Posted by: Lindsey Fairbrother13 MAR 2020
Open access article
The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.
To learn more about coronavirus, please visit: https://www.rpharms.com/resources/pharmacy-guides/wuhan-novel-coronavirus
On 26 February 2020, before panic-buying toilet roll in fear of COVID-19 became the norm, an unwell patient presented in our community pharmacy. Nothing unusual, quite routine — a cough or cold, we thought.
We operate an extended care ear, nose and throat service at our pharmacy, so the patient was taken through to our consultation room, and soon enough we established that she had recently returned from northern Italy, an area recognised as high-risk for COVID-19 infection.
This was before NHS England and NHS Improvement had shared their standard operating procedure for managing suspected cases of COVID-19 in community pharmacy, but thank goodness for Public Health England’s (PHE’s) essential flowchart, which helped us make our next steps.
We asked the patient to return home immediately to self-isolate, and we set to work notifying the authorities. First a call to 111 to organise a home test for the patient, and then a call to PHE.
Our close proximity had been very brief, lasting a couple of minutes at most, but our asthmatic pharmacist had been within two metres of her in a small consultation room — would we be notified if the patient tested positive for COVID-19?
“No news is good news” was PHE’s advice, which was very unnerving. Like most pharmacy referrals, we never find out the outcome, but this time the uncertainty was stressful.
Staff at PHE talked us through isolating our consultation room: “close for 24 hours then deep clean” was their advice.
But all our examination equipment, from the blood pressure monitor to the otoscope, was still in the room, so we could not offer services requiring these tools for 24 hours. We didn’t know whether to inform the Directory of Services about this.
In the end, we took the pragmatic approach to triage to our neighbouring pharmacists, who also offer these services. It was only an afternoon and a morning, we thought, and we could keep the pharmacy open. We were lucky that we were able to deal with everyone who came into the pharmacy, and we did not have any referrals from the community pharmacist consultation service over the period.
Learning how to deep clean was a nightmare. Only chlorinated cleansers would do, so the TCP antiseptic we stocked was no good. We discovered online that Dettol antibacterial surface cleaner is expected to kill human coronavirus. We recommend you stock up with appropriate cleaning materials now, so staff can act fast if they need to.
Finding out which products to use was the easy bit. But how do you deep clean a room that contains files, equipment, chairs and a sink, with no personal protective equipment (PPE)? No masks were available anywhere. I was so disappointed that the appropriate authorities did not recognise, until prompting by Keith Ridge, chief pharmaceutical officer at NHS England, that pharmacy is on the front line and it needs the same PPE support as GP surgeries and other primary care settings.
So, at the time, we had to just get stuck in. I manned the pharmacy and supported our patients, while my business and life partner braved the consultation room, spending four hours cleaning every single surface, including the floor, the ceiling and the walls. We didn’t feel it was right to ask a staff member.
Open packs of ear covers for the thermometer, lancets for pre-diabetic screening, otoscope covers — they all had to be discarded. All notices in the room, including vaccination certificates and hand-washing advice posters, ironically, had to be bagged for destruction.
We’re lucky we quickly identified that our patient was at risk of COVID-19. It would have been a major blow to us for our consultation room to have been out of action for any longer, so we’re not sure that isolating patients in these rooms, according to recent guidance, is tenable.
If a patient is well enough to enter the pharmacy, they are well enough to go back home and should not have presented themselves in the first place. I am reminding my patients to this end on our social media pages. But I am concerned that staff may stay at home if they catch a cough or cold, and any pharmacy will find it difficult to operate in this short-staffing situation.
For now, our pharmacy is back to normal. I am so proud of my staff for their professionalism — for acting so quickly and sensibly.
We reacted, sorted the problem and survived. Just another day in community pharmacy.
Lindsey Fairbrother, owner and superintendent pharmacist, Good Life Pharmacy, Derbyshire