Category Archives: Practice

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Time is Relative

After vacation, you could say we encountered some rather bad luck. I say we, but the sympathy should be reserved for my wife, who after two days back at work, suffered a nasty fall and shattered her olecranon. My diagnostic skills are weak in this area, but my hack medical description of this injury would place it as a Type IIIB, replete with instability of the forearm and multiple fragments. Lest we say that it wasn’t funny at all (cue collective groan).

Having never had a catastrophic injury before, when I received her phone call that something was wrong, her voice was a bit higher-pitched, but the timbre and inflection didn’t suggest anything worthy of alarm. In fact, she seemed more concerned about a set of keys that dropped through a sewer grate during the tumble. Assuming shock was playing a part, we arrived at the emergency with the arm immobilized, and she proceeded to sit and read her book for 4 hours in the waiting room. She felt some discomfort when she tried to move, but no agonizing pain. We were both aghast when the doctor returned with the x-ray results; her ‘bad sprain’ would require immediate surgery. In hindsight, the fact she could no longer locate the knob of her elbow probably should’ve been a giveaway.

So the ER doc forwarded paperwork to the main hospital, but it was one in the morning and the services were closed. So he applied a cast, asked she refrain from eating or drinking, and head to the hospital at 9 in the morning (basically cast, fast, and last). The morning comes, they take x-rays, perform a work-up triage, and….send her home…on a Friday. The new instructions were to start fasting at midnight, and wait by the phone for a possible call in the morning. Saturday morning rolls in and no call. Now I might add, she is not taking anything for pain, just frequent icing and sleeping uncomfortably in a chair with a cushion supporting her thankfully non-dominant arm. By 3pm, I’m calling the hospital myself as she now hasn’t eaten in over 15 hours. Lo and behold, the nurse had thought someone already called. No surgery today due a multiple trauma situation. Repeat the midnight fast. Two MORE days go by until she gets in on the Monday morning. With a little hardware insertion, she is now partially bionic and taking on any arm-wrestling challengers (kidding).

Through the ordeal, we realized that as pharmacists entrenched in the healthcare system, we are providing care to patients, and don’t often ponder the role of the consumer. To find ourselves on the flip side dealing with the uncertainly of a foreign process, we honestly had a frustrating few days. Healthcare is often measured in units of length, not quality. How long will it take to fill my prescription? How long is the wait in the emergency room? How long is the wait list for my carpal-tunnel surgery?

As a provider, we understand all the moving parts and systems that help us deliver quality healthcare. The time we take to ensure we’re being prudent, thorough and safe can not be understated. To us, 30 minutes for a prescription may be completely realistic so that everyone in line for a medication service will receive the same experience, regardless of whether it’s an injection, a medication review and/or a simple refill. In order to maintain consistency and sustainability, that block of time is necessary for very good reasons.

As a consumer on the other hand, we lacked the understanding, and every missed phone call, or being ‘bumped’ was hard to comprehend. My wife is unable to function for 3 1/2 days; no real sleep, fasting cycles, trouble performing any regular tasks we may take for granted (laundry, cooking, dressing, showering, etc). We’ve since determined that an ‘eternity’ is now defined as 3 1/2 days. Just at the point of feeling helpless and distraught, it dawns on us that we need to trust the professionals to provide us with the best care under the system that binds them. How can we, as pharmacists, expect patients to trust us when we say that their prescription will take the time we quote them, when we’re not willing to give that same latitude to those trying to help us?

So I propose we attempt to measure the time in a different way. Specifically, let’s look at duration of relationships. How long have you had the same family doctor? Did he/she treat your parents or kids? How long has your pharmacist been following up on that pesky diabetes? How long is the history you’ve had with a dental clinic? Usually, the strong bonds you form in primary care are a testament to the quality you receive, and yes, most people will feel it’s worth the wait.

Time is relative. A service may seem to take too long, but merely a speck in what could become a rewarding long-term relationship.

 

 

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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First Aid

It was time for my renewal for standard first aid (SFA) and Cardiopulmonary Resuscitation (CPR) so I registered for the 2-day course and completed my certification last week. This is a requirement to perform injections, but also an expectation as a health professional in the field. Every workplace location should have a trained individual on site at all times.

Is it just me, or does the training seem to change every year?

My first foray into first aid was to earn a badge as a cub scout. One of our group leaders was a trainer with St. John Ambulance and I recall it took place at someone’s house. There were about a dozen of us around the age of 8-10. I only retained a few items from that session: the constant warning of the graphic videos they could have shown us, how to tie a tourniquet, and just how scared to death I was to be confronted with a true first aid situation.

There was so much to remember. During the demonstrations where someone would have to take charge, we all looked at each other with eyes as wide as dinner plates. Almost everyone forgot at least one aspect of the primary survey (introducing yourself as a first-aider, determining multiple casualties, removing hazards, etc.). When manipulating limbs for splints and bandaging, the wrong hand placement led to drops or contortions that would probably do more harm than good. For the CPR component, we would disagree on timing of breaths or whether to do chest compressions first. This was well before the Good Samaritan Act so there was hesitation for fear of doing the wrong thing in the wrong order.

Since then, the training seems to have evolved to be more of a ‘stay calm and collected, assert control, and remember that you’re trying to help the person’. It’s a welcome switch, but watching the scenarios played in the videos are thorough to the point of no longer feeling like an emergency situation. For example, a young girl cuts her hand lengthwise in the kitchen and calls for help. Presumably the father comes in assesses the scene by asking her if anyone else was hurt and check her breathing. He then gloves up and proceeds to check the shoulder all the way down to the arm. The girl does not appear alarmed. By all accounts, this is of course the proper way to perform first aid, but if I was the casualty, I’d wonder why we were spending time doing a head-to-toe assessment. I imagine some folks would be a bit scared and hysterical as well.

CPR is much more simplified. For all cases, a 30:2 compression-to-breath ratio is easy to remember. For choking, the Heimlich Maneouvre (or abdominal thrusts) seemed to have fallen out of favour due to lack of evidence of effectiveness, but is being taught again in combination with back blows. Nose bleeds used to be pinching the nostrils with the head tilted back, but is now angled forward. Shock wasn’t discussed at length like before; if you treat the injury/injuries, then that’s the best way to minimize the effects of shock. Pen devices that administer epinephrine and AEDs are much more direct and straightforward when taught. My biggest disappointment is that tourniquets are no longer in the curriculum; I thought those were pretty cool. Ring pads are out of favour too, as they tend to be unstable on a wound. Pre-fabricated ring pads used to be part of a first aider’s kit. Who knew?

So I should be in good shape for another few years with a re-certification in between. Here’s hoping it’s a set of skills that will be needed infrequently. Should I find myself in a crisis situation, this training may make the difference between a favorable and a catastrophic outcome.

 

 

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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Inter-Professional Appreciation Day

So the votes are in, and with a track record of 39% accuracy, last week the groundhog predicted an early spring. I’m not sure how I feel about that, but the sky looked pretty cloudless here so those of us slogging through a winter funk have reason to be hopeful.

Since it is an unofficial, cute, holiday, I figured it was worth proposing my own. As I attempt to defy convention once again, consider the following question:

Ever give someone a sponge bath?

In my (ahem) younger days, the idea of a sponge bath was how I needled a close friend who was working towards her nursing degree. Naturally it’s completely ignorant and ridiculous to think that nursing, or any direct patient care could be reduced to one task. In fact, what may seem rather menial in nature and by no means glamorous, is of utmost importance for those that can not bathe themselves. I know how much I appreciate feeling clean, so I can only imagine how helpless it must feel to understand the benefits of good hygiene, but be unable to carry through the behaviours on your own.

Although I didn’t become a pharmacist to avoid sponge baths, it certainly didn’t rank on the list of responsibilities I envisioned for a career. Now that I’m well into my chosen occupation, it seems that my view of other health professions has always been colored by their impact on my own. This inherent bias has really prevented me from appreciating the multitude of care considerations outside of medication management.

Physicians and nurses have been so complementary all these years so it’s fair to start with them. From a medication standpoint, it shouldn’t be a surprise that those prescribing and administering don’t always know the chemical names of generic brands, dosage forms strengths or interactions. Even after taking a four-year degree concentrating solely on them, there are so many drug options in the CPS, it’s surprising I remember a small fraction without needing to research. Physicians are the leaders in primary care. They diagnose every ailment through any available means: inspection, manipulation, blood tests combined with subjective and objective measurements. It must be a huge weight to provide answers to those feeling their worst on any given day. Being the one to inform a family that a spot on a lung is terminal cancer, or confirming that protracted mobility issues are due to ALS, would be heartbreaking. Not to mention the hospital visits, the special authorizations, the referral letters all while trying to keep abreast of the newest science in the field. It’s amazing and since it has become an expectation, often underappreciated.

Shifting gears, have you ever seen a relaxed nurse on the job? Most of whom I’ve met have so many balls in the air they could put buskers to shame. Being responsible for the quotidian care of many individuals is not an easy undertaking. Things we take for granted: getting dressed in the morning, toileting, having the dexterity to handle a spoon are significant challenges for folks of all ages whether in an institutional setting or transitional care. It takes compassion to help change hearing aid batteries, or massage a sore shoulder. It takes fortitude to debride open wounds or clean up accidents related to continence.

Other health professions contribute to well-being and are responsible for bettering quality of life. Dietitians instill healthy mealtime discipline but allow for that diabetic to enjoy his/her favorite treat now and then. Occupational therapists adapt environments and modify tasks to help regain or maintain daily productivity. Physiotherapy will intervene after a hip fracture to increase mobility and function.

We all have a part to play, and every professional requires practice and support from the other fields. A truly holistic approach to patient care demands it.

This pharmacist would like to send along a hearty ‘thank-you’ to all of my healthcare allies in whatever capacity you may touch the life of our mutual patient. We all share a passion for the same thing: to help others feel the best they possibly can for as long as they possibly can. Your contribution matters. We promise to work at our craft to ensure that we hold up our end of the bargain.

 

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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Team Dynamics – Greater Than The Sum of its Parts

It’s no great secret that if given the option, individuals would prefer to be in control of their current situation, their short-term goals and long-term dreams. You’ve no doubt heard that sitting and waiting for opportunity to come along doesn’t usually end up as expected. It may knock once and awhile, and being prepared to answer that door takes commitment and a tenacious attitude. So what if the opportunity presented means being an integral part of a strong team?

A very close friend of mine has been in various leadership roles for well over a decade. He recently sent a message to his teams opining that some of his strongest teams did not always comprise of his strongest individual performers. I hesitate to use the word chemistry due to buzzword cliches, but we’re in the world of pharmacy so the subject shouldn’t be completely foreign. A mixture of complementing skills are necessary. Some people are excellent at rote tasks; they are consistent with details and process. Others have excellent customer-service skills and some may be solid project managers. If someone was behind on the prescription assembly counter due to an extended customer interaction, then another would recognize and backfill to prevent a bottleneck (and therefore a future, more negative customer interaction). A pharmacist manager working on staff reviews jumps out of the office to perform a flu shot because her staff is out of the dispensary for an OTC counsel. It takes a certain level of awareness and good chemistry to adapt depending on the circumstances.

The strongest teams seem to grow into that adaptive mentality and it never happens overnight. Routines are developed (e.g. mixing methadone batches on Wednesday afternoons), and trends are identified (e.g. many people pick up prescription orders on Thursdays over the supper hour). Folks begin to understand non-verbal cues or body language from their colleagues that betray a rising sense of anxiety, such as a deep-breath after a series of interruptions, or a rash of careless mistakes to suggest rushing.

I should point out that complementing skills doesn’t just mean balancing relative weaknesses, it’s also about enhancing inherent strengths within the team. That’s why the saying goes, “the result is greater than the sum of its parts.” So why does a team of strong performers not always share a strong level of success? This phenomenon happens in sports all the time; a dream team is bought or drafted and grossly underwhelms, looking disconnected and listless in the process.

There are a few different theories as to why this occurs. One is a measure of ego; a strong performer is used to having a degree of autonomy in their job, and has a specific way to complete tasks. The trust that another may be able to meet the same standard can take time to develop. In a competitive environment, the strong performer has an incentive to use these tasks to display their own skills and may feel a threat to their autonomy if another meets or exceeds the same standards.

In a similar vein, strong performers often have take charge attitudes. For team production, some of those folks need to be comfortable supervising, and others will need to follow. If there is no deference from anyone, it begins to feel like ‘too many cooks in the kitchen’. Everyone has their own plan but it may conflict with another. The whole point of being proactive is to plan ahead and avoid potential conflict, that’s why big-picture thinking is so important at the outset of any project.

As a manager myself, I certainly derive my work satisfaction from watching others being proactive and working together. They identify problems before they present, and take steps to always be ahead of any change on the wind. Those qualities can serve as fuel because there always has to be a new challenge, or a variety of tasks to master. I need to stay proactive to keep the team growing and motivated. The leaders I respect and look to for guidance all seem to do the same. We make each other better, and we find ways to reach heights we could never have imagined on our own.

Is your team ready to answer the door?

 

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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Giving Your 97%

What do leaders typically ask for? What do you often ask of yourself, no matter what you’re doing? In sports, the adage is giving 110%, to give more than you ever have, and push harder than you imagine you can. While in short spurts, this sounds good in theory, nobody can expect to operate at capacity all of the time.

I can tell from my flight of ideas that this can devolve into a rambling stream of consciousness. I’ll be breaking things up a bit to keep myself on track.

This concept grew out of something quite benign; I have inventory coming up at my pharmacy in the next six weeks or so (cue the collective eye-roll). No really! As a manager for a dozen years or so, I’ve always placed an importance on fiscal responsibility but also service. Running a pharmacy, up until about 4-5 years ago when expanded scope was introduced, usually meant that folks needed medications, and that we filled them as ordered. If we didn’t have the product, we could lose a customer, or if we didn’t have enough of one, it was an inconvenience especially if it happened repeatedly. We also knew that achieving 100% service level (having all products all the time) was impossible as well. There were strategies to combat this, but it really came down to this: the closer you got to 100%, the resources you needed kept on going up exponentially. Put another way, if having an inventory of $200K allowed you to fill 90% of orders, then it may take another $30K to get to 95, and another 30K to get to 97, then another 30K for 98, etc. There has to be a balance.

We used 97% as our benchmark. This meant that we aimed to fill orders for 97 out of every 100 requests, and accepted that 3 out of 100 may be disappointed in some way but of course, we took steps to mitigate these in some way, either by calling them ahead of time, or trying to obtain the product from another source.

So I began thinking about capacity in the workplace and decided that I should apply those same lessons to help myself and others. The ideal would be for an operation to run at 100%, but that leaves little wiggle room to grow. We should try to average out to be 97% to give that same balance between looking after our duties in the near and long term, but allow for training, transition, or having the ability to jump on new opportunities to increase volume or promotion without feeling helplessness and anxiety.

How about personal, mental, emotional, or professional capacity? Nobody can operate at their best all of the time. Life is rife with illness, distractions, drama, change, tragedy, you name it. To expect we can stay consistent, let alone at our maximum capacity through those highs and lows is pretty overwhelming. As professionals, we take pride in working through illness, and shutting out distractions because our patients need us to be there for them but sadly we are not immune. Some days, 80% may be all we have to give. We may need to take an extra few minutes for lunch, or feel we need to check an interaction a few more times because it doesn’t seem to be processing as usual. If we aim for that same 97%, we leave ourselves some leeway to learn, stay in control, and execute. It also allows us to have a bit extra to give when we need it. A couple things for clarification:

  1. One thing of which you can give 110% is your time but…You can absolutely work 44 hours in a week when the expectation is 40, but it can’t be equated to capacity or production. Fatigue is a big part of it, so those last 4 hours after a long week might be subpar to your standards and start to drag the average down from your personal 97. Get to know your skill-set and limits; they may project to a shorter, more intense week, or a longer, more relaxed week.
  2. My 97 may not be the same as your 97. Surprise! Everyone is different. The best performance from an inexperienced graduate may not offer the same production as a middling performance from a 20-year veteran in the field. Allowing that 3% space for personal growth and opportunity will continue to make the other 97 that much more dynamic.
  3. 97% does not apply equally to specific duties. By this I mean if pharmacists or technicians routinely made 3 mistakes out of 100, we wouldn’t be very effective and ridiculously unsafe. Instead it refers to our focus and energy to do the job properly as individuals and as teams.

For my New Year’s resolution, my personal goal is to trust my abilities and that the members of my team will step up when I need them. We will create the capacity we need to keep moving forward and continue to grow within those capabilities.

I don’t think it’s being unreasonable. I’m not asking for 110%…I’ll settle for a solid 97 🙂

 

 

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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Long Hours (The days just ‘Flu’ by…)

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.

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Drifting on an Ocean of Change

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:

Buoy - PA

*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.

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Pharmacy Awesomeness

Healthcare is a large community with many moving parts and overlapping worlds. The words ‘community’ and ‘pharmacy’ can be put together to mean either the setting where pharmacy activities take place (community pharmacy) or in reference to the larger pharmacy group (pharmacy community). All pharmacists in all settings are connected by our shared scope of practice, although our day-to-day tasks may differ.

A colleague of mine, Dylana Arsenault, is a hospital pharmacist and director. As a life-long learner, she has always been fascinated with the latest clinical evidence and pharmacy trends in social media. She has been asked many a question from peers as well as other healthcare practitioners on a variety of subjects. Once she stumbles across a great article or reference, there is always some excitement that goes along. A little while back, she sought a way to share that information with others that may be interested. Enter Pharmacy Awesomeness.

This facebook page began as a fun project to post links, articles, news items to friends and friends of friends, but it’s quickly expanded to include professors, entrepreneurs, retail, hospital, industry pharmacists from many locales. Due to facebook privacy policies, it remains a closed group but those that ask to join will be treated to an amalgam of fun and education from a very diverse group of contributors.

Currently, there are internet memes interspersed with links promoting apps that help switch antidepressants and university academic detailing resources for oral contraceptives. A little scrolling will bring you to guidelines on prescribing hydrocortisone and a skin cancer self-exam book-ending a funny image featuring Star Trek’s Captain Picard. Everyone likes a little levity now and again, and this format really lets you browse through and trip on amusing items and many topics that may not be on the forefront of your practice, but feature pearls that you can use today. I also find that my academic curiosity is stoked to research and rediscover subjects that have been gathering dust in the dark recesses of a mind that graduated 14+ years ago.

So to all members of this great pharmacy community: stay curious, and stay connected. Take an extra minute to check a news feed, or scroll a Twitter trend that resonates with you. Most importantly, if it’s helpful or fascinating for you, chances are there are many others who would feel the same, so find a way to share it. I have a quick suggestion. Perhaps send Dylana a note asking to post your article/link/amusing pic/resource and become one of the three-hundred plus who receive instant notifications.

Whenever the passion for the profession seems to wane, it’s refreshing to feed off of the excitement of others and rekindle that fire. Pharmacy is awesome. A reminder now and then certainly doesn’t hurt.

 

 

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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Lists

Whenever an overwhelming sensation appears at the back door like an unwelcome family of raccoons clawing through the garbage, I feel the need to decompress. Part of the ‘stepping back’ process is trying to figure out exactly from where the worry stems.

Enter = lists

Sure, lists are archaic. It’s a call back to simpler times before your phone tracked your shopping habits and email inboxes spewed endless reminders about what to do when. Everybody has their own twist to organization, and I thought of myself as the last person who would buy a Dayminder to keep track of things, but it really came down to two simple but related items:

  1. The more things I had to remember, the higher the anxiety and stress.
  2. The energy expended to mentally keep track of everything took away from the energy needed to actually perform the tasks. Procrastination created a vicious cycle of more items leading to less production, leading to more items.

I like to think my memory is half-decent. I can be extremely rough on myself if refill requests are missed, phone calls aren’t returned on time, or communication isn’t clear and the team repeats mistakes as a result. When I managed smaller operations, there seemed to be time to address most tasks immediately. Any backlog items stood out and screamed to be completed. As I worked my way up to larger and more complex operations, those backlogs became a black cloud that hung around. The day-to-day quick hits were manageable but every new info request or investigation pushed the big picture/long-term growth items further down the list. I was reacting to everything, a trap in which we often find ourselves. I also find that the longer you’re in a role, your value to others increases because you have more ready answers than before. If I didn’t have a strategy to cope with the distractions and increased workload, before long I would be riding the hamster wheel to Burnout City.

My response was to purchase an agenda book, arranged by tabbed months and two calendar days on each page. The first step was to unload my mind by writing down every item, be it emails to be sent, phone calls to be made, references to check, or just thoughts about things I didn’t quite understand. Once it was on the page, I no longer had to remember it. Even though my first list was lengthy, I could look at it differently; instead of bouncing from one thing to another as it popped into my head (worried that I’d forget again) and juggling multiple half-completed tasks, I could now pick a few things that fit in to the time available that morning and afternoon. Might I add that physically crossing something off is much more satisfying than dismissing an alert or closing a window.

So at the beginning of every shift, I take two minutes and carry forward any items from the previous day and re-write them in priority groups. Throughout the day, if something comes up that isn’t immediately manageable, or if I get another brainwave for a project or opportunity, it’s pen to paper right away to be prioritized the following day. It sure saves on post-it notes scattered around the computer monitor. Over time, I can balance the quick and dirty jobs with one or two of the long-range projects so there’s always a feel of progression. Currently my list is somewhat smaller than when I started, but it still fills half a page. There are some payroll submissions to follow-up, narcotic reconciliation for the month, and narcotic destruction to complete. I have some incidents to report, policy and procedures to review, and obtain a status report on some store renovations. There are tasks to delegate to others, like hiring and onboarding practices, which require time for training. Finally, there are the bigger projects: analysis and revamping of our drug and wound care inventory, engagement initiatives for the staff, and clinical intervention activities for our consultant pharmacists including flu clinics and prescribing within our expanded scope.

If there are visitors scheduled in the upcoming weeks, it’s in the book. Any meetings or conference call commitments are in the book. The key really is that I keep it close by and refer to it often, as you never can tell when a distraction will come along (like a surprise College audit last week) and throw a wrench in your plans.

So whether your list is of the work or home variety, I suggest a purging of the mind, be it on paper or on a fancy tablet/phone/dictation machine. It helps me focus on things that are important to me now and later and keeps the stress level somewhat in check. As opposed to drowning in work, clear the mind and start swimming for the shore.

There. Completed the article. Time to cross it off my list 😉

 

 

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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#Neverfail

I was thinking recently about what it meant to people to discuss failure. Wikipedia provides the standard definition:  “Failure is the state or condition of not meeting a desirable or intended objective, and may be viewed as the opposite of success.” Further in the article, it touches on failure as being a matter of perspective or following an individual’s belief system, so I’d like to pick up that baton and run with it for a bit.

In order to fail, one requires a defined expectation or a set of expectations. These may be personal goals (working out three times a week, learning a new language) or work-related (reducing incident rates, increasing inventory turnover), but from the get-go there are usually criteria for success and deadlines to be met. If those conditions are not met, then we would deem it a failure. It feels so final, and somewhat dejecting.

So what if we took control over those conditions?

Think of a complex project. Perhaps there are ten things to accomplish to complete the project, and when the deadline approaches, only eight are met. Would that be a failure? Worst-case scenario, even if the project hinged on all ten being completed, and therefore the eight completed steps were rendered meaningless, there would be positives. The experience gained by pushing through the completed portions would give a sense of confidence and allow for more efficient action the next time. On the other hand, those remaining pieces were either too challenging with the timelines given, or required resources or training that weren’t available. So, on reflection, we are set up to have a greater chance of success for the next project.

Instead of ‘failing’, it’s more like we’re ‘on the path to success’. Let’s look at prescribing services. It’s been a few years since legislation was passed in Nova Scotia to allow pharmacist prescribing. Other provinces have taken up the mantle and are promoting to the public in varying ways. Our version features limited funding for government drug plan beneficiaries for select minor ailments. This is a positive step and the measurement of success is outcome-based; will the service be in-demand, will it save clinic or emergency room visits? Most importantly, will the pharmacist gain the trust of the public to carry out the services start to finish independent of a primary care physician? To place the yardstick to measure service value, we need repetition and a significant volume of interactions. So if we don’t reach a specified number, does that make the project a failure?

I prefer to think of it in terms of positives. What this opportunity has created is a forum for pharmacists to work towards a common goal and discuss what has worked and what hasn’t. Each new patient discussion extends the awareness to another family or community group, each physician notification provides education as to what we are able to remove from a hectic clinic workload. As pharmacists receive support to change their practice styles, this will allow for successful prescribing activities, and every dipping of the toe into the new waters is an encouraging one.

Really, the only failure in any of this is a failure to try something new. It’s like disliking a food you’ve never tried (which I’m sure we’ve all done at some point); you will never know if you’re missing out. So be bold – if you’re willing to learn from mistakes, and aren’t afraid to find success, then you can #Neverfail.

 

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.