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COVID-19 Information for Health System Pharmacy

GENERAL RESOURCES

APC Compounders' Shortage Drug Source for Hospitals 4-23-20

APA Letter to Medicaid regarding COVID-19   3-19-20

AL Medicaid Response to APA Letter 3-24-20

AL Board of Pharmacy Issues Institutional/Hospital Pharmacy Policy - State of Emergency

Society of Critical Care Medicine Infographics on Critical Care Patients (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/

Key Pharmacist Takeaway Points from SCCM Surviving Sepsis COVID-19 Critical Care Guidelines (pdf)

ASHP Website

ASHP Assessment of Evidence for COVID-19-Related Treatments (pdf)

 

COVID-19 AND HEALTH SYSTEM PHARMACY


COVID-19: CDC

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Symptoms: Fever, cough, myalgia, fatigue and shortness of breath
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)

http://alabamapublichealth.gov/infectiousdiseases/cov-testing.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 recommends that symptomatic patients at high risk seek testing for COVID-19:

▪ High Risk

▫ Older Adults
▫ People with serious chronic medical conditions 
       ◊ Heart disease, diabetes, lung disease

Preferred that a physician refers a patient for testing; however, workers will screen patients upon arrival to testing sites if without a physician referral.

 

PPE SHORTAGES AND COMPOUNDING STERILE PRODUCTS (CSP) CONCERNS

At this time, all pharmacists and HCP are encouraged to sparingly use PPE.

◦ PPE for direct patient care should take priority above all else.

If not already done, an inventory of PPE should be taken immediately and evaluated daily.

◦ General recommendations are to plan for inventory that will last until June.

For sterile compounding purposes, gowns, masks, and hair nets should be reused at this time due to the ongoing shortage.

◦ Ideally, PPE should not be reused; however, it can be when shortages occur.

Amount of time that PPE is reused may be institution specific. Discuss within your institution the plans that work best for you.

The number of individuals working in the IV room should be limited as much as possible at this time to further limit PPE use.

◦ Everything that can possibly be done outside of the clean room should be.

Because reuse of PPE is likely during this time, ensure that clothing worn into clean room is laundered daily.

 

FACE MASKS AND ALTERNATIVES

Reuse of masks never recommended nor ideal; however, it may be necessary to preserve inventory.

When reusing, masks should be donned and doffed on the “dirty” side of the anteroom to ensure that microbial state of clean room is not compromised.

Pharmacists and technicians should place their initials on outside of masks and place them in a small paper bag in the ante room.

◦ A new paper bag should be used each time face mask is doffed.

Determining how long masks may be reused is based on your best judgement.

◦ Visibly soiled masks should be discarded immediately.

◦ Proper handling technique is crucial when masks are being reused.

Ensure that all staff are appropriately trained and educated on new procedures that are in place.

N95 respirators are an alternative for clean room use.

◦ Fit testing for CSP is not required.

◦ Fit should be snug around bridge of nose and chin.

◦ These should be reserved for those in direct patient care above all else.

Clean fabric, such as a polyester bandana or launderable surgical mask, may be used for severe PPE shortages.

◦ Use of a clean fabric alternative with each entry into the clean room is encouraged.

 

STERILE GLOVES

Availability of sterile gloves should be prioritized for CSP purposes.

Contamination via direct contact is the highest risk for CSP. 

At this time, glove supply is not anticipated to be affected by interruptions in production; however, inventory should still be carefully evaluated.

 

GOWNS

Most hospitals are already seeing significant shortages.

Gowns may be reused for 1 week unless visibly soiled.

Non-Sterile sleeves are recommended for those reusing gowns.

◦ Sterile sleeves are appropriate if non-sterile are not available.

◦ Reuse of sleeves should be avoided unless inventory becomes critically low.

Reused gowns should be donned in ante room followed by sleeves and gloves in the sterile compounding area.

 

SHOE COVERS

Reuse is not recommended.

If stock reaches a critical point, the use of designated clean room shoes is encouraged.

◦ These should stay in the clean room and be donned in the area where shoe covers are normally donned.

 

STERILE ISOPROPYL ALCOHOL SHORTAGE

https://peernetwork.criticalpoint.info/posts/sterile-compounding/strategies-to-cope-with-garb-and-ipa-shortages

Sterile isopropyl alcohol (sIPA) should be reserved for spraying gloves prior to sterile compounding, wiping down critical sites, and wiping down the direct compounding area.

Denatured ethanol should not be used in place of sIPA.

◦ It can break down plastic on IV bags and other supplies.

For institutions with no supply of sIPA consider following the Critical Point recommendations for making sIPA batches.

 

CONTACT PRECAUTIONS AND PREVENTING STAFF EXPOSURE

For pharmacists verifying orders and scheduling medications, when possible schedule medications to be administered at the same time to limit nurse and other HCP exposure from entering room.

Globally, limiting rounding services is not recommended at this time.

◦ There may be institution specific recommendations for limiting pharmacist exposure that should be followed.

Decentralized pharmacists working on floors with positive COVID-19 cases may consider working from within central pharmacy if institutional structure will allow for this.

 

ENVIRONMENTAL MONITORING OF STERILE COMPOUNDING AREA

Surface testing of the ISO 5 space in the direct compounding area should be increased to weekly while PPE is being reused.

If a failure occurs during weekly testing:

◦ Immediately clean direct compounding area and retest.

◦ If repeat tests are failure, consider decreasing beyond use date (BUD) or only compounding for immediate use if the source of contamination cannot be readily identified.

Reuse of PPE alone is not a reason to decrease BUD.

Increased air monitoring within the sterile compounding area is not recommended at this time.

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