Table 2.
Thematic framework of analysis.
| Domain | Themes | Subthemes (where available) | Facilitators | Barriers |
|---|---|---|---|---|
| Reducing the health risks posed by COVID-19 | Minimising the spread of COVID-19 in the workplace | Social distancing | -Organisational and estates arrangements to allow social distancing -Resources to build facilities in pharmacy to allow social distancing |
-Physical facilities not allowing social distancing |
| Risk stratification of patients in the clinical setting | -Availability of facilities to segregate patients as per risks | – | ||
| Availability of PPE | -Availability of PPE | -Lack of access to good quality personal protective equipment -Lack of adequate personal protective equipment -Lack of resources to buy PPE |
||
| Knowledge about correct use of PPE | -Training on how to use PPE | -Lack of training and knowledge about how to use PPE | ||
| Sanitisation and hygiene practices | -Availability of chemicals and equipment for sanitisation | -Inadequate supply of sanitising chemicals | ||
| Educating the public on reducing the spread of COVID-19 | Actions undertaken to educate the public such as provision of information around transmission risks in community pharmacy | -Resources to develop educational materials -Time to develop educational resources and provision of advice |
-Lack of public acceptance of advice -False information available from other sources |
|
| Preparedness | Ensuring timely and effective response systems are in place | Adjustment of physical layout and infrastructure | -Organisational preparedness in adjusting clinical facilities -Availability of spaces to build temporary critical care units |
– |
| Maintaining safe staffing levels | Adjusting pharmacist distribution across clinical settings | -Readiness of pharmacists to practice in a new clinical setting -Training to adapt new roles -Staff readiness to commit to new roles -Creation of new teams -Readiness to cover for new staff |
-Lack of training -Lack of knowledge and understanding of clinical procedures and drugs in a new setting -Lack of willingness to work from home -Lack of access to clinical records from home |
|
| Adjustment of leave and staff absences | -provision of accommodation and shuttle services for staff -Flexibility to work from home -Remote access to clinical records when working from home -Government decisions to restrict opening hours of community pharmacy |
-Burnout and fatigue -Difficulty sourcing locums |
||
| Getting students to help out | -Availability of space to accommodate students | -Social distancing measures limiting the number of staff in a clinical setting | ||
| Testing staff for Covid-19 | Access and availability of COVID-19 test facilities | -Early testing and isolation practices | -Lack of access to testing | |
| Action- response and adjustment | Ensuring uninterrupted supply of medications and ensuring business continuity plans | Sourcing and ordering medicines | -Government support to source medicines -Good procurement services in the clinical setting -Ordering medicines to ensure business continuity |
-Lack of availability of medicines for intensive care medicine |
| Rationing of medicines and medical supplies | -Time and resource to repackage and label -Availability of alternative brands and products -Patient acceptance of alternative brands and smaller pack sizes |
– | ||
| Making therapeutic substitutions | -Doctor's acceptance of therapeutic substitutions | – | ||
| Extending repeat prescriptions without doctors' agreements | -Flexibility in legislations to allow special supply provisions | -Lack of availability of medicines to ensure seamless supply | ||
| Impact and adjustment of routine clinical practice | Low use of healthcare services by patients | – | -Patient fears about the use of healthcare settings | |
| Cancelled elective appointments in hospitals | – | -Patient fears about the use of healthcare settings | ||
| Interruption to routine clinical pharmacy services such as blood pressure checks and cholesterol testing | -Patient acceptance and understanding to reduced services | -Lack of coordination between primary care and community pharmacy -Lack of ability to conduct appropriate monitoring of disease and medicines use |
||
| Offering home testing kits for disease monitoring | -Patient resources to buy home testing kits | – | ||
| Providing care plan for the patients to care at home | -Family/carer support for patients at home | – | ||
| Communicating with patients and healthcare professionals | Use of telephone, video and social media | -Availability of appropriate digital platform | -Lack of appropriate digital platform | |
| Ensuring effective remote communications | -Patient access to digital platforms -Patient confidence to use digital platform -Family and carer support to patients for the use of digital platform |
-Patient lack of access to digital platform -Patients with reduced cognitive states facing difficulty with digital platforms -Lack of time to set up digital communications -Difficulty persuading patients to adhere to their medicines when communicating remotely |
||
| Barriers to effective communications due to PPE | – | -Interference with voice and body language due to pharmacist use of PPE -Patients with sensory disabilities, different first language and reduced cognitive functions not able to understand masked communications |
||
| Impact on inter-professional communications | – | -Reduced rate of acceptance of pharmacists' interventions when made remotely (compared to face to face) | ||
| Advocating pharmacy's role and being source of information to doctors | Searching and appraising information and evidence | -Access to online resources and journals | – | |
| Professional role and identity | -Recognition of pharmacists' expertise and knowledge by senior management and other healthcare professionals -Use of same uniform and PPE by all healthcare professional leading to lack of professional hierarchy |
-Lack of recognition of pharmacists' expertise and knowledge by senior management and other healthcare professionals | ||
| Taking care of COVID-19 patients | Sourcing and appraising information | -Access to online resources and journals | – | |
| Availability and access to guidelines from professional societies and public health agencies | -Availability of clinical guidelines -Availability of training opportunities and webinars -Access to peer reviewed journals |
-Mismatch of information across guidelines -Conflicting advice from various clinical disciplines in practice |
||
| Monitoring safety and effectiveness of new drugs | -Ability to monitor patients on new drugs | -Lack of knowledge about the experimental drugs | ||
| Recovery and returning to normal | Sustainability of social distancing measures | – | -Benefits to high risk patients such as in transplant care | – |
| Greater use of technology in communications and clinical care | – | -Availability of effective and efficient digital platforms | – | |
| Extended roles for pharmacy profession | – | -Other healthcare professionals' recognition and acceptance of pharmacists' clinical roles -Patient reluctance to use general practice services -Pharmacists’ confidence to offer extended services |
– – |
|
| Readiness to offer vaccination for COVID-19 | – | -Pharmacists’ readiness to deliver new services | – | |
| Reflection of personal experience, attitudes and behaviours | Personal experiences and coping strategies | – | -Pride in serving patients and humanity -Professional pride -Being able to help others -Being able to look after each other in the healthcare team |
– |
| Motivation | – | -Professional pride -Service to humanity -Seeing COVID-19 patients discharged and returning home -Looking after patients and each other -Effective clinical leadership |
– | |
| Measuring successes and failures | – | -Being able to measure patient outcomes -Being able to keeping themselves and staff safe |
-Lack of benchmarks to measure successes or failures | |
| Knowledge and skills learnt [e.g. -critical care, extemporaneous dispensing, use of telecommunications and telemedicine, clinical trials, resilience and adaptability] | – | -Readiness of pharmacists to practice new skills and in a new clinical setting | -Lack of recognition of pharmacists' skills and expertise from other healthcare professionals |
COVID-19: Coronavirus Disease; PPE: Personal Protective Equipment.