A view from North Wales
At the start of 2020, no one could have predicted the impact that COVID-19 would have on the world. Almost overnight, the pharmacy teams across Betsi Cadwaladr University Health Board have adapted to working differently to manage the crisis. Presented below are some changes already implemented. We need to reflect after the worst is over, keep what works and let go of what does not. When we look back, will we see it as the turning point of how BCUHB pharmacy services are delivered?
Repeat dispensing has been rolled out to help pharmacies and GPs to manage their workload and provide a more resilient system for surges in demand. Mobile phones are being used for dedicated ‘healthcare professional lines’ and local collaboration has led to new ways of sharing patient information securely. Community pharmacy has increasingly been recognised as a vital part of the wider NHS family, e.g. with COVID 19 testing and PPE provision.
GP practice working
At the start of the COVID-19 pandemic the GP practice pharmacy teams focussed on the supply of medication to patients by increasing batch prescriptions to ensure access to medicines without causing shortages. More patients have been encouraged to use My Health Online ordering system to negate the need to travel to their pharmacy or GP to order medication. With social distancing being difficult in some of the smaller GP practices, the pharmacy teams have delivered some services remotely such as medication reviews, telephone consultations, and giving advice on medication issues. NMP pharmacists have been able to support queries and acute requests in GP practices, which has allowed the GPs to concentrate on the red hubs and local assessment centres. We are also training our pharmacy technicians to undertake POC INR testing.
As beds have increased and the patient type has become more complex we have had to re-train pharmacy staff to undertake the role of supporting community hospitals. This has involved staff being trained in aseptic non-touch technique to support nursing staff in preparing intravenous injections. It has also been necessary to develop ways to support community hospitals remotely.
Pharmacy Technical Services
Technical services has adapted to provide aseptically prepared products to meet new demand. The service has prepared over 3000 doses of ready to administer injectable medicines, saving valuable nursing time. The use of a new automated syringe-filling device has significantly helped to meet this demand along with redeployment of current and recently retired staff. In order to maintain social distancing, there has been centralisation of some aspects of the service onto one site and shift working has been introduced. Looking towards the future, improved scheduling of chemotherapy, provision of aseptic products to critical care and utilisation of the syringe filler will all be carried forward.
Medicine procurement has been a critical function during the pandemic to ensure the right medicine reaches the right patient at the right time. The supply chain for medicines has been under extreme fragility with the demand for critical care medicines unprecedented. Our pharmacy procurement teams built on existing working relationships to work collaboratively at regional and national level to ensure extensive and responsive medicines procurement. Our collaborative and mutual working with Health Courier Service Wales (HCSW) and national pharmacy teams has transformed access to medicines across Wales with the provision of an alternative logistic solution for distributing critical medicines to the greater area of need.
The safety lead pharmacists and medicines management nurses have produced a ward guide for a range of gravity-administered medicines to allow removal of pumps from acute wards for reallocation to critical care units. This followed a stocktake in BCUHB early in the pandemic, which identified a shortfall to meet the anticipated demand with minimal chance of receiving an additional supply due to international demand. Existing IV administration-training programmes were adapted and a rapid training cascade put in place. This ward guidance for gravity or bolus injection will continue to offer a safe alternative for low risk medicines.
Clinical pharmacy service
Shift working has been introduced to provide a 7-day week service as well as to manage potential staff illness and limit the viral spread. Pharmacy staff have been equipped with the basic knowledge and skills to look after critically ill COVID-19 patients utilising UKCPA, RPS and other resources, which have been made available on a BCUHB pharmacy website that all staff can access. Technician support has been introduced to critical care areas to track critical medicines and carry out stock top-ups ensuring that procurement and medicine supply is responsive to needs of patients.