Monthly Archives: June 2014

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Spring Has Sprung…Finally

As I was out mowing the grass today, I began to think back to the lawn metaphor I used to describe why I write this blog. I do it to help make my own environment a little bit better. Hopefully I can help others do the same.

As a tip of the mortarboard to new graduates entering the profession across the country, I’d like to re-visit this metaphor one more time.

I give you: new practitioners – the grass seeds of pharmacy.

Are you still reading? Work with me on this.

 

Grass seeds start out as tiny things but with huge potential. They require water, sun, and a little TLC to germinate and grow. We may need more of them in rough patches: brand new lawns, places where planters have been or where weeds have gotten out of control. However with some nurturing and protection from the elements (birds, digging animals, intense sun, etc.), they can grow into a beautiful, resilient lawn.

New grads are just like grass seed. And not just any seed, let’s get the coated seed that supposedly absorbs ten times the water and grows anywhere. They too hold a large amount of potential but need some coaching and moulding, especially at the beginning of their careers, to truly become great practitioners. New graduates are ready to make their mark on the profession. Bringing new energy and a certain naivete to current practice environments can be a real advantage to filling clinical service bare patches.

If your new clinical leads are faced with too much exposure without proper coaching, they too will burn, and it may take awhile to reverse the damage. I’m sure most of us have performed a med review and stumbled upon a concern justifying a recommendation to a primary care provider. Unfortunately, these recommendations aren’t always well-received. I’ve heard horror stories where physicians refused to share lab values or provided snippy replies to reasonable recommendations.  The most extreme case involved a patient taking advantage of minor ailment prescribing in Nova Scotia. Unfortunately it ended with the physician threatening the patient by asking them to choose between them and the pharmacist. This kind of salvo can be a blow to even the most seasoned clinician, let alone someone who is green (pardon the pun). On the bright side, these cases are becoming exceedingly rare as other professions recognize benefits of the new contributions we can make.

Coaching and support doesn’t need to come only from the manager or supervisor. It should be a complete team approach, with every clinical success, from identifying new ways to help, to appointment bookings, to follow-up being shared and celebrated.

So here’s to a greener lawn! Grow a robust clinical patch. Your yard, and your work environment will be a source of pride to share and show off. It’s amazing what a little water can do.

 

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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The Anatomy of Error

Quick show of hands…How many of you are perfect? 

Everyone? Well I agree you are all perfect in your own ways but I really need to get this post started.

Okay, how many enjoy messing up?

 

There are very few people out there that don’t have a fear of failure. For every task there’s a plan, and for every plan there’s an action. The action produces results. This oversimplification leaves out one crucial element: expectations. Every plan has an expected outcome, or at least it should. Some plans are doomed to fail. They fail if they aren’t addressing the task, are too complex, or don’t have realistic expectations worked into the plan itself.

Even with the best plan, the best people, and solid execution, mistakes still happen. In the world of pharmacy, we refer to these mishaps as ‘medication discrepancies’, forerunners to the dreaded ‘medication incidents’. After new pharmacists have completed their degrees and written their licensing exams, everything becomes so real. There’s an professional institution to uphold, and standards are high. Every slip of concentration may result in a missed interaction or an inappropriate dose that holds potential for harm. If that mistake comes back to you, panic can set in:

Will the person sue me?

Will I be disciplined?

Will I be fired?

All of these questions rattle around and try to defeat your resolve. By my estimation, new grads take upwards to 6 months after licensure to begin feeling comfortable with their style of practice. They feel less paranoia about making mistakes and maybe don’t need to quintuple-check the things they do.

Mistakes happen to everyone. They always will, and the human condition will manage to attach a negative emotion to a mistake each time one occurs. The feeling of letting a patient or teammate down is bad enough, but most of the time, you’re letting yourself down. That’s the one that really hurts.

I have had my share, and I’ve counseled others who have been unlucky enough to experience an error fallout. My approach is summed up by the legendary John R. Cash:

You build on failure. You use it as a stepping stone. Close the door on the past. You don’t try to forget the mistakes, but you don’t dwell on it. You don’t let it have any of your energy, or any of your time, or any of your space.

Johnny Cash

 

For someone who wrote well-known songs such as ‘Ring of Fire’, and ‘Folsom Prison Blues’ (neither bringing to mind the imagery I’m looking for in this post), the above quote is perfect for any situation.

To become a health professional, there has to be a genuine desire to help people, and ensure no harm comes to them. Mistakes that may result in harm are not intended by anyone involved. Discipline is usually reserved for instances when someone willingly sabotages a system, or is neglectful in their maintainance of a system. Once someone has accepted that mistakes happen, addressing the circumstances that led to the error will help prevent it from recurring.

For some, that personal failure is a lot to handle. It can create anxiety, it can create doubt. At the beginning of a career or at the end, that heightened awareness sometimes works against you and more errors result. Why? My theory is that the focus sharpens on the aspect of the process where the error occurred. Wrong strength on a medication? Next 100 times, we’ll be extra vigilant to confirm with the doctor. Missed interaction? Like a branding iron, that drug-drug combo will be etched in the brain forever, and similar ones will be heavily researched from that point on. By dwelling, and putting that extra effort to prevent a similar mistake, perhaps a wrong doctor is missed, or the label instructions are vague. It can spiral, and owning mistakes is stressful at the best of times.

Circling back to the genuine desire to help people, it’s important to remember that we help hundreds of people every day. Errors are and will be a part of life, but if we own up to them and help minimize any impact on those affected, we can show that we care. If the uncomfortable interaction causes us to put a guard up, it may prevent us from investing ourselves in all of our subsequent interactions. Those other folks need our best as much as the person affected by the error.

With expanded scope responsibilities, we will make errors in new ways. We could misinterpret a lab value, perform an injection that doesn’t go as smooth as we’d like, or prescribe for a minor ailment and later find a missed red flag. If we stay true to ourselves and our capabilities, we will use them as stepping stones to constantly improve the quality of care we provide.

Dissect the anatomy of an error. Understand it. Control it. Learn from it. Move on from it. You will be better for it.

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.