1. to move, climb, or go upward; mount; rise:The airplane ascended into the clouds.
2. to slant upward.
3. to rise to a higher point, rank, or degree; proceed from an inferior to a superior degree or level:to ascend to the presidency.

Death and taxes may be the two absolutes in life, but I’m going add a third: learning. Every day we spend on this Earth is another day of life experience. Some of it in the form of the international news, some of it a horrible emotional or physical trauma, and lots of it intentional self-improvement.

As I age, this body of mine doesn’t always seem to rebound as I remember. Mentally? Well some would tell me my brain also does not rebound as it should. In some ways that is true, but it makes for a rich experience and a good story. There have been personal interactions, both loving and in conflict, and professional situations that have played out in the hundreds. There has been travel to take in culture abroad, and DIY projects of which I could be proud (through trial and error and lots of YouTube videos). I do feel that I’ve grown an enormous amount, and happy to share what I’ve learned with anyone who seeks advice. I also crave advice from my own mentors.

In fact, one of my favourite parts of reaching middle age is enjoying the confidence and credibility to mentor others, but also recognizing how much I don’t have figured out. I find being both a mentor and mentee very rewarding. Every situation, every piece of knowledge, every resulting emotional reaction pushes me further up the mountain and is potentially useful to someone else.

A feeling of pride to discover a high-risk drug-related problem and potentially save a catastrophic health event? That lesson may be helpful for a colleague. Up we both go.

Warning signs that go unheeded in a broken relationship? That lesson may be helpful to a close friend or family member. Up we both go.

The anxiety of preparing for PEBCs and the expectations of your first day as a newly licensed pharmacist or technician? That lesson is certainly helpful for those experiencing for the first time. Once again, an opportunity for us both to improve ourselves.

Speaking of first times, those will continue to happen whether you like it or not.

As professionals, we experience many firsts in the course of our careers. Things like our first counsel, the first time a patient asks for us specifically to address their concerns, our first medication incident and how destroyed we all felt at the time.

Even after nearly 20 years in the profession, firsts are still happening every week. Recently, an individual arrived at the counter to request a naloxone kit. I was not dispensing, but was onsite for an unrelated administrative matter. I was asked to perform the counsel. Having undergone the training, I had not yet had the opportunity to put that knowledge in practice. A younger me may have hesitated, but the whole time I had Laura, PharmAspire editor, on my shoulder. She is very passionate about mental health issues and the ongoing opioid crisis. She would NOT let me have this individual walk away without a naloxone kit, so I needed to step up. I reviewed the material once more, took my time to slow a slightly elevated heart-rate, and proceeded to have a positive patient interaction. It brightened my day and boosted me just a little bit higher.

At the risk of sounding smarmy, every day can offer a gift if we choose to accept it. A good friend of mine close to retirement told me the other day that even after 41 years, he still loves pharmacy and is amazed at the constant change. Every day, he wakes up and finds some way to add on to the amazing career he has built. It may be a clinical nugget about NOACs, or a new way to phrase a difficult conversation about a cancer diagnosis. He will miss the chance to use those pearls in a structured setting, and the smiles of all of the people he has helped through the years. Many have become life-long friends.

That is a career I can only hope to emulate. As for now, I can’t quite see his current plateau just yet, but I’m making decent progress of my own.

Another foothold on the mountain.

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.

My fondness of words often gets me into trouble when expressing my thoughts in these pages or in person. Every few drafts, my editor Laura needs to snap me back into reality by stating how a reference, or in some cases, complete tangents make very little sense. Re-writing paragraphs is part of the routine now, but I swear it’s so clear in my mind as I type.

A new year is upon us, and another fresh start. I found many parts of 2017 challenging. Many people close to me were dealing with personal strife and it seemed to pile on. Losses of family members, relationship breakdowns, catastrophic injuries and prolonged recoveries all made multiple appearances during the year. My hope is that 2018 will hold more good fortune. The pharmacy profession has been the one constant through my adult life, so I tend to reflect on that first to regain my footing when I’m starting to wobble.

It happens to be mid-year review season for our company’s employees and I’m beginning to have some productive conversations with my management team. For the sake of simplicity, my message for 2018 consists of two points and they will always be front of mind when making decisions for our dispensaries:

1. Patient-focused care vs distribution-focused care.
2. Own the therapy, not the physical prescription.

For the first one, it’s more of a reinforcement of the discourse we’ve been having for as long as I remember. The difference to me is that we have much better measures and overall evidence to the health benefits of adherence strategies and care plans. These have been part of pharmacy practice for a long time, and pharmacists from all over have wanted to have productive conversations with their patients. I can personally attest to the pressures of filling prescriptions on time; sometimes those interactions are shortened, and that extra open-ended question remains unasked. Removing barriers to clinical care is essential to the next evolution of pharmacy practice.

For the second, Wikipedia is always handy for a quick definition:

Therapy (often abbreviated tx, Tx, or T_x) is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is usually synonymous with treatment (also abbreviated tx or T_x). The English word therapy comes via Latin therapīa from Greek: θεραπεία and literally means “curing” or “healing”.^[1]

A *prescription* is a health-care program implemented by a physician or other qualified health care practitioner in the form of instructions that govern the plan of care for an individual patient.^[1] The term often refers to a health care provider’s written authorization for a patient to purchase a prescription drug from a pharmacist.

Unless the pharmacist is the prescriber, and owning the administrative side of a prescription as well, I am also reinforcing that pharmacists can own the therapy more than ever before. The crux of the matter is defining the clinical (treatment) versus the technical (program) portions of that therapy. We do this every day in practice. For example, how many times has a family member or mutual friend asked for an opinion on a new sample they started taking, or a drug regimen that their doctor is considering? Each of us have a process whereby we collect info about allergies and medical conditions, other medications, relevant blood test results, etc. and arrive at a recommendation. We may agree with the drug, the dosage, the frequency, and the necessary monitoring plan or we may need more information to properly assess. Then we’re done. We stand by our response. At that stage, there is no written or virtual piece of paper. There is no suggestion of how many the physician wants dispensed at one time. There is no discussion about different brands or changes in the shape of tablets. Only an assessment of whether it’s appropriate or not, and how to get the most out of the regimen. Idealistically, we could envision a day where that same approach could apply to a busy dispensary. Some have already begun defining that clinical/technical separation by investing in layout changes, new automation, and role adjustments, including regulated technicians. Lab values are being requested in some provinces already and the availability of this information is becoming more accessible. Demonstration projects are being developed to take advantage of a pharmacist’s expanded scope.

These two tenets are closely intertwined. By staying patient-focused, and having dispensary teams adhering to a patient-first philosophy, it becomes much easier to own the therapy because the relationships are that much deeper, the conversations broader, and the interventions that much more meaningful.

There is a lot of good work ahead, and complexities to overcome along the way. Hopefully by keeping the messaging simple, those barriers in the distance won’t seem so difficult after all.

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.

Pharmacy finds itself in a bit of a conundrum when it comes to workforce needs over the next 5 years. Many pharmacists from my generation of 15-20 years ago remember the recruiting environment whereby students in all years of study were engaged with all sectors of the industry. They really had more control when it came to planning their entry to a career. Oftentimes, opportunities were available in many regions of the country so settling in a preferred location was commonplace.

In the time since then, changes to the economics of pharmacy have prompted many changes to the services being provided, and the scope of practice for most health professionals has been evolving quicker than we had seen in the decades before. Pharmacists are being sought out for their cognitive abilities to help lessen the burden on family physicians, who in turn help lessen the burden on specialists, etc. In doing so, the technical aspects of the jobs are increasingly being back-filled by a set of new professionals: the registered technicians.

Between university programs exploring entry-level PharmD graduate designations, and community college intensifying their technology curriculum, we should have seen this coming 5-7 years ago. The appetite to change pharmacy practice is growing at an accelerated rate, further away from drug distribution and more into clinical services. The constructive non-conformists among us enabling this change need to have the support behind them.

For the longest time, there was excitement for pharmacy assistants to update their skills through bridging programs offered by accredited bodies. The expense was prohibitive for many, and those committed to becoming licensed were taking a risk that the workforce would not be ready to take advantage. Maintaining that license when opportunities were scarce could be deflating, and as a result a large number of individuals took the wait-and-see approach. As time went on, motivation began to wane.

In reviewing the NS Regulations, the deadline for bridging is here:

 (2)    An applicant who has all of the following qualifications on or before December 31, 2017, is eligible for registration and licensing as a pharmacy technician:

              (a)    successful completion of a program approved by the Council to educate and train persons to be pharmacy technicians;

              (b)    at least 2000 hours of work experience in a direct patient care pharmacy practice in Canada in the 3-year period immediately preceding entering the program referred to in clause (a);

              (c)    all the qualifications set out in clauses (1)(b), (c), (e), (f) and (g).

As for the letters at the bottom, most applicable are:

               (e)    successful completion of the examination to assess required professional competencies;    

                (f)    successful completion of an assessment of the applicant’s basic competencies in a direct patient care practice setting approved by the Council;

For other jurisdictions with similar limits, the PEBC qualifying exams are only held twice yearly, and the successful completion of an assessment may vary. Regardless, if a commitment wasn’t made to complete the requirements at this point, it would be virtually impossible to meet them by the end of this calendar year for those hoping to practice in Nova Scotia. In Ontario for instance, bridging programs needed to be completed prior to Jan 1, 2015.

This is adding up to a situation where current long-term employees in community and hospital would need to return to classes to upgrade their skills to gain eligibility for licensure. Confounding this point, new graduates entering the workforce potentially have very little practical experience. We certainly trust that our regulatory bodies have established vetting procedures and oversight that matches those of pharmacists, but as a new profession, there is still a degree of uncertainty. It will take time for widespread acceptance, but happily, that integration is well underway.

The success of these individuals will directly drive the clinical opportunities and roles for pharmacists in the future. Pharmacy programs are being retooled to become even more clinically-focused and patient-centred. We need to support those that are completing their training, and do what we can to integrate their skills into our dispensaries. Technicians will benefit. Pharmacists will benefit. Teams will benefit and all together pharmacy will reach new heights.

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.

The inspiration for today’s post is from an unlikely source, and I’m struck by my inability to get the song out of my head over the past week.

My father recently lent me Mick Fleetwood’s autobiography, he being the seminal figure in the evolution of Fleetwood Mac. I had heard records when I was little. The album Rumours was released in 1977 and the band was quite the rage during my infancy. His writing style is free and easy, and genuinely feels like you’re sitting in a room having an extended chat. The man has lived a wild life, and is unabashed by the drama and destruction that has followed him around. It’s interesting to pass through all of the many distinct chapters of his life and that of the band that shares his namesake. Most folks will identify with the commercial success of the current lineup, but there have been a total of 16 members since 1967. That’s a lot of change in 50 years, and he’s welcomed all of it, much of which he created.

So naturally I’ve found myself rediscovering their music and all of the songs I may have heard and not realized the artist. One of those songs is ‘Don’t Stop’. It stands as one of their most famous and used as a theme for Bill Clinton’s 1992 presidential campaign. The chorus serves as an earworm:

Don’t stop, thinking about tomorrow.

Don’t stop, it’ll soon be here.

It’ll be here, better than before.

Yesterday’s gone. Yesterday’s gone.

This is how I like to think about pharmacy practice. Through difficult times, we want to look ahead and use lessons of the past to make something better. Recently, I spent three days in a room full of my peers discussing patient-focused care and re-discovering what it was that drove me to pharmacy in the first place: the professional-patient relationship and the ability to help people. They come to us because of our expertise in drug therapy, but our capacity to help can go so much deeper. We see the person instead of the drug list. We offer assistance starting with their goals instead of academic theory.

It’s invigorating to have so many positive experiences on which to build. Maybe someone presents feeling tired and irritable. After an assessment, it’s suspected that thyroid supplementation may help, along with that nagging itchy dry skin and a pesky feeling of cold most of the time. Connecting the dots, and discussing benefits of therapy modifications can be so rewarding.

Don’t stop….thinking about tomorrow.

I have so many tomorrows to think about right now. How do I want to re-energize the pharmacy teams with what I’ve learned? We can discuss shuffling workstations, moving equipment, organizing appointments on overlap shifts, or simply having regular short, daily meetings to bring everyone together.

Don’t stop…it’ll soon be here.

Why wait? Every tomorrow is a new opportunity to introduce and refine behaviour. Being excited for all of the ‘what if’ possibilities is the way to go. Many provincial jurisdictions have robust prescribing opportunities for chronic conditions, and allow for pharmacist-driven lab requisitions. That future will arrive soon for everyone practicing in Canada.

It’ll be here, better than before.

Keep an open mind. Even systems and processes that seemingly work well today can be tweaked and enhanced when we get new information or new ideas to drive them.

Yesterday’s gone. Yesterday’s gone.

…but by no way forgotten. Disappointing patient interaction? It happened. We learn from those experiences and move to the next. It won’t be the last, and we haven’t found a cure for the human condition. Awesome interactions are also in the past, but the passion we carry from those experiences will touch tomorrow’s colleagues and patients and heighten their engagement.

I’m closing on 19 years in the industry. There have been plenty of stops and starts, and periods of stagnation, but we’ve always risen to the occasion for the needs of our patients, who over time become more like friends and family. Whether you’re a new graduate, or experienced clinician, a community or hospital pharmacist, together we are the profession. We guide it by refusing to stop, and constantly thinking about what we can do tomorrow.

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.

After returning from some time off, it never ceases to amaze me how easily we can shove our brains into overdrive and expect them to keep up for any period of time. Taking a step back, my idea of ‘relaxing’ is usually forcing myself to turn off my phone. Hopefully the angst of not knowing what’s happening in the world will subside in a few days and I can properly enjoy the remainder of the week before having to ramp up once again. I want to believe I’m getting better as I age, but sadly that is likely not the case.

The fact is we live in a fast-paced, information age. If we obsessively try to stay on top of all that’s happening in the universe, our attention span inevitably suffers from the sheer volume of information available. Conversely, if we make a point to avoid the network and are ill-informed, we’re living like dinosaurs.

I remember when our family’s first computer was a Vic20 by Commodore. I also remember upgrading to a Commodore 64 and splurging on a Datassette peripheral that ‘played’ data off of cassettes. Games had 8-bit graphics, simple animation, and cheesy synthesized music that we fell in love with during the 80’s. I remember stressing about completing projects in school; the library closing at 9pm and an absent-minded 10-year-old me leaving my notes in class. The feeling of jealousy crept over when I recall that a buddy’s parents just bought the latest edition of Encyclopedia Brittanica, at least 5 years newer than my set at home.

Nowadays, everything is seemingly instantaneous. From television to banking, from dating to stock trading, from music to DIY projects, we can repeatedly click the mouse with our brains on autopilot, and results will appear on screen quicker than you can blink. For example:

“When in Rome, do as the Romans do.”

We take this to mean whenever you’re unsure of your surroundings, observe and copy behaviours of others. Well I have some good news; now we can prepare. Thanks to Google (founded 1998), why don’t we actually do what the Romans are doing?

I guess they’re abstaining from consuming or imbibing around the water fountains for one.

“If I jumped off a bridge, I suppose you would do that too.”

…is another saying that speaks to common sense. Ill-advised decisions shouldn’t be duplicated. In other words, do as I say, not as I do. Prior to 2005, when YouTube came online, I don’t imagine the RCMP had to issue statements warning folks to refrain from doing just that after a video went viral.

As healthcare providers, we are keenly aware of all of the knowledge available on the web. Unfortunately, much of it may be distorted by media reporting, bias, and even interpretation from family and friends. Disease states are emotional triggers for those receiving a difficult diagnosis. No sooner does the word diabetes leave a physician’s lips, then out comes a smartphone to research tests, diets, treatments, and outcomes.

This can be so overwhelming. As I see it, part of my role is to help sort out the vital information and deliver it in a way that puts someone at ease, and feeling more in control of how to use that information. Instead of overloading, we often need to have multiple conversations to reinforce and build on understanding. A clear mind with a clear path has a much better chance to succeed.

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.

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.

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.

Image courtesy of the Computer Whisperer: http://www.thecomputerwhisperer.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.

Over the past four years or so, I’ve attempted to make physical fitness more of a priority in my life. What began as training for an upcoming Multiple Sclerosis (MS) Bike Tour has perpetuated to present day. This is something about which I am a bit proud. I’ve also come to embrace the infernal elliptical machine as a necessary evil. A muse most cruel in punishing your body so that you may feel ‘good’. The  elliptical burns energy but as the body recharges, it gives you more than it uses, allowing you to push through the pain it causes the next day.

On one particular day, I found myself watching Joel Osteen on stage in Texas. Mr. Osteen is an evangelical preacher known for extremely large congregations, writing inspirational self-help books, and constantly needing lots of money. In case you’re curious, watching this wasn’t really my choice; my Sunday morning cardio just happened to coincide with a program lineup of fishing shows and infomercials peddling foot-massagers. Pickings were rather slim.

Stripping out the religious portions of this particular sermon, one message that struck me as stunningly obvious (though often forgotten in daily life), was that of positive thinking. You really need to believe that something will be successful before it has the possibility of being realized. Consequently, proving that something can not be done doesn’t take much effort or forethought. Be it a project, or personal goal, how many people do you know who predict colossal failure but accidentally succeed? Unless you’re describing my attempts to bowl or play pool, I would say the answer is very few people.

We’re all a bit apprehensive about trying something new. The pharmacy world has experienced plenty of new in the past half-dozen years. I, for one, have been guilty of wanting to feel ‘safe’. Let someone else take the lead on minor ailments for example; whatever mistakes they make, or third party audit claw-backs they receive, staying on the sidelines until the bugs get worked out is certainly easier. The level of negative energy has been on the rise because the industry has taken a series of hits without enough visible wins. There has been progress, and we do try to highlight the works of specific pharmacists or sites in hopes they inspire others to follow their lead.

The phrase ‘keep your eye on the ball’ isn’t just meant to be a sports reference. A firm endpoint or goal is extremely important, for motivation and for measurement. If the endpoint is carefully developed and visualized ahead of time, the unforeseen challenges that could potentially create hurdles won’t slow you down. Not all negative energy is bad; it may uncover those hurdles earlier and allow for better planning, but just like a battery needs two terminals to create fuel, there has to be a balance.

So, I’m thinking we need to lean on each other to create a positive charge to bring that balance back. Our thoughts need to stay positive during these precarious times. We need to act,  and to charge toward those goals. Collaborative practices may be better developed in other provinces, but are beginning to take root in Atlantic Canada. With that comes a wealth of possibilities for prescribing, monitoring plans, authorizing lab tests, and outcome research.

Direct the current. Stay grounded. Feel the electricity.

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.