Pharmacies: recommended practices and personal protective equipment (PPE)

Interim guidance: June 1, 2020

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Phase 1‒2: no evidence of community spread

The following are interim guidelines for the use of PPE in pharmacies. Given the current epidemiology of COVID-19 in Yukon, we do not recommend you assume and treat each patient as suspect for COVID-19. Rather, each patient encounter should be evaluated based on risk.

Providers have been encouraged to fax their prescriptions with their urgency and patients who've been advised to self-isolate are not to present to pharmacies for pick-up. Patients should designate a non-self-isolating person to:

  • pick up their medications; or
  • use the pharmacy’s delivery service.

The presence or absence of risk factors will direct the provider or staff member to the recommended steps for that particular encounter. We strongly recommend the utilization of a virtual health platform for patient care, if applicable.

Risk factors for COVID-19

  • Any travel outside Yukon or Canada in the past 14 days
  • Named as a possible contact and currently under self-isolation
  • Any household members who are currently under self-isolation
  • Presence of any of the following symptoms:
    • fever and/or chills;
    • cough; and
    • difficulty breathing.

For patients who've screened positive for symptoms, advise them to:

If any 1 of these risk factors is present, the patient should not come to the pharmacy, except for extenuating circumstances. Posting signs at the entrance signalling patients to call the pharmacy and not enter could be a means to limit these patients from presenting. For patients who require the administration of an injection, it's at the clinical discretion of the pharmacist and the ordering provider. If possible, postpone the visit until:

  • the patient has been evaluated by a medical provider and is no longer symptomatic or the self-isolation period is complete; or
  • refer to the healthcare provider clinic to administer the injection.

If your patient requires urgent, essential evaluation and treatment, follow the process and recommendations outlined below.

Strep throat swabs

At this time we recommend that pharmacies do not offer point-of-care strep throat swabs until further notice. Refer patients to their primary care physician.

Augmentation of routine practices

The presence of any 1 of the above risk factors will indicate the need for augmentation of routine practices.

What are routine practices?

Routine Practices are the infection prevention and control (IPC) “practices for use in the routine care of all patients at all times in all healthcare settings and are determined by the circumstances of the patient, the environment and the task to be performed.”

Point-of-care (POC) risk assessment

Central to these routine practices is a point-of-care (POC) risk assessment. A POC risk assessment is performed by healthcare workers to determine which IPC measures are appropriate to assure safe patient care, taking into account:

  • the symptoms of the patient;
  • the intended interaction; and
  • the protection the healthcare worker from exposure to infection (such as exposure to body fluids, respiratory secretions, sharps, etc.).

Routine practices include, but are not limited to:

  • point-of-care risk assessment;
  • hand hygiene (either soap and water or an alcohol-based hand sanitizer);
  • aseptic technique;
  • patient placement and flow; 
  • appropriate use of PPE ; and
  • management and cleaning of the patient care environment. 

Public health measures

The continuation of basic public health measures shown to reduce the risk of transmission and acquisition of COVID-19 is imperative to all interactions:

  • physical or social distancing;
  • hand hygiene; and
  • respiratory etiquette.

Additional measures

Additional measures can be put in place to help to create a safer environment for the patient and staff. Such environmental measures and visual cues include:

  • visual cues and signage at doors encouraging patients to call ahead if symptomatic;
  • visual cues and signage re-enforcing good hand hygiene practices and respiratory etiquette;
  • Plexiglass barrier for administrative staff or screeners;
  • duct tape or other visual cue indicating appropriate spacing between patients; and 
  • staggering scheduled appointments in order to maximize capacity for physical distancing in the pharmacy.
Patient: no COVID-19 risk factors

Appropriate PPE for patient care based on target personnel and activity

If there are no COVID-19 risk factors, continue routine practices relevant for the intended interaction.

Target space  Target personnel Activity/Interaction Recommended practices
Screening or  triage area staff Screener or administrative staff Screening or greeting a patient, not involving direct contact 
  • Maintain at least 2-metres separation or behind Plexiglass
  • Limit the number of patients in the pharmacy, assuring appropriate social distancing 
Screening or triage area patients Patients without respiratory symptoms or risk factors for COVID-19  Being screened 
  • Hand hygiene 
  • Maintain at least 2-metres distance 
Witnessed dosing of medications staff   Staff Administering medication
  • Hand hygiene 
  • Maintain at least 2-metres distance or behind plexiglass
Witnessed dosing of medications patients   Patients without respiratory symptoms or risk factors for COVID-19 Receiving medication  Hand hygiene
Maintain at least 2-metre distance
Clinical or work space: staff Staff Tasks that do not involve patient contact 
  • Maintain at least 2-metre separation  
  • Regular practices of respiratory etiquette and hand hygiene
Waiting room: patients  Patients without respiratory symptoms and absence of risk factors for COVID-19  Waiting for prescriptions
  • Hand hygiene Maintain at least 2 metres from other patients
  • Encourage patients to wait in their cars until the prescription is complete
Consultation room: staff Pharmacists or pharmacy technicians  Performing injections on patient without respiratory symptoms and absence of COVID-19 risk factors 
  • Hand hygiene
  • Routine practices for administration of injections
Consultation room: patients Patient without respiratory symptoms and absence of risk factors for COVID-19  Undergoing consultation for medications or administration of pharmaceuticals  Hand hygiene
All patient care areas: environmental services Environmental services Cleaning and decontamination of patient care areas Routine cleaning, any equipment shared between patients must be cleaned and disinfected. Find out more about cleaning and disinfecting the workplace.

 

Patient symptomatic or self-isolating: no other way to deliver services

Appropriate PPE for patient care based on target personnel and activity

If your patient needs an injection or medication and these treatments cannot be delayed until they have no symptoms or are no longer self-isolating, and it’s not possible to deliver these services in any other way, follow the following recommendations for practice and PPE. 

If PPE is not available in your facility, consider referring your patient to their healthcare provider if they:

  • have risk factors for COVID-19; and
  • cannot wait for their injection.

It is strongly recommended to have this patient come during certain hours to reduce risk to other patients. For example, schedule as the last patient of the day.

Target space  Target personnel Activity/Interaction Recommended practices
Screening or  triage area staff Screener or administrative staff Screening or greeting a patient, not involving direct contact 
  • Maintain at least 2 metres separation or 
  • Behind plexiglass
Screening or triage area patients Patients with respiratory symptoms or risk factors for COVID-19  Being screened 
  • Hand hygiene
  • Surgical/procedural mask
  • Give tissues for respiratory hygiene
  • Maintain at least 2 metres distance
  • Assure safe disposal of used tissues
Witnessed dosing of medications staff   Staff Administering medication
  • Hand hygiene 
  • Maintain at least 2-metres distance or behind Plexiglass
Witnessed dosing of medications patients   Patients with respiratory symptoms or risk factors for COVID-19 Receiving medication 
  • Hand hygiene 
  • Surgical/procedural mask 
  • Give tissues for respiratory hygiene 
  • Maintain at least 2 metres distance 
  • Assure safe disposal of used tissues
Clinical or work space: staff Staff Tasks that do not involve patient contact 
  • Maintain at least 2-metre separation  
  • Regular practices of respiratory etiquette and hand hygiene
Waiting room: patients  Patients with respiratory symptoms and/or presence of risk factors for COVID-19  Waiting for prescriptions pick-up and/or injections
  • Hand hygiene
  • Surgical or procedural mask Respiratory etiquette
  • If possible, isolate in room or in a designated area. If not feasible, maintain at least 2 metres from other patients
  • Encourage to wait in car until medication is filled
Consultation room: staff Pharmacists or pharmacy technicians  Administering injectable and/or consultation to a patient with respiratory symptoms and/or risk factors for COVID-19
  • Hand hygiene
  • Droplet and contact precautions: surgical or procedural mask; gown; gloves; goggles or face shield
Consultation room: patients Patients with respiratory symptoms and/or presence of risk factors for COVID-19  Receiving an injection and/or consultation 
  • Hand hygiene 
  • Surgical or procedural mask 
  • Respiratory etiquette 
All patient care areas: environmental services Environmental services Cleaning and decontamination of patient care areas Routine cleaning, any equipment shared between patients must be cleaned and disinfected. Find out more about cleaning and disinfecting the workplace.

The following are interim guidelines for the use of PPE in pharmacies. Given the current epidemiology of COVID-19 in Yukon, we do not recommend you assume and treat each patient as suspect for COVID-19. Rather, each patient encounter should be evaluated based on risk.

Providers have been encouraged to fax their prescriptions with their urgency and patients who've been advised to self-isolate are not to present to pharmacies for pick-up. Patients should designate a non-self-isolating person to:

  • pick up their medications; or
  • use the pharmacy’s delivery service.

The presence or absence of risk factors will direct the provider or staff member to the recommended steps for that particular encounter. We strongly recommend the utilization of a virtual health platform for patient care, if applicable.

Risk factors for COVID-19

  • Any travel outside Yukon or Canada in the past 14 days
  • Named as a possible contact and currently under self-isolation
  • Any household members who are currently under self-isolation
  • Presence of any of the following symptoms:
    • fever and/or chills;
    • cough; and
    • difficulty breathing.

For patients who've screened positive for symptoms, advise them to:

If any 1 of these risk factors is present, the patient should not come to the pharmacy, except for extenuating circumstances. Posting signs at the entrance signalling patients to call the pharmacy and not enter could be a means to limit these patients from presenting. For patients who require the administration of an injection, it's at the clinical discretion of the pharmacist and the ordering provider. If possible, postpone the visit until:

  • the patient has been evaluated by a medical provider and is no longer symptomatic or the self-isolation period is complete; or
  • refer to the healthcare provider clinic to administer the injection.

If your patient requires urgent, essential evaluation and treatment, follow the process and recommendations outlined below.

Strep throat swabs

At this time we recommend that pharmacies do not offer point-of-care strep throat swabs until further notice. Refer patients to their primary care physician.

Augmentation of routine practices

The presence of any 1 of the above risk factors will indicate the need for augmentation of routine practices.

Routine Practices are the infection prevention and control (IPC) “practices for use in the routine care of all patients at all times in all healthcare settings and are determined by the circumstances of the patient, the environment and the task to be performed.”

Point-of-care (POC) risk assessment

Central to these routine practices is a point-of-care (POC) risk assessment. A POC risk assessment is performed by healthcare workers to determine which IPC measures are appropriate to assure safe patient care, taking into account:

  • the symptoms of the patient;
  • the intended interaction; and
  • the protection the healthcare worker from exposure to infection (such as exposure to body fluids, respiratory secretions, sharps, etc.).

Routine practices include, but are not limited to:

  • point-of-care risk assessment;
  • hand hygiene (either soap and water or an alcohol-based hand sanitizer);
  • aseptic technique;
  • patient placement and flow; 
  • appropriate use of PPE ; and
  • management and cleaning of the patient care environment. 

Public health measures

The continuation of basic public health measures shown to reduce the risk of transmission and acquisition of COVID-19 is imperative to all interactions:

  • physical or social distancing;
  • hand hygiene; and
  • respiratory etiquette.

Additional measures

Additional measures can be put in place to help to create a safer environment for the patient and staff. Such environmental measures and visual cues include:

  • visual cues and signage at doors encouraging patients to call ahead if symptomatic;
  • visual cues and signage re-enforcing good hand hygiene practices and respiratory etiquette;
  • Plexiglass barrier for administrative staff or screeners;
  • duct tape or other visual cue indicating appropriate spacing between patients; and 
  • staggering scheduled appointments in order to maximize capacity for physical distancing in the pharmacy.

Appropriate PPE for patient care based on target personnel and activity

If there are no COVID-19 risk factors, continue routine practices relevant for the intended interaction.

Target space  Target personnel Activity/Interaction Recommended practices
Screening or  triage area staff Screener or administrative staff Screening or greeting a patient, not involving direct contact 
  • Maintain at least 2-metres separation or behind Plexiglass
  • Limit the number of patients in the pharmacy, assuring appropriate social distancing 
Screening or triage area patients Patients without respiratory symptoms or risk factors for COVID-19  Being screened 
  • Hand hygiene 
  • Maintain at least 2-metres distance 
Witnessed dosing of medications staff   Staff Administering medication
  • Hand hygiene 
  • Maintain at least 2-metres distance or behind plexiglass
Witnessed dosing of medications patients   Patients without respiratory symptoms or risk factors for COVID-19 Receiving medication  Hand hygiene
Maintain at least 2-metre distance
Clinical or work space: staff Staff Tasks that do not involve patient contact 
  • Maintain at least 2-metre separation  
  • Regular practices of respiratory etiquette and hand hygiene
Waiting room: patients  Patients without respiratory symptoms and absence of risk factors for COVID-19  Waiting for prescriptions
  • Hand hygiene Maintain at least 2 metres from other patients
  • Encourage patients to wait in their cars until the prescription is complete
Consultation room: staff Pharmacists or pharmacy technicians  Performing injections on patient without respiratory symptoms and absence of COVID-19 risk factors 
  • Hand hygiene
  • Routine practices for administration of injections
Consultation room: patients Patient without respiratory symptoms and absence of risk factors for COVID-19  Undergoing consultation for medications or administration of pharmaceuticals  Hand hygiene
All patient care areas: environmental services Environmental services Cleaning and decontamination of patient care areas Routine cleaning, any equipment shared between patients must be cleaned and disinfected. Find out more about cleaning and disinfecting the workplace.

 

Appropriate PPE for patient care based on target personnel and activity

If your patient needs an injection or medication and these treatments cannot be delayed until they have no symptoms or are no longer self-isolating, and it’s not possible to deliver these services in any other way, follow the following recommendations for practice and PPE. 

If PPE is not available in your facility, consider referring your patient to their healthcare provider if they:

  • have risk factors for COVID-19; and
  • cannot wait for their injection.

It is strongly recommended to have this patient come during certain hours to reduce risk to other patients. For example, schedule as the last patient of the day.

Target space  Target personnel Activity/Interaction Recommended practices
Screening or  triage area staff Screener or administrative staff Screening or greeting a patient, not involving direct contact 
  • Maintain at least 2 metres separation or 
  • Behind plexiglass
Screening or triage area patients Patients with respiratory symptoms or risk factors for COVID-19  Being screened 
  • Hand hygiene
  • Surgical/procedural mask
  • Give tissues for respiratory hygiene
  • Maintain at least 2 metres distance
  • Assure safe disposal of used tissues
Witnessed dosing of medications staff   Staff Administering medication
  • Hand hygiene 
  • Maintain at least 2-metres distance or behind Plexiglass
Witnessed dosing of medications patients   Patients with respiratory symptoms or risk factors for COVID-19 Receiving medication 
  • Hand hygiene 
  • Surgical/procedural mask 
  • Give tissues for respiratory hygiene 
  • Maintain at least 2 metres distance 
  • Assure safe disposal of used tissues
Clinical or work space: staff Staff Tasks that do not involve patient contact 
  • Maintain at least 2-metre separation  
  • Regular practices of respiratory etiquette and hand hygiene
Waiting room: patients  Patients with respiratory symptoms and/or presence of risk factors for COVID-19  Waiting for prescriptions pick-up and/or injections
  • Hand hygiene
  • Surgical or procedural mask Respiratory etiquette
  • If possible, isolate in room or in a designated area. If not feasible, maintain at least 2 metres from other patients
  • Encourage to wait in car until medication is filled
Consultation room: staff Pharmacists or pharmacy technicians  Administering injectable and/or consultation to a patient with respiratory symptoms and/or risk factors for COVID-19
  • Hand hygiene
  • Droplet and contact precautions: surgical or procedural mask; gown; gloves; goggles or face shield
Consultation room: patients Patients with respiratory symptoms and/or presence of risk factors for COVID-19  Receiving an injection and/or consultation 
  • Hand hygiene 
  • Surgical or procedural mask 
  • Respiratory etiquette 
All patient care areas: environmental services Environmental services Cleaning and decontamination of patient care areas Routine cleaning, any equipment shared between patients must be cleaned and disinfected. Find out more about cleaning and disinfecting the workplace.