Pharmacist Mahmoud Ammar, PharmD, recently consulted with Jessica Luyckx, RN, on the York Street Campus Surgical Intensive Care Unit (SP 6-1). Things are returning to the “new normal” for Ammar and his Pharmacy colleagues, who took on new duties during the height of the COVID-19 surge throughout Yale New Haven Health.
Before Yale New Haven Health had its first COVID-19 patient, Corporate Pharmacy Services leaders and staff were preparing for a perfect storm.
With the rapid spread of COVID-19 came a worldwide spike in demand for antiviral medications, drugs used to aid intubation and keep patients comfortable while on ventilators, and those used to treat breathing and cardiovascular concerns. To complicate matters, COVID-19 patients in intensive care require three to five times more of some medications than non-COVID-19 patients.
“Healthcare organizations have been dealing with different drug shortages for years, but the intense demand for these medications, combined with the severity of illness some COVID-19 patients experience, have made this shortage particularly challenging,” said LeeAnn Miller, YNHHS vice president of Corporate Pharmacy Services and chief pharmacy officer.
In response, Pharmacy devised a multi-pronged approach to increase supplies, identify alternate drugs and produce its own medications. These efforts continue, with COVID-19-related shortages expected to persist, and many of these medications needed for surgeries and other non-COVID-19 treatments that are resuming.
“Before COVID-19 really impacted the health system, we knew we would have five times more patients in the ICUs than we normally have, and not enough medications to meet the demand,” said Mahmoud Ammar, PharmD, clinical pharmacy specialist, Inpatient Pharmacy Services.
He and other Pharmacy staff worked with Corporate Supply Chain to find and obtain drugs from various sources, but with many drugs in short supply, Pharmacy staff identified numerous alternatives. Before the alternatives could be used, Pharmacy staff had to research their safety and effectiveness, vet them with ICU physicians, develop guidelines for their use with COVID-19 patients and work with Information Technology Services to add information to Epic.
“We’re fortunate to have a good critical care pharmacy group to advise us on alternate medications,” Ammar said. “We also have structures in place to expedite approvals for these medications.”
During the height of COVID-19, YNHHS’ Drug Supply Policy Team met daily with treatment teams on nursing units to determine how to best meet patients’ needs.
“The pharmacists on the treatment teams had to stay up on the latest information about the virus and its effects,” Miller said. “That information was coming in fast and furious.”
To prepare for a COVID-19 patient surge, clinical pharmacists on the York Street Campus Adult Emergency Department treatment team worked with colleagues in Central Pharmacy to increase medication quantities in the ED. They also found ways to minimize staff exposure to the virus.
“Normally, we perform clinical interventions at the bedside with the care team,” said clinical pharmacist Evan Zahn, PharmD. “With COVID-19, we discussed patients’ cases with other care team members outside the rooms, and used Alexa devices to communicate with them while they were in patient rooms.”
Pharmacy staff also took on different duties during COVID-19’s height. Some of YNHHS’ 41 Pharmacy residents provided support at different delivery networks; others made hand sanitizer. Staff at YNHHS’ Specialty Pharmacy and Apothecary arranged medication home delivery for all patients.
Pharmacists who normally work at ambulatory sites staffed the Heart and Vascular Center’s anticoagulation clinics so clinic nurses could be redeployed to other areas.
Claudio Vasquez, lead substance control technician, Greenwich Hospital Pharmacy, used skills he’d gained in previous positions to compound urgently needed IV medications for COVID-19 patients. He and his colleagues also delivered medications to COVID-19 units and, with units being relocated to accommodate COVID-19 patients, made sure medications were in the right place for patients.
“The teamwork was absolutely amazing,” Vasquez said. “We knew what was needed and we stepped up. We did our best for our patients.”
