Posted on March 19, 2020
As the number of cases of COVID-19 continue to rise in the US, healthcare facilities are being challenged to meet the surge in demand. There is no antiviral treatment available to manage this particular infection, and in talking with other stewardship pharmacists, it feels at times we are quite helpless as the crisis unfolds.
But thinking about this more, there ARE some things we can start doing to help our colleagues.
While the FDA has not announced any significant drug shortages as of this writing, and I would be delighted to see none emerge in the coming days, nevertheless it would be reasonable to start conserving your pharmaceutical inventory to prepare for the influx of patients. Sourcing raw ingredients, decreased manufacturing capacities due to an ill workforce, increased demand, and global transportation/logistic interruptions all present risks to our pharmaceutical supply chain. As mentioned above, while we do not have antiviral treatment for COVID-19, inevitably some patients will develop secondary bacterial infections who will require antimicrobial therapies.
Maintaining a solid inventory involves looking at supply and flow rate. I am not advocating hoarding to exacerbate interruptions in the supply chain, so instead let’s look at the flow rate. The work to be done here is what we excel at: continue to focus on duration review and de-escalations. Review your patients to see if the continual use of antimicrobials are necessary, a vial of vancomycin not used today is a vial you can save for someone in need tomorrow.
While we are not trained as Infection Preventionists, we do look at the same clinical data and speak the same vocabulary. They are understandably busy during this period. Reach out and see if you can help them identify any patients who no longer need to be isolated (e.g. reviewing culture/diagnostic results, work up colonization history, etc) to conserve the use of personal protective equipment (PPE). Familiarize yourself with your hospital’s infection control policies and protocols for discontinuing isolation. Help your physicians and nurses understand and interpret them, and make the recommendations as appropriate. Your IPs will thank you for fewer phone calls from front line clinicians.
The national anxiety level is understandably high, and every cough or illness will trigger an internal alarm. Given the inadequate testing capacity at the moment, it is important to help educate people on the signs and symptoms of COVID-19. Consider what you can do to educate your professional peers, friends, families, and neighbors. Let’s keep the “worried well” from overwhelming the emergency rooms and hospitals. In communities with widespread transmission and limited hospital capacities, you can help educate people how to self manage this illness at home and keep everyone safe. Simple patient counseling 101, we’ve trained for this. Here’s a free resource from UpToDate to help guide those patient discussion. Let’s step up and help our colleagues in other disciplines.
Written for clinicians