Electronic monitoring of potential adverse drug events related to lopinavir/ritonavir and hydroxychloroquine during the first wave of COVID-19.

During Switzerland's first wave of COVID-19, clinical pharmacy activities during medical rounds in Geneva University Hospitals were replaced by targeted remote interventions. We describe using the electronic PharmaCheck system to screen high-risk situations of adverse drug events (ADEs), particularly targeting prescriptions of lopinavir/ritonavir (LPVr) and hydroxychloroquine (HCQ) in the presence of contraindications or prescriptions outside institutional guidelines. Of 416 patients receiving LPVr and/or HCQ, 182 alerts were triggered for 164 (39.4%) patients. The main associated risk factors of ADEs were drug-drug interactions, QTc interval prolongation, electrolyte disorder and inadequate LPVr dosage. Therapeutic optimisation recommended by a pharmacist or proposals for additional monitoring were accepted in 80% (n=36) of cases. Combined with pharmacist contextualisation to the clinical context, PharmaCheck made it possible to successfully adapt clinical pharmacist activities by switching from a global to a targeted analysis mode in an emergency context.

New missions of a hospital pharmaceutical technology unit during the COVID-19 pandemic.

The pharmaceutical technology unit of the Geneva University Hospitals played a significant role in the fight against COVID-19 through four different missions: (1) providing enough hydroalcoholic solution at the peak of the pandemic; (2) facing supply chain management issues; (3) adapting the workload to the crisis and, above all, (4) managing the human resources necessary to handle these activities.

Gestion de la pandémie COVID-19 en Suisse : rôles et défis d’une pharmacie interhospitalière

Résumé Du 16 mars au 18 juin 2020, en raison de la pandémie COVID-19, le Conseil fédéral suisse a déclaré une “situation extraordinaire” au sens de la Loi sur les épidémies. Ce travail évalue les rôles d’une pharmacie interhospitalière dans la lutte contre le SRAS-CoV-2 en Suisse dans le contexte du Service sanitaire coordonné. Pendant cette période, toutes les missions effectuées par cette pharmacie ont été systématiquement collectées et évaluées. Elles ont également été comparées à ses responsabilités traditionnelles. Les missions spécifiques ont été principalement gérées par la cellule de crise et les 4 secteurs de la pharmacie (Logistique pharmaceutique, Fabrication, Pharmacie clinique et Approvisionnement des maisons de retraite): (1) garantie de la continuité des ressources humaines, (2) sécurisation de l’infrastructure propre à la pharmacie (notamment en termes d’hygiène), (3) approvisionnement spécifique en médicaments (par exemple : anesthésiques, sédatifs, antiviraux, y.c. pour les essais cliniques), (4) production et approvisionnement de désinfectant pour les mains, (5) appui clinique (particulièrement dans les unités de soins critiques), (6) fabrication de médicaments individualisés, (7) gestion des pharmacies d’unité de soins, et (8) fourniture de masques hygiéniques pour les professionnels de la santé de la région. Les missions (4) et (8) ne faisaient pas partie des rôles habituels de la pharmacie et ont été réalisées avec le soutien de la protection civile suisse. Un défi particulier a été la gestion de la pénurie de divers produits et l’identification d’options thérapeutiques alternatives. En conclusion, notre pharmacie d’hôpital a été confrontée à divers défis durant la première vague de la pandémie. Certaines missions réalisées ont même dépassé les responsabilités traditionnelles. Sur la base des enseignements tirés de cette pandémie, le plan d’urgence de notre pharmacie, ainsi que la formation associée du personnel, ont été développés. Summary From March 16 to June 18, 2020, due to the COVID-19 pandemic, the Swiss Federal Council declared an “extraordinary situation” in terms of the Epidemics Act. The present work assesses the roles of an interhospital pharmacy in the fight against SARS-CoV-2 in Switzerland, in the frame of the Coordinated Medical Service. During this time, all missions performed by the pharmacy were systematically collected and evaluated. They were also compared to its official duties. Specific missions have been mainly managed by the crisis unit and the 4 departments of the pharmacy (Logistics, Manufacturing, Clinical Pharmacy and Nursing Homes Supply): (1) guarantee continuity of human resources, (2) interne infrastructure securing (especially in terms of hygiene), (3) specific drug supply (e.g. anesthetics, sedatives, antivirals, incl. for clinical trials), (4) hand disinfectant production and supply, (5) clinical assistance (especially in the Critical Care units), (6) individual drug manufacturing, (7) management of ward pharmacies, and (8) hygienic masks supply for healthcare professionals in the area. The missions (4) and (8) were out of the usual duties of the pharmacy and have been achieved with the support of the Swiss civil protection. A particular challenge was the management of the shortage of various products and the identification of alternative therapeutic options. In conclusion, our pharmacy has faced various challenges during the first wave of the pandemic. Some missions performed were even beyond the traditional duties. Based on the lessons learned from this pandemic, the disaster plan of our pharmacy, as well as the associated staff training, have been further developed.