Tag Archives: Pharmacy technician

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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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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.