LAUSR

To the Editor—Antimicrobial stewardship programs responded to the coronavirus disease 2019 (COVID-19) pandemic by developing treatment pathways to monitor the use of potential COVID-19 therapies to ensure appropriate management and to mitigate toxicities.1,2 These approaches mimicked traditional stewardship efforts by using the shortest effective duration of therapy, assessing drug–drug interactions, and monitoring drug safety and efficacy parameters. Given the rapid rise in the number of patients with confirmed or suspected COVID-19 cases combined with the national shortage of personal protective equipment (PPE), we identified an immediate opportunity for pharmacists, as integral members of the antimicrobial stewardship team, to help conserve PPE and limit healthcare worker (HCW) exposure by consolidating the number of times medications needed to be administered throughout the day. In our hospital’s pharmacy practice model, decentralized pharmacists perform daily patient chart reviews to optimize pharmacotherapy, including antimicrobials. Pharmacists utilize a clinical surveillance software (Theradoc, Premier, Charlotte, NC) using both real-time alerts and structured workflows for anticoagulation monitoring, renal dose adjustments, therapeutic drug monitoring, and microbiology review. We leveraged existing work flow and infrastructure to develop this consolidation initiative. By incorporating positive SARS-CoV-2 PCR results into pharmacists’ daily workflow via our surveillance software, pharmacists can easily identify these patients and assess their medication administration record for optimization. Persons under investigation were identified during routine chart review. The initiative provided pharmacists with guidance on strategic methods of consolidating the medication administration record based on 3 domains: (1) consolidation of medication administration times, (2) optimizing pharmacotherapy, and (3) therapeutic drug monitoring.