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Broaching Breaches

The expectation of privacy in today’s world is becoming increasingly difficult. Everything is becoming electronic; online banking, online shopping, email lists and profiles built on computer system are common in every business nowadays. Pharmacy is no different. With the advent of the Personal Information Protection and Electronic Documents Act (PIPEDA), ground rules are in place for private sector businesses to collect, maintain and disclose any type of personal information contained in a database. Obtaining consent is essentially the gateway to collection;  if we are not able to collect, maintain and use the information for the purpose of filling prescriptions, it’s very difficult to  provide service, if at all. Having accurate allergies and diagnoses can definitely impact the appropriateness of a new therapy or dose change.

The issue of consent can be a minefield. For instance, the Personal Health Information Act (PHIA) in Nova Scotia doesn’t specify an age of consent. The individual must have the capacity to provide informed consent, that is to say that when given all of the pros and cons of allowing personal information to be used in a given situation, they  have a choice to provide that authority, limit the scope, or revoke their previous permissions. In 2008, the criminal code of Canada raised the age of consent in sexual matters to 16, with exemptions down to 14 and in some cases if two minors are involved, even as low as 12. This is important because pharmacists need to determine whether a protective parent should be included within a young patient’s circle of care. As an example, a new birth control prescription is presented by a teen, but her mom picks it up. It’s not always straightforward. The same thing goes for those suffering from mental illness or cognitive decline. A spouse or other family member may be a more reliable source of information when making clinical decisions, but the patient has every right to keep information from being shared with them.

Even with safeguards in place, breaches have happened and will happen from time to time. Faxes sometimes end up at the wrong office or two people with similar names pick up each other’s prescriptions. Nobody intends for these incidents to happen, but the reality is that systems can fail. Perhaps an address wasn’t confirmed or was misheard at pickup. Maybe a large order accidentally included someone else’s bottle during the bagging process. As mentioned above, a counsel session could be initiated with someone who is not within the patient’s circle of care. With expanded scope of services, pharmacists have a heavier burden to communicate any injections or prescribing activities to the primary care-provider. We may not necessarily have longstanding relationships with everyone that receives a flu shot, so while faxing is more convenient than calling an office, we are relying on the patient to specify their family doctor and the potential for error is real. It happens in the other direction as well. Our site has received patient profile requisitions from hospital units intended for other locations, or transfers intended for other pharmacies.

I believe we do an admirable job at upholding these responsibilities. Use of personal information is appropriate to properly advise and advocate for patient care and we’re about to receive more of it in the form of the Nova Scotia Drug Information System (DIS). Other provinces are in various stages of integration; examples include H-Link in Alberta, the Pharmacy Network in Newfoundland and Labrador, PharmaNet in British Columbia and Health PEI. They all currently feed data from institutional and community settings into a central database. While this endeavour is aiming to provide a comprehensive patient profile of all provided health services, it also poses challenges to maintaining privacy. More information will be available to more people in real-time. Applications for this information will be new to many users and perhaps mistakes will be made with security permissions and protocols. Perhaps a look-up with a misspelled name results in accessing the incorrect profile, and adding a care note that doesn’t pertain to that individual. Lab values may be routed to the wrong ‘Dr. Smith’ and communications end up at the wrong office as a result.

At the end of the day, we will continue to apply due diligence in all cases to protect and maintain the integrity and security of the database. The additional information will be available so we can make better, well-rounded clinical decisions for our shared patients. Connecting healthcare providers in community and institutional settings is a huge positive. We can speak the same language based on the same complete profiles. Frankly, many patients seem to assume we already have this access when caring for them, so when we finally do, let’s make the most of it shall we?

 

 

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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Law & Ethics

One of the hats I wear is that of a pharmacy skills-lab demonstrator at Dalhousie University. The fourth-year graduating class is lucky enough (or unlucky, depending on who you ask) to have me stand in as a patient, physician or family member with whom to interact as part of given case scenarios. They are assessed on clinical knowledge but also delivery and style; body language and empathy make up a good portion of the final scoring rubric.

Sometimes I forget just how awkward it is to be a student.

Every year the course evolves, and the content of lab scenarios is tweaked to account for the expanding scope of practice. Prescription adaptations are new within the past two fall semesters, as are injection training modules. A couple of weeks ago, the lab focused on law and ethics, which has always been part of the curriculum, but not always represented in lab scenarios. The written cases were excellent, and would be challenging for seasoned practitioners, let alone mature students.

I have been practicing for over a decade. Although I have first-hand knowledge of some difficult moral and ethical dilemmas that occur in the pharmacy world, most times they have been second or third-hand. Staff members stealing narcotics from the safe, substance abuse in the workplace, and sexual harassment are just a few examples of uncomfortable situations that can arise in a dispensary. None are straight-forward and all require discipline to separate responsibilities under the law and the empathy for the person or persons involved. The law doesn’t care if it was a one-time occurrence or a habitual behaviour, the situation needs to be dealt with as dictated. However the follow-up may have a few more layers. Does the individual have mental health issues that have not been treated? Are they a danger to themselves or others? Is this terrible error in judgement easily corrected?

As preceptors, it’s natural to shield students on rotation from these difficult situations because they have so much on their plates already. So the students in lab were in a bit of a quandary. The scenarios were new and surreal. They had to think fast, interact with a possible offender and gather the information they needed to make a sound decision. The weird thing was that when I had received the case to review, the scenario almost exactly matched an incident I experienced during my first management role. The emotions I felt at that time came flooding back, mostly about how afraid I was to confirm my suspicions that someone was dispensing to themselves. As a new manager at the time, I made the situation about me, and how much trouble I would be in had I been wrong. That said, it was dealt with properly but I completely understand the thought process my students utilized. My answers to their questions were the same as I had received when I went through the situation myself, as was the doubt I tried to create that it was more than a harmless misunderstanding.

The feedback I provided to the students along with their responses identified the two adjoining conclusions: you can uphold the law by reporting and documenting a potential crime or professional misconduct, while at the same time ethically supporting individuals by referring them to a mental health specialist or social worker as needed. For the most part, it is not one over the other.

It amazes me each year the empathy and comfort the students display in their interactions, even awkward ones. There is no doubt that they will all encounter a situation or two that test their knowledge of pharmacy law and blur the lines of the ‘right’ and ‘wrong’ ways toward a resolution. Introducing these new professionals to a few of these possible scenarios should aid their thought processes for when they’re out practicing on their own.

I would say the lab was a resounding success.

 

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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Flu Shot Redux

Oct 19,2014.

The date has been bandied about for the commencement of this year’s flu vaccination season. Although the date may change slightly from this posting, Nova Scotia is ramping up for a robust campaign to exceed last year’s success. Pharmacies in the province provided upwards of 80,000 doses of the seasonal vaccine while physicians provided only about 18,000 doses less than the prior year. Interestingly enough many pharmacies, including my own, were late receiving supply or had only one injection-certified pharmacist on staff for a good portion of the fall/winter months.

Last year, performing injections was new for pharmacists here, but we got pretty good at it. In the time since, I’ve been keeping in practice with travel vaccines and have recently been in demand for the shingles shot as patients become more comfortable dropping in to ask about them. For a service so straightforward and quick (the act, not necessarily the pre- and post-documentation), people genuinely appreciate the convenience and most will happily pay any associated fees to avoid sitting in a clinic waiting room.

I’ll be the first to confess that I’m not that excited about needles; whether I’m giving or receiving a shot, my feeling is quite neutral. I know there are plenty of practitioners who can give and not receive, or have a mental block when it comes to touching a patient. The sight of blood in any amount may not be on your daily agenda but the reality is that pharmacists have proven we can fill a large care gap…a care chasm as it were. An at-risk individual may be stopping in for a blood-pressure medication refill and perhaps receive a shot at the same time. A family of four with two kids under the age of ten come to pick up a few things on the way back from a matinee and now they’re no longer influenza carriers for Christmas dinner with Nan. A pregnant woman’s fears about harming her baby will be allayed.

The point here is that I see the value in providing the service to those that want it. Many members of the public are against flu vaccination. That is their right, and I have no interest in putting anyone on the defensive. I DO however want to be available to anyone who is eager to protect themselves and will pass the word that we’re ready and willing to provide for their family and friends if they are so inclined. Waiting on our first lot of vaccine is making for suspenseful week with the multitude of phone calls we’ve been fielding, so the demand is there. Signs are up and clinics are being planned. It appears we’re going to be receiving Agriflu, which is pre-filled 0.5mL of convenient, time-saving goodness. To be sustainable, our approach will be to treat any request for a vaccination no different than an acute medication for a patient; wait times may vary depending on the time of day and the volume we’re processing. These are duties we will carry out as best we can with the flow of the day.

You can bet that as long as the flu vaccine supply lasts, pharmacies will be instrumental in finding deltoids to receive it. When the season passes, we’ll be ready for the travel rush of winter.

Emergency kits inspected? Supplies ordered? Forms printed? Staff primed on intake? This year, it looks like we’re all ready to rock.

Just remember to save a shot for yourself.

 

 

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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Engagement of One

There are things in this world about which I hold strong opinions. Most often these are in the realms of personal development and group change. There needs to be an inherent trust between members of a team. It doesn’t matter how big the team is; two people in a partnership, or a global brand spread across continents all require a level of engagement to truly be effective at executing strategy. There has to be an emotional attachment to the mission and a shared satisfaction to reach a goal.

The most successful organizations understand that their greatest strength is their people. Taking that one step further, it’s the development of those people that set them apart. I could use a collection of cliched buzzwords here that have a tendency to say everything and nothing at the same time, but the gist is this: it’s one thing to have quality people in leadership roles to succeed today, but it’s another to have those same people prepared and inspired to take on tomorrow.

I am confident and proud to work for an employer that takes engagement seriously from the top down. They recognize the differences in learning styles between generations, and have an evaluation process that focuses on behaviors that contribute to the business, trusting that desired results will follow. I currently feel that I’m valued, and have mentors looking out for my best interests personally and professionally.

So how does one engage another person or group for a common goal? Job satisfaction means different things to different people, so one approach is to try and understand what motivates and rewards different groups.

A quick Google search brought me to this document discussing staff development from none other than the United Nations.

The link is a fairly easy read, but the content is nevertheless fascinating. The title is: ‘What Matters and How They Learn’ and breaks down the generation gaps in the workplace. I’ll let you have a skim and then we’ll continue the post. I’ll wait for you here…

(Interlude music)

So the groupings themselves: Baby Boomers, Gen X, and Gen Y comprise the vast majority of the current workforce. There are some Traditionalists, but their number is declining into retirement. By grouping generations in this way, commonalities emerge around the fault lines. For example, I fall near the tail end of the Gen X timeline, meaning that I may share a similar value set as a 50-year-old colleague with respect to being goal-oriented and self-reliant. At the same time, there are flickers of the Gen Y group that I recognize as well; when it comes to sociability and collective action, I completely embrace that culture in the workplace.

[As an aside, one of the distinctions between Gen X and Y as written in the document of Techno-literal vs. Tech-savvy. One needs step-by-step instructions and the other finds technology intuitive. If I was able to start a blog, but have no idea of any advanced features, does that make me advanced-techno-literal?]

So, we know the workplace is comprised of blended learning styles. Training should therefore contain elements that appeal to most workers. Gen X apparently respond well to graphics/design and brevity of training materials. Gen Y wants to learn when and where is comfortable, and being connected online is very important to them. The key is knowing the audience, and it takes a significant investment of time to learn how to relate to the individuals. Once that emotional attachment is established, you begin getting back more than you put in. You challenge one another and learn together. On a personal note, the occasions that I am wrong tend to be the most rewarding experiences in the end.

One final point I’d like to make is that there are many tools or devices being used for engagement, be it team-building exercises, group dinners or retreats, in-house competitions, monetary rewards, surveys or even one-on-one meetings. What tends to get missed is that engagement starts with people and ends with people; the tools are not the answer by themselves, nor do they have an endpoint. When used by someone who is already engaged, any strategy has a chance to reach others who may in turn, pay it forward by seeking to engage their other colleagues.

If you’re like me and truly engaged, that passion will keep you coming back for more, and you’ll have confidence that someone will always be waiting for you to challenge, learn and grow. Take advantage of that feeling and the opportunities that will present, just be ready to create those same feelings and opportunities for others when the time comes.

 

 

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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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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The Payback of a Little Charity

A couple weekends ago I hopped on my bike and pedaled close to 100 km in my 4th MS Bike Tour.

The distance is one thing, and the need for a good pair of padded undergarments always provides ample fodder for tour volunteers and non-riding supporters. This year turned out to be one of the best yet, though very different than my previous three. This difference was for reasons that didn’t occur to me until afterwards.

We rode from the Windsor Exhibition Grounds to Acadia University under a comfortable, cloudy sky. After the first day, my new team settled into the residences at Acadia for an afternoon of swimming before the annual banquet. After dinner, we ended up back in our rooms to have a wobbly pop or two. During the evening, the dozen of us took turns explaining our reasons for being there. All were insightful and inspiring, and topics always involved family members or close friends with multiple sclerosis. Some were diagnosed at a young age and deterioration ran the gamut from slow (decades) to rapid (<2 years). You may get the impression that I can sometimes be rather long-winded, and you would probably be right. I’ll share the condensed version here for the sake of brevity:

Thirteen years ago, a mentor and friend began an MS Bike Tour team in support of a longtime colleague’s wife. I was aware of the team, but saw it as a cause with which I didn’t connect. I knew little about the disease, the progression, or the treatment options. Year after year, along with her wife, she would invest time in planning fundraising events, theme designs for the team picture, and seeking corporate donations. Each year she would ask me and I’d hedge. Perhaps I had plans the weekend of the event, or I didn’t have a decent bike, or even worse I was in terrible shape and wouldn’t survive it. It all changed when I found out my aunt was afflicted with a mild form of the disease. As kids, sometimes playdates with the cousins were cancelled for unknown reasons. Come to find out that her fatigue would persist for days or weeks, and she would be unsteady on her feet. At this point, my excuses rang a bit hollow and I made up my mind to commit to the cause.

2011 – The Cycledelics were celebrating their 10-year anniversary on the tour. Our black t-shirts were printed up as tuxedos with red-bow-ties. We sported top hats on our helmets and twirled canes into the banquet hall. I was 30-lbs overweight and my cargo shorts didn’t have a lot of padding. On the way back, I couldn’t stand to sit back on the seat and couldn’t walk for the better part of a week, but I made it.

2012 – We had a cowboy theme this year: plastic ten-gallon hats on our helmets and rodeo shirts. We rode into the banquet on hobby-horses. I bought a better bike, some padded shorts, and lost 20 lbs. Raised more money than the previous year and I wasn’t the last rider on the course this time.

2013 – ‘The Swarm’: dressed as bees, with bright-yellow t-shirts and electrical-tape pinned in place for stripes. We all wore headbands with antennae and big-round shades. This time the banquet attendees had us buzzing around their tables. All in good fun. I felt I was in the best shape of my life to date. I had trained for the 3-months before and my riding partner and I flew through the course. Even managed to do the extra 38 km loop on day 1 for good measure.

This brings us to 2014, and I had since taken on the pharmacy manager role at Sobeys. I was connected to a store manager in town who had also ridden on the tour and wanted to start up a corporate team. We brought 5 stores into the fold and pooled our riders fundraising efforts with a goal of $10,000. We had store BBQs, a poolnight, and two paintball afternoons. We had casual days for staff, we sold MS oatmeal cookies from the bakery, and sold 50/50 tickets. We went on to raise almost $14,000 for the fight against MS. Not too bad for year #1.

2014 MS Team

I was apprehensive leading up to the ride. I had hoped to see members of my former team but wasn’t aware of where they were staying or who would be attending. This new team was a hodge-podge of riders from different stores, and none I knew well. My fears were allayed once we arrived at Acadia. My former team members were two floors down in the same residence and we hung out exactly the way we did in previous years. I even ran into a friend I had not seen in well over a decade cutting fruit in the cafeteria (Nice to see you HB). Our team was the newest of the three corporate teams on tour and managed to take home some hardware for our efforts:

 

Corporate Hero Award 2014-MS  Team Cheer Award - 2014-MS

Our cheer was to the theme of Gilligan’s Island. Not everyone in attendance got the reference.

 

So why was this the best one yet? I didn’t train as much, and had a pair of dead legs 3/4 of the way through, so that wasn’t it. I doubled my previous personal best in fundraising, but that wasn’t it either.

This was the first tour that I felt like a leader. New riders would come to me for their preparation and itinerary. MS Society staff called me by my first name. Most importantly, I had a new appreciation for the passion and dedication shown by the staff, volunteers along the route, and the 330 riders who participated. People were giving of their time and energy to help others not because they were forced to, but because they wanted to. It’s contagious;  we spent the whole night planning fundraisers for next year’s event. I know I’ll be recruiting some of you to join me on the 2015 ride.

When it’s all said and done, we really did pull together to make a difference in the lives of those suffering from MS. Drum-roll, please…

MS Tour Total 2014

Makes it all worthwhile, doesn’t 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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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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Honouring a Colleague

On these pages last September, I referred to the unfortunate passing of one of our own pharmacy community. Karen Zed was someone who has had an impact on my practice for my entire career. Working with the same company since before graduation, her visibility within the profession as a mentor and advocate was evident through her work with our Nova Scotia regulatory body as well as the Dalhousie College of Pharmacy.

My working relationship with Karen developed over the years. I worked first as a student, then as a relief pharmacist, before transitioning into management roles. With each step, I was reminded of the respect she commanded from her peers. We may not have always agreed with her opinions, but they carried weight and inspired healthy debate. Although I did not know her well on a personal level, it was obvious how much she thrived when precepting students, interns, or anyone with an interest in pharmacy. She was staunch in defending her practice site as a true ‘real-world’ experience; you learned by doing, by making mistakes and fixing them, all with an eye towards the patient above all else.

In the 10+ months since, I have been lucky enough to be appointed as secretary of our pharmacy alumni division at the university. With Karen being taken away so suddenly, there was an appetite to celebrate her contributions on a grander scale. That is why the Dalhousie College of Pharmacy Alumni Division (DUCPAD) is pleased to announce the annual Karen Zed Spirit of Community Pharmacy Award. This award recognizes students who share Karen’s passion for community pharmacy as both a place to learn and to provide caring support for those in need of our medication expertise.

Details on how to donate to the award fund may be found in the June 2014 issue of the DUCPAD Dispatch, or by following the link below:

http://alumniapps.dal.ca/giving/giving.php

Rest in peace Karen. May your spirit endure in the next generation of community pharmacists.

 

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.