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In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have quickly adapted to respond to a critical situation characterized by the constant and continuous admission of patients with severe pneumonia who needed treatment, requiring a transformation of the hospital in order to increase the number of hospital and critical beds. Moreover, other out-ofhospital spaces have been transformed into hospitalization units to absorb the large number of patients that had to be treated and isolated. To guarantee the distribution of medicines and the quality of the pharmaceutical care, drug distribution systems, such as unit dose and automated dispensing systems, have undergone transformations. Standard stocks were assigned for COVID units, and different dispensing circuits to avoid the risk of cross-contamination between COVID and non-COVID units were created, as well as disinfection protocols for medication transport systems and medication return protocols. All this without forgetting COVID treatment protocol's changes that were affected by the availability of the drugs. The increase in the number of beds in out-of-hospital spaces, such as field hospitals, hotels, socio-medical centers and nursing homes, has challenged Pharmacy Services, since new medication dispensing and conciliation circuits have been created forcing the increase of pharmacy staff's presence and modifying work shifts, to afford all the new tasks successfully. Selleck CAY10603 Development of contingency plans for the different Pharmacy Service activities and providing fluent communication channels are key elements for crisis situations or health emergencies such as the current pandemic.As in other areas of the health system, COVID-19 has had a dramatic impact on hospital compounding. This area has faced numerous challenges, including the shortage of frequent-use products (hydroalcoholic solutions, lopinavir/ritonavir suspension), the use of new preparations for SARS-CoV-2 (tocilizumab, remdesivir), or requests from overwhelmed wards unable to assume the safe preparation of a high volume of medications (intravenous solutions). The demand for all types of preparations (topic and oral medications, intravenous solutions) has increased dramatically. This increase has highlighted the shortage of resources allocated to this area, which has made it difficult to meet the high demand for preparations. In addition, the pandemic has revealed the scarcity of research on such basic aspects as agent stability and drug compatibility. One of the most relevant conclusions drawn from the COVID-19 pandemic is that the basic areas of hospital pharmacy, along with other, must be maintained and reinforced, as these are the areas that make us essential.The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care area, mainly the fact of not being integrated into the health system. The objective of this work is to describe the pharmaceutical care developed by a hospital pharmacy service established in a nursing home and, from a more global perspective, analyze the strengths and weaknesses found from the various experiences of hospital pharmacy in all spanish autonomous communities to deal with this pandemic. Specialized pharmaceutical care has provided rigor in the validation and treatments review processes from a comprehensive perspective, maximizing safety and collaborating in the establishment of the therapeutic intensity degree most appropriate to the individual situation, has ensured the availability of all necessary medications, has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal nursing homes sectorization and has facilitated the coordination between the nursing home and the health system. It is clear that the crisis casued by COVID- 19 has put relevance of the need to integrate the social-health level into the health system. And also, the contribution of specialized pharmaceutical care in improving healthcare coverage and coordination with health services has highlighted the urgency of developing the current legislation, prioritizing the establishment of pharmacy services able to provid specialized and specific care for this area, so that it meets healthcare needs and is integrated into the health system.Since the implementation of the Antimicrobial Therapy Optimization Programme, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain. Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in hospitals. The COVID-19 pandemic forced hospital pharmacists to abruptly suspend all their structured activities and concentrate on the health crisis. Realtime information sharing between different medicine specialties is an effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear. Hospital pharmacies had to reorganize their activities to respond to the pandemic. On the one side were patients with COVID-19, and on the other were routine hospital pharmacy tasks, with the added difficulty of adapting to individual protection measures. New communication and collaboration strategies were adopted. Protocols were established for the management of COVID-19 patients, with continuous changes; special medications had to be prepared and distributed; circuits were designed for the home- or institution-based care of patients; internal circuits were created to minimize the movements of hospital staff and professionals caring for COVID-19 patients. The most effective antiviral drug and anti inflammatory therapy remains elusive. In this scenario, hospital pharmacists emerge as a key player, as they have a deep understanding of the mechanisms of action of drugs and potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary teams has become essential for the optimization of clinical outcomes.The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals located in the Autonomous Community of Madrid, Spain. Team working and reciprocal trust have made it possible to meet the unprecedented demand for health services and has facilitated rapid decision making. Strategies have been developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency Departments pharmacy services, and between these services and Emergency Departments during the pandemic. Multidisciplinary cooperation and information sharing have traditionally formed the base for efficient and quality work, along with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give rise to a new model of pharmaceutical care, which should not replace face-to- face Emergency Department pharmacist support and advice. Promoting the re- humanization of healthcare and pharmacy services is essential. An adequate technical training and the development of abilities such as flexibility, planning and coordination skills, and an assertive communication and management of emotions will be key to the successful management of unimaginable settings in the future.The Intensive Care Unit (ICU) of the University Hospital of Fuenlabrada was forced to critically increase its capacity in the COVID-19 pandemic. The objective of this work is to describe the activities promoted by the pharmacist in the care of the critically ill patient in this context. A new organizational structure was designed, analyzing the tasks necessary to make the processes profitable. Two pharmacists joined the critical patient care to help the pharmacist who was already integrated in the ICU team. The development of the operational structure was carried out on three levels. The healthcare activity highlights the daily participation of pharmacists in the two clinical sessions in which the ICU teams evaluated all cases and made decisions. This in turn facilitated the pharmaceutical validation that was carried out in the critical units themselves. In addition, one of the pharmacists created the Immuno-COVID Committee, in which they participated together with different specialists for therapeutic decisiecision-making and improvement actions, it provides the climate of inter-professional trust necessary to respond to the complexity of the critical patient and promote joint projects.During the pandemic caused by the SARS-CoV-2 virus, pharmacy services have had to adapt their service portfolio, and yet ensure efficient, equitable and quality pharmaceutical care. Given the limited scientific evidence available, most drugs have been used off-label or in the context of clinical trials, which should be the preferred option in order to create new evidence. Among kind different situations we have faced are the increase in workload, the expansion of coverage to new wards and ICUs and shortages, which have caused the use of alternative drugs and even other routes of administration. Given that covid-19 affects elderly population with greater severity and many of them are polymedicated, great effort have been focused on monitoring interactions, both pharmacokinetic and pharmacodynamic (specially prolongation of the QT interval), monitoring correct concentrations of electrolytes, nutritional support, adaptation of chemotherapy treatment protocols and anticoagulant management, among others. The use of personal protective equipment added difficulty for nursing work and some measures had been taken to minimize the number of entries into the rooms. Eventually, team's split to guarantee care, the challenge of teleworking, remote validation, telemedicine and telepharmacy for communication between professionals and patients, as well as training in this pandemic situation have been a challenge for our profession. These difficulties have risen up new learning opportunities we hope will be useful to us in the event we have to face similar situations in the future.Type 2 coronavirus pandemics that is plaguing almost all the world has caused qualitative and quantitative strains in health systems that have had to be responded to. The lack of known vaccines and effective treatments has generated the need to use drugs with very little evidence for their incorporation into pharmacotherapeutic protocols agreed by the clinical team. The hospital pharmacist, within the multidisciplinary team, has been responsible for critically evaluating the alternatives and positioning them in these protocols. Finally, some ethical and legal questions that should be considered in this scenario are analyzed in this article.