Comments from March 2020 MSOS Member Briefing Q&A on COVID-19

Below is a summary of some of the questions, answers, and comments submitted by participants in the March 2020 Medication Safety Officers Society (MSOS)  Member Briefing regarding the COVID-19 pandemic. 

Tracking Events Related to Covid-19

  1. COMMENT: Our incident reporting system added a question: "Is this event related to COVID-19 (Coronavirus)?" to help centralize those events and improved visibility for hospital leadership.

  2. COMMENT: I believe a weekly summary is being shared with the command center

Independent Double Checks (IDC)

  1. QUESTION: Are there any recommendations regarding eliminating IDC for high alert medications?

    • ANSWER: In light of Covid, we are still doing this. The med is still dangerous. If it doesn’t need an IDC with COVID, why does it need one in normal times?

    • ANSWER: Independent double checks are being done at the doorside before accessing the isolation room to save on PPEs.

    • ANSWER: questions around removing the forced dual signoff functionality within EPIC for IDC meds. 

    • ANSWER: We are interested in how other hospitals might be cutting down their IDC list.

    • ANSWER: We are moving as much verification of orders offsite as possible.

ANSWER FROM ISMP: See “Behavioral Drift” in the March 26, 2020 Special Edition COVID-19 Acute Care Medication Safety Alert!

Pumps Outside of Rooms

  1. QUESTION: There is lots of discussion around using extended tubing to keep pump outside the door if any advice/thoughts?

ANSWER FROM ISMP: See “Clinical experiences keeping infusion pumps outside the room for COVID-19 patients” in the April 3, 2020 Special Edition COVID-19 Acute Care Medication Safety Alert!

Automated Dispensing Cabinets (ADCs)

  1. QUESTION: People are raising questions regarding filling automated dispensing machines. Are the technicians going into the areas or is nursing filling the machines?

    • ANSWER: Techs are refilling ADCs - if going to ED or Covid unit, they are wearing goggles and face mask.

    • ANSWER: We are utilizing OR nurses for obtaining meds from Accudose for the COVID nurses in sequestered rooms.  Also, we are teaching them how to load meds in Accudose.

    • ANSWER: We have a dedicated COVID unit and nursing is filling it for us.

    • ANSWER: Pharmacy techs are still doing same process; except they now wipe down ADC and bio-id scanner.

    • ANSWER: We didn't change our ADC refill. Pharmacy techs are doing them-- however, the only change with ADC use was using username and password to access the devices rather than biometric access (was discussed on the MSOS as well, seems controversial issue).

Returned Medications

  1. QUESTION: Any guidelines for handling of unused medications returned to pharmacy from COVID units?

    • ANSWER: Meds from designated COVID floors - return meds should be bagged in a ziplock and the date written on the outside of the bag.  Bagged meds will be placed in bin in pharmacy. After at least 3 days, a pharmacist will look at the meds and make a decision on what should be restocked/discarded.

    • ANSWER: Meds from non-COVID floors will be handled the same as we have previously, with the exception of multi-dose containers.  All multi-dose containers should be disposed of in the appropriate manner.

    • ANSWER: For patient's own med storage with infected patients- meds are coming pre-bagged, wiped down. Then re-bagged. For other meds- only what is needed should enter patient area. If it is unused, I believe we are discarding. However, the question arose of current practice for any isolation patient (not just Covid).


  1. QUESTION: Common cannister MDI is a real issue given limited MDI availability, can anyone speak to this?

    • ANSWER: We are allowing patients to use their own albuterol inhalers if they have them/bring them. Have not discussed how to reuse albuterol inhalers we dispense.

    • ANSWER: Yes, we are restricting MDI's to PUI and Covid-19 positive.

    • ANSWER: Common canisters with spacers have been used due to short supply of MDIs. 

ANSWER FROM ISMP: See “Revisiting the need for MDI common canister protocols during the COVID-19 pandemic” in the March 26, 2020 Special Edition COVID-19 Acute Care Medication Safety Alert!

Medications in Patient Rooms

  1. QUESTION: Is anyone leaving multidose medications or patients home meds they are taking, in COVID patient rooms?

    • ANSWER: We are leaving patient own meds in the patient's room for COVID suspected or confirmed.

    • ANSWER: For patient medications, we are allowing them to stay in the rooms.  They are locked in the small lock boxes in the room and nurses have keys.

    • ANSWER: We are allowing the use of home meds that are believed to treat COVID-19 for other reasons. Other home meds would need to have a significant need that couldn’t be supplied by our formulary meds.


  1. QUESTION: Has anyone changed their staffing patterns?

    • ANSWER: Operations must continue to report. Clinical and project and admin are working from home with the condition that if there are enough sick calls, they must be available to report to hospital in 30 minutes.  Rounding is via video conference.

    • ANSWER: We are starting to have some pharmacists work from home next week. We have restructured our floor pharmacists to the main pharmacy or pharmacy offices if they aren’t at home.

    • ANSWER: We have changed our staffing pattern for our entire department (peds and adults).  We have moved to a 7 on 7 off model. We have also moved our staff around since we have some additional space where we prepared workspaces for people that are not in main hospital. They rotate in and out. That way, pharmacists have 3 weeks away from inpatient contact.

    • ANSWER: Hours are flexing, pharmacists are working remotely from home. We are also training people like our 340B pharmacists in the IV room.

    • ANSWER: We have moved about 60% of clinical staff to remote. They are using zoom and messengers to keep people connected.

    • ANSWER: We have started creating different staffing models depending on criticality of our number of COVID cases. Starting to get secure remote access for order entry.

    • ANSWER: We've made several changes to staffing patterns with Rx leadership team, but not daily patterns yet, by creating a tier approach with productivity.

Code Cart Management

  1. QUESTION: I wonder what others are doing in terms of crash carts and pneumatic tubes?

    • ANSWER: We are keeping code carts in hallway but created a "grab bag" with enough to get started.  Contains 3 epi, 1 calcium chloride, 1 bicarb,, 1 D50, 6 flushes.

    • ANSWER: Regarding crash carts, we are using a similar process with the crash carts outside the room, needed meds are passed in.

    • ANSWER: We are leaving code carts outside the rooms and leaving a work phone in the room for communication.


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