COVID-19: Taking Community Pharmacy to the Doorstep

It’s not surprising to see how resourceful community pharmacists are being as they serve their communities during COVID-19. But the new, smart, creative ways these pharmacies are reaching their patients deserves showcasing, both to share best practices and to say thank you – so please read on.

Starting at the Door
Because current medical guidelines discourage gathering in groups, many pharmacists have chosen to close their store interiors to customers or to limit the number of people allowed inside at any one time. This video from Mt. Carmel Pharmacy in New York shares their solution: a 6-foot table on the sidewalk in front of the store with pharmacy staff and a phone connecting them to the pharmacy system. Signs in English and Spanish advise customers of the store’s COVID-19 safety precautions, which include only allowing 5 people inside at a time. Police-provided barricades control customer lines along the 2 city blocks leading to the corner pharmacy, and red lines mark the 6-foot distance that customers must maintain from each other.

Community Pharmacy Enhanced Services Network (CPESN^®) best practices during COVID-19 encourage pharmacists without a drive-thru to consider closing their storefront and using curbside pickup. If the storefront must remain open, ask customers to touch as little as possible and to remain 6 feet apart. Pharmacy staff can offer to do shopping with or for customers, which could be especially helpful for those at increased risk. Taping squares 6 feet apart on flooring leading to the register is also recommended.  

Moving to the Curb
A QS/1 customer recently shared with us that they began adapting to COVID-19 social distancing recommendations by using the DeliveryRx^® app in their pharmacy’s parking lot. As they received guidance about the possible virus-transmission issues with capturing signatures, they began instead to simply keep a list of names and tallies for pickups, and they believe many other pharmacies are now handling pickup this way.

Because EMV chip card transactions do not require a signature, you may consider changing settings for OTC-only transactions to not require a signature for transactions below a certain dollar amount, or not at all. This could at least prevent people from touching the sig pad unless they are getting prescriptions. Or consider moving everything to paper to avoid anyone touching the sig pad. Recent CMS guidance and communications from stakeholders like Express Scripts^® acknowledge that pharmacies will be servicing patients in unique ways right now, and that documentation could come in many forms: pharmacists logging in a book the prescription number and date of service, cash register receipts that include prescription numbers, text messages or emails from patients, notes on hard copies, electronic annotations in the pharmacy system, and others.

Driving Through and Driving There
If your store does have a drive-thru window, no doubt it’s in heavy use right now. CPESN recommends that you use signage in the parking lot to encourage drive-thru/drive-up use, that staff wear gloves to pass medications and bags along to patients, and that you try to proactively queue your drive up/drive thru at certain times of the day to manage long lines.

But perhaps nothing better illustrates how community pharmacists are going the distance for their patients than ramped-up home delivery – many are even offering free delivery, especially to high-risk patients. For example, the Community Pharmacy Association of New York State announced today that its members will offer free home medication delivery (in-person delivery, courier service or by U.S. mail, UPS, FedEx, etc.) for patients during the COVID-19 pandemic period.

CPESN best practices for home or hand delivery are to wear latex or another type of glove when delivering, to drop medicines off and go back to the vehicle, and to write down the cell phone number of the delivery driver on the package with a note to call the driver in the car while it’s still parked if the patient has questions. Pharmacies should also have the driver document on a form that the patient received the delivery or that the patient understands that the delivery was left outside.

Reproduced here is the Delivery Protocol Example provided to CPESN by one pharmacy (available for download at the link above), whose objective is to protect both its patients and its community health workers by reducing interaction without losing medication supply chain integrity.

1. Pharmacists/technicians will target high-risk patients (over 60 years of age, especially over 70, and/or with an underlying risk factor such as HTN, DM, lung disease, immunocompromised) for delivery/curbside pickup.
   
2. Offer free delivery for these patients.
   
3. Team will ask if patient has any questions for the pharmacist.
   
4. Team will get credit card information over the phone whenever possible for non-house account individuals.
   
5. Team will run credit cards prior to delivery and print an extra receipt. One copy of the receipt can go in the patient’s bag, and one will be attached to the documentation sheet as described below. Signature pad at pharmacy will be signed “Delivery.”
   
6. For patients who insist on paying with cash/check, team will instruct patient to leave cash/check in an envelope taped to the door. If change is needed, team must be informed prior to driver leaving the pharmacy.
   
7. Team will inform patients of this protocol (steps below) prior to delivery.
   
8. Driver will leave delivery on the front porch/assigned area (may have to hang on the door handle etc. – this is done in consultation with patient).
   
9. Driver will call patient from driveway to inform delivery is there and ask if patient can get it in real time.
   
10. Driver will document on form attached to receipt either visually seeing the patient get the delivery or documenting patient understanding that delivery is outside, and they are taking “control” and responsibility for medications.
    
11. Documentation will be kept as normal delivery signature logs are kept.

Keep Going
The protocol above is just one example of what community pharmacists across the country are doing to adapt their service to patients during the COVID-19 crisis. There are of course many others. Resources to find them include this CPESN page that gathers social media posts with the hashtag #covidrx and this NCPA^® photo gallery.

Thank you, pharmacists, for your dedication and resourcefulness in serving all of us during this time.