Prof. Dr. Mahendra Patel

By Mahendra Patel

Pharmacists, like all other colleagues involved on the NHS frontline with delivering health and care services against the colossal challenges of Covid-19, are certainly not without their own individual and additional challenges.

Supporting my colleagues in the community setting, for example, allowed me to bring some of these challenges much closer to heart, and importantly take in a perspective that opened my eyes more widely than I foolishly thought I already had.

Understanding more about the operational aspects working at the coalface during this Covid19 climate, and how pharmacy teams as a whole try as best as they can under the circumstances to cope with a nowhere near full workforce, was personally saddening for me to come to terms with.

I would hasten to add, this was of course, very different to my often regular and customary role of advising and helping to develop and provide strategic support in dealing with such issues, and that from afar!

Equally, it was very different to when I worked as a locum just not long before Covid-19 being an epidemic and nowhere near the pandemic that we all currently have to live with and know only too well.

It is simply not acceptable that pharmacists and pharmacy teams, alongside our NHS colleagues, are not been provided with the appropriate personal protective equipment (PPE).

The PPE that had been provided by the pharmacy (bought through eBay), presented its own challenges. I tried hard to grapple with the various equipment including mask, eye visor and gloves in order to carry out my professional duties as safely as possible.

The quality of the PPE left little room for confidence but it was all that was available under the circumstances. One could not help but think it must be better than having nothing.

The visor was definitely a poor attempt to protect the eyes from over my spectacles, as they kept misting up. This meant constantly having to adjust and touch my spectacles to correct them, and subconsciously often my eyes too. This presented an increased risk of transmission, and undoubtedly is something colleagues in similar situations elsewhere have experienced too.

The gloves further added to the potential risk of contracting coronavirus. They almost acted like another pair of hands only without being washed as much. Regular use of alcohol sanitiser was essential but often neither practical nor possible, depending on how busy the pharmacy became.

The fluid resistant surgical masks (FRSMs) were also another likely source of increased risk of transmission  if not used properly. Once fitted over the nose and face, the nose clip required regular adjusting to prevent the mask from slipping. This increased the chances of touching the nose and mouth areas – primary sites for viral transmission.

One important safety point to emphasise is that FRSMs are there to protect spread to others more than they are there to protect oneself.

Currently PHE recommends the following regarding the use of surgical masks:

  • Cover both nose and mouth
  • Not allow to dangle around the neck after or between each use
  • Not touch once put on
  • Change when they become moist or damaged
  • Be worn once and then discarded – hand hygiene must be performed after disposal

In terms of exercising hand hygiene, some prefer to using gloves owing to the now very frequent use of alcohol santisers leaving hands severely dehydrated for many. This is again deterring people from its frequent use.

Naturally people’s behaviours, attitudes, and even inclination to follow instructions for the correct and proper use of protective wear, all contribute hugely in helping to minimise spread of the virus.

These understandings and actions vary widely from individual to individual and pharmacy to pharmacy. However, without appropriate and sufficient PPE protection pharmacists and their teams are clearly at risk of catching and spreading coronavirus to patients as well as colleagues.

Adhering to the PHE social distancing recommendations of keeping two meters apart becomes another daily challenge for pharmacies. Within a small and often crowded dispensary this is invariably problematic and even impossible in some cases.

Not surprisingly, with constantly new evidence emerging regarding the benefits of using PPE, we continue to witness changing opinions and recommendations from various health organisations and advisory bodies, nationally and internationally.

PHE have now changed its guidance on PPE to give more clarity around when pharmacists should be wearing Type IIR FRSMs.

Its guidance issued on April 10 recommends that pharmacy staff should only wear PPE when in contact with possible or confirmed cases of COVID-19. This is different from earlier guidance, which stated that FRSM was recommended where social distancing could not be maintained.

The Royal Pharmaceutical Society (RPS) advises pharmacists to wear FRSMs when working around staff, as well as patients, wherever a distance of two metres cannot be maintained. Various other interpretations from NHS England state that pharmacists and pharmacy teams do not need to use PPE while working with colleagues in a dispensary – a view that the RPS does not support.

Amid the continuous and ever-growing evidence of information made available to us, it is vital we all continue to refer to the most recent, approved, and trusted guidance in our fight against Covid19.

Finally, as we continue to work in putting patients first we must at the same time remember to protect ourselves as well as others.

Keeping safe has become a priority for all.

Dr Mahendra Patel, a senior academic pharmacist, is member of the RPS English pharmacy board.

This article also appears in the May issue of Pharmacy Business.

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