Following the Disaster Action Plans and recommendations of the WHO4 and the European Centre for Disease Prevention and Control5, hospital management organizational and general coordination measures included the establishment of governance groups, in which the PS was actively involved:

Daily meetings were held by the operational COVID-19 Crisis Committee, which was composed of Hospital Management, Medical Management, Nursing Management, the services of Microbiology and Infectious Diseases, Emergency and Intensive Care, Internal Medicine, Pharmacy, Occupational Health, Preventive Medicine and Quality, Information Systems, Communication, and Administration Management. The main functions of this Committee were to reorganize the hospital based on daily epidemiological reports, approve protocols, and coordinate with other centers.

A second very important committee was the COVID Protocolization and Treatment Committee, comprising the services of Microbiology and Infectious Diseases, Pharmacy, Emergency Unit, Internal Medicine, Intensive Care, Pneumology, Hematology, Cardiology, Nephrology and Immunology. This committee periodically reviewed the available scientific evidence on the treatment of COVID-19 and defined the protocol for its therapeutic management.

Likewise, the need to generate knowledge about the effectiveness and safety of the treatments led naturally to the creation of a Research Committee or Consortium of the main services involved, including the hospital's Research Institute. This Committee promoted the participation of the institution in clinical trials and observational studies.

The PS management created an Internal Crisis Committee that evaluated the situation daily, based on the information gathered by the different committees in which it was involved and on the status of critical processes, new circuits established and resources. To this end, the Committee designed a daily monitoring scoreboard that supported decision-making.

If a quality management system is key to achieving the objectives of a PS, in a critical situation it is essential to document all the procedures that were designed for the health emergency. Table 1 contains a checklist of the procedures to be considered for the reorganization of a PS in a pandemic, which are addressed throughout this article.

Social distancing imposed by COVID-19 forced the suspension of face-to-face meetings and medical sessions. The PS of the HGUGM developed a communication plan to the sharing of information and work coordination. The communication plan addressed the following aspects:

• 1.

  Internal communication:

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    Creation of a repository of standard operating procedures shared with and easily accessible by all professionals.

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    Access to and training in the use of online communication tools for secure communication (e.g. Teams, Zoom, etc.).

• 2.

  External communication:

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    Identification of the key pharmacist for each of the committees and clinical service agents.

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    Creation of online communication channels with the General Sub-directorate of Pharmacy of the Autonomous Community and other PSs in the area, especially for the coordination and management of shortages of supply.

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    In addition, the protocol for alternative remote communication with chronic patients has been essential, including key messages and resolution of the most frequent doubts of patients who contacted the PS by phone, email, and social networks.

Different strategies were established to reduce the impact of the pandemic on the organization of PS workers:

• 1.

  Reduction of the movement of PS personnel:

  Access of external personnel to the PS was limited. Face-to-face visits from the pharmaceutical industry, clinical trial monitors, supervised interns, and external rotations were suspended.

• 2.

  Protection of PS professionals in all areas/activities:

  The individual protection equipment required for all PS activities was defined with the collaboration of the Occupational Health Service. Three risk categories were established: internal activities, direct patient care, and medication replacement in the automated dispensing systems of clinical units. To guarantee infection control in the PS, the cleaning protocol for the different areas of the service was updated in collaboration with the cleaning service.

• 3.

  Establishment of teleworking and special shifts:

  Teleworking and special shifts were established with a two-fold objective: (i) reduce the risk of contagion, and (ii) balance work-family life. In addition, in the PS of the HGUGM, where 30% of the pharmaceutical professionals were infected during the first 10 days of the pandemic, teleworking and the commitment of professionals were key to maintaining service quality standards.

  Another model of people management was applied in Complejo Hospitalario Universitario de Santiago, where the impact of the pandemic came with a few days’ delay, and work shifts and teleworking were organized according to the vulnerability of the professionals, their personal circumstances, and the criticality of the jobs6.

• 4.

  Vacancy-filling, education, and training:

  At least two people were assigned to each PS role in the HGUGM, and a knowledge updating program was designed to facilitate staff rotation in the event of absences.

  Welcome and training protocols were adapted, especially for the technicians and nursing staff who incorporated to fill vacancies due to sick leaves.

The success of the PS lies in that processes were rapidly redesigned to meet the high demand, ensuring a safe and efficient use of medicines (Table 1). To this end, one of the first decisions made was to provide continuous 24-hour PS care with the physical presence of pharmacists and technicians.

Procurement and supply activities were conditioned by the frequent modification of protocols. Critical medicines increased from 40 to 130 references in a matter of days, which led to shortages of supply and the adaptation of procurement models (direct to supplier, with prior authorization from the AEMPS, or centralized redistribution by the Autonomous Community depending on the activity).

Prescription assistance and pharmaceutical validation activities focused on incorporating protocols into information systems, clinical alerts, and other relevant information on the safety and effectiveness of treatments. These assistance activities were particularly relevant to the wide range of professionals, ranging from senior doctors to sixth-year medicine students.

The medication dispensing circuit underwent a major adaptation, from inventories and standards for the correct use of automated dispensing systems7 to the creation of new circuits for the care of COVID inpatients and outpatients.

Likewise, the centralized development and packaging of ready-to-use medicines was critical, with activity increasing by 186% in the case of the HGUGM.

Among the new circuits, it is worth highlighting the dispensing of medication upon discharge or in the event of referral to another health center. To this end, two types of kits were developed, which included combinations of standard medication (hydroxychloroquine, lopinavir/ritonavir, azithromycin, and paracetamol) and medication for transfer to another center (enoxaparin, cefixime, hydroxychloroquine, lopinavir/ritonavir, loperamide, paracetamol, and metoclopramide), which was individualized at the time of dispensing according to the prescription and while information on its use was provided to the patient. This organization made it possible to dispense the medication safely and without delay to more than 50 patients/day.

Finally, it is crucial for PS organization to plan how critical non-COVID activities will be maintained, such as the administration of treatments in day hospitals, in perfect coexistence with the activity related to the pandemic. An example of success was the implementation of telepharmacy programs8.

The disease is experienced by the patient and the family in great loneliness. The patient stays completely isolated in the hospital (or other healthcare setting) or at home, facing alone the uncertainties and fears of the disease, about which so little was known.

For all these reasons, accompaniment at a distance becomes more necessary than ever, and the PS must remain close to patients. Patients indicated that they needed more information about the medicines they were receiving. Some of the actions that can be implemented include:

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  Technologies to obtain information about the disease and the treatment being administered (e.g. chatbot, links to websites with scientific evidence).

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  Reminders to take medication (“at the hospital they told me to use the inhaler“).

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  Sending messages of encouragement with medication that was sent home (e.g. “these pills are pearls of hope”), or dispensed in the emergency room or upon discharge.

In the outpatient area, the goal was to protect patients by reducing hospital visits. Some of the actions implemented were the protocols for off-site pharmaceutical care with the organization of “express pick-up” points for medication without the need to enter the hospital, or sending medication to the patient's home. In many hospitals, messages of encouragement and accompaniment were provided (Figures 1 and 2). The degree of satisfaction of the patients was very high, highlighting the decrease in risk and the care received. A satisfaction survey was carried out by the PS of the HGUGM on 341 patients, with an overall score of of 9.7 points given to the service over a 10-point scale, with 100% of respondents stating that they recommend PS services to other patients.

Figure 1.

Messages to patients with home delivery (Hospital Ramón y Cajal, Madrid).

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Figure 2.

Customized packages for pediatric patients (Hospital General Universitario Gregorio Maranon, Madrid).

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The new infrastructure required is a hurdle, but at the same time it must convey security and closeness. Signs were placed to mark distance between patients, and screens were placed in consultation rooms and dispensing stations. These barriers are “anti-humanization”, and patients must be explained that they protect everyone and that PS professionals are closer than ever to patients. Messages with positive phrases can be placed on the screens (Figure 3).

Figure 3.

Screen of the pharmaceutical care consultation room (Hospital Ramón y Cajal, Madrid).

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This health emergency also hit professionals hard. However, constant care was more tangible than ever, not only within the PS, but also between the different services.

The initial phase of the emergency was characterized by a deep fear of contagion and infecting family members, along with large doses of anxiety and uncertainty. All of this was coupled with an immense workload that had to be rapidly organized.

Caring for people in this case relied on implementing actions that helped professionals feel protected, united, and supported:

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  Activating emotional intelligence to reduce fears and uncertainties.

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  Reorganization: changes in working hours and teleworking to facilitate work-life balance, ensure social distancing and reduce exposure to the virus.

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  Making everyone feel involved in decision-making. The perspective of the professionals who faced the risk most directly was crucial.

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  Identifying people who could promote a climate of serenity and create a favorable environment, for example, by recording and sharing videos of the PS with other professionals to give visibility to the role of the PS in the crisis, or thanking donations.

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  Celebrating every success achieved in the hospital (e.g. the first extubated patient).

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  Communicating to the professionals the gratitude received.

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  Offering a break or taking care of the health of our professionals (e.g. bringing breakfast and drinks to the PS, or foodtrucks in the courtyard).

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  Offering psychological support to professionals.

Once stabilized, we must prepare tools to assess their emotional state and act in time. The Hospital Ramón y Cajal in Madrid developed the SER+CONTRA COVID application aimed at making professionals aware of the effort and strain experienced through an acute stress self-assessment questionnaire and offer support resources.

COVID-19 has achieved to make all professionals truly place the patient at the center, not only of our processes, but of our lives.