4 ways MGH’s pharmacy services team has contributed to the hospital’s COVID-19 pandemic response and patient care

When Michael Garron Hospital’s (MGH) pharmacy services team was first advised of a mysterious respiratory illness that was making its way across the world, they knew they had a short amount of time to prepare themselves for what was to come.

“One of the earliest concerns we had when we first heard about coronavirus, as it was called then, was how much uncertainty there was around this illness” says Andrew Liu, director of pharmacy services at MGH. “We had no concrete information about when and how it would affect our local community or our patients, but we couldn’t wait for things to unfold. We knew that we had to we had to act and that our team would have an important role to play throughout the hospital.”

Within days of receiving the news, Andrew and his team began working closely with the hospital’s infection prevention and control team to learn about the illness and understand what was needed to care for those who were sick. Over the next few months, the pharmacy team found several creative and innovative ways to support care for COVID-positive patients and to assist staff and clinicians involved in their care. Here are four ways they made this happen:

1. Finding new and creative ways to procure necessary drugs and medications  
   “In the earliest days of the pandemic, we began to review our medication and drug inventory and tried to think ahead about any shortages we might face because of high demands or disruptions to commercial trade and delivery.

   We quickly noticed while caring for the first few critically ill COVID-positive patients that their requirements for critical care infusions were much higher than other patients. We realized that we would need to work aggressively and creatively to procure a sufficient supply of these life-saving medications to prepare us for the possible number of ICU (intensive care unit) patients we might have.

   One creative solution we found was to source and compound some of our drugs in large doses from a specialty compounding company that we already had an established relationship with. As we were able to use this strategy early on in the pandemic, we were able to make sure that we had enough medication for our first wave of ICU patients – many of whom needed 3 to 5 times the usual amount of critical medications. This has also helped us to remain in good standing for our medication needs moving forward."   

2. Creating new strategies to prevent drug wastage
   “COVID-19 changed our typical patient population and thus changed our drug demands. Part of making sure that we had enough drug inventory was preventing any possible wastage. Looking at our in-house processes of preparing drugs has allowed us to reduce wastage internally.

   Our pharmacy sterile preparation service prepares many important intravenous products for patients all throughout the hospital. With the ramp up in ICU, acute care and the cancellation of most operating rooms, we had to actively reassess the needs of each area – increasing service in some areas while decreasing it in others – to prevent drug wastage and expiry. Additionally, we recognized that manipulation or dilution of any drug product significantly shortens its shelf life. We transitioned to purchasing medications that were already in the standard doses required, eliminating the need to divide or manipulate them and allowing us to keep these products in stock for much longer.”

3. Assessing and adjusting drug formulations to maintain the health and safety of patients and staff
   “Knowing that COVID-19 is spread through droplets, our team looked at medications that generate aerosols to see if they could be delivered in a safer way.

   One of the formulations we looked at reducing was nebulized medications (liquids that are converted into an inhalable vapour) because of the risk that the vapour droplets can transmit COVID-19 infection from one person to another. Our team initiated a practice change to administer these same medications by an inhaler instead, thus preventing the spread of infectious droplets and protecting the health and safety of our patients and staff.”

4. Consolidating medication dosing times
   “We knew that one of the simplest ways in which you can reduce the risk of transmission of COVID-19 is by reducing the exposure that healthy people have to those who are sick. We implemented a process called “medication dosing time consolidation’, in which a pharmacist reviews a patient’s medication regimen to stop any non-essential medications as well as assessing patient’s medication delivery times to align them with scheduled patient care. By consolidating medication administration with patient care, one can reduce the number of times nurses come and go into patient rooms, reducing the risk of exposure while also saving important personal protective equipment (PPE).”

   As the pharmacy services team continues to work through the pandemic, they are shifting their focus to recovery and future sustainability. For Andrew, this shift has given him a chance to pause and reflect on the amazing work his team has done.

   “I’m really proud of our team’s response throughout all of this. Everyone has stayed really engaged and done their best to understand how they can help our patients and clinicians,” he says. “I’m also proud of the ways in which we’ve been there to support one another as we deal with pandemic at work and at home where possible. It’s just another reason why I’m proud to call myself a member of the pharmacy services team!”