FEATURE: State Pharmacists and APA

Personal protective equipment being unloaded in Arkansas

Governor Asa Hutchinson announces the first presumptive positive coronavirus case in March

State Pharmacists and APA Adapt to the New Normal

Although little information was shared about the scheduled press conference on March 11, the air in the room had a grim heaviness to it as reporters gathered into the governor’s reception room at the state capitol. News reports from other states and rumors from within our own were pointing to the likeliest scenario, soon confirmed by Governor Asa Hutchinson: officials had identified the first presumed case of the novel coronavirus in Arkansas. The news came as a strikingly bitter reminder that virtually no area of the globe would remain untouched for long from the growing pandemic. Within weeks, the world would be reminded of another stark truth: while many people were able to secure the safety of themselves and their families by staying home and sheltering in place, healthcare officials including pharmacists put their lives on the line to protect the health and wellbeing of their patients.

Over the following months, Americans saw changes that were once unimaginable. What began with advice to wash your hands repeatedly and avoid shaking hands soon lead to classes moving online for millions of students, restaurants shifting to curbside pickup, gyms, barber shops and other businesses shuttering their doors, and several “shelter in place” and mask mandates by dozens of governors and local governments. The phrases “social distancing” and “flattening the curve” by APA Director of Communications Jordan Foster

became part of the national zeitgeist. Yet through it all, pharmacists across Arkansas didn’t miss a step. Community pharmacists transitioned to drive-thru, curbside pickup, or delivery. Health system pharmacists worked diligently to monitor PPE and drug shortages at hospitals throughout Arkansas. Compounding pharmacists made thousands of bottles of hand sanitizer when a shortage hit. Consultant pharmacists worked with state leaders to develop regulations for nursing homes, one of the earliest and hardest hit areas of the pandemic in Arkansas. UAMS and Harding faculty and staff worked feverishly to make a seamless transition to online learning and reschedule rotations to protect students. Pharmacists statewide stepped up to the challenge of serving their patients in a brand-new world.

At the Arkansas Pharmacists Association, the pandemic forced us to adapt as well. In mid-March, APA CEO John Vinson made the decision to allow staff to work remotely for their safety. Twelve-hour workdays were not uncommon as information about the coronavirus continuously evolved and state rules and regulations were constantly having to be amended, suspended, or upended. Through the APA COVID Resource webpage and daily COVID email update, we aimed to keep our members informed ofthesteadilychangingflood of information.

VIRTUAL Reality

“Virtual” is a word that will be forever linked with the COVID pandemic. As many events across the country went from inperson to virtual, APA shifted many of our events to an online experience to keep in line with social distancing requirements. We celebrated the students of the UAMS College of Pharmacy and the Harding College of Pharmacy with virtual pinning and graduation ceremonies. We hosted several virtual townhalls with Arkansas pharmacy leaders. John Vinson even interviewed Governor Asa Hutchinson during APA’s first ever Q&A with a sitting governor.

But with June approaching quickly and the APA annual convention essentially an impossibility, staff began working on an ambitious, all-day Virtual Seminar featuring topics including a Supreme Court panel discussion spanning multiple states and a COVID update from one of the state’s leading authorities. More than 100 attendees tuned in to see APA President Dean Watts and CEO John Vinson broadcasting live from a makeshift television studio at the DoubleTree Hotel in Downtown Little Rock. Due to the success of the Virtual Seminar, we are looking at similar opportunities to offer CE to our members in the future.

The Arkansas Pharmacy Foundation and Fredeirica Pharmacy team up with student pharmacists to compound hand sanitizer

Many pharmacies and other businesses had to adapt to new guidelines like delivery or drive thru only to protect their staffs and patients.

STAYING Safe

Two crucial weapons in the fight against the COVID pandemic emerged with a commonsense approach: use a mask to help prevent passing anything from yourself to someone else and keep your hands clean through washing with soap and water or hand sanitizer.

Unfortunately, the pandemic created a rush on both masks and hand sanitizer, denying healthcare workers of valuable tools to stay safe. Due to unprecedented demand, huge shipments of personal protective equipment were being constantly diverted as virtually every global leader jockeyed for access to PPE for their country. Even here at home, Governor Asa Hutchinson, during one of his daily COVID press briefings, shared his frustrations over a shipment of PPE purchased by state officials for use in Arkansas hospitals being diverted at the last minute to other states.

For weeks, healthcare workers were re-using masks and gloves or

Past President Dean Watts and CEO John Vinson host the first ever APA Virtual Seminar, broadcasting live from downtown Little Rock.

using whatever they could find. Finally, a break came when a tip was shared with APA CEO John Vinson about a local company that had access to a supply of masks. Through several days of bargaining, arranging, and planning and hundreds of emails, phone calls, and texts, the Arkansas Pharmacists Association procured a large shipment of surgical masks and N95 respirators and immediately announced a reservation system to allow pharmacies to claim masksfortheirstaff.

Within an hour of announcing that masks were available to APA members and accepting orders, the word came back that the distributors supply chain had been disrupted and the cargo ship carrying our shipment of masks was being diverted to another area, meaning the masks were gone. However, in the following days, APA continued to work with our original distributor and together we were able to secure several shipments of L3 surgical masks and make them available to APA members. (As of print time, we still have some surgical masks available. If you’d like to order a bundle, go to www.arrx.org and look for the link under News & Announcements).

While APA was securing masks for pharmacists throughout the state, the Arkansas Pharmacy Foundation teamed up with Lyn Fruchey of Freiderica Pharmacy in Little Rock and volunteer student pharmacists from UAMS and Harding Colleges of Pharmacy to focus on a vulnerable community that had been overlooked in the COVID pandemic. Volunteers from the Arkansas pharmacy community spent several days compounding 110 gallons of USP-grade pharmaceutical quality hand sanitizer into approximately 1,800 8-oz bottles to be distributed primarily to homeless shelters in Arkansas. Thanks to the organizers and volunteers, homeless shelter residents and staff had a muchneeded weapon to help combat the coronavirus.

The COVID pandemic affected virtually every Arkansan in some way. As the most accessible healthcare provider, pharmacists were directly impacted by the pandemic and had to adapt to new ways of serving their communities. Here, in their own words, are some of Arkansas’s pharmacists relaying their stories of COVID’s reach and impact in Arkansas. thru testing and have opened community testing sites in areas

Helping Out

“Arkansas Medicaid prefers Proair for their formulary albuterol inhalers. In March, our sources were depleted due to COVID-19. I reached out to John Vinson at APA to see what we could do to open up options for generics. The formulary was changed by the next day. The quick action taken by John and Arkansas Medicaid We are utilizing the Abbott ID NOW COVID-19 tests, which is less

was essential to making sure our patients didn't go without this important medication.” – Greta Ishmael - Econo-Med Pharmacy, Cherokee Village

“We knew there would be a huge need for hand sanitizer, especially for people who work with the public on a daily basis. We donated 100 masks and 160 bottles of hand sanitizer to the LRPD to help protect the department as they work to protect our city.” – Adam Wheeler - Tanglewood Drug Store, Little Rock

“When we closed the lobby at the pharmacy, our daughter and money, and whatever else was needed. Seeing everyone come together and support each other even during a pandemic was – Krystal Soo - Soo's Drug Store, Jonesboro

gift shop manager Sydney Carter, along with her employees Janie Thompson and Kari Bounds, dug out old sewing machines, cut out patterns, and sewed masks for the pharmacy employees. Word got out to the community and they ended up cutting, ironing, and sewing 1 more than 1,000 masks and used the proceeds to make a $2,000 donation to the local food bank. Their masks were everywhere, even shipped out of state, but unfortunately the project ended when they ran out of materials and couldn’t find any more.” – Karen Watts - Dean's Pharmacy, Dewitt

Testing

“Stott’s Drug Store in Searcy was selected as one of only 63 independent pharmacies in the nation to participate in a public private partnership for COVID-19 testing through a partnership with Healthmart Stores and eTrueNorth. We were honored to be the first independent pharmacy in the state to perform COVID-19 tests. Being able to show our city, state, and nation that pharmacists can step up and provide valuable clinical services is an important step moving forward in our profession. COVID-19 testing, along with the changes we have had to make to keep our pharmacy operating during this crisis, has had its challenges, but we have all adapted PBM issues and other local issues as they arise. Working together

and continue to serve our community.” – Peyton Harvey - Stott’s Drug Store, Searcy

"When we were approached by HealthMart to partner with eTrueNorth and the US Department of Health and Human Services to serve as a COVID test collection site, our pharmacy leadership did not hesitate to sign on. The decision to offer COVID testing in our community was also an opportunity to advocate for the 2 of the healthcare team, we must continuously adapt to do what is necessary and practice at the top of our licenses." – Allie Staton - West Side Pharmacy, Benton

“Walmart is part of communities all across America, and we believe we can play a vital role by helping our neighbors in a time of crisis. We are committed to supporting efforts to expand COVID-19 driveof need in cooperation with federal, state and local officials. We continue to look at ways to expand testing by partnering with states, labs and insurance companies in order to serve our communities during this time.” – Amber Bynum - Walmart, Bentonville

“Walgreens opened a pharmacist run COVID-19 testing site in Little Rock on June 19th. At this location, Walgreens pharmacists are overseeing individuals self-administering the test in their vehicles. invasive for the patient and we are able to provide results quicker. All tests are processed onsite in our CLIA Waived lab in the store, so patients get their results within 24 hours. We are happy to be able to provide this service to our community during these unprecedented times.” – Lindsey Butler - Walgreens, Little Rock

Community Focused

“In addition to overcoming the challenges of maintaining high levels of customer service during COVID-19, pharmacies across Jonesboro were forced to deal with the aftermath of a tornado that ripped through our city. Several of our customers, as well as one of our employees, sustained significant damage or destruction of their 3 homes. It was amazing to see our citizens, in addition to people from surrounding areas, come together to donate their time, food, wonderful. I am proud of our city. We are truly #JonesboroStrong.”

“In our community, Kevin and I have always had “friendly” competition and worked well together and collaborating in these trying times is just another example of this. I believe we should show mutual agreement in the decisions we make in the time of a pandemic to prevent overreacting and stirring panic or fear. As independent pharmacy owners, we face bigger struggles on a daily basis so we have to stand together on issues we can control.” – Eddie Mitchell - Mitchell Main St Pharmacy, Mountain View

“Eddie Jack and I talk on a fairly regular basis. We help each other with stock shortages, check with each other concerning profession of pharmacy. To be recognized as essential members

as the COVID crisis emerged seemed like a "no brainer." We also took the opportunity to coordinate with local clinics to decrease confusion for patients concerning lobby accessibility vs curbside service and will continue to do so as needed in this ever-changing environment.” – Kevin Caldwell - Best Drug, Mountain View

“We decided to keep our lobby open in the early stages of the pandemic. While we had increased curbside & delivery, we realized how much some customers enjoyed coming in and having personal interactions outside of their home. With that knowledge & feedback, we strived harder and more diligently to maintain employee health & 4 store sanitation. As exhausting as all the repetitive sanitary methods

are, we were able to find some levity while performing the routine tasks. The idea for a fun, uplifting video came as an extension of the changes the staff was making to adapt to COVID. My 14-year-old daughter Bailey put it all together, we shared it on our social media, and we were humbled as the video went viral and our customers and the pharmacy community found it entertaining.” – Philip Way - Remedy Drug, Little Rock

Med Watch

“Amneal Pharmaceuticals donated 100,000 hydroxychloroquine tablets to the State of Arkansas to help in the treatment of the COVID-19 Pandemic. A collaborative group from UAMS, Arkansas Department of Health, Arkansas Board of Pharmacy, and Arkansas Pharmacist Association determined a process for equitable distribution. This group was made aware of the shortages caused by diversion of product to state supplies and thoughtfully decided to expand the distribution to Arkansas Community Pharmacies for the maintenance therapy in Lupus and Rheumatoid Arthritis. To date, 62,300 doses have been distributed across the state. The remaining supply is still being distributed upon request.” – Jeff Cook - UAMS, Little Rock

“For health systems that were struggling with the unknowns during the COVID19 pandemic, it was a blessing to receive donations of remdesivir from Gilead. We were thankful at White River Health System to have been designated as a hospital in our area of the state to have some of the medication on hand to treat our patients as well as help our neighboring hospitals. We appreciated how well the ADH worked with our hospitals across the state to efficiently distribute the medication.” – Erin Beth Hays - White River Medical Center, Batesville

Education

“As with any situation that requires ‘gathering’ people, the UAMS COP has been affected by the pandemic. Our didactic learning spaces were closed to students in mid-March and we completed the semester with remote delivery of live lectures and examinations. For the didactic Fall 2020 semester, UAMS COP will be a mix of masked face-to-face with a social distance where possible and with recommended levels of personal protective equipment where social distancing is not possible.

Our experiential education was stopped for 1-2 weeks in March but other than that we have been able to continue offering IPPEs during the summer and APPEs for the Classes of 2020 and 2021. The senior curriculum was adjusted to at least nine APPEs from ten. We are so grateful for our IPPE and APPE preceptors; they have involved students in this unprecedented time by providing them robust learning opportunities. We cannot say thank you enough!

We are committed to providing the highest level of education and will double our efforts to support our student pharmacists during this difficult time.” – Cindy Stowe - UAMS College of Pharmacy

“Harding University College of Pharmacy is committed to providing a safe and effective learning environment for our students during the COVID-19 pandemic. To date, that has included moving the majority of our didactic (classroom) instruction to a remote delivery format and requiring strict social distancing and personal protective equipment utilization during pharmacy practice experiences for our students. Our four key health practices for a healthy semester for all of campus include hand washing, wearing face coverings in the presence of others, maintaining 6 feet of distance between individuals and daily self-monitoring for illness. We are excited for the return of our students back to campus this fall under a carefully designed plan that includes a number of contingencies designed to ensure the safest possible learning environment.” – Jeff Mercer - Harding University College of Pharmacy

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