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COVID-19 and Community Pharmacy

GENERAL RESOURCES

CLIA Application for Certification

Community Pharmacy Best Practices for COVID-19 Response
- NCPA/CPESN

Sample Letter for Essential Employees

Express Scripts Communication Regarding Signature Logs  3-19-20

Prime COVID-19 Refill Too Soon Override

Alabama Medicaid Pharmacy Updates Related to COVID-19 3-17-20

Alabama Medicaid Extends Temporary Telemedicine Coverage

CDC: Considerations for Pharmacies During COVID-19 Pandemic 4-6-20

CDC Hand Hygiene  (pdf)

Podcast: Evaluating the unknown QTc/torsades risk of hydroxychloroquine and azithromycin: 

https://www.pharmacyjoe.com/podcast/the-elective-rotation-podcast/488-evaluating-the-unknown-qtctorsades-risk-of-hydroxychloroquine-and-azithromycin/


APA Relief Listing Sign-up for Pharmacists and Pharmacy Technicians
Sign-up for APA relief listings for pharmacists and pharmacy technicians.

COVID-19: CDC
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Symptoms: Fever, cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell.

Incubation Period: 2-14 days
• Transmission: Occurs via respiratory droplets when an infected person coughs or sneezes; transmission via touch is unclear at this time
• Testing: Nasopharyngeal swab


COVID-19 TESTING: ADPH (ALABAMA DEPARTMENT OF PUBLIC HEALTH)
https://www.alabamapublichealth.gov/covid19/patients.html
• If you or a patient suspect COVID-19 infection, call your healthcare provider (HCP). If you do not have a healthcare provider, please call the COVID-19 24/7 hotline at 1-  888-264-2256.
• There are no longer certain criteria that patients must meet in order to be tested for COVID-19; however, currently, HCPs are the only persons who can perform specimen collections and request testing

ADPH Bureau of Clinical Laboratories COVID-19 testing criteria:
▪ Patient is symptomatic with at minimum measured/subjective fever OR cough OR shortness of breath, and...
▫ The patient is hospitalized, immunocompromised, 65 years or older, associated with a LTC facility, a healthcare worker, or has co-morbidities (chronic lung disease, diabetes, heart disease, chronic kidney disease, immunocompromised, neurologic disorders, pregnancy)


COMPOUNDING HAND SANITIZER:
• Pharmacists may compound hand sanitizer while ensuring to follow usual Alabama policies and the FDA guidelines found here → https://www.fda.gov/media/136118/download
• USP has issued guidance on emergency compounding of hand sanitizer which can be found here → https://www.usp.org/sites/default/files/usp/document/about/public-policy/usp-covid19-handrub.pdf

• APC ALERT: More on hand sanitizers


SOCIAL DISTANCING: CLEVELAND CLINIC 
https://health.clevelandclinic.org/covid-19-understanding-quarantine-isolation-and-social-distancing-in-a-pandemic/
• Avoiding large gatherings to slow down the spread of a highly contagious disease
• Consider limiting the number of patients present in the pharmacy at one given time
• When available, encourage patients to use the drive-thru whenever possible assisting with OTC items to be provided as well.
• Offer curbside delivery if/when drive-thru option is not available

EMERGENCY REFILLS FOR MAINTENANCE MEDICATIONS (EFFECTIVE UNTIL TERMINATION OF THE STATE OF EMERGENCY RELATIVE TO COVID-19 PER ALBOP): 
https://cdn.ymaws.com/www.aparx.org/resource/resmgr/covid-19/albop_coronavirus_-_emergenc.pdf


EPA-APPROVED DISINFECTANTS:
To ensure that your pharmacy is using an EPA-Approved disinfectant visit 
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

WHAT TO DO IN THE CASE OF A POTENTIAL STAFF EXPOSURE TO COVID-19 IN A HEALTHCARE SETTING: CDC
1. Visit this CDC website for appropriate next steps: 
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
2. Determine type of exposure
3. Determine level of risk
4. Follow appropriate monitoring for associated level of risk
5. Follow appropriate guidelines for returning to work


AHFS DRUG INFORMATION
Available for public access for the next 60 days at https://www.ahfsdruginformation.com/ 
USERNAME: ahfs@ashp.org; PASSWORD: covid-19


FROM NWS HEALTH, TN PHARMACISTS ASSOCIATION, & CDC
https://www.health.nsw.gov.au/Infectious/diseases/Pages/covid-19-preparedness.aspx

Establish a governance structure for your pharmacy:

  • Dedicate staff, time and resources to carry out recommendations within this document
  • Set regular meetings and delegate roles clearly
  • Communicate regularly with your staff and patients regarding updates

Monitor for updated information on COVID-19

Plan for business continuity including surge staffing

Pharmacist in charge should consider the need for:

  • Reallocating staff and resources to preparedness activities
  • Contingency plans to surge staff in the event of high rates of absenteeism as staff become unwell with the expected respiratory tract infections including COVID-19, or are required to stay home to care for a family
  • Review annual leave arrangements and vacancies in key areas
  • Role substitution of staff at higher risk of infection (ex. Allow immunosuppressed staff to perform back-of-house functions without direct patient contact)
  • Additional staff during high demand periods. Familiarize new staff with preparedness activities.
  • Implement conservative policies to ask that all unwell staff remain home.

Pharmacy managers should plan to mitigate the impacts of widespread community transmission on: medications, personal protective equipment, other medical equipment and delivery options

Patient Flow

Consider the flow of patient movement through your pharmacy of those who are symptomatic with respiratory illness:

  • Signage in front of the pharmacy to instruct symptomatic patients to move directly towards a specific location or to use the drive- thru, curbside pick-up, etc.
  • Provide hand sanitizer at the entrance for patients entering and exiting to use and include signage encouraging good hand hygiene
  • Provide a surgical mask and hand hygiene options, if available, to the symptomatic patients
  • Social distancing strategies such as advising symptomatic patients from across the counter with a distance of 6 feet
    • Consider placing a line on the floor to indicate a distance of 6 feet
  • Enable easy access to products in high demand such as cough/cold treatments
  • Consider alternative pathways for collecting medicines, such as encouraging patients to leave their prescriptions on file and calling ahead to order, or arranging for caretakers to collect prescriptions to minimize attendance by symptomatic patients

Influenza prevention

  • Influenza/COVID-19 co-infection can compound the burden on community pharmacies
  • Implement strategies to prevent influenza infection
    • Staff immunization
    • Promotion of influenza immunization to patient base
    • Early referral for influenza testing
  • Pharmacists performing routine vaccination should follow standard precautions. A mask and gloves may be used when providing direct patient care (immunizations).

Principles of infection control and prevention

  • Promote appropriate cough etiquette and hand hygiene
    • Remain a distance of 6ft from patients actively coughing
    • Cough into your elbow or cover with tissues and wash hands afterwards
    • Ask patients to wash hands or use sanitizer before using keypads
    • Wash hands before/after direct patient contact; after touching a patient’s money, prescription hardcopy or other personal property; every 30 minutes if handling medications; after signing portable signature pads for store deliveries (FedEx, UPS, wholesaler); after taking out the trash
    • Have outside workers (maintenance, IT, delivery drivers) sanitize hands regularly while in the pharmacy
  • Promote regular disinfection of frequently touched surfaces (keyboards, signature pads, pill trays, doorknobs etc)
    • Disinfecting countertops, pens, pen pads and phones immediately after patient use
    • Disinfect deliveries coming into the pharmacy including the outside of plastic containers
  • Additional infection prevention and control
    • Wash jackets/work uniforms after each shift
    • Do not use clipboards made of porous surfaces for patient use

Patients presenting with respiratory tract infection symptoms

Upon presentation to the pharmacy, symptomatic patients should:

  • Self-identify through use of pharmacy signage
  • Be provided a surgical mask to wear during the pharmacy presentation
  • Be referred to ADPH (phone # included here) to discuss COVID-19 testing or consider an ambulance if patient is having difficulty breathing

Masks

  • The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g. pharmacies) especially in the areas of significant community-based transmission
  • Use gloves and masks when coming into direct contact with patients (delivery drivers, immunizations, providing direct patient care)

Waste Management

  • No additional guidance required for disposing of wastes. Follow routine disposal processes


LINK TO CDC RESOURCES TO PRINT & GIVE TO PATIENTS:
https://www.cdc.gov/coronavirus/2019-ncov/communication/factsheets.html
Available in several different language versions
•  “Share Facts About COVID-19” Document 
•  “What You Need To Know” Document 
•  “What To Do If You Are Sick” Document

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