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Partnering on Pharmacy with ASHP · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the podcast series.
• 0:10
  SPEAKER_01: We're all in this together, COVID-19 Allies in Infection Prevention, as part of the Society for Healthcare Epidemiology of America Shay's Rapid Response Program.
• 0:21
  SPEAKER_01: I am Whitney Buckle.
• 0:22
  SPEAKER_01: I am the System Antimicrobial Stewardship Pharmacist Manager for Intermountain Healthcare, and I will serve as your SHA moderator and speaker.
• 0:30
  SPEAKER_01: I'm also happy to welcome Katie Reisbig, Clinical Services Pharmacy Manager, Department of Pharmacy at Nebraska Medicine, who will serve as our American Society of Health Systems Pharmacist Speaker for today's podcast.
• 0:43
  SPEAKER_01: Discussion on the podcast does not reflect Shay or ASHP's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:54
  SPEAKER_01: Today's episode will focus on collaboration between healthcare epidemiology and hospital-based pharmacists and how we as a team can work together to address the most important questions surrounding the COVID-19 outbreak.
• 1:05
  SPEAKER_01: Let's get started with our first question.
• 1:08
  SPEAKER_01: Katie, thank you for joining us.
• 1:11
  SPEAKER_00: Yes, thank you for having me.
• 1:12
  SPEAKER_01: Would you share a little bit about your involvement with COVID-19 to date?
• 1:16
  SPEAKER_01: What are the biggest challenges that pharmacists are particularly concerned about with this pandemic?
• 1:21
  SPEAKER_00: That's a great question, Whitney.
• 1:23
  SPEAKER_00: I think overall, I'm just one part of a bigger team here within our pharmacy department, and I'm sure that many other organizations have many members of their team that are contributing to this COVID-19 crisis.
• 1:37
  SPEAKER_00: My role is in working with the teams and the pharmacists that cover our critical care emergency department, and then I also work with cardiology, PEADs, and transplant.
• 1:47
  SPEAKER_00: So I have co-managers that work closely with the area of infectious disease and the medical surgical areas, operations, et cetera.
• 1:55
  SPEAKER_00: So our leadership team, as we get together, and there's five of us in total, which again probably parallels many organizations set up.
• 2:03
  SPEAKER_00: I would say the things that we focus most on, and each of us kind of have a key lead role with this, are things such as medication shortages, staffing planning, communication strategies.
• 2:14
  SPEAKER_00: We always are focused on mitigating burnout, but specifically right now when we know that people are working harder and under highly stressful conditions.
• 2:23
  SPEAKER_00: And then, of course, we're always worried about safety, both safety of our personnel and a big focus that we've had is safety of our product and our IV room and our clean room setups.
• 2:34
  SPEAKER_00: So those are just a few of the things I think that leadership has been most focused on.
• 2:37
  SPEAKER_00: Of course, balancing all of that with your normal position requirements.
• 2:41
  SPEAKER_00: I think my pharmacists, the pharmacists within our department and all in various degrees, I think their main focus has been on adequate staffing coverage and safety.
• 2:52
  SPEAKER_00: So from a perspective that they're providing still the highest level of care and putting the patient first.
• 2:58
  SPEAKER_00: And as is the case with many healthcare professionals, I think their focus on personal safety is a bit centered on themselves.
• 3:05
  SPEAKER_00: Obviously, everybody wants to kind of make sure they stay safe, but their why is often making sure that they personally stay safe so that they don't transmit anything to their patients, to other colleagues within the organizations, their families, and just the overall community.
• 3:22
  SPEAKER_00: So making sure that they have appropriate personal protective equipment in times where some of those requirements and where you wear what is always evolving.
• 3:32
  SPEAKER_00: Again, we began care of these patients kind of very early on in this time.
• 3:37
  SPEAKER_00: We activated our biocontainment unit.
• 3:40
  SPEAKER_00: So our organization got a little early exposure.
• 3:43
  SPEAKER_00: And in our biocontainment unit, as we did for Ebola, you know, there's a high level of personal protective equipment that's worn.
• 3:50
  SPEAKER_00: And so when you go from that high level of everyone in Pappers and then begin to slowly shift out into your mitigation and your mitigation strategies, there's just been a big evolution on what the appropriate PPE is and where those different thresholds are at.
• 4:07
  SPEAKER_00: So when you need to change when we went to universal masking and when do you need to be in an N95, things of that nature.
• 4:14
  SPEAKER_00: And then I always important because how could we function without them?
• 4:17
  SPEAKER_00: When we think of our technicians and our pharmacy support staff, you know, they're often the eyes and ears to things and questions that come up even before many of us would think about it.
• 4:26
  SPEAKER_00: So when can I bring this product back to pharmacy?
• 4:29
  SPEAKER_00: When can I tube this?
• 4:30
  SPEAKER_00: And can I send things to this area?
• 4:32
  SPEAKER_00: How do I ensure safety?
• 4:34
  SPEAKER_00: And one of our big focuses, as I would imagine many hospitals are, is making sure that our IV room stays as sterile as possible, stays as cold.
• 4:43
  SPEAKER_00: If you're thinking of a cold, warm, and hot zone, we want to keep our IV room as cold as possible.
• 4:48
  SPEAKER_00: And so I think our technicians and our pharmacy support staff really continue to bring forward a lot of really great questions for us as leadership and our pharmacist teams to think about and address.
• 4:59
  SPEAKER_01: Yes, Katie, you bring up so many good points.
• 5:02
  SPEAKER_01: I want to follow up with a couple different questions for you.
• 5:06
  SPEAKER_01: With this focus on safety, I think this is so important.
• 5:09
  SPEAKER_01: And I'm glad that that was one of the main points that you brought up.
• 5:12
  SPEAKER_01: Have you done any sort of innovative ideas to help with safety?
• 5:16
  SPEAKER_01: One of the ideas that comes to mind for us is that you know, pharmacists are really involved in taking medication histories.
• 5:23
  SPEAKER_01: And so one of the things that we re-enacted was trying to do more medication histories over the phone in patients' rooms rather than entering patient rooms.
• 5:32
  SPEAKER_01: Do you feel like you also encountered similar things where the usual processes had to change to help with that safety component?
• 5:41
  SPEAKER_00: Yeah, absolutely.
• 5:43
  SPEAKER_00: We too have moved to more tello approach on our medication history intake and probably redirected how and when that work is done.
• 5:52
  SPEAKER_00: For example, we have our technicians that do medication histories in our emergency department, but we have an entire zone that we've declared a hot zone in which we have our patients coming in that are in the rollout status, they're high-risk known rollouts.
• 6:06
  SPEAKER_00: And so we don't have our technicians enter that area.
• 6:09
  SPEAKER_00: So much of their work is done over the phone.
• 6:11
  SPEAKER_00: I think to your point, many different small workflows were created.
• 6:15
  SPEAKER_00: So when we do emergency response, typically our pharmacists are very much at the bedside, but in effort to conserve PPE as well as keep all of our colleagues safe, we met with our CPR committee or code committee and determined, you know, who are the key people that need to be in the room, and then you know, who's on deck to enter the room, things like that.
• 6:37
  SPEAKER_00: And it was determined that the pharmacist would stay just immediately outside of the room.
• 6:41
  SPEAKER_00: And so we had to have mechanisms to hand in product.
• 6:44
  SPEAKER_00: We chose to get some different product in-house.
• 6:47
  SPEAKER_00: We all know that Epi, for example, has been on a nationwide shortage for a few years now, the pre-made EPIs.
• 6:52
  SPEAKER_00: And so we've been preparing those at bedside in our emergencies for some time now.
• 6:57
  SPEAKER_00: But we did reach out to our 503B company, for example, and were able to get some pre-made syringes in that are just for that initial response.
• 7:04
  SPEAKER_00: So we could, you know, minimize opening the doors and hand in the medications that are needed, yet serve as a resource.
• 7:11
  SPEAKER_00: Our nursing staff put our phones in baggies, their iPhones they carry, they put them in baggies so they can still communicate.
• 7:18
  SPEAKER_00: And in some cases, they have downloaded software so there can be like a FaceTime communication with people that are outside of the room.
• 7:26
  SPEAKER_00: And the other thing from a safety perspective that I think would be interesting to your listening audience is one of our antimicrobial stewardship pharmacists had the idea to, they had done some surface sample testing up in our biocontainment unit.
• 7:41
  SPEAKER_00: He is now working with the individual that did that surface testing to test a number of our medications that enter different places.
• 7:50
  SPEAKER_00: So, you know, tablets or things that come off our robot, ID bags, just various different things.
• 7:56
  SPEAKER_00: And I believe this is going to get expanded here in short order.
• 7:59
  SPEAKER_00: I don't want to go into too many details, but we've gotten some preliminary information back on when we took medications into a hot zone room, laid them in normal spaces that we would normally keep the medications at for some period of time, and then brought them back out.
• 8:15
  SPEAKER_00: And so we were able, we're getting some initial results back on that.
• 8:18
  SPEAKER_00: So very exciting.
• 8:19
  SPEAKER_00: It's been very innovative work on his part.
• 8:21
  SPEAKER_00: So I have to give all the credits to him and the team that our med safety team.
• 8:25
  SPEAKER_00: So it was our infectious disease group and then our safety team that have partnered together.
• 8:30
  SPEAKER_00: And so they're hoping to do some more formal research in that regard and you know get that fast tracked out to the community and share those results because I think it gives a little line of sight to the things that we should be worried about in the pharmacy arena.
• 8:44
  SPEAKER_00: Oh, that's great.
• 8:45
  SPEAKER_01: We're definitely excited to see those results.
• 8:47
  SPEAKER_01: We've had several discussions about, you know, if a medication enters that hot zone, can you recirculate it back into the general supply?
• 8:55
  SPEAKER_01: And do you, you know, incubate it or keep it in a room for how many days in order for it to be appropriate to recirculate?
• 9:02
  SPEAKER_01: And I think it's really important because drug shortages are such a big deal that we don't really want to be tossing all medications that enter a hot zone that really may not have been exposed to COVID, or we really don't, we don't really know.
• 9:15
  SPEAKER_01: So that is really exciting information.
• 9:19
  SPEAKER_01: That's been a great wrap for safety.
• 9:20
  SPEAKER_01: I think we'll now switch over a little bit.
• 9:23
  SPEAKER_01: Speaking of drug shortages and treatment, one of the things that I thought was really interesting in listening to several of the different webinars that are available for the experience in New York is how important the role of clinical pharmacy has been during the COVID-19 pandemic, and that it's there's the operational piece, but also the clinical piece.
• 9:42
  SPEAKER_01: So ASHP has developed many resources available to pharmacists to help with this clinical component of treatment and also with their listservs.
• 9:51
  SPEAKER_01: Would you share a little more with our audience about the work that ASHP is doing on this front to address COVID-19?
• 9:57
  SPEAKER_00: Absolutely.
• 9:58
  SPEAKER_00: I probably can't give justice to all of the things they're working on because they've been such an incredible resource during this time.
• 10:05
  SPEAKER_00: ASHP was very quick to put together a COVID-19 resource center, which is available on their website, and they have been collating all of the various evidence so that it's just kind of summarized and at an easily accessible place for all of our clinical pharmacy staff.
• 10:21
  SPEAKER_00: And then, as they've always had, they have they've always had the community connect, but they um went ahead and rolled up a dedicated COVID-19 Connect community so that everyone could kind of go into one shared space instead of all of our various Kinect communities that might be on our clinical practitioners or a pharmacy management focus.
• 10:40
  SPEAKER_00: And so it's not uncommon that you see things cross-posted amongst various communities.
• 10:44
  SPEAKER_00: And so to help facilitate the discussion, they put up a dedicated community, which I think it as we've discussed previously, an area that I frequently go to is the Kinect community, because that's often the times that people are grappling with questions that don't even really quite have the evidence yet, something new, late-breaking, or a challenge that people are facing.
• 11:07
  SPEAKER_00: And I use the example of like our medication shortages.
• 11:10
  SPEAKER_00: And so as we address face a certain shortage, it's a place where everyone across the nation is very quickly talking about how they're working through it, what alternatives they've gone to, and or what type of workflows can we use to potentially prepare the medication in a different way so that we're still able to meet the patient need.
• 11:30
  SPEAKER_00: So those are some of the resources in addition to just the ongoing advocacy, I think, that we've seen ASHP take, both to remind folks of the importance of pharmacists' role in this crisis as well as their future abilities, as it'll be probably forthcoming.
• 11:46
  SPEAKER_00: There'll be a, I imagine, a big push for pharmacists, local pharmacies to do testing and help support our communities in that way.
• 11:55
  SPEAKER_00: And so I think kind of always being one step ahead.
• 11:58
  SPEAKER_00: But prior to all of these formal things getting pushed out, I appreciated as a member just receiving even personal notes from some of the ASHP staff just asking what the needs were.
• 12:09
  SPEAKER_00: And they really responded to the call of their membership very quickly.
• 12:13
  SPEAKER_00: So I'm appreciative of everything they've done to help support us, as well as organizations like Shay.
• 12:18
  SPEAKER_00: It definitely shows the time where this membership in these organizations saves you a lot of time on the front lines if you can go somewhere and connect with colleagues across the country.
• 12:28
  SPEAKER_01: Yes, I completely agree.
• 12:30
  SPEAKER_01: I think it's been a benefit of having a pandemic in this era of all this technology that we can connect with people across the country and in other countries to be able to share information faster than we've ever been able to share.
• 12:46
  SPEAKER_00: Yeah, you're so right.
• 12:47
  SPEAKER_00: I mean, one of one topic that I've been following, I have to say, there's it's a pharmacist up in Canada that I have been watching, you know, everything that this individual posts.
• 12:56
  SPEAKER_00: Just it's interesting when they have different laws and kind of a different space they're practicing in, but just you know, it helps give you insight to maybe an innovation direction you can think about.
• 13:07
  SPEAKER_00: If you just have to now change the law and then and then maybe execute on that solution.
• 13:14
  SPEAKER_00: But it's it's been cool to see the international response.
• 13:18
  SPEAKER_01: Yes, I agree.
• 13:19
  SPEAKER_01: That's a great story.
• 13:20
  SPEAKER_01: I mean, I think there really are some really creative solutions.
• 13:23
  SPEAKER_01: And hopefully, I also hope that maybe a silver lining of some of this is that we really thoughtfully think about what are the roles that each discipline can play and can we practice at the top of our license?
• 13:34
  SPEAKER_01: So I like the examples that you've provided.
• 13:37
  SPEAKER_01: Now that we've gone over some of ASHP's great resources and the advocacy that's been provided, I want to transition over to a really kind of hot topic lately, which is remdesivir.
• 13:49
  SPEAKER_01: So, Katie, can you speak a little bit to your experience so far with Remdesivir and how the pharmacist has played a crucial role with this?
• 13:57
  SPEAKER_00: Well, I will try.
• 13:58
  SPEAKER_00: I have to say that this is a time where I really lean heavily on my uh my co-managers as well as really it's been our antimicrobial stewardship pharmacists.
• 14:06
  SPEAKER_00: We have a couple of them, and I think they've been working tirelessly to help support the remdesivir conversations.
• 14:14
  SPEAKER_00: I think what was interesting about this, and it of course something that many of us have not faced in our careers to date, is the fast track approval and then the allocation from the federal level to various states.
• 14:27
  SPEAKER_00: So our state served as kind of the depot for the initial supply that was allocated to our state, and then our antimicrobial stewardship pharmacist, as well as I'm sure people across the state, worked with the state representatives to determine how this product was going to be allocated into our communities.
• 14:47
  SPEAKER_00: Our facility was engaged in one of the studies that wrapped up.
• 14:51
  SPEAKER_00: We're now in the second phase of that study.
• 14:52
  SPEAKER_00: So we had product on hand and enrollment.
• 14:55
  SPEAKER_00: But it was interesting when this arrived, the state allocation, it was in that gap period of when we our first phase of the study had closed, and then they were moving into the second phase of the study.
• 15:06
  SPEAKER_00: And so determining for us specifically, we had study drug that was arriving on site, and then we also had, you know, this allocation drug.
• 15:15
  SPEAKER_00: So they had to work with a state medical director and determine just what the right process was.
• 15:22
  SPEAKER_00: And so this was a multidisciplinary effort.
• 15:24
  SPEAKER_00: I mean, pharmacists and physicians and getting together very quickly and determining, like, you know, who should receive the medication, how should it be sent out, there's the solution, and then there's the powder form.
• 15:35
  SPEAKER_00: So, you know, in our facility, we're a mixed adult and pediatric area.
• 15:39
  SPEAKER_00: So they had to work on getting the IT infrastructure set up.
• 15:43
  SPEAKER_00: And the part that made it interesting is because it doesn't have an NDC number yet.
• 15:47
  SPEAKER_00: You have to get everything set up so that you can ensure that it's safely scanned.
• 15:51
  SPEAKER_00: We had to set up our dosage system, so our scanning technology to be able to ensure that we were using the right product and preparing for the right patient.
• 16:00
  SPEAKER_00: So adults versus pediatrics needing the powder form.
• 16:04
  SPEAKER_00: That's been interesting as we get on our various IT calls.
• 16:08
  SPEAKER_00: Um, so it really kind of pulls together, you know, pharmacy leadership.
• 16:11
  SPEAKER_00: We had to work with our multidisciplinary partners, we had to work with our IT system just to operationalize the use of that allocated medication here.
• 16:20
  SPEAKER_00: And then again, our antimicrobial storage group has been working on getting it tracked and sent out to the various hospitals and sites across our state to ensure that they had product there.
• 16:33
  SPEAKER_00: They then have had sent along guidelines on how patients should be selected for that emergency use authorization and recommendations for duration of therapy and things of that nature.
• 16:45
  SPEAKER_00: So, I mean, really put together what in a normal world would probably take, as many of us know, six months to a year, maybe to get these types of protocols rolled up and they uh accomplish this within a matter of days.
• 16:58
  SPEAKER_00: So very impressive.
• 16:59
  SPEAKER_01: Yeah, it is definitely a sizable task.
• 17:02
  SPEAKER_01: I think there's the one challenge of just trying to figure out clinically the criteria, like you said, the duration.
• 17:08
  SPEAKER_01: There's a lot of different moving parts from a clinical standpoint, but then also the safety.
• 17:13
  SPEAKER_01: And we know that there have already been reported medication errors with REM desivere and the dosing, you know, being mistakenly given a different way.
• 17:21
  SPEAKER_01: And I think that so we're trying to come up with different ways to make sure by barcode skating and other things to make sure that we do the best for our patients.
• 17:31
  SPEAKER_00: Yeah, it definitely highlights, and I can imagine that you know our challenges were we were already using it, you know, in the study realm and had seen favorable results.
• 17:41
  SPEAKER_00: So we had many of our intensivists and providers very excited to continue using it, both by way of the study or by the emergency use authorization.
• 17:50
  SPEAKER_00: So you think of like that perspective that we're dealing with, but then you're sending this out across the state to places that don't have experience with it yet.
• 17:58
  SPEAKER_00: And so having to deal with all of our varying levels of knowledge, um, anyone's various levels of knowledge with using the agent and how to provide the right information and then you know, having these separate kinds of challenges that are faced with it.
• 18:11
  SPEAKER_00: So I think you're right, it's definitely a work in progress and requires very fast response given that we're in unprecedented times.
• 18:20
  SPEAKER_00: Yes, I agree.
• 18:21
  SPEAKER_01: Yep, unprecedented times for sure.
• 18:23
  SPEAKER_01: I have two more questions.
• 18:25
  SPEAKER_01: If we have time today, so the first here is I know that we've already touched upon some important things with pharmacy in regards to infection prevention.
• 18:35
  SPEAKER_01: Is there anything that you'd like to add for our SHA membership that is infection prevention focused with regards to COVID-19?
• 18:45
  SPEAKER_00: You know, I guess the thing I've just personally remained impressed with.
• 18:49
  SPEAKER_00: We observe this all the time amongst our pharmacists that are in the specialty knowledge bases and as well as nursing colleagues, et cetera, that get into these specialized areas of practice, with infection control, infection prevention being one of those areas of practice.
• 19:03
  SPEAKER_00: And the role that I find them falling into very frequently is in that bridging role where they really know how to get things done.
• 19:11
  SPEAKER_00: They write policies very frequently, they write protocols, order sets, et cetera, like just very much the working side of all of this great work that often comes forward.
• 19:21
  SPEAKER_00: Whereas the providers are often in that role of informing and reviewing and guiding, you know, what the content should look like.
• 19:29
  SPEAKER_00: But, you know, because providers are very busy practicing at the top of their license and seeing patients and advising various councils and in their realm, I see that our pharmacists and our nursing staff and all of the other support, they're actually bringing a lot of this stuff, kind of that whole package together when it involves drug product, is where I'm highlighting the role of the pharmacist.
• 19:50
  SPEAKER_00: And so I think that that has continued to shine through this pandemic is the facilitator role that they're able to take on and where they're able to help execute the use of a scarce resource.
• 20:02
  SPEAKER_00: And then on the advocacy side, we have ASHP out there advocating for transparency in the product because you know, pharmacy can be stuck in that middle zone of helping to ensure that the providers are receiving the education they need to receive, both with regards to how these agents should be used, but also what the federal component of it is.
• 20:21
  SPEAKER_00: I mean, people have various knowledge of where obviously the infectious disease guys are following this like night and day.
• 20:28
  SPEAKER_00: But you know, some of our frontline staff have been taking care of patients night and day.
• 20:31
  SPEAKER_00: And so they're like, just tell me the quick part.
• 20:33
  SPEAKER_00: What can I do?
• 20:34
  SPEAKER_00: What do I need to know?
• 20:35
  SPEAKER_00: Things like that.
• 20:36
  SPEAKER_00: And so I think our pharmacists are really serving in that kind of bridge role of providing key information to the frontlines.
• 20:44
  SPEAKER_00: And then I'd say, like on the clinical side, our nursing staff, we went into micro teams for our ICU.
• 20:50
  SPEAKER_00: So that means we have like extender, um, non-ICU nurses in our ICU areas that are kind of providing an extender level for the nursing staff and our clinical staff.
• 21:00
  SPEAKER_00: I think something that came forward is you know, how much nursing really is the level of peace or reassurance that the pharmacist brings when they kind of see that we're, you know, that we're reviewing things, we're on it, et cetera, they appreciate us being up there.
• 21:14
  SPEAKER_00: So as we initially had kind of pulled our pharmacists out of being in some of the hot zone areas, we're able to procure PPE and get them back in there because just having some of those face-to-face and on-site support was something that our nursing staff has placed high value on.
• 21:31
  SPEAKER_00: And I'm very thankful that our leadership has been so supportive of the role that we've always had, as well as our providers, et cetera, that have helped advocate for us having all of the appropriate PPE.
• 21:43
  SPEAKER_00: I think very quickly you think, well, pharmacists don't need to be here.
• 21:46
  SPEAKER_00: Well, until we're not there, uh they're like, oh my goodness, you were doing all our medication prep at that code.
• 21:51
  SPEAKER_00: You're like, uh huh, yep, we'll be back.
• 21:54
  SPEAKER_01: So yes, I think those are all great additions.
• 21:57
  SPEAKER_01: And one thing I'd like to add too is Shay is all.
• 22:00
  SPEAKER_01: Focused on antimicrobial stewardship.
• 22:02
  SPEAKER_01: So pharmacists continue to play key roles in antimicrobial stewardships that we we did before the pandemic that are also still very valuable and very important.
• 22:11
  SPEAKER_01: So we've played a good role in evaluating our antibiotic treatments for pneumonia in patients with COVID-19 and helping make some of those nuanced decisions about risk-benefit of continuing or stopping therapy.
• 22:26
  SPEAKER_01: And also, we've tried to focus on can we consolidate drugs so that the nurse enters the room less frequently?
• 22:34
  SPEAKER_01: You know, can we optimize our dosing or the timing of administration?
• 22:38
  SPEAKER_01: Or even better, if they don't need the antibiotic anymore, we could get rid of that entirely and then not have to have those additional room entries.
• 22:44
  SPEAKER_00: And oh my goodness, that's such a good point because definitely not having to re-enter and shifting timing around, you're absolutely right.
• 22:53
  SPEAKER_00: I think this has been such an amazing time for you know for our various learners.
• 22:58
  SPEAKER_00: Um so we have a PGY2 that's um in, you know, in doing an infectious disease, PGY2 resident.
• 23:05
  SPEAKER_00: And so we've seen a lot of support from ASHP in kind of helping us manage our residency programs during this time and able to redirect because you know, they might not do be doing their traditional learning they were doing before, but oh my goodness, like what a time to be learning, be a learner.
• 23:22
  SPEAKER_00: I mean, hopefully this is a once in this is the first in my career of 20 years.
• 23:26
  SPEAKER_00: And so it's been exciting to see the role that the learners have.
• 23:30
  SPEAKER_00: So our animacrobial stewardship folks have been so invaluable in helping with, you know, obviously all of the things from death severe and COVID, but also just managing, you know, remember we're doing all this on top of our normal daily business.
• 23:43
  SPEAKER_00: So still managing the things you mentioned, like how do we take care of pneumonia?
• 23:47
  SPEAKER_00: We pivoted in our emergency department, and we've always had support from our antimicrobial stewardship pharmacists on this, but in our whole subcommittee.
• 23:55
  SPEAKER_00: But we do all of the culture callbacks out of our ER, which I know is a common thing at many academic emergency departments.
• 24:01
  SPEAKER_00: And obviously, hospitals were faced with how do they give response, how do they follow up with their patients that are COVID positive.
• 24:09
  SPEAKER_00: We initially they had various teams working on this, but in our ER, for example, it was identified that pharmacists already had a very well-laid role on how we call back on strep throat, neurocultures, things like that.
• 24:22
  SPEAKER_00: That's all protocols that we've developed internally.
• 24:25
  SPEAKER_00: So we partnered with infection control and began calling back our positives that were discharged out of the ER.
• 24:30
  SPEAKER_00: So we call back and do all of the counseling.
• 24:32
  SPEAKER_00: And if we need to partner with an interpreter, and if we can't reach them, how do we send them education and a note and get them alternative housing?
• 24:40
  SPEAKER_00: And then that's where we partner with social work.
• 24:42
  SPEAKER_00: So I think with a word you've probably heard me say is partner, and we do partner with a lot of people.
• 24:48
  SPEAKER_00: Um, there's just so many people behind the scenes that help to successfully care for the one patient.
• 24:55
  SPEAKER_00: The only other person I wanted to just call out or team that might not come forefront is our formulary management team here, or many people might call like your drug info pharmacist.
• 25:06
  SPEAKER_00: We have one here that has been make following tracking boards on so we could watch our utilization of just common antibiotics as we brought our surgeries back online so that we could do surgical prophylaxis, as well as all our ICU medications and things that we, you know, we worried about.
• 25:22
  SPEAKER_00: But for the minute that hydroxychloroquine was an issue, we began um, you know, tracking, watching that.
• 25:27
  SPEAKER_00: So he has made some of the most phenomenal Excel sheets that I've seen with, you know, various different trending graphics and things like that, so that we could report those on a weekly basis to our incident command structure.
• 25:40
  SPEAKER_00: And so, you know, that's hours of work put into one summary graph.
• 25:44
  SPEAKER_00: So I've been very appreciative of that.
• 25:46
  SPEAKER_00: And that's been helping inform people like our animal group and all of our frontline staff on where we're at and when do we need to pivot.
• 25:53
  SPEAKER_00: We had to pivot last week on our neuromuscular blocker approach because we didn't have adequate inventory to continue with the agent that we had.
• 26:01
  SPEAKER_00: So just the additional things that I kind of wanted to emphasize as far as the role of the pharmacists, many of our pharmacist support that we've had.
• 26:10
  SPEAKER_01: Thanks, Katie.
• 26:11
  SPEAKER_01: Yeah, that's great.
• 26:12
  SPEAKER_01: I think hopefully we haven't forgotten any key pharmacist group.
• 26:15
  SPEAKER_01: Clearly, pharmacists are so integral in so many different ways.
• 26:18
  SPEAKER_01: We've already gone over their response and codes, antimicrobial stewardship, ED culture callback, the care of our patients on the ICU and floors and preparing medication and shortages and drug information.
• 26:30
  SPEAKER_01: I mean, I think there's just a lot of value that the pharmacist adds to this COVID-19 pandemic.
• 26:37
  SPEAKER_01: And partnering is probably the perfect word for it.
• 26:39
  SPEAKER_01: Really partnering with pharmacy, I think, is the way that we can provide the best care for our patients clinically and from a safety standpoint as well.
• 26:48
  SPEAKER_01: So thank you so much, Katie, for your time today.
• 26:51
  SPEAKER_01: I've really enjoyed this conversation.
• 26:53
  SPEAKER_01: I think we've highlighted a lot of important collaborations that Shea members can have with pharmacists as this pandemic continues.
• 27:01
  SPEAKER_00: Absolutely.
• 27:02
  SPEAKER_00: Well, again, thank you for having me, and it's been really great getting to know you and being able to have this conversation for all of our healthcare partners that are out there.
• 27:10
  SPEAKER_01: Thank you very much to our speaker, Dr.
• 27:12
  SPEAKER_01: Reisbig, for joining us today and sharing your perspectives and experiences.