By James Morrison B.Sc.Phm. C.D.E.
Marcel Laporte is the designated manager of two Wholehealth Pharmacy Partners banner locations: BMC Pharmacy Sarnia and Chatham. The pharmacies specialize in both alcohol and opioid withdrawal management for patients.
As a result of self-isolation, patients have expressed they never thought staying home would be so difficult. Some patients required to stay home are experiencing tougher times due to isolation. Marcel encourages these patients to go outside for a walk when needed, get fresh air, and clear their minds, while staying away from others. Marcel addresses mental health concerns by connecting patients to resources in the community and makes himself available to those who need someone to talk to over the phone.
Marcel explained that there has been an increased demand for opioid withdrawal services, “With all of what is going on, the movement of goods, illicit and otherwise have been greatly restricted. People need to stay close to home. For some patients they quickly realised and saw it as a great time to get treatment.” The pharmacy has been able to support new patients and begin their treatment in a timely manner.
BMC Pharmacy has implemented policies to care for patients in isolation for various reasons including travel history and had one confirmed infected patient. The pharmacy provided non-contact delivery and worked with patients to implement technology for auditing remaining methadone doses at home over video calling.
Marcel implemented several operational changes to the pharmacies to address the pandemic. Some patients are sensitive to any change in the dispensing process. Marcel carefully explained that the changes were made to protect patients and staff from the virus in both directions and were not motivated by fear of patients. Furthermore, he informed patients that procedures will revert to normal operations as soon as the pandemic dissipates.
In order to prevent cross-infection between pharmacy staff, two distinct teams were formed. Each team consists of a pharmacist, a technician, and one or two assistants. Rather than alternating days they decided to split the week into segments of three or four days. At the end of each team’s three or four day stretch there is a deep sterilization of all common surfaces in addition to their daily cleaning regimen. The staff were understanding and supportive of the schedule change, but it was nonetheless challenging due to the tightknit nature of the team. Employees were encouraged to socially connect with their coworkers virtually and continue to do everything it takes to keep patients and staff safe.
The implementation of split shifts resulted in less staff on duty each day. The dispensing of methadone and buprenorphine/naloxone requires very timely dispensing for observed daily doses. Marcel is mindful that many of his patients are employed at essential services in Sarnia’s refineries and maintain their work schedules. These patients often attend the pharmacy first thing in the morning or late in the day after work. To alleviate wait times the pharmacy prepares some of the workload in advance and manages patient expectations carefully. Non-urgent prescriptions may be delayed until later in the day and patients are called when the order is ready.
The pharmacy now has a “one-way” policy, “Because we specialize in withdrawal management, we have traditionally had many interactions with passing paper, cups, bottles, etc. back and forth between staff and patients. Anything that is touched by the patient either leaves with them or is put into the garbage,” Marcel explained. Witnessed methadone doses are double cupped. Once the dose is confirmed with the patient, the labelled outside cup is retained inside the pharmacy, and the unlabeled cup is provided to the patient. The unmarked cup is placed into the garbage by the patient after taking their dose.
The “one-way” policy is also followed for buprenorphine/naloxone. The most common doses are prepackaged in a dosette package to reduce handling and dispensed into an unlabeled cup. The cup is discarded outside the dispensary once the patient takes their dose.
The pharmacy installed a plexiglass barrier and limited the number of patients inside the premises to five patients to promote physical distancing. Within the pharmacy there are four spots marked on the floor for patients to form a line, and a fifth spot in the vestibule. The line extends to the sidewalk outside the pharmacy during peak times such as first thing in the morning and during the after-work rush. Patients have cooperated well with the social distancing policy, likely due to explaining the policy initially to all patients.
The installation of a plastic barrier has hindered communication with patients more than one would expect. While muffling voices through the barrier it simultaneously traps or amplifies the noises generated within the dispensary. Marcel explained, “Communication has become even more important. We must let patients know we enjoy talking with them and recognize their struggles.” He described the challenges of communicating through a barrier and how he must be remarkably close to the glass in order to speak clearly with his patients and maintain the relationship. He is eager to take the barrier down as soon as possible to resume usual communication with patients.
James Morrison B.Sc.Phm. C.D.E. is the Director of Pharmacy Excellence, Wholehealth Pharmacy Partners