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COVID-19 Recommendations for Texas Pharmacists

COVID-19Texas pharmacists are busy working on the front lines to care for patients amid the coronavirus/COVID-19 pandemic. The health and safety of pharmacy professionals is paramount during this declared state of disaster.

The Texas Pharmacy Association has compiled recommendations from the CDC, other states, national associations, and other sources to help pharmacists and their staff members practice in a safe and effective manner.

Implement Universal Use of Face Coverings

Everyone entering the pharmacy should wear a face covering, regardless of symptoms

  • Cloth face coverings are recommended for source control but should not be placed on young children under age 2, anyone who has trouble breathing or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
  • Pharmacists and pharmacy technicians should always wear a face mask while they are in the pharmacy.
  • When available, face masks are generally preferred over cloth face coverings for healthcare professionals for source control.  If there are shortages of face masks, prioritize them for those healthcare professionals who need them for personal protective equipment.

Social Distancing Strategies

Pharmacies open to the public should consider the following strategies to minimize contact between individuals:

  • Divert as many customers as possible from entering the pharmacy by utilizing drive-through windows or curbside delivery, especially if people feel unwell. Marketing strategies (large signage/marketing efforts) would be useful.
  • Develop a process for older adults (60+), pregnant women, and individuals with chronic health conditions to pick up medications without waiting in line. For example, post signs encouraging drive-through pickup, senior hours, etc.
  • Provide over-the-counter medication and other products through drive-through windows. Marketing strategies (large signage/marketing efforts) would be useful.
  • Increase use of delivery and mail services.
  • If customers must enter the pharmacy, maintain social distancing (6-feet between individuals) as much as possible. The use of stanchions or other physical barriers to demark a 6-foot distance for interacting with pharmacy/retail staff as much as possible, may be considered. Consider taping squares six feet apart on the floor leading to the register(s).
  • Install a section of clear plastic (Plexiglas type material) at the customer contact area to provide barrier protection to shield against droplets from coughs or sneezes. If feasible, configure a pass-through opening at the bottom of the barrier for people to speak through or provide pharmacy items.


Infection Control

Pharmacies should implement infection control procedures, especially for waiting areas.

  • Wear gloves to pass medications/bags along to patient, including in the drive-through. Packages can be placed on a counter for the customer to retrieve, instead of being directly handed to a customer.
  • Consider posting signage or utilize other methods to ensure patients who are waiting are maintained at a safe distance. (Clearly, this would not apply to patients who must interact with pharmacy staff for payment, immunizations, etc.)
  • Pharmacists providing patients with chronic disease management services, medication management services, and other services that do not require face-to-face encounters should make every effort to use telephone or tele-pharmacy strategies.
  • Postpone and reschedule delivery of routine clinical preventative services, such as adult immunizations. Pharmacy staff should ensure patients seeking vaccinations are sent reminders to return to the pharmacy at a later date..
  • Regularly clean and disinfect counters, credit/debit card devices, waiting areas, and other spaces where public interaction occurs with an EPA-approved disinfectant. Clean at least every hour or after every 10 patients, whichever is more frequent.
  • Since COVID-19 lives on surfaces, be mindful of checking in orders and handling mail.
  • If available, place alcohol-based hand sanitizer next to the checkout window so customers can sanitize their hands after using common items, like the pen used to sign for prescriptions or devices used to process credit/debit card transactions.
    • Provide hand sanitizer containing at least 60% alcohol on counters for use by customers.
  • Encourage prescribers to submit prescription orders via telephone or electronically.
  • Pharmacies should develop procedures to avoid handling paper prescriptions in accordance with appropriate state laws, regulations or executive orders.
  • Staff should avoid handling insurance or benefit cards. Instead, have the customer take a picture of the card for processing or read aloud the information that is needed (in a private location so other customers cannot hear).
  • Discontinue use of magazines, self-serve blood pressure units, or other shared items in pharmacy waiting areas.


If Sick Customers/Patients Are in Pharmacies/Stores

During the pandemic response, it is possible that customers/patients who appear to be sick may present in pharmacies and come in contact with pharmacy team members and other store personnel.

  • This exposure is likely to be classified as “low risk”, defined as "brief interactions with patients with COVID-19 or prolonged close contact with patients who were wearing a cloth face covering or face mask for source control while the health care professional was wearing a face mask."
  • If the health care professional is wearing a face mask during a low-risk exposure, actions to be taken include no restriction on movement and self-observation.


Pharmacy Workforce Protection

Protecting pharmacy staff is critical. Suggestions include:

  • Provide regular breaks for staff to engage in proper hand hygiene (i.e. routinely washing hands with soap and water for at least 20 seconds). Consider setting a timer to remind staff to wash hands and sanitize workstations every hour.
  • Have sufficient hand sanitizer containing at least 60% alcohol for staff.

Consider managing staff shifts to decrease potential exposure:

  • Expand hours and/or split shifts
  • Have a hard shift change for pharmacy staff in the middle of the day
  • Nonessential staff to entering and filling prescriptions should perform duties in an isolated room of the pharmacy or work from home
  • Consider moving full-time staff to the majority of the days of the week and part-time staff to 2-3 days per week.

During the pandemic response, it is possible that pharmacy team members and/or other store personnel may be confirmed or suspected with COVID-19. For staff member(s) who came in contact, it is important to ascertain whether exposure was “low risk” or “medium risk.

  • Recommendations for “low risk” exposures include no restriction on movement and self-observation.
  • “Medium risk” exposure includes health care professionals with prolonged close contact with individuals with COVID-19 who were wearing a cloth face covering or face mask while the health care professional’s nose and mouth were exposed to material potentially infectious with the virus.
  • Precautions for “medium risk” exposures include active monitoring and exclusion for work for 14 days after the last exposure.
  • There is no evidence that the virus can cause illness from medication that came in contact.
  • The physical store: Follow interim guidance for community-based environmental cleaning and disinfection.

Staff exhibiting or reporting symptoms of respiratory illness (including fever, cough, or shortness of breath) should be sent home and should stay away from the workplace until they have recovered.

Follow interim guidance for additional recommendations on potential exposures in a health care setting.

DISCLAIMER: The above compilation of recommendations is provided as general information for Texas pharmacists seeking advice during the COVID-19 pandemic. Pharmacists should always follow any specific protocols established by their employer, practice setting, or government agencies.


View additional coronavirus resources for Texas pharamacists.

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