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COVID-19 Changes Complicate Efforts to Assure Medication Safety

Ensuring medication safety is one of the primary goals of pharmacists, but the COVID-19 pandemic and related changes to the healthcare system are making that more difficult than ever. Find out what pitfalls the AHRQ has identified that make pharmacists jobs more challenging during the novel coronavirus outbreak.

BETHESDA, MD – Pharmacists might be having a more difficult time ensuring medication safety because of the COVID-19 pandemic and the response of the healthcare system, according to a new perspective article.

The report from the Patient Safety Network of the Agency for Healthcare Research and Quality (AHRQ) point out that challenges associated with medication shortages, changes to the pharmacy workflow, an evolving evidence base associated with the pharmaceutical treatment of COVID-19 complications and limited availability of personal protective equipment (PPE) all are factors.

“Medication safety and the prevention of medication errors is always one of several priority safety concerns for pharmacists when treating patients across care settings,” write authors from the American Society of Health-System Pharmacists and colleagues.

The article points out that that medication error can include any of the following:

• Patient receipt of the incorrect prescription (e.g., receiving the wrong drug or the correct drug but at the wrong dosage),
• Harmful drug-to-drug interactions and
• Errors in medication preparation or delivery.

Those can result in adverse drug events or other undesirable outcomes associated with medication use, including allergic reactions, side effects, and overmedication.

One of the biggest problems relates to medication shortages during the COVID-19 pandemic, which are expected to worsen. “Shortages are primarily being felt because of two unique scenarios driven by this unprecedented global situation,” according to the authors. “The first is the sudden, rapid influx of patients with COVID-19 symptoms into the healthcare system. The most serious of these cases require mechanical ventilation, leading to a much higher demand for the medications used in this process.”

In some cases, drugs used to treat other conditions, such as lupus and rheumatoid arthritis, have been proposed by medical researchers as potential treatment options for virus symptoms, leading to medications shortages, according to the article, which states, “However, this is becoming less frequent as evidence surrounding other treatment options is becoming more established.”

At the same time, the authors warn of disruption to the global supply chain resulting from decreased or suspended drug exports from manufacturing locations overseas, notably from India and China. They caution, “While in many clinical settings pharmacists are assisting in developing treatment algorithms to decide how to ration medications, such as remdesivir, for the hospitalized patients, these medication shortages may also force pharmacists to recommend second- or third-line treatment options with which they are less familiar, may be less effective, and/or have more side effects.”

The report emphasizes that, while pharmacists are the best-positioned professionals to ensure safety through the preparation, delivery, and ongoing management of medications, like most healthcare providers, they have faced upheaval in workflow and operations due to COVID-19. For example, the writers point out that ICU bed expansion and providing care in non-traditional hospital settings, such as surge hospitals set up in convention centers and university arenas, have forced pharmacists to change how they do their jobs.

Other issues are increased informatics and technology changes, as well as decreased workforce, as pharmacy employees are forced to work from home, are sick or are furloughed.

Finally, the report discusses the challenges faced by pharmacists because of shortages of products such as hand sanitizer, gloves, and face masks. “In addition to their direct patient interactions, pharmacists use this equipment when preparing sterile products for intravenous administration (such as those used in the ventilating process or in many cancer treatments) to ensure the medication remains sterile,” the authors note. “With a finite supply of PPE, it is critical to consider how health systems allocate this resource to ensure the safety of all staff and the patients they are interacting with.”