COVID-19 Pharmacy SNF Updates

March 23, 2020

There has been significant publicity and regulatory activity around the role of the drug Hydroxychloroquine this week.  Please see this important update regarding allowable prescribing practices in your state.

Read Update

 

March 23, 2020

Important Update on Temporary Delivery Changes

Beginning March 24th, Consonus is making temporary adjustments to our delivery methods to maximize our Infection Prevention and Control efforts.  All deliveries from Consonus will be in disposable paper bags, no signature is required upon acceptance of delivery – the driver will simply record the name of the recipient, and returns will be sent in pharmacy provided plastic bags. More details provided in the link below.

Delivery Change

 

March 19, 2020

Q: Is there any evidence that NSAIDs (non-steroidal anti-inflammatory drugs), such as Ibuprofen, worsen COVID-19 if used to manage the symptoms of pain or fever?

A: No. The World Health Organization (WHO) clarified recent guidance on ibuprofen. There is currently no strong scientific evidence that ibuprofen, or other NSAIDs, can make COVID-19 worse.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, ““I have not seen any firm data to indicate there is a problem or prove there is not a problem”. He also said physicians widely believe acetaminophen (Tylenol) is best for reducing a fever, if that is the primary goal of the treatment.

NSAID use is often limited in the older population related to known side effects and risks (bleeding, peptic ulcer, increased blood pressure and kidney injury) that often outweigh the benefits. Current advice includes that these medicines are used at the lowest effective dose for the shortest possible period.

If your patient is already taking Ibuprofen, or another NSAID, to manage conditions such as rheumatoid arthritis or other chronic pain, we do not advise stopping out of concern about COVID-19.

As with all medication research in context of the pandemic, it is constantly evolving. If you have any questions around the use of NSAIDs or other medications, please contact your consultant pharmacist.

March 18, 2020

Today’s update applies to both Skilled Nursing Facility (SNF) and Assisted Living Facility (ALF) Customers: 

Q: Are there any approved treatments for COVID-19 today?

A: No. Some specific treatments are under investigation and will be tested through clinical trials. The World Health Organization is helping to accelerate research and development efforts with a range of partners. None of the investigational therapies are proven, but literature is evolving quickly. Currently, we do NOT recommend folding any of the investigational therapies into practice. Some of the options that are under investigation are:

  • Hydroxychloroquine (Plaquenil)/ Chloroquine– best known for its use in rheumatic diseases/malaria, being investigated for activity for coronaviruses
  • Antivirals (oseltamivir)– no antiviral drug has been proven to work against COVID-19 in humans, although many randomized controlled trials are ongoing
  • Remdesivir (GS-5734, RDV) -not FDA-approved and is available for investigational use only. It is a nucleotide analog antiviral
  • Corticosteroids– are not recommended as part of treatment for COVID-19 unless other indications exist
  • Nebulized bronchodilators- may risk spread of the virus, in general meter dose inhalers (MDIs) are preferred. Ask your pharmacist for guidance.
  • Antibiotics- are generally NOT recommended
  • Empiric neuraminidase (NMD) inhibitor- Data does not support use for COVID-19
  • HIV therapies-Lopinavir/ritonavir (Kaletra)- under investigation
  • Tocilizumab (Actemra) – inteurlukin-6 (IL-6) inhibitor being investigated for cytokine storm associated with severe COVID-19 disease
  • ACE-inhibitors/ ARBs (angiotensin-receptor blockers)- no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-I or ARB medications

Resources for ongoing studies and drugs in the pipeline:

https://clinicaltrials.gov/

https://www.idstewardship.com/coronavirus-covid-19-resources-pharmacists/

https://www.empr.com/home/news/drugs-in-the-pipeline/pipeline-investigational-therapies-for-covid-19/

If you need additional information on these investigational therapies, please contact your Consultant Pharmacist.

March 16, 2020

Consultant Pharmacist Visitation Update:

With the new guidance restricting visitor access to all facilities our consultants are leveraging technology to provide services remotely for our customers. To help prevent and control the spread of COVID19 we are eliminating all non-essential visits. Pharmacists will be completing MRR (medication regimen review) off-site using Electronic Health Records/MARs and participating in IDT meetings via teleconference or webinar options.

For communities that do not have remote chart access or paper charts, we will work with facility leadership on a plan to provide a modified service to ensure compliance with MRR regulations during this National State of Emergency. We understand the consultant services are essential to patient safety and we don’t want to lose focus on the importance of medication management in addition to infection control. In addition to the scheduled MRR, we will continue to provide admissions reviews (aMRRs) for SNFs and interim reviews (iMRR) on demand to meet patient needs.

Consultant Nurse Visitation Update:

In line with the pharmacist visitation policy, the nurse will also be leveraging technology to support you and your team. The goal of the nurse consultant team, is that there is no disruption to your normal consulting schedule. The Consonus Nurse Consultants are well versed in eHR’s and can assist with monitoring your health record, while you are focused on patient and resident care. The nurses are also available to do education via webinar and answer any questions related to pharmacy processes that you may need clarification on. Please don’t hesitate to reach out to your consultant team for any question and ideas on how they can support your patient care efforts.

 

March 12, 2020

Consonus Pharmacy’s Regional Director of Operations, Teri Ferriera, is a featured presenter in ASCP’s free webinar “COVID19: Latest Guidance from the Front Lines” on Friday, March 13th.

Hear from the Teri and other pharmacists and health professionals helping to care for some of the nursing facilities in Washington State and around the country already hit hard by the coronavirus.

Watch LIVE at 12:00pm ET on March 13 at ASCP.com/disaster or ASCP.com/LinkedIn.

There is NO pre-registration for this webinar.

 

March 10, 2020

Q: Do I need to notify the pharmacy if we have suspected or confirmed cases of COVID-19 within our facility?

A: Yes. Consonus Pharmacy is taking every precaution to reduce the spread of COVID-19. If you have a suspected or confirmed case, please reach out to your consultant nurse, pharmacist or call the pharmacy directly. Upon the receipt of this information Consonus Pharmacy will elevate the pharmacy infection control policy to Level 4, which includes more intensive precautionary steps in order to keep our patients and staff safe and our operations and customer facilities void of contaminants.

Q: Can the pharmacy provide COVID-19 Test Kits to clinicians?

A: No. The CDC indicates as availability of diagnostic testing for COVID-19 increases, clinicians will be able to access laboratory tests for diagnosing COVID-19 through clinical laboratories performing tests authorized by FDA under an Emergency Use Authorization (EUA). Clinicians will also be able to access laboratory testing through public health laboratories in their jurisdictions.

Q: Are there any antiviral medications recommended to prevent or treat COVID-19?

A: No. There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat COVID-19.

However, those infected with the virus should receive appropriate care to relieve and treat symptoms, and those with severe illness should receive optimized supportive care. Some specific treatments are under investigation, and will be tested through clinical trials. World Health Organization is helping to accelerate research and development efforts with a range of partners.

The FDA is aggressively monitoring the market for any firms marketing products with fraudulent COVID-19 diagnosis, prevention or treatment claims. The FDA will use every authority at their disposal to protect consumers from bad actors who take advantage of a crisis to deceive the public. Refer to trusted sources for information, such as CDC, FDA, WHO or contact your pharmacist with questions.

 

March 4, 2020

IMPORTANT UPDATE FROM CONSONUS PHARMACY

Consonus Pharmacy is committed to keeping your staff and residents safe.  This Frequently Asked Questions update addresses common inquiries that we’ve been receiving regarding the impact of Coronavirus (COVID-19) on your pharmacy services.  The news is changing rapidly.  We will send new updates as conditions change.

Date:  Information based on status at 5 PM PST, March 4, 2020.

Q:  Do any of the sites served by Consonus currently have verified cases of COVID-19?

A:  No.

Q:  Will the pharmacy have a shortage of meds? How should we ensure meds are available?

A:  There are no indications that medication supplies will be negatively impacted at this time.

Consonus Pharmacy sources our medication supply through?Cardinal Health, one of the three largest distributors of medications in the U.S. We are in constant contact with their team as they monitor the impact of Coronavirus on the world’s drug supply chain. At present, there is no immediate direct threat to availability of medications. There are some raw material suppliers in the area of Wuhan, China, but the overall supply chain has not been negatively impacted. None of Cardinal’s generic products come from these sites. Cardinal has been proactively monitoring the situation for the last month, and they have worked with suppliers to secure additional safety stock. We will continue to monitor and will advise if the supply situation is impacted in any way.

Q:  I have families requesting a private purchase of a 1-month extra supply.? If we ask for costs and place an order on their behalf do you recommend this?

A:  Current conditions do not merit advance purchase of medication supply.

There have been advisories published in the media that recommend advance purchase, but those are aimed at members of the public not currently residing in care settings with medication management practices in place. We can accommodate this request if it is important for peace of mind to a resident, but it is not something we recommend at this time.

Q: Are any delays in pharmacy services anticipated? 

A: No delays in pharmacy services are expected at this time.  We remain fully staffed, and delivery services are operating on usual timelines.

Q: What safeguards are being put in place to ensure uninterrupted pharmacy service?

A: Consonus is equipped and staffed to sustain a 24-7 operation.  We have a full Emergency Preparedness plan in place and have initiated escalated hygiene practices to help prevent transmission of COVID-19.

Q: Will my Consulting Pharmacist or nurse visits be impacted?

A: Consultants who might pose a risk to facility staff and patients will not visit served facilities.  Ideally, we have remote access available to your EHR system in place and can continue full service without interruption.  If you would like to take further steps to arrange remote access, please contact your consultant to arrange.  The full policy is:

  • Consultants that are sick should not visit facilities and notify supervisor
  • Employees who have symptoms of acute respiratory illness?(cough, shortness of breath, sore throat)?are recommended to stay home and not come to work until they are free of fever (100.4° F [37.8° C] or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing?medications
  • Consultants?should refrain?from visiting the buildings for non-essential reasons
  • Consultants should not work in facilities that are having a respiratory outbreak
  • Before?visiting a facility,?Consultants should contact facility leadership?on the same day?and ensure there are no respiratory outbreaks?or surveillance for outbreaks
  • Consultants should monitor?e-mails daily?for pharmacy communication regarding?infectious disease outbreaks in?facilities
  • Before entering a building,?Consultants should monitor for signs posted outside?to notify the?public of any respiratory outbreak
  • If consultants are working in a facility?and become?aware of documented respiratory outbreaks or surveillance for respiratory outbreaks, they should leave the facility?and reschedule the work or complete remotely if possible
  • If consultants have the option, they?should?complete?reviews remotely with electronic health records
  • Recommend technology to attend IDT meetings (zoom, webinar, conference calls)
  • If?remote reviews are?not an option?and the review/meeting cannot be postponed, please contact your supervisor?for guidance
  • Before?consultants?travel, they should check the?CDC’s Traveler’s Health Notices for the latest guidance and recommendations?and consult supervisor
  • Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

Q: Can we purchase protective gear (PPE) (i.e. masks (surgical/procedural/N95, gloves) through your pharmacy?

A: Consonus does not currently have enough to distribute.  Those products are on allocation, which tends to lock supply down to existing business relationships.  Facilities should work closely with their current medical supply provider to maximize your allocation of PPE products.  Consonus will continue to effort through our industry contacts to secure PPE product, but none is available at this time.

Q: Can Consonus assist with the logistics of getting staff fitted for N95 masks?

A: Consonus does not provide N95 mask fit testing services.  However, our research has found that many area hospital systems offer this service as part of their Occupational Health service. While some of these hospital systems only provide this service to staff, many have opened their doors to outside companies for fit testing services.

Additionally, many private companies, such as Concentra, have locations found throughout the Consonus footprint and are willing to schedule these services after connecting with their team.

Q: What additional steps is Consonus taking to reduce the likelihood of transmission between the pharmacy and facility?

A: Consonus escalated to Level 2 in our Hygiene Policy.  That policy focuses on practices in the pharmacy and our direct interactions with facility and community staff and patients.  All steps in that policy are designed to reduce the likelihood of transmission of infectious agents between the pharmacy and all points of service.  Level 2 practices include delivery drivers with PPE gloves that will be disposed after each delivery drop, and tote cleaning procedures to disinfect returned pharmacy totes.  We recommend that e kits and Cubex cubies remain in the medication room when not in transport to and from your facility.

Care facilities should be diligent about executing your internal infection control policies and engage in thorough communication with your staff to gain adherence to basic hygiene practices recommended by the CDC.

Q: Do we need to proactively get providers orders?

A: Continue to follow standard practices for managing medication orders.

Q: What can we focus on to reduce the chance of Emergency Room visits?

A: Reducing the chance of Emergency Room visits can prevent bringing illnesses back to the community.

  • Confirm that you have a COVID-19 Admission Policy based on current guidance from CDC, Health Department, and AMDA Guidelines
  • Review if your providers have a Physician/NP provider decision-making protocol or tool for SNF/ICF, ALF and residential patients with COVID-19
  • Follow protocols from CDC, DHS, and ACHA for best practices for preventing the spread of the COVID-19. Be in close contact with your local and state health department and monitor the CDC COVID-19 website for the latest information as public health guidance will shift as the outbreak evolves.

 

March 3, 2020

 

Consonus Pharmacy sources all our medication supply through Cardinal Health, one of the three largest distributors of medications in the U.S. We are in constant contact with their team as they monitor the impact of Coronavirus on the world’s drug supply chain. At present, there is no immediate direct threat to availability of medications. There are some raw material suppliers in the area of Wuhan, China, but the overall supply chain has not been negatively impacted. None of Cardinal’s generic products come from these sites. Cardinal has been proactively monitoring the situation for the last month, and they have worked with suppliers to secure additional safety stock. We will continue to monitor and will advise if the supply situation is impacted in any way.