ABSTRACT
As medication experts, clinical pharmacists play an active and dynamic role in a medication shortage response. Supplementing existing guidelines with an actionable framework of discrete activities to support effective medication shortage responses can expand the scope of pharmacy practice and improve patient care. Dissemination of best practices and illustrative, networked examples from health systems can support the adoption of innovative solutions. In this descriptive report, we document the translation of published shortage mitigation guidelines into system success through broad pharmacist engagement and the adaption and implementation of targeted strategies. The profound, wide-reaching medication shortages that accompanied the coronavirus disease 2019 (COVID-19) pandemic are used to highlight coordinated but distinct practices and how they have been combined to expand the influence of the pharmacy enterprise.
Subject(s)
Antiviral Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Coronavirus Infections/drug therapy , Heart Rate/drug effects , Hydroxychloroquine/adverse effects , Pneumonia, Viral/drug therapy , Action Potentials/drug effects , Aged , Antiviral Agents/pharmacokinetics , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , COVID-19 , Cardiotoxicity , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Humans , Hydroxychloroquine/pharmacokinetics , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , COVID-19 Drug TreatmentABSTRACT
PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for health systems around the world. We describe our approach to adapting the pharmacy leadership structure to address critical medication shortages through innovative data analysis, procurement strategies, and rapid implementation of medication policy. SUMMARY: Yale New Haven Health deployed a system incident management command structure to effectively respond to the COVID-19 crisis. System pharmacy services adopted a similar framework to enable efficient communication and quick decision-making in key domains, including drug procurement and policy. By refining a model to project health-system medication needs, we were able to anticipate challenges and devise alternative treatment algorithms. By leveraging big data and creating a system knowledge base, we were able to consolidate reporting and coordinate efforts to ensure system success. Various procurement strategies were employed to ensure adequate supply, including frequent communication with our wholesaler, sourcing direct from suppliers, outsourcing of sterile products compounding to registered 503B outsourcing facilities, and acquisition of active pharmaceutical ingredients for compounding of essential medications. Strategic positioning of pharmacists within the health system's incident command response teams and rapid adaption of drug use policy governance fueled accelerated response and nimble implementation. Communication was streamlined and executed via multiple outlets to reach a broad audience across the health system. CONCLUSION: With medication shortages posing a threat to patient care, dynamic pharmacy leadership proved essential to providing patient care at the height of the COVID-19 pandemic. System alignment and the rapid adaption of the existing framework for drug shortage management and medication use policy were crucial to success in crisis response.