Keeping patients and colleagues safe during COVID-19

Our head of clinical governance and professional standards, Victoria Steele, reflects personally on Spring 2020.

Looking back, it’s hard to remember exactly when things changed. In mid-February we were involved in one of the UK’s first cases of the, at that point, unnamed coronavirus, but by the beginning of March we were operating in a very different environment.

The pace that we had to adopt to develop new ways of working became apparent very quickly and so was who was core to the team of decision makers and implementers.

Every day, we hit the ground running. Every day we felt a complete brain drain but somehow managed to operate on adrenaline to redesign our operations whilst all the time focussing on two key things: getting medicines to patients safely and the health and welfare of our colleagues. Nothing else mattered and the focus gave us absolute clarity.

I tried to leave the office each day at five to listen to the government briefing in the car but inevitably there was more to deal with from home. Any conversations with friends and family were dominated by COVID-19 and I was usually the one with most knowledge of the situation.  They just wanted to talk about it, but it meant I found it really hard to switch off.  When we were at work it was easy to get on with the job in hand but the evenings were when the overwhelming concern and worry about what was actually happening in the world hit home.  We all had concern about parents and loved ones that were so far away.

The objective was to get ahead of the game before the next thing struck us, though I’m not sure that we ever achieved that. It took us a few weeks to get alongside the issues, particularly after we made a significant number of changes, that did seem to ease the tension slightly and I do feel we were able to reduce the workload for stores who were dealing with such extraordinary circumstances.

I was incredibly grateful for the strong network of superintendents in the CCA who communicated regularly, shared the same experiences and had the same priorities – all sense of competition gone. The Patient Safety Group included representatives from 19 organisations, so we were able to provide support to those from smaller companies too.

We risk assessed everything, then rang representative bodies and regulators to tell them what we were doing – there was no time to ask!

March 19 will stay in my head forever as the zenith of the crisis in my world. We took so many decisions that day: limiting the number of patients in pharmacy (many were operating with locked doors), remote supervision, we empowered pharmacists to make good, safe, sensible decisions around controlled drugs dependent on each set of individual circumstances when they couldn’t contact prescribers, arrangements for doorstep deliveries, taking the patients that it was safe to do so off community dosage systems to limit workload… it just went on and on.

I implemented an 8.45am briefing – just a 15 minute check-in to keep everyone up to speed on the changes and to make sure team members were OK. Whilst I know the best place for me was alongside my colleagues making a wide range of decisions, as a pharmacist I was desperately concerned about our frontline colleagues. These calls are one of the things we’ve decided to keep, though now just three times a week.

When ‘lockdown’ was announced on March 23 there were more decisions. Two in, two out policy, PPE, screens.  We were lucky to have been in touch with our colleagues in McKesson Italy who had dealt with the more serious impacts of the pandemic ahead of us.  We’d discussed the possibility of screens for a few weeks but once the decision was made it was amazing how quickly we got them installed.

Through it all I’ve felt very lucky to be one of the very few people in office, not just as it meant decisions could be made and implemented at high speed, but it provided a sense of normality and camaraderie.

The main things I have learnt are how good we are at working at pace and making good decisions and to value collaboration internally and externally. The strength of my team and the relationships I’ve been able to build over many years really helped us to achieve more.

I’m now reflecting on our changes to ways of working and what we see as levers for change. For instance, I think we can now have a very different conversation about remote supervision.  We could agree a framework about how to implement it, I can see a way forward now. I also think we can learn from GPs about remote consultation and open up our capability for more services.

The experiences of the last few weeks will stay with me forever and I’m massively proud of what we’ve achieved. I’m fortunate in that my team and my family have been untouched by the virus, that is not true of so many people.