Monthly Archives: May 2017

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The Evolution of Tech Regulation

For decades, whenever the pharmacy industry referred to ‘licensed staff’ they were obviously talking specifically about pharmacists and certified dispensers. These individuals were wholly responsible for the operation of a pharmacy, be it in a community or hospital setting, rural or urban areas. Audit results, public image, complaints, level of service requirements, these were all included under the umbrella. Even if the dispensary license holder wasn’t present, the licensed staff on duty have all of the professional responsibilities as an independent clinician for prescribing services, injections, education, and ensuring optimal use of medication therapy. Full names are displayed in public view and on name tags. Credentials are made available for scrutiny if requested.

So this decade has seen the emergence of a new profession, and for pharmacists, the new challenge of wrapping our minds around a different stripe of licensed staff. These team members have their own scope, their own mandates, and their own vision for the contributions they can make to complement and help evolve the pharmacist role.

For the longest time, dispensaries were primarily pharmacist-centric. Every situation, whether clinical, operational, logistical or workflow-related flowed through the pharmacist on duty. Naturally, our primary role was safe drug distribution. Reducing daily distractions and interruptions was the end goal. Strategies were developed to use technology to filter incoming phone calls, layout of pharmacies were planned to encourage support staff to handle external requests and better triage the pharmacist’s involvement.

Nowadays, it’s generally recognized that pharmacists hold tremendous value as a collaborative team-member in the realm of medication management. With so much information available to other health professions and to the lay public, we are the authority, the subject expert on everything medication-related. Clinical activities are taking place at hospital nursing stations and nursing homes. Travel clinics provide prescribing services and vaccination administration. Medication reviews allow the identification, and often resolution, of drug-related problems. Pharmacists are needing to be more accessible and patient-facing than ever before. Even with the advent of these specialized clinical roles, the actual distribution of medications still needs to occur safely, and with the same degree of excellence that we have always known.

My light-bulb moment came in the fall of 2015. We had introduced a regulated technician to our dedicated long-term care site a few months prior, and admittedly, my fellow pharmacists and I were apprehensive. We had an idea of how workflow would be impacted, but we still felt ownership over every step in the process. We were still the responsible dispensary managers. We still answered for any breakdown in the distribution process. We were still left to manage discrepancies and handle incidents that occurred. Those things are still true today, but it took awhile for trust to build and allow someone to share some of the burden.

Our regulated tech was committed to quality, willing to challenge our boundaries and remain patient as we worked through our own thoughts and feelings about these changes. She often needed to quell her frustration and exasperation when two steps forward led to one step back. Everything we knew needed to be broken down: where did she fit in the current process? What steps are we comfortable delegating? Where are we physically positioned in the pharmacy? Do we need to adjust workstations? What order do functions occur to ensure completeness and safety as before?

Sometimes it took a day, sometimes weeks, sometimes even months. Eventually, she was taking away significant technical functions off of our plates and freeing us up to make extra phone calls, better investigate interactions, follow-up on recommendations, etc.

My Eureka moment:  One day I was working through my onscreen clinical check. It was a prescription for a new antibiotic for a UTI, with some renal clearance concerns to assess. I called the attending nurse to discuss the therapy. Based on the patient’s age, current weight and recent serum creatinine, the dose was appropriate and I electronically signed off on the prescription. I then realized my work on that prescription was done. Really? I thought to myself. What about collecting the label? Technical. What about ensuring the DIN matches the bottle from the shelf? Technical. Hmmmm. Well surely I need to see the visual contents of the vial before it goes out the door to the nursing home…

No I didn’t. My clinical duties were complete. Those technical duties? I had entrusted them to my regulated technician. I could move on and focus on another prescription that needed clinical evaluation. Accepting that I was no longer the last step in the distribution process was quite mind-blowing, and very weird at first.

Since that day, my whole perspective has changed. We have licensed staff in our pharmacy community who want to take responsibility for all technical aspects of distribution. They are capable. They are ready to prove themselves. In my location, we now forget what it was like without a regulated tech and really notice when there is illness or vacation.

They will make us better. They just need the chance to evolve with us.

 

 

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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Keeping It Under Our Hats

We pharmacists take pride in the many hats we wear on a daily basis. As with any collaborative health professional, we often are involved in patient cases that require much more than providing information about drug therapy.

 

A·poth·e·car·y (əˈpäTHəˌkerē/) – a person who prepared and sold medicines and drugs.

At one time, this was our most recognizable hat. The physician diagnosed, put a plan together, and off you went to the chemist (British term for pharmacist) to receive an elixir or compounded salve to cure your ills. Providing the right medications and the proper doses is still a large part of a pharmacist’s role, but as we evolve, so does our headgear.

Teach·er (‘tēCHər/) – a person who helps others to acquire knowledge, competences or values.
As drug therapy becomes more complex, and monitoring vital to positive outcomes, pharmacists need to constantly be prepared to educate on all types of regimens. These range from over-the-counter drugs to specialized biologic treatments. We must include what to watch for in terms of side effects as well as any positive measures of surrogate endpoints (e.g., A1C, total cholesterol).
Assessor (əˈsesər/) – a person who evaluates the quality of a person or thing.
We put on this hat in the counseling room when we need to assess understanding. ‘Please demonstrate how you are using your inhaler’. ‘Are you familiar with the term INR, and why frequent blood testing is necessary?”Explain when and how to use an Epipen or Naloxone Kit.’ This will usually lead into further teaching moments over the course of many interactions.
Nav·i·ga·tor (ˈnavəˌɡādər/) – a person who directs the route or course of a ship, aircraft, or other form of transportation, especially by using instruments and maps.
Navigator
Image courtesy of the Computer Whisperer: http://www.thecomputerwhisperer.us
This would look pretty sharp with a lab-coat, don’t you think? You can thank my involvement with mental health initiatives for this one. The founders of the Bloom Program here in Nova Scotia realized that our mental health system featured a wealth of resources and community-based initiatives that were not being used to capacity or not expanding due to lack of awareness. One of the original tools developed was called, appropriately enough, The Navigator and aimed to collect all known programs, community groups, hotlines and resources for each jurisdiction around the province. The goal was to empower community pharmacists to be more comfortable with being the first point of contact during crises and provide direction to patients and their families. This extends not just to specialist care, but financial aid, legal aid, counseling, and long-term care resources as well.
Coun·se·lor (ˈkouns(ə)lər/) – a person trained to give guidance on personal, social, or psychological problems.
I hesitated to list this one because pharmacists can not replace the skills and roles of trained counseling professionals. We do find ourselves in situations that require counseling ability in a more general sense. A supportive ear in the right place at the right time can sometimes make the difference in building trust and opening the door to a proper referral.
Ad·vo·cate (ˈadvəkət/) – a person who publicly supports or recommends a particular cause or policy.
Whether it’s recommending an equally effective generic combo instead of a newfangled drug therapy or suggesting a suspension for someone unable to swallow large capsules, we aim to put the patients’ health first. Pharmacists have called shelters to get those in need a place to stay, and are regularly contacting drug plans to wade through complex coverage policies. If we notice a patient’s condition rapidly decline, we may alert family members in their circle of care or help connect them with specialized programs.
Men·tor (ˈmenˌtôr,ˈmenˌtər/) – an experienced and trusted adviser.
The pharmacy community is strong. As much as we coach patients to take responsibility for their health, we also take time to precept students, giving them real life experience and challenging their knowledge. This is invaluable to their development as leaders within the profession. These relationships often last throughout careers and beyond.
And lastly, the most important hat of all:
You – the person behind the degree, under the lab coat.
As health care professionals, we possess a common set of trained skills, but our effectiveness is predicated on the passion that we bring to our work, our hobbies, our relationships, and our experiences. I wore a ball cap for many years of competitive baseball, and a felt cowboy hat for variety shows. Others don biking helmets for tours through Paris or Spain. Perhaps a hard-hat is worn for charitable works in impoverished countries, or simply a headband for another satisfying hour at the gym.
It’s true that as a service provider, some consumers just want to see a pharmacist, but countless others want you. Your thoughts, your opinions, your advice matter greatly to all of those you aim to help. Develop your style, get comfortable with infusing your soul into whatever you do. Everyone will benefit.
So lift up that brim. We can’t keep personalities under our hats.

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.