Matthew Mitchell, Pharm.D., BCACP
Clinical Pharmacist Manager
If your pharmacy is anything like ours, our workflow has been dominated by COVID-19 vaccines the past several months. Just as vaccination volume appeared to be dissipating and our staff was enthusiastic about re-focusing our efforts on FtP, our local hospital reached out to see if we could assist with dispensing COVID19 antiviral medications. Needless to say, this became our highest priority, and our pharmacy team scrambled to find a sufficient process to support this service in less than a week.
Here are the initial steps that we took to get this program up and running:
Email communications were sent to all providers in our community to inform them that we had these COVID19 antivirals in-stock.
Providers were given tip sheets for both Paxlovid and molnupiravir to educate themselves on appropriate use of these medications and how to prescribe these medications.
A referral phone line was created for providers to call and request pharmacy evaluation for a patient to receive COVID19 antiviral treatment.
A centralized clinical team of pharmacists and technicians were assigned to perform evaluation of these medications and to assure that they are being dispensed consistent with FDA authorization and EUA compliance.
A referral process was created between our pharmacy team and hospital team members if antiviral treatment options may not be the best fit for patients. For example, patients who have contraindications to Paxlovid can be quickly referred to receive monoclonal antibody treatment.
I am encouraged that the pillars of FtP are still visible within our COVID antiviral workflow. First, we have been restructuring our workflow through medication synchronization for several months now to improve operational efficiencies and get the pharmacists “off the counter.” Because of this, we can permit two clinical pharmacists to remain off the pharmacy counter for the most part to be focused on clinical services. We have centralized the clinical review of these COVID antivirals to these pharmacists. They perform medication reconciliation, scrutinize drug-drug interactions, and counsel patients on appropriate use of these COVID antivirals. They really take the pressure off of the dispensing pharmacists as they perform medication reconciliation, identify drug interactions, confer with providers on significant drug interactions, obtain necessary lab values, and counsel the patient on taking the antiviral and how to pick up the medication with our curbside service. All this is done before the prescription is even filled at the pharmacy.
Second, we have leveraged our non-pharmacist support staff by developing new, advanced roles for our pharmacy technicians, called clinical pharmacy service technicians. With these COVID antivirals, they are responsible for obtaining required information from providers on the referral phone line, requesting updated medication lists and GFR values from providers, and inputting medication lists into drug interaction checkers for pharmacists to review. They really are an integral part of the team who optimize the pharmacists’ efficiency and permit the pharmacists to be focused on patient care services.
Third, our pharmacy team is establishing working relationships with providers in our community and optimizing the use of technology to provide better patient care. Our pharmacy team is accessing patient records through EPIC, the main electronic health records system that is used by providers in our area. This permits the pharmacy team to obtain needed information such as health conditions, current medication regimens, and laboratory values to confirm appropriate dosing of medications. We can also communicate to providers and address significant drug interactions and offer mitigation strategies directly in the patient’s chart, rather than awaiting a response from a fax or telephone call.
Thus, despite falling short the past couple months on FtP progressions due to the prioritization of vaccines and COVID antivirals, the transformation process may be more apparent than you realize as it was for our pharmacy. The foundational steps still permitted our pharmacy to offer a new clinical service that is uniquely primed for pharmacist intervention. Our pharmacy viewed this a great opportunity to build lasting collaborative working relationships with providers in our community, despite poor reimbursement. From our experiences so far, providers are welcoming this connectivity with the community pharmacy team. They are really looking to the medication experts to assure they are meeting the EUA requirements for dispensing these medications and greatly value the mitigation strategies our team is offering to eliminate or lessen potential drug-drug interactions. Building these relationships with providers is setting the stage for potential medication management partnerships in the future, which permits our pharmacists to practice at the top of their licenses.