Advancing ambulatory pharmacy practice through a crisis: Objectives and strategies used in an ambulatory care action team's response to the COVID-19 pandemic

Abstract

Purpose: The objectives and strategies used by an ambulatory care action team operating within a large health system's pharmacy incident command structure during the initial response to the coronavirus disease 2019 (COVID-19) pandemic are discussed.

Summary: In a time of crisis, a pharmacy ambulatory action team was formed to provide ambulatory clinical pharmacy expertise and meet an immediate and ongoing need to limit nonemergent care during the COVID-19 pandemic. By building a strong communication infrastructure and partnership with ambulatory care providers, clinic medical and operational leaderships, clinical laboratory staff, and infusion centers, the team was able to swiftly execute solutions and respond to new issues and requests. Ambulatory care pharmacy practice continued to advance through provision of services to vulnerable patient populations with chronic conditions that were anticipated to experience gaps in care management during the COVID-19 pandemic. These efforts resulted in expansion of pharmacists' involvement in collaborative drug therapy management, support of patients' transition from in-clinic injection to home self-administration, provision of medication assistance support, and management of 1,300 patients via protocol-based warfarin management. Additionally, ambulatory pharmacy services in 15 primary care, anticoagulation, and specialty clinic sites were transitioned to telehealth. The ambulatory action team also implemented several strategies to manage medication therapy associated with COVID-19-related shortages and implemented electronic decision support to guide prescribing of hydroxychloroquine and azithromycin.

Conclusion: Building a strong communication infrastructure and a pharmacy ambulatory action team were essential to respond to a crisis and continue ambulatory clinical pharmacy services expansion.

Keywords: COVID-19; ambulatory care; coronavirus; pharmacy practice advancement; pharmacy service.