Understanding motivations and behaviours of our influencers: What can pharmacists learn from their leaders?

Background: There has been considerable discussion regarding the "leadership crisis" in pharmacy, with concerns that insufficient numbers of pharmacists want to take on leadership roles in their own profession. This exploratory study of leaders and influencers in pharmacy was undertaken to characterize the motivations for and behaviours of titled and untitled leaders, in order to help other pharmacists learn from their experiences. Methods: Interviews with 28 individuals who self-identified or were described by others as leaders (with or without formal titles) and influencers in pharmacy were conducted using online platforms (e.g., Zoom, Teams). A semistructured interview guide was used and refined during the interviews. Data were analyzed using a constant comparative method to identify common themes. Results: While participants in this study all described different trajectories towards leadership or influencer roles, several common themes emerged, including 1) personal characteristics that enable leadership roles/activities, 2) environmental supports and drivers that propel leadership forward, 3) positive reinforcers that maintain momentum towards leadership aspirations and 4) general predictors of success as a leader/influencer in pharmacy. Discussion: To address the "leadership crisis" in pharmacy, it will be necessary to motivate and support individuals in assuming these roles. Findings from this study have highlighted the complex and individual pathways current leaders have undertaken to achieve these roles and have signposted ways in which organizations, managers and mentors can support nascent leadership aspirations in productive ways.

Optimizing patient education of oncology medications: A quantitative analysis of the patient perspective.

BACKGROUND: With the ever-increasing complexity of cancer treatments, oncology medication patient education is becoming a progressively important component of cancer care. Despite this, cancer patients frequently report that they receive inadequate information and feel that their education needs have not been met. OBJECTIVE: To explore patients' perspectives of optimal oncology medication education across Nova Scotia. METHODS: This was a descriptive survey of adult medical, hematological and gynaecological oncology outpatients receiving intravenous chemotherapy within the Nova Scotia Health Authority between January 26 and April 30, 2018. RESULTS: One hundred forty-two responses were included; 41% and 47% of respondents reported being satisfied or very satisfied with their oncology medication education, respectively; 30% and 43% of respondents would like the opportunity to receive education or follow-up from a hospital pharmacist, respectively. Respondents with post-secondary education were found to have 2.82 higher odds of wanting to make an appointment for education with a hospital pharmacist. CONCLUSIONS: Patients were generally satisfied with their oncology medication education despite the majority not receiving education from a hospital pharmacist. Patients with a higher level of formal education were more likely to want the opportunity to schedule an appointment for education with and/or receive follow-up from a hospital pharmacist. The oncology medication education participants received in the past appeared to align with their education preferences. Findings from this research can be used to optimize the limited time healthcare professionals have to provide meaningful and effective oncology medication patient education and improve patient-centered care.

Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study.

BACKGROUND: Nimodipine improves outcomes following aneurysmal subarachnoid hemorrhage (aSAH) and current guidelines suggest that patients with aSAH receive nimodipine for 21 days. Patients with no difficulty swallowing will swallow the whole capsules or tablets; otherwise, nimodipine liquid must be drawn from capsules, tablets need to be crushed, or the commercially available liquid product be used to facilitate administration through an enteral feeding tube (FT). It is not clear whether these techniques are equivalent. The goal of the study was to determine if different nimodipine formulations and administration techniques were associated with the safety and effectiveness of nimodipine in aSAH. METHODS: This was a retrospective multicenter observational cohort study conducted in 21 hospitals across North America. Patients admitted with aSAH and received nimodipine by FT for ≥3 days were included. Patient demographics, disease severity, nimodipine administration, and study outcomes were collected. Safety end points included the prevalence of diarrhea and nimodipine dose reduction or discontinuation secondary to blood pressure reduction. Predictors of the study outcomes were analyzed using regression modeling. RESULTS: A total of 727 patients were included. Administration of nimodipine liquid product was independently associated with higher prevalence of diarrhea compared to other administration techniques/formulations (Odds ratio [OR] 2.28, 95% confidence interval [CI] 1.41-3.67, p-value = 0.001, OR 2.76, 95% CI 1.37-5.55, p-value = 0.005, for old and new commercially available formulations, respectively). Bedside withdrawal of liquid from nimodipine capsules prior to administration was significantly associated with higher prevalence of nimodipine dose reduction or discontinuation secondary to hypotension (OR 2.82, 95% CI 1.57-5.06, p-value = 0.001). Tablet crushing and bedside withdrawal of liquid from capsules prior to administration were associated with increased odds of delayed cerebral ischemia (OR 6.66, 95% CI 3.48-12.74, p-value <0.0001 and OR 3.92, 95% CI 2.05-7.52, p-value <0.0001, respectively). CONCLUSIONS: Our findings suggest that enteral nimodipine formulations and administration techniques might not be equivalent. This could be attributed to excipient differences, inconsistency and inaccuracy in medication administration, and altered nimodipine bioavailability. Further studies are needed.

Health Care Professionals' Perceptions of the Role of the Clinical Pharmacist and Expanded Pharmacist Coverage in Critical Care.

BACKGROUND: During the first wave of the COVID-19 pandemic, coverage by critical care pharmacists (CCPs) was expanded in 2 medical-surgical intensive care units at the Queen Elizabeth II Health Sciences Centre, in Halifax, Nova Scotia, from 8 hours per day, 5 days per week, excluding holidays, to 8 hours per day, 7 days per week, including holidays. OBJECTIVES: To describe health care professionals' opinions about and perceived impacts of the expanded CCP coverage on patient care, as well as their opinions about the role of the CCP as a member of the critical care team. METHODS: An electronic 22-item survey was distributed to critical care health care professionals to capture opinions and perceived impacts of expanded CCP coverage. The perceived importance of 25 evidence-informed CCP activities was assessed using a 5-point Likert scale. RESULTS: Thirty-eight complete responses were included (15% response rate, based on distribution of the survey to 249 health care professionals). Most respondents agreed or strongly agreed with the following statements: CCPs are integral members of the critical care team (34/38 [89%]), CCPs play an important role in improving patient outcomes (34/38 [89%]), the presence of CCPs on the unit and on patient care rounds allows other health care professionals to concentrate on their own professional responsibilities (33/38 [87%]), and the expanded CCP coverage improved patient care (29/35 [83%]). Respondents most frequently categorized 23 of the 25 CCP activities as very important. CONCLUSIONS: Expanded CCP coverage was perceived to have a positive effect on both patient care and members of the critical care team. Most CCP activities were perceived as very important. Given the findings of this quality project, novel staffing models are being explored to optimize CCP coverage.

CONTEXTE: Au cours de la première vague de la pandémie de COVID-19, la couverture par les pharmaciens de soins intensifs (PSI) a été étendue dans 2 unités de soins intensifs médico-chirurgicaux du Queen Elizabeth II Health Sciences Centre, à Halifax (Nouvelle-Écosse) : de 8 heures par jour, 5 jours par semaine, hors jours fériés, la couverture est passée à 8 heures par jour, 7 jours par semaine, y compris les jours fériés. OBJECTIFS: Décrire les opinions des professionnels de la santé sur la couverture élargie des PSI et leurs perceptions des incidences de celle-ci sur les soins aux patients, ainsi que le rôle des PSI en tant que membres de l'équipe de soins intensifs. MÉTHODES: Un sondage électronique comportant 22 questions a été distribué aux professionnels de la santé en soins intensifs pour recueillir les opinions et les impacts perçus de l>élargissement de la couverture des PSI. L'importance perçue des 25 activités des PSI fondées sur des données probantes a été évaluée à l'aide d'une échelle de Likert à 5 points. RÉSULTATS: Trente-huit réponses complètes ont été incluses (taux de réponse de 15 %, basé sur une distribution de l'enquête à 249 professionnels de la santé). La plupart des répondants étaient d'accord ou fortement d'accord avec les affirmations suivantes : « les PSI font partie intégrante de l'équipe de soins intensifs ¼ (34/38, 89 %); « les PSI jouent un rôle important dans l'amélioration des résultats pour les patients ¼ (34/38, 89 %); « la présence des PSI dans l'unité et lors des tournées de soins aux patients permet à d'autres professionnels de la santé de se concentrer sur leurs propres responsabilités professionnelles ¼ (33/38, 87 %); et « la couverture élargie des PSI a amélioré les soins aux patients ¼ (29/35, 83 %). Les répondants ont le plus souvent classé 23 des 25 activités du PSI comme « très importantes ¼. CONCLUSIONS: L'élargissement de la couverture des PSI était perçu comme ayant un effet positif à la fois sur les soins aux patients et sur les membres de l'équipe de soins intensifs. La plupart des activités des PSI étaient perçues comme très importantes. Compte tenu des résultats de ce projet de qualité, de nouveaux modèles de dotation en personnel sont à l'étude pour optimiser la couverture des PSI.