Leveraging pharmacy residents during COVID-19 pandemic.

As many health systems across the United States are preparing for and/or experiencing the surge in patients with coronavirus disease 2019 (COVID-19), pharmacy residents are asking how they can best contribute. Residency program directors (RPDs) are trying to balance exposing residents to a once-in-a-lifetime experience while also keeping them safe. Perhaps one of the only positives about the timing of this pandemic is that pharmacy residents are fully trained and versatile and can be leveraged to do administrative, operational, and clinical duties—all while continuing to meet necessary learning objectives.

Our health system consists of 7 hospitals and has the capacity to care for approximately 1,250 inpatients. Our pharmacy residency program consists of 30 total residents in the following specialties: Health-System Pharmacy Administration MS; postgraduate year 1 (PGY1); pharmacotherapy; PGY2 emergency medicine; PGY2 critical care; PGY2 cardiology; PGY2 hematology oncology; PGY2 infectious diseases; PGY2 solid organ transplant; PGY2 pain and palliative; PGY2 informatics; and PGY2 ambulatory care. In an effort to be equipped for the surge of patients with COVID-19, our health system is at reduced capacity, with additional sites preparing to accept patients if needed. After reading through ASHP’s “Pandemic Effects on Residency Programs Q & A” guidance document in addition to countless listservs and social media posts, we wanted to share some of our institution’s strategies to use and protect residents during the COVID-19 pandemic.[1]

Our RPD residency advisory committee (RAC) decided to keep residents on scheduled rotations with the caveat that direct patient care rotations would involve limited patient exposure in accordance with local hospital and state recommendations. All pharmacists, including residents, at our institution were encouraged to use secure chat functions within the electronic medical record to continue having a virtual presence on rounds while rotating on- and off-site consistent with organizational requirements of telework. Virtual platforms such as Cisco Webex are being used for patient reviews in addition to topic discussions when residents and preceptors are off-site. This has allowed residents to continue gaining clinical experience while also completing necessary learning objectives to remain on track to receive their residency certificate. Some programs have even created an additional COVID-19 pandemic response learning experience for their residents, while others have adjusted learning activities to include responsibilities related to patients with COVID-19. Residents were also incorporated into more global emergency response activities (eg, code blue, strokes, ST-elevation myocardial infarction [STEMI]) while on-site to limit total pharmacist exposure to the hospital setting.

Many of our residents, in collaboration with pharmacy administrators and specialists, have been involved in preparation activities as well as development of guidelines on how to care for patients with suspected or confirmed COVID-19. Table 1 highlights our health-system pharmacy resident contributions as of April 4, 2020.

Table 1.

Pharmacy Resident COVID-19 Contributions

Initiative	Contribution(s)	Resident Group
Planning for surge of COVID-19 patients	Created plans for medication distribution, clinical staffing, pharmacists training to cross cover, and preparation of the department for expansion to patient care areas not previously used (eg, dorms, convention center)	MS/HSPA Residents
Viral media for COVID-19 testing preparation	Prepared and packaged viral media for distribution to COVID-19 swab testing stations throughout the state to increase the capacity of tests completed per day	All Residents
Nonprescription swab station kits	Ordered, created, and distributed nonprescription medication kits at COVID-19 swab testing stations, including the front entrance of the hospital, to eliminate patients’ need to go to stores for symptomatic medications, such as antipyretic and cough suppressants	All Residents
COVID-19 call center	Volunteered at the COVID-19 call center where the mission was to stratify patients calling to see if the patient qualified for COVID-19 testing; if the patient qualified, the resident would place the COVID-19 testing order and direct the caller to the nearest swab station	All Residents
Airborne isolation code blue kits	Created crash cart kits with initial lifesaving medications that could be handed into a suspected or COVID-19 positive patient’s room during a code blue to limit additional personal protective equipment need and exposure to pharmacists	All Residents
Medication inventory management	Contributed to the drug shortage committee in creating innovative solutions to handle impending drug shortages such as reevaluating counts of drugs stored in crash carts and automated dispensing cabinets and reviewing concentrations of critical care drips to limit waste of medications	All Residents
Emergency department preparedness	While continuing to provide direct-patient care, participated in swab tents, education refreshers for emergency medicine nurses caring for critically ill patients and updated automated dispensing cabinet contents to minimize the number of medications dispensed from central pharmacy to ensure bundling of medication administration	PGY2 EM Residents
COVID-19 guideline development	Contributed to COVID-19 guideline development, including: • COVID-19 infectious diseases treatment guideline • Management of the critically ill COVID patient guideline ◦ Sedation and analgesia considerations in COVID-19 patients ◦ Pharmacologic treatment of acute respiratory distress syndrome • Blood conservation protocol • Recommendations on managing COVID-19 in cardiovascular disease • End-of-life palliative care protocols for COVID-19 patients • COVID-19 solid organ transplant treatment guideline • Transition of care document recommending proper steps for COVID-19–positive patients transitioning to outpatient settings	PGY2 Infectious Diseases, PGY2 Critical Care, PGY2 Cardiology, PGY2 Pain and Palliative, PGY2 Solid Organ Transplant, PGY2 Ambulatory Care Residents
STEMI treatment algorithm in COVID-19– positive or suspected patients	Created a thrombolytic for STEMI checklist and a thrombolytic STEMI dosing card, drafted a pharmacist progress note to document for services provided during a STEMI, constructed a STEMI order set for additional thrombolytics recently added to formulary, and provided education for pharmacists and providers involved in STEMI care	PGY2 Cardiology Residents
Department of pharmacy communication	Drafted daily COVID-19 update email that included “pharmacy brags” and updated treatment guidelines, drug shortage alerts, changes in hospital policies, and daily wellness activities that were sent out to the department of pharmacy	MS/HSPA Residents
Advocate for expansion of pharmacy services reimbursement	Drafted communication to distribute to payors to highlight the numerous telehealth services pharmacists can provide in hopes to further expand pharmacists’ provider status and reimbursement of services	PGY2 Ambulatory Care, MS/HSPA Residents
Conversion of ambulatory care services	Involved in converting face-to-face visits to telehealth options including phone or video visits and using alternate sites of care for patients (eg, drive-up international normalized ratio checks) and virtual transitions of care postdischarge for COVID-positive patients	PGY2 Ambulatory Care Residents

Abbreviations: COVID-19, coronavirus disease 2019; HSPA, health-system pharmacy administration; PG, postgraduate; STEMI, ST-elevation myocardial infarction.

Pharmacy residents have been instrumental in preparing our health system for the surge in patients with known or suspected COVID-19. As the need to care for more critically ill patients arises, we will be deploying residents to operational areas in need, including alternate sites of care. In trying to balance an experience with overall safety, health, and wellness, the RPD RAC also highly encouraged residents to take time to focus on themselves by implementing some of the wellness activities included in the department of pharmacy daily communication. While COVID-19 has presented new challenges for health systems across the country, pharmacy residents are rising to the occasion in continuing to progress toward completion of their respective residency certificate, all while maintaining a strong level of involvement in COVID-19 preparation and response.