The rapid spread of the novel coronavirus disrupted many standard processes and protocols in hospitals across the country. Likewise, the pandemic disrupted clinical and operational workflows for pharmacies, forcing pharmacists to discover new ways of performing common tasks to protect care team members and the community.

THE PROBLEM

Watching the impact of COVID-19 across the country, leaders at Murray, Utah-based Intermountain Medical Center quickly created a remote pharmacy services plan prior to a rapid rise of coronavirus cases in Utah. The plan was designed to limit the risk of exposure to the virus and mitigate potential staffing shortages due to illness or quarantine.

The goals were to protect the general public, patients, clinical pharmacists and other caregivers while maintaining high standards of pharmacy clinical services.

"Proactive measures helped ensure pharmacy personnel had appropriate remote access and were equipped with the right technology and resources that enabled them to participate remotely in daily patient care rounds and consults and in verifying medication orders and delivering medication education to patients," said Gabe Fontaine, PharmD, clinical pharmacy coordinator, critical care medicine, at Intermountain Medical Center, and an associate professor at Intermountain Healthcare.

PROPOSAL

Intermountain Medical Center is a level I trauma center, which includes a comprehensive stroke center. It serves four surrounding states and is the largest of Intermountain Healthcare's 25 hospitals. It has 504 inpatient beds and 80 emergency department beds with approximately 90,000 annual ED visits.

When the remote pharmacy services plan was implemented, there were 157 pharmacy staff, including 73 pharmacists and 7 residents.

"The plan, designed by a multidisciplinary team, was a hybrid of remote and on-site pharmacy services," Fontaine explained. "It was created to prevent exposure and subsequent illness, proactively address potential staffing shortages, and ensure uninterrupted clinical pharmacy services.

"As more was learned about the spread of the virus, the hospital developed a rotating schedule to keep workgroups together on-site and then alternate through remote assignments," he continued. "There were also contingency plans at the ready if a certain number of pharmacists became ill or required quarantine."

"The technology was critical for clinicians to connect with the right team member, especially if the contingency staffing plan was in place."

Gabe Fontaine, PharmD, Intermountain Healthcare

The plan outlined the strategies that Intermountain Medical Center would implement to consolidate personnel according to the number of healthy pharmacists, and also based on competencies of those available pharmacists.

"Clinical and IT team members implementing the remote pharmacy services plan knew that its success depended squarely on seamless and effective communication between the pharmacists working remotely and on-site hospital caregivers and patients," he said.

MEETING THE CHALLENGE

To enable fast and efficient collaboration between remote pharmacists and their clinical colleagues inside the hospital, Intermountain Medical Center relied on the Vocera Badge, a hands-free, voice-controlled communication device that care team members have been using to connect and collaborate.

Additionally, staff leveraged their telehealth audio-visual equipment, an integral part of Intermountain's telehealth platform, known as Connect Care Pro, that includes microphones and high-definition video cameras.

"The wearable Vocera device allows caregivers to call and connect with each other in real time simply by saying a name, role or group," Fontaine explained. "There is no need to remember phone numbers or know who is on call. The device also enables users to set reminders, leave messages and forward calls to other mobile devices and landline phones.

"Incoming calls to remote pharmacists' hands-free devices were rerouted to their cell phones or soft-phone lines connected to their laptops," he continued. "Remote clinical pharmacists leveraged the technology to contact physicians and other on-site caregivers to collaborate on patient rounds, consults, clinical recommendations, virtual huddles and patient education."

Virtual huddles became essential to identify and address gaps in coverage. Pharmacists working remotely checked in with nursing managers and caregivers, who wore the badges, to proactively address questions and concerns at the point of care. Pharmacists didn't need to know names or numbers of nurse managers in every unit. They could simply call by role.

"The technology was critical for clinicians to connect with the right team member, especially if the contingency-staffing plan was in place," he said. "Under the contingency-staffing plan, pharmacists and caregivers also used instant messaging software to communicate emergent needs throughout the day.

"Nurses could instantly connect to their floor or unit-based pharmacist via Vocera to discuss new medication orders, ask questions and relay information from the frontline care teams," he added.

RESULTS

The remote pharmacy services model led to an increase in interdisciplinary collaboration on clinical and operational initiatives, largely stemming from improved connectivity between care team members, regardless of location. Given the success of the remote pharmacy services, Intermountain Medical Center plans to extend various features of the program when the pandemic recedes.

To continue protecting the public, patients and caregivers, Intermountain Medical Center has established an intermittent work-from-home program for pharmacists who are undergoing COVID-19 testing or exhibiting symptoms.

"The remote services plan also revealed new uses for its patient-monitoring technology, prompting leadership to enhance those capabilities to improve care for critically ill patients," Fontaine noted. "Additionally, the use of existing audio and visual resources led to increased attendance for clinical team meetings and presentations."

ADVICE FOR OTHERS

"When time is of the essence, it is important to look at the resources and technologies already in place and reimagine new ways to use them," Fontaine advised. "Listen to frontline healthcare workers at every level of the organization. They often use technology in ways beyond the original intent.

"By leveraging existing technology resources, Intermountain Medical Center has been able to redesign pharmacy services during a pandemic while protecting patients, pharmacists and other caregivers, and preserving excellent clinical pharmacy coverage to support optimal patient care," he added.

Other health systems considering process changes to improve their safety protocols could achieve similar outcomes by adopting a comparable approach, but it is important to be proactive, he said. Have the right technologies, resources and contingency plans in place before the next crisis, he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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