key: cord-0899750-8o7vt3n6
authors: Campbell, Peter; Witenko, Corey; Dzierba, Amy L
title: Perseverance in a pandemic: A unique pharmacy residency learning experience
date: 2020-06-04
journal: Am J Health Syst Pharm
DOI: 10.1093/ajhp/zxaa206
sha: 9ca1029a0dbe55242b4d3fe7f63130b26f7690bf
doc_id: 899750
cord_uid: 8o7vt3n6

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Perseverance in a pandemic: A unique pharmacy residency learning experience C linicians in New York City (NYC), the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in the United States, had provided care for over 50,000 patients requiring hospitalization for COVID-19 as of May 17, 2020. 1 As NYC experienced the surge of patients with COVID-19, pharmacists of all training levels embraced the responsibility to optimize medication therapy in collaboration with their healthcare teams.

NewYork-Presbyterian Hospital (NYPH) system is comprised of 7 hospitals with over 2,600 beds across Manhattan, the Bronx, and Westchester. Within NYPH there are a total of 13 postgraduate year 1 and postgraduate year 2 pharmacy residents. As the staffing models changed rapidly and bed ca pacity was expanded, the demand for pharmacists exceeded the supply and pharmacy residents were positioned to work independently in clinical and operational settings.

At the peak of the pandemic, two-thirds of the residency year was completed; therefore, some residents were deployed to provide independent direct patient care. This independence afforded the residents an opportunity to build relationships with team members by providing expertise on appropriate dosing and monitoring of many drug therapies, including sedation regimens, venous thromboembolism prophylaxis, and COVID-19-specific treatments, whether on rounds or during one-on-one informal discussions. Other residents performed crucial sterile compounding duties to meet medication demand driven by increased hospital ca pacity and resulting drug shortages. As intensive care unit (ICU) patient volumes increased, the acquisition of medications such as sedatives and analgesics, particularly those normally obtained as premixed products, became increasingly difficult. The residents were instrumental in compounding these products to maintain continuity of patient care. The shortages also necessitated deployment of residents to help care for critically ill patients in order to diligently monitor inventory levels, which changed on a near daily basis. Tracking real-time inventory levels allowed residents to understand how to better allocate drugs and make clinical decisions based on the availability of certain products and concentrations. Residents attended twice-weekly pharmacy management meetings during which operational and clinical aspects of crisis management were deliberated. This opportunity allowed the residents to participate in real-time and high-level discussions and decisions, which included logistical considerations such as optimizing drug concentrations and increasing automated dispensing cabinet par levels to further reduce staff exposure to high-risk patient care areas.

Working independently in uncharted territory inevitably creates challenges and the need for urgent solutions. Traditionally, pharmacy residents have worked with teams that routinely care for critically ill patients and recognize the role of a pharmacist. Additionally, a set of objectives and learning activities are established at the commencement of each learning experience. However, at the start of the COVID-19 case surge a rapid switch to "all-hands-on-deck" mode forced innovation and creativity on the part of residents to establish themselves in new roles. With new roles come immense responsibilities, and all residents embraced the responsibilities of reading and appropriately interpreting a plethora of COVID-19 literature, delivering evidence-based recommendations, and offering guidance to help overcome practice variances. As with any other learning experience, residency program directors established set times for meeting with residents to assuage any anxiety and provide guidance and support.

The hospital system's response to the pandemic provided opportunities for pharmacy residents to gain handson experience in patient care that cannot be simulated; it also provided the residents with acumen in various aspects LETTER of crisis management. While many of the daily learning experiences and activities of pharmacy residents at NYPH were temporarily disrupted during this time of crisis, the residents encountered an unparalleled learning experience and were invaluable to the department. Residency program directors at NYPH were agile in their response and altered learning experiences so that residents still met program requirements while learning in a flexible and adaptive manner.

COVID-19 data

Acknowledgments: The authors acknowledge and thank all of the pharmacy residency program directors and pharmacy residents at NewYork-Presbyterian Hospital for their efforts and collaboration during the described events.