Pharmacy Residency in the time of COVID-19

“It feels like a strange start to my career, but it has added a unique experience to my training,”

Kayleigh Mitchell, PharmD, second-year emergency medicine pharmacy resident, walks her usual route, through the quiet University of Arizona Health Sciences campus, to Banner – University Medical Center Tucson. After getting her temperature checked at the entrance, and donning her protective mask, she navigates her way to the hospital’s Adult Medical Intensive Care Unit (MICU) which has been transitioned into a COVID-19 unit. It’s there that she’ll begin another day at her pharmacy residency program.

“The patients on this unit are critically ill with either a confirmed positive COVID-19 test, or a suspicion that the patient may have it,” explains Dr. Mitchell. “They’ll remain in this unit until they have tested negative or no longer require ICU level care.”

At Banner, Dr. Mitchell works with a team of respiratory specialist designated to care for COVID-19 patients. Each day, she reviews the patients and their medications, completes rounds with the Respiratory ICU (RICU) team members, and makes recommendations regarding the patients’ therapies.

"All team members are taking extra precautions throughout the day, especially when entering the rooms to provide care for patients,” said Dr. Mitchell. “This involves an extensive process of sanitizing any equipment and medications entering the room, and donning all of the appropriate PPE. Although this requires extra time, the team is doing everything possible to protect their patients, themselves and others."

The University of Arizona College of Pharmacy has several affiliated residency programs including partnerships at Banner - University Medical Center Tucson and Banner - University Medical Center South. Resident pharmacists in these programs find themselves in a unique position amid this pandemic. They are pharmacists and trainees, balancing their growing knowledge with an illness about which much still remains unclear. They are developing their skills, but doing so in the current health care environment means adjusting daily routines to embrace new norms while surrounded by uncertainty.

“Education is Vital”

Second-year infectious disease pharmacy resident Alanna Rufe, PharmD, has seen significant changes to her work in the ICU and in the HIV/ID clinic she spends her weekends at.

“My HIV/ID clinic is now all conducted through a virtual platform,” explained Dr. Rufe. “Some of my patients are able to use these virtual platforms; others are limited to a phone interaction, but I am still able to perform all of my regular patient interviewing and counseling. This has limited our vaccination interventions, but it’s the safest thing for us and our patients for now.”

Because of the limitations placed on the amount of people who can be in a room at one time, other educational components of residency training such as conference sessions, standing meetings, and morning table rounds have largely moved online as well.

Despite having less direct access to their patients, Dr. Rufe and the other clinical pharmacists and residents have helped to maintain the quality of patient care by developing treatment guidelines, summarizing and critiquing new research, and educating others on the healthcare team.

“Education is vital at this time, and many of the other healthcare workers rely on us to provide them with the latest recommendations and the rationale behind it,” said Dr. Rufe.

Creative Alternatives

On the opposite side of town, Sumaya AlMohareb, PharmD, is conducting her second specialized year of pharmacy residency in internal medicine at Banner - University Medical Center South. Since the pandemic began, Banner - South, like many other hospitals, has enacted new procedures to limit the exposures of staff to COVID-positive patients.

Dr. AlMohareb’s team has come up with creative alternatives to keep their fellow healthcare workers safe. Pharmacists have optimized and aligned medication administration times to decrease the frequency with which nurses have to enter a patient’s room. They have also developed protocols to reduce the spread of disease by recommending alternative administration techniques such as oral versus intravenous as well as minimizing the use of nebulizers in favor of meter dose inhalers which decreases the nano aerosol droplets in the air.

“We have limited our in-person interaction with all patients who have confirmed or suspected diagnosis of COVID-19. However, our care continues by finding alternative ways to communicate with them,” said Dr. AlMohareb. “Now, we call the patient’s room to provide education on their medication, and we’ve begun utilizing printed education materials to avoid further exposure.”

Moving Forward

In the midst of this ever-evolving situation, the American Society of Health-System Pharmacists has developed an extensive guide for residents, residency program managers, and pharmacy schools to help answer questions on the shifting timelines, cancellations and adjustments to testing, rotations and other events. Despite every effort being made to minimize disruptions to their programs, COVID-19 has left an indelible mark on each of these young pharmacists.

“It feels like a strange start to my career, but it has added a unique experience to my training,” shared Dr. Rufe. “I will be better prepared to handle public health crises like this should it happen again."