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Like Riding a Bike

Recently, after a challenging stretch with my team, I’m reminded of the value of long-term outlooks. As a father, as a pharmacy manager, and as a semi-regular blogger, it’s so important to have clear goals in front of you.

I was out last weekend with my 7-year old in a grocery store parking lot. Having watched me prepare the past few years for the MS Bike Tour (click here for my fundraising page), she decided that this would be the summer to conquer the 2-wheel balancing act. We pumped up the tires and adjusted the seat height. Starting in the driveway, I ran along beside her for a couple of runs before making the 5-minute walk to the lot. I don’t remember details of my own learning experience with a bike, but hearkened back to my driving instructor’s advice from many moons ago: always look to where you want to go, and not the road in front of your wheels.

It took some practice. Being tentative, every time she watched her front wheel start to wobble, her sense of equilibrium followed suit and violent jerks on the handlebars failed to keep her upright. Soon enough, the chin came up, the arms relaxed a bit and she was able to pedal unattended for two seconds at first, then five. She was so excited to show her mother when she got home from work.

She taught me that my experience is no different. In my role, I’m expected to lead people. If I’m always looking at my front wheel, chances are I won’t be leading them very far, and the distance we do travel will be rife with wobbly or uncertain moments. At this point, I have this urge to expand on my meaning. I sense a bullet list coming on…

  • A leader’s vision is enhanced by the relative vision of his/her subordinates – Have you ever watched someone walking with a dog that is seemingly distracted by or reacting to just about everything they pass? Having to circle back and regroup takes time and effort. If there is good communication, and staff are trained to look further down the road themselves, then they may recognize steps to take today that will directly impact how fast they get there. Say, if the goal was to give 1000 flu shots, then finding easier ways to triage patients and pre-populate administrative paperwork will certainly enhance that ability.
  • Everyone has to have a long-term goal – In the same vein as above, the president of a company or the director of a university needs to be focused on long-term planning 95% of the time, to retain viability and competitive advantages. Perhaps middle-management needs to be about 50% focused on long-term and 50% on day-to-day functions. That trickles down to part-time front-line staff. They may fill a specific need 95% of the time, but they still need something to work towards over a 3-6-month period. I like to show these people aspects of inventory management, for instance.
  • Braking and turning are still important to learn – So the vision is communicated and we’re making good progress down the chosen road. What happens if the path needs to veer off (changes in the reimbursement model, etc.), or stop due to a roadblock (Information Technology limitations, etc.)? My daughter still has these aspects to work on, and so does my team. Maintaining that balance and control through the unknown will keep us from hitting a wall or flying into the bushes.

I want to say that managing a team is as easy as riding a bike, but I have a feeling you may have already seen that coming  😉

 

 

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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An Anniversary

March 28 holds a special meaning for me. It’s early spring and summer vacation planning needs to be in over the next week. My two siblings have birthdays coming up, so that’s always good for a pair of celebrations. From a pharmacy standpoint, in Nova Scotia the government drug benefit plan resets on April 1st, so cue the shock and awe from patients once again having co-pays on their prescriptions.

The special meaning for that date is really derived from my choice to start this blog. Three years ago, I jumped into these waters expecting very little. Inspiration was the title and summed up my feelings at the time. They have not changed and hope they never will. Laura has been editing my posts from day one and does an excellent job in keeping me on point when I offer too many platitudes. Thank you to all readers, wherever you may be; your kind words of encouragement and acceptance of my often rambling consciousness has a profound impact on this soul of mine. So much so, that challenges never feel as challenging, and spinning chaos in a positive light has a definite healing effect. I’m looking forward to what’s in store for year number four.

As long as we harbor aspirations of betterment, personally and professionally, there will always be stories to tell, and topics worth writing about.

 

 

http://pharmaspire.ca

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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Dirty Laundry

Oh, how I would love to offer something salacious to justify the outrageous title. If I had the forethought, I should be writing an episodic daytime drama that captures the emotion and mystique of community pharmacy.

Just think: the excitement of finding a favorite pen that a colleague had been hoarding, the heartbreak of losing a customer who had developed into a close friend, and the passive-aggressive dance to decide whose turn to grab the cash. In  15 years, I never seem to run out of stories to tell, although on second thought, most are the ‘you had to be there’ variety.

After a stressful week, I am left to ponder the sobering realities of my chosen profession. One question in particular comes to mind:

How do I keep my lab coat white?

A quick reference check from the most trusted website on all of the internets, Wikipedia, tells us that lab coats were introduced to the medical profession in the late 1800’s to denote cleanliness. I admit, it’s very easy to tell if the lab coat gets grungy, especially around the cuffs from resting on dusty, drug residue-covered counters, or having a collection of pen-stripes above the pockets when you forget to retract the tip.

The symbol has evolved to portray trust and knowledge. To wit:

18ed_grovers_lab_coat

Image courtesy of our friends at Thinkgeek.com:
http://www.thinkgeek.com/images/products/zoom/18ed_grovers_lab_coat.jpg

Though we are far from infallible, we are trained to make judgement calls and defend our decision-making processes. This may be intimidating for many members of the public; previous generations would never dare challenge their family physician and lived in fear of disappointing them. White-coat hypertension is a very real phenomenon for many patients wary of the unknown, who build up stress in advance of an appointment, akin to waiting outside the principal’s office or prepping for a job interview.

Lab coats can be a bit on the controversial side as well. Many in professional settings eschew wearing an extra, often hot and uncomfortable layer. There is also growing concern of cross-contamination with super-bugs like methicillin-resistant Staphylococcus aureus (MRSA). There’s also the practicality argument: lab coats used in laboratory settings protect the wearer from chemical spillage on their clothes or skin. Generations ago, when most medicines were compounded, this may have been a solid stance, but then again smoking in the dispensary was also acceptable too.

My personal take? Over the years I’ve softened on the need for a white coat. As students taking pharmacy degrees or technician certification discover in their first years of study, receiving a white coat welcomes you into a strong, trusted community. I’ve always worn one, and feel pride when I interact with patients, colleagues and other professionals. The analytical side of me identifies with the science and the constant drive for higher knowledge. That said, I don’t question another professional’s preference to avoid wearing one unless it’s part of a uniform outlined by an employer or educational institution. Pharmacists find themselves in so many collaborative settings nowadays, be it committee-work, nursing homes, regulatory, administrative roles, etc. that are founded on relationships and trust that go much deeper than a symbolic white coat. In public forums, there’s no mistake that a lab coat will certainly draw attention and identify the wearer as someone who more than likely comes from a scientific or healthcare-related background (just ask any pharmacist in a grocery-store setting running to the deli for a quick lunch break).

So my point is: anyone have a recommendation on a good bleach?

 

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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Welcome to Canada

By now, everyone has heard of the Syrian refugee crisis. The Syrian people, having witnessed unspeakable tragedy and horror, are fleeing their home country in the hopes of finding a new, safer, more prosperous life elsewhere.

The Government of Canada has committed to resettling 25,000 Syrians here in Canada. It may have been naive of me but I didn’t think many of them would be coming to our humble little province. I assumed they would be heading west, to Ontario, or Quebec or even further west. How very wrong I was.

I should have known that Nova Scotians would step up to the need. Mosques, church groups and government agencies have sponsored families. They are supporting them as they enter their new lives and helping them with things we all take for granted. As of February 5 of this year, over 500 refugees have arrived in our wonderful little province and I have had the pleasure of meeting a few of them in my capacity as their new pharmacist.

My first meeting came when a gentleman and his interpreter arrived at our store asking for help with itchy skin. He didn’t have his paper that would allow him to go to the doctor, and as myself, my manager and my student all worked to find out how to get him his paper and if he could see a doctor, his interpreter kept telling us that he was saying over and over “Canada is the best country in the world.” At the end of our interaction, we all welcomed him to Nova Scotia and wished him well. We felt we did very little for him – a Google search, a phone call. But to both men, it seemed this little act of kindness was huge and brightened their day. It certainly brightened ours.

The next time I met a refugee was when a gentleman and his son arrived at the pharmacy with the proper papers in tow but not a single syllable of English. Through mime and drawings, we were able to convey to him that his son was to take his amoxicillin three times daily until they were finished. Once they finally understood, they smiled and said thank you. Apparently, in a super Canadian fashion, thank you was the one phrase they had learned.

After both of these scenarios, I was able to go home to my warm house, snuggle my fluffy cat and make a nice meal for myself. I was able to call my friends and family and ask how their days were, read a good book have a cup of tea and go to bed. As I went through the motions of my day, I was struck by how brave these people truly are. I tried to imagine myself in a country in which I didn’t understand the language. I imagined trying to navigate a doctor’s visit, a trip to the grocery store, a walk down the street. I couldn’t imagine what it would be like to have to do all of those things that I take for granted in a totally new country after having fled a war zone. And these folks are doing it with a smile on their faces! They’re so glad to be out of the war zone and starting fresh. They will have lots of healing to do, and lots of learning to do. And so will we. We have to learn how to help these people. How do we communicate effectively? How can we make them feel welcome? How can we tell them where the nearest grocery store is? These are all things that we will learn as they learn to adjust to this new, snowy place.

Despite the fact that their English was broken at best, at the end of both of my interactions with the above mentioned folks, I left them with a sentence they understood right away. As soon as I said it, either alone or through an interpreter, their faces split into some of the brightest smiles I’ve ever seen- Welcome to Canada!

For more information on refugees and what we as health professionals can do, visit www.isans.ca or your pharmacy college website!

 

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

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Inter-Professional Appreciation Day

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

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

Ever give someone a sponge bath?

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

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

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

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

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

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

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

 

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

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Team Dynamics – Greater Than The Sum of its Parts

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

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

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

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

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

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

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

Is your team ready to answer the door?

 

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

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Giving Your 97%

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

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

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

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

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

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

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

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

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

 

 

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

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Holiday Musings

We’re now within a week of my favourite holiday of the year. I prefer the giving aspect of it; my bah humbug is reserved for trying to figure out where in the house we put all the new stuff the kids end up receiving from two large and loving extended families.

It’s also a great time of year to reconnect with friends and family. We actively seek each other out to arrange gift exchanges, plan turkey dinners, decide on play-date activities for the kids, and share some holiday drinks (note – Amaretto is sweet, and complements the egg nog quite well).

On that note, I want to break from the script for a moment to mention an item I feel compelled to write about given the proximity to Christmas. There was terrible news circulating recently about a young mother from New Brunswick who had gone missing on the Caribbean island of Grenada where she lived with her husband and two young boys. She was discovered the following week under tragic circumstances. I knew this woman as an acquaintance, dating back to the wedding of one of my oldest and dearest friends. She and her husband met at university and met my friend around the same time. Their families have been close ever since; even across long distances they regularly speak and their kids are friends with each other. My thoughts have been with them steadily over the past two weeks as they try to grapple with a sober reality none of us thought possible. There has been an outpouring of emotion to honour and remember her gift to the world as a wife, a mother, a friend and colleague. Rest in peace Linnea – your spirit is alive and well in everyone you’ve touched.

‘Grief starts to become indulgent, and it doesn’t serve anyone, and it’s painful. But if you transform it into remembrance, then you’re magnifying the person you lost and also giving something of that person to other people, so they can experience something of that person.’ – Patti Smith (courtesy of Brainyquotes.com)

Read more at http://www.brainyquote.com/quotes/quotes/p/pattismith590997.html#0pAjtAV5UKBYIwHj.99

 

In reading the section above, the tone of this piece has definitely darkened more than I had hoped. This blog has and always will be a release and a look inside my experiences. Not only as a professional, but  also as a person who’s constantly trying to understand the world. The good comes with the bad, the unpleasant with the euphoric. The challenge is to avoid taking for granted good health, and the good will of those around you. Time really does march on, and we have pockets of it where everything seems right. By cherishing those moments, it really does help manage the fear and despair when those emotions come to call.

So this Christmas season, hug that loved one a wee bit tighter. Enjoy the company and just be; no work distractions, no side projects that can wait till the New Year (that’s what resolutions are for). Try to let go of slights or grudges, even if it’s just for one day. To those traveling, we wish for good weather and patience in the airport security line. To the Syrian refugees who now call Canada home: we wish you a safe and peaceful holiday season.

From my family to yours, have a very Merry Christmas and Happy Holidays!

  • Your friends at PharmAspire

 

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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Palliation – A Needed Discussion

This post is a tough one for me. The topic of palliation is deeply felt by most healthcare professionals, either via direct care or through personal experience. Although preventative medicine is the over-arching goal, we still tend to see the majority of people during periods of acute illness or marked progression of chronic disease.

My family is no different than many. Our family history is riddled with various cancer scares with at least one related death, significant heart disease, and diabetes. I have been very fortunate to date that the vast majority of my relatives are in good health; they all live in their own homes and can look after their own affairs. However, the time is approaching when end-of-life measures will become a significant topic that none of us are truly ready to accept, myself included.

Most folks are familiar of the concept of a will. The stipulations for funeral arrangements and the dividing of assets is rife with legalese to ensure nothing is left in a grey area. Lesser known is the idea of advanced health care directives, or more commonly, a living will. With Canada’s aging population, widespread education of the public will be needed to facilitate conversations with healthcare teams. Borrowing from an infographic published by the Canadian Hospice Palliative Care Association (CHCPA), one statistic referenced on the Wikipedia link (above) stands out:

Polling indicates that 96% of Canadians think that having a conversation with a loved one about planning for the end of life is important. However, the same polls show that only about 13% have actually done so, or have created an advance care plan for themselves.

Incredible. I encourage readers to have a look at the complete document for some additional eye-popping nuggets: http://hpcintegration.ca/media/56049/TWF%20double%20survey%20infographic%201pg.pdf

The timing of this topic may seem a bit strange so close to the holidays, but I’ve decided to share from my personal experience and also my experience as a pharmacist. The personal side first:

My wife and I were slow to the game. A will was something we had talked about completing but never had the interest, or urgency to follow-through. Now that we have kids, a house, a car, and even a blog (ha!), it was time to make sure we were prepared in the event of catastrophe. We recently sat with a lawyer and were so far out of our depth, it felt like standing on the bottom of the ocean. The questions being asked about asset shares, and custodial rights of the kids were met with knee-jerk responses that we honestly hadn’t thought all the way through. That bit of guidance really made a difference to our peace of mind. I’m writing this on a Thursday, and our first discussion about advanced health care directives literally just happened. Peering over dueling laptops, we agree that if an objective healthcare team determines that the line in the sand has been crossed, we are comfortable with stopping all oral treatments, blood tests, imaging, etc and focusing solely on symptom management. Just verbalizing it now and working through the what ifs (e.g., whether there is dementia or mobility issues) will allow for a degree of clarity during a stressful, highly emotional time.

As a professional, my current role is managing a pharmacy dedicated to nursing home facilities. Nursing homes have palliative care order templates with the various options for pain, dyspnea, secretions, mucosal dryness, delirium, and anxiety. When these are enacted, the expectation is that the philosophy has moved from active treatment to comfort measures. That said, the waters can get muddy when there is disagreement. If the resident is lucid and can still swallow daily medications, will changing daily routines make things easier or more stressful? If diabetes is no longer treated and blood sugars are allowed to soar, will that ultimately add to discomfort? We’ve had occasions where some oral meds were stopped but not others, or specific medications are lifted from the palliative care orders and written separately in order to have select measures in place without continuing down a chosen road. No doubt it’s complicated, and pharmacies only tend to see the medication side of things. Other support functions are invaluable during the decision-making process; chaplains, grief counselors, and social workers can all play a role to ease transitions, particularly if items have been decided ahead of time.

So this appeal goes out to as many as it can reach: the young, old, sick, healthy, families large and small. Please share your end-of-life wishes with your loved ones to avoid any uncertainty as to your wishes for yourself and for them. How do _you_ want to be cared for when you’re no longer able to process options or articulate decisions? Even though they won’t be needed for a lifetime, choices made today will mold the end of one.

http://www.cdha.nshealth.ca/palliative-care

 

 

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

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Long Hours (The days just ‘Flu’ by…)

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

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

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

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

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

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

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

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

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

 

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