What changes should pharmacies make to ensure the safety of both staff and patients? We look at what some are already doing and get expert advice
A new reality across all pharmacies is having to update workplaces, teams, schedules and more based on the COVID-19 threat.
But what really needs to be done? As the crisis is ever-evolving, with most pharmacies doing the best they can to keep up, we share some advice from the PSA’s webinar on pharmacy layout and protection from Wednesday night.
Webinar guest Chris Campbell, who is PSA Queensland branch president and Professional Practice Manager across TerryWhite Chemmart’s 450 pharmacies, said changing the pharmacy environment to enforce social distancing “is now a minimum expectation of patients when they come in”.
“Markers on the ground every 1.5 metres, sneeze screens particularly with lack of PPE available … ensuring we’re making [hand sanitiser] available for both pharmacists, pharmacy staff and customers … I’m seeing in the majority of places these rules are being followed and implemented,” said Mr Campbell.
“Depending on the size of your pharmacy, you’ve got the four square metre rule to how many people can be within a space – that’s including staff,” he said.
“We’re lucky is the majority of pharmacies have gondolas breaking up some of that space and then it’s marking 1.5 metres. But it’s now a requirement to [manage] how many people you have inside the business.”
Regarding cleaning the pharmacy, Mr Campbell says the best examples he’s seen is pharmacies that have set up a cleaning roster and then tick each cleaning job off.
“At minimum, it’s the counter once an hour, all staff maintaining hand hygiene after serving a patient, for immunisation space in clinic rooms it’s cleaning after every patient – so wiping down any surfaces that they touch as it’s quite an intimate space that they’re coming into,” he said.
He added that pharmacists can a good cleaning guide from the Department of Health.
Webinar host, PSA national president Chris Freeman, brought up the suggestion of splitting teams into two and how that could work considering it poses challenges from a business point of view.
“One of the best things we’ve seen is to run through the pharmacy tasks that don’t necessarily have to occur within the pharmacy,” said Mr Campbell.
“We’re getting invoices entered in at home, we’re having lists of patients where medications have been out of stock, and so those staff members have been allocated that role to call back patients to say it’s now back in stock,” he said.
“What some other pharmacies are doing is printing off their top two or three hundred patients that they have in their dispense software and making phone calls to reach out for them. Yes, staff members if we broke them up into Teams A and B can be quite productive particularly in terms of patient care, what my worry is that whilst we’re quite good at physical distancing, hand hygiene, getting in and out nice and quick, we’re missing that opportunity to connect particularly with those most at risk.
“One of the items on our Team B – those who are not physically in the pharmacy – is that it’s not necessarily a day off for them, they’re reaching out to patients,” explained Mr Campbell.
“We also have pharmacies who stretch out the hours, so who work longer hours. We are having quite a difficult time in terms of our digital scripts – how they are arriving, the amount of paperwork that’s happening, the re-stocking of dispensaries so physically some of our staff are having to work longer hours so we’re breaking that down into two-days or three-days on split teams.”
Mr Campbell added that with faxes sent to pharmacy skyrocketing from just a couple a week on average to 200-300 per day, it’s important to assign someone a role to receive those faxes.
He also encouraged pharmacies to ensure they have a digital fax, as it’s much easier to save and sort files.
Associate Professor Freeman posed a viewer question – “if we do split our teams up, do you have any tips to manage their mental health and stress who are expected to perform the same level of service but with less resources?”
“When your team is running on skeleton staff, if that happens one or two days most pharmacists are fine. But you do that back to back to back, we know that’s going to be quite draining from a mental health perspective,” said Mr Campbell.
“What I am seeing working well in those scenarios is having someone at the front of the pharmacy almost triaging patients as they come in,” he said, adding that this reduces worry about patients not social distancing in the pharmacy.
Another suggestion was to reach out for help in the form of peer support and counselling.
“You’re on the front line, you’ve got that feeling of risk and it’s not something we’ve had to deal with before – do not hesitate to reach out,” said Mr Campbell, highlighting the availability of the Pharmacists’ Support Service.
“Any pharmacist I’d encourage to reach out, even if it’s to run through how others are dealing with the increased pressure.”
Associate Professor Freeman added that pharmacy staff should make sure to have regular check-ins with their team as a group.
“If you are separating they can themselves feel isolated particularly if it’s a group that is more isolated than others. So having regular team meetings over FaceTime or Skype or Zoom or any of those other pieces of software to make sure the team is still connected and it’s a way of actually sharing information through the pharmacy,” he said.
“You might be doing a session simply on people’s mental health and how they’re coping with this whole thing. It might not be simply a traditional staff meeting sort of thing.”
Mr Campbell said one of the best examples he’s seen was a pharmacy that ran a trivia night with the whole team – “trying to take the focus off [COVID-19] and create an environment that is a little bit safer, and enjoying the time next to people who are under the same pressure.”
Watch the replay of the PSA webinar on pharmacy layout and protection here
What are others doing?
AJP and the Pharmacists’ Support Service also recently hosted a webinar on how pharmacists and pharmacy staff can go from “surviving to thriving” during the COVID-19 crisis.
Webinar presenter Helen Lowy asked the participants to share what they had instituted in their pharmacy to encourage social distancing and ensure safety for patients and staff.
Here’s what participants said they are doing in their pharmacies:
· Cones so people don’t touch stock.
· Hourly cleaning schedules.
· Put waiting chairs outside.
· Taped out the waiting room area for 1.5m apart. Offering delivery.
· Split shifts for staff to encouraging social distancing.
· We have no waiting for scripts. 30-minute call back.
· Signs out the front to limit amount of customers in store.
· Close during quiet time to clean.
· Discuss possibility of working from home/remotely.
· We currently have no patients in the pharmacy at all, have put large tables in front of shop.
· Not letting the customers come in. We serve at the front door
· We work in TEAM A and TEAM B at different times.
· Bring own pen.
· Putting a sign stating 1.5m distance requirement.
· Removing chairs from tea room.
· Two teams of staff – they do not interact. We close the store for 10 minutes for cleaning for staff handover.
· Masking tape with squares and arrows on carpets – meeting people at door and hand sanitise. One way in and one way out.
· Increasing the number of phones to minimise sharing.
· We’ve placed crosses on floor for distance spaces. Bins in front of counters to keep customers leaning on counters. No signing scripts.
· We have hand sanitiser at the entrance (only one entrance is being used); no more than 4 customers in the shop at a time and waiting outside for scripts (encouraging them to call back). Regular cleaning of benches etc.
· We have separated the waiting chairs in the pharmacy and reduced the number of chairs, we have also increased deliveries.
· We introduced a hand sanitation station at the front entrance. Side entrance has been locked.
· We have a very small community so have stopped access into the pharmacy. Pharmacy assistants at door with a table. Reminding customers to maintain social distancing outside pharmacy.
· Cashless payments, less waiting chairs.
· Customer flow arrows.
· Reduced trading hours to clean and arrange deliveries.
· Asking people if they have actually run out of meds or if they can call back?
· Daily register for staff – who is on what phone, register, computer etc.
· Deliveries with no contact for any high-risk patients, those over 60 or on immunosuppressants.
Any readers who are distressed can call 1300 244 910 for anonymous and confidential support from a pharmacist colleague over the phone through the Pharmacists’ Support Service (PSS), available 8am to 11pm EST 365 days of the year.
For urgent assistance when PSS is not available, call Lifeline on 13 11 14.
Pharmacists can access further PSA resources on COVID-19 at https://www.psa.org.au/coronavirus/