How did the Covid-19 experience impact on pharmacy staff in terms of their roles and ways of working?
The COVID 19 pandemic has had a significant and potentially long lasting impact on the Pharmacy services within the NHS. The below reflects the change and impact experienced in an integrated Trust supporting a medium sized district General Hospital with a tertiary oncology centre and community services (including 2 community hospitals).
Communication and Leadership
The rapidity of change within the organisation necessitated significant change in the pharmacy leadership and communications structure. Senior leadership team meetings were initiated twice daily, once in the morning to assess the current pharmacy operational situation, and again after lunch to plan changes required to meet the emerging Trust needs. This reduced to daily once Trust COVID plans were more settled. A COVID whiteboard was set up to ensure staff could easily understand changes (hot/cold areas, PPE etc) without needing to seek out information. Update emails were regularly sent to Pharmacy staff and they were asked to give feedback on changes or suggest improvements.
The rapid decision making and clear communication during the pandemic highlighted where we can work more efficiently. The senior team reviewed our business as usual ways of working and several changes have been made to meeting structures, length and how we operate as a team. Whilst it is too early to fully evaluate, the changes appear to be adding the benefits seen within the COVID operations to normal working in the department.
A significant number of operational changes were made during the pandemic, in order to support wards and the changing care they were providing, ensure patient safety within the hospital and reduce footfall where possible.
The primary change which delivered all three of the above objectives was the drive-through Pharmacy. The Trust provides tertiary cancer services, and these patients were highlighted as a high risk group. In mid-March a request was made of Pharmacy to reduced hospital wait. By the end of March a portable cabin had been transformed into a drive-by medicines hand-out & counselling point, and a courier service implemented for patients unable to travel to the Trust. The Pharmacy tracker system was upgraded to send messages to patients when their medicines were ready, and processes were redesigned to ensure prescriptions were not lost or delayed in the new system. This service has proved to be highly appreciated by patients, and is now being scoped as a main priority for the Trust as an initiative to carry forward in a more permanent structure.
The Pharmacy clinical structure changed to support services. A 7/7 ICU rota was implemented (The Trust has not previously provided 7 day services). The clinical service model changed from a ward specific deployment to a model based on numbers of new admissions and assumed acuity. Unfortunately without ePrescribing or an electronic patient record (both due 2021) full prioritisation based on known acuity is not yet possible, but this way of working has led to ongoing changes with how we run our clinical service. The support for ICU has also ensured all divisions have requested the 7 day Pharmacy service is prioritised post COVID.
It quickly became apparent that the ICU in the hospital was the area most needing support. It doubled in size, and was being staffed with many non-ITU nurses. Our licensed aseptic manufacturing facility had capacity due to the reduction in chemotherapy. This was used to produce pre-filled syringes (PFS) for ICU. As patient numbers increased during the peak, plans were created for manufacture of PFS in an unused theatre using pharmacy and nursing staff. These plans were signed off through formal governance processes but here not needed as patient numbers started to significantly reduce. They are ready for immediate implementation if a second wave occurs.
It has been a difficult time for all NHS staff during COVID19, staff resilience and professionalism has been astounding. The above is a snapshot of some of the larger schemes, but significant amounts of other changes have also occurred over the period. The ability of the team to work together, contribute and adapt to change, and support each other has ensured the safety of patients throughout this period.