A chill is once again in the air. Oak leaves are covering my yard and the daylight savings time in this part of the world has wreaked havoc on our daily routines. Morning feels closer to normal, but suppertime feels like bedtime. I’m getting ready for an off-site flu clinic this afternoon that was requested by a nursing home facility for their staff and their residents’ families. After our last appointment, we get to spend an hour driving in the dark all the way home.

Remember back to the first flu season that pharmacists were trained to vaccinate? We really didn’t know what to expect in terms of public acceptance or overlap with services provided by other health providers. I wrote about it back in 2013 and the temperature at that time was rather lukewarm. Pharmacists were tentative, cautious and, in many cases, reluctant to jump in.

Oh how times have changed.

Each successive year has pushed the practice to new heights. Year 2, the public health office had a better idea of distribution and vaccine supply was more accessible. In the first year, a number of pharmacists hadn’t yet obtained their injection permits. That limitation was abated in year two and pharmacy capacity for accommodating walk-in appointments skyrocketed.

Year 3, all staff were ready from the October announcement. Not only had workflow been adapted to accept appointments and walk-in requests, pharmacists were now out in their communities making it all the more convenient for employers and community groups alike to receive flu shots. Some were in community rooms and schools, meeting rooms and church halls. Loved ones visiting a parent at a nursing home may have been greeted by a pharmacist from a local dispensary.

This year, flu shots seem like they’ve always been part of pharmacy services. Not only are all of the experiences in previous years being repeated, but now the pharmacists are being sought out to provide these clinics. Word of mouth has led to invitations from previously unknown locations. Employer groups have started to recognize the cost-savings gained by having their staff vaccinated at work to minimize illness. Many of them had never received a shot and would not have made a special trip to the physician’s office. Rural communities with minimal medical services have enjoyed improved vaccination rates due to pharmacist injections. Entire families are coming back to see the same clinician, and are able to shop and run other errands at the same time. ‘Done for another year’ is a common quote as another satisfied customer pulls on their jacket sleeve.

The best part is the team pride. Pharmacists impress themselves with the number of shots they can comfortably do by themselves…on a Monday night…on seniors’ day…with an extra doctor in the after-hours clinic. Managers wait to see the latest aggregate counts year-to-date to see how they stack up to previous years. They speak wistfully about the reluctant child that left with a smile, or the administrator that sends chocolates as a thank you for such a smooth workplace clinic. Awareness is at a high, with more people getting their shots earlier in the season, with minimal disruption to their lives.

It hasn’t been a fluke, but rather a testament to our profession’s resilience; we have risen to meet a new challenge, and after 3+ years, the results are nothing short of impressive.

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.

June 17/16 was a historic day in Canada. It was the day that bill C-14, legislation on medical assistance in dying (MAiD) received royal assent.

Picking the title for this post was tough. The pun idea was what initiated the post in the first place, but reading it may imply a lack of respect which is unintentional. My feeling is that Canada took the bold step to acknowledge that dying with dignity belongs in our consciousness and in how we care for those suffering the unimaginable. Now that this step was taken, and the discussions have occurred, there is no putting the toothpaste back in the tube. Providing patient care in this setting is a marked departure from anything most of us have been involved with in our careers. We are trained to be exacting in our standards and level of detail to prevent patient harm from dosing errors or drug interactions. Recognizing what was always viewed as the most extreme degree of harm as holistic patient care is not an easy feat.

It’s no surprise the debate was prolonged. The subject of death in any form is an extremely sensitive topic. It’s never supposed to be a planned event, and when it is, it’s associated with tragedy and unanswered questions. There is now a provision in the criminal code for an individual to seek assistance in ending their personal suffering on their terms without penalty to themselves or the healthcare providers involved in carrying out those final wishes.

In Nova Scotia, the regulations make clear the pharmacist’s involvement. In my opinion, the document is transparent, and is well-written. Should our team be approached with a request, we’ve discussed our comfort with the sourcing and dispensing of the medications (some of which we’ve never actually dispensed in retail). We understand our role in the process, and those of the physicians and the nursing staff. Still, when the request is actually made, it’s difficult to predict the emotions we will feel…and that’s perfectly okay. I’ve spoken with colleagues that have been approached and they describe the process as extremely collaborative and supportive. In the lead-up, it’s all about following the protocol: receiving the orders, collecting the medications and associated supplies, labeling the kits, and arranging dispensing to the responsible physician. It’s usually only after the required notification is received that the gravity tugs a little stronger.

The CBC published an article in May of this year with a province by province snapshot of the developing guidelines based heavily on the Supreme Court ruling in the case of Carter v. Canada in Feb 2015. All had defined criteria for eligible candidates, and all outline ‘effective referral’, a clause requiring any health professional unable to provide service themselves to ensure that it is received. Not everyone will be comfortable with medically-assisted dying and we respect those who decide not to participate. Since that point, there have been additional provisions and court challenges that deem the laws too restrictive, so the conversation is far from settled.

In closing, I don’t usually like to provide opinions on controversial topics. We are a community of mostly pharmacists and complementary health care providers, meaning one opinion is one voice, and no more or less important than that of a fellow pharmacist, nurse, or physician. I have been asked, and to me it really comes down to the individual making the request. If they were my loved one; a spouse, a sibling, a parent and they were suffering helplessly, would I wish for them to have that choice? Would I wish to have that choice should my health decline to the point where comfort measures are the only form of therapy available? As many times I’ve replayed the arguments, I seem to always settle on ‘Yes’.

If you have not already done so, please read the decision and the MAiD materials before you are called on to respond. Whether you participate is a deeply personal decision that can not be made lightly. History will never be undone, so we all need to be at peace with how we move forward and evolve with this change.

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.

I’m sitting here on a Saturday morning watching my girls make rainbows out of clay while Minecraft videos are playing on the laptop. Outside the window, the browning oak leaves are fluttering in a way that dares me to attempt some raking before they fall and completely cover the yard again. It’s shaping up to be a beautiful, quiet day. I realize they haven’t been very plentiful as of late; it’s year three of the pharmacist flu-shot blitz so like many of my colleagues, we are doing our best to accommodate the current demand for our services.

In Nova Scotia, now that we find ourselves riding in our third flu-shot rodeo (wait for public health to say, ‘go’, and hang on for as long as outbreaks are a possibility), the mood has definitely shifted.

In year one (fall 2013), pharmacy teams were unsure of public acceptance of this new skill. The regional deployment of vaccine to different providers created some confusion and shortages. There was also a scary incident out west where 5 flu-related deaths after the New Year  prompted a second surge of vaccination demand.

For last flu season, we were much better prepared. The method of vaccine distribution was more straightforward, and contacts made from the previous year made planning off-site clinics seamless. The impact on workflow was known, so pharmacists were able to factor in the additional time between prescriptions, or have additional staff members available for clinics. Staying ahead of the documentation paperwork was, and still is difficult, but the forms are familiar.

This year feels like we have been emboldened in a whole new way. Pharmacists are being sought out like never before to hold clinics, to attend workplace events, and educate community groups on the benefits of the vaccination. Many sites have set goals for themselves and are excited about their increased capacity. Increasingly, family physicians recognize that we are complementing their services by creating awareness and reaching more patients than ever before.

In my site, we offer vaccination services to our long-term care facilities. We cater to facility staff, residents and their families. The coordination has been fantastic, but allowing a pharmacist to be off-site three afternoons a week means that long-hours are required to run the dispensary. Even with the planning, regular tasks fall behind. My to-do list grows longer by the day, but it’s a good investment of my time to keep my team engaged and really challenge some folks to step up when we’re a bit tight on staff.

The time of year is significant as well. Vaccines were released on Oct 5th, giving us less than 12 weeks before the holiday season. Finding slots for shopping, putting winter tires on the car, servicing the snowblower, coordinating Christmas parties, etc. add weight to an already heavy load. In recent years, I’ve had to resort to taking vacation time in order to line up the tasks above for efficient completion. Not that I’m saying that taking a holiday is necessary, but it’s my strategy to manage the busyness and chaos.

It’s the nature of the beast, this profession; we’re in it for the patients and their needs. We work long hours to get the job done and the weeks have a way of blending together. The public health need at the moment is providing access to the flu vaccine. Not all of us inject, but we can all educate as to the benefits and cover dispensing duties to allow appointments to be kept, and clinics to be run. The reward of gratitude can be seen immediately. The mother of three that all get their shots at the grocery store while they pick up a few last-minute items. The real-estate agent who pops in around supper hour between house showings. A young child realizes that the quick needle isn’t as traumatic as originally thought.

So roll up those lab-coat sleeves and get your hands dirty. On second thought, let’s review proper hand-washing technique instead…

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.

Change is fluid. Like the ocean tides, change can have a degree of predictability. Like the storm-driven swells, change can also randomly toss you about and threaten to pull you under the surface.

Change affects various groups of people differently, and balancing the dynamic between members of a team is essential to success. There are many well-worn concepts floating about but one of my favorites is the traffic-light model that designates an individual’s readiness for change. Red is not ready to consider change, yellow is cautiously optimistic of change, and green signifies already in the process of changing with no barriers. This may apply to any behavior, or environmental change, and readiness can vary depending on the topic. For a pharmacy example, you could be a green for administering vaccinations, a yellow for sharing duties with a regulated technician, and a red for minor-ailment prescribing.

Perhaps after a year or two of flu shots, you’ve got it figured out; it’s an enjoyable part of the job to educate folks on the value of vaccinations in general, and the staff keep the appointments on track. At the same time, this new profession has appeared on the horizon. Technician regulation has been in the works for some time, but now candidates are ready to take the reins. It sounds like they will help allow pharmacists to further immerse themselves into clinical duties, but many will hesitate not knowing if they will be ultimately liable for mistakes made by a technician. It will take time to get comfortable. Finally, meeting the demands of patients arriving at the pharmacy with rashes and cold sores is causing some angst; what will the family doctor think? Will I miss a red-flag? What if I make the problem worse? What references should I use?

It’s a good thing change is fluid, as the personal experiences come and others provide positive reinforcement, that red light may assume an orange hue on it’s way to yellow.

Within a team, everyone may be a different color. Anytime change is imminent, psychological reactance rears its head as members of the group digest how it will affect them. Like a newly-diagnosed diabetic told to avoid sugary foods will obsess about ice cream on the drive home, our first reaction is to resist change until we feel in control of it. We’re all different, so the timelines to readiness, and the conditions required to move towards green will vary. The thing is, that diversity is essential for effective group change. I’m sure some of you figure that the red lights are counter-productive. In fact, those in the room that come across as negative and always have reasons to maintain the status quo are just as important as the go-getters that see the limitless sky. The key is the right balance, as mentioned above.

Take a buoy floating on our change ocean:

*Image courtesy of http://www.trekearth.com/gallery/Europe/Malta/South/Malta/Valletta/photo1396766.htm

Let’s say the green, ready-to-inspire, ready-to-act group is the beacon on the top of the buoy. They are visible, shine the light, and can direct people away from the rocks or mark a position. The middle section above the water is heftier. They are the yellow group, watching with hopeful intent that the beacon will indeed take them where they want to go. The red group are the ballast, bobbing just below the surface, providing an anchor and stability to the structure. Their reasons for staying in the water could be entirely reasonable, and there may be barriers they are not yet ready to overcome. This perspective is healthy, and spurs debate. Perhaps those ready to go are overlooking a valid point that may undermine long-term success. In their eagerness, a plan is not well-defined or executed, so a pull from below is necessary to evaluate the next steps.

Too much green, and the structure is top-heavy: chances are good it will topple over and float wherever the ocean decides. Too much yellow, and the beacon will be dim by comparison; although the buoy is a functional structure, initiating change is less aggressive, and will take a lot longer. Too much red, and more of the structure sinks into the depths, rendering it ineffective.

As far as I’m concerned, if we want to reach the sky, let’s make sure we foster a balance that keeps our buoy pointed up straight and tall.

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.