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Rounding Remotely During COVID-19

Published on 12 June 2020

As the COVID-19 pandemic swept across the U.S. in March and states began issuing stay-at-home orders for residents, health care providers nationwide had to quickly adapt to providing services virtually in an effort to meet patient needs while keeping them safe.

For many clinical pharmacists, the changes meant pulling their work out of the hospital and into their homes.

Paul Juang, professor of pharmacy practice at St. Louis College of Pharmacy, serves as a clinical pharmacy specialist in one of the medical intensive care units (ICU) at Barnes-Jewish Hospital, and spent the past several weeks rounding from his home.

When the pandemic first hit the St. Louis region, Juang was conducting rounds on site in the ICU when it began caring for severely ill COVID-19 patients.

“As clinical pharmacists, rounding for us means we are in the hospital early in the morning to review patients’ medication profiles, labs, X-rays and other medical information, and we conduct daily walking rounds where we talk face-to-face with other health care professionals and patients,” Juang said. “Within the ICU at Barnes-Jewish where I was working, there were two negative isolation beds, and those were assigned as COVID-19 beds, so I was rounding with those patients directly. At the time, widespread COVID-19 testing capability wasn’t available, so we were seeing an interesting combination of really sick [potentially COVID-19-infected] patients, and some who were potentially getting sick, but not yet showing serious symptoms.”

As the pandemic ramped up in St. Louis, Juang says Barnes-Jewish began dedicating increasing numbers of ICU beds for COVID-19 patients and sealing off COVID-19-specific units within the ICU. Within the sealed off units, only essential medical staff were being allowed to have direct contact with patients, and Juang was asked to begin performing his clinical pharmacy duties remotely.

“My rounding was done via videoconferencing, which gave me and members of my team the ability to communicate with each other and those who were providing direct patient care to COVID-19 patients within the hospital,” Juang said. “Our nurse practitioners and physician assistants set up a connection with the medical team via a tablet positioned on a cart they pushed through the unit. This allowed me to call in and round with the team in the same way I always had, except I was on the other side of the tablet.”

In his remote role, Juang was responsible for evaluating COVID-19 patients and making recommendations on their medication regimens, including medications to help with the symptoms of the virus.

“Working in an academic hospital, there’s a lot of discussion about trying more novel medications,” Juang said. “At this time, there’s no magic pill we’re finding. It involves a lot of educated adjustments, working directly with patients and trying medication combinations we feel will work best with their patient profiles.”

Juang has now returned to the hospital, resuming on-site rounds within a regular medical ICU for non-COVID patients. Reflecting on the past few months, he notes that working through a time of crisis in a health care environment was challenging, but says such work offers great opportunities for students and health care providers to develop interprofessional relationships.

“It’s times like these members of the health care community realize each other’s strengths and utilize those strengths to provide better care for patients,” Juang said. “We lean on our interprofessional relationships, and this crisis is a lesson in how people can work together to solve a huge problem, no matter what part of the health care team you represent.”

St. Louis College of Pharmacy is proud of the health care heroes, many that are faculty, alumni and current students at the College, who have stepped up during the COVID-19 pandemic.

The College is committed to sharing these stories to highlight the leadership and selfless dedication demonstrated by members of our community, and to recognize the critical contributions of pharmacists and health care workers.

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