Medication bundling service for COVID-19 management

By Anjana Sengar and Trupti Kulkarni

At the onset of the global pandemic, healthcare systems were overwhelmed with the global shortage of personal protective equipment (PPE). Organizations like the World Health Organization, the Canadian Cardiovascular Society, and Ontario Health all issued recommendations to facilitate optimal PPE availability and to reduce in-hospital spread of COVID-19. These guidelines advised minimizing the number of times healthcare workers need to enter a patient’s room. One strategy to achieve this is to bundle or cluster healthcare activities.

Trillium Health Partners (THP) is one of the largest health systems in Canada. It is situated in the Peel Region of Ontario, which has seen a large proportion of COVID-19 and patients under investigation (PUI) admits since March 2020. For patients admitted with infectious diseases and requiring isolation, standard practice at our hospital did not include having medications reviewed specifically for medication bundling. With the guidelines for minimizing spread and optimizing PPE in mind, the pharmacy department identified a need to focus on bundling medication management at our organization. Through this initiative, we aimed to optimize the safety of healthcare workers (primarily nurses) by decreasing unnecessary exposure. We also intended to enhance the safety of patients through improved traffic control, thus reducing the risk of in-hospital transmissions and conserving hospital PPE supply.


Medication bundling is a pharmacist-led initiative at THP which includes holding non-essential medications and reducing the dosing frequency of medications by considering extended-release products. We also synchronize medication administration with procedures or meals, in consultation with the patient’s nurse, and we reassess the frequency of blood work required for therapeutic drug monitoring. Pharmacists review all requests for drug levels and prioritize them based on urgency.  We recommend drawing level at the same time the nurse would be entering the room for other bloodwork or care. Clinical pharmacists at THP are able to perform these duties under a pharmacist clinical scope of practice policy our organization recently implemented. (See “Pharmacists’ clinical scope of practice.”) This initiative has been well received by both nursing staff and pharmacy staff.

Like other frontline healthcare workers, during the pandemic pharmacists have had to find ways to rapidly respond to the needs of their patients and their colleagues.  Despite the added workload, these innovations gave pharmacists a deep level of satisfaction, knowing they were actively contributing to the safety and well-being of their patients and fellow health care providers.

 

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