The following four themes were identified: clinical pharmacists’ roles, working experiences, psychological feelings, and career expectations. The results are described as Fig. 1.
Theme 1: roles of clinical pharmacists
Clinical pharmacists’ roles in the prevention and control of COVID-19 mainly involved two aspects: (1) Participation in consultation and case discussion; (2) Nutritional support; (3) Preparation of pharmaceutical books related to epidemic prevention and control.
1.1 Participation in consultation and case discussion
The primary way clinical pharmacists participated in consultations was over telephone when providers directly contacted the pharmacy department. Within the pharmacies, there were designated clinical pharmacists available for consultation. Clinical pharmacists of respiratory and cardiovascular specialties were also involved in the COVID-19 core expert treatment group. They conducted rounds and worked with clinicians in multi-disciplinary case discussions. Clinical pharmacists also joined the Henan COVID-19 Treatment Expert Group through the hospital telemedicine system.
"Clinical pharmacists also participated in the telemedicine consultation organized by the Health Commission of Henan Province, the expert group came back daily in the face of over 130 designated hospitals in the province to give remote guidance to such hospitals. Then three issues of expert consensus in Henan Province were published.” [P13].
Clinical pharmacists were actively monitoring patients’ drug therapies, adverse drug reactions, drug interactions, and adjustments to medication regimen for special populations.
"As I worked on the anticoagulation, one patient suffered from massive bleeding after being discharged from hospital due to poor management of medical workers in the hospital in which the patient was admitted, and the nurse didn't notice the coagulation indicators on that day when the patient was discharged from hospital. The coagulation indicator was extremely high on the day of discharge, and anticoagulants should have been given to the patient [P6]."
"Many critically ill patients were admitted in the hospital, some specialists were impossible to take overall consideration with respect to the medication and interaction, hence our pharmacists would be asked to adjust some regimens [P13]."
Pharmacists played an indispensable role in the clinical setting. Their responsibilities included ensuring drug compatibility, proper preparation and administration, completing medication reconciliation, and integrating clinical application of traditional Chinese medicine injections.
"Because the severe patients were complicated with infections in the end in most cases, and the adjustment on the anti-infection therapeutic regimen was proposed by us [P10]."
"Like the effects of continuous dialysis on drugs, and the effects of ECMO on drugs, if its concentration could reach their effective treatment concentration, and we were allowed to get involved in such issues [P9]."
1.2 Nutritional support
Nutritional support serves as the basis of treatment for patients with COVID-19. Clinical nutrition pharmacists participated in the daily multi-disciplinary consultation. They monitored patients’ condition changes and assisted physicians in adjusting nutrition regimens.
"I could offer great guidance and improve patients’ nutritional status by fully relying on my knowledge, and at least I could improve physical fitness even through no obvious improvement in one index was found [P11]."
1.3 Participation in the development of pharmaceutical books related to epidemic prevention and control
Pharmacists prepared COVID-19 guidebooks for providers and hospital management. These books included chapters on hospital COVID prevention and control, medication reference list, a quick search of therapeutic regimens, and medication information.
"We have also compiled the quick reference list for medications, which was equivalent to the pocket book, being easy for physicians to read. In addition, we participated in the verification and proofreading of Guidance Manual for COVID-19 Prevention and Control prepared by Clinical Pharmaceutical Society, Chinese Medical Association.” [P9]
Theme 2: Working experience of clinical pharmacists
Clinical pharmacists’ working experiences showed dual characters. Most felt that their professional value was well recognized by the medical team. However, some pharmacists thought they were not fully integrated into the clinical practice due to insufficient work experience.
2.1 Positive working experience
2.1.1The medical team had strong demand for clinical pharmacists
Medical departments and medical teams actively invited clinical pharmacists to join the diagnosis and treatment discussions. They had great demand for pharmacists in managing patients’ complex and quick-changing conditions.
"The medical department made it clear that clinical pharmacists must be involved in the expert group when it is expected to be set up, of course, this is a preliminary work; they may see the accumulation of the process for all these years and various works you participated in, and they accepted. They think it is useful to listen to the opinions from teachers in pharmacy during multiple key disease consultation, including consultation of various difficult cases in the hospital [P10]."
2.1.2 Cooperation with other medical workers
Departments with good cooperation with clinical pharmacists before the outbreak were more willing to work with pharmacists. Through early collaboration, these clinical teams have a more intuitive knowledge and understanding of the pharmacist teams’ professional quality and recognize clinical pharmacists’ values.
"Furthermore, efforts for phone calls in practice have been made by us for many years, and they have got used to make a phone call and asked us to search information or for assistance if they have some problems, or they don't have time to query [P2]."
"Under such circumstances, as usual, you just come and participate in. Usually, we have done a good job, and basic work also has been done well, so it is recognized clinically [P13]."
"It is also increasingly dependent on our pharmacy; for sure, no matter what major you learn, you have what you focus on, you should think how it work, and how to let others accept us [P6]".
2.2 Negative working experience
2.2.1 Low degree of overall participation
The interview found that the degree of participation for clinical pharmacists were relatively low.
"They (physicians) considered efficacy first, then safety; save life first, because it is most important. Sometimes, you have to consider efficacy first, regardless of big adverse reactions [P5]."
"What I considered at that time was nursing or doctors' shortage, may be nursing was scarcer. What they focused more actually was people who needed treat their diseases, and refined treatment and pharmaceutical care were considered next.... Finally, we were not included in this respect [P7]."
2.2.2 Insufficient clinical work experience
Pharmacists had insufficient experience in recommending drug treatment. Most treatment recommendations were based on experiences against SARS in 2003 .
"Traditional Chinese medicine injection was not necessarily safe, so we reminded doctors which ones were less safe. However, what were recommended at that time was determined by expert consensus, which maybe had no evidence-based basis [P6]."
"Since diagnosis and treatment guidelines were modified every week, and large dose of ribavirin (more several times than daily dose) was recommended in the 5th Edition, which was very controversial. It remained controversial afterwards. After 5 days, this dose was changed again and again at a national level; actually a lot of attempts were done [P10]. "
Theme 3: psychological feelings of clinical pharmacists
Clinical pharmacists’ psychological feelings were complicated during the fight against COVID-19. Positive psychology primarily showed that as members of a medical team, pharmacists were very proud of their contributions to the country. They also felt very happy when patients got better, and the number of infected persons dropped. Negative psychology mainly arose when patients’ conditions were complex, and there was no effective therapy. Clinical pharmacists and the medical team felt stressed, anxious, and powerless when patients died.
3.1 A sense of professional identity and pride
With the deepening of work, pharmacists feel that their professional value is reflected. Therefore, pharmacists have a strong sense of professional pride.
"I think I have a certain sense of professional identity and pride, because it's like a battle which all the people are involved. Our power is very limited, but I think I can find some problems and solve some by own professional knowledge. Moreover, I think it’s very useful to give opinions about pharmacy from different perspectives [P10]. "
"The more you have done, the more confident you have. We can learn more, such as knowledge of other departments, which can be learned during consultation, and learn from each other [P6]."
3.2 A sense of the confidence
By participating in the treatment of patients on the spot and witnessing the recovery of patients, the professional pride of pharmacists has been further enhanced. In addition, positive media reports will also enhance the confidence of pharmacists.
"The happiest was that we received critical patients whose conditions were not good. But some people were cured and discharged from the hospital, and we were happy that those people recovered from critical disease. And I heard many reports from the front, including Wuhan, I was very excited and shed tears. I also feel it is very proud that you are involved, regardless of roles [P10]."
3.3 A feeling of psychological pressure
Due to the seriousness of the epidemic, it is very difficult for the medical team to treat patients, which will also bring great psychological pressure to the pharmacists.
"Then as the disease progressed, what you have seen that doctors were helpless. Actually, we were also helpless; although I have been engaged in this for many years, it was rare that all of us were at a loss. Actually, the whole process was quite depressed, everyone was very nervous and tired, and got a lot of pressure; for me, I almost had no rest [P11]. "
Theme 4: career expectations of clinical pharmacists
This pandemic exposed some problems related to pharmacists. These included insufficient knowledge reserve, little experience in emergency response, failure to work in heavy clinical tasks due to physical fitness, and failure to be competent at intricate clinical work due to inadequate professional skills. There are areas of future improvements for pharmacists and the profession.
4.1 Sufficient ability is the basis
Pharmacists are eager to participate more in clinical work, but sufficient ability is the basis for clinical work.
"Then I think we should be involved deeper and broader, but this involvement also has a premise. That is, your own professional ability should reach a certain level. As you know, for doctors,if you intend to be involved, they want you to solve the problem, if you cannot solve the problem, it doesn't matter if you are there or not [P10]. "
4.2 Ability is not sufficient enough
At frontline, pharmacists feel that their ability is not enough to help clinicians solve clinical problems. The reason may be that many pharmacists do not receive sufficient training and exercises, resulting in insufficient basic knowledge reserves and clinical experience.
"Only about one third of people throughout clinical pharmacy discipline can reach the current recognition, and the rest still need to be improved. Those with more advanced qualifications can reach this level, because they have been involved in the clinic since 2000. This is a very important point. Some other young ones have not yet reached this level [P13]. "
"Of course, there are a lot of things you don't understand, and then you have to learn [P6]."
4.3 Clinical skills of pharmacists should be proved in the future
Clinicians have high expectations for pharmacists and clinical pharmacists are expected to help them solve drug-related problems. Especially when clinicians encounter more complicated patients, they hope that clinical pharmacists will provide timely support in the perspective of pharmaceutical specialty. Therefore, improving the comprehensive ability and clinical skills of pharmacists is the direction of future development.
"But when you encountered this situation, they didn't care about (what your duty is), they thought you were a pharmacy worker, and you had come to help me. If I asked you for anything, you must immediately do it, and you must provide a solution for me immediately. This is something that I think is very difficult. The reserve of my entire knowledge and the professional ability of emergency response is (not enough) [P13]. "
"Because they didn't have your help at the beginning, they didn't think they needed you. If you have been providing help to them and you have achieved the effect they want, they will definitely want this kind of help [P6]."