Hero clinical pharmacists and the COVID‐19 pandemic: Overworked and overlooked

Clinical pharmacists “assume responsibility and accountability for managing medication therapy in direct patient care settings, whether practicing independently or in consultation or collaboration with other health care professionals.” ¹ The operative words here in this definition are “direct patient care”: that is, they are at high risk during this pandemic similar to physicians, nurses, and others. They show up everyday along with their colleagues. Yet, in (appropriately and assuredly) praising health care workers for their bravery during this time, clinical pharmacists are often not included with the other heroes: doctors, nurses, respiratory therapists, hospital cleaning staff, et al. I always look for us to be mentioned and know others do also (much to their frustration) as shown by complaining emails to me, twitter and other various social media communications. I practiced clinical pharmacy in an academic medical center for the first 20 years of my career and so I know that physicians know, nurses know, and respiratory therapists know—about us and what we do and what value we provide to them and their/our patients. But this knowledge has apparently not always been translated to the public, the news media, and politicians. Part of this can be explained by the fact that we have much fewer numbers than the others, not all health care settings have a critical number of clinical pharmacists (like academic medical centers affiliated with colleges of pharmacy) and clinical pharmacists are relative newbies compared to doctors and nurses. Although I sometimes share your frustrations, there is also some progress on recognizing the role of clinical pharmacists.

Recently, Centers for Medicare & Medicaid Services (CMS) under the Trump administration issued new rules aimed at easing restrictions and improving flexibility on health‐care workers during this crisis. ² These included expanded telehealth capabilities for physicians and scope of practice for nurse practitioners. For pharmacists, it only relaxed the need for masks (to conserve them for other uses) for sterile compounding. In addition, and much more importantly, the US Department of Health & Human Services (HHS) issued a new guideline allowing pharmacists to order and administer COVID‐19 tests. ³ In addition, clinical pharmacists have been appointed to important national committees that help shape treatment guidelines for COVID‐19. I refer you to the letter to the editor by Gross and MacDougall in this issue of the Journal for a more complete summary. But clearly there needs to be more; progressive approaches to better utilize clinical pharmacists during the crisis are hopefully going on at the state level. Relaxing scope of practice restrictions for other health professionals has been described as an “all hands‐on deck” approach, which is clearly necessary and should include an expanded scope of practice for board certified clinical pharmacists. Clinical pharmacists have always embraced all hands‐on deck.

American College of Clinical Pharmacy (ACCP), thus, its name, was founded on the tenet that clinical pharmacists are different—different than other pharmacists. And to be clear: not better, just different. Our profession has always struggled with this concept: evidence being that although everyone calls us clinical pharmacists, our specialty is called pharmacotherapy. The diversity of pharmacists and pharmacy practice should be considered a strength. That is not to say that other pharmacists are not heroes and are not at risk. Indeed, they are—pharmacists in crucial dispensing roles are either in healthcare system pharmacies or retail pharmacy ⁴ settings. This is where sick people are. There are reports that they are at risk without adequate protection. ⁵ But clinical pharmacists have specialized training, are up to their necks in this pandemic and could easily and seamlessly expand their scope of practice during this time—and frankly, probably are without some CMS mandate. I refer you to “ACCP's Clinical Pharmacy Response to COVID‐19: Read a Story, Share a Story” (https://www.accp.com/membership/clinicalPharmacyInAction/covid19.aspx) and just some of the examples.6, 7, 8 You are the invisible heroes right now. Thank you—because I know.