1. Be proactive, but don’t overstock.
Overstocking IV fluids and end-of-life drugs can cause negative consequences, says Jennifer Hardesty, PharmD, FASCP, chief clinical officer, corporate compliance officer for Remedi SeniorCare. “Make sure there is a demand for medications before ordering more than you need,” she says.
All pharmacists strongly encourage a dose of reason when it comes to medication availability.
“Reducing unused PRN medications is a good strategy to ensure that only those who actually need these medications that are in short supply are actually receiving them,” adds John Dombach, PharmD, general manager for Turenne PharMedCo-Nashville.
2. Stay calm and avoid safety lapses.
“The single biggest mistake throughout this crisis is running with a headline, which has driven some clinicians and nursing homes to make blanket decisions about care,” says Chad Worz, PharmD, BCGP, chief executive of the American Society of Consultant Pharmacists.
“Much was rushed into practice, such as vitamin C, zinc, hydroxychloroquine, azithromycin, and antiviral medications. Your local team has the acumen to answer the questions on safety and make educated guesses on efficacy. By taking some time to consider the many treatments being thrown around, a good team of doctors, pharmacists and nurses can develop approaches that will manage the situation until stronger evidence and guidelines emerge.”
Hardesty urges caution during medication administration and the hygiene around it. Each interaction is rife with opportunities for infection.
“Skilled nursing facilities can remain proactive by designating drop-off areas and coordinating the best means for the delivery of medications that will limit any potential exposure to the facility,” says Frank Grosso, RPh., principal at ActualMeds.
Joe Kramer, vice president of sales at Geri-Care Pharmaceuticals, suggests SNFs practice “quarantine drills” with residents.
3. There’s no better time to engage consultant pharmacists.
A few examples of how these special professionals can help long-term care providers:
“They can show how to reduce the number of nursing touchpoints with facility residents through medication regimen modifications, focusing on those residents who were suspected or confirmed COVID-19 positive,” says Kevin Coggin, PharmD, consultant pharmacist for Turenne PharMedCo.
They also can inject calm in decision-making. When a facility recently got its first COVID-positive resident, its consultant pharmacist dissuaded them from making impulsive, broad changes to care processes, “and initially writing orders for every patient to have an albuterol inhaler,” adds Erin Marriott, RPh, clinical and regulatory support manager for Guardian Pharmacy Services.
Allowing CPs remote access to eMARs/eHRs minimizes contact risk while helping with monthly medication regimen reviews, says Marci Wayman, PharmD, consultant pharmacist for Turenne PharMedCo.
4. Take the stress off staff shoulders.
It’s likely never been harder or more stressful on long-term care workers. Experts advise taking measures to lighten their load, when possible.
This includes limiting non-essential med passes and reducing unnecessary clinical monitoring to save on PPE and limit over-exposure with positive residents, says Coggin.
Automated dispensing systems would be another plus, according to T.J. Griffin, RPh., senior vice president, long-term care pharmacy for Pharmerica.
The University of Maryland recommends consolidating medication dispensing times and using liquid medications so pill crushing is not necessary, adds Kramer..
William M. Vaughan RN, BSN, vice president, education and clinical affairs for Remedi SeniorCare, suggests facilities consider reducing the number of routine bedside diagnostic checks.
5. Don’t forget the rules.
“Even though the Centers for Medicare & Mdicaid Services has taken its foot off the regulatory gas pedal a little, nine months from now when someone is getting their annual survey, the lookback period is going to include what’s happening today,” cautions Vaughan.
Marriott advises facilities that while CMS has issued many changes and waivers regarding certain requirements, pharmacy services conditions for participation had not been waived as of press time.
“We continue to perform medication regimen reviews, which include antibiotic stewardship and infection control, review controlled substance documentation, perform quality assurance audits of medication carts and rooms, and restock first dose machines as required,” she adds.
While CMS temporarily waived rules requiring family members to be present during handoffs, certain things like skimping on medication reconciliation at time of admissions could come back to haunt, Grosso warns.