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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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My 60/40 Rule

Every job has its drawbacks. That’s one reason it’s called a job in the first place. If work always felt like play, we would have reached a utopian state where we made a living doing only what we loved to do, be it counseling, writing, or playing golf. We wouldn’t need to worry about pesky things like ‘stress’, ‘pressure’, or ‘tact’ when dealing with others.

On the other side of the same coin, destroying your mental health for the sake of advancement or financial gain doesn’t strike me as a worthwhile endeavour either.

My personal rule is simply 60/40: three days out of any given work week need to be rewarding in some way. The 60/40 split is hardly cutting edge, it’s used for investing, relationships, and describing rear-seating in newer sedans. In my case, it serves as a guideline for contentment with my job, and a personal threshold to feel I bring value to my current role. Projects I may take on, people with whom I interact, and results I can help generate all contribute to that ever-elusive job satisfaction. Those other two days? Maybe it was a terrible night’s sleep, or one of the kids is sick, or perhaps I run into the wrong customer that day (see ‘No-Win Situation‘). Regardless of the reason, I can accept the not-so-fun 40% if I can freely enjoy the other 60%.

I used to work a lot of overtime. Through travel commitments and a seemingly endless cascade of crises to manage, a 55-60 hour work-week away from home happened more often than I want to admit. In addition, when I was home, my mind was still focused on that next task, and the incoming urgent email. My workaholic tendencies were born out of a fear of failure, and it wasn’t that I always loved the work, it’s that I didn’t know how to effectively remove myself from it.

It took awhile for my brain-hamsters to illuminate the lightbulb. My work-week was woefully out of balance, but instead of stepping back to evaluate my routine and maybe learn to appreciate the more mundane facets of the job, my approach was to add an extra day or two and fluff it up with things I wanted to do. I was able to re-establish my 60/40 and it worked…for a bit. With a wife and two kids, I wasn’t making it any easier on them or me. Change was necessary and ultimately, a relief.

Truth be told, there was plenty I enjoyed about that time, and with very few regrets. I’m still an ambitious person with a strong passion for pharmacy, but I needed to step back to rediscover my own personality and how my unique skill set can best contribute to the profession. If I hadn’t, there would be no committee work, no successful foray into advocacy, and no PharmAspire. I feel that my professional life is much richer, and my corner of the world is much more well-rounded…by more than 60% anyway.

 

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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Improving the Quality of Life for the Frail and Elderly

The current healthcare system is stressed. As the population ages, the coupling of increased life expectancy with a decreased workforce means that resources (financial, human, medication supply, etc) to care for our citizens are constantly being reviewed and re-allocated.

Over the past 10-15 years, from the courses I took in school to present day, the importance of preventative therapies as a justifiable investment towards future savings has always been stressed. These savings come in the form of doctor’s visits, emergency room visits, hospital admissions, reduction in debilitating illness, or premature deaths. In actual fact, the proper term is ‘cost avoidance’ unless the healthcare system has a bank account somewhere for a rainy day. Although the disease-prevention message wasn’t new when I started, it’s been a mantra with which many of us are familiar. Through aggressive targets for things like cholesterol levels and A1C, we can keep ambulatory patients in their homes longer, and reduce the need for direct nursing care or renovations to the house (ramps, lifts, grab bars, etc).

So what happens once an individual can no longer live alone? Sometimes this is a result of a physical or mental disability, a tragic accident, or a stroke. In these cases, age does not matter. More often than not, however, nursing homes are the residences of our frail and elderly. They are from all walks of life, and from countless backgrounds. They are trusting their healthcare teams to make decisions that better, or at least maintain, the quality of life they have left to experience.

Quality of life has always been a subjective measurement. It can mean something different for each person being measured. An elderly man living at home may see quality of life as maintaining his driver’s license through glaucoma therapy. Conversely, a lady with a hip fracture may see quality of life as avoiding weekly bloodwork for her warfarin regimen. A person with diabetes in the community places priority on treating his/her neuropathy so that they can enjoy walks with their spouse. Whereas a person with diabetes on dialysis may gain enjoyment in sampling a high-sugar treat like that fresh-baked cinnamon bun from the kitchen.

A patient-focused care model certainly helps prioritize our interventions, but what other tools are there? Most guidelines use evidence from demographics representative of the larger population. Unfortunately, frail and elderly patients are usually not amongst those being targeted. I’ll use a diabetes example to illustrate: aggressive blood sugar control is the hallmark of preventing progression of the disease and its resulting sequelae. In the frail and elderly, the risk of falls is much more of a detriment to quality of life. Episodes of low blood sugar are significantly greater with aggressive control, leading to more falls. By relaxing the targets, we can manage that risk.

Fortunately, a new project is on the horizon to address these issues:

http://polypharmacy.ca

Pharmacists are drug experts and have strong opinions on what constitutes appropriate versus inappropriate prescribing. This occurs in every practice and in no way does it denigrate other practices or professions; it’s what we were specifically trained to do. Although the term polypharmacy simply refers to the use of multiple medications by a patient, it lacks a universally consistent definition in literature. It’s often used to describe excessive or unnecessary prescribing that increases the risk of adverse drug reactions, drug-drug interactions, and higher costs.

Thankfully, as pharmacists are finding increasing opportunity to collaborate within healthcare teams, we are able to use our expertise to perform impactful medication reviews in the settings of continuing and long-term care. The polypharmacy site offers a number of clinical tools and guidelines that may help in the decision-making process. Check it out. It’s a public site that anyone can access.

It’s a huge initiative, and pharmacists have the perfect skills-set to educate and implement these interventions.

 

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 Lighter Side

Sometimes it’s just more fun to observe the pharmacy world day-to-day and let the posts write themselves 😀

1) ‘uid’ vs. ‘od’

When I started as a pharmacist in New Brunswick a decade or so ago, we had a family physician who probably graduated med school not long after the Second World War. To say his style was old-fashioned was definitely an understatement. One of his quirks was that he exclusively wrote ‘once daily’ as ‘u.i.d.’ Just try to Google it…you won’t find much. My best guess is that it was an extrapolation of the Latin abbreviations b.i.d. (bis in die = twice a day), t.i.d. (ter in die = thrice a day), etc. The Latin word for ‘one’ is ‘unus’ so perhaps this kindly gentleman wanted to differentiate his abbreviation from ‘u.d.’ (ut dictum = as directed). I don’t know how many phone calls he fielded, but as a new relief pharmacist, I thought I was losing my mind.

On a sidenote, the French way to write for ‘one tab orally once daily’ looks like ‘1 co po die’. The first time a doctor ran that together on a script, it took me 10 minutes to figure out what a ‘copodie’ was.

2) I had a good chuckle with a doctor a number of years back when I questioned why he was calling in ‘Trazadone 50mg, same as before, sixteen years refills’.

It didn’t immediately occur to me that he meant, ‘sixty, and a year’s refills.’ Say it fast, you’ll notice it sounds very similar.

3) Auxiliary labels come in a variety of colors and serve to remind consumers of more common instructions or warnings for their medications. Unfortunately, limited colors mean that in a pinch, users may on occasion grab the incorrect label for the prescription in hand. Not to make light of human error, but I would sincerely hope that proper counseling would cause someone with a chest infection to question if their clarithromycin prescription was ‘for rectal use’.

4) Erectile dysfunction is a sensitive topic but an important one. It predominantly affects older males, though sexual dysfunction is also diagnosed in women more often than people think. Common prescription medications used for depression may also create these problems. Even after practicing all this time, it’s difficult to know just how comfortable someone will be discussing their affliction the first time they pick up a prescription therapy. I give you a few simple ‘Do’s and Don’ts’ that I believe to be helpful from MY past experiences.

 

DO

– Treat as any other prescription: respect confidentiality, offer to counsel and answer questions.

– Offer a phone consultation if that would be more comfortable for the patient

– Ensure that they have discussed risks with their doctor with respect to cardiac troubles.

 

DON’T

– Get caught in a counseling session with a pen that looks like this:

the-spring-pen-514

(Image courtesy of http://www.custom-product.com/)

I wish I was making this up.

I was running out the door for an errand and as the only male pharmacist on staff that day, a patient requested I counsel him on his new ED medication. Since I did not have my lab coat on, I happened to seize a novelty pen dropped off on a recent drug rep visit on my way. The patient’s comment was something like, ‘looks like the pen needs this more than I do.’ We both had a great chuckle, though my embarrassment was definitely apparent.

 

Oh, the world of pharmacy…do we ever run out of stories?

 

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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One Year in the Blink of an Eye

It’s a wee bit stormy out here on the east coast. Spring has decided to pack up and go to Florida to avoid 30cm of blizzard leftovers.

I’m in awe that 1) it has been a full year since I published my first post on PharmAspire titled ‘Inspiration‘ and 2) as my gender is not always known for remembering certain occasions, I have earned my gold star on this day.

It has been a banner year for personal and professional growth. Even from post #1 the tone and feel of the blog is exactly how I had originally envisioned it: a place to explore all of the positives in our lives as pharmacists in the words of those living it. Other places may serve to spotlight all of the crazy/annoying/mundane aspects of our profession and it’s often a good laugh, but at the end of the day, it keeps the mind trapped in all the things we dislike about what we do. At the very least, what can we take from those examples to illustrate what we have control over to improve the situation for the next time?

It was never meant to be all about me, and consequently, many of the experiences I’ve had over the past year have been shared with or inspired by others. A couple of other author-friends have taken a turn writing their own pieces, and they are certainly worth a read.

Reviewing some of the topics covered, we have delved into job satisfaction and handling ‘no-win’ situations. We have taken on mental health in numerous posts, including mobile outreach, community group participation and addiction. There have been heavy topics (suicidal ideation) that have balanced with lighter fare (Odds & Ends). Current events in Nova Scotia include the journey towards technician regulation and our first foray into administering injections. Quite a mixed bag, wouldn’t you say? All posts may be found in the archives if you’d like to check them out.

All in all, and I repeat myself often in saying that it’s been extremely satisfying to watch this blog idea grow. It has reached more people than I could have expected in such a short time. To top the year off, the blog is being featured in the March 2014 issue of Pharmacy Practice +. I am both honored and humbled by the support I’ve received.

A sincere thank you goes out to Laura M, who has been my blog editor since day 1. My ideas are sometimes convoluted and my metaphors don’t always make sense. I’m so glad she has stuck with me and pushes me to be a better writer.

So what’s in store for year #2?

A lot has happened in the pharmacy world and continues to happen. As I wade through my own experiences with expanded scope and collaborative practice, I hope to share as much of the highlights as I can. Plans are in the works to continue mental health outreach with the More Than Meds project (http://morethanmeds.com). Other upcoming features include further follow-up on my smoking-cessation sessions, a deeper look into palliative care, and a profile on a new provincial initiative (http://polypharmacy.ca).

Stay tuned!

 

Twitter: @PharmAspire

Facebook: https://www.facebook.com/pharmaspire.ca

email: dcovey@pharmaspire.ca

 

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 Lawn Care

***This post was originally created March 3rd and may be found as a static page on the left sidebar under ‘About PharmAspire’. It was inspired by the editor of Pharmacy Practice +. Thank you Vicki 🙂

Recently I was asked to write a blurb to introduce myself and expand on the creation of PharmAspire. Over the past year, I’ve tried to share pieces of me through my thoughts and experiences, but haven’t really given any background to the ‘who I am’ and ‘why I created a blog’ questions. I guess that would be a good place to start.

I have been a community pharmacist since graduating from Dalhousie in 2001. Since then, I have been involved in many aspects of community pharmacy. This includes exposure to pharmacy management, marketing, human resources, professional development, corporate direction and process analysis. I’ve met many great leaders and have several mentors within the profession. I’ve had moments of burgeoning job satisfaction and also some periods with an empty, ‘is-this-for-me?’ feeling inside.

I have been fortunate that my career has had been mostly ups with only a sprinkling of downs. Here are a few of the highlights that capture my journey as a practitioner. Firstly, in 2005, I was asked to manage a dedicated long-term care site. This role required me to not only provide medications to nursing homes, but also use consulting hours each week specifically to support facility initiatives. I was able to be part of a collaborative team along with the administrative staff, the nursing staff, the medical director, and a recently added nurse practitioner. I was invited to chair pharmacy and therapeutics meetings, help draft policies and procedures, perform training sessions, and take part in facility events for the residents.

My second example is from my time at corporate office. I had always enjoyed the professional development side of human resources, and was fortunate enough to have a hand in preparing and delivering numerous events for staff. There was quite a variety, ranging from orientation of new pharmacists, to managers-only sessions, to training events for the entire pharmacy staff across multiple provinces.

The single largest change in my career was in July, 2012. Changes to legislation had begun to severely impact the life of a community pharmacist. Our new expanded scope of practice required that changes to practice be integrated on an accelerated schedule to counter drastic changes to the existing economic model. I was leading a team through these transitions, but realized that I was struggling with my readiness to change my own practice. I made the personal decision to step back and rediscover what drove me to pharmacy in the first place. PharmAspire began as a way for me to channel my thoughts and observations to focus on the positive.

Pharmacists thrive in many sectors of the healthcare system. When significant changes come about, there are almost always negative aspects associated with the transition. The old cliche, ‘the grass is always greener on the other side’ starts to resonate and folks look for new pastures, and new challenges. However, many of us have roots in the sector in which we work, and if our experience can influence how the changes are implemented, it can only help to sand down the rough patches. My goal with the blog is to inspire and motivate pharmacists. Wherever you may be, grab a bag of fertilizer and make your own grass greener. Strengthen those roots and get excited about sharing new experiences.

So what kind of pharmacist do you aspire to be? The tagline is, ‘The Practice of Pharmacy On Your Terms…In Your Terms.’ and those ideas can spring from anywhere at anytime. The act of describing in our own terms the barriers we’ve overcome and the rewards we reap, will help the entire pharmacy community to evolve our practice to meet the needs of the healthcare system, on our own terms.

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 Unexpected Experience of Mental Health Outreach

Since May, I’ve been a proud member of the More Than Meds team (@morethanmeds, http://morethanmeds.com). I’ve been led off the beaten path of conventional community pharmacy and have begun to test my own beliefs about mental health and stigma that goes with it. I’ve certainly had my eyes opened, and many doors and opportunities too. I think it is fair to say that being a part of this program has really helped me to better understand what patients and their families go through on a daily basis – the hope, exasperation, set backs, isolation, support, and progress. This understanding didn’t happen by remaining in the dispensary.

About four weeks ago, I was invited to attend a meeting with family members of patients struggling with psychotic and schizo-affective disorders. This group has been meeting monthly for about 10 years now. From what I observed, they have grown into a big supportive family. Mostly there were couples, but some single parents attended. Each would provide insight and support to the others in the group by sharing their own experiences with mental health services, inpatient stays, the multitude of care providers, challenges with housing, and of course, the medications. While I am very familiar with the commonly used psychotropic medications, I am far out of my comfort zone when it comes to addressing the non-pharmacological issues of mental health care. While I knew it on some level, being at the support group really crystallized for me the importance of being much more than meds (see what I did there?). Educator, navigator, collaborator, and advocate (definitely advocate) roles make much more sense now, whereas before I didn’t really ‘get’ how to fit them into my practice. Quite frankly, I was overwhelmed by how much information I had to offer. Information that they needed, information that brought the members of the group understanding and clarity and/or new therapeutic paths to follow. Their appreciation was more than humbling.

During a round-table discussion, a member of the group touched on something that I can’t seem to shake, and I paraphrase:

“Our son lives with schizophrenia. He’s been doing well of late. His meds are stable. He is living independently. When he was a teen, he was a gifted athlete and musician. Now mostly he plays video games. We actually get concerned that he has stopped his medications when he gets back to playing music…and he’s really really good!”

This comment really struck me, flooding me with all sorts of thoughts and mixed emotions. This illness, especially the negative symptoms, is so frustrating to families, and to me. What can we do to help? Are his medications stifling his creativity? The concept of blunted affect has been written about extensively (http://en.wikipedia.org/wiki/Blunted_affect, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632232/). Would suggesting a change in his pharmacotherapy be a good idea? Does it keep hope alive or set up false expectations? How do we say in so many words, “things could get better. Would you like to try (x)”? Simply by saying it we are, in fact, pointing out that the current situation is somehow unsatisfactory, but who are we to judge? This may be counterproductive as it may only serve to cause the family frustration rather than hope. As pharmacists, we may struggle to determine our role in these situations. We do not title ourselves as mental health care specialists but we do contribute to mental health services. In a broad sense, we contribute every time we speak with someone about their sleep, their mood, their worries, and the medications that affect those things.

That said, I am glad that I chose to accept the invitation to speak. Even just to be a part of  a community searching for help and support. On the topic of medication regimens: sure, they help the families and caregivers cope. They can also provide stability, the lack of which could otherwise prevent the return to work or leading to the loss of yet another relationship. However, not everyone likes the medication experience. It’s been said that the cost of stability may be a little less color in one’s world. For that evening, I may not have had all the answers to their many questions. I may not have been able to recite the most relevant head-to-head trials or know all the rare side effects for each medication, but I learned that my imperfect knowledge and my experience allowed me to give so much in the way of support, information, and encouragement.

After a couple of sessions with families and patients, I don’t consider myself an expert but I certainly feel that my awareness has changed for the better. I hope to participate in more evenings like the one mentioned above.  I know my daytime patient care activities will benefit from 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.