TABLE 2.
Summary of cardiology pharmacists' collaborative practices before and during the COVID‐19 pandemic
| Before COVID‐19 | During COVID‐19 | |
|---|---|---|
| STEMI | Patients admitted directly to CCL for intervention |
Patients stop in the ED first Some will receive thrombolytic therapy instead of PCI |
| Adjunctive therapy for STEMI | Aspirin | Aspirin |
| Ticagrelor, prasugrel, and clopidogrel | Clopidogrel (preferred with thrombolyitcs) | |
| Heparin or enoxaparin | Consider enoxaparin | |
| Cardiogenic Shock |
Inotrope/vasopressors TMCS |
Balance availability of resources, staff, and drug shortages |
| Emergency response (Code blue, strokes, STEMI) | Pharmacists respond and draw up medications at bedside | Pharmacists attend but remain outside patient room providing medications |
| Grab and go kits added to cart to provide easy access to initial ACLS drugs | ||
| QT prolongation drugs | Hospital policies center around anti‐arrhythmic medications and monitoring | Developed new policies to cover chloroquine and hydroxychloroquine |
| Education to staff who may not be as familiar with interpreting an EKG or medications that prolong QT | ||
| Pulmonary hypertension | May use inhaled treprostinil or epoprostenil | Converting to IV prostacyclins to decrease virus spread, unless intubated |
| May use nitric oxide if available | ||
| ACEI/ARB | Proven effective to treat hypertension, heart failure, and coronary artery disease | Educating medical staff and patients |
| Prevent discontinuation unless necessary due to hypotension or renal complication | ||
| Drug shortages | Amiodarone | Transition from IV to oral; Lidocaine |
| Vasopressin | Consider phenylephrine or norepinephrine | |
| Thrombolytics | Consider order of preference | |
| Diuretics | Consider transition of oral, combination diuretics | |
| Patient Education/Medication Reconciliation/Transition Of Care | Provide face‐to‐face education on antiplatelet therapies, anticoagulation, transplant medications | Use video conferencing and phone calls to provide the same information before COVID‐19 |
| Staffing | Provide direct patient care in‐house by interacting with medical staff | Remotely provide direct patient care via video/phone conferencing |
| Provide education to medical staff and pharmacy residents | Cross training in various areas | |
| Develop processes /procedures for new treatment as they arise | Developing new processes/procedures for COVID‐19 + patients | |
| Video conference for staff Education on these changes | ||
| Resident training | Provide patient care in‐house by interacting daily with medical staff to optimize drug therapy | Remotely provide patient care |
| Assist in developing new processes or treatments for various patient populations at risk | ||
| Encourage layered learning to help PGY‐2 residents refine precepting skills |
Abbreviations: ACLS, advanced cardiac life support; CCL, cardiac catheterization lab; ED, emergency department; EKG, electrocardiogram; IV, intravenous; PCI, percutaneous coronary intervention; PGY‐2, postgraduate year 2; STEMI, ST‐elevation myocardial infarction; TMCS, temporary mechanical circulatory support.