March 10, 2020
Interview: The hospital pharmacy team deserves a closer look – and Pharmacy Awareness Month is a good time to do it
March is Pharmacy Awareness Month and as leaders from the Canadian Society of Hospital Pharmacists (CSHP) explain, there is a lot more to hospital pharmacy teams than we know.
Pharmacists and pharmacy teams play an increasingly important role in the clinical care of patients. We celebrate their contribution and educate Canadians about the services pharmacists provide every March during Pharmacy Awareness Month. In recognition of Pharmacy Awareness Month, HealthPRO spoke to Tania Mysak, CSHP President and Jody Ciufo, CEO of CSHP. For Tania and Jody, the true value of Pharmacy Awareness Month is highlighting the contribution of hospital pharmacy teams and making their work understandable and tangible not just for patients and families, but for other healthcare professionals as well.
What is the importance of Pharmacy Awareness Month?
From the perspective of hospital pharmacy, we’re not nearly as visible to the public as the community pharmacy is. It’s not uncommon to discover that people don’t know hospital pharmacies even exist; they don’t think about where the drugs come from, how they get there or how all this comes together. I think within the hospital system, we have a fairly high degree of awareness with our peers, but when we plan our events during Pharmacy Awareness Month we try to go to public areas of the hospital to remind patients, visitors and families that we are here and what we do to ensure that patients are getting safe, effective care.
Pharmacy Awareness Month is important for building awareness not just of pharmacists, but of the whole pharmacy team, including our pharmacy technicians who are playing a bigger role in how the department runs and the distribution component. Not every unit has exposure to clinical pharmacists and the role we play behind the scenes in policy development or pre-printed orders, things like that that really speak to safety but are not as obvious as the person standing in front of you or the person who answers the phone when you’re missing a medication or you have a question.
There are often misconceptions about what hospital pharmacists do. Usually people assume their work centres on the distribution of meds. Distribution channels are extremely important but it’s not about counting pills.
Our work is truly clinical in nature: we advise on the best possible use of medications and we factor into the full patient outcome during their stay in hospital.
There have been a variety of studies that point to the fact that when a pharmacist is engaged in the clinical care of the patient, they see faster releases from hospital and fewer patients being re-admitted in the short term. There is data there, but people aren’t going to read through pages of scientific studies to find that out. So, this is where Pharmacy Awareness Month is really helpful; it takes the valuable contribution of the pharmacy team and makes it digestible, understandable and tangible for patients but also for other healthcare professionals.
What makes you proud when you think of the hospital pharmacist and what they contribute to healthcare?
Reflecting on what I saw when I was a student doing a rotation in a hospital setting to what we expect now, we’ve come leaps and bounds. Pharmacists are fully integrated into the team, we participate in rounds, we’re taking responsibility for managing medication therapies. In Alberta, our pharmacists are prescribing and really taking accountability for seeing through safe, effective medication practice. It’s a huge change from when we would just drop in when there’s a problem, provide a suggestion and leave it for someone else to make the decision. Pharmacists are very much there, proactively seeking and driving care forward and I think that’s amazing.
Hospital pharmacists have transitioned to being on the leading edge of the continuity of care that is taking place – making sure that when patients are discharged from hospital there is a counselling process in place, so patients understand the medications they are taking and the things that might have changed. They are also instrumental in making the connection with community pharmacy.
I think what’s just as important as the patient interactions is the idea of practicing to scope: making sure the pharmacy team is fully integrated into the healthcare professional team looking after the patient – being part of the briefings, clinical discussions, the best practices, making sure the patient is on the right medications, and really having fulsome discussions with other healthcare professionals.
This year’s Pharmacy Awareness Month theme is clearly focused on patients and what pharmacists have to offer as both subject matter experts and patient advocates. Can you tell me some of the challenges we continue to see when it comes to patient safety in the realm of hospital pharmacy?
There are a couple of things – the first is something HealthPRO is intimately familiar with and that’s the challenges around drug shortages. This has a huge safety impact because you have to look at whatever alternative is being offered to what drug is on short supply – those alternatives aren’t always easily substituted or there is potential for risk or error when you are making substitutions. There’s also the possibility the pharmacy will be asked to compound (this happens more often in the hospital setting than the community setting, just because of the volume we make of intravenous medications). We might not be able to make the medication a certain strength so we’re asked if the pharmacy can make it a different strength. There are all these tentacles of potential error that you have to walk through to ensure that you are still ultimately providing a safe product for the patient.
The second big challenge is that expectations are changing around how technology supports patient care, whether it’s through electronic charting, barcoding, etc. – all of those are huge change management pieces. From my work experience, I’ve seen the important role pharmacy and pharmacists have had in laying the groundwork and making sure our foundations support an effective and safe system. All these little pieces have to connect together – from making sure a product is barcoded and that the systems support the right clinical software – so at the end of the day, it’s seamless to frontline staff and the patients. The science is always changing, what we’re learning is always changing, the ability to measure the impact on patients and staff is always changing. You need to be continuously vigilant and look for better and safer ways to do things.
Drug shortages are truly a problem in hospitals across the country. Managing these shortages – for all health professionals and certainly the pharmacy team in the hospital – eats up a terrible amount of time.
There are a variety of things we pay attention to in order to make sure this doesn’t impact patient safety. Something as simple as re-packaging for example. If there is a drug shortage in one item, it might only be a brand switch, but if the brand comes in a different package that raises the risk of error because as humans, we innately look for what is familiar. Then you look at differences of strength and size of meds; if you get a vial that’s filled with the same medication but is a different concentration, it might need to be prepared differently. These are the details that pharmacy teams are dealing with and it’s multiplied exponentially when dealing with shortages. Yes, there are checks and balances to reduce the risks, but everything has to be communicated through the entire drug supply chain and this creates a higher possibility for error.
What CSHP initiative are you most excited about right now?
It’s a time of big change at CSHP – we have a new CEO; we’re changing how the office works; and we’re really trying to reinvigorate the Society to look at how we can best support pharmacy practice, both in education and in pursuing practice excellence.
We’re also looking at how we can incorporate pharmacy technicians into that as well because they are an emerging profession with their own voice and issues requiring advocacy. Previously, technicians were not a regulated profession and pharmacists assumed responsibility for anything pharmacy-related, but now that they’re regulated, pharmacy technicians have much more accountability in terms of how the system works. A lot of what we do in our professional spheres is aimed at ensuring we include the technician role and voice. For CSHP, as an association, it’s looking at how we can also build those connections and advocate for these things collaboratively.
Membership associations are going through an interesting period right now and have been for a few years – we’re seeing declines in membership because so many things are changing across the country and internationally. More specialty organizations are starting up, so people have a lot more choices about where they spend their membership dollars.
We’ve got a fantastic Board that is really enthusiastic about addressing these challenges head on. They’ve approved a strategy outlining where we’re going to invest in the association: its products, its members and its services over the next three years.
One of the first elements of that strategy was creating a marketing and communications department. We have done some amazing things on the advocacy front and in pharmacy practice but when we don’t formally talk about it, our members don’t realize what we’re doing. It’s important that we share that information with people.
Another important change is bumping up our contingent of pharmacists in the office. I’m not a pharmacist and it’s essential that we have a senior, respected person to lead the pharmacy practice, so we created a new Chief Pharmacy Officer (CPO) position. In addition to bringing on Christina Adams as CPO, we’ve supported that department by adding two new pharmacy practice specialists. It’s really a matter of amplifying the commitment the organization has made to providing assistance, direction, and guidelines to our members and concrete advocacy on things that hospital pharmacists really care about.
If you could share one piece of advice with someone preparing to become a hospital pharmacist or pharmacy technician, what would it be?
I would say stay open to change. I don’t know if I could have anticipated how much things were going to change over the course of my career, but I do know looking back now, that change is a huge part of it. When you’re being pushed to your uncomfortable zone, that’s when you’re going to do the most learning and the most growing professionally and personally and to not be afraid of that. We often are hard on ourselves as pharmacy professionals and in healthcare in general for being risk averse and I think that’s true, but there is something to be gained from trying something that hasn’t been done before and just being open to that possibility.
This is going to sound self-serving but it’s true! I would really recommend that anyone interested in working in a hospital or collaborative healthcare setting as a pharmacist or pharmacy technician should become involved with CSHP. It’s all about networking and understanding the potential that exists for making a difference in patients’ lives. What has really struck me since I joined the association is how discussions are genuinely focussed around patients. When we’re talking about policies and position statements we’re developing, there are always pharmacists at the table asking, what is the end result for the patient? It’s not a token question – the people who are engaged really mean this. We’re not going to advocate for practices unless we can demonstrate that whatever program this is, it has an outcome that is proven to be effective for the patient.