Author Archives

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Dispensing Pride

The terms ‘pharmacy’ and ‘dispensing’ go hand-in-hand. Prescribers diagnose disease and approve treatment. We fill the treatment orders and dispense the therapy, along with any important educational points, to patients and their families. This has been our role for generations. We are known as some of the most trusted and most accessible health professionals in the world.

I admit to being a proud dispenser, but my priorities are beginning to shift. Medication has always held a fascination for me: the clever brand names (remember Desyrel? I still have ‘DEpressive SYmptom RELief’ bouncing in my skull somewhere), the odd shapes of certain tablets and the splashy marketing campaigns. Sometimes missing however, was the proper transfer of information to others. My counseling skills took time to develop, and early on I felt robotic and scripted when interacting with patients.

As a student, I recall basic functions such as writing up manual credits to Blue Cross or the now defunct Maritime Medical. We made funky compounds with Anthralin powder that stained everything a heinous shade of yellow ochre that would make Bob Ross proud. We were the gatekeepers of all things pharmaceutical and sometimes a cursory counseling session was all that a patient received. Sure, in classes and labs we were coached on communication styles and higher standards but the reality was a bit disheartening; dispensing was the main focus and any clinical intervention seemed like an exciting ‘Eureka’ moment for the team to share instead of the norm.

Doing pharmacy relief immediately after graduation had it’s advantages and disadvantages. Although leaving work at work when a shift was over was nice, ensuring patient follow-up and continuity of care was extremely inconsistent from one site to the next. Every interaction was a point-in-time and documentation was rather erratic from one pharmacist to the next. We were however excellent at monitoring days supply of benzos and narcs. I may not have had the relevant history or familiarity with the tools to best determine your pain control but I could certainly attest that those sixty OxyContin 40mg were triple-counted by three different people.

My, how times have changed…

So, there is less of a focus on pack sizes and pricing (still important, but more of a management focus as opposed to pharmacist); better prescription software has lessened the need to manually update every drug file or pricing strategy. Now it’s more empowering to take a deeper look at interactions and latest research guidelines. The volume of calls to the third-party plan to correct date of birth issues are tasks that now may be delegated. We are becoming more intimately involved with special authorization criteria and therapeutic substitutions. Cognitively, we have more opportunity to apply ourselves; with prescribing rights, we can now identify certain DRPs and be able to solve them for a patient. Things like INR and renal adjustments may now feature a pharmacist’s name on the order as we get other health professionals to recognize our new-found decision-making abilities. In fact, just the other day, I was able to halve a sulfamethoxazole dose for an elderly resident with a compromised creatinine-clearance.

The paradigm shift started long before my degree, but the visionaries who foresaw such radical changes had their work cut out for them. The baby-boomers were heading into retirement, and the aging population needed more medications to combat heart disease, diabetes and high cholesterol. In lockstep with that, they were also going to need more clinical care, and more than what general practitioners would be able to handle, especially in rural areas. I look forward to plugging some gaps through medication reconciliation, minor ailment prescribing, and lab requisitions.

To sum up: I am proud of my dispensing hat, I am proud of my expanded clinical duties now, and trust that I will enjoy however the role evolves from here. I guess I’m just proud to be a pharmacist.

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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My Managing Theory – Qualities of a Good Manager

I’m always looking to push myself. In taking my new role, the reflection process has begun and lists are being made to prioritize the skills I need to leverage, and the ones I need to work on.

Management is a different animal, no matter what the setting. Be it a physician’s office or a warehouse, a restaurant or a bank branch, a manager is someone who manages resources to make an operation run. Many have arrived at that level as people who know the business intimately and show an aptitude for producing results. Others are brought in because of certain qualities that have been identified as lacking, even if their practical expertise is weak (i.e. a human resource background running an IT division, etc.)

I’ve been managing people for most of my pharmacy career, and it’s something I quite enjoy. I am far from perfect but have had mentors in the past who have given me tips on creating a positive culture in the pharmacy. Over time, I have distilled three main qualities that I feel make a well-rounded manager. They are in areas of administration, human resources and vision. In the past, I have used this thought process to help set goals for people in management positions. It can help to highlight their individual strengths and weaknesses by asking specific questions:

 

1) Administration – This is the detail-oriented piece. Are you able to be responsive via email or phone? Do you meet deadlines for audit responses and status updates? Are policy/procedure systems in place and followed?

Pharmacy examples: Timely responses for College audit action plans, preparation for quarterly/bi-annual inventory counts.

2) Human Resources – This theme centres around people management. For both paying customers and staff, how well are tense situations defused? How consistent is the communication (do all team members get the same message and training)? How consistent is the service provision (do all customers receive the same level of care)? For teams, are evaluations being done? Have goals been clearly set and carried through? Are individuals given opportunities to expand roles or prepare for possible promotions? Do people feel they’re treated fairly and maintain positive morale?

Pharmacy examples – Setting up regular conference calls or staff meetings to keep everyone informed and addressing issues as they arise, using job descriptions to determine if employees are challenged to their full potential.

3) Vision – This one is the toughest to quantify but is really about long-term planning. How do you see the team in 6 months to a year? What future events impact the operation and how will that impact be mitigated? Do employee goals reflect the expected needs for a given role should it evolve?

Pharmacy examples – Evaluating a site to implement expanded scope for pharmacists. This involves assessing readiness of the clinicians, identifying training opportunities, and determining appetite for new prescribing services among customers.

 

All managers possess a strength that fits well in one of these buckets. Usually when a person is described, phrases like 1) ‘They are always on the ball’, 2) ‘Their staff love her/him’ or 3) ‘He/She always has great ideas to improve things’ are used to generalize. Individuals with two strengths out of the three are harder to find. The qualities an individual possesses help to shape a professional development action plan. I’ve divided the three main combination types of managers into larger buckets that I’ll outline below:

Admin/HR – These folks have the day-to-day management down pat. Staff love them, patients love them. They are timely with communication and know their team and operations extremely well. Training is a priority, so day-to-day functioning is excellent. Employees developed in these environments are high-functioning and autonomic. In this case, suggested change can cause discomfort as it may upset the current dynamic but usually once given a plan of attack, the execution is excellent.

Admin/Vision – Managers with this strength combo are analytic and methodical. They have excellent planning skills and really enjoy the organization piece of their role as manager. Any ideas are well-thought out and articulated. I have found that they tend to be introspective in nature and may need additional support and coaching to train and sell their ideas to staff.

HR/Vision – These are the motivators and idea people. They are able to aim high for their customers and team and have an infectious, boundless energy. The menial administration tasks are often put on the back-burner in lieu of the next exciting project. I’ve found that this type of management style can be a challenge and is often dependent on the strength of the core team: if another pharmacist or assistant possesses the admin savvy they can often complement a relative weakness, although their experience is often gained in a previous role with a different mentor.

 

I’ve simplified these buckets to make them easier to digest. I use them to coach others but also for myself. I would put my relative strength in the HR group, with vision being second. My administrative skills are solid, but not my passion compared to the other two. I am lucky to know mentors and current managers (not just in pharmacy) that are much stronger than I in each of these areas. As much as possible, I try to absorb their strategies to help create structure and accountability for my staff.

Properly executed change doesn’t happen overnight. I need to manage expectations for my superiors and my team, but most importantly, I need to manage my own.

 

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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New Year, New Challenges

As I rang in the New Year with a few close friends, it really started to sink in. Everything had been a blur the previous week and it was finally starting to catch up.

And no, I’m not talking about rum and eggnog.

On December 30, I accepted a new position to manage a dedicated long-term care site. You can never predict when opportunities like this come along, and although hesitant to leave the most stable position I’ve held in a long time, the application was sent. At this stage in my career, my only real fear is stagnation; I’ve felt that sensation before and have no desire to dance with complacency. Thankfully, that stage has not yet arrived but could have appeared on the horizon at any moment. It’s best for me to be thinking ahead.

I have done this kind of work in the past and had always hoped to make it back, but this time it feels different. My first foray was helter-skelter; long hours, rushed chaos, problem-solving emergency calls after closing time, and staff watching me learn as I muddled along. To this day, I thank them for their patience. Amid all of that, it was also my first real exposure to institutional pharmacy. Under the guise of a semi-retail operation, we provided medications solely to nursing homes, with a few supplies and/or convenience items the facilities needed. As primary consultant, I can speak fondly of my interactions with nursing staff, administrators, the medical director and a Nurse Practitioner with whom I have been working to promote polypharmacy.ca.

Nowadays I feel I have grown in a myriad of ways professionally. I’ve worked on some amazing teams and helmed some progressive projects. I have worked with student pharmacists and 30-year veterans. There has been pharmacy-related exposure to academia, government, hospital and most recently, journalism. Although I feel ready for the role ahead, suffice it to say there is still a long way to go. It’s a bigger team in a site with larger growth ambitions but the structure is sound so we can hit the ground running. Everyone is pointed in the right direction and I need to find a way to feed that positive energy.

Oftentimes when I have entered new environments, they have been in need of stability. The desire to be proactive is usurped by the need to be reactive, at least at the beginning. Ensuring policies and procedures are being followed to cut down on incidents, being detail-oriented with communication so everyone knows how to handle situations serve as a good place to start. The key is promoting consistency, which sometimes challenges current habits. The squeaky wheel often gets the grease, but sometimes the reverse is also true: your most patient customers / colleagues / support figures give you more rope when the going gets tough. It’s much appreciated, sure, but must not be taken for granted. It’s a nice change to begin where most of that coaching has already taken place.

I am excited to meet my new team and to see if I can fit in without upsetting the chemistry they’ve developed. My learning curve will be steep, but manageable. Respect is not an entitlement; I must earn it from every person I work with and for. After receiving a debrief from upper management, I can already feel the synapses firing on projects we can undertake and roles we can expand.

So as I bid farewell to my current team over breakfast this weekend, the gratitude will spill over like the Horseshoe Falls. We shall celebrate how far we’ve come and how close we’ve grown, almost as a family. I have friends for life (or as long as they’ll have me) and they deserve the best in the next phase. I’m not an emotional sort, but I couldn’t be more proud of the pharmacy and the grocery store proper. You’ve helped me grow and learn even more about myself. You’ve prepared me for this next challenge and I promise to not let you down. You’re welcome to check in anytime; I will be doing the same.

Onward and upward…

 

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 Bloom Program

Before you all jump on me for using another lawn/garden reference, please know that this is purely coincidental (though it does go tidily with the growth of our profession).

On these pages, I have written about my experience with the More Than Meds program. Its philosophy is entirely patient-centric. It uses a pharmacist’s medication expertise and accessibility to promote early intervention at the community level. Networking with my local mental health and addiction service centres has been eye-opening. for someone who prides themselves on having a good understanding the pharmacy side of things, gaining a first-hand perspective from those living with mental illness has made me realize just how deep stigma can run. Patients will send family members to pick up prescriptions because they feel judged at the counter. They may feel is distrust of the ‘system’ and feel no satisfaction due to treatment failures or embarrassing side effects. I was missing tools on how to listen properly instead of simply force-feeding advice. I stopped assuming that what I wanted to tell someone about their new therapy was what they wanted to hear. My line of questioning became much more open-ended.

So fast-forward to the current day. The next iteration of this mental-health community outreach project has become the Bloom Program. In partnership with the NS government, this demonstration project (a study to demonstrate value of an intervention) has been funded to build on the positive feedback generated. It is starting out small with only select sites approved to enroll patients. In doing this, promotion has been fairly under the radar with sites being responsible for making contacts within the mental health community where they are located. My chance was early December when I was invited to a nearby hospital to briefly introduce the program.

I was nervous. Unsure of who would be in the audience, I went over in my head the history of the program and the philosophy of the approach. Those involved with Bloom believe strongly that early intervention in mental health illness, in terms of recognizing potential problems and building a support network, can mean the difference in the lives of individuals and their families. As front-line practitioners, pharmacists are often the first point of contact for those unfamiliar with available services in the area, but not all pharmacists will know themselves where to turn or how to refer. To meet that challenge, a resource called ‘The Navigator’ was put together. Broken up by health district, the Navigator attempts to capture as many of those services in the form of ‘helping trees’. For any query, be it crisis-management, sexual assault, suicide, legal aid, continuing care, social services, etc, a list of groups and their phone numbers are available in one place. This has proved invaluable on a number of occasions to give people options to try. Sometimes I find myself calling on someone’s behalf to gather information on intake procedures or meeting times for various support groups.

That said, I’ve been guilty of harboring a sense of intimidation when the word ‘specialist’ arises. I have a feeling that many practitioners, from both the pharmacy and medical sides prefer not to challenge drug therapy regimens due to the relative complexity of the symptoms being treated and the associated adverse effects being managed. Sometimes it gets lost that many folks diagnosed with a mental illness often have smoking habits, poor sleep, or family history of diabetes and hypertension. These conditions need a similar amount of attention and may indeed be exacerbating the highs and lows.

In some ways, it was better that I didn’t know to whom I was speaking. There were about a dozen in the room and at least two specialists. Nurse managers from different departments (outreach, addictions) were in attendance and curious as to how I would be looking to work with them. Hopefully, they went away with a bit of inspiration to have a deeper collaboration with community pharmacy. I just need to be ready when they 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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Holiday Musings

Ah, the holiday season is upon us. In the case of retail pharmacists, it’s a time to fit shopping and decorating in between adjusted schedules to allow for staff to have a few days off. Patients become less patient due to the bustle and we are managing care while physician’s offices close until the New Year (which is becoming easier every year now that we have prescribing authority).

So as life slows down for at least a couple of well-deserved days of rest, I would like to take the opportunity to look back on a very eventful year for PharmAspire. Every interaction I have, every bit of news that pops into my inbox, all seems to find its way into the writings somehow.  Sometimes, I have wondered if the list of topics would reach an endpoint or the themes would become stale. But pharmacy is so fast-moving, chasing that moving target continues to make this site fun.

Let’s see here:

We started with New Year’s  and all of the expectations we create for ourselves. The follow-up on that was more interesting to me only because I realized how much was forgotten about the original post; although I was somewhat successful with my goals to that point, it wasn’t because I had a constant reminder to keep me on track. Maybe that will be my first resolution for next year…

The next item to highlight is one of my favorites, and it came in 50 shades. This drew on my personal experience and attempted to emphasize the uncertainty of what new clinicians may be dealing with, including myself. February was a turning point in that I was contacted by Pharmacy Practice + with an offer to work together for the publication. It has been an honour to work with such a fantastic editor. Vicki, your support this past year has been phenomenal and I look forward to seeing what is in store for 2015. I can’t thank you enough.

Fast-forward to the spring and we had a couple of lifestyle pieces about Life Outside Work and the 60/40 rule. Then heading into the fall, we visited regulation-related topics including licensed technicians and lab requisitions.

It’s been quite the journey, but a rewarding one that continues to push me to be a better practitioner and a better person. None of this would be possible without a few key people:

 

My friends – After a post, I will inevitably receive a tweet / email / text / phone call from someone giving me encouragement. They look through the magazine when it’s delivered. They’ve elected to receive email alerts the site. They’ve started following me on facebook and Twitter. Pharmacy is a huge community, and I’m blessed to be a part of it.

My family – Di and the kids have been the unsung heroes through my roller-coaster career. They keep me grounded. They provide perspective to who I am and what I strive to be.

Mom and Dad – I can always count on mom to be asking for back issues of any months she may be missing. They are with us every step of the way, helping two full-time shift-workers maintain a semblance of normalcy amongst a chaotic routine.

Laura M. – She’s been there since the beginning. Over oat cakes and lattes, she showed me what a blog actually was. Her input has helped my confidence and simply put, made me a better writer. By making sure I don’t take short-cuts when articulating my thoughts, or using confusing similes / metaphors, she takes my flight of ideas and condenses them into readable prose. She has also written a number or pieces for the site as well. A heartfelt thank-you for everything you’ve done and continue to do.

Finally, to you the readers – This blog is an avenue for us to explore our lives in pharmacy with a positive light. Taking the time out of your day to check out a post means a lot. As therapeutic as it can be for me, hopefully some of the topics will continue to resonate with your own practice and professional development.

 

So what’s in store? I’ve had a couple of people suggest vlogging, which frankly I find terrifying but if it encourages collaboration, I may be convinced. There are a few irons in the fire that may drive content early in the New Year, so stay tuned for that. I’m always looking for folks wanting to contribute ideas, discussion points, or media items. Feel free to contact me:

email: dcovey@pharmaspire.ca

Twitter: @pharmaspire

Facebook: pharmaspire

 

Let’s raise a glass of egg-nog-infused cheer! Have a Merry Christmas and Happy Holidays!

 

 

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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Pharmacists Abroad

When you live on the east coast in Canada, you come to expect that the weather in November starts to get chilly. Temperatures regularly tease with the freezing mark and the occasional snowfall get folks scampering for their winter tires after traffic reports fill up with snarls.

So some friends and family decided to bypass November and head for sunnier climes in Florida…and were hit with torrential rains and single digit temperatures (or state-side, ‘in the forties’). We brought the kids to a magical place which you may have heard about. I went to go meet some famous princesses, and begrudgingly agreed to bring the kids with me. Three of our group were pharmacists and try as we may, conversation often turned to pharmacy topics much to the chagrin of everyone else.

Pharmacists are a passionate bunch, to be sure. Although vent sessions prove popular on occasion, most of the conversation turned to the differences in pharmacy between countries and the many signs of progress we’ve seen in the past 5-7 years. Who would have thought that giving injections for flu or travel vaccines would be in such high demand? I was completely ignorant to this when I graduated and figured that the awareness and growth of this service would be organic, not the year over year explosion that we’ve seen. It’s the same with prescribing; it’s becoming much more intuitive for me today to explore my options when a patient arrives at the counter with an expired prescription or a hospital discharge ordering a non-formulary medication.

Some folks would never see a doctor if they could get away with it. Nurturing and maintaining that circle of care is still very important for monitoring and education. However, I do see inefficiency rear it’s ugly head in the form of one to three-month supplies with no refills for stable therapy that has gone unchanged for years. It shouldn’t be much of a surprise that people expect (and often demand) that we extend or re-new their prescriptions. The good news is that now in many instances, we can do just that. Taking on that prescribing liability is a huge adjustment, but as a group we’re warming up quickly to the idea. Contrast that potential liability with buying Prozac off the shelf in a Mexican airport terminal – no danger there of course.

So maybe pharmacy isn’t as magical as say, frozen castles and fireworks (though the apothecary on Main St. serves some magical-tasting sweets), but our ability to adapt in such a short transition period of 3-5 years is pretty impressive. We’re just getting started too: with integrated databases and future ability to request blood-work, some of that maintenance burden may be lifted from general practitioners. They can focus on diagnostics and problem-solving while allowing pharmacists to help screen and respond to T3 and INR values.

We will continue to be pharmacists in other lands. We will be curious to visit pharmacies in other countries and to see how their healthcare system works. What products are available for self-selection and which ones are prescription? Sometimes we see drugs that have not yet been approved in Canada, or an old standby that goes by an exotic name.

Have fun on vacation. Sometimes the time away from the ‘job’ can help rebuild the love for the ‘profession.’

 

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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Potential Potential

I know you’re thinking, ‘Why the double-word title? It makes no sense and now my day is beginning with confusion. I’m going back to bed.’

It’s actually a combination of potential (verb – having or showing the capacity to become or develop into something in the future) and potential (noun – latent qualities or abilities that may be developed and lead to future success or usefulness).

 

Everyone has the potential to become an encourager. You don’t have to be rich. You don’t have to be a genius. You don’t have to have it all together. All you have to do is care about people and initiate. – John C. Maxwell*

 

How many people do you live with, or work with, or know in passing that have a penchant for under-performing or appear to be unmotivated? Your perception of them may be incorrect as their current behavior may not tell the whole story. We’re all slave to our egos to some degree, and the self-esteem we carry has a direct impact on our work quality and our confidence to produce results. If my boss applauds that our most recent inventory was spot on, everything that day seems a bit easier to get through. When I give a flu shot to someone afraid of needles and they exclaim that it didn’t hurt at all, I can walk out of the counseling room with shoulders back and chest out. On the opposite side, if I make a medication error and a patient expresses doubt as to my competency, my turtle shell will be waiting in the office as a safe haven. So perhaps those who seem lazy and unmotivated are actually terrified and have been doubting their abilities for so long that they refrain from really taking responsibility for anything.

The quote above speaks to encouragement. ‘All you have to do is care about people and initiate.’ It’s so simple in principle, yet difficult for so many people, especially the ‘initiate’ part. A lot of the time it’s because of the first part of the quote, ‘Everyone has the potential to become an encourager.’ It’s one of those circular arguments where you recognize that a potential encourager needs to be encouraged themselves to unlock their potential to encourage others. It’s quite a mouthful to say, but if you don’t have a mentor or colleague that reinforces what you do and pushes you outside of your boundaries, why would you be expected to do that for someone else, or even know where to start for that matter?

I have been fortunate to have family and friends support me through the wonderful highs and a smattering of lows. I dedicate my blog to inspiring members of the pharmacy community, and live my daily life according to the following mantra:

 

When you catch a glimpse of your potential, that’s when passion is born. – Zig Ziglar*

 

Whether it’s baking, singing, playing soccer, or identifying a drug-related problem that significantly impacts a person’s quality of life, finding what excites someone takes time and effort to encourage and cultivate. Once they catch that glimpse of what they like, and what they’re good at, it can open up doors they never thought possible. Maybe they are excellent at providing customer service and serve as a model for new staff. Perhaps they have a knack for technology and enjoy training others on a new computer system. There might be scenarios where someone has enormous value in the human-relations department due to their conflict-management skills.

I assume everyone has potential potential. Pharmacy assistants, pharmacists, regulated techs, department managers, all the way up to the executive levels have unexplored paths to follow. They may have the capacity to do more, see more, discover and develop skills they didn’t know they had. If in some small way, I can help shine a light on one of those interests or skills, having a front-row seat to watch a new passion grow is the most satisfying feeling I have ever experienced.

 

*Quotes courtesy of http://www.brainyquote.com/

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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Broaching Breaches

The expectation of privacy in today’s world is becoming increasingly difficult. Everything is becoming electronic; online banking, online shopping, email lists and profiles built on computer system are common in every business nowadays. Pharmacy is no different. With the advent of the Personal Information Protection and Electronic Documents Act (PIPEDA), ground rules are in place for private sector businesses to collect, maintain and disclose any type of personal information contained in a database. Obtaining consent is essentially the gateway to collection;  if we are not able to collect, maintain and use the information for the purpose of filling prescriptions, it’s very difficult to  provide service, if at all. Having accurate allergies and diagnoses can definitely impact the appropriateness of a new therapy or dose change.

The issue of consent can be a minefield. For instance, the Personal Health Information Act (PHIA) in Nova Scotia doesn’t specify an age of consent. The individual must have the capacity to provide informed consent, that is to say that when given all of the pros and cons of allowing personal information to be used in a given situation, they  have a choice to provide that authority, limit the scope, or revoke their previous permissions. In 2008, the criminal code of Canada raised the age of consent in sexual matters to 16, with exemptions down to 14 and in some cases if two minors are involved, even as low as 12. This is important because pharmacists need to determine whether a protective parent should be included within a young patient’s circle of care. As an example, a new birth control prescription is presented by a teen, but her mom picks it up. It’s not always straightforward. The same thing goes for those suffering from mental illness or cognitive decline. A spouse or other family member may be a more reliable source of information when making clinical decisions, but the patient has every right to keep information from being shared with them.

Even with safeguards in place, breaches have happened and will happen from time to time. Faxes sometimes end up at the wrong office or two people with similar names pick up each other’s prescriptions. Nobody intends for these incidents to happen, but the reality is that systems can fail. Perhaps an address wasn’t confirmed or was misheard at pickup. Maybe a large order accidentally included someone else’s bottle during the bagging process. As mentioned above, a counsel session could be initiated with someone who is not within the patient’s circle of care. With expanded scope of services, pharmacists have a heavier burden to communicate any injections or prescribing activities to the primary care-provider. We may not necessarily have longstanding relationships with everyone that receives a flu shot, so while faxing is more convenient than calling an office, we are relying on the patient to specify their family doctor and the potential for error is real. It happens in the other direction as well. Our site has received patient profile requisitions from hospital units intended for other locations, or transfers intended for other pharmacies.

I believe we do an admirable job at upholding these responsibilities. Use of personal information is appropriate to properly advise and advocate for patient care and we’re about to receive more of it in the form of the Nova Scotia Drug Information System (DIS). Other provinces are in various stages of integration; examples include H-Link in Alberta, the Pharmacy Network in Newfoundland and Labrador, PharmaNet in British Columbia and Health PEI. They all currently feed data from institutional and community settings into a central database. While this endeavour is aiming to provide a comprehensive patient profile of all provided health services, it also poses challenges to maintaining privacy. More information will be available to more people in real-time. Applications for this information will be new to many users and perhaps mistakes will be made with security permissions and protocols. Perhaps a look-up with a misspelled name results in accessing the incorrect profile, and adding a care note that doesn’t pertain to that individual. Lab values may be routed to the wrong ‘Dr. Smith’ and communications end up at the wrong office as a result.

At the end of the day, we will continue to apply due diligence in all cases to protect and maintain the integrity and security of the database. The additional information will be available so we can make better, well-rounded clinical decisions for our shared patients. Connecting healthcare providers in community and institutional settings is a huge positive. We can speak the same language based on the same complete profiles. Frankly, many patients seem to assume we already have this access when caring for them, so when we finally do, let’s make the most of it shall we?

 

 

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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Law & Ethics

One of the hats I wear is that of a pharmacy skills-lab demonstrator at Dalhousie University. The fourth-year graduating class is lucky enough (or unlucky, depending on who you ask) to have me stand in as a patient, physician or family member with whom to interact as part of given case scenarios. They are assessed on clinical knowledge but also delivery and style; body language and empathy make up a good portion of the final scoring rubric.

Sometimes I forget just how awkward it is to be a student.

Every year the course evolves, and the content of lab scenarios is tweaked to account for the expanding scope of practice. Prescription adaptations are new within the past two fall semesters, as are injection training modules. A couple of weeks ago, the lab focused on law and ethics, which has always been part of the curriculum, but not always represented in lab scenarios. The written cases were excellent, and would be challenging for seasoned practitioners, let alone mature students.

I have been practicing for over a decade. Although I have first-hand knowledge of some difficult moral and ethical dilemmas that occur in the pharmacy world, most times they have been second or third-hand. Staff members stealing narcotics from the safe, substance abuse in the workplace, and sexual harassment are just a few examples of uncomfortable situations that can arise in a dispensary. None are straight-forward and all require discipline to separate responsibilities under the law and the empathy for the person or persons involved. The law doesn’t care if it was a one-time occurrence or a habitual behaviour, the situation needs to be dealt with as dictated. However the follow-up may have a few more layers. Does the individual have mental health issues that have not been treated? Are they a danger to themselves or others? Is this terrible error in judgement easily corrected?

As preceptors, it’s natural to shield students on rotation from these difficult situations because they have so much on their plates already. So the students in lab were in a bit of a quandary. The scenarios were new and surreal. They had to think fast, interact with a possible offender and gather the information they needed to make a sound decision. The weird thing was that when I had received the case to review, the scenario almost exactly matched an incident I experienced during my first management role. The emotions I felt at that time came flooding back, mostly about how afraid I was to confirm my suspicions that someone was dispensing to themselves. As a new manager at the time, I made the situation about me, and how much trouble I would be in had I been wrong. That said, it was dealt with properly but I completely understand the thought process my students utilized. My answers to their questions were the same as I had received when I went through the situation myself, as was the doubt I tried to create that it was more than a harmless misunderstanding.

The feedback I provided to the students along with their responses identified the two adjoining conclusions: you can uphold the law by reporting and documenting a potential crime or professional misconduct, while at the same time ethically supporting individuals by referring them to a mental health specialist or social worker as needed. For the most part, it is not one over the other.

It amazes me each year the empathy and comfort the students display in their interactions, even awkward ones. There is no doubt that they will all encounter a situation or two that test their knowledge of pharmacy law and blur the lines of the ‘right’ and ‘wrong’ ways toward a resolution. Introducing these new professionals to a few of these possible scenarios should aid their thought processes for when they’re out practicing on their own.

I would say the lab was a resounding success.

 

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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Flu Shot Redux

Oct 19,2014.

The date has been bandied about for the commencement of this year’s flu vaccination season. Although the date may change slightly from this posting, Nova Scotia is ramping up for a robust campaign to exceed last year’s success. Pharmacies in the province provided upwards of 80,000 doses of the seasonal vaccine while physicians provided only about 18,000 doses less than the prior year. Interestingly enough many pharmacies, including my own, were late receiving supply or had only one injection-certified pharmacist on staff for a good portion of the fall/winter months.

Last year, performing injections was new for pharmacists here, but we got pretty good at it. In the time since, I’ve been keeping in practice with travel vaccines and have recently been in demand for the shingles shot as patients become more comfortable dropping in to ask about them. For a service so straightforward and quick (the act, not necessarily the pre- and post-documentation), people genuinely appreciate the convenience and most will happily pay any associated fees to avoid sitting in a clinic waiting room.

I’ll be the first to confess that I’m not that excited about needles; whether I’m giving or receiving a shot, my feeling is quite neutral. I know there are plenty of practitioners who can give and not receive, or have a mental block when it comes to touching a patient. The sight of blood in any amount may not be on your daily agenda but the reality is that pharmacists have proven we can fill a large care gap…a care chasm as it were. An at-risk individual may be stopping in for a blood-pressure medication refill and perhaps receive a shot at the same time. A family of four with two kids under the age of ten come to pick up a few things on the way back from a matinee and now they’re no longer influenza carriers for Christmas dinner with Nan. A pregnant woman’s fears about harming her baby will be allayed.

The point here is that I see the value in providing the service to those that want it. Many members of the public are against flu vaccination. That is their right, and I have no interest in putting anyone on the defensive. I DO however want to be available to anyone who is eager to protect themselves and will pass the word that we’re ready and willing to provide for their family and friends if they are so inclined. Waiting on our first lot of vaccine is making for suspenseful week with the multitude of phone calls we’ve been fielding, so the demand is there. Signs are up and clinics are being planned. It appears we’re going to be receiving Agriflu, which is pre-filled 0.5mL of convenient, time-saving goodness. To be sustainable, our approach will be to treat any request for a vaccination no different than an acute medication for a patient; wait times may vary depending on the time of day and the volume we’re processing. These are duties we will carry out as best we can with the flow of the day.

You can bet that as long as the flu vaccine supply lasts, pharmacies will be instrumental in finding deltoids to receive it. When the season passes, we’ll be ready for the travel rush of winter.

Emergency kits inspected? Supplies ordered? Forms printed? Staff primed on intake? This year, it looks like we’re all ready to rock.

Just remember to save a shot for yourself.

 

 

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.