By Julie Schmidt, Pharm.D., BCPS, clinical pharmacist, Bronson Methodist Hospital, Kalamazoo

It is safe to say we have all heard of the opioid epidemic currently happening in our nation and the effects it is having in our communities. If you are not aware of this situation, please refer to our mainstay pharmacy reference, Google, where you will find countless articles regarding the detrimental effects these medications are having on people and communities. What may not be the first article that pops up is an article about a local pharmacist with an opioid addiction, or a nurse caught for “pocketing” the fentanyl she pulled from an automated dispensing cabinet that was really supposed to be given to a patient. While you may not exactly find these specific stories on Google, I can assure that you will find plenty that share extreme similarities. While the rest of the nation continues to fight the opioid epidemic in the streets, perhaps we should take a little closer look in our own workplaces.

Data from the American Nurses Association report that about one in 10 nurses are thought to be abusing drugs and may be impaired while taking care of patients. While the overall incidence of drug abuse is about the same in healthcare workers compared to the general population, healthcare workers have some exclusive patterns to their population regarding drug abuse. For example, healthcare workers are more likely to misuse prescription medications as compared to street drugs since prescription medications are often easy to access. While healthcare workers experience every day stressors just like the general population, they are also known to experience stress from handling patient illness and death, long hours and demanding work. Unfortunately, the misuse of these medications not only affects the one abusing them, but they may also directly impact patients. As a result of diversion in a healthcare setting, patients may receive diluted medications, infections from contaminated needles/syringes and potential errors if the healthcare professional is impaired.

How do we avoid medication diversion in our own workplace? First off, expect it. This does not mean it is acceptable, but rather it means that steps need to be taken in order to prevent it in the first place. This may include, but is not limited to, ensuring access is only given to necessary personnel, regular auditing and utilizing technology such as automated dispensing cabinets (ADCs). ADCs may be helpful in tracking medication diversion by recording trends, keeping a rolling inventory of medications and ensuring there is a systematic way to document waste. Together with ADCs, hospitals and other healthcare systems should have established policies to identify those responsible for drug diversion, ensure reporting is completed on a routine basis and execute disciplinary action as necessary.

In addition to the steps listed above, many helpful resources are available online when evaluating your own workplace’s policies and procedures regarding medication diversion. See references below for access to some of these resources. By regulating controlled substances in our workplace and making sure policies and procedures are followed, we can help protect not only ourselves and coworkers from potential misuse, but also our patients from unnecessary negative impacts.

References:

1. Brummond PW, Chen DF, Churchill WW, et.al. ASHP Guidelines on Preventing Diversion of Controlled Substances. Am J Health-Syst Pharm. 2017;74:325-48.
2. Diversion Central. Omnicell website. https://www.omnicell.com/diversion. Accessed Oct. 1, 2018.
3. Diversion and Loss Prevention. BD website. https://www.bd.com/en- in/our-products/integrated-analytics-solutions/diversion-and-loss-prevention. Accessed Sept. 30, 2018.

By Ryan Bickel, Pharm.D., MHA, pharmacy manager, Mercy Health – Saint Mary’s, Grand Rapids and Diana Behnam, Pharm.D., pharmacist, Genesys Medical Regional Center, Grand Blanc 

Pharmacists and many other healthcare professionals utilize leadership skills in their practices on a daily basis. Some hold formal leadership positions (e.g., manager), while others who do not possess an official title still rely on these skills sets. Because of this, many healthcare team members have the desire to expand upon or hone the leadership skills they learned in their formal education and training. This can be achieved through a variety of methods, including seeking graduate degrees, mentorship and professional development courses. Two formal training programs available to Michigan pharmacists include the Michigan Pharmacy Foundation’s (MPF) Healthcare Professional Leadership Academy (HPLA) and the American Society of Health-System Pharmacists (ASHP) Foundation’s Pharmacy Leadership Academy^® (PLA).

The HPLA program is led by Brenda Wagenknecht-Ivey, a professional leadership consultant and coach, in conjunction with Michigan Pharmacy Foundation (MPF) leadership. It is a nine-month program designed to teach and apply leadership skills and knowledge. While most participants are pharmacists, the program is open to all healthcare team members, including physicians, nurses and pharmacy technicians. HPLA consists of four mandatory day-long seminars in Lansing, six monthly webinars, a main project, personal goal setting and more. The program offers some individualization, as each participant selects a project and creates personal goals. Each participant is also assigned a project advisor to help guide, discuss and answer questions. In addition, participants receive live continuing education (CE) credits for attending the in-person seminars. Visit www.MichiganPharmacists.org/foundation/initiatives to learn more. 

As a direct participant of HPLA, the experience was remarkable. Live sessions were fun and filled with multiple interactive games, while learning valuable life skills. The lessons learned are used throughout daily life; they are not limited to work-related environments. The program assists in building character, discovering more about yourself and understanding the outside world from a different perspective. Leadership is more complicated than the perceived individual in a position of authority. True leadership exists in everyone, irrespective of status or titles. The program, which is filled with individuals who lead by example, is inspiring in its delivery.                                                        

-Diana Behnam

The ASHP Foundation’s PLA is a year-long program comprised of seven, six-week modules, which focus on various aspects of leadership with a specific emphasis on strategic orientation, change leadership and impact and influence. ASHP fellows and other recognized, national pharmacy leaders serve as the facilitators and utilize similar methods of instruction as the HPLA program. Group discussions and presentations are facilitated using a web-based conferencing system. Participants receive 15 hours of ACPE-accredited CE upon completion of each module. In addition, participants earn credits towards a Master’s degree (MBA, MHA, MS) at five different colleges/universities. Upon completion of the program, graduates may use the designation Diplomate, Pharmacy Leadership Academy (DPLA).

Having participated in Great Lakes Young Pharmacists Leadership Conference [a predecessor to the MPF’s HPLA program], I was interested in continuing my leadership development.  After researching my options, I felt that ASHP Foundation’s PLA was the best choice for me. The program allowed me to participate via webinar, which allowed me to spend more time at home with my young family. I enjoyed interacting with pharmacy thought leaders and fellow pharmacists from across the nation. Many of the relationships that I formed continue to this day. Finally, the program offered college credit at several graduate programs, which greatly appealed to me. After the program, I transitioned directly into a Master of Healthcare Administration program, as did a significant portion of my fellow PLA classmates. Overall, I found the PLA to be an exceptional experience.

-Ryan Bickel

While multiple methods of leadership development exist, HPLA and PLA are unique as participants have the opportunity to network with colleagues and pharmacy leaders. Pharmacy professionals seeking further leadership development are encouraged to research their options and determine what program or method best fits their needs. Program fees and other associated costs are often covered or subsidized by employers or through professional association grants.