Pharmacy Heroes

Rachel Balick

The stories of the pharmacists and pharmacy technicians who served patients and communities during the COVID-19 pandemic are crucial to staying prepared for health crises of the future. Here are the stories of two pharmacists who stood up for the pharmacy community and patients.

A pharmacy provides COVID-19 testing for its underserved community

If you’re seeking health care in Surgoinsville and Hawkins counties in Tennessee, there’s basically one game in town: Surgoinsville Pharmacy.

That imbues Surgoinsville Pharmacy’s owner and chief pharmacist Beth Bryan, PharmD, with a deep sense of responsibility.

“I have a unique space in the pharmacy because [the area does] not have health care—it’s something I’ve tried to get here for almost a decade,” Bryan said. “About a year ago, I restructured some of the pharmacy, creating about a 600-square-foot clinic space. We have a couple of exam rooms, a restroom, and an exit door.”

Within that clinic space, Surgoinsville Pharmacy staff perform several CLIA-waived point-of-care tests. “We started with doing strep and flu because we have a couple of schools and some industries nearby, so it made sense in our area,” Bryan said. The pharmacy also provides or is preparing to provide tests for UTIs, anemia, and A1C, the latter as part of a diabetes prevention and education initiative Bryan is working to get off the ground.

So when COVID-19 started hitting the United States, Bryan explored how she could use her pharmacy to help fight the pandemic. To get started, Bryan reached out to the local health department.

“That’s when we discovered the need for testing in our area. We had a shortage of tests, and we had a shortage of testing sites.” Surgoinsville Pharmacy had already been working with an area university for a month to get a collaborative practice agreement going, but when the U.S. Office of the Assistant Secretary of Health—a division of the U.S. Department of Health and Human Services (HHS)—issued guidance authorizing pharmacists to order and administer COVID-19 tests, the agreement was no longer necessary.

“We did check with our state laboratory board. We had an [established] relationship with a lab, and as long as we are working with the lab and doing the tests according to their protocols, then we’re fine,” Bryan said. “Once we do antibody testing, though, we will need to [tell the Tennessee State Board of Pharmacy]. But as long as we’re following the lab protocols, then the state laboratory board is okay with that.”

The pharmacy does not handle the actual testing—it leaves that to the lab it works with. “We are using the nasopharyngeal swab—we’re only collecting the sample from the patient, and then we send that off to the lab,” Bryan said. The lab reports the results to the pharmacy, and Surgoinsville staff then counsel patients.

Bryan said the pharmacy never could have gotten up and going without support from the community. “We wouldn’t have N95 masks if it hadn’t been for the community donating them. The fire chief got us our Tychem suits so we would have protection,” she said. “We can wash and reuse those until they expire. So, it’s been a collaboration from a lot of people.”

The pharmacy’s set-up was perfect for drive-up specimen collection. Outside, they put up a tent large enough for a car to park under.

“We sealed off from the rest of the pharmacy one exam room, the restroom, and the exit door completely for COVID testing,” she said. “Then we go out the exit door to the tent outside. We can clean everything and keep it safe, and there’s nobody coming in the pharmacy.”

With every test, pharmacy staff urge patients not to return to work until they get their results, and they provide the CDC recommendations on handwashing, social distancing, and other prevention strategies.

It’s a team effort. “My staff is me, a fill-in pharmacist, and four technicians counting my clinical technician, and we are all involved.”

Patients interested in testing call the pharmacy, and staff conduct a phone screening and obtain insurance card information if available.

“The technicians help with gathering information from the phone call—we try to do everything over the phone so that the only hands-on experience with the patient is the actual collection,” Bryan said.

“I do the testing, and the technicians help me with the packaging. So, they help me from data collection, insurance collection, paperwork, all the way to making sure that everything is ready for the lab to pick up.”

The system Surgoinsville Pharmacy uses allows patients to get results fast. “Testing in our area is taking so long, and people are having to wait 2 or 3 weeks for their results to come back so they can get back to work,” Bryan said. “We’re able to get a quicker turnaround—we tell people about 1 to 3 days.”

So what happens if a patient tests positive?

“The lab will let the health department know, but it’s our responsibility to let the patient know. We have a protocol just like we do with any other point-of-care testing on how to follow up with the patient. We follow up at test results day 7 and day 14 with this particular test,” she said.

Bryan advises pharmacies looking to launch similar efforts to research the regulations and rules in their states and think hard about how testing is going to affect their workflow.

“Are they ready for how it’s going to affect their technicians and how they’re going to utilize their staffing? And I would think about personal protective equipment [PPE],” she said. “If they don’t have access to PPE, there’s no way I would do COVID testing. I would consider how you’re going to clean everything, and to make sure you’re going to have the proper cleaning supplies.”

And don’t expect to make a big profit on it—not yet, anyway. Bryan thinks of her program as a community service.

“This is not a huge money-maker right now, but I do think this is a waymaker for professional development. We’ve been screaming that we need provider status, and then here HHS comes out and hands us this on a silver platter,” Bryan said.

“I think we should take this as an opportunity for professional development and a gateway into the antibody testing that will come. I think we should consider workflow changes, I think we should consider using the appointment-based model, I think if you’re not doing med sync already, then that should be something you should consider in your workflow so that you have the time to do the appointment-based model,” Bryan said.

“I think we should still continue to try to get provider status on a federal level so that we can get paid to do these services just like any other health care provider.”

A weary workforce finds virtual camaraderie online

Stephen Meyer, PharmD, of Sycamore Hills, an independent community pharmacy, had his own scary experience with COVID-19 relatively early in the crisis. It inspired him to become an  advocate for robust mitigation strategies for the public health emergency’s  duration.

“We had a pharmacy technician who came into contact with two presumptive positive cases,” Meyer said. 

Neither the technician nor the presumptively positive people she had come into contact with qualified for COVID-19 testing, as testing was still quite limited at the time. “That provided quite a bit of anxiety and strain on my family and my staff,” Meyer said.

Sycamore Hills shifted to curbside-pickup-only in mid-March. Meyer knew he was sacrificing OTC revenue, but thankfully, the pharmacy already had free courier services, and patients respected the decision to be cautious. Meyer quickly became a proponent for similar measures at all pharmacies, even appearing on local news outlets to speak out about pharmacies that he viewed as acting irresponsibly toward patients and staff.

Meyer feared that pharmacies could shift from a hub for wellness to a hub for viral transmission, threatening thousands of lives. He started a Facebook group called “Ohio Pharmacy Staff for COVID-19 Support,” which he hoped would lead to change in his home state.

“Within 2 days I realized I wasn’t aiming high enough,” Meyer said. He removed “Ohio” from the name and modified his mission statement to reflect a nationwide goal to keep pharmacists and pharmacy staff—as well as patients—safe from COVID-19. The page quickly took off and now has more than 40,000 members from across the world.

Meyer credits a team of administrators and moderators for the Facebook group’s success.

“It started with me, but within a few days we had added Eric Geyer, PharmD, host of Political Pharmacist Podcast and a community pharmacist at a large chain, and Jackie Boyle, PharmD, blogger at The Happy PharmD and associate professor and assistant dean of student success at Northeast Ohio Medical University College of Pharmacy (NEOMED),” he said.

The group has since added to the team Carl Palladino, a pharmacy intern and student pharmacist at NEOMED; Abbey Agler, PharmD, clinical pharmacist at University Hospitals and assistant professor of pharmacy practice at NEOMED; Dan Arendt, PharmD, a resident at University Hospitals; and Sean Avedissian, PharmD, assistant professor at University of Nebraska Medical Center.

“They help me maintain the content in the group and have also been instrumental in helping spread our message,” Meyer said.

The Facebook group has mostly been a safe space for the pharmacy staff struggling to fight fears and keep themselves and their patients healthy, though Meyer said a few members lost their jobs after posting comments critical of their employers—something that pains him deeply.

“Most posts have been constructive, but there have also been a fair amount of cries for help. Some of the membership was disappointed in my allowing these types of posts to be posted on the page, but I think the group has been a valuable place for individuals to vent as a way to cope,” he said. “The message in its essence is that people are going to die unnecessarily if something doesn’t happen soon, so naturally there is quite a bit of fear built into some of the posts. My fellow outpatient pharmacy team members are scared, and they have a right to be.”

The primary theme of the posts on the community page is that pharmacists and pharmacy technicians want to help their patients but want to be provided the tools to do so safely, Meyer said. “For instance, what good is a checklist for hourly cleaning if you don’t have the supplies or the tech hours to accomplish the cleaning? What good is a 2-foot-high plastic sneeze guard if the patient is going to hand you a credit card to the side of it or simply be tall enough to sneeze over it?”

The group, he said, “has definitely brought people together in my profession in a way I have never seen before. It can be very empowering to hear others voice the same concerns as your own. I think of this as a mental support group in some ways.”

But the page has also fostered conversations Meyer never expected.

“I think an unintended positive consequence of the pharmacy advocacy group are the clinical discussions. I truly underestimated the power of putting a bunch of smart people in a room together,” he said. “Very early on, clinical pharmacists were sharing relevant information for COVID-19 that had nothing to do with my original idea of a group to promote mitigation strategies.”

He also noted that members of the group were instrumental in spreading the word about inappropriate prescribing of COVID-19 therapeutics like hydroxychloroquine. Several medical boards subsequently explored potential investigations into unethical practices.

As the page has flourished, Meyer and the team have adopted more sophisticated means of ensuring members are able to access the information they need.

“I began to build a topic hierarchy on the page so users could navigate to the content that they came to see. For instance, a thread about curbside delivery isn’t relevant to an inpatient pharmacist with a drug shortage issue.”

One of the topics is appreciation.

“I see uplifting posts literally every day,” Meyer said. “Any time somebody recognizes us as a profession in the public eye, a member will post about it, which I think helps everyone realize that we are not being forgotten. We have also had several mental health experts share resources to help our members cope with the intense fear and isolation.”

Meyer believes the group’s promotion of mitigation strategies could save countless lives. “I hope our industry and the professionals who make it work stay safe and are recognized for our efforts, because we deserve it—our response to COVID-19 has been nothing short of heroic.”