¹Department of Pharmacy Services, ²Department of Gastroenterology & Hepatology, Lady Reading Hospital, Peshawar, Pakistan

Pharmacists have played an active role in the recent pandemic of coronavirus disease 2019 (COVID-19), especially in countries where pharmacy practice is well established. Lady Reading Hospital (LRH), a 1770-bed tertiary care government hospital, is one of the largest hospitals in the province of Khyber Pakhtunkhwa of Pakistan. The hospital has been responsible for treating moderate and severe COVID-19 cases and has dedicated a 250-bed COVID-19 unit and a 15-bed intensive care unit (ICU), respectively, to these efforts.

LRH’s Department of Pharmacy Services has been established for the past 2 decades but, before COVID-19, services offered were limited to the procurement and dispensing of medicines. The emergence of COVID-19 raised many supply chain concerns regarding medications such as unavailability and high cost. In addition, the pandemic led to the realization of the need for pharmacists in the clinical setting.

Two pharmacists became involved in direct patient care, one in the ICU and one in the COVID-19 unit, and all inpatient pharmacists were trained to review all medication orders. Pharmacists delivered pharmaceutical care services to patients with COVID-19, which included reviewing patient profiles with respect to drug dose and renal dose adjustment. The two pharmacists who delivered direct patient care services were involved in medical rounds in the ICU and COVID-19 unit. In addition, one of the pharmacists was involved in an online multidisciplinary medical team of specialists representing nephrology, internal medicine, and pulmonary services of national and international hospitals. Pharmacists made new COVID-19–related interventions. Table 1 provides a summary of pharmacist interventions between May and July 2020. This new activity helped ensure the rational use of antibiotic and anticoagulant therapies (Figure 1). Furthermore, a multidisciplinary committee was developed on the suggestion of pharmacy services that included members representing the ICU and the Internal Medicine, Pulmonology, and Quality Assurance departments to establish clinical guidelines. The committee issued three editions of treatment guidelines for COVID-19. Pharmacists have played a vital role in enforcing these guidelines and have discouraged any unnecessary medication use. Another major role of pharmacists has been ensuring rational use of COVID-19 medications that are limited in supply or associated with serious adverse effects (e.g., tocilizumab).

Table 1. Details of Pharmacists’ Interventions and Engagement with Physicians, May – July 2020

Because of the activities undertaken by pharmacists during the pandemic, there has been a sudden surge toward including them in clinical rounds. Indeed, the pharmacy department has received requests for pharmacists to be involved in medical rounds from the acute medical ward and all ICU units. Because of limited staff pharmacists, only two pharmacists are currently taking part in clinical rounds in the general ICU and acute medical units. However, further discussions are under way with the Pediatric Department for standardization of doses and clinical rounds.

Figure 1. Pharmacist interventions by drug class, May – July 2020.

Pharmacists’ involvement in clinical units and their acceptance by physicians has been difficult to achieve, especially in the oldest and largest tertiary care government hospital in Pakistan. Under normal circumstances, the same process would have taken years. But the COVID-19 pandemic has provided an opportunity for pharmacists to express their worth. LRH pharmacists have been alongside patients’ beds taking the same risk as other health professionals.