From January 2020 until March of 2022, I was one of two inpatient pharmacy supervisors at Community Regional Medical Center (CRMC) in Fresno, California. CRMC is a big level one trauma center. They have about every imaginable service, minus only bone marrow and solid-organ transplants. The pharmacy is large and busy. The size and complexity of the place generated plenty of opportunities to make changes, test out new processes, and work through complicated patient care issues.
Thinking back, you will note that COVID-19 was in full swing during my time at CRMC, especially during late 2020 and throughout 2021. The fallout from the virus created some interesting problems for pharmacy, namely supply chain issues and increased patient acuity, resulting in increased workload. One particularly troublesome issue was the strain that COVID-19 put on CRMC’s sterile compounding service. The inability to get product, combined with increased demand for certain types of infusions, wreaked havoc on the department.
In response, our team did some interesting things to simplify, streamline, and improve IV production during this time. The work was some of the best I had ever done. I felt so good about it that I thought others might like to review the process. I thought someone might be able to learn from our successes and failures. So, along with a couple of colleagues, I decided to write what I thought would be a publishable article. Turns out there’s a reason I started a blog more than a decade ago instead of trying to push information through mainstream publications.
The article manuscript was uploaded to the AJHP portal and sat for quite some time. Once the review process began, it wasn’t long before it was summarily rejected. Not “hey, fix these things and we’ll publish it”. Nope, a straightforward “we regret to inform you…”. Apparently, the information wasn’t worth publishing. Some of the comments received from reviewers were valid, and worth consideration, but others were quite silly. Someday, I might post the reviewer comments here just to see what others think. However, right now I’m irritated, so it doesn’t seem like a great idea.
Overall, I found the reviewers comments lacking in basic understanding of what goes on day-to-day in a large inpatient pharmacy. Some of the comments — “What type of inventory adjustment occurred when usage patterns changed?” – had me scratching my head. Had these folks ever worked in a real pharmacy? I mean, adjusting inventory isn’t rocket science. Ask yourself what happens when your family starts going through two gallons of milk every week instead of one. You buy more milk. Or, for empty nesters like me and my wife, when you hardly ever need milk anymore, you only buy it when you need it. Common sense, people. Common sense.
Anyway, my original intent for the article was to disseminate information to those that might find it useful. So, for those people, I’m including it here in its entirety, warts and all. With that said, the article is written in a more formal tone than my normal writing, which honestly makes it more difficult to fully understand. All told, the necessary information is probably a 1-page weblog. Regardless, I hope you get something out of it. Happy reading.
Oh, one thing that I think is important but got left out of the article is how manual the processes were that we used to improve our sterile compounding. Shocking, really. My love of technology and automation offered no benefit here. Healthcare – and by association pharmacy – is so disjointed and fragmented that I quickly abandoned any attempt to automate this project. Simple, manual tasks continue to rule the day.
Sterile product optimization during the SARS-CoV-2 pandemic at a large academic medical center pharmacy