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Pharmacy in the Time of H1N1

HOSPITAL AND HEALTH-SYSTEM PHARMACISTS around the country are struggling to keep up with demands being put on emergency rooms by increasing numbers of patients who are walking in with H1N1 flu symptoms.

“This virus has been a huge burden to our emergency room, and there have been a number of areas where our pharmacists have been asked to step up,” said Heather Draper Eppert, Pharm.D., BCPS, clinical specialist in emergency medicine and an assistant professor at the University of Tennessee College of Pharmacy, Knoxville. “Our ICUs are full, both with the usual high-acuity conditions but also with younger patients on the verge of respiratory failure.”

The H1N1 influenza outbreak officially reached pandemic proportions in November 2009, moving into high gear with the advent of the school year. According to the Centers for Disease Control and Prevention (CDC), by mid-November, nearly 22 million people in the U.S. had fallen ill with the virus. Close to 99,000 people had been hospital- ized, with almost 6,000 deaths reported.

Adding to the burden caused by the outbreak has been the media hype regarding the safety of the vaccines to help prevent its spread. The combination of these factors has driven even healthy patients to come to the ER to be checked, further stretching the limits of the nation’s medical infrastructure.

Yet the story has one bright spot: The challenges of H1N1 have also provided openings for hospital pharmacists to demonstrate their skills and knowledge, according to Draper Eppert, including patient education, vaccination administration, and emergency preparation.

Pharmacists as Advocates

One of the more alarming aspects of the H1N1 outbreak is the misunderstanding about the safety of the vaccines that can help prevent its spread. An October 2009 ASHP poll of hospital pharmacy directors found that most hospital workers are not vaccinated. According to the study, only 37 percent of the responding hospitals reported staff vaccination rates that topped 70 percent.

The problem, it appears, is that even hospital staffs have been misinformed about the safety of the vaccine despite recommendations from the CDC that all health care and emergency services personnel be vaccinated.

“If we aren’t successful at convincing hospital workers to get vaccinated, how can we convince patients?” said Mary Andrawis, Pharm.D., M.P.H., director of ASHP clinical guidelines and quality improvement. “This is an area where pharmacists need to become advocates for everyone to get vaccinated for the seasonal flu as well as H1N1.”

Pharmacists as Vaccinators

An area where pharmacists’ skills have proved invaluable during the outbreak is in their role in dispensing and administering vaccines and antivirals like Tamiflu®. Draper Eppert noted that one of the challenges her team of pharmacists face is making tough decisions regarding the potential rationing of drugs like Tamiflu during an inventory shortfall.

“We even have healthy patients who want a prescription just in case they get sick,” she said. “We have to make tough decisions about whether someone else needs it more.”

With the campaign for immunization under way, pharmacists from around the country have stepped up to administer vaccines. “ASHP has actively been encouraging hospitals and health systems to consider using pharmacists to administer vaccines in order to increase vaccination rates,” said ASHP president Lynnae Mahaney, M.B.A., FASHP.

Even pharmacy students have gotten involved. In Texas, students at the University of Houston College of Pharmacy who completed an immunization course administered more than 2,500 vaccines in a partnership with the Harris County health department.

“The students and faculty preceptors have been excited to get involved and to use their skills for something as important as preventing the further spread of a pandemic influenza virus,” said Kevin  Garey, Pharm.D., M.S., initiator of the program and chair of the department of clinical sciences and administration at the university.

Pharmacists and Emergency Preparedness

Emergency preparedness has become a priority for hospitals and health systems in the wake of September 11, and pharmacists continue to play a critical role in such planning. The outbreak of H1N1 and other potential pandemics require planning in terms of vaccine and antiviral stocking and the skills necessary to monitor mass dispensations of those medications. Pharmacists have begun to play an even greater role in assisting public health departments in their planning efforts, according to Andy Stergachis, Ph.D., professor of epidemiology and global health and adjunct professor of pharmacy at the University of Washington School of Public Health, Seattle.

“Public health departments can’t do this alone for two reasons,” said Stergachis, who is also the pharmacy adviser to the public health department of Seattle and King County. “First, health departments have been losing personnel due to the recession. Second, health departments have never had the capability to conduct mass dispensations. This means that public-private partnerships offering pharmacists’ expertise in medicines and distribution are critical to meet community needs.”

Since 1979, the state of Washington has recognized pharmacists’ capabilities to prescribe and administer medications. That year, it created a collaborative drug therapy agreement providing pharmacists with prescriptive authority.

This has allowed pharmacists to play a major role in administering vaccines and to establish relationships with public health departments.

“Pharmacists were brought into the planning process early on and have been able to rapidly assume responsibility for providing oral antivirals and vaccine during the pandemic,” said Tim Fuller, M.S., FASHP, pharmacist consultant to the Washington State Department of Health Board of Pharmacy, which helps manage the state’s stockpile of vaccines and antivirals.