APhA coronavirus watch: CDC releases guidance for pharmacies and providing immunizations during pandemic

On an April 2, 2020, APhA webinar, a CDC representative announced that the agency would release guidance for pharmacists and pharmacy staff as they navigate the COVID-19 pandemic.

Lisa M. Koonin, DrPH, MN, MPH, who serves as a senior advisor in support of the CDC 2019 Novel Coronavirus (nCoV) Response, told webinar attendees that the guidance is intended to assist pharmacies on how best to provide care for patients without COVID-related disruptions. The guidance, Considerations for Pharmacies in the COVID-19 Pandemic, can be found at https://www.cdc.gov/coronavirus/2019-ncov/healthcare-resources/pharmacies.html.

CDC recognizes that pharmacies are a vital part of the health care system, Koonin said, and ensuring continuously functioning pharmacies during the pandemic is important for communities, patients, and the nation. “I know that pharmacy staff are doing everything they can to serve patients, and I want to express my appreciation and gratitude for that,” Koonin said.

The guidance covers four main topics. The first is a recommendation “making sure that pharmacy staff who have fever or any respiratory symptoms stay home and away from the workplace until they have recovered,” Koonin said. Koonin directed webinar attendees to CDC’s “very specific guidance about that on [the] web.”

The second part is about filling prescriptions. Although the actual process of preparing medications for dispensing is not a direct patient-care activity, “we know that other parts of medication dispensing, such as prescription intake, patient counseling, and patient education could expose pharmacy staff to individuals who have respiratory illness.”

In its guidance, CDC outlines steps to facilitate as much physical distancing as possible. Recommended steps include encouraging all prescribers to submit prescriptions electronically or by phone; having patients take a photo or read out loud the information on their benefit or insurance cards, so pharmacy staff doesn’t have to handle them; and washing hands or using hand sanitizer after coming in contact with items a patient has touched.

The guidance also suggests strategies to minimize close contact between patients and pharmacy staff and other patients.

“We know that a lot of pharmacies are doing this already in terms of maintaining social distancing for people who are entering the pharmacy—using signage, barriers, or floor markers to instruct waiting customers to remain 6 feet back from the counter and from each other,” Koonin said. “Some pharmacies are installing sections of clear plastic material so that there can be a barrier of protection at the counter.”

The guidance also recommends frequent cleaning and disinfection of all customer service counters and customer contact areas. “If a pharmacy has a co-located retail clinic, [use] signs to ask customers and patients who have respiratory symptoms to wait for their appointment in a specific part of the store.” Pharmacies can also promote the use of self-checkout stations, which should be regularly cleaned and disinfected.

Administrative controls include using signs on pharmacy doors to divert as many patients as possible to either drive-through windows, curbside pickup, or home delivery; and requesting in text messages that patients who are sick send someone else to get their medication or use alternative pickup methods. Pharmacies could also limit their number of people in the store at one time to avoid crowding and long lines.

Pharmacists who provide chronic disease or medication management services or other counseling could explore providing the services over the phone or through telehealth and telepharmacy, Koonin said.

The guidance’s final recommendations deal with COVID-19 testing. “Pharmacies that are participating in legitimate public health testing for COVID-19 should communicate with their local or state public health staff to determine which persons meet the needs criteria for testing, and also about how to collect, store, and ship specimens.” Koonin advised that the guidance includes links to information about testing and infection control guidance for pharmacy staff conducting COVID-19 testing.

“We hope that this guidance can be useful and instructive during this outbreak,” Koonin said.

As of April 6, additional CDC recommendations were released regarding the use of cloth facial masks when N-95 or surgical masks are not available and recommendations for pediatric and adult immunizations. Adult immunizations requiring face-to-face encounters and in areas with community transmission of SARS-CoV-2 should be postponed except when

  • An in-person visit must be scheduled for some other purpose, and the clinical preventive service can be delivered during that visit with no additional risk
  • An individual patient and their clinician believe that there is a compelling need to receive the service based on an assessment that the potential benefit outweighs the risk of exposure to the virus that causes COVID-19