COVID-19 Efforts Q1 2020

In the later portion of 2019, reports of a novel coronavirus were being reported in Wuhan, China. SARS-CoV-2 is a contagious respiratory infection that is spread through respiratory droplets when an infected person is in close contact with another person. Our entire organization watched the news footage each day that showed healthcare providers in heavy duty PPE take care of patients that were lining the halls – filling hospitals at rates that just could not be managed. Cities were shut down and we learned about quarantines, citywide lockdowns and social distancing. But until late February, SARS-CoV2 seemed a world away until cases were reported in the United States. The first NJ COVID cases were reported in Bergen County in early March 2020 and then proceeded to exponentially increase. New Jersey Governor Phil Murphy declared a state of emergency on March 9th and on March 10th the first known COVID death occurred in New Jersey. Non-essential businesses and schools closed as a state-wide stay at home order was issued. Large swaths of the population began working from home to help slow the burden of disease and impact to hospitals as providers scrambled to ascertain how to treat patients with this deadly disease.

With a quickly rising tide of fear and uncertainty on many fronts, the RWJBH Pharmacy Enterprise chose to act in unison to face the known and unknown challenges that the COVID-19 pandemic would present to our organization. Our hospitals, in particular the critical care and emergency departments were seeing rapid increases in demand for services. Facilities had to become creative in converting existing patient care areas, conference rooms and cafeterias into makeshift critical care areas. Teams across the system innovated to ensure patients could be taken care of safely. Our team members worked with nursing and respiratory colleagues to adjust medication administration times to limit the number of times a patient’s room would need to be accessed. Due to the significant amount of personal protective equipment (PPE) needed a nationwide shortage of PPE quickly emerged. Across the country, healthcare providers had to reuse PPE to take care of patients and to prepare medications – a practice that was never done previously, as there were severely limited supplies. The system worked diligently to try to obtain PPE for providers. Our teams worked with the NJ Board of Pharmacy to apply for waivers to work outside established practices so the pharmacy departments could continue to prepare medications despite not having adequate PPE. The Corporate Pharmacy team worked to receive donations of advanced PPE called PAPR along with other greatly needed items such as propofol for sedating the sickest patients and Oxygen concentrators. Patients were so ill that our supplies of something as simple as oxygen were extremely limited. Rapid increases in use and subsequent shortages of many necessary products for care of the critically ill patient were encountered. Ventilators and the medications needed to keep patients safely treated while on mechanical ventilation were being used at never before seen rates. PPE, ventilator and drug shortages caused non-emergency surgeries to be put on hold as there was not adequate medication and supplies to treat non-emergency surgical cases across the system. Even while not serving their intended purpose, operating rooms and PACU areas were turned into much needed COVID ICU’s which further contributed to patients holding off on surgeries as much as possible.

Pharmacy leaders quickly mobilized and began meeting daily to update policies and procedures, address drug procurement issues and disseminate treatment guidelines. The central warehouse was activated and central purchases were made to ensure supply of medications for the most critically ill patients. The Pharmacy Enterprise Buyers council met weekly to address supply needs. The clinical council increased frequency of their meetings to share issues encountered for shared learning across the system as well as evaluate the rapidly emerging literature on treatments. COVID patients flooded the EDs and acute care facilities in the northern regions to begin with and then slowly increased at sites across the state. Pharmacy leaders across the enterprise redesigned their staffing models and workspaces to avoid the very real possibility of an outbreak within a department completely immobilizing provision of pharmacy services. Workstations were distanced and work teams were developed to minimize staff exposure to outside groups. Contingency plans were created to establish rapid succession plans that could be implemented in the case members of pharmacy teams became
temporarily or permanently unavailable to fulfill their responsibilities due to COVID.

Guidelines and treatment recommendations were changing almost daily because of drug shortages and new clinical evidence. A system wide inventory and utilization tracking tool was developed. With this information, it allowed the corporate team help sites pivot between products and utilize the medications that could be procured through the central warehouse. Teams of physician and pharmacy specialists reviewed literature and published treatment guidelines weekly for months as drug availability and clinical evidence changed. The systems medical and pharmacy leaders chose to align with NIH and IDSA treatment recommendations to ensure a consistent approach and guidance for alternative medications were created and reworked continually to provide the front line staff with the most current information available. The Corporate Pharmacy team worked with pharmaceutical industry appeal boards, garnering information on actual use of medications to advocate for increases in allocation of all the scarce resources. Our pharmacy residents helped to research alternatives to the FIT testing solution needed to check that the new PPE masks we were able to obtain worked to protect our team members. They were able to procure an available product and compound the FIT testing solution to allow for testing of an additional 40,000 employees. Outside of our organization herculean efforts were being made by pharmaceutical companies to rapidly create therapies to treat COVID-19 infections and vaccines to prevent infection – two key elements of getting the pandemic under control.