Considerations in the time of Corona: Pharmacists’ protocols and guidelines in Italy and worldwide

Considerations in the time of Corona:

Pharmacists’ protocols and guidelines in Italy and worldwide

We are experiencing a very peculiar historical moment, a very difficult one which has created a mutual network to counteract a common lethal enemy: the Covid-19.

I am taking the liberty to write this article on behalf of my clients, the pharmacists, whose many letters I have been collecting every day from all over the world. We advise and support each other. It is what makes the difference throughout moments like this.In that respect, I would like to make some comparisons amongst several protocols which Pharmacists are adopting throughout their countries to defeat all together this common enemy. I have unwillingly become a bit of an expert about the Coronavirus, mainly because I live in Italy and am personally experiencing the whole scenario since the last weeks of February. Italy has arguably been the first Western country to face the epidemic crisis, the first one to disclose the problems and counteract them, the first one to test some options before introducing the total lockdown solution.

What does living for over a month within total constraints mean? 
To me, it means to go through many emotions all together: anger, anxiety, fear for one’s family, friends and acquaintances. It means to keep on pushing against all odds to fight and react all together. Isolation can be looked at as a step before sharing one’s feelings.

There is the awareness that all these patterns are common within all families. People must be in a position to make this will to resist and win all together stronger than negativity. The idea of what you can do to improve yourself and your business comes from these very thoughts. Pharmacies must be reconsidered in the light of the new relation between patients and pharmacists. The latter ones are seen as trustable professionals and more and more individuals are counting on them.

There have already been #9 casualties amongst pharmacists here in Italy, people who professionally do their job everyday at the forefront. They smile at us just with their eyes since their mouths are hidden behind their masks.

Please find enclosed some protocols’ guidelines used by my clients who were interviewed throughout these weeks.

First of all pharmacies which remained open must be differentiated from the ones working with their shutters closed.  

A Pharmacy working with shutters closed is the one where clients are served not within the premises but throughout the outside windows and medicines dispensers.
This option is certainly safer but it does create more distance. There are not even impulse purchases from clients’ side anymore or products to be bought because of a last minute reminder.
It must not be forgotten that a huge amount of patients’ percentage is currently accessing pharmacies for the purpose of buying medicines. There are very limited goods which can result interesting throughout these delicate days.
Pharmacy clientele is generally very impatient now and willing to get out smoothly. It is advisable to mark the premises floor with some noticeable tapes in order to guarantee the needed distance amongst people in case of queues.
Pharmacists need support desk as working, some island to place the POS, a computer connected to the cash point and references rotating so very quickly. And a pharmacist must obviously be trained to walk back and forth to access medicines!

All open Pharmacies must adopt very strict protocols: 

1. PHARMACISTS: when a safety routine is established staff feels more reassured and ready to work complying with rules.
All individuals accessing the pharmacy back office must be equipped with a safety set of items:Vinyl gloves and masks to be kept at all times (FFP2 and FFP3 models without valves are preferred). Temperature must be taken in the morning before working and after the lunch break.
Protection visors have been worn more consistently by pharmacists, sanitizing gels are always available on the desk (75% alcohol solution) and in the toilet in conjunction with disinfectant soap, The environment must be sanitized before gloves are worn.
Disposable overalls are often worn on top of professional uniform, shoe covers and white coats are sent to the laundry shop once a week to be sanitized. Many pharmacists put daily their clothes directly in the washing machine and shoes are locked inside cupboards.

2. PHARMACY LAYOUT: it has already been changed in many pharmacies: straight after the door people are kindly requested to keep a certain distance amongst each other.
The same line must be kept up to the ethical desk with tapes on the floor or plexiglass protection screens.
Access is limited to 1, 2 or 3 people at a time in accordance to the pharmacy size.
Access pathway is differentiated from the exit one when possible. There is a distance to be kept from the desk (approx 100cm / 6 ft) and amongst people inside. Gel distribution totem for hands is placed at the entrance. Doors are kept open in addition to HVAC.
Ozonator is on to sterilize pharmacies during the night and it is recommended to keep it on throughout the day as well to reduce viral load. Any product display is better happening via gondolas placed along the path and the stopby of patients. 

PHARMACY SAFETY: All counter desks must be equipped with protections which must minimize contacts and be in plexiglass to guarantee transparency. Pharmacy desks must be cleaned and disinfected three times a day with water/ hydrogen peroxide solutions (for plexiglass screens) or 75% alcohol solution or hypochlorite. It is very important to cope with an adequate communication of hygienic standards to patients throughout well-visible spaces.

 

 PHARMACY MATERIALS: furniture should be mostly made with materials easy to be sanitized. Corian, ABS and glass are some of the most washable and disinfectable materials as well as not porous surfaces.

3. PATIENTS MANAGEMENT:

WELCOMING: it is recommended to use a queue ticket dispenser in order to keep under control the stress due to the many people waiting for their turn outside the pharmacy premises.

ATTITUDE: patients must be kept with their spirits up throughout a very positive and cohesive team. Pharmacists’ eyes can “smile” and their words must give comfort and reassurance;

 PAYMENT: disinfectant gel must be used on the gloves as if you were working with bare hands and straight after each client served. Before and after every operation via POS the device must be sanitized. Clients should be encouraged where possible to pay by credit cards. It seems that the viral load on coins is less intrusive than on paper money. The copper present on coins exerts a more effective antimicrobial activity (source: Dr. Johannes Knobloch from Hamburg- Eppendorf Klinik, Apr 2020).

SERVICES: they are usually implemented with home delivery services (drop off at the door) in addition to Curb side pickup but remember to put a sign saying: “Curb side pickup sick or not feeling well call……..”. Also the drive through area must be totally sanitized. No more vaccinations services at this time but video/audio call services for consultation/questions and concern.

4. PRODUCTS: sales in the pharmacy during this period have changed too. The best selling products are obviously always related to the virus: masks, gloves, gel, alcohol-based disinfectants, remote thermometers, oximeters in large quantity and then sell more often others such as hair dye and hair removal stuff.

As far as drugs are concerned, it is obvious that there has been a boom in all antipyretics, immune prevention products, vitamins and supplements. However, it must be kept in mind that the pharmacists and his staff are the ones advising and suggesting products to be supporting and helping patients.

There are many drugs which have been tested off-label against the Covid, in addition to antiviral ones already known. The hydroxychloroquine is the only one sold directly in the Italian pharmacies.

PHARMACISTS are today at war just like they used to be in the past. By honoring his oath he becomes once again the focus point of community. The challenge now will be to keep and improve such a role even after the emergency is over. The creation of multiple services oriented to the Pharmacy can make it become a place far beyond the display of products.

….this is not the end of the article but the beginning of an international collaboration between pharmacists against a common enemy… so if you like:

leave your comment to enhance the topics covered or leave your opinion about it or take part in the free Webinar we are organizing in early May which will be entitled:

"Pharmacy now & after the Covid" 

to reserve your Pc front row seat and receive all the details:

Look forward to your attendance!

if you need info about the plexiglass screen

I want to thank you for all the info: Lombardi Pharmacies , Greca Pharmacy, Ricciuti Pharmacy, Welltopia Pharmacy, My family Pharmacy, Purecare Pharmacy, Lapucci Pharmacy, Cenami Pharmacy, Bluebird Pharmacy, Marra Pharmacy and many other pharmacists that have contributed:

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