s Workplace Pressure in Pharmacy | I2P: Information to Pharmacists - Archive
Publication Date 01/02/2013         Volume. 5 No. 1   
Information to Pharmacists

Editorial

From the desk of the editor

Well 2013 has certainly begun and I must admit it has been hard to get out of “holiday mode” and back into “pharmacy mode”.
This year is looking quite challenging as many issues left in abeyance in 2012 are bubbling over , so I don’t anticipate a restful year.
One important issue we will cover for some time yet is the quality of drug  evidence in the Australian setting, and to kick off the debate the feature article  “Sense About Science”describes what is happening in the UK to help tidy up science in that country.
Comparisons have been made with the Australian experience and it seems that we have a long way to go before it can be regarded as “tidy”,

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News Flash

Newsflash Updates for February 2013

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated.

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Feature Contribution

Sense About Science – or Up To Your Ankles in Waste Water

Neil Johnston

My recent holiday reading included catching up on subjects that have slipped off my radar, mainly because the issues themselves have adopted a lower profile.
Then an article in the 6Minutes e-publication caught my eye.
It concerned a UK initiative by a group called Sense About Science”, that has started a campaign to have all clinical trials registered and have the results published, while simultaneously urging the patients to boycott trials if the researchers cannot guarantee the findings will be made public.
They have published a petition (found at www.alltrials.net) and are encouraging people to sign it.
The petition has the support and backing of the BMJ, the James Lind Alliance and Ben Goldacre (author of Bad Pharma) and is designed to put pressure on researchers, pharmaceutical companies and institutions who are in a position to bury research data that may reflect on reputations and drug company profits.

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Face of Priceline - Australian of the Year 2013

Peter Sayers

Few would not recognise Ita Buttrose, an iconic Australian well-deserved of the Australian of the Year Award for 2013. The award was presented in Canberra on Australia Day (January 26 2013), by PM Julia Gillard.
And there must be a lot of backslapping going on in the Priceline camp for their recent signing of her to front for their 200 member pharmacy franchise.
Ita’s profile was already stellar, but with the added impetus of the Australian of the Year Award, the Priceline brand will now increase in value considerably.

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Determining needs and wants…

Joseph Conway

In pharmacy media commentary, I often come across the idea that we need to give people advice on what they need as opposed to what they want. This is understandable given that we have specialist knowledge on medication therapy and live our lives discussing health issues with patients and dispensing their medication. We get to know very intimate details about people and many pharmacists working in community pharmacy get to follow people as they grow older and are a tiny (but important) part of their lives sharing their health issues over ongoing chats at the dispensary counter if they choose to shop at our store.

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Is the ‘weekend’ an anachronism whose usefulness and relevance has passed?

Neil Retallick

When I taught Sunday School, which seems to be about a hundred years ago but was only about forty, we learned from the Bible that on the seventh day, God rested.
After all, he had been busy for six days.
I do not wish to belittle anybody’s religious beliefs in these comments but use them to focus attention on just how much our society has changed.
At the same time I was teaching Sunday School, the shops all closed at mid-day on Saturday and at 5.30pm during the week.
A trip into town to shop on the weekend meant getting up bright and early on Saturday morning and being at the bus stop by 8.30am at the latest.

Comments: 1

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Fitting Your Pharmacy for the Future - Funding & Depreciating for Best Tax Effect

Chris Foster

Editor's Note:
I2P will be developing a series on pharmacy designs - ideas and concepts in respect of clinical services spaces.
In designing such spaces it was realised very early in the exercise, that to be properly integrated in an Australian pharmacy setting it could not be just an “add-on” but a whole of pharmacy redesign.
Similarly with the introduction of automated dispensing machines (original packs and dose administration aids) it is important to design workflows properly to capture efficiencies, and this also entails a “whole of pharmacy” redesign.
2013 may be the year of decision in terms of the type of pharmacy design to house your market offering. To survive you need to be different and there is not a lot to differentiate one pharmacy from the other, even if you belong to a marketing group.

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Ransomware - The New Kid on the Block

Steve Jenkin

Editor's Note:
Late in 2012, a medical practice on the Gold Coast of Queensland came under cyber attack in a unique way.
Instead of patient data being stolen, it was kidnapped in place, by encrypting all practice data so that it could not be read.
A key was then offered at a price so that the data could be opened.
Thus was born "Ransomware", and a a new threat had emerged.
i2P asked Steve Jenkin, our resident IT expert to give some insights to this new threat and what precautions we might all need, to eliminate this new approach to hacking.
If you need an incentive, just imagine if your PBS claim data was locked up for a week and your ability to generate a claim was locked up for six weeks, plus all attendant costs in restoring your data.
Would you survive in your business?
This reference article by Steve is important enough to use as a checklist for your IT provider or for your IT consultant to utilise in the next complete review of your entire system.
Steve's comments follow:

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Workplace Pressure in Pharmacy

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

The psychological definition of stress is a feeling of strain and pressure.  Small amounts of stress may be desired, beneficial, and even healthy.  Positive stress helps improve performance.  It also plays a factor in motivation, adaptation, and reaction to the environment.  Excessive amounts of stress may lead to many problems in the body that could be harmful.  Symptoms may include a sense of being overwhelmed, feelings of anxiety, overall irritability, insecurity, nervousness, social withdrawal, loss of appetite, depression, panic attacks, exhaustion, high or low blood pressure, skin eruptions or rashes, insomnia, lack of sexual desire (sexual dysfunction), migraine and gastrointestinal difficulties (constipation or diarrhoea).  It may also cause more serious conditions such as heart problems.

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Arm Yourself For The Battle For The Mind

Barry Urquhart

Social media, and the internet in general, are largely “blind” media.
They can be frustrating, time-wasting and inefficient.
Entries and enquires about wide-ranging but pertinent topics, products and services elicit countless responses, most of which are irrelevant and unappealing. Information overload abounds.Use of SEO's (Search Engine Optimisers) simply cluster companies, brand and service names, among large, often spuriously ranked groupings.Being on the shopping list has very little quantifiable and lasting value. Nor does the standing of being “first amongst equals”.
Establishing and sustaining unique, differentiated presences in the marketplace is difficult.
In the brave and new world of digital, mobile, on-line, multi or omni-channel reality, the importance, nature and value of effective branding is deepened and broadened.

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Positive thinking has no negatives

Harvey Mackay

One of life's great annoyances is the tendency of folks who ask you to perform an impossible task, list the issues they foresee and the problems that have plagued previous attempts -- and then admonish you to "think positive."
Wow! Does that mean you are so good that you can achieve what no one else has? Or are you being set up to fail?   
Because I am an eternal optimist, I prefer to believe the first premise. Positive thinking is more than just a tagline. It changes the way we behave. And I firmly believe that when I am positive, it not only makes me better, but it also makes those around me better. I think that good attitudes are contagious. I want to start an epidemic!

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Feasting on Fat

Loretta Marron OAM BSc

With the Christmas and New Year opportunities to over-indulge, it was easy for girths to increase a little.
If so, it might be very difficult to lose those extra kilos.
Many advertised products and services allegedly help us lose fat without diet and exercise.
Most will fail; some might even be dangerous.

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Hanukkah, Oxygen Masks and Christmas

Mark Neuenschwander

I've been thinking about Hanukkah, oxygen masks, and the Christmas presents I am duty bound to muster for my kids and grandkids. Thank God dad asked for pajamas.
Today I’m flying from Las Vegas to Seattle. About the only thing I liked about Sin City was the fountain show at Bellagio, the Elvis Christmas songs that popped up here and there, and a pretty good keynote address by Bill Clinton. Just thinking of shopping makes me wonder if the cabin isn’t losing its pressure.

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Antioxidants Prevent Cancer and Some May Even Cure It

Staff Writer

Orthomolecular Medicine News Service, January 24, 2013

Antioxidants Prevent Cancer and Some May Even Cure It

Commentary by Steve Hickey, PhD

(OMNS Jan 24, 2013) It is widely accepted that antioxidants in the diet and supplements are one of the most effective ways of preventing cancer. Nevertheless, Dr. James Watson has recently suggested that antioxidants cause cancer and interfere with its treatment. James Watson is among the most renowned of living scientists. His work, together with that of others (Rosalind Franklin, Raymond Gosling, Frances Crick, and Maurice Wilkins) led to the discovery of the DNA double helix in 1953. Although his recent statement on antioxidants is misleading, the mainstream media has picked it up, which may cause some confusion.

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HMR Moratorium – Killing Jobs in Pharmacy

Joseph Conway

It’s no secret that the Pharmacy Guild has called for a moratorium on HMRs until the alleged abuse of a tiny minority of Independent Pharmacists potentially rorting the system is investigated and the system is changed to reduce the possibility of such rorting.
They say that this is necessary as the budget for HMR’s has been overrun and any potential rorting could put the viability of future pharmacy-centric programs at risk too.
The Guild want payments stopped so that the business rules behind HMR’s are “tightened” to stop this apparent rorting.
If there is actually rorting going on, then I think that it’s in all pharmacists’ interest to “fix” this issue.
I for one have nothing against tightening the rules to stop pharmacists “Warehousing” HMRs?
This is great.

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Part one -HMR Evolution

Neil Johnston

With the furore created when the PGA went to print stating that the funds available for HMR’s were almost exhausted, it created an instant “blame game” and conjecture as to what really lay behind the belated PGA announcement.
I came to a conclusion early that it was a result of PGA mismanagement as the immediate problem, but also coupled with an underlying systemic flaw that was the major problem.
Between them they impact and threaten the long term development and survival of the consultant pharmacist program.
It has prompted me to create an analysis of some aspects of the program to evaluate what has gone wrong.

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Part two - Fixing the HMR Flaws

Neil Johnston

The PGA has succeeded in upsetting a broad spectrum of pharmacists that includes all accredited pharmacists, some employer pharmacists (with designs on creating a business model with professional services at the core), and employee pharmacists who see job opportunities being squandered.
It is obvious that the “engine room” for consultant pharmacists (The Australian Association of Consultant Pharmacy) needs urgent reform and a new focus, or be replaced completely.
And the PGA should stop its interference.

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Part three - a Better Umbrealla Organisation

Neil Johnston

Because a workable umbrella model for management consultants already exists, it is suggested that this model be adapted for consultant pharmacist use.
The existing umbrella model established for consultant pharmacists would need to be altered dramatically and be opened up to other organisations e.g Consumer Health Forum, APESMA)
Or an entirely new organisation could be developed from scratch.
This is, in fact happening and is unrelated to any of my activities.
However, I am suggesting that the umbrella model of organisation provided by the Institute of Management Consultants (Australia) provides an excellent reference to adapt to a consultant pharmacist version.

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Thought Bubbles From a Book Group Refugee

Gerald Quigley

Editor's Note:
One night recently, I received the following email from Gerald:
"My wife has a book-group here. I’m locked in my study and inspired to write!"
That's good news for an editor/publisher - getting copy in on time well in advance!
Then followed (the same night), three separate and disparate thoughts that were not directly concerned with a pharmaceutical issue.
But they all had application for pharmacy improvement, with a bit of applied creativity.
As these "thought bubbles" wafted in over the Internet I began to wonder how I might splice them together with some editorial ingenuity.
The following is the result.

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What Really Causes Kidney Stones (And Why Vitamin C Does Not)

Staff Writer

Orthomolecular Medicine News Service, February 11, 2013

What Really Causes Kidney Stones
(And Why Vitamin C Does Not)

(OMNS Feb 11, 2013) A recent widely-publicized study claimed that vitamin C supplements increased the risk of developing kidney stones by nearly a factor of two.[1] The study stated that the stones were most likely formed from calcium oxalate, which can be formed in the presence of vitamin C (ascorbate), but it did not analyze the kidney stones of participants. Instead, it relied on a different study of kidney stones where ascorbate was not tested. This type of poorly organized study does not help the medical profession or the public, but instead causes confusion.

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For health's sake, time to take on food giants

Staff Writer


Food Industry marketing practices are increasingly being brought under the spotlight as are various other worrying problems regarding additives to manufactured food products, also how food is grown using genetically modified seed and the range of toxic herbicides and pesticides.
These latter substances now pollute the entire food chain and not enough is being done to protect our food chain.
Many illnesses can be traced back to ingestion of unnatural substances over a long period of time.
It's time to grow your own.

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Consultant Pharmacists Should Lead The Way - But They Have No Leaders.

Mark Coleman

Isn’t it time that consultant pharmacists took control of their own direction and carved out a future?
Or is the current system of a single-product (HMR) service controlled by the PGA and the PSA, sufficient to provide an interesting and creative future?
How can the aspirations of consultant pharmacists be serviced by an organisation controlled by two major pharmacy-political bodies, when one of them (PGA) is directly working against consultant pharmacist interests.

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APESMA Campaigns for Pharmacist Lunch Hour Entitlements

Staff Writer

Australian pharmacists have been warned to carefully check exactly how much compensation they are getting for routinely working through lunch after an APESMA survey found 28 per cent of Australian pharmacists reported that they receive no financial compensation at all for the lack of a lunch break.
CEO of APESMA Chris Walton said working through every lunchtime was an unacceptable practice that could cause dangerous levels of fatigue.
APESMA has advised pharmacists who have signed any agreement to remove their lunch breaks to immediately ask their employer to itemise any compensation they are being paid in lieu of all award entitlements such as their lunch breaks.

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CHC Emphasises the Importance of Research

Staff Researcher

In light of a recent paper published in the Royal Society's Open Biology journal, proposing a theory that antioxidants can be detrimental in the late stages of cancer treatment, the Complementary Healthcare Council (CHC) of Australia emphasises the importance of clinical trials and studies into the prevention and treatment of cancer. Executive director of the CHC, Dr Wendy Morrow, highlighted this theory as being interesting and warranting more research.

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Advancing our understanding and treatment of motor impairment

Staff Researcher

NeuRA has secured significant funding to expand research into motor impairment, a problem that arises from many diseases and aging, and a growing public health challenge.
Everything the human body does requires movement, but our muscles—and our brain and nerves that control them—are often the first tissues attacked by a long list of disorders that includes stroke, spinal cord and brain injury, multiple sclerosis, Parkinson’s disease, musculoskeletal injury and cerebral palsy.Prof Simon Gandevia is an expert in the brain’s control of human movement at NeuRA (Neuroscience Research Australia) and will spearhead the nearly $7 million multidisciplinary program of study, funded by the National Health and Medical Research Council of Australia.

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PSA WELCOMES GOVERNMENT’S HMR ANNOUNCEMENT

Peter Waterman

Media releases issued from the office of Tania Pliberseck and the PSA arrived this morning.
What follows is the PSA take on recent events surrounding HMR managent.

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Pharmedia - The Vaccine Poll Hijacked by Pharmacists?

Neil Johnston

Editor's Note:
Professional services development was stymied when the AMA reneged on an agreement to support pharmacist vaccination clinics.
It has caused anger and unprofessional behavior has evolved on both sides.
It also appears that while the professional bodies of the AMA and the PGA attempt to disrupt each other, patients at large will become the eventual losers.
The PGA is central to other clinical service disruptions, even those within pharmacy involving contractor pharmacists.
This is damaging to an orderly development of clinical services in a pharmacy setting and demonstrates that current leaders of the PGA and the AMA are not fit to claim the title of "leader".
We asked Mark Coleman to provide commentary on an article recently published in Australian Doctor.

Comments: 2

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Workplace Pressure in Pharmacy

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

articles by this author...

Kay Dunkley is a pharmacist who has worked in hospital and organisational pharmacy for over 20 years.  She has a broad experience working in public hospitals and in providing support to health professionals through government funded bodies and professional organisations.  Kay also has a strong interest in the health and well being of health professionals and especially the role of peer support.  Kay first became involved as a volunteer with the Pharmacists’ Support Service, a group which has been providing telephone support for pharmacists in Victoria since 1995.  In 2005 Kay became the Program Coordinator for the Pharmacists’ Support Service and has assisted the service to become an independent organisation which is currently seeking to expand to provide support to pharmacists throughout Australia.  In 2007, when AMA Victoria approached the Pharmaceutical Society of Australia (Victorian Branch) with a view to establishing their own Peer Support Service; Kay accepted an invitation to assist.  The AMA Victoria Peer Support Service commenced operation in February 2008.  Kay currently coordinates both of these services and also works part-time as a consultant pharmacist in Residential Care Facilities.

The psychological definition of stress is a feeling of strain and pressure.  Small amounts of stress may be desired, beneficial, and even healthy.  Positive stress helps improve performance.  It also plays a factor in motivation, adaptation, and reaction to the environment.  Excessive amounts of stress may lead to many problems in the body that could be harmful.  Symptoms may include a sense of being overwhelmed, feelings of anxiety, overall irritability, insecurity, nervousness, social withdrawal, loss of appetite, depression, panic attacks, exhaustion, high or low blood pressure, skin eruptions or rashes, insomnia, lack of sexual desire (sexual dysfunction), migraine and gastrointestinal difficulties (constipation or diarrhoea).  It may also cause more serious conditions such as heart problems.

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A common theme for pharmacists calling the Pharmacists’ Support Service (PSS) is stress. 
Pharmacy practice can be stressful, especially when there are events outside our control impacting on the way we practice. 
Some of the causes for stress in pharmacy include: workload, unpredictable or inconsistent workflow, the workplace environment, lack of breaks or meal times, staffing levels, administrative requirements and red-tape, mundane tasks, challenging or difficult customers, difficulties with inter-professional communication with prescribers and other health care providers, the need for accuracy and vigilance to protect patients from harm, financial pressures, professional development requirements and the need to keep up-to-date, lack of professional empowerment and limited professional acknowledgement. 
The way pharmacists work has changed considerably over the years and there is now much more pressure on pharmacists and our work is more complex. 

As professionals we need to take responsibility for our well-being to ensure that we can provide service of a high standard and reduce our risk of errors.

Many pharmacists believe that working long days, without a break and with a constant barrage of prescriptions and requests for advice, in a noisy environment is normal in pharmacy and acceptable.  Pharmacists who find this situation difficult or make a mistake in this environment are treated with disdain. 
Pharmacists making a dispensing error may be subject to investigations at many levels and in addition their employer may give them a warning or threaten dismissal from their position as a consequence.  As individuals we pharmacists often set ourselves high standards and we frequently “beat ourselves up” for our mistakes and dispensing errors. 

In another pharmacy forum, in a discussion about lunch break entitlements, some pharmacists were derogatory about anyone who complained about not being able to take a break for lunch using words like “suck it up”, “stop whingeing” and stating “pharmacy has always been like this and always will be”.  I believe that this attitude and culture needs to change but this will take time and effort by the profession and a change in focus from dispensing with speed to clinical activities.

As individuals to ensure that we enjoy a satisfying professional life it is important that we address the causes of our stress and strive to minimise the impact it is having on use. 
There are two aspects to this; addressing the situation itself and also attending to our own resilience and ability to manage our response to a challenging situation. 

There are practical ways of minimising some stressors in pharmacy. 
For example workload and workflow can be improved by reviewing processes, pharmacy layout and the use of staff. 
Some examples to smooth out peaks in dispensing follow:

* Good communication between pharmacy staff and customers as well as provision of an accurate and appropriate indication of waiting time will modify the expectation of customers.
* Prioritising urgent requests and encouraging people to come back later or organising a delivery will reduce pressure.
* Resolving potential problems when a script is first received will improve efficiency.

Minimising interruptions to dispensary staff (non-dispensary staff should always answer the phone) will enable a focus on the task at hand increasing speed and decreasing the chance of an error.

It is also necessary to improve our own ability to cope with pressure.  For example managing stress as an individual is assisted by achieving a balance in life between work, rest and play.  Some simple steps we can take include ensuring that we have:

* Regular exercise.
* A healthy and nutritious diet.
* Adequate sleep.
* An activity we enjoy outside work.
* Regular holidays.
* Time with our families, loved ones and friends.

In New Zealand a group of pharmacy organisations lead by the Pharmacy Council of New Zealand has compiled a very valuable resource for pharmacists titled “Workplace Pressure in Pharmacy: practical advice for New Zealand pharmacists, pharmacy staff and employers”.  http://www.pharmacycouncil.org.nz/cms_show_download.php?id=350  I commend this publication to you. 
Although it has been prepared with the New Zealand pharmacy environment in mind there are many useful tips which are relevant to pharmacy in Australia. 

Australian pharmacists who find their workplace stressful can talk anonymously to a colleague over the phone through the Pharmacists’ Support Service.  The service is available for the cost of a local call (mobile rates may apply) on 1300 244 910 between 8am and 11pm every day of the year.

Please note all the views expressed in this article are my personal opinion and do not necessarily reflect the opinion or attitude of any of the organisations that I am employed by or associated with.

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