Category Archives: Practice

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Resolution Follow-up

For the first time ever, I have accompanied my morning coffee with an ample bowl of Lucky Charms. Hey, when you’re on the go you need to eat some kind of breakfast in the morning. If you can’t get excited about sugary marshmallows with the consistency of dense styrofoam floating in your cereal, then I guess that makes you older than six. It just so happens to be the perfect combo of sugar and caffeine to get the writing juices flowing.

It’s a bit overdue, but with the new school year upon us it seems like a good time to revisit my New Years Resolution Post. Eight months is a good yardstick to see if I’m making progress, albeit a completely arbitrary mid-point.

So first off: gym. I’ve been steady at getting there twice a week between shift-work and evenings at home with the kids. Sometimes it’s not the most energetic session, but my cardio is decent and remains fairly stable.

#2) Guitar – Ah yes, my muse. ‘I know chords’ is a sure fire way to let people know you own a guitar and mess around with it on occasion. A small update on that front: since January, a few friends and I have started a garage cover band and I’ve discovered the bass. So to anyone who is interested in how that’s going, ‘I know chords’.

#3) Getting the house in order – There is always stuff to do around the house. By my standards, I’ve been rather slack. My father and I were successful at tearing down the rotten deck on the back of the house. Landscapers have since put in a french drain and flagstone patio. I’ll take that as a win.

Finally, the practice resolutions:

#4) Letting go – I couldn’t be more proud of how my team has developed over the past year, both in cohesiveness and as a visible presence in the grocery store where we work. I made a key hire in November 2013 for an assistant supervisor and even though I had high expectations, she is well on her way to exceeding most of them in less than a year. This has allowed me to delegate many of my dispensary manager duties. Functions including evaluating and hiring assistants, payroll, accounts receivable, team communication, scheduling, budget reviews, and department meetings are all shared between us. I’ve had more time to focus on promotion, special projects, succession planning, and most importantly spending the time I need with patients (occasionally I get an idea for writing as well). It has been a pleasure to watch her grow into the role and flourish.

5) Inviting a prolonged patient interaction – believe it or not, this is still not as instinctive as I once thought. We still have daily pressures that can make conditions for such an interaction difficult. That said, my relationship with many of our patients gets stronger every day. I enjoy seeing them visit and they will ask for me. I recently had an extremely positive interaction with a patient frustrated with his diabetes control. The doctor appreciated my recommendations and now we have a baseline from which to work. Another gentleman with chronic pain shook my hand the other day to thank me for ‘being good to (him)’. One more off the top of my head is a man who underwent surgery for cancer and is doing well. Through a miscommunication with his wife, they accidentally transferred out, then immediately transferred back and apologized profusely.

Overall, have I met my targets? Not all of them, but I’m not beating myself up over it. There are so many positives I can point to that make the exercise worthwhile. We’re positioned better than ever to provide injections through the flu season, we’re providing medication review services to a larger number of patients, and my team is still growing and improving. The biggest winner in all of this is me; they make me better, and I resolve to ride this wave as long as I can.

 

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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Thoughts on Technician Regulation

Guess what? There are some marked differences between hospital and community pharmacy.

As the blueprint for pharmacy practice transitions across the country, these two working environments really serve to highlight those differences, especially from a training and orientation standpoint. My personal experience in hospitals over the past decade is pretty much non-existent. I have be on some site visits, and have marveled at how the dispensaries were run. My curiosity led me to question how such large teams can become so consistent in their discipline to complete tasks. Like cogs in an assembly line, if one piece gets shifted or removed, another is prepared to repair or replace without missing a beat. Through my observations and discussions, it has got me thinking: in many ways, hospitals are holding back technician regulation because they’ve been too effective in their integration of current assistants to roles requiring more training and responsibility.

Let’s back up a bit…

Here in Nova Scotia, hospitals operate under different regulations than community-based practice. I’m sure this is true in many jurisdictions. Health professions can collaborate freely within the confines of the hospital and have some flexibility to re-define roles in response to new service demands. Tech-check-tech processes were introduced in the hospital long before it was being used in long-term care or community settings. Specialized technical roles had non-pharmacists in charge of sterile preparations, stat-box management and unit-dose dispensing. Dispensary managers are often former technicians that are now administrators, developing and enforcing policy and procedure, while overseeing site-specific training modules that may require upwards of 6 months to complete.

This has allowed pharmacists to spend more and more time in clinical, collaborative practice and minimal time in the actual dispensary. Many full-time positions are entirely clinical in nature, opening the door to take full advantage of approved expanded scope services (i.e. – lab test requisition).

Therein lies the rub: technician roles have been leveraged so well that regulation doesn’t appear to have the same dramatic impact on hospital technicians as it would in a community setting.

As a community pharmacist in both retail and previous long-term care environments, I can see the potential in the investment towards tech regulation to free up pharmacist time. The main difference is that we need the regulation in place to take advantage of some of the opportunities before us, where pharmacists aren’t the ones who primarily verify a completed prescription or compliance packaging, and instead can spend more time injecting, reviewing medications, and documenting interactions with patients. Hospitals were able to integrate those functions without the formal regulations in place, and are thriving as a result.

In closing, although it’s taken a long time, regulation is finally here. There are excellent people in pharmacy assistant positions that are stepping up to support the pharmacy profession. The glass ceiling is cracking and is primed to shatter. A new profession, with new leaders being recognized as the professionals they are, will push us to the next level.

 

 

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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Quick…To the Lab!!

I can’t help it. Every time I see the word, ‘lab’, it evokes images of smoke, arcing Tesla coils, boiling green flasks, and crazy Christopher Lloyd hairstyles.

When a pharmacist in A community setting refers to lab values, they’re usually asking a patient directly to ascertain whether all the bases have been covered. More often than not, the patient does not know what they’ve been tested for, let alone the actual LAB values. Fortunately, With our newly expanded scope of practice, coupled with the incoming drug information system, these awkward conversations with patients will soon come to an end.

As clinicians taking on broader responsibilities, performing lab requisitions is one more unknown that we need to navigate. There are numerous applications that scream for pharmacist intervention. A1C and INR are at or near the top of the list, but I suspect that many other practical uses are waiting to be discovered.

In speaking with a close RN friend of mine, she thought pharmacists having access to lab values was a wonderful idea, but brought up a number of pitfalls that we’ll need to consider when we officially begin:

– Shall we be authorized to request all tests, or be restricted in some fashion through a permit system?

– The cost of a test.

– The appropriate monitoring frequency for a given test.

– Are tests to be used to aid diagnosis or strictly to monitor existing therapies?

– Who owns the test results and the right to intervene if necessary?

– What is the lab capacity in a given jurisdiction?

 

There is a fear that once able, pharmacists in community settings will want to create baselines for all patients. Some of these will be absolutely reasonable and will fill gaps in patient care. Others may be open to interpretation and potentially create conflict with other care providers. I offer a couple of examples from my time in long-term care. At the time, the Nurse Practitioner and I routinely spent a couple of hours reviewing 50 patient charts at a time ahead of meeting with the nursing staff and medical director of the 200-resident facility where we worked.

1) B12 – We performed a focused medication review on patients receiving vitamin-B12 injections, noting that many did not have blood counts requested since their admission years prior. Out of a dozen patients, we were able to discontinue six of them that showed upwards to three times therapeutic levels. Although the long-term toxicity was not much of a concern, it was one more injection to track (and thereby eliminate for the time being) and in two of the cases, blood counts had not rebounded due to a relative iron-deficiency that had gone unchecked.

2) T4/TSH – As per accreditation standards at the time, we aimed to have a complete medication review performed with 6 weeks of admission. Often patients discharged from hospital were relatively stable on their current regimens, and needed time to get acclimated to their new surroundings. Usually at this time, we determined monitoring parameters for bloodwork and obtained baselines if the file was incomplete. During one session, we decided to review all patients taking thyroid hormone and discovered that some residents had not been screened in years. Many were frail and drawing blood was difficult, but we didn’t see that as a reason to stop monitoring. Almost all required a dosage adjustment and corrected some previously unexplained symptoms due to hyper or hypothyroidism.

It was not always easy. One of the stumbling blocks was the impact to workflow on Thursdays. Blood was normally collected in the mornings and shipped to the lab in the early afternoon. This of course added some extra work that wasn’t always easy to plan. Another was the attending physician’s apprehension in having us discover an issue that was missed or ignored due to a plausible reason. He would then need to possibly defend his/her action/inaction to us, nursing staff, and perhaps even the resident or their families.

I guess it will be another learning experience for all of us, but I look forward to the day when we can ask and receive a clearer picture of an individual’s health from a lab test. I’ll even bring my own Tesla coils.

 

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 Necessity of Grief

I consider myself a lucky man. I have a good career, a supportive family and all of my needs (along with some wants).

I attended a funeral service this week in support of a friend who lost someone very close to her. It made me realize just how lucky I’ve been; I have never had to go through the tragic loss of someone so near and dear to my heart. Yes, there have been people I’ve known and respected who have passed that have left a hollow feeling. Acquaintances, people I’ve met through my career, and mentors have been taken before their time. All of these experiences have left me searching for solace. Before a life can be celebrated, there is a profound sense of loss among family and friends.

A dear friend has helped to put the experience into perspective:

Here are some things you should think about:  It can take people years to get over a profound loss. I am only now, 2 years later, just getting back to the old me (prior to the loss of a close friend). If a person hasn’t experienced that type of grief, it can be hard for someone who HAS experienced it not to feel bitterness towards them.Fortunately, after you get through all that, you are able to look back at the life and smile. I can now talk about her without crying and can recount the hilarious tales of our adventures together without breaking down. It comes as a huge relief but it took years and lots of therapy to get there. Basically, the death of someone really close to you truly messes you up for a long, long time. The grieving process is necessary but at times it can feel like it’s crushing you. They don’t teach us about this in school.

As pharmacists, we build relationships with people and their families. We stand beside them through diagnoses, hospital admissions, surgeries, lengthening medication lists and the associated emotional roller-coasters. When the inevitable happens, you may find out through an obituary, but more often than not, a family member builds up enough courage to bring a plastic bag full of medications that they won’t be needing anymore. Suffice it to say the interaction is brief and as they walk away, it can be accompanied by a stunned silence in the dispensary for a moment or two. Even if the news is somewhat expected, the mood changes instantly.

Perhaps a card, or a bouquet follows. In the subsequent interactions, there may be a change in their demeanor, or new prescriptions to fill. We may only be a small part of their lives, but an important support during a difficult time.

Circling back to the comments above, I would have to agree that school does not really address the subject of death. Granted it wouldn’t be easy to do unless units or lectures were introduced addressing therapeutic considerations at end-of-life or in palliative care programs. It wasn’t until I had been brought in to consult at my first nursing home before I really understood Do-Not-Resuscitate orders and medicating for comfort. I do try to apply that experience when interacting with patients in their homes as they prepare for what lies ahead.

Knowledge may be power, and as pharmacists, we’re trusted because of our knowledge. When folks are at their most vulnerable, they may lean on that trust to listen, to share, and to help make sense of an emotional crisis that isn’t supposed to make sense. Everyone grieves differently, and you don’t have to know how to help or what to say. If you want to help, you will.

 

 

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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Spring Has Sprung…Finally

As I was out mowing the grass today, I began to think back to the lawn metaphor I used to describe why I write this blog. I do it to help make my own environment a little bit better. Hopefully I can help others do the same.

As a tip of the mortarboard to new graduates entering the profession across the country, I’d like to re-visit this metaphor one more time.

I give you: new practitioners – the grass seeds of pharmacy.

Are you still reading? Work with me on this.

 

Grass seeds start out as tiny things but with huge potential. They require water, sun, and a little TLC to germinate and grow. We may need more of them in rough patches: brand new lawns, places where planters have been or where weeds have gotten out of control. However with some nurturing and protection from the elements (birds, digging animals, intense sun, etc.), they can grow into a beautiful, resilient lawn.

New grads are just like grass seed. And not just any seed, let’s get the coated seed that supposedly absorbs ten times the water and grows anywhere. They too hold a large amount of potential but need some coaching and moulding, especially at the beginning of their careers, to truly become great practitioners. New graduates are ready to make their mark on the profession. Bringing new energy and a certain naivete to current practice environments can be a real advantage to filling clinical service bare patches.

If your new clinical leads are faced with too much exposure without proper coaching, they too will burn, and it may take awhile to reverse the damage. I’m sure most of us have performed a med review and stumbled upon a concern justifying a recommendation to a primary care provider. Unfortunately, these recommendations aren’t always well-received. I’ve heard horror stories where physicians refused to share lab values or provided snippy replies to reasonable recommendations.  The most extreme case involved a patient taking advantage of minor ailment prescribing in Nova Scotia. Unfortunately it ended with the physician threatening the patient by asking them to choose between them and the pharmacist. This kind of salvo can be a blow to even the most seasoned clinician, let alone someone who is green (pardon the pun). On the bright side, these cases are becoming exceedingly rare as other professions recognize benefits of the new contributions we can make.

Coaching and support doesn’t need to come only from the manager or supervisor. It should be a complete team approach, with every clinical success, from identifying new ways to help, to appointment bookings, to follow-up being shared and celebrated.

So here’s to a greener lawn! Grow a robust clinical patch. Your yard, and your work environment will be a source of pride to share and show off. It’s amazing what a little water can do.

 

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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The Anatomy of Error

Quick show of hands…How many of you are perfect? 

Everyone? Well I agree you are all perfect in your own ways but I really need to get this post started.

Okay, how many enjoy messing up?

 

There are very few people out there that don’t have a fear of failure. For every task there’s a plan, and for every plan there’s an action. The action produces results. This oversimplification leaves out one crucial element: expectations. Every plan has an expected outcome, or at least it should. Some plans are doomed to fail. They fail if they aren’t addressing the task, are too complex, or don’t have realistic expectations worked into the plan itself.

Even with the best plan, the best people, and solid execution, mistakes still happen. In the world of pharmacy, we refer to these mishaps as ‘medication discrepancies’, forerunners to the dreaded ‘medication incidents’. After new pharmacists have completed their degrees and written their licensing exams, everything becomes so real. There’s an professional institution to uphold, and standards are high. Every slip of concentration may result in a missed interaction or an inappropriate dose that holds potential for harm. If that mistake comes back to you, panic can set in:

Will the person sue me?

Will I be disciplined?

Will I be fired?

All of these questions rattle around and try to defeat your resolve. By my estimation, new grads take upwards to 6 months after licensure to begin feeling comfortable with their style of practice. They feel less paranoia about making mistakes and maybe don’t need to quintuple-check the things they do.

Mistakes happen to everyone. They always will, and the human condition will manage to attach a negative emotion to a mistake each time one occurs. The feeling of letting a patient or teammate down is bad enough, but most of the time, you’re letting yourself down. That’s the one that really hurts.

I have had my share, and I’ve counseled others who have been unlucky enough to experience an error fallout. My approach is summed up by the legendary John R. Cash:

You build on failure. You use it as a stepping stone. Close the door on the past. You don’t try to forget the mistakes, but you don’t dwell on it. You don’t let it have any of your energy, or any of your time, or any of your space.

Johnny Cash

 

For someone who wrote well-known songs such as ‘Ring of Fire’, and ‘Folsom Prison Blues’ (neither bringing to mind the imagery I’m looking for in this post), the above quote is perfect for any situation.

To become a health professional, there has to be a genuine desire to help people, and ensure no harm comes to them. Mistakes that may result in harm are not intended by anyone involved. Discipline is usually reserved for instances when someone willingly sabotages a system, or is neglectful in their maintainance of a system. Once someone has accepted that mistakes happen, addressing the circumstances that led to the error will help prevent it from recurring.

For some, that personal failure is a lot to handle. It can create anxiety, it can create doubt. At the beginning of a career or at the end, that heightened awareness sometimes works against you and more errors result. Why? My theory is that the focus sharpens on the aspect of the process where the error occurred. Wrong strength on a medication? Next 100 times, we’ll be extra vigilant to confirm with the doctor. Missed interaction? Like a branding iron, that drug-drug combo will be etched in the brain forever, and similar ones will be heavily researched from that point on. By dwelling, and putting that extra effort to prevent a similar mistake, perhaps a wrong doctor is missed, or the label instructions are vague. It can spiral, and owning mistakes is stressful at the best of times.

Circling back to the genuine desire to help people, it’s important to remember that we help hundreds of people every day. Errors are and will be a part of life, but if we own up to them and help minimize any impact on those affected, we can show that we care. If the uncomfortable interaction causes us to put a guard up, it may prevent us from investing ourselves in all of our subsequent interactions. Those other folks need our best as much as the person affected by the error.

With expanded scope responsibilities, we will make errors in new ways. We could misinterpret a lab value, perform an injection that doesn’t go as smooth as we’d like, or prescribe for a minor ailment and later find a missed red flag. If we stay true to ourselves and our capabilities, we will use them as stepping stones to constantly improve the quality of care we provide.

Dissect the anatomy of an error. Understand it. Control it. Learn from it. Move on from it. You will be better for 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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Life Outside Work

The nature of a job in a health profession is that we care for a living. If you ask anyone in the health field to define their job, most definitions will include some iteration of “I take care of my patients.” This is the most rewarding and exciting part of our job. It can also be the part that wears us out the fastest.

I remember finding out that one of my patients had had a resurgence of breast cancer. Her partner came in to pick up her pain meds and told me the terrible news. I cried with her and hugged her and told her I’d be there through it all to help them both. When that patient passed away, I cried and hugged her partner again. This is the sort of stuff that I bring home. Third party issues, doctors calls, injections and med reviews can all be left at work;  it’s the emotional side of caring for my patients that often makes its way into my psyche and hitches a ride home with me at the end of the day.

It is well-documented that health professionals often put themselves last. We do a great job of caring for other people but are not so great of taking care of number one. I can also attest to the fact that if a pharmacist (i.e. myself) is not in top emotional and mental health, work will suffer. A bout of depression does not bode well for accuracy and enjoyment at work.

So, how can we wage war against burn out?

I would argue the answer to the question is not more vacation time or shorter work weeks. It’s having a hobby. Recently, I have taken up wine as a hobby. Not in the “come home and drink a bottle of wine” sense. I have been taking wine education classes and am currently enrolled in the sommelier program put on by the Canadian Association of Professional Sommeliers. Once a week I have a four-hour class on the history of wine, how grapes are grown, grape physiology, how wine is made, etc. I also have papers to write and exams for which to prepare. I love absolutely everything about this course. It is so very different from my daily work experience. It is giving me a totally new and different set of skills. I am meeting new, like-minded people who share my passion for the history, science, and art of wine making.

Now, you’re probably reading this and asking, “but Laura, what does this have to do with me?” No, dear readers, I do not suggest that the key to happiness at work is to enrol in wine school. The point of sharing my story with you is this: having a hobby gives you an out. It allows your mind to escape into a place that has nothing to do with the wonderful world of pharmacy.  As a bonus, pharmacists pride themselves on being lifelong learners. A hobby has the ability to massage a different part of the brain that has been left dormant for too long. New skills can be learned and enjoyed. It gives you something to look forward to that is different from the day to day grind of getting up and going to work.

Do you have a hobby? Do you like to cook, or go to karaoke, or take in Zumba classes twice a week? Do you paint? Is there something you’ve always wished you could do? If you are looking at this article and thinking that you’ve always wanted to take an art history class then I say do it, friends. Join the running club you’ve been thinking about. Sign up for the pottery class you’ve been eyeing. Yes, it will take extra time out of your schedule. Yes, you may have to miss a class every so often. But I can tell you from personal experience that the richness a hobby will add to your life is worth any investment.

Here is a link to HRM recreational programs: http://www.halifax.ca/rec/documents/online.pdf

This would be a great place to start if you’re looking for a new hobby. Programs tend to be inexpensive and cater to any ability level. So here’s to getting out there and having a life outside of work!

 

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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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.