of restriction but somewhat justified due to the risk of having one team member exposed and the whole supply chain potentially forward-exposed and at risk.

I thought I'd share this to note the planning we’re doing but also to see if others have any learnings around this topic. Hospital pharmacy teams are often in situations in NZ whereby they perform two key functions – medicines supply and clinical advice – the medicines supply is considered "core" and almost always prioritised over the clinical advice function; however, the clinical advice function has become so well ingrained that activities, such as medicines reconciliation now rely on the clinical pharmacists to do this activity well. They're also somewhat unique to other hospital teams in that the back-up to the main supply team is the clinical team and both teams generally share the same departmental space. This could be adjusted, but in order to have a robust system, with all well-trained in the supply function, we really need to see the clinical teams being pulled back and available to swap in/out with the supply teams. So over time, as the situation ramps up, it seems likely that the clinical function may become on request only or something along the highly restricted lines. This is also due to quite a limited capacity at the best of times for the clinical service in most areas.

I’d be really interested to hear how other teams, pharmacy in particular, are managing this from a practical sense.

Ngā mihi (best wishes)

Dan

Dr Daniel Bernal (BPharm, hons, PhD)

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