Tag Archives: Pharmacy

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The Term Accessibility: It’s Gaining a Double-Edge

It was a hot sunny Thursday in July and I’m finally starting to feel a bit better. The previous two weeks were a collection of progressive symptoms from dry cough, then wet cough, then sinus block, then pain in the diaphragm, culminating in a wheezy mess with some shortness of breath mixed in. I’ll save the vibrant descriptions of the sights and sounds emanating from my lungs, but let’s just say that both my condition and demeanor were quite phlegmatic.

I was just recently contacted for a new family practitioner. My former physician retired in November of 2022 and the waitlist finally reached my name. Unfortunately the intake appointment was not for another three weeks, so the next Monday I decided to research booking an appointment at a local after-hours medical clinic. Looking at the government website, it listed nine locations in the province. In checking the hours of each, I discovered that only ONE (1!) had hours listed for the day, but it was an evening clinic from 5-9pm, located over an hour away, AND you had to pre-book an appointment. A pharmacist-led walk-in clinic no doubt would have resulted in a referral, so I decided to hit the nearby hospital emergency department.

I’m very fortunate to not have been in need of any medical intervention during these past few years. As such, navigating the current system as a patient was foreign to me. With all of the changes introduced throughout the pandemic, and a severe shortage of family practitioners, I was unsure of whether my situation warranted a spot on the emergency department triage list.

I rolled the dice and parked in the 4-hour parking lot, hoping it’d be enough time to at least get through the preliminary assessment. Hearing horror stories of 9-hour waits meant I’d be moving my car at some point. There were three steps: 1) Triage, 2) Registration, and 3) Wait for your name to be called. The first two were fairly quick, within 45 minutes, and I settled in for a lengthier stay. At this point of the morning, the monitor hanging above the department conveyed there were 25 others sharing the waiting room, with an additional 73 patients already within the unit. There were plenty of people in and out of the doors, but my perception was that there were very few in visible distress. It did appear that like me, many were orphan patients that needed attention or follow-up for chronic conditions, and had very few options other than wait their turn.

I received an ECG (requiring a wee bit of shaving) and chest x-ray before receiving a diagnosis of atypical pneumonia and a couple of prescriptions. The whole process took about 3 hours and 45 minutes. When I got back to the car my thought was that I made out like a bandit. I may have been classified as a 3 – Urgent on the Canadian Triage and Acuity Scale but to be in and out under four hours? I had plenty of time to drop off my orders at the pharmacy for filling and be home in time for supper.

Then it occurred to me…

Why don’t pharmacy practitioners enjoy a similar grace? Why is the on-demand nature of pharmacy services becoming such a flashpoint for patients and practitioners alike? With burnout reaching a fever pitch, methods for protecting pharmacy staff should include mechanisms that give a similar control over triage and capacity to address patient needs. Inevitably, this has led to sombre reflection on one of the singular tenets of pharmacy practice for as long as I can remember: accessibility.

The pharmacy profession has long touted accessibility as a calling card. For decades it was understood that pharmacists were relatively underutilized; as drug experts, there was significant education provided towards pathophysiology, medicinal chemistry, pharmacology, and evidence-based disease state management. Although diagnostics were not a focus, inter-professional collaborative practice allowed for plenty of exposure to assessment and documentation. Pharmacists achieved a degree of comfort with many common self-limiting ailments and the savvy to make strong referrals for medical interventions beyond their scope. The public were initially wary, and advocates really pushed for pharmacy to shoulder more of a primary healthcare burden.

When the pandemic hit and services became increasingly scarce, once again pharmacy professionals did their best to position themselves as a trusted point of contact for patients in need. Whether it be a long-time patient needing renewals on their diabetes medications, or an orphan patient with uncontrolled hypertension needing an adjustment in therapy, pharmacy staff did their absolute best to intervene and monitor those conditions.

In fact, they were so successful in delivering that care, the public quickly recognized the value and convenience, which began to affect conventional dispensary workflow. Investing and dedicating staff to provide these clinical services has come with a new suite of challenges, with two of the major ones being 1) the transition from a ‘walk-in’ to an appointment-based practice, and 2) inconsistent / confounding funding models for service provision. Yes, pharmacists are legally permitted to perform a range of prescribing activities, however many are subject to conditions or restricted to specific scenarios to be eligible for coverage. Depending on your province or jurisdiction, the management of clinical problems may differ somewhat.

A current example is the recent statement from the Government of Canada regarding the shortage of combination pain-relievers containing codeine and oxycodone. Due to a manufacturing disruption, these products are in short supply for the next few months. As acute pain relievers, these medications are used as part of recovery regimens for minor dental and surgical procedures, as well as critical options for breakthrough relief for many patients with chronic pain syndromes. On the front lines, pharmacists are feeling the brunt of this problem; patients are upset and nervous that their therapies will be disrupted. Potential solutions could include therapeutic substitutions and prescription adaptations within a pharmacist’s scope, and in many cases those services are now expected. At issue is the underfunded time spent to provide these services, which make it exceedingly difficult to plan ahead and increase capacity within existing pharmacy practices without taking substantive risks.

So the question remains: how does the profession stay accessible whilst controlling that same accessibility? Although I am apprehensive of the idea of using a weapon to illustrate a concept, it stands to reason that there is inherent danger in how the issue is handled. If this accessibility ‘sword’ isn’t properly balanced, it could risk bringing harm to the patients (less access to timely services) or to the practitioners seeking to provide quality care (more access but without proper supports). It’s delicate, but we’re well on the way to finding the new sweet spot.

It will take practice and discipline, but we are more than up to the challenge. Of course, changing behaviors and perceptions is a huge undertaking, however the pharmacy community has proven itself to be incredibly resourceful and resilient. We will continue to lean on each other as we grow as clinicians. I strongly believe the solutions we need are all here within the community. In a future post we shall endeavour to review some strategies and generate even more discussion.

Make no mistake, in a short time, we will become proficient in wielding this accessibility sword and achieve that proper balance. The healthcare system will benefit, the pharmacy teams will benefit, and the public will benefit most of all.

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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Post-Script – Re-Visiting Pharmacy

Regular readers of this blog have noticed a pronounced swing towards travel and personal interest pieces. The 10-part Odyssey was borne out of a desire to relive my recent trip to the US last August whilst learning and sharing various anecdotes along the way. This was never intended to be a permanent shift.

This is not a travel blog, but rather a pharmacist who happens to be writing about travel.

Let me explain…

It has been over a year now since my pharmacy career was interrupted. Using a simple sports team analogy, there was a change in strategy. I was summarily substituted from my role and took my place on the sidelines.

When I wrote Changes & Choices, it was about embracing the opportunity to evolve and grow in unexpected ways. It was about feeling those nerves when attempting a new task or planning a large project. It was about surrounding myself with supporting voices that cheered and challenged, lifted the spirits and tempered the expectations. It is a huge relief to have mentors for strength and guidance through the emotional whirlwind. They continue to keep me hungry and excited for what’s next.

Part of this sabbatical was to take a long, hard look at my track record to date; as an employee for sure, but also as a father, son, brother, spouse, and friend. How has my career trajectory impacted those around me, and my own sense of self? How have I adapted through the years, mentally and physically? How did I foster leadership with my teams, and how did I ask for support from my leaders when I was struggling?

This trip was emblematic of that reflection. Taking two plus weeks off in the middle of August was not something I had ever done before, as a relief pharmacist, as a manager or in any of my corporate roles. When there was vacation, often it came with frequent email and text check-ins to arrange coverage and respond to emergencies. This time the focus was on my parents, my fiancée, and enjoying every adventure along the way. The people we met, the towns we explored, the places where we ate, and all the miles in between were healing in so many ways. Those memories are forever, and brought out the best in me.

Truth be told, this blog was borne out of a similar reflection 12 years earlier (I repeat….12 YEARS). At that time, I made the decision to take a step back from a middle management pharmacy role and return to the front lines. The practice of prescribing was new for the profession and many pharmacists were grappling with the ethical dilemma of both prescribing and dispensing medication. Seeing your name on a prescription vial really was a vital step to owning the process. With turf battles being waged with other professional associations and exacting reimbursement criteria, confusion reigned for a time. On this front, I had a conservative approach; focusing on the diagnostic assessment as opposed to the resulting prescription felt like a solid starting point. The valid counter to this was to take the narrow expansion of scope and identify patients who would benefit. For example, we could now prescribe for cold sores, so cruising the OTC aisle for customers asking for Abreva or Lipactin would provide an opportunity for a consult and to educate the public at the same time. Stomach and sleep remedies were also popular. Unfortunately, the general assessment itself was not subject to funding, but was instead tied to specific prescribing activities.

The issue was quite simple: the operational side of me was aware of the possibilities that would come with dogged execution of our newfound abilities, but the burgeoning clinician in me wasn’t ready to take the plunge. I needed to be confident in my own practice before coaching others to navigate the change. It was tough to step down the ladder, but it was necessary and allowed me to be more effective when I received the chance again.

So here I am on replay, but this time I have a better idea of my strengths and weaknesses. I have explored different work environments and practice settings, if only to see if I can picture myself thriving in different roles. I have become more involved in advocacy and regulatory committee work, so It’s not a question of if…it’s when! The pharmacy profession continues to be a huge part of who I am, and want nothing more than to continue my contributions.

Therefore this pharmacy blog shall continue…and I can’t wait for that next piece of inspiration.

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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Chased By The Dinosaur – Part 2

Back in Part 1, we took a brief look at the pandemic’s impact on pharmacy and the substantial wave of change we face from primary dispensers to primary clinicians.

This evolution has been occurring over the past decade since medication reviews and minor ailment prescribing were first offered in a number of provinces. With post-pandemic reopening, the difference now is that pharmacists are no longer carrying all of the burden to promote and create public awareness of accessible, pharmacy-driven clinical services. You could easily argue the opposite; members of the public are coming to expect and demand that pharmacy fill gaps in the healthcare system, particularly with assessments and disease-state management. This demand is driving innovation and challenging the very image of a standard dispensary that has existed for as far back as most can remember: a pharmacist in a white coat standing in the middle, surrounded by support staff who are greeting customers and filling orders.

To wit, I am very proud of my company’s latest partnership here on the east coast! It’s a pharmacy model that eschews the reliance of imagery that uses counting trays, pills in bottles or ointment jars to promote pharmacy. Instead the focus is on allowing pharmacy to be available for orphan patients, and better triage healthcare needs. This should help reduce the glut in emergency rooms, decrease wait times for services, and aid in the management of various disease-states.

So with all of this pushing forward, is there any hesitation? Perhaps, so let’s dive in.

First off, I have never spoken to anyone in the profession, from students, to recent retirees in all pharmacy environments, that hasn’t endorsed giving pharmacists increased latitude with respect to clinical decision-making. I have heard plenty of stories where pharmacists did indeed have a better understanding of a patient’s needs but recommendations to a prescriber were either ignored or rejected. When they first appeared in the standards, some held trepidation that they could perform injections or diagnose minor ailments. When the title of pharmacy technician became regulated around 2010, it took awhile for the profession to integrate the role.

Counting my university degree, this marks my 25th year as part of the profession. Relating my introduction into pharmacy practice with PharmD graduates of today is quite the discussion. I do tend to forget how much has come and gone until someone reminds me of something notable. For example, I recall when statins were being hyped in the late 90’s as a game-changer in lowering cholesterol and reducing cardiovascular risk. We learned the mechanism of action of these HMG-CoA reductase inhibitors in lecture. When Zocor (simvastatin) was approved in Canada during 1999, Merck shipped sleek boxes containing foil packs of shield-shaped tablets that served as a conversation pieces in the dispensary. There were a bunch of similar drugs introduced in the coming years and most are still available in generic form today. One notable molecule lost in the annals of time was Bayer’s Baycol (cerivastatin), that was pulled from the market in 2001 due to alarming reports of rhabdomyolysis, a condition caused my damaged muscle tissue releasing proteins and electrolytes into the blood. Another emerging drug class in the early 2000’s were the COX-2 Inhibitors for arthritic conditions. Effective for inflammation but less corrosive to the stomach lining than previous therapies, physicians were handing out samples for Celebrex (celecoxib) and Vioxx (rofecoxib) to patients eager to find relief. Unfortunately, the sheen came off of this therapy class due to evidence of increased heart-related events, and subsequent removal of rofecoxib from the market in 2004. It’s worth noting that these variants were pulled voluntarily. Both classes are still widely used and provide significant benefit to scores of patients worldwide. The takeaway from me was recalling the countless conversations with our scared and/or upset patients that needed to look for alternatives.

Further skipping down memory lane, we reminisce of the days of writing third party credit claims on carbon copy forms and counting pill bottles to manually create drug orders. There was no internet, no email, or laser printers. Every store had an outdated Remington’s reference and CPS versions dating back to the 70’s. Smoking was still permitted in workplaces until the mid-2000s. Older physicians wrote for arcane drug names like Ilosone, Ledercillin, and Doral. We wished that all pills were shaped like Premarin because of how they spread out on the counting tray just right.

The good news is that some things haven’t changed too much:

  1. Patients still need us to guide them through the healthcare system and trust us to be their advocate.
  2. An appropriate drug regimen can manage disease and significantly increase quality of life.
  3. Relationships made within the pharmacy community last for careers and beyond.
  4. We still feel rewarded when patients bring their baking at Christmas as a show of their thanks.
  5. Mentors are valuable no matter when or where you are on a career path.

The last point is resonant on a few different levels. When I graduated, the world was an oyster. I had a brain chock full of the latest guidelines, all the me-too drug names (brand AND generic) and 15 minute counseling monologues to deliver on each. My preceptors valued my ability to find the best answers to clinical questions, and my eagerness to create algorithms for the staff. They would admit to feeling like dinosaurs; their knowledge was a bit dated, and that we forced them to step up their games. On the other hand, I would marvel at how they would be so relaxed with a cancer patient, or be able to pick out the three most important items on a counseling document. It amazed me at the ease of which interaction risks were contextualized with the history and desires of the patient. Finally, I appreciated when they had the perfect piece of friendly advice for every situation I would encounter.

So now that I am a full generation away from that first shift, I could acknowledge that I’m too far behind, start coasting and risk being eaten whole, but I refuse to throw my hands up in the face of massive change. The work experience gained and relationships forged over the years will serve me better now than ever before. I may offer perspective and guidance to ensure new clinical tools are properly integrated into a struggling healthcare system. The advice that I still receive from my mentors may now be dispensed to the next wave of practitioners. We will complement and support each other on our respective journeys.

For those of us beyond the first leg of our careers, the dinosaur running behind us is fading further behind. The only thing at risk of extinction is the notion that our value to the profession is somehow diminished. Whether you have 5 years, 15 or 50, the quality of patient care you deliver every day will never get old.

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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Time is Relative

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

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

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

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

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

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

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

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

 

 

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

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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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Sharing a Vision

“Vision is the art of seeing what is invisible to others.” – Jonathan Swift*

The author of such noted works as Gulliver’s Travels and A Modest Proposal offers this piece of wisdom for anyone in a role that requires forward thinking and plan execution. My favorite part of this quote is the word ‘art’ being used as a descriptor. Art is creation; it’s translating ideas and intuition into reality. That’s the power of the human mind: what you see could very well be invisible to those around you, but those around you are also seeing things that may be invisible to you. When I graduated, the idea of paid medication reviews was foreign. We were available to the public for all of their medication needs, whether it be a 3-minute consult or one lasting half an hour. Those off-hand medication reviews were not formalized or necessarily valued as they should have been. It wasn’t until a small group lobbied associations and governments to fund these services that they started to appear.

The best part? Vision as an art, is not defined in black and white. It’s like a rainbow in that every person views through their own prism; the conditions and viewing angle are unique and the person directly next to you will not capture the same arc or brilliance. Whether narrow or broad spectrum, a vision is defined by a person’s individuality, style and skill-set. Those same medication reviews now have a framework, but it’s up to each pharmacist to create value for their patients and for themselves as practitioners.

Now anyone can be artistic but most often the quality is measured by social perception or taste. Do you have a favorite genre of music? How about painters or sculptors? For those that don’t thrill you, does that make the artist any less talented or the art of poorer quality? Does anyone remember the controversy when the National Gallery of Canada spent $1.8 million dollars to buy the Voice of  Fire? Regardless of our own opinions on Abstract Expressionism, this piece was a result of Barnett Newman’s vision and is admired and appreciated by many. If you are interested in viewing more of Mr. Newman’s works, please visit: https://www.artsy.net/artist/barnett-newman

So if everyone has artistic capability and may see things others can’t, why do certain folks stand out in the crowd as being visionaries in their respective fields?

 

‘Great leaders communicate a vision that captures the imagination and fires the hearts and minds of those around them.‘ – Joseph B. Wirthlin*

It’s rather difficult to formulate an opinion or contribute to a vision if you’re not aware it exists. That song on the radio was written, arranged and recorded, but until it was promoted there were few listeners. Van Gogh was certainly eccentric but if he had never dared to show his canvas to anyone, it’s doubtful he’d have much of a place in history. In the Canadian pharmacy world, our leaders have provided the Blueprint For Pharmacy and on an increasing scale, policy decisions are being made in reference to the Blueprint vision.

We are all experiencing enormous change integrating these new clinical services to current practices. Our local leaders are communicating their visions through provincial associations and government relations. Demonstration projects are popping up in Nova Scotia in the form of the Bloom Program and funded minor ailment prescribing. Perhaps there are plenty of items happening that were once invisible to you. By the same token, it’s up to us to communicate our visions as well. Insert yourself into the discourse and create your own art for how your future should look. Have a supportive family doctor in the clinic that performs home-visits? Perhaps there is an opportunity to collaborate on a disease-state management program. Interested in reading lab screening for thyroid disorders? Someday, endocrinology may be needing our help to identify red flags or coordinating dose adjustments. There is no wrong answer or approach so don’t be afraid to apply your style.

After all, you’re seeing things no one else can; only you can make them visible.

 

*Quotes courtesy of Brainy Quotes – http://www.brainyquote.com/

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

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It Comes in 50 Shades Apparently

A few years back, I was hosting a segment of our yearly 2-day orientation session for new pharmacist hires to the company. Most were new graduates but some were coming to us from other provinces and/or chains.

I was aware that a certain book was making the rounds at about that time and somehow my improvisational skills led me to drop the title with respect to the new expanded pharmacy scope. To my ‘surprise’, at least 3 people in the audience were in the midst of reading this book and were justifiably confused (though intrigued) by my seemingly random tangent. Although pharmacy is an exciting place, it seemingly pales in comparison to the plot of a story I should have spent more time investigating.  Now, I have never read the book and understand it to be a wholesome story of two people that meet and enjoy going for coffee, holding hands and don’t-you-dare-leave-this-book-laying-around-anyone-under-18.

After about 30 seconds, folks started reaching beneath the tables to gently pick their jaws back up from the floor. Queue the giggling. I enjoyed the mid-morning giddiness myself.

My point was that pharmacists, in a general sense, are used to having set rules to follow. Now every profession has rules in the form of guidelines, regulations, acts, or policies. We also have best practice memos to further help direct and support us as individuals. These documents are vital to minimizing liability as practitioners while stressing public safety. Those rules prior to the legislative changes meant we had our comfy room in the healthcare house; the boundaries were established and many scenarios had played out countless times. Black, meet white. Now, if somebody came to the door of the pharmacy room and invited you out, then you would have a taste of collaborative practice and it seemed like a treat. It was like being allowed to eat at the big-kids’ table at Thanksgiving; an experience you’ve waited for and look forward to the next time it happens.

So enter the blueprint of pharmacy and changes to pharmacy acts across the country. We now replace the walls to that comfy room with strips of yellow duct tape on the carpet. Now you can see the hallway, or venture into the next room without needing approval. You know where you used to spend all of your time, but your space got a whole lot bigger. Needless to say, each scenario with medication reviews, prescribing, administering, or ordering blood tests is new to everyone, and therefore virtually impossible to predict. Becoming a clinician means a certain degree of trial-and-error, and judgement calls based on the best information possible. There may not be a tidy ‘right answer’ or a similar situation on which to build.

As we gain confidence in our worth and abilities, many pharmacists may completely leave their yellow outline and settle in different areas of the healthcare house. They may join travel clinics and vaccinate full time, or perhaps pharmacists may liaise with physicians’ offices to perform medication review consults in their offices. They may become more visible and independent in rural communities as they perform minor ailment and emergency prescribing services.

In each possibility, and for each and every pharmacist delving into said opportunity, there will be fifty shades. You will be making decisions and backing them up with gusto. You will be challenged from time to time, but so is each and every health professional out there.

Embrace the grey. Explore the new rooms. Make yourself at home.

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

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Pharmacy Technician Regulation and My Journey To Become Licensed in Nova Scotia

Greetings pharmacy community! I am a pharmacy assistant in Nova Scotia and was asked by Devin (ages ago – sorry Devin!) to write a bit about the adventure I have been on to become a regulated pharmacy technician, and how I feel about the process.

When I began as a pharmacy assistant in 2007, regulation wasn’t even a thought in Nova Scotia. I was hired as a “pharmacy technician.” I was told to “listen to the pharmacist and do everything they ask you to do – they are your direct supervisor on shift, and you are there to support them and the work they do.” So I was trained on the job and became what my pharmacist needed me to be.

I loved my new job! I enjoyed helping my patients, and taking phone calls (even if I was confused as to which “little white pill” my elderly patients were looking to have refilled), filling scripts, and learning everything I could from my pharmacist. For the first time I felt like I had found purpose in what I was doing, and I was quite satisfied with my work. Yes, there were challenging times and tough questions, but there were funny moments as well.

To condense my tale, I ended up working at a very busy retail pharmacy that had a lot of unique things going for it.  As I was away from home, family and friends, I started looking at pharmacy websites and reading about the pharmacy technician regulation process that was happening in Ontario and Alberta.  I decided that this was the next step I wanted to take in my pharmacy career. To do this, I felt I  that needed a bit more knowledge of pharmacy laws, pharmacology, etc. In the summer of 2009, I purchased a few text books, and began to study the NAPRA, PANS, and NSCP websites in anticipation of writing the PEBC Evaluation Exam. I wrote the Evaluation exam in Halifax in April of 2010, with a room full of other hopeful candidates.

And then the waiting game began. As everything was new and nothing was in the Pharmacy Act, I, along with countless other assistants in Nova Scotia, could go no further. In 2011 we finally heard word that we could begin taking the four Pharmacy Technician Bridging Programs being offered through various colleges online (now only being offered by Selkirk College). I completed the final course through Humber College in the spring of 2012, and wrote the PEBC Qualifying Exam (MCQ and OSPE) in March of this year. It was a terrifying experience – so much rested on my abilities and knowledge, and at times I felt like I was failing miserably. I questioned whether I could ever be successful as a pharmacy technician. However, in May I received word that I passed the PEBC!

And then more waiting. Was the new Pharmacy Act ever going to get passed? No one was sure. I didn’t think that I would stick around Nova Scotia much longer, and so in July I started looking into the process to move to Ontario and pursue licensure through their process. Thank goodness that I didn’t! At the end of July we found out that the new Nova Scotia Pharmacy Act would be passed and in effect on the 6th of August! A bit more waiting as many changes were made in the Act (including the ability for pharmacists to give injections to their patients -go and get your flu shots!). Then news came that the NSCP would be offering jurisprudence exams for hopeful pharmacy technicians. I didn’t do much preparation as I used to spend hours on the website, but I did bring a binder stuffed to the hinges with everything I could think of to print. After all, you don’t necessarily need to know 100% of everything for pharmacy – but you do need to know where to find the information you need and how to interpret what you find. The exam was offered last week, and so now I am waiting on the results.

The final step is the Pharmacy Technician Assessment (PTA) which is being offered sometime after December, and once I am successful with this aspect, I should be ready to register as a pharmacy technician!

And so I return to Devin’s original request when he asked me to write for PharmAspire and talk about how the whole regulations process has been. I’d be lying if I said it was an entirely awesome, stress-free experience. Tears have been shed, and drinks have been consumed after exams. There has been so much preparation and anticipation; anxiety and agitation, but also excitement and that feeling of pride once another step in this five year process was achieved successfully.  I can say that I have learned so much through and from the process that I feel I can take on anything! My understanding of pharmacology is so much better (“Your little white pill? You have two on file. Were you looking for the one for your blood pressure or for your diabetes?”) and I feel like I am able to assist my patients more effectively and efficiently.  I am already putting to good use the knowledge that I have gained, and only hope that I can be utilized further once I am licensed to do so.

And so that’s been my journey thus far!

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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 Quest for Job Satisfaction – Choose Your Own Adventure

What does job satisfaction mean to you?

-Really-

Have you ever thought about it? Is it the wage you earn or the vacation you accrue? Is it winning arguments with colleagues or landing that huge business opportunity? Is it directing a team or nurturing individuals in their roles? Are you proud of work accomplishments?  Is it the value you provide to the operation/team/public?

Is it all of the above?

True job satisfaction doesn’t seem to follow a formula or template. If it does, I certainly have been looking in the wrong places. My personal adage is simple and goes something like this:

Job satisfaction is not something that anyone can give to you, be it the boss, your colleagues, or your friends. You have to want it, you have to recognize what adds to (or subtracts from) it, and most importantly, you have to feel it.

The quest part represents the fact that we never stop growing, and therefore the source of your personal job satisfaction may evolve over time. Tasks or responsibilities that were once daunting start becoming less of a challenge. The environment you’re in may shift and offer new and exciting opportunities of which you may want to take advantage.

The new pharmacy landscape will offer plenty of potential niches to fill, ledges to reach for, wide open spaces to explore, and peaks to ultimately summit. This quest, should you choose to accept it, requires an open mind and an awareness of current personal or logistical limitations, as they may impact the first direction you choose to go. You may also need a few things:

1) Mentors – folks you look up to and make you think. It’s in their nature to push you places you may not go otherwise.

2) Leaders – Provide a vision for where pharmacy is going. Well-respected in the community and among their peers, they motivate and set the tone for how we may approach perceived barriers (i.e. – public acceptance of pharmacists providing flu shots).

3) Supporters – Colleagues, peers, friends, family. This network forms the glue that keeps your aspirations focused and achievable.  If you need a boost, they’re right behind you and really mitigate the negative slides.

4) Resources – Could be people, but more often it is information. Ask questions, read whatever interests you. Whether it’s renal failure or cancer research, mental health or menopause, stoking those passions will provide insight into what really gets you out of bed in the morning.

So choose your own adventure. Just like the book series, take it a day at a time and when you have a choice to make, be convicted and accept the consequences on the random page you end up flipping to. I for one am looking forward to exploring all the possible endings. Are you?

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Inspiration

It comes in many forms…sometimes it can be subtle, sometimes succinct and other times, it bashes you over the head and leaves you in the alleyway wondering what the next step might be.

The pharmacy climate is changing faster than most of us ever thought possible. Legislation has been tabled in many parts of the country allowing pharmacists to make and own drug-related clinical decisions for patients with the intent of allowing quicker access and better-quality healthcare in all practice settings. With these changes also comes a need to adopt a philosophy towards how we approach drug-related problems; we are no longer simply drug experts to be used as a resource or to provide recommendations, we are entering a realm where we are able to assess independently and have final authority on therapy decisions within our scope. Needless to say, many of us are struggling with whether or not we will be comfortable in our new surroundings and/or will we still excel in our roles as consumer expectations change.

The profession of pharmacy has given me plenty over the last 15 years: an education, a lifestyle, growth opportunities, and a perspective on healthcare that alternates between cynicism and excitement. Most importantly, it has provided me the chance to meet and learn from so many fascinating people. Though not an exhaustive list, there are pharmacists, students, doctors, social workers, nurses, NPs, business people, educators, mentors. Those folks are the real reason behind this blog. I truly believe that the answers to every obstacle are already among the group and are waiting to be discovered through engagement and networking.

That said, this site is intended to be a forum where leaders within our profession can provide opinions, commentary, and brainstorm possible solutions to all things known or unknown. There may be debate, and there may be reality checks, but the tone will be constructive and provocative.

Hopefully, we can inspire each other and ASPIRE to become the practitioners we want to be. The tagline captures the attitude: ‘The practice of pharmacy…On your terms…In your terms’.