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ADAPTING CLINICAL PHARMACY SERVICE PROVISION TO THE EMERGENCY DEPARTMENT DURING THE COVID19 PANDEMIC

European Statement

Clinical Pharmacy Services

Author(s)

Dearbhla Murphy, Mariosa Kieran, Jennifer Brown

Why was it done?

The Emergency Department (ED) at our institution is one of the busiest in Ireland. In 2019, there over 84,000 attendances. The ED CPS is multifaceted and involves clinical review of prescribed drugs, consultation with medical and nursing colleagues to ensure safe, effective and rational prescribing, drug supply and Medicines Reconciliation (MR). In order to meet patient requirements during the COVID19 pandemic, the ED was re-configured. The departmental changes necessitated realignment of the CPS to ensure evolving institutional requirements were being met while maintaining service provision.

What was done?

• ED Stock lists were reviewed and modified to ensure prompt availability of COVID19 treatments.
• Drug lists were devised for new ED zones to ensure availability of emergency and antidote medicines on a 24/7 basis.
• ED requirements for COVID critical medicines e.g. neuromuscular blockers, propofol, midazolam and antivirals were implemented in response to emerging evidence.
• Appropriate drug and fluid storage locations were reviewed in line with legislative requirements.
• Pharmacy technician top-ups were modified and standing orders introduced.
• Technician staff received Personal Protective Equipment (PPE) training to facilitate topping-up of drug presses in high-risk patient-facing areas.
• Access to critical care and COVID19 Respiratory Infection treatment protocols was expanded to ensure point of care access
• All associated SOPs were updated
• CPS provision was reviewed, changes introduced include:
1. fixed zone staffing allocations to reduce cross-contamination of staff
2. guidance on Infection Prevention and Control measures for completing MR patient interviews
3. electronic transfer of Clinical Pharmacist handover to ward based pharmacists

How was it done?

• A multidisciplinary team (MDT) of stakeholders was formed of Nursing Management, ED Consultants and the Pharmacy Department.
• The ED pharmacist coordinated the Pharmacy review.
• The procedures and policies governing CPS provision and ED drug stock holdings, storage and availability were reviewed and adapted.
• The MDT supported roll out of the changes in practice through communication and staff training.

What has been achieved?

Continuity of the CPS provision to the ED during COVID19 pandemic was ensured.

What next?

Through this review, the multidisciplinary ED team collaborated to successfully review CPS provision to adapt for the unique and evolving clinical needs of patients during the COVID19 pandemic. This ensured the safe delivery of a high quality CPS and continuity of drug supply.

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