Navigating ASHP Midyear

Date and Time: Sunday, July 30th from 12:30pm to 1:30pm in Las Vegas

Number of Participants: OVER 70 Student Pharmacists

When I was chosen as a speaker for the 2017 Student National Pharmaceutical Association National (SNPhA) meeting, I was excited, but nervous. I had some experience in giving presentations, but always struggled with connecting with my audience and engaging their interest. Coincidentally, my presentation was scheduled a week after the Teaching Certificate Summer Seminar. It was a perfect opportunity to incorporate what I had just learned into my presentation. I used a power point as teaching aid and made my presentation more conversational.

When I reflected on my presentation delivery, I felt a sign of accomplishment because the audiences participated and I used more relatable examples than I usually would. I also had the opportunity to talk to a few students who attended my presentation during the seminar and here is what some of them had to say:

"The Navigating ASHP talk was an enriching experience for me as a student pharmacist, and reinforced the importance of networking, service to the community, leadership development, and simply being present in all aspects of my pharmacy journey."

"It was encouraging to have the opportunity to learn from professionals in diverse fields of pharmacy ranging from the government to community, hospital to industry, and beyond."

"Thank you to all the presenter for sharing your knowledge and expertise, and to SNPhA for providing this platform for us to build our pharmacy networks and cultivate these relationships through which our professional and academic skills will continue to develop!"

"Attending this event provided me with a lot of helpful information that I may not have learned elsewhere."

"The presentation was very insightful no matter where you were within your academic matriculation. Particularly for me, it helped me to narrow my interests hearing the perspectives from the panel and their personal experiences. I can now do some research on some of the programs that they mentioned and know to begin saving now for my 4^th year. "

To me, this was a new beginning for professional growth and venturing out of my comfort zone. I had a first-hand experience trying newly learned techniques, such as, engaging my audience effectively, bringing the conversations back to relevance in a respectable manner, answering questions effectively and precisely, and referring audience to another expert and follow up post seminar. My topic “Navigating ASHP Midyear Seminar” was easy to deliver because I experienced the seminar in the previous year. I also discovered I had many examples and tips for success just from my reflecting back at my experience and talking to other friends about their personal experiences. This example made my audience participate and I got a glimpse of my topics' relevance.

One lesson I learned was to always pick a topic you can relate to, if I ever have the option to choose what I teach. The more I teach the less nervous I feel and the more I see the art in lesson delivery. At the end of my presentation, I truly appreciated the time I spent preparing and practicing my content delivery. Again, every lesson is an art to me and it sets the stage for a new opportunity to connect to different people.

Presentation: https://drive.google.com/open?id=1wGExPcyg0dr8R9p-xGBlHA3E9MgtS4KI

Student National Pharmaceutical Association (SNPhA) Post-Graduate Discussion Panelist

Career Roundtable Panelist : Audience : Student National Pharmaceutical Association (July 2017)

Number of Students: 50

I had the opportunity to be a panelist at the SNPhA convention . This session was held after the Navigating ASHP Midyear discussion, on day 2 of the conference. I had the opportunity to network and talk to many students on the first day of the conference. I made it a duty to remember the names and chapter names (Pharmacy school attending). I also asked a few students if they were attending the panel discussion scheduled for the next day. This was a goal I had set for myself, to know at least 5 names before the panel discussion. I am glad I met this goal, and I could share a few thoughts and conversations extracts from my interactions with students the previous day.

When I referenced a conversation had with a student on day one of conference by calling her name and sharing her testimonial, she was very surprised. She met with me after the panel to thanked me for listening to her and expressed how shocked she was that I even remembered her name and chapter.

Honestly, I am very bad with names, I usually don’t remember people's name as I should. After my success at the panel with keeping five names in mind, I have become very conscious and intentional about every interaction and relationship in my practice.

I have seen progress in my practice as I relate to patients more and create a relationship while identifying them by their names. I am constantly trying to make meaningful encounters and reminding myself the importance of creating a safe and approachable environment for my patients. Every day, I remind myself to be the best advocate any patient needs and be the kind of pharmacist I would be sure to trust with my family’s health. I know if I was the patient, I would want to feel like I count and I am not just a number or customer.

Spring Into Wellness Health Fair

Venue: The Pointe Bentonville Apartment Complex Conference Room

Date: April 5, 2018

Number of Participants: 6 participant attended the lecture series and completed feedback survey and 13 participant stopped by table with questions, but did not stay for the presentation. One participant made an appointment for an additional one-on-one session (reflection in the individual session below) this event took place on April 5th 2018 from 6 pm to 9 pm at the Pointe at Bentonville club house.

I prepared a power point and poster presentation for the event. Other items I was able to use were: over-the-counter multi-vitamins, tums, and a blood pressure measuring machine. I had 6 members who sat through the power point presentation and over 13 other participants who stopped at the poster board to learn. One of the community members had a lot of questions about multi-vitamins, so I decided to ask her some follow up questions to understand her interest and I discovered she had bariatric surgery one year ago.

After our 30 minutes conversation about vitamins and life style modification, I offered to have a more detailed session with her on another day, which she agreed to. The rest of the participants, especially the 6 who sat through the presentation, where very interactive. This was because I had learned to ask thought provoking questions to my audience and it had become easier with practice. I was reassured about my progress in the TCP program due to the reaction of the audience. The process of recruiting an audience for the heath fair, pushed me out of my comfort zone and helped me create new relationships within the community.

I encountered an audience member that would quickly answer every question that was posed to me during my presentation. This gave me a chance to practice the concept of rolling with resistance. I was very satisfied when I successfully redirected the questions she was answering and provided a more comprehensive answer while applauding her for participation. The two main lessons I took out of this experience were: an increase confidence in recruiting an audience and applying the concept of rolling with resistance. I was also satisfied that I had mastered the concept of engaging my audience and ensuring participation during my presentations.

Elderly patients and Medication Adherence

“Should All Pills Be Separated?”

March 4 , 2018

Everyday, I am reminded of the reason I chose community pharmacy by all the smalls wins. I am constantly reminded of the importance of pharmacists in the front line of healthcare. One morning, I had an elderly patient (about 75 years old Caucasian male) approach the consultation window with a question regarding his constipation medication (Linzess). He initially requested for my colleague (pharmacy manager), but my colleague was busy on the phone with another patient. I opted to be of assistance, but the patient insisted to talk to my colleague. I told him I was a pharmacist, too, and I will try my best to help him until my colleague gets off the phone, then she could take over from me. He was finally convinced.

My patient asked when he could drop off his hand written prescription (Linzess), since the doctor had given him samples. I was able to teach him about the expected expiration date for prescription. I also informed him to bring back the script to the pharmacy at least 30 days before it would be considered invalid, even if he still has samples. This way, we could request a refill from the doctor, in case, his prescription expired before he needed it filled.

After our conversation about constipation, I identified my patient as a candidate for Complete Medication Review (CMR). I asked his permission to talk about his other medications if he had any. He immediately took out of his wallet his medication list and handed it to me. My first observation was his administration times. He was taking his morning (AM) medications every 15 minutes, and he had over 9 morning medications. I also noticed he did same for his evening (PM) medications. I asked my patient about his reason behind such specific administration times, and his response “I don't want my medications to interact with each other, so I separate them out”. It was very evident that my patient spent most of his hours in a day taking his medications. He even woke up at 7 AM daily, against his wish, to make sure he took his medicines on time.

I sat down with him, grouped his medications into disease states: Atrial fibrillation (rate control [beta blocker], rhythm control [calcium channel blocker], and anticoagulant), blood pressure, constipation medication and more. I also ran a drug interaction check and provided him with information that convinced him the medications are safe to be administered together. Lastly, we concluded on a three times daily medication schedule (9AM, 3PM, 9PM), rather than multiple times daily.

He expressed his happiness and even mentioned he would sleep in longer in the mornings, since he didn't need to take any medications at 7 AM any longer. I took three main lessons from this teaching experience: rolling with resistance, effective listening, and the importance of observation.

Rolling with resistance: I was able to convince my patient that I could be a resource for him. Despite of being an unfamiliar healthcare provider to him, the patient gained trust and communicated openly as our conversation progressed.

Effective listening: In listening to my patient question, I could read some non-verbal cues and those helped me in my decision to probe for more information.

Importance of observation: When my patient gave me his medication list, I was quickly drawn to his medication administration times he had in parenthesis. Those times (written in parenthesis on his medication list) made me investigate more and I eventually identified a need for patient education.

If I have a similar experience moving forward in my career, I am sure I will be very comfortable in my teaching and my use of motivational interviewing.

New Rheumatoid Arthritis Diagnosis

“The Pains of Low Health Literacy”

September 20, 2017

Another teaching opportunity presented when I went to update my health record at my healthcare provider’s billing office. It was a cold Friday morning and I was happy to be off from work and scheduled numerous errands to run. My first stop was the medical billing and records office at North West Regional Hospital in Bentonville, AR.

I met a social worker who helped me with the update of my records. While we talked about the information she needed from me, I could not help but ask her if she was in pain as she appeared very distressed and uncomfortable to me. I followed the question with an apology and explained to her that I could not help, but notice something was not okay and I am a pharmacist, trained to identify signs and symptoms.

The young lady was in her mid-forties if I had to guess. When she realized I was a pharmacist, she asked if I had time to talk to her about her medicines. She went forward to say, she had just been diagnosed with Rheumatoid arthritis the previous month and she was struggling with the pain.

I quickly jumped at the opportunity, I asked her what medications she was prescribed and how she has been taking it. She had a whole basket of her medications with her at work.

Honestly, I was very surprised at the fact she carried all her medications with her to work. I started by asking her if she had been taking all the medications as she should. Her answer was no. During our conversation where I employed motivational interviewing, I identified four main drug problems:

• She was afraid to take her celebrex because she was scared of developing a heart disease in the future
• She did not take her plaquenil because she was afraid she might get blind as she already had bad sights
• She was overwhelmed by her diagnosis and had been put on anxiety and depression medications and she did not believe she needed any of those, hence she did not take it
• She believed in natural medicine and vitamins, but was frustrated they were not working for her anymore

I spent my next 45 minutes doing a complete medication review. I had lexicomp on my phone, so I ran a drug interaction check, and counseled her about holding some of the natural products that interacted with her medicines.I also convinced her that the benefits of her Plaquenil and Celebrex outweighed their risk if she took them proper.We talked about stress control and future plans for exercise.

Lastly I explained the disease state and what was happening to her to a point of her understanding and educated her on the prognosis and how it might get worse if she is not adherent and she will eventually need other medications with much more serious side effects like Methotrexate and/or biologics.

Finally, we talked about her need for a pill box and safe storage of her medications at home. She agreed and understood why she did not need to carry all her medicines to work daily.

I took away from this teaching experience a sense of purpose and a new found passion for what my career. I had an opportunity to explore my teaching skills and use motivational interviewing. I had truly begun to master the art of teaching and patient relationships. Thanks to the TCP program, I have become very intentional and aware of each interaction and the possibilities of impact in every situation.

New to Blood Glucose Testing

“Speak Another Language, Not a Problem!”

February 14, 2018

My patient came through drive through to pick up his diabetic testing supplies. When I asked him if he had used the blood glucose monitor before he said no, but he had seen the nurse use it on him while he was hospitalized. I also asked if he was newly diagnosed and he said yes. I immediately invited him inside so we could walk through the blood glucose testing steps together. He accepted the offer and mentioned he had been thinking of the process earlier and he felt slightly overwhelmed.

My patient was a in his mid-forties and a Laotian male who spoke very little English. My first challenge was the communication barrier. Luckily, at Walmart we have translation services. I was able to use the translation call line to bridge our communication gap.At the end of the our conversation, he was reassured that they could effectively monitor their blood sugar levels.

In this experience, one of the most important lesson I took away was the ability to effectively use the resources available to me as a provider. It was the first time I had ever used the Walmart translation services. Moving forward, I will know exactly how to help a patient with communication barrier and I will be better at doing it because practice makes permanent.

Another lesson for me was the realization that, language barrier is not always evident in patient interaction. Through the drive through window, I believed if I had used open ended questions, I would have realized the language barrier. Most of the responses I got from my patient were “yes, no and okay". This experience was a reminder to always pause and listen to myself while I counsel. Am I using medical terminology or common knowledge words? Am I asking open ended questions or not? I have become better at counseling because of intentional self-checks from unforgettable experiences such as this.

New to Insulin?

“The A,B and C’s of insulin administration in New Patients”

March 18, 2018

One Saturday morning, I encountered a patient who had just been diagnosed with Type II Diabetes Mellitus and was put on insulin for the first time. During my counseling, I realized he was new to insulin and was stressed about his diagnosis. He was most concerned about his new regiment which required him to test his blood glucose levels twice a day.

He mentioned that while the nurse had told him how to do this, he did not feel comfortable doing it. I invited him to the consultation area, sat down with him and performed a blood glucose check on him while walking him through each step with the use of motivational interviewing. Once I was done, I urged him to practice while I watched to see if he had a mastery of the process. Behold, my patient excelled in the teach-back test.

I did not feel comfortable asking him for feedback on our lesson. I was under the impression that it was not necessary because he had a lot going on already and asking him to fill out a survey for me at the time would have appeared somewhat selfish.

Over the Counter Counseling “Which Supplement is Recommended for Me?”

February 14, 2017

My patient was an 80 year old man who walked up to the pharmacy consultation desk with a couple of bottles of Magnesium supplement. He asked me which brand was better for him and how they worked. My first thought was poly-pharmacy. I wondered what other medications he was on and any co-morbidities I had to worry about. I walked him to the Over The Counter (OTC) section to help him pick out the right supplement.

During our conversation, I realized he was already taking “ONE A Day for Men 65+”. This was a teaching opportunity. I picked up a pack of “One a Day” and explained to him it already contained magnesium and I encouraged him to continue his home regiment. I also applauded him for asking a question before starting new medication. My patient promised to share our lesson with his friend, who recommended the supplement he was initially trying to purchase.

In this scenario, I learned the importance of listening and asking the right questions in an open-ended manner. This technique helped me get valuable information from my patient despite the absence of his patient profile. I also learned how to speak up a little louder when talking with the elderly.

The challenge I faced with my patient was lack of objective information as he was not a Walmart pharmacy patient and this made me feel a little nervous about the patient counseling without knowing his background. I overcame that with communication and effective listening and I was very satisfied with the outcome. I will continue to practice motivational interviewing with each patient encounter.

Every Patient Deserve a Smile “Chronic Disease Entails Life Long Learning"

A memoir of my Medical Mission trip to Cameroon

BightStar Foundation (BSF) is a non-profit organization based in Buea, Cameroon. BSF aims to support sickle cell patients and their families. BSF promotes advocacy in the management of sickle cell disease while eradicating the sickle cell disease stigma. The stigma around sickle cell disease in countries like Cameroon is very devastating and heartbreaking. Patients and their families do not want to be identified by their genetic predisposition and are very hesitant to seek medical help even when necessary. BSF is a young and growing foundation, with focus on sickle cell disease education.

In December 2017, I had a chance to travel to Cameroon alongside other BSF members for a medical mission trip. The BSF team has been working tirelessly to build a solid support network and encourage self-awareness and empowerment amongst sickle cell patients and their families. The foundation focuses on identifying individual patients, connecting them with other patients in their communities, and providing education empowerment to help patients prevent sickle cell disease crisis and complications.

For the past four years, BSF has hosted numerous annual seminars, reached over four hundred sickle cell patients. Their annual workshops have been held in different cities in the southern region of Cameroon precisely, Buea, Muyuka, Limbe and Ekona. BSF’s first medical mission trip was hosted in January 2018, with the help of volunteers like myself and other healthcare providers in the Cameroonian Community. The mission was 10 days long starting from January 2 to 11, 2018.I had the opportunity to educate health care workers, volunteers and patients on Sickle Cell Disease and its complications.

Like any other event, this workshops was not free from substantial preparations. Prior to the events, there were; radio announcements, radio interviews, public service announcements, volunteer meetings, patient home visitations, hospital visitations, and finally a visit to the Cameroon health delegation in Buea. The event was very interactive with training workshops that dealt with topics such as; basics about sickle cell anemia, hydration in sickle cell disease, pain management in sickle cell disease, crisis triggers and self-care in sickle cell patients and other complications in sickle cell disease (wound healing, hormonal imbalance, jaundice and anemia). During the seminar, there was free screening for Hepatitis A and B, Malaria and Hemoglobin levels. Patients had an opportunity to meet with our medical team (2 medical doctor, 6 nurses and 4 student pharmacists) to discuss their laboratory finding.

Our event was graced by fun and entertainment from patients and volunteers. We had amazing talent shows and shared lunch together as a sickle cell community. Teatime and short breaks were also observed during each of the event.

Team BSF was assisted by two medical doctors, eight nurses and forty volunteers to make the event a success. Presentations were done in English, French and other local languages like Pidgin English (local mother tongue). Our audience was made of patients ranging from 9 months old to 40 years of age. A larger number of our patient population was adolescence and preteens. Patient testimonials were an integral part of the seminar, as many patients shared their personal struggles and willingness to acquire knowledge to overcome these struggles. The seminar was very interactive and visual aids were used to aid in content explanations. There was room for question and answer sessions that was also very interesting and interactive. Below are some of the activities I was assigned and teachings completed;