Author Archives

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Improving the Quality of Life for the Frail and Elderly

The current healthcare system is stressed. As the population ages, the coupling of increased life expectancy with a decreased workforce means that resources (financial, human, medication supply, etc) to care for our citizens are constantly being reviewed and re-allocated.

Over the past 10-15 years, from the courses I took in school to present day, the importance of preventative therapies as a justifiable investment towards future savings has always been stressed. These savings come in the form of doctor’s visits, emergency room visits, hospital admissions, reduction in debilitating illness, or premature deaths. In actual fact, the proper term is ‘cost avoidance’ unless the healthcare system has a bank account somewhere for a rainy day. Although the disease-prevention message wasn’t new when I started, it’s been a mantra with which many of us are familiar. Through aggressive targets for things like cholesterol levels and A1C, we can keep ambulatory patients in their homes longer, and reduce the need for direct nursing care or renovations to the house (ramps, lifts, grab bars, etc).

So what happens once an individual can no longer live alone? Sometimes this is a result of a physical or mental disability, a tragic accident, or a stroke. In these cases, age does not matter. More often than not, however, nursing homes are the residences of our frail and elderly. They are from all walks of life, and from countless backgrounds. They are trusting their healthcare teams to make decisions that better, or at least maintain, the quality of life they have left to experience.

Quality of life has always been a subjective measurement. It can mean something different for each person being measured. An elderly man living at home may see quality of life as maintaining his driver’s license through glaucoma therapy. Conversely, a lady with a hip fracture may see quality of life as avoiding weekly bloodwork for her warfarin regimen. A person with diabetes in the community places priority on treating his/her neuropathy so that they can enjoy walks with their spouse. Whereas a person with diabetes on dialysis may gain enjoyment in sampling a high-sugar treat like that fresh-baked cinnamon bun from the kitchen.

A patient-focused care model certainly helps prioritize our interventions, but what other tools are there? Most guidelines use evidence from demographics representative of the larger population. Unfortunately, frail and elderly patients are usually not amongst those being targeted. I’ll use a diabetes example to illustrate: aggressive blood sugar control is the hallmark of preventing progression of the disease and its resulting sequelae. In the frail and elderly, the risk of falls is much more of a detriment to quality of life. Episodes of low blood sugar are significantly greater with aggressive control, leading to more falls. By relaxing the targets, we can manage that risk.

Fortunately, a new project is on the horizon to address these issues:

http://polypharmacy.ca

Pharmacists are drug experts and have strong opinions on what constitutes appropriate versus inappropriate prescribing. This occurs in every practice and in no way does it denigrate other practices or professions; it’s what we were specifically trained to do. Although the term polypharmacy simply refers to the use of multiple medications by a patient, it lacks a universally consistent definition in literature. It’s often used to describe excessive or unnecessary prescribing that increases the risk of adverse drug reactions, drug-drug interactions, and higher costs.

Thankfully, as pharmacists are finding increasing opportunity to collaborate within healthcare teams, we are able to use our expertise to perform impactful medication reviews in the settings of continuing and long-term care. The polypharmacy site offers a number of clinical tools and guidelines that may help in the decision-making process. Check it out. It’s a public site that anyone can access.

It’s a huge initiative, and pharmacists have the perfect skills-set to educate and implement these interventions.

 

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 Lighter Side

Sometimes it’s just more fun to observe the pharmacy world day-to-day and let the posts write themselves 😀

1) ‘uid’ vs. ‘od’

When I started as a pharmacist in New Brunswick a decade or so ago, we had a family physician who probably graduated med school not long after the Second World War. To say his style was old-fashioned was definitely an understatement. One of his quirks was that he exclusively wrote ‘once daily’ as ‘u.i.d.’ Just try to Google it…you won’t find much. My best guess is that it was an extrapolation of the Latin abbreviations b.i.d. (bis in die = twice a day), t.i.d. (ter in die = thrice a day), etc. The Latin word for ‘one’ is ‘unus’ so perhaps this kindly gentleman wanted to differentiate his abbreviation from ‘u.d.’ (ut dictum = as directed). I don’t know how many phone calls he fielded, but as a new relief pharmacist, I thought I was losing my mind.

On a sidenote, the French way to write for ‘one tab orally once daily’ looks like ‘1 co po die’. The first time a doctor ran that together on a script, it took me 10 minutes to figure out what a ‘copodie’ was.

2) I had a good chuckle with a doctor a number of years back when I questioned why he was calling in ‘Trazadone 50mg, same as before, sixteen years refills’.

It didn’t immediately occur to me that he meant, ‘sixty, and a year’s refills.’ Say it fast, you’ll notice it sounds very similar.

3) Auxiliary labels come in a variety of colors and serve to remind consumers of more common instructions or warnings for their medications. Unfortunately, limited colors mean that in a pinch, users may on occasion grab the incorrect label for the prescription in hand. Not to make light of human error, but I would sincerely hope that proper counseling would cause someone with a chest infection to question if their clarithromycin prescription was ‘for rectal use’.

4) Erectile dysfunction is a sensitive topic but an important one. It predominantly affects older males, though sexual dysfunction is also diagnosed in women more often than people think. Common prescription medications used for depression may also create these problems. Even after practicing all this time, it’s difficult to know just how comfortable someone will be discussing their affliction the first time they pick up a prescription therapy. I give you a few simple ‘Do’s and Don’ts’ that I believe to be helpful from MY past experiences.

 

DO

– Treat as any other prescription: respect confidentiality, offer to counsel and answer questions.

– Offer a phone consultation if that would be more comfortable for the patient

– Ensure that they have discussed risks with their doctor with respect to cardiac troubles.

 

DON’T

– Get caught in a counseling session with a pen that looks like this:

the-spring-pen-514

(Image courtesy of http://www.custom-product.com/)

I wish I was making this up.

I was running out the door for an errand and as the only male pharmacist on staff that day, a patient requested I counsel him on his new ED medication. Since I did not have my lab coat on, I happened to seize a novelty pen dropped off on a recent drug rep visit on my way. The patient’s comment was something like, ‘looks like the pen needs this more than I do.’ We both had a great chuckle, though my embarrassment was definitely apparent.

 

Oh, the world of pharmacy…do we ever run out of stories?

 

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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Innocent Bystanders

Receiving a diagnosis, especially one that has a poor prognosis, is devastating. It may have begun with a nondescript pain somewhere that doesn’t seem to go away. Perhaps there is seizure activity, or uncharacteristic behavior that prompts a deeper set of testing.

Once the doctor or specialist confirms their suspicions, it’s a game changer. There’s no going back, and although some treatments may slow progression of disease such as diabetes or cancer, or force it into remission, it’s now a part of the medical history. Health decisions from that point forward may carry risks that weren’t there before. Everything from insurance questions, to retirement planning, to travel considerations may be affected. For a person, even the diagnosis itself can have a profound impact on underlying mental health. Are they able to enjoy their favorite foods or hobbies? Has a reduced life expectancy caused a re-evaluation of a personal bucket list?

Below is a quote from an English writer who passed during the Depression era:

“The trouble with always trying to preserve the health of the body is that it is so difficult to do without destroying the health of the mind.” – Gilbert K. Chesterton

These words hold great wisdom but I propose an extension to this theory: this not only affects the individual with the affliction, but also that person’s support network of family and friends. Whose health of the body are we trying so hard to preserve? Whose health of the mind are we destroying?

Is it always the same answer?

When that diagnosis is confirmed, the game changes not only for the patient, but for everyone close to them as well. Behaviors change in order to support that preservation of health. The family now has to be wary of salt restrictions, or sugary foods in the pantry. Considerations are made for home care and mobility. Visitors may be restricted due to fatigue or risk of infection. In many ways, the support network would benefit from its own support network.

Quite some time ago, I had a lady approach the counter to pick up a prescription for a common Alzheimer’s medication. It was for a dosage increase and she had some basic questions about side effects and what dosing time was best as it had been increasingly difficult following her husband’s recent erratic behavior. It only took about a minute for me to get the sense that there was much more to this story. I asked if she would like to sit down and discuss things more in depth. Like many others, she had been from a generation where she looked after the household, from the cooking and cleaning, the finances, and all the daily planning. Unfortunately, her spouse’s condition had deteriorated to the point where she could not physically look after him anymore. She didn’t know where to turn and as much as she recognized the relief she would feel, it was accompanied by a profound sense of guilt to leave him in the care of someone else.

I realized during the interaction that my patient wasn’t only the person with the name on the prescription, it was also his loving partner who needed guidance to help cope with her own feelings. Thankfully, I was able to provide her information on community-based support groups and phone contacts for financial and legal aid. She certainly seemed appreciative and more at ease after the interaction.

In our practices, this happens countless times and we may not even be aware of it. The innocent bystanders that have their own lives turned upside-down may not realize at first just how or when they will be affected. Maybe if we ask the right question, we may just help them avoid getting overwhelmed.

 

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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One Year in the Blink of an Eye

It’s a wee bit stormy out here on the east coast. Spring has decided to pack up and go to Florida to avoid 30cm of blizzard leftovers.

I’m in awe that 1) it has been a full year since I published my first post on PharmAspire titled ‘Inspiration‘ and 2) as my gender is not always known for remembering certain occasions, I have earned my gold star on this day.

It has been a banner year for personal and professional growth. Even from post #1 the tone and feel of the blog is exactly how I had originally envisioned it: a place to explore all of the positives in our lives as pharmacists in the words of those living it. Other places may serve to spotlight all of the crazy/annoying/mundane aspects of our profession and it’s often a good laugh, but at the end of the day, it keeps the mind trapped in all the things we dislike about what we do. At the very least, what can we take from those examples to illustrate what we have control over to improve the situation for the next time?

It was never meant to be all about me, and consequently, many of the experiences I’ve had over the past year have been shared with or inspired by others. A couple of other author-friends have taken a turn writing their own pieces, and they are certainly worth a read.

Reviewing some of the topics covered, we have delved into job satisfaction and handling ‘no-win’ situations. We have taken on mental health in numerous posts, including mobile outreach, community group participation and addiction. There have been heavy topics (suicidal ideation) that have balanced with lighter fare (Odds & Ends). Current events in Nova Scotia include the journey towards technician regulation and our first foray into administering injections. Quite a mixed bag, wouldn’t you say? All posts may be found in the archives if you’d like to check them out.

All in all, and I repeat myself often in saying that it’s been extremely satisfying to watch this blog idea grow. It has reached more people than I could have expected in such a short time. To top the year off, the blog is being featured in the March 2014 issue of Pharmacy Practice +. I am both honored and humbled by the support I’ve received.

A sincere thank you goes out to Laura M, who has been my blog editor since day 1. My ideas are sometimes convoluted and my metaphors don’t always make sense. I’m so glad she has stuck with me and pushes me to be a better writer.

So what’s in store for year #2?

A lot has happened in the pharmacy world and continues to happen. As I wade through my own experiences with expanded scope and collaborative practice, I hope to share as much of the highlights as I can. Plans are in the works to continue mental health outreach with the More Than Meds project (http://morethanmeds.com). Other upcoming features include further follow-up on my smoking-cessation sessions, a deeper look into palliative care, and a profile on a new provincial initiative (http://polypharmacy.ca).

Stay tuned!

 

Twitter: @PharmAspire

Facebook: https://www.facebook.com/pharmaspire.ca

email: dcovey@pharmaspire.ca

 

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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Pharmacy Lawn Care

***This post was originally created March 3rd and may be found as a static page on the left sidebar under ‘About PharmAspire’. It was inspired by the editor of Pharmacy Practice +. Thank you Vicki 🙂

Recently I was asked to write a blurb to introduce myself and expand on the creation of PharmAspire. Over the past year, I’ve tried to share pieces of me through my thoughts and experiences, but haven’t really given any background to the ‘who I am’ and ‘why I created a blog’ questions. I guess that would be a good place to start.

I have been a community pharmacist since graduating from Dalhousie in 2001. Since then, I have been involved in many aspects of community pharmacy. This includes exposure to pharmacy management, marketing, human resources, professional development, corporate direction and process analysis. I’ve met many great leaders and have several mentors within the profession. I’ve had moments of burgeoning job satisfaction and also some periods with an empty, ‘is-this-for-me?’ feeling inside.

I have been fortunate that my career has had been mostly ups with only a sprinkling of downs. Here are a few of the highlights that capture my journey as a practitioner. Firstly, in 2005, I was asked to manage a dedicated long-term care site. This role required me to not only provide medications to nursing homes, but also use consulting hours each week specifically to support facility initiatives. I was able to be part of a collaborative team along with the administrative staff, the nursing staff, the medical director, and a recently added nurse practitioner. I was invited to chair pharmacy and therapeutics meetings, help draft policies and procedures, perform training sessions, and take part in facility events for the residents.

My second example is from my time at corporate office. I had always enjoyed the professional development side of human resources, and was fortunate enough to have a hand in preparing and delivering numerous events for staff. There was quite a variety, ranging from orientation of new pharmacists, to managers-only sessions, to training events for the entire pharmacy staff across multiple provinces.

The single largest change in my career was in July, 2012. Changes to legislation had begun to severely impact the life of a community pharmacist. Our new expanded scope of practice required that changes to practice be integrated on an accelerated schedule to counter drastic changes to the existing economic model. I was leading a team through these transitions, but realized that I was struggling with my readiness to change my own practice. I made the personal decision to step back and rediscover what drove me to pharmacy in the first place. PharmAspire began as a way for me to channel my thoughts and observations to focus on the positive.

Pharmacists thrive in many sectors of the healthcare system. When significant changes come about, there are almost always negative aspects associated with the transition. The old cliche, ‘the grass is always greener on the other side’ starts to resonate and folks look for new pastures, and new challenges. However, many of us have roots in the sector in which we work, and if our experience can influence how the changes are implemented, it can only help to sand down the rough patches. My goal with the blog is to inspire and motivate pharmacists. Wherever you may be, grab a bag of fertilizer and make your own grass greener. Strengthen those roots and get excited about sharing new experiences.

So what kind of pharmacist do you aspire to be? The tagline is, ‘The Practice of Pharmacy On Your Terms…In Your Terms.’ and those ideas can spring from anywhere at anytime. The act of describing in our own terms the barriers we’ve overcome and the rewards we reap, will help the entire pharmacy community to evolve our practice to meet the needs of the healthcare system, on our own terms.

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 Unexpected Experience of Mental Health Outreach

Since May, I’ve been a proud member of the More Than Meds team (@morethanmeds, http://morethanmeds.com). I’ve been led off the beaten path of conventional community pharmacy and have begun to test my own beliefs about mental health and stigma that goes with it. I’ve certainly had my eyes opened, and many doors and opportunities too. I think it is fair to say that being a part of this program has really helped me to better understand what patients and their families go through on a daily basis – the hope, exasperation, set backs, isolation, support, and progress. This understanding didn’t happen by remaining in the dispensary.

About four weeks ago, I was invited to attend a meeting with family members of patients struggling with psychotic and schizo-affective disorders. This group has been meeting monthly for about 10 years now. From what I observed, they have grown into a big supportive family. Mostly there were couples, but some single parents attended. Each would provide insight and support to the others in the group by sharing their own experiences with mental health services, inpatient stays, the multitude of care providers, challenges with housing, and of course, the medications. While I am very familiar with the commonly used psychotropic medications, I am far out of my comfort zone when it comes to addressing the non-pharmacological issues of mental health care. While I knew it on some level, being at the support group really crystallized for me the importance of being much more than meds (see what I did there?). Educator, navigator, collaborator, and advocate (definitely advocate) roles make much more sense now, whereas before I didn’t really ‘get’ how to fit them into my practice. Quite frankly, I was overwhelmed by how much information I had to offer. Information that they needed, information that brought the members of the group understanding and clarity and/or new therapeutic paths to follow. Their appreciation was more than humbling.

During a round-table discussion, a member of the group touched on something that I can’t seem to shake, and I paraphrase:

“Our son lives with schizophrenia. He’s been doing well of late. His meds are stable. He is living independently. When he was a teen, he was a gifted athlete and musician. Now mostly he plays video games. We actually get concerned that he has stopped his medications when he gets back to playing music…and he’s really really good!”

This comment really struck me, flooding me with all sorts of thoughts and mixed emotions. This illness, especially the negative symptoms, is so frustrating to families, and to me. What can we do to help? Are his medications stifling his creativity? The concept of blunted affect has been written about extensively (http://en.wikipedia.org/wiki/Blunted_affect, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632232/). Would suggesting a change in his pharmacotherapy be a good idea? Does it keep hope alive or set up false expectations? How do we say in so many words, “things could get better. Would you like to try (x)”? Simply by saying it we are, in fact, pointing out that the current situation is somehow unsatisfactory, but who are we to judge? This may be counterproductive as it may only serve to cause the family frustration rather than hope. As pharmacists, we may struggle to determine our role in these situations. We do not title ourselves as mental health care specialists but we do contribute to mental health services. In a broad sense, we contribute every time we speak with someone about their sleep, their mood, their worries, and the medications that affect those things.

That said, I am glad that I chose to accept the invitation to speak. Even just to be a part of  a community searching for help and support. On the topic of medication regimens: sure, they help the families and caregivers cope. They can also provide stability, the lack of which could otherwise prevent the return to work or leading to the loss of yet another relationship. However, not everyone likes the medication experience. It’s been said that the cost of stability may be a little less color in one’s world. For that evening, I may not have had all the answers to their many questions. I may not have been able to recite the most relevant head-to-head trials or know all the rare side effects for each medication, but I learned that my imperfect knowledge and my experience allowed me to give so much in the way of support, information, and encouragement.

After a couple of sessions with families and patients, I don’t consider myself an expert but I certainly feel that my awareness has changed for the better. I hope to participate in more evenings like the one mentioned above.  I know my daytime patient care activities will benefit from 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.

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It Comes in 50 Shades Apparently

A few years back, I was hosting a segment of our yearly 2-day orientation session for new pharmacist hires to the company. Most were new graduates but some were coming to us from other provinces and/or chains.

I was aware that a certain book was making the rounds at about that time and somehow my improvisational skills led me to drop the title with respect to the new expanded pharmacy scope. To my ‘surprise’, at least 3 people in the audience were in the midst of reading this book and were justifiably confused (though intrigued) by my seemingly random tangent. Although pharmacy is an exciting place, it seemingly pales in comparison to the plot of a story I should have spent more time investigating.  Now, I have never read the book and understand it to be a wholesome story of two people that meet and enjoy going for coffee, holding hands and don’t-you-dare-leave-this-book-laying-around-anyone-under-18.

After about 30 seconds, folks started reaching beneath the tables to gently pick their jaws back up from the floor. Queue the giggling. I enjoyed the mid-morning giddiness myself.

My point was that pharmacists, in a general sense, are used to having set rules to follow. Now every profession has rules in the form of guidelines, regulations, acts, or policies. We also have best practice memos to further help direct and support us as individuals. These documents are vital to minimizing liability as practitioners while stressing public safety. Those rules prior to the legislative changes meant we had our comfy room in the healthcare house; the boundaries were established and many scenarios had played out countless times. Black, meet white. Now, if somebody came to the door of the pharmacy room and invited you out, then you would have a taste of collaborative practice and it seemed like a treat. It was like being allowed to eat at the big-kids’ table at Thanksgiving; an experience you’ve waited for and look forward to the next time it happens.

So enter the blueprint of pharmacy and changes to pharmacy acts across the country. We now replace the walls to that comfy room with strips of yellow duct tape on the carpet. Now you can see the hallway, or venture into the next room without needing approval. You know where you used to spend all of your time, but your space got a whole lot bigger. Needless to say, each scenario with medication reviews, prescribing, administering, or ordering blood tests is new to everyone, and therefore virtually impossible to predict. Becoming a clinician means a certain degree of trial-and-error, and judgement calls based on the best information possible. There may not be a tidy ‘right answer’ or a similar situation on which to build.

As we gain confidence in our worth and abilities, many pharmacists may completely leave their yellow outline and settle in different areas of the healthcare house. They may join travel clinics and vaccinate full time, or perhaps pharmacists may liaise with physicians’ offices to perform medication review consults in their offices. They may become more visible and independent in rural communities as they perform minor ailment and emergency prescribing services.

In each possibility, and for each and every pharmacist delving into said opportunity, there will be fifty shades. You will be making decisions and backing them up with gusto. You will be challenged from time to time, but so is each and every health professional out there.

Embrace the grey. Explore the new rooms. Make yourself at home.

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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Out of Bullets

“We offer flu shots, but have run out until the middle of next week.”

Unfortunately, my site is far from the only one parroting these words ad nauseam this past weekend:

http://atlantic.ctvnews.ca/n-s-pharmacies-having-a-hard-time-keeping-up-with-flu-shot-demands-1.1637675

In this article, it states that 60,000 people have been shot…er…vaccinated by their pharmacist in Nova Scotia when that number was expected to only be around 20,000. In addition, 435,000 flu shots have been distributed. That number represents 47% of the population, which puts NS in line to be the most vaccinated province in Canada. Those are some impressive numbers.

The first frenzy took place mid-Oct with media advertisements and statements from public health. Due to an administrative hiccup, my site had one pharmacist out of three with the authority to administer injections so we had to be creative with scheduling. Still, we managed to exhaust our initial supply and applied for another distribution. Then, the fever died down (pun intended). Things went quiet over the holidays with only the occasional inquiry. Then we get thrown a curveball from our sister province Alberta:

http://www.cbc.ca/news/canada/calgary/alberta-flu-cases-spike-5-deaths-confirmed-1.2482027

Not exactly a happy New Year to be sure.

Needless to say, this was a scary item to read online or hear on the 5 o’clock news. People reacted and started coming out in droves. When physicians’ offices began running out, pharmacies were the place to go. We had families calling from 45 minutes away to see if we had supply and offered the service. In saying yes, often the following question was “where are you located exactly?” People who had so far resisted getting vaccinated had their minds made up to receive one. Parents were bringing in their kids (5 years and up) and weren’t leaving even if it took a bear hug from mom or dad to control flailing limbs. It was pretty intense at the dispensary last week managing these requests. That is, until we burned through our relatively small supply and started to turn folks away.

Reports indicate that the flu season is only expected to peak in February and we’ve already begun to see a spike in positive influenza tests across the country. The FluWatch report issued by the Public Health Agency of Canada up to Jan 4 notes that cases are being reported in a higher proportion of adults 20-64, which is a change from last year. You can find the full report here:

http://www.phac-aspc.gc.ca/fluwatch/13-14/w01_14/index-eng.php

That last link took me awhile to digest. At least the graphs were varied and pretty-looking.

All in all, I believe we can surmise that pharmacy has strongly impacted awareness and access to the flu vaccine so far in our first season. Now, I say this with the caveat that the season is not over and final vaccination rates are not yet available.  Incorporating an injection service into our current processes is new, and it’s unpredictable, but I have to admit it’s been satisfying. Congratulations to all of my fellow colleagues who took the plunge and are embracing this new public health service with fervor and professionalism. If you’re like me, the overwhelming feedback from patients has been supportive and appreciative.

On that note, a quick story from Friday night…

A family of four from quite a distance away called to ask about having their kids vaccinated. One was 5, the other was 7 and their family doctor had no vaccines left. Once they arrived over the supper hour, I prepared the syringes and laid out the supplies. I had not uncapped the needle when the tantrums started. A boy and a girl were both convicted in the fact that whatever was going on was NOT happening on this night. The parents were worried that supply wouldn’t be there if they had to return and as it stood, I was down to about a half-dozen at that point. There were tears, and kids are slippery when they want to be. However, with a little patience, I was able to follow through without incident even though I wondered about them ever wanting to see me again. Five minutes later, the mom and a now sheepish little girl approached. The conversation went like this:

Mom: “What did you say? Did you want to tell him what you just told me?”

Girl: Hides behind mom

Mom: “She asked that if next year Dr. xxx isn’t able to give the shot again, would she be able to come see you?”

Me (in full blush): “Of course! You did very well.”

I found the rest of the night to be a bit of a blur 🙂

I hope we get our next allotment soon…

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 New Year’s Resolution Post

Of course this site needs one. 2014 is a new year, and with a clean slate, what better time to evaluate what’s been happening and strive to make those changes that have been put off all year? Getting back to the gym 2-3 times a week, learning how to play the guitar, finally getting the house in order…of course all of these things will happen simply because you received a new calendar for Christmas and can’t wait to hang up the January picture.

Therein lies the rub: heightened expectations mean a bigger fall if we don’t achieve our goals. During smoking cessation sessions, one point that resonates is the dreaded ‘quit date’. After relaxing over the holidays, a lot of folks attempt to turn the page by making a New Years’ resolution that often sets the bar beyond what they have the confidence to achieve.

Practicing pharmacy has some parallels. At first blush it may not seem like it but weening ourselves off technical aspects of our jobs involves training of others, trusting of others and the actual letting go. The exacting nature of what we do makes this troublesome as we are so used to being the centre of the dispensary. Giving up any control at all is uncomfortable. Letting others ‘own’ a responsibility means they first have to be shown all aspects of the job then left to their own devices. If it gets screwy, then that ‘owner’ oversees the cleanup and resolution. I’m not at all suggesting that pharmacists don’t maintain an awareness of what’s going on, but as far as a drug distribution assembly-line is concerned, our role is becoming more and more the beginning (assessing appropriateness of therapy) and end of the process (counseling and follow-up). Anything that occurs in between should be evaluated and adjusted by those who are most directly involved. Occasionally this is a pharmacist, but more often than not, technical assistants are capable of running the show. Since this isn’t happening at my site yet, empowering members of my team to ‘own’ more than they have will be a precursor to any clinical goals I set.

Since a smooth workflow is conducive to a lower-stress day, checking prescriptions remains a priority that we balance with the newer clinical services. One of my resolutions is to avoid seeing patient interactions as ‘interruptions’ to the day-to-day workflow and embrace those opportunities to build relationships. Perhaps I can start with this suggestion from a former pharmacy professor:

https://twitter.com/RxDeanMac/status/416466843600044033

Simple, but the question is open-ended and your time commitment is predicated on the answer you receive. Now, truthfully, will I be able to follow my resolution 100% starting Jan 1st? I seriously doubt it in the sense that my routine for the past 12+ years has been largely technical in nature. Currently, checking and dealing with insurance issues takes up a large part of the day. While both provide a satisfactory service to a vast majority of patients, breaking this cycle is not something that comes naturally to my practice. That said, my goal is to take the initiative to invite a patient into an extended interaction each day (as opposed to waiting for it to happen). If wait times increase slightly from time to time because of this initiative and staff messaging to consumers is well-delivered, we can have the cake, and be able to have a nibble or two. I’m confident that performing within our expanded scope of practice will be sustainable, but also realistic and ultimately rewarding.

Stay tuned. I hope to have some wins to report in the near future. I also can’t wait to hear some of yours 😀

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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Happy Holidays

Many of my posts seem to be about reflection.

Whether it be people, places, events or anecdotes, the spirit of this blog is to reach as many pharmacists with thoughts and experiences that may help them achieve a rich practice experience wherever they choose. Contributors range from all across the spectrum and include not just pharmacists, but other health professionals affiliated with pharmacy practice. I find the added perspective from nurses, technicians, doctors, benefit providers, and educators (to name a few) really help to enhance our messaging (yay, flu shots!) and support contributions that we may overlook (taking 5 minutes to review discharge orders, or explain special auth processes).

Candy cane mortar

The past year has been very rewarding for PharmAspire. The social media aspect is a strange animal so it’s taken some time to get a handle on it. Some of the posts seem to have connected with readers from the comments I’ve received. For users of the wordpress site, these comments have been posted directly on the blog but I’ve had supportive feedback through email and text as well.

Building on these successes, 2014 is anticipated to be even better with a variety of content styles, and from a larger pool of contributors. If you would like to be a part of the project or have any content ideas to pass along, feel free to contact me:

Email: <dcovey@pharmaspire.ca>

Facebook: https://www.facebook.com/pharmaspire.ca

Twitter: @PharmAspire

After such a shameless plug, I have plenty to be thankful for this time of year. A special holiday thanks goes out to Laura M. She has been invaluable in not only introducing me to the blogosphere, but kicking my behind to promote on the above social media sites, and most importantly, applying gentle amounts of spit and polish to all of my ramblings so they are more easily read and on point (mostly). Her pieces on the site have added a real-world, front-line flavor that are genuine and powerful. Thank you Laura for the motivation and inspiration.

To all current readers, this would also not be possible without your interest in the writings and discussion. Pharmacy is dear to the hearts of all of us. Our careers, our public personae, our future opportunities all hinge on the events of today and how we navigate them. Our collective thoughts and observations are vital to seizing those opportunities as they arise. If this project helps connect two pharmacists or health professionals that have never met for the good of the profession, then we all benefit.

From myself, Laura M. and all PharmAspire contributors, we wish you a very happy holiday season. Here’s to good health and good times with family and friends! See you in the New Year!

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.