Eastern Health dealing with impact of pharmacy shortage

KIRK SQUIRES
The Packet

Eastern Health is walking a fine line between finding a solution to the pharmacist shortage while also trying to address the concerns of nurses.

In an effort to retain the pharmacists it has and attract new ones, the health board is offering pharmacists a temporary $12,000 market differential allowance.

But that won’t solve the immediate problem at the G.B. Cross Memorial Hospital in Clarenville.

Thanks to the pharmacists shortage there is no full-time pharmacist covering the Saturday and Sunday shifts. As a result, nurses have been charged with the duty of retrieving medications for patients on weekends.

That has raised concerns around patient safety in the event there is an interaction between two prescribed medications. Nurses also wonder who will be liable in event there is a serious drug interaction.

"Patient safety is our main priority," says Pat Coish-Snow, Chief Operating Officer for Peninsulas Area-Eastern Health.

As part of the contingency planning to deal with the pharmacy shortage Coish-Snow says a team — with representatives from nursing, pharmacy and physicians — meets weekly meetings to discuss issues arising from the vacancy at G.B. Cross.

"Nurses have identified, through the union, a representative for that group. They meet weekly to talk about issues and concerns and . . . other solutions to help relieve this problem," says Coish-Snow.

One of the impacts has been the increase in nurses’ workload.

The most recent solution has been to add nursing staff on Saturday and Sunday.

"What we have tried to do is work with nurses to add an extra nurse in the building on Saturday and Sunday so they have someone else to call upon," says Coish-Snow.

Coish-Snow says that additional nurse would not only be responsible for medication retrieval but would also offset any additional workload in the building.

"If it is really busy in Emergency and they need a medication for a patient, rather than take them away from the bedside they can call on another nurse in the building to get that medication for them. This is how we have seen an interim solution to a vacancy in the pharmacy.

"I understand there are some concerns from the nurses union about that and we need to work through on what those concerns are."

She says the administration is working with nurses on understanding what their concerns are. She stresses they are not asking nurses to work as pharmacists

"Nurses are not replacing pharmacists," she says of the decision to add the additional nurse on weekends.

"What we are asking nurses to do, because we have a vacancy, is what they would normally do when we don’t have a pharmacist in the building."

She explains pharmacists prepare the medications and dispense them into a single dose system. They are then stored in the "electronic night cupboard."

Nurses retrieve that medication from the cupboard.

"That’s what a nurse would do in our organization . . . when a pharmacist is not in the building at night or in the evening. That is not an unusual thing," she says.

Coish-Snow explains the physician writes the medication order for the patient and the physician is available for consultation if the nurse feels the medication is not appropriate or there is some concern about giving that medication. She adds the pharmacist is also on call 24-hours to provide clinical advice.

"What nurses are saying is they would like pharmacy to review those orders like they always do. What we have put in place is a mechanism where they can telephone a pharmacist to review the order if they have a concern. We are also looking at ways, electronically, to send a copy of that order to another pharmacist at another site."



Contingency

The addition of extra nuses on weekends is inteneded to be a short-term solution.

But will there be other ramifications if Eastern Health is unable to recruit more pharmacists in the near future?

"That’s the hard question to answer," says Coish-Snow.

"They (pharmacists) are integral part of the team. When you don’t have all the partners in the room you have to improvise and create some contingency plans, all the while maintaining patient safety and ensuring professionals only do what is allowed within their professional scope of practice.

"We have not gone beyond that in this case. It does place added stress on each of the other players in the system and we have to work with them . . . and find solutions to how we can reduce that stress."

Meetings between Eastern health and the union were planned for Friday afternoon.

Coish-Snow says Eastern Health wants to work collaboratively with the union and the professional association to provide safe patient care.

"We always like to have strong relationships with the union.

"What we want to hear from the nurses’ union is what are the options they are suggesting that can work, that are also acceptable for the global picture."

Source.