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Latest News

Resource Spotlight: Venous Thromboembolism in Pregnancy 

January 26, 2023
 

Written by Duaa Osman

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

Background

In Canada, venous thromboembolism (VTE) is the second most common cardiovascular disorder and is estimated to cause the healthcare system $600 million per year. Pregnancy is a well-established risk factor for VTE, with all stages of pregnancy resulting in increased risk, especially the post-partum period. When compared to non-pregnant women of similar age, pregnant women experience a 5 to 10-fold increase in risk of VTE during pregnancy and a 15 to 35-fold increase during the post-partum period. This “Resource Spotlight” contains links to associations and guidelines that help pharmacists learn more about VTE in the context of pregnancy, along with helpful resources to share with patients. To learn more about VTE in pregnancy, check out CSHP’s recent Clinical Pearls article on Venous Thromboembolism in Pregnancy. 

External Resources  

Unless otherwise noted, the Canadian Society of Hospital Pharmacists (CSHP) does not endorse or imply endorsement of the resources provided here. These resources are provided without warranty of any kind, either expressed or implied. It is the responsibility of the user of the resource to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall CSHP or any persons involved in providing the resource be liable for damages arising from its use. Resources are free unless otherwise indicated.  

Thrombosis Canada 

Thrombosis Canada is an organization aimed at improving the care of patients with thrombosis. They provide helpful resources such as point-of-care guides and educational resources for both patients and healthcare professionals. With respect to venous thromboembolism in the context of pregnancy, Thrombosis Canada offers clinical guides on the diagnosis, treatment, and prevention of DVT and PE in pregnant patients. To support patient education, they also offer Patient Information Sheets on a variety of topics relating to thrombosis such as drug and disease information sheets. Thrombosis Canada has also recently developed and launched a national survey aimed at patients currently on anticoagulant therapy with results expected to be released to their website by the end of January 2023.  

Canadian Venous Thromboembolism Research Network (CanVECTOR)

CanVECTOR is a pan-Canadian network of researchers, healthcare professionals, patient groups, and public/private partners with the overall goal of reducing incidence of VTE in Canada and improving the safety and quality of care of those impacted by VTE. One way the organization supports its mission is by providing funding for research pilot projects relating to VTE. Funding for these pilot projects is determined through an annual pilot trial competition. A list of the projects funded by CanVECTOR can be found here. With respect to VTE in the context of pregnancy and the post-partum period,  CanVECTOR also publishes Evidence Summary articles where they summarize key findings from studies to help healthcare providers make evidence-based decisions. Some notable examples of topics addressed in these articles include assessing the risk of recurrent VTE in women who experienced an unprovoked VTE, assessing the need for thromboprophylaxis during pregnancy, and the effects of hormone therapy on the risk of recurrent VTE

Canadian Patient Safety Institute

In Canada, VTE remains to be one of the leading causes of maternal mortality due to increased risk factors during pregnancy. In collaboration with the Canadian Institute for Health Information, the Canadian Patient Safety Institute released a Hospital Harm Improvement Resource detailing evidence-based recommendations hospitals can implement to reduce the incidence of hospital-acquired VTE in adult and obstetrical patients.  

Society of Obstetricians and Gynacologists 

The Society of Obstetricians and Gynaecologists of Canada published clinical practice guideline outlining their recommendations regarding the diagnosis, treatment and thromboprophylaxis of VTE in pregnancy and the post-partum period. The venous thromboembolism and antithrombotic therapy practice guideline summarizes available evidence and can act as a useful resource to healthcare providers. They also offer evidence-based patient-friendly resources about pregnancy and childbirth on their Pregnancy Info website.  

January 26, 2023
Resource spotlight: Venous Thromboembolism in Pregnancy

Latest News

Together 2023: Frequently Asked Questions

January 18, 2023
 
With no shortage of excellent programming, Together: Canada’s Largest Hospital Pharmacy Conference is sure to provide attendees with unmatched opportunities for education while connecting the hospital pharmacy community across Canada.
To help make everyone's experience as seamless as possible in this new hybrid format, CSHP has developed an FAQ to clarify any questions that you may have.
 
Q. How many CEUs can I earn in total? 
A. Together attendees can earn up to 22 CEUs (pending CCCEP accreditation).
Here is a breakdown of those credits:

Conference ticket
Pre-conference credits (separate paid registration)
Sponsored satellite symposia (individually accredited by the sponsor)
  • Additional credits may be available through separate registration for sponsored satellite symposia, depending on the sponsor completing the accreditation process independently. 
 
Q. Can I earn all 22 CEUs if I’m attending virtually?
A. Up to 15 CEUs are available to virtual attendees. Sessions like the hands-on Pre-Conference Sim Lab: An Introduction to Managing Common Overdoses - A Toxicology Sim Lab for Everyone and the Hospital Pharmacy in Canada Survey Workshop are only available for those attending in-person
 
 
Q. Which other conference items are unable to be broadcast virtually? 
A. The face-to-face Student and Resident Networking Event and hospitality suites are not available on the virtual portal. 
 
Q. How long will conference recordings remain available?
A. Most recordings will be available on demand for a full year! However, to receive your CEUs, you must complete the accredited sessions by March 26, 2023

Q. If I can’t attend a session, can I watch the recorded session and still get my CEUs?
A.  Yes. Regardless of if you're attending in person or virtually, you can watch missed recorded sessions via virtual portal access (accessible on Thursday, March 9). Be sure to watch these sessions by March 26, 2023 to obtain your CEUs!

Q. Is the conference accredited for both pharmacists and technicians?  
A.  Yes, the conference will be accredited for both!  
 
Q. How do I know which sessions are accredited?  
A.  The sessions that are accredited will be indicated on the conference website with the CCCEP accreditation logo  (which will be updated closer to the conference).
 
 
Have a question that hasn't been answered here? Reach out to events@cshp.ca.

  
Register
  

 
 
January 18, 2023
Together 2023: Frequently Asked Questions

Clinical Pearls: Venous Thromboembolism in Pregnancy 

January 16, 2023
By Duaa Osman

This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.

Background

In Canada, venous thromboembolism (VTE) is the second most common cardiovascular disorder and is estimated to cause the healthcare system $600 million per year.1 Pregnancy is a well-established risk factor for VTE, with all stages of pregnancy resulting in increased risk, especially the post-partum period. When compared to non-pregnant women of similar age, pregnant women experience a 5 to 10-fold increase in risk of VTE during pregnancy and a 15 to 35-fold increase during the post-partum period.2

VTE is comprised of two main conditions, deep vein thrombosis (DVT) and pulmonary embolism (PE) – both of which are well established complications of pregnancy. Thrombosis typically occurs due to over-activation of hemostasis at the site of an injured or uninjured blood vessel. In general, factors that increase the risk of VTE are those that increase hypercoagulability, stasis of the blood, or vessel wall injury – also known as Virchow’s triad.3 Increases in clotting factors during pregnancy results in a hypercoagulable state. During the second and third trimesters, an increased resistance to activated protein C is observed, resulting in poor anticoagulant response. Stasis of the blood increases due to decreased venous capacitance and compression of the large veins caused by the enlargement of the uterus. Finally, an increase in vessel wall injury can occur due to labour and delivery, increasing the risk of VTE during the post-partum period.4 

VTE can manifest during pregnancy as an isolated DVT in the lower extremities, or a portion of the embolus may travel from the lower extremity to the lungs resulting in a PE. Early detection and treatment of DVT and PE during pregnancy is crucial as PE represents the 7th leading cause of maternal mortality, accounting for 9% of maternal deaths.4

Diagnosing VTE in pregnancy

Distinguishing symptoms of DVT from symptoms of pregnancy can be difficult as there are many hemodynamic changes that occur during pregnancy. With respect to clinical presentation, pregnant women have a higher likelihood to experience left-sided DVT than non-pregnant women, with greater than 80% of DVT cases in pregnancy occurring in the left leg.2 DVT in pregnant women is also more likely to be isolated to the iliac and/or femoral veins than in non-pregnant patients.2 This is thought to be due to the right common iliac artery compressing the left common iliac vein as a result of the enlargement of the uterus.5 Signs and symptoms of DVT include erythema, leg swelling, and warmth of the lower extremity.2

The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends investigating suspected DVT using compression ultrasound of the proximal venous system from the iliac to the popliteal vein. Doppler studies should also be performed on the external iliac vein to ensure presence of blood flow. If the initial examination is negative, the test should be repeated within 7 days. If an isolated DVT is suspected to be in the iliac vein, an MRI can be considered following the initial examination.6 Suspected cases of PE can be investigated using D-dimer test combined with compression ultrasonography.6 Once an acute case of VTE is confirmed, anticoagulation therapy should be promptly initiated. The SOGC guidelines recommend that pregnant women should be hospitalized or closely monitored as outpatients for the first two weeks of VTE treatment following diagnosis.6

Therapeutic options: Anticoagulants 

The cornerstone of VTE therapy is anticoagulation therapy; however, during pregnancy certain safety considerations must be kept in mind to uphold maternal and fetal safety.  

Table 1: Anticoagualnt options available for the treatment of VTE 7,8

*Except in patients with a history of heparin-induced thrombocytopenia

In most cases, subcutaneous LMWH is the drug of choice for the treatment of DVT in pregnancy due to its safety and efficacy profile. UFH is preferred for patients with severe renal failure, or those at increased risk of bleeding or persistent hypotension resulting from PE.6

Warfarin is contraindicated during the first trimester of pregnancy since it can cause warfarin embryopathy resulting in stippled bones, midfacial and limb malformations. Warfarin use during pregnancy can also result in fetal hemorrhage or death. Therefore, the use of warfarin should only be considered in exceptional circumstances, for example, in women with mechanical heart valves.9

Anticoagulants should be administered for a minimum of 3 months when treating acute VTE. Following this initial treatment period, anticoagulant use can be decreased to intermediate or prophylactic use for the remainder of the pregnancy. Treatment can be discontinued at 6 weeks post-partum.6

Thromboprophylaxis in pregnancy  

The need for thromboprophylaxis in pregnancy should be assessed during pregnancy, the post-partum period, and at any transitions of care. Pharmacologic and non-pharmacologic options are available for thromboprophylaxis. Non-pharmacologic options include graduated compression stockings or use of intermittent pneumatic compression devices.  
 
Pharmacologic prophylaxis can be considered for pregnant women with a history of multiple VTEs or estrogen associated VTE. The preferred agent for pharmacologic prophylactic treatment is LMWH. In patients with severe renal insufficiency, UFH is preferred. It is recommended that prophylactic therapy be continued through the pregnancy. During the final weeks of pregnancy, prophylactic treatment should be reassessed to determine if any changes or discontinuation is needed.10 

Determining the optimal dosing for LMWH during pregnancy and the post-partum period remains to be a challenge due to existing knowledge gaps.5 A recent multicentre open-label, randomised controlled trial, the Highlow study, sought to determine optimal dosing of LMWH in pregnant and post-partum women with a history of VTE.11 The primary efficacy outcome of the study was incidence of confirmed VTE, and the primary safety outcome was assessing for risk of bleeding. The study randomised 1110 pregnant women to receive either a weight-adjusted intermediate dose of LMWH or a fixed low dose of LMWH. The study found that fixed low dose of LMWH is an appropriate thromboprophylaxis dosing strategy during pregnancy in patients with a history of VTE. With respect to the post-partum period, a post-hoc analysis of the study suggested that an intermediate dose of LMWH may be more effective than a low dosing strategy, however this needs to be confirmed through future studies.11

Pharmacist's role

 As part of a multidisciplinary team, pharmacists can play a vital role in the care of patients with VTE. Anticoagulation therapy requires frequent assessment and monitoring to ensure safety and efficacy. Several studies have found that effective patient education and regular long-term follow-up help improve medication adherence.12 In an assessment of the impacts of a pharmacist-led DOAC monitoring clinic, Haché et al. found an increase in patient adherence to guideline-directed care along with a decrease in observed adverse events. In this clinic, pharmacists were the first point of contact for patients during follow-up appointments where patients were assessed for adverse events and adherence. During these visits pharmacists were also able to make changes to medication regimens based on patient assessment, ensuring medication management was in accordance with guideline recommendations.12 In addition, a study by Ogilvie et al. assessing a pharmacist-lead prescribing model in an Australian emergency department found a significant improvement in accuracy and safety of the medications prescribed to patients for VTE.13   With respect to oral contraceptive medication use during the post-partum period, it is recommended that women at risk of VTE avoid combined oral contraceptives during the first 6 weeks of the post-partum period.7 This presents an opportunity for pharmacist intervention for patients at high risk of VTE. Pharmacists are well positioned to make tailored recommendations regarding oral contraceptives based on a patient’s risk of VTE. They can also play a significant role in patient education, effectively enhancing patient safety. 

 

References

  1. Canadian Venous Thromboembolism Clinical Trials and Outcomes Research Network. Venous thromboembolism. Accessed December 14, 2022. https://www.canvector.ca/venous-thromboembolism  
  2. Thrombosis Canada. Pregnancy: Diagnosis of DVT and PE. Updated September 14, 2021. Accessed December 14, 2022. https://thrombosiscanada.ca/clinicalguides/?search=pregnancy#  
  3. Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of Venous Thromboembolism in 2020 and Beyond. J Clin Med. 2020;9(8):2467. Published 2020 Aug 1. doi:10.3390/jcm9082467 
  4. Malhotra A, Weinberger SE. Deep vein thrombosis in pregnancy: Epidemiology, pathogenesis, and diagnosis. In: Post T, ed. UpToDate. UpToDate; 2022. Accessed December 9, 2022. www.uptodate.com  
  5. Devis P, Knuttinen MG. Deep venous thrombosis in pregnancy: incidence, pathogenesis and endovascular management. Cardiovasc Diagn Ther. 2017;7(Suppl 3):S309-S319. doi:10.21037/cdt.2017.10.08 
  6. Chan WS, Rey E, Kent NE, et al. Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014;36(6):527-553. doi:10.1016/s1701-2163(15)30569-7 
  7. Kosar L, LeBras M. Peri-Pregnancy: Drug treatment considerations for women. May 2022. Available from www.rxfiles.ca 
  8. Thrombosis Canada. Pregnancy: Venous thromboembolism treatment. Updated 2, 2022. Accessed December 14, 2022. https://thrombosiscanada.ca/clinicalguides/?search=pregnancy#  
  9. Malhotra A, Weinberger SE. Deep vein thrombosis and pulmonay embolism in pregnancy: treatment. In: Post T, ed. UpToDate. UpToDate; 2022. Accessed December 9, 2022. www.uptodate.com  
  10. Malhotra A, Weinberger SE. Deep vein thrombosis and pulmonay embolism in pregnancy: Prevention. In: Post T, ed. UpToDate. UpToDate; 2022. Accessed December 9, 2022. www.uptodate.com  
  11. Bistervels IM, Buchmüller A, Wiegers HMG, et al. Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial. Lancet. 2022;400(10365):1777-1787. doi:10.1016/S0140-6736(22)02128-6 
  12. Haché J, Bonsu KO, Chitsike R, Nguyen H, Young S. Assessment of a Pharmacist-Led Direct Oral Anticoagulant Monitoring Clinic. Canadian journal of hospital pharmacy. 2021;74(1):7-14. doi:10.4212/CJHP.V74I1.3035 
  13. Ogilvie M, Nissen L, Kyle G, Hale A. An evaluation of a collaborative pharmacist prescribing model compared to the usual medical prescribing model in the emergency department. Research in social and administrative pharmacy. 2022;18(10):3744-3750. doi:10.1016/j.sapharm.2022.05.005 
     

Latest News

January 16, 2023
Clinical Pearls: Venous Thromboembolism in Pregnancy

Latest News

Call for applications: CSHP Foundation Board Pharmacy Technician Trustee 

January 11, 2023

 

Call for applications

The CSHP Foundation Board is seeking applications for a Pharmacy Technician Trustee (new position)

Selection Criteria:

  • CSHP Member (Pharmacy Technician – an individual who is licensed by or registered with a provincial college of pharmacists/pharmacy or in the province of Quebec, comparable education and/or experience).
  • Demonstrated interest in programs that advance the practice of pharmacy and patient care in hospitals and other collaborative healthcare settings and support the mission and vision of the CSHP Foundation.
  • No conflict of interest with the work of the Foundation.

Pharmacy Technician Trustee Term: 3 years (option to renew once, 6 years total).

CSHP Foundation Pharmacist, Pharmacy Technician, Industry and Public Trustees are voting members of the Foundation Board. This is your opportunity to become directly involved in the work of the CSHP Foundation.
 
Are you interested? Information on CSHP Foundation Board Member responsibilities and application forms are available on the Foundation’s website at  https://cshp-scph.ca/foundation-board-member-recruitment

For additional information on position responsibilities and commitments, contact Michael LeBlanc, Chair, CSHP Foundation Board Trustees, at michael.leblanc@horizonnb.ca.

Completed application forms and other required documents should be submitted electronically to Rosemary Pantalone at rpantalone@cshp.ca.

 

Deadline Date for Applications is March 24, 2023  

The CSHP Foundation supports research and educational programs that advance pharmacy practice and patient care in hospitals and other collaborative healthcare settings. The Foundation raises funds that are used to: promote research, advance pharmaceutical science and programs of pharmaceutical education.

January 11, 2023
Call for applications: CSHP Foundation Board Pharmacy Technician Trustee

Latest News

Resource spotlight: Precepting tools

January 3, 2023

 

Written by Eric Katula

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

 

Background

A crucial part of pharmacy education is experiential learning, which gives students and interns the chance to apply their vast knowledge to real-world situations while being directed by pharmacists with relevant expertise. Being a preceptor is a difficult and crucial job that aids in
preparing graduates for the expanding complexity of the health care system, varied modes of care delivery, navigating the diversity and ambiguity of clients, and the quickening pace of technological advancements. This article aims to highlight tools and resources that can aid in facilitating preceptors' important roles. 

University of Alberta
The faculty of pharmacy and pharmaceutical sciences at the University of Alberta has a preceptor guide that contains answers to any questions preceptors may have about student placements. The guide provides a range of information and suggestions regardless of the student’s year. Among other resources, the faculty offers a checklist for new preceptors, a policies and procedures manual for PharmD students, a guide to teaching clinical problem solving, complete training modules for preceptors, and a document outlining novel models of precepting. Also, the Alberta Health Services has a free preceptor module to help enhance preceptors’ skills. 

Dalhousie University
Dalhousie University offers a free preceptor eLearning course, available to students and instructors at the university, that provides both refresher modules and comprehensive preceptor practice information. The course highlights preceptor roles, teaching methods and styles, providing feedback and evaluation, and interprofessional learning. 

University of Saskatchewan
The university has resources and tools for new and seasoned preceptors that can help guide them through student mentorship. The university has a one-page document outlining the reasons to become a preceptor, how to be an effective preceptor, the roles of a preceptor, and Saskatchewan Health Information Resources and Partnership (SHIRP), a health information resource. 

Western University
The Preceptor Education Program is an online interprofessional program that has eight interactive learning modules. The program is free and available to the public. The modules include downloadable resources, learning exercises, video case scenarios and references. Learning is self-directed and the modules can be completed in any order. The learning modules will help preceptors to prepare for their roles, help students develop learning objectives, resolving conflicts, foster clinical reasoning, and learn how to provide effective feedback

American Society of Hospital Pharmacists
The ASHP offers its active members resources to help mentor and educate students in real world settings to fulfill experiential learning objectives. Their resources can serve as guidance as preceptors develop the most effective methods to teach and mentor students and residents. Such resources include a generational learning document that outlined tips to offering feedback to students of different generations, residency specific resources, student-specific resources, and a preceptor’s playbook that includes nine modules designed to enhance the skills of pharmacy preceptors. 

Suggested Reading Materials

Below are links to reading materials that outline current research on improving preceptors' abilities to guide students throughout their rotations. The studies and articles contain practical ways to implement the suggestions into practice.
 
  • Biagioli FE, Chappelle K. How to be an efficient and effective preceptor. Fam Pract Manag. 2010;17(3):18-21. This paper is a tool for preceptors to aid in pharmacy students' development of professionalism. The article defines professionalism, describes it in the context of contemporary pharmacy practice, discusses the professional socialization process of students, and suggests strategies for preceptors to facilitate improvement in professionalism among students during experiential training.

The following studies and articles introduce preceptors to the clinical reasoning and problem solving. The teaching strategies offered in the articles are aimed at facilitating the preceptor role in helping students develop their own clinical reasoning. 

January 03, 2023
Resource spotlight: Precepting Tools

Latest News

Notice for 2023 Sabbatical Grant competition

December 28, 2022
 
 

APPLY NOW for an Education Sabbatical Grant


The CSHP Foundation is pleased to offer dedicated funding to a maximum of $5,000 to support an Education Sabbatical Grant


CSHP Foundation Sabbatical Grant eligibility criteria


  • Applicant is a current CSHP member.

  • Applicant has been a CSHP member for at least 12 months at the time of the grant submission. (Membership in the past 12 months could have been as a CSHP member, new member or member-in-training)

  • Application does not duplicate funding already held for this sabbatical. If an additional funding source is being solicited, the funding source and decision date for that funding source is to be declared.

  • Applicant has not received a CSHP Foundation Education Grant in the past two years.

  • The following activities are not eligible for an education sabbatical grant: conference attendance and related travel; residency and fellowship programs; accredited academic degree programs; and research projects.


Applications will be reviewed by the Foundation’s Education Grant Committee.


Education Sabbatical Grant submission: required elements


For the applicant:

  1. A written proposal (no more than 2 pages) which includes:

    • Reasons for wanting to complete a sabbatical.

    • Description of the specific skills that will be acquired during the proposed sabbatical.

    • How the new skills will enhance the applicant's future performance as a pharmacy practitioner (educator, clinician or researcher).

    • How the skills will be applied to the applicant's practice.

  2. A written report (no more than 2 pages) to include:

    • Description of the clinical practice at the mentoring facility

    • A detailed timeline for the proposed sabbatical activity which must be completed by April 30, 2024 (unless otherwise negotiated).

    • A detailed budget with description of costs. (Maximum amount available is $5,000)

      • Funding can be used for travel, meals on travel days only (subject to CSHP Travel Expense Reimbursement policy limits), lodging, and tuition.

      • Funding cannot be used to supplement any existing salaries or compensate the grantee's group for time lost in practice.

  3. Applicant's curriculum vitae.

  4. A letter of support from the applicant's employer, if applicable.


For the mentor:

  1. A letter of support (no more than 2 pages) including an assessment of the applicant's ability to complete his or her proposed program.

  2. Mentor's curriculum vitae.


Send submissions to Rosemary Pantalone, CSHP National Office, at rpantalone@cshp.ca
All files should be in PDF format.
Grant decisions will be announced in late June 2023.


DEADLINE FOR SUBMISSIONS: Thursday, April 13, 2023

December 28, 2022
Notice for 2023 Sabbatical Grant competition

Latest News

Together 2023: Timely topics for pharmacy technicians

December 27, 2022  
 

 

Pharmacy technicians are vital members of CSHP. At Together: Canada’s Hospital Pharmacy Conference (March 10-12), you'll find cutting-edge sessions of particular interest to pharmacy technicians. Register by January 16 to catch early bird rates: Save up to $70!

Register now

Expanding the Scope: Hospital Pharmacy Technicians Through the Pandemic 

Karyann Dorn, Ruth-Ann Paxton
Welcoming the expanding scope of the technician with resilience.  What does resilience look like?  How is that going to help you embrace an expanding scope?  In this session we will answer those questions along with learning some problem-solving skills. Having resilience, being curious, and embracing change will help you step into an expanding scope.  

 

The Perks of Centralization

Jennifer Bean
When the words centralization or standardization are used, they are typically met with the question of "what's in it for me"? This session will take a look at the benefits that come with centralization and standardization of the Centralized Drug Production & Distribution Project (CDPD) model, and what it means for staff and patients as they navigate the waters of a new way to provide medications. 

Implementation of Technology to Assist Dispensary Workflow in a Regional Hospital 

Shannan Neubauer
Technologies to enhance patient safety in the medication system include: computerized physician order-entry and clinical decision support software (prescribing step), pharmacy information systems that retain images of the order (transcribing step), automated packagers, camera checking and robots (dispensing step), and automated dispensing cabinets with barcoding (administration step). Let's discuss how the sequencing of technology implementation affects your workflows.   

Managing Drug Shortages – How has COVID impacted drug shortage management? 

Tracey Simpson
Drug shortages continue to be very challenging and an everyday issue for both hospital and community pharmacists. AHS has various tools and resources available to communicate drug shortages and mitigation strategies within our organization. One mitigation strategy is escalation of shortages to Tier 3 status via the Tier Assignment Committee and exceptional importation and sale of foreign-labeled drug. During COVID, various strategies were used to mitigate drug shortages and as a result, Health Canada implemented a number of regulatory changes to make these mitigation measures permanent. 


Register now

 
December 27, 2022
Together 2023: Timely topics for pharmacy technicians

Latest News

Together 2023: Must-attend sessions for pharmacy leaders

December 27, 2022
 
At Together: Canada’s Hospital Pharmacy Conference (March 10-12), you'll find cutting-edge sessions of particular interest to pharmacy leaders. Register by January 16 to catch early bird rates: Save up to $70!

Register now 

Give back and share your expertise: Student and Resident Networking Event

The Canadian Pharmacy Residency Board (CPRB) and CSHP present the popular Student and Resident Networking Event. This is a fantastic opportunity during the Together Conference for students and residents to join pharmacy leaders and preceptors to discuss career pathways and strategies for success. It's an inspiring opportunity to give back to the profession, to connect with the next generation of our colleagues, and to shape the future of pharmacy. Please encourage your team members to join us! 
 

Practicing with Pride! Actionable strategies for pharmacy team members to improve 2SLGBTQ+ health 

Kyle Wilby
This session will provide learners with theory, perspective, and evidence relating to systemic oppression of 2SLGBTQ+ people in pharmacy practice. Presenters will review the Minority Stress Model and the Lens of Systemic Oppression. Examples from their own lived experiences, as well as data collected through research projects, will be used to stimulate learning, and help participants understand the individual, interpersonal, and system factors that contribute to systemic oppression and health disparities observed within the 2SLGBTQ+ population. Presenters will also provide evidence-based data from completed and ongoing research projects to propose actionable strategies for the pharmacy profession to consider when working towards dismantling systemic oppression within the Canadian healthcare system.

Climate Action: Pharmacy on the Frontline 

Brenda Chang, Celia Culley, Jessica Visentin, Kaitlyn Watson, Shellyza Sajwani
Air pollution, environmental hazards, and climate change are all hazards to human health. Paradoxically, the healthcare sector, while caring for patients, pollutes the air and contributes to the manufacture and disposal of pharmaceuticals as well as significant greenhouse gas emissions. This session will provide participants with insight into how pharmacy professionals can, and need to, adapt to a changing climate, as well as provide concrete steps for participants to mitigate pharmacy practice’s environmental impact.

Hospital Pharmacy in Canada Survey Workshop 

The Hospital Pharmacy in Canada Survey is the single most important resource for hospital pharmacy leaders, policy makers, professionals and management.
This three-hour workshop will show you how to use this data to make the case for resources, funding and special practice issues. Editorial Board members will demonstrate how to frame survey results into powerful evidence-based recommendations and solutions for hospital pharmacy issues. Enjoy small group case studies with expert leaders on hand to guide discussion. Add this separate paid event to your in-person registration.
 

Nova Scotia’s Hospital Pharmacist-Led Pandemic Response: Lessons Learned for COVID And Beyond  

Tasha Ramsey
To support Nova Scotians and their healthcare providers, three hospital pharmacy-based consult services were created: the COVID-19 Non-Severe Therapy Pharmacist Consult Service, the COVID-19 Moderate-Severe Therapy Pharmacist Consult Service, and the COVID-19 Vaccine Pharmacist Consult Service. From vaccines to pre-exposure prophylaxis, non-severe treatment, and severe treatment, the consult services provide multi-faceted guidance.  Catch this session to create a spark for your own consult service evolution.
December 27, 2022
Together 2023: Must-attend sessions for pharmacy leaders

Latest News

Top 5 CJHP articles of 2022

December 16, 2022

In 2022 the Canadian Journal of Hospital Pharmacy published four issues focusing on pharmacy in hospitals or other collaborative healthcare settings and optimizing safe and effective drug use for patients in Canada and throughout the world. Of the over 60 peer-reviewed articles included in their prestigious pages, the following articles caught the eyes of readers most:
 

Standing Against Injustice and Working Towards Reconciliation in Health Care by Jody Ciufo, Zack Dumont, Tania Mysak, Shirin Abadi, Tamar Koleba

This commentary comes from CSHP's Board of Directors' Executive expanding on how the Society is committing to combat racism in healthcare and how they are calling upon members to promote equity and inclusion in their practices. To see what you can do to best serve as an ally in pharmacy, click here.

Addressing Racism in Hospital Pharmacy Practice Research by Lauren Bresee 

In an editorial by Lauren Bresee makes it clear that racism in medicine is not only prevalent in clinical practices, but also in patient-based clinical research. Learn how to best address and dismantle the racial barriers in research by clicking here.  

Hyponatremia Secondary to Decreased Oral Intake and SIADH and Possibly Exacerbated by Horsetail (Equisetum arvense) by Duane Bates, Tam B Duong, Sasha Kheyson, Kim Moore 

In this case report, a team out of Alberta walks readers through their usage of Horsetail and its impact on their elderly patient. To view this report, click here

Burnout among Hospital Pharmacists: Prevalence, Self-Awareness, and Preventive Programs in Pharmacy School Curricula by Colby Weichel, Joan S Lee, Justin Y Lee 

This original research article set out to determine the prevalence of burnout among hospital pharmacists and how pharmacy school curriculums can be tweaked to prevent this state pre-emptively. Read this piece by clicking here

Health Care Professionals’ Perceptions of the Role of the Clinical Pharmacist and Expanded Pharmacist Coverage in Critical Care by Kristin Kaupp, Emma K Reid, Hannah Corney, Sarah Burgess, Lauren Hutton 

Finally, thanks to a group of pharmacists from Nova Scotia Health, this brief research report covers the opinions and impacts of expanded critical care pharmacists (CCP) coverage on patient care as well as their opinions about the role of a CCP as a member of the critical care team. To access this article, click here

Here's to all of the incredibly educational articles that CJHP published in 2022, and for an even more riveting set of issues in 2023.


December 16, 2022
Top 5 CJHP Articles of 2022

Clinical Pearls: Effective precepting - tips and tricks 

December 15, 2022
By: Eric Katula

This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.
 

Experiential education is an essential component of pharmacy education that allows interns and students to experience real-life scenarios while being guided by experienced pharmacists1. Without preceptors, quality experiential learning would be near impossible to achieve. Effective preceptorship is among the major components that produce excellent pharmacists capable of positively representing the pharmacy profession1Preceptors build trust and responsibility while easing the student's transition into professional practice. Being a preceptor is a challenging and important role that helps prepare graduates for the growing complexities of the health care system, various methods of delivering care, coping with ambiguity and diversity of patients, and the rapid changes in technology. Paired with an experienced pharmacist, pharmacy students learn by observing, following guidance, questioning, participating in education, and promoting the health of patients, families, and society. Preceptors facilitate learning through their ability to articulate expectations, being supportive and flexible, and having a desire to help students learn1. This article aims to provide preceptors with tips and tricks to facilitate their role and enable pharmacy students to enjoy experiential education.  

Role Modelling2

Good role modeling is one of the most important contributions a preceptor can make toward a student's professional development2. Most students acquire important skills such as interacting with patients, healthcare providers, and other staff by observing how the preceptors conduct themselves when interacting with such individuals2. Therefore, as a preceptor, it is extremely important to be an exemplary role model that the student may emulate to acquire professional behaviors that confer respect to the pharmacy profession. Students consistently cite their preceptors' support, willingness to help, and caring attitude as the most important attributes that made their learning experience valuable3. A positive disposition toward the profession is also critical as students ready themselves to enter practice. Disgruntled pharmacists with a negative attitude toward the pharmacy profession should not become preceptors because students need encouragement as they prepare to enter their chosen careers4

Give Constructive Feedback

To improve, students need to know and understand their performance. Pharmacy schools provide mechanisms for formal assessment; examples include the midpoint and final evaluations. However, students need to receive regular and consistent feedback regarding their performance during their experiential learning2. Feedback should be timely, targeted, and specific for it to be useful to the student2. It also needs to offer recommendations for improvement3. It is extremely frustrating for students to discover for the first time that they did not meet the preceptor's expectations at the end of the rotation. Students need to understand areas of improvement early in the rotation and be provided opportunities to address any deficiencies. 

When providing feedback, preceptors should prioritize their ideas to ensure their feedback focuses on the most important issues. To provide constructive feedback, preceptors should concentrate on the following: 

  • Concentrate on the behaviour, not the person5. Preceptors can start by briefly stating the conduct in question and then describing why such behaviour is appropriate or inappropriate. For example, a preceptor can say, "I have not seen you interacting with patients for a week; I am worried that you are missing an important aspect of your rotation. Can we meet soon to discuss this?" 
  • Be specific5. Preceptors should avoid generalizations that can be of no benefit to the student. Including examples of what the preceptor would like the student to do may clarify the feedback and thus make it more useful to the student. 
  • Use the "Sandwich approach"5. Start by providing feedback on the student's strengths. Then identify areas of improvement and how to change. And conclude the feedback with a positive comment. For example, "Your interaction with the patient was good. You maintained good eye contact and answered all his questions and concerns. You were a little hard to follow as your voice was very low. It is important to project your voice a little more, especially when talking with elderly patients. Overall, you did well and can overcome this with a little more practice. Keep up the good work."
  • Be realistic5. Preceptors should provide feedback that students can use to improve their learning and advance their skills. It can be very frustrating to receive feedback that is hard to implement or that students cannot control. It is also important to avoid statements such as "you always …" or "you never …" because people's behaviours are rarely consistent5,6.
  • Be timely5. Preceptors should give all feedback as soon as possible to avoid frustration and resentment resulting from delayed feedback. Prompt feedback, unlike delayed feedback, maintains its impact5.
  • Be Supportive5. Preceptors should follow up on all feedback given to students to assess its impact on their learning and skill development. Students should know that their preceptors are available to them if they have any questions or need assistance5,6.

 

Access and Provide Structure

Students have varying levels of therapeutic knowledge, experience, and career goals. Therefore, preceptors need to be flexible and individualize their teaching methods to students' needs and goals. Preceptors should regularly discuss with students and conduct assessments of students' therapeutic knowledge, past pharmacy experiences, and learning gaps at the beginning of each experiential learning rotation7. Students should express teaching methods that they have greatly benefited from in the past. Sharing such practices allows the preceptor to adjust their teaching style to fit the learning style of the student10.  In addition, early in the rotation, preceptors should strive to determine any specific goals that the student has for the experiential learning rotation. 

Although pharmacy students should assume responsibility for their learning, it can be difficult for students to know where to direct their focus, especially when exposed to a new practice environment in which they have no prior experience. Until evidence proves otherwise, preceptors should avoid assuming students know how to immerse themselves into the workflow of the site at which the experiential learning is being conducted. Preceptors should provide structure with sufficient flexibility to accommodate the student's individual needs10

Communication

A successful experiential learning experience requires open communication6.  Effective communication can resolve problems and avoid misunderstandings8.  Before the student arrives for their experiential rotation, preceptors should express their goals and expectations7.  Preceptors and students should frequently communicate expectations, learning styles, learning objectives, student progress, and teaching styles. Preceptors can initiate such types of conversations by asking questions such as "Is there any type of condition or patient you would like to focus on today?"2.  Such questions help students narrow down their goals. Employing questioning and quizzing techniques keep students actively involved in their education7. To elicit reflection, preceptors can ask questions like "What did you learn today?" or "Is there a different way that I could teach to facilitate your learning?"2,7.  Answers to such questions can guide future discussions or teaching techniques. Active listening is also part of effective communication. Preceptors can demonstrate active listening by avoiding multitasking while talking with students, repeating what they have heard, clarifying questions, and listening more than talking7

Provide context for future practice

To be committed to the experiential learning rotation, students must understand how their experience contributes to their future practice8. Providing context for how assignments and learning activities relate to future practice enables students to understand the importance of what they are learning and not feel like they are just completing school requirements. For example, a student may not know why they must write reports on a given topic that may seem unrelated to pharmacy practice. In such instances, the preceptor needs to explain to students the importance of being able to write clearly and concisely as future healthcare providers. The explanations would enable the students to view the assignment as training that will sharpen their writing capabilities, a crucial skill for future pharmacists. Also, students may not understand why they must evaluate themselves and provide feedback to each other. Preceptors should explain the importance of assessing oneself as the students will be practicing independently in the future and therefore need to be able to identify gaps in their knowledge to improve as healthcare professionals. 

As a crucial part of students’ journey towards becoming effective healthcare professionals, preceptors teach and guide future pharmacists by being good role models8,9,10, giving constructive feedback, providing structure, and communicating effectively with students8,9. This article discussed tips and tricks that preceptors can utilize to facilitate their duties in helping students gain knowledge and become pharmacists that bestow respect and admiration for the pharmacy profession. 

References

1. Biagioli FE, Chappelle K. How to be an efficient and effective preceptor. Fam Pract Manag. 2010;17(3):18-21. 
2. Benbassat J. Role modeling in medical education: the importance of a reflective imitation. Acad Med. 2014;89(4):550-554. doi:10.1097/ACM.0000000000000189 
3. Phuma-Ngaiyaye E, Bvumbwe T, Chipeta MC. Using preceptors to improve nursing students' clinical learning outcomes: A Malawian students' perspective. Int J Nurs Sci. 2017;4(2):164-168. Published 2017 Mar 6. doi:10.1016/j.ijnss.2017.03.001] 
4. Sarcona AR, Burrowes JD, Fornari AJ. Characteristics of an Effective Preceptor: Dietetics Education as a Paradigm. J Allied Health. 2015;44(4):229-235. 
5. Receiving and giving effective feedback. Centre for Teaching Excellence. https://uwaterloo.ca/centre-for-teaching-excellence/teaching-resources/teaching-tips/assessing-student-work/grading-and-feedback/receiving-and-giving-effective-feedback. Published May 13, 2020. Accessed October 12, 2022. 
6. Jahromi VK, Tabatabaee SS, Abdar ZE, Rajabi M. Active listening: The key of successful communication in hospital managers. Electron Physician. 2016;8(3):2123-2128. Published 2016 Mar 25. doi:10.19082/2123 
7. Phuma-Ngaiyaye E, Bvumbwe T, Chipeta MC. Using preceptors to improve nursing students' clinical learning outcomes: A Malawian students' perspective. Int J Nurs Sci. 2017;4(2):164-168. Published 2017 Mar 6. doi:10.1016/j.ijnss.2017.03.001 
8. Hardie P, Darley A, Redmond C, Lafferty A, Jarvis S. Interpersonal and communication skills development in nursing preceptorship education and training programmes: a scoping review protocol. HRB Open Res. 2021;4:9. Published 2021 Mar 11. doi:10.12688/hrbopenres.13201.2 
9. Pere K, Manankil-Rankin L, Zarins B. Preceptors' experiences of one to one preceptorship model for students undertaking an accelerated undergraduate nursing program: An interpretive descriptive qualitative study. Nurse Educ Pract. 2022;63:103373. doi:10.1016/j.nepr.2022.103373 
10. Byszewski A, Hendelman W, McGuinty C, Moineau G. Wanted: role models--medical students' perceptions of professionalism. BMC Med Educ. 2012;12:115. Published 2012 Nov 15. doi:10.1186/1472-6920-12-115 

Latest News

December 15, 2022
Clinical Pearls: Effective precepting - tips and tricks

Latest News

Call for judges: CSHP-CAPSI Evidence-Based Practice (EBP) Competition 

December 14, 2022


 

CSHP is looking for pharmacist member volunteers to judge the CSHP-CAPSI Evidence-Based Practice (EBP) Competition taking place in January 2023.

This nationwide competition provides pharmacy students with an opportunity to work together in teams to review a patient case, identify drug therapy problems, and provide recommendations using primary literature searches and/or established guidelines. Student teams will complete a written submission which will be judged based on a marking key. The highest-scoring team will be awarded a prize sponsored by CSHP.

If you’re interested in volunteering as a judge for this exciting competition, please send a letter of interest and your CV for consideration to htauqeer@cshp.ca by Friday, January 27, 2023.








December 14, 2022
Call for judges: CSHP-CAPSI Evidence-Based Practice (EBP) Competition

Latest News

Resource Spotlight: Cystic Fibrosis

December 5, 2022
 

Written by Duaa Osman

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca


Background

Cystic Fibrosis (CF) is an autosomal recessive genetic disease caused by a mutation in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein resulting in abnormal ion transport across cell membranes, affecting multiple organ systems such as the pulmonary, reproductive, and digestive systems. According to the Canadian Cystic Fibrosis Registry 2020 annual report, a total of 4,332 Canadians are affected by CF attributing to 1 in every 3,600 live births. Early diagnosis and treatment of CF is a crucial component of long-term survival. This “Resource Spotlight” contains links to associations, guidelines and studies that help pharmacists learn more about cystic fibrosis and its management, along with helpful resources to share with patients. To learn more about cystic fibrosis, check out CSHP’s recent Clinical Pearls article on Cystic Fibrosis

External Resources 

Unless otherwise noted, the Canadian Society of Hospital Pharmacists (CSHP) does not endorse or imply endorsement of the resources provided here. These resources are provided without warranty of any kind, either expressed or implied. It is the responsibility of the user of the resource to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall CSHP or any persons involved in providing the resource be liable for damages arising from its use. Resources are free unless otherwise indicated. 

Cystic fibrosis Canada

Cystic fibrosis Canada is a non-profit organization committed to supporting patients with cystic fibrosis. The organization provides useful resources to patients with CF, caregivers, and healthcare professionals. Healthcare providers can make use of the organization’s published guidelines concerning the treatment and management of CF such as the Canadian Clinical Consensus Guideline for Initiation, Monitoring and Discontinuation of CFTR Modulator Therapies for Patients with Cystic Fibrosis, as well as Antibiotic Dosing Guidelines for Cystic Fibrosis. Each year, Cystic Fibrosis Canada publishes a report surveying CF patient data across Canada to provide a snapshot of CF care across the nation. The data from these reports helps healthcare providers and researchers gain knowledge which can be used to help improve health outcomes for patients with CF. In addition, their clinical trials network, Cystic Fibrosis Canada Accelerating Clinical Trials (CF CanACT), can be used to easily search for ongoing clinical trials and eligibility criteria for enrollment. 

The management of CF can be overwhelming for patients and caregivers as the disease can affect a multitude of organ systems. To support patients and caregivers, Cystic Fibrosis Canada also provides patient-friendly resources on topics such as transitioning from pediatric to adult care, parenting with CF, supporting students in schools, and general health recommendations. An email helpline (helpline@cysticfibrosis.ca) is also available to connect patients with staff at Cystic Fibrosis Canada.

In addition, each year, Cystic Fibrosis Canada hosts the Walk to Make Cystic Fibrosis History event which aims to raise funds to support the care of patients diagnosed with CF. The overall goal is to help improve health outcomes by improving access to CF medications, advancing research efforts, and improving the overall quality of CF care provided in Canada. 

Government of British Columbia

In 2018, the government of British Columbia’s Ministry of Health released guidelines on Standards of Care and Nutrition Management for patients with CF. The Standards of Care guideline outlines recommendations for patient care in both inpatient and outpatient settings, infection prevention and control measures, as well as the role pharmacists play in interdisciplinary CF care teams. The nutritional management guideline can act as a useful tool for pharmacists when assessing a CF patient’s nutritional support with respect to vitamin supplementation. It provides recommendations on types of supplements, dosing, and monitoring parameters. The BC Ministry of Health also provides a webpage on CF describing the condition and treatment options in patient-friendly language.

To support COVID-19 vaccination efforts for patients with CF, the ministry has also released a COVID-19 clinical guidance document outlining available evidence relating to safety and efficacy of the COVID-19 vaccine along with the risk factors of COVID-19 infection in patients with CF. 

Current literature

European Cystic Fibrosis Society best practice guidelines1  revised in 2018, provide an overview of cystic fibrosis newborn screening, diagnosis, treatments -including treatment of bacterial infections, nutritional supports, and complications. 

An article by Bierlaagh et al2, also provides an update on treatments for CF, specifically developments related to CFTR modulator therapies. CFTR modulators are a class of medication that aims to partially restore CFTR function by targeting underlying genetic mutations found in patients with CF. Available modulator therapies can potentially work to limit the progression and expression of cystic fibrosis. 

As therapeutic options for the management of CF continue to advance, and life expectancies continue to increase, there has been an observed increase in the number of patients with CF who have successful pregnancies. Pregnancies in patients with CF have several clinical considerations which are discussed in this article by Montemayor et al.These considerations include preconception health optimization, medication management during pregnancy and lactation, and considerations for treatment of pulmonary exacerbation in pregnant patients.

References 

1. Castellani C, Duff AJA, Bell SC, et al. ECFS best practice guidelines: the 2018 revision. J Cyst Fibros. 2018;17(2):153-178. doi:10.1016/j.jcf.2018.02.006
2. Bierlaagh MC, Muilwijk D, Beekman JM, van der Ent CK. A new era for people with cystic fibrosis. Eur J Pediatr. 2021;180(9):2731-2739. doi:10.1007/s00431-021-04168-y
3. Montemayor K, Tullis E, Jain R, Taylor-Cousar JL. Management of pregnancy in cystic fibrosis. Breathe (Sheff). 2022;18(2):220005. doi:10.1183/20734735.0005-2022

 

 

December 05, 2022
Resource spotlight: Cystic Fibrosis

Clinical Pearls: Cystic Fibrosis 

November 21, 2022
By Duaa Osman

This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.

Background

Cystic Fibrosis (CF) is an autosomal recessive genetic disease caused by a mutation in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein resulting in abnormal ion transport across cell membranes.This altered ion transport causes CF to affect multiple organ systems such as the pulmonary, reproductive, and digestive systems.1 

Mutations to the CFTR protein can be divided into five classes which differ in severity, with classes I-III generally being more severe than classes IV-V (see Table 1). Although differences in severity may be observed based on the class of mutation, it is important for clinicians to avoid solely using these classifications to define severity.2

 

Table 1: Classification of Cystic Fibrosis CFTR mutations2,3


Patients with CF may present with shortness of breath, productive cough, digital clubbing, nasal polyps, and pancreatic insufficiency. Pulmonary function tests may also indicate a reduced forced expiratory volume at 1 second (FEV1) due to pulmonary obstruction.4

According to the Canadian Cystic Fibrosis Registry 2020 annual report, a total of 4,332 Canadians are affected by CF attributing to 1 in every 3,600 live births.5 It is estimated that the current median life expectancy of patients with CF in Canada is 55.4 years.5 Early diagnosis and treatment of CF is a crucial component of long-term survival.Current diagnostic guidelines recommend that patients presenting with any of the following undergo a sweat chloride test to screen for CF6:
  • Positive newborn screening result
  • Signs and/or symptoms of CF
  • Family history of CF (e.g., siblings diagnosed with CF)

Sweat chloride testing is regarded as the gold standard screening method for CF. Using pilocarpine ionophoresis, the test quantifies the amount of chloride present in the sweat which can be used to aid in the diagnostic process (see table 2). Due to the dysfunction of the CFTR protein, patients with CF tend to present with elevated sweat chloride concentrations.6


Table 2: Sweat chloride test result interpretation6,7

 

Management of CF: Therapeutic options 

At present, there is no available cure for CF, however several therapeutic products can be used to help manage the disease by increasing airway clearance or partially restoring CFTR function. Patients with CF may also require nutritional support such as high calorie diets, fat soluble vitamin supplementation, and pancreatic enzyme supplementation.1

Therapies aimed at increasing airway clearance help patients improve their overall lung function and reduce the risk of pulmonary infections. A combination of non-pharmacologic airway clearance techniques, such as postural drainage (conventional chest physiotherapy), active cycle breathing techniques, airway oscillating devices, and exercise8, along with pharmacologic therapies. In patients 6 years and older, the following sequence of administration is typically followed: bronchodilators, followed by mucolytics, then non-pharmacologic airway clearance techniques, then inhaled antibiotics.1,4

In addition to therapies aimed at increasing airway clearance, patients may also be treated using CFTR modulators which aim to partially restore CFTR function. Currently, 4 CFTR modulators are available in Canada, the newest of which being Trikafta® (ivacaftor/tezacaftor/elexacaftor) Trikafta® is a triple combination CFTR modulator new to the Canadian market for the treatment of CF in patients 6 years and older.9 The treatment is targeted at patients who have at least one CFTR gene mutation, specifically the F508del mutation which is estimated to affect up to 90% of patients with CF.4 Trikafta® works by binding to sites on the CFTR protein to increase its activity. When compared to baseline, patients receiving Trikafta® in clinical trials demonstrated a 14% increase in lung function. Of note, patients participating in the Trikafta® trials all continued on their existing bronchodilators, mucolytics, and inhaled antibiotics, but discontinued any other CFTR modulators.9 While CFTR modulators present many benefits to patients with CF, access to these medications remains limited due to cost barriers. First generation (Kalydeco®) and second generation (Orkambi®) modulators can be accessed through some provincial formularies; however, their access remains highly limited.

Table 3: Non exhaustive list of available therapeutic options in Canada for CF.4
 

In addition to pulmonary complications such as respiratory insufficiency, patients with CF may experience non-pulmonary complications. Examples of these complications include CF-related diabetes, pancreatic insufficiency, and osteoporosis. Due to the prevalence of complications among patients with CF, it is important that clinicians implement effective screening and preventative strategies in their care plans of patients with CF.14 

The role of pharmacists and pharmacy technicians in CF management

Due to the nature of the condition, it is integral that patients are adherent to their CF medication regimens to help prevent hospitalization and further complications. It is estimated that patients with CF are prescribed an average of 10 medications for the management of their condition. Pharmacists can play an integral role in the medication management of patients with CF to help improve adherence. A study conducted at the Intermountain Primary Children’s Hospital in the Utah found that pharmacist intervention resulted in nearly a 3-fold increase in adherence to Dornase alpha and was associated with a decrease in hospitalization rate due to non-adherence.15 In addition, the inclusion of pharmacy technicians in CF clinic specialty pharmacies resulted in reduced wait times for specialty medications through timelier deliveries. The improved efficiency of medication delivery also resulted in a decreased need for patients to utilize multiple pharmacies to access their medications.11 Overall, integrating members of the pharmacy team into the management of patients positively impacts patient care through timely access to specialty medications (through decreased delivery times and time required for prior authorization), improved patient education/adherence, and reduced hospitalization.16

 

References

1. Wright CC, Vera Y. Cystic Fibrosis. In: DiPiro JT, Yee GC, Posey L, Haines ST, Nolin TD, Ellingrod V. eds. Pharmacotherapy: A Pathophysiologic Approach, 11e. McGraw Hill; 2020. Accessed September 15, 2022. https://accesspharmacy.ca 
2. Katkin JP. Cystic Fibrosis: Genetics and pathogenesis. In: UpToDate. UpToDate; 2022. Accessed September 23, 2022. www.uptodate.com 
3. Types of CFTR mutations. Cystic Fibrosis Foundation. Accessed September 23, 2022. https://www.cff.org/research-clinical-trials/types-cftr-mutations#conduction-mutations 
4. Tang A, Crawley A. Cystic Fibrosis: Drug comparison chart. January 2022. Available from www.rxfiles.ca 
5. The Canadian Cystic Fibrosis Registry. 2020 Annual report. Published February 2022. Accessed September 21, 2022. https://www.cysticfibrosis.ca/registry/2020AnnualDataReport.pdf  
6. Farrell PM, White TB, Ren CL, et al. Diagnosis of Cystic Fibrosis: Consensus Guidelines from the Cystic Fibrosis Foundation [published correction appears in J Pediatr. 2017 May;184:243]. J Pediatr. 2017;181S:S4-S15.e1. doi:10.1016/j.jpeds.2016.09.064 
7. Katkin JP. Cystic Fibrosis: Clinical manifestations and diagnosis. In: UpToDate. UpToDate; 2022. Accessed September 20, 2022. www.uptodate.com 
8. Wilson LM, Morrison L, Robinson KA. Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2019;1(1):CD011231. Published 2019 Jan 24. doi:10.1002/14651858.CD011231.pub2
9. Vertex Pharmaceuticals. Trikafta product monograph. Available at: https://pi.vrtx.com/files/Canadapm_trikafta_en.pdf 
10. Ipratropium (Oral Inhalation). In Lexi-Drugs. Lexi-Comp, Inc. Updated October 25, 2022. Accessed November 18, 2022. https://online.lexi.com
11. Levofloxacin (Oral Inhalation). In Lexi-Drugs. Lexi-Comp, Inc. Updated November 10, 2022. Accessed November 18, 2022. https://online.lexi.com
12. Tobramycin (Oral Inhalation). In Lexi-Drugs. Lexi-Comp, Inc. Updated November 2, 2022. Accessed November 18, 2022. https://online.lexi.com
13. Aztreonam (Oral Inhalation). In Lexi-Drugs. Lexi-Comp, Inc. Updated September 19, 2022. Accessed November 18, 2022. https://online.lexi.com
14. Regard L, Martin C, Chassagnon G, Burgel PR. Acute and chronic non-pulmonary complications in adults with cystic fibrosis. Expert Rev Respir Med. 2019;13(1):23-38. doi:10.1080/17476348.2019.1552832
15. Zobell JT, Schwab E, Collingridge DS, Ball C, Nohavec R, Asfour F. Impact of pharmacy services on cystic fibrosis medication adherence. Pediatr Pulmonol. 2017;52(8):1006-1012. doi:10.1002/ppul.23743
16. Grant JJ, McDade EJ, Zobell JT, Young DC. The indispensable role of pharmacy services and medication therapy management in cystic fibrosis. Pediatr Pulmonol. 2022;57 Suppl 1:S17-S39. doi:10.1002/ppul.25613

Latest News

November 21, 2022
Clinical Pearls: Cystic Fibrosis

Latest News

CSHP Foundation Welcomes New Trustees

November 16, 2022
 

Pharmacist Trustee

Jennifer Jupp was recently appointed Pharmacist Trustee of the CSHP Research and Education Foundation. Jennifer replaces Trustee Sheryl Zelenitsky, who completed her six-year term (including one year as Chair) on the Foundation’s Board.

Jennifer Jupp graduated from the University of Alberta in 2000, obtaining her Board Certification in Oncology in 2007 and her Master of Arts in Healthcare Leadership in 2022. Jennifer has been a Pharmacy Clinical Practice Leader with Provincial Pharmacy Services at Alberta Health Services, since 2011. 

As a clinical practice leader, she provides clinical practice support and mentorship for pharmacist teams in pediatric and adult oncology. More recently, Jennifer has been supporting the provincial implementation of an electronic health record by providing project leadership to align clinical practice and provincial initiatives with technical functionality.

Jennifer is strongly committed to advancing the practice of clinical pharmacists within the multidisciplinary team and enjoys participating in practice-based research. Jennifer is the current Chair of the International Society of Oncology Pharmacy Practitioners Research Committee and continues to be involved with CSHP AB and the Canadian Association of Pharmacy in Oncology.

 
Public Member Trustee

Dara Willis was recently appointed Public Member Trustee of the CSHP Research and Education Foundation. Dara replaces outgoing Public Member Trustee Marlo Taylor, who completed her six-year term on the Foundation’s Board.  

Dara Willis is a strategic communications and marketing professional with 20+ years of experience supporting clients in various industries, with a focus in healthcare, through complex and regulated communications challenges. 
With clients ranging from large-scale pharmaceutical companies, industry associations and patient stakeholder groups, Dara has had a front row seat to witness and respond to the dramatic changes that have impacted Canada’s healthcare system. 

Dara recognizes the challenges that organizations face when they are looking to educate and reinforce positions and policies, regardless of the audience and has spent the better part of her career helping clients formulate their position on topics of interest (including potential issues) and help develop communications programs and initiatives that are strategic and effective in their goals. 

She has also worked extensively with stakeholder groups and foundations in their pursuit of funding for research and educational programs and is unique in that she has supported clients from both sides of the funding paradigm – pharmaceutical companies looking to partner with stakeholder groups for specific initiatives and stakeholder groups looking to break free from the crowded funding landscape to bring programs of interest forward to potential funding organizations. 

Dara has a Bachelor of Arts (Honours) with a speciality in Archaeology from McMaster University, and a post-graduate certificate in Public Relations from Humber College. 

 
 
 

Introducing the 2022-2023 Foundation Board


Pharmacists Trustees
Michael LeBlanc (Chair)

Heather Kertland (Past Chair)
Sharon Seow
Nkem Iroh
Jennifer Jupp

Industry Trustees
Mark Lachovsky
Sherry Piersol

Public Member Trustee
Dara Willis

Foundation Chief Administrator
Jody Ciufo (CSHP CEO)

A special thank you to
Sheryl Zelenitsky (outgoing Pharmacist Trustee)
Marlo Taylor (outgoing Public Member Trustee) 

For the complete biographies and photos of all current Foundation Trustees, please visit the Foundation webpage here.

 

November 16, 2022
CSHP Foundation Welcomes New Trustees

Latest News

2022 AGM Weekend Highlights 

November 8, 2022
 
CSHP had a busy and extended AGM weekend with a combined joint-symposium with l'Association des pharmaciens des établissements de santé du Québec (A.P.E.S.), multilateral meetings with Indigenous Pharmacy Professionals of Canada (I.P.P.C.), and our own Annual General Meeting.  

Here are some of the highlights. 

IPPC (Indigenous Pharmacy Professionals of Canada) 

Thank you to the Indigenous Pharmacy Professionals of Canada co-chairs Amy Lamb and Jaris Swidrovich for their presence at multi-lateral meetings as well as for Amy’s address at our Annual General Meeting. 

We held these meetings along with our colleagues from CPhA, NAPRA, AFPC, CPRB and Pharmacy Examining Board of Canada. The goal of these meetings was to introduce IPPC’s mandates then determine ways that we could all support Indigenous Pharmacy Professionals and patients in Canada. The representing organizations also shared their ongoing work relating to Indigenous pharmacy and brainstormed how IPPC fits in to their future plans.  

Your crucial insight on respect, reverence, sustainability, and family strength left us all inspired to inspect our day-to-day approach. We look forward to our ongoing collaboration and we will continue to spread the word about this new community built to support Indigenous pharmacy professionals. 

Pandemic Takeaways for Hospital Pharmacy 

On Oct. 28 and 29 we held our first-ever joint symposium between A.P.E.S. and CSHP after many years of being strategic allies. The symposium covered a topic that profoundly affected and still affects us all -   both professionally and personally- the COVID-19 Pandemic. The purpose of this event was to reflect, regroup, and reassess how we dealt with this pandemic and how we can best deal with future ones. Thanks to our amazing speakers and guests, we did just that! 

AGM (Annual General Meeting)

The CSHP 2022 Annual General Meeting was held at the Four Points by Sheraton, Gatineau-Ottawa, this past weekend. The Board of Directors and members alike were provided with a thorough update on CSHP, and were given a year in review presentation and voted on critical issues for the Society. 

At these meetings, the board approved a motion to amend articles 5, 8 and 9 of our Articles of Continuance. In simpler terms, article 5 saw the change to the minimum and maximum number of directors to 13 and 25, respectively. Article 8 clarified that there is only one class of members and eliminated any references to Branches since these are covered in our bylaws. Finally, article 9 touches on if CSHP were to dissolve, the remaining assets would be distributed to like-minded organizations across Canada. 

For CSHP Bylaws, a motion was made to make substantive changes to bylaw 1. Namely, these changes include the number of members required to establish a new branch as well as updating wording, definitions, powers, and rights seen throughout this bylaw.  

We also added some fresh faces to the board and saw some shifting among positions including: 
 
  • President Sean Spina (Victoria, BC) 
  • Past President Zack Dumont (Regina, SK)  
  • President Elect Ashley Walus (Winnipeg, MB)  
  • Nova Scotia Delegate Kimberley Abbass (Halifax, NS) 
  • Ontario Delegate Andrea Beaman (Toronto, ON)
  • British Columbia Delegate Karen Dahri (Vancouver, BC) 

Board Updates 

In addition to the additions made to the board, CSHP also bid adieu to four incredible members of our Board of Directors. Please join us in thanking departing delegates Arden Barry (BC), Alanna McQuaid (NS), and Vivian Lee (ON). Special thanks and gratitude are due to Past President Tania Mysak who led CSHP through the unprecedented COVID-19 pandemic and the upheaval it caused in our Society, our hospitals, and our homes. Thank you, Tania, for your dedication to CSHP and to hospital pharmacy.  

Please visit the board page to see all current members of the Board of Directors! 

Hospital and Not-for-Profit Supporters

The board approved a new membership supporter category, Not-for-Profit Supporters, which will provide these organizations (ex: colleges, advocacy organizations, trade unions, government agencies, etc.) a discounted price for their supporter membership. Additionally, they voted to revamp the Hospital Supporter category. There will be a shift from the title Corporate Hospital Supporter to simply Hospital Supporters. This change will also refocus this supporter-ship to being more about the products and services that CSHP offers. There was also a change to Hospital Supporter fees. These changes provide an opportunity for these organizations to benefit further from supporting the Society, starting with special pricing for CSHP Hospital Pharmacy 101 seen here. To learn more about Hospital & Not-for-Profit Supporters, click here.

 

November 08, 2022
2022 AGM Weekend Highlights

Latest News

Supporting the future of hospital pharmacy 

November 8, 2022


"The Canadian Society of Hospital Pharmacists (CSHP) have always been committed to the advancement of hospital pharmacy, so it is crucial to support the next generation: our Student Supporters, Members-in-Training and new Members. We want the future of the profession to feel that their Society is working hard to reflect their values, their ambitions, and their dreams — so they can contribute fully to the best possible patient outcomes.” - Jody Ciufo, Chief Executive Officer of CSHP 

CSHP is proud to invest in the many stages of student education and pharmacy residency. 

Flocking to residency

Pharmacy Residency Application Roadmap Program  - 82 Registrations
 This CSHP course offers didactic sessions and take-home coursework focused on the intricacies of residency programs and applications. After welcoming 125 people to our free module, “Making the pharmacy residency choice”, over the summer, we had 82 registrations for the programs with 74 also taking part in the mock interview. We are pleased that participants continue to be able to apply their learnings in their applications. 

Pharmacy Residency Application and Matching Service (PRAMS) -  313 Registrations
 The Pharmacy Residency Application and Matching Service (PRAMS) is a national application and matching service that provides a coordinated process to help match pharmacy residency applicants with positions at hospital pharmacy residency programs across Canada. The Canadian Pharmacy Residency Board (a semi-autonomous body of CSHP) runs PRAMS, in addition to conducting accreditation surveys, issuing accreditation awards, establishing accreditation policies and procedures, and developing and promoting education and research initiatives related to residency programs and residency training. This fall, we had a total of 445 applicants, with 313 applicants completing all the necessary requirements to make it through to the interview stage. Interviews will take place over the fall months, with the Match taking place in early January. In total, there are 133 residency positions available for the 2023-2024 residency year. 

CSHP loves CAPSI

“While the PharmD programs aim to balance teaching us all aspects of the pharmacy profession, sometimes students want more exposure to certain areas. CSHP focuses on hospital practice which allows us a link to hospital-specific resources and those working directly in the field for students who have a strong desire to work in the hospital sector.” - Madison Wong, CAPSI President-Elect 

CAPSI
CSHP has held a long-term working relationship with this student-run national organization, composed of over 4,000 members committed to their individual professional development and to the advancement of the pharmacy profession. 

CAPSI representatives  
As part of their mission to advocate for pharmacy students' interests in the country's pharmacy schools, the CAPSI National Council is comprised of executives and local representatives that help with the creation and planning of major developmental opportunities. CSHP frequently meets with CAPSI representatives to collaborate on Professional Development Week, the Evidence-Based Practice Competition, and Pharmacy Appreciation Month.  

Evidence-Based Medicine Competition 
CAPSI developed the Evidence-Based Practice Competition with CSHP in 2013. CSHP has been providing support for the competition, such as writing hospital patient cases. The purpose of this competition is to challenge members to apply current literature and guidelines to therapeutic recommendations and use their clinical knowledge to do so. This competition has also helped students to improve their collaboration and communication skills. 

CAPSI + CSHP Student Award 
This award is presented to an undergraduate pharmacy student who exhibits the traits of a future hospital pharmacy practitioner through participation in the education of healthcare practitioners, the public or patients, and/or through voluntary participation in CSHP activities.  

Professional Development Week (PDW) 
During this conference, students from across the country apply their practical skills and expand their knowledge of healthcare topics. CPRB and CSHP proudly sponsor a booth every year and we have a wonderful time engaging with students as they take their learning outside of the classroom.

Developing passionate leaders now

“Being the National Student Delegate for CSHP has been a great experience so far as I have been able to liaise between CSHP and pharmacy students across Canada to inform them and teach them about hospital pharmacy. CSHP provides so many learning opportunities and conferences for pharmacy students and I am so glad I get to promote these opportunities to pharmacy students across Canada.” - Abby Krupski, National CSHP Student Delegate  

National Student Delegate
Representing pharmacy students across the country, the CSHP Board of Directors’ National Student Delegate helps shape and lead the future of hospital pharmacy in Canada. They are the voice of pharmacy students and are a voting member on the Board. They also serve as a liaison to CAPSI and CSHP school representatives. 

CSHP Branch student symposia
CSHP Branch and pharmacy school representatives host student symposia to introduce second-year students to what CSHP does and what hospital pharmacy looks like. CSHP Branches work with the national office on funding and materials for these engaging and informative events. 

Curriculum feedback 
Earlier this year the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) was reviewing accreditation standards and requested feedback from CSHP. While combing through the standards, we were able to provide feedback that reflected the COVID-19 pandemic’s impact on healthcare and the significant changes in pharmacy education. 

Ongoing student placements at CSHP 
CSHP’s Professional Practice team has been fortunate to be preceptors for seven students, just this year, from our partner institutions at the University of Waterloo, the University of Saskatchewan, the University of British Columbia, and the University of Toronto. During their non-clinical placement with us, students not only take on critical projects like writing Clinical Pearls or Resource Spotlights but also participate in CSHP's advocacy and research activities under the mentorship of the Professional Practice Team. 

Association of Faculties of Pharmacy of Canada (AFPC)
The Association of Faculties of Pharmacy of Canada (AFPC) is the national voice for academic pharmacy, providing leadership and resources for faculty members across Canada. CSHP has worked closely with AFPC, including writing a letter of support for the creation of the University of Ottawa’s faculty of pharmacy that will start accepting students in September 2023. 

Faculties  
CSHP also proudly works with the individual universities of AFPC (Dalhousie University, Memorial University of Newfoundland, Université de Montréal, Université Laval, University of Alberta, University of British Columbia, University of Manitoba, University of Saskatchewan, University of Toronto, and University of Waterloo) by maintaining a presence with their respective Pharmacy councils, assisting Academic advisors, and having student liaisons. 

Summary

Not only are we excited about continuing our support of students, but we are also looking forward to discovering new ways to support our Student Supporters and Members-in-Training. There are many volunteers to thank for their hard work in making sure that the future of hospital pharmacy continues to be excellent. In addition, we have the following individuals who work for—or closely with— CSHP to help serve students even better: 

CSHP student program staff lead – Hira Tauqeer 
CSHP National Board student delegate – Abby Krupski 
Current CAPSI president – Christine Vaccaro 
CPRB (Canadian Pharmacy Residency Board) Coordinator – Vanessa Glasby 
CSHP National Awards program administrator – Robyn Rockwell
CAPSI evidence-based medicine competition coordinator & student preceptor – Minh-Hien Li 
Student preceptor – Kiet-Nghi Cao 

November 08, 2022
Supporting the future of hospital pharmacy

Latest News

Resource spotlight: Breast cancer 

November 7, 2022

 

Written by Maria Ahmed

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca


Background

Breast cancer is the second most diagnosed cancer in Canada among women with about 1 in 8 Canadian women will develop breast cancer in their lifetime. Approximately 20-30% of breast cancers incorporate high levels of a protein known as human epidermal growth factor receptor 2. These cancers are called HER2+ breast cancers and are likely to be treated with targeted drug therapies. This “Resource Spotlight” contains links to associations, guidelines and foundations that help pharmacists learn more about breast cancer and its management. To learn more about targeted therapies in HER2+ breast cancer, check out CSHP’s recent Clinical Pearls article on Targeted Drug therapies for HER2+ Advanced Breast Cancer.

External Resources 

Unless otherwise noted, the Canadian Society of Hospital Pharmacists (CSHP) does not endorse or imply endorsement of the resources provided here. These resources are provided without warranty of any kind, either expressed or implied. It is the responsibility of the user of the resource to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall CSHP or any persons involved in providing the resource be liable for damages arising from its use. Resources are free unless otherwise indicated. 

Canadian Healthcare Resources  

BC Cancer incorporates a comprehensive cancer control program for people in British Columbia. It encompasses cancer research, patient resources and educational content for healthcare professionals. They are partnered with BC Cancer Foundation which supports world-leading scientists and clinicians across the province. They have a variety of special services that incorporate virtual support programs, supportive care information, and an Indigenous cancer control page to plan, coordinate and evaluate cancer to provide equitable and cost-effective health care for people living with or affected by cancer.  

Cancer Care Ontario (CCO) is the provincial government’s principal cancer advisor that equips healthcare professionals, organizations and policymakers to have the most current cancer information and tools to deliver high-quality patient care. They have educational content, guidelines, pathway maps of a patient’s journey and a clinical guide on managing symptoms to help guide people living with or affected by breast cancer.
 
The Canadian Partnership Against Cancer corporation works collaboratively with provincial, territorial, and national partners to share information and accelerate work that improves the effectiveness of cancer control in Canada. One of their partners, Canadian Cancer Trials, incorporate cancer trials where patients can take part if they are eligible in their province.

For other provincial/territorial resources, they can be found in the following links: Alberta, Saskatchewan, Manitoba, Quebec, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, Yukon, and Northwest Territories.

International Guidelines and Healthcare Resources 
Keep in mind, these resources are not Canadian and may not be translated into Canadian practices.  

The National Comprehensive Cancer Network (NCCN) is an American not-for-profit alliance that incorporates 32 leading cancer centers that are devoted to patient care, research and education. It has great patient resources (available in French Canadian, Russian, Spanish, and Ukrainian) and updated breast cancer guidelines that can help guide healthcare professionals with information, resources and tools to successfully implement best practices. 

The American Society of Clinical Oncology (ASCO) is the world’s leading professional organization for physicians and oncology professionals caring for people with cancer. They have breast cancer guidelines that are available through the ASCO Guidelines App for free via iPhone/iPad or Android at the touch of a button. To stay up to date, they also have Podcast available on Apple or Google

The European Society of Medical Oncology (ESMO) is a Swiss-registered not-for-profit organization that incorporates more than 25,000 members representing oncology professionals across 160+ countries worldwide. Their main mission is to improve the quality of cancer care, from prevention and diagnosis to palliative care and follow-up. They have general educational content, breast cancer guidelines and patient resources to help clinical pharmacists in their respective practices. 

Foundations 
The Quebec Breast Cancer Foundation is an organization that provides support to women with breast cancer and aid in psychosocial support, financial aid, provide a virtual clinic and peer support within the community. The main language of communication is in French to ease the language barrier for some individuals. Their donation page can be found here.

The Canadian Cancer Society (CCS) is an organization that unite and inspire Canadians to take control of cancer. They fund research that improves cancer outcomes and address polices that include cancer prevention, treatment access, affordability, and patient support. They have great breast cancer resources for patients that elaborate on life with cancer, life after cancer, information for caregivers, and living with advanced cancer. Their donation page can also be found here.
 

The National Breast Cancer Foundation (NBCF) in a non-profit organization that support women with breast cancer screening, navigating patients with breast cancer, educate with outreach events and provide support services for patients with breast cancer. They incorporate free educational guides, additional resources for patients and their donation page can be found here.

November 07, 2022
Resource spotlight: Breast cancer

Clinical Pearls: Targeted Drug therapies for HER2+ Advanced Breast Cancer

October 21, 2022
By: Maria Ahmed 

This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.

Background

Breast cancer is the 2nd most commonly diagnosed cancer in Canada among women which resulted in 5400 deaths in 20211.  About 1 in 8 Canadian women will develop breast cancer in their lifetime and about 1 in 24 will die from it1. Of those 1 in 8 individuals, about 15-20% of breast tumors have high levels of a protein known as Human epidermal growth factor receptor 22. These cancers are called HER2+ breast cancers, which demonstrate a poor prognosis3. HER2 is a proto-oncogene that is amplified and over-expressed and is associated with tumor aggressiveness which is likely to be treated with targeted drug therapies3. Targeting breast cancer through its vital oncogenic protein has been a major step in improving patient outcomes2. Targeted therapy can either be monoclonal antibodies or small-molecule drugs; refer to Table 1 for the common targeted therapies available2,3. However, resistance to treatment remains a challenge, which increases demand for the need for novel therapies.
 
Table 1: Summary table of the current targeted therapy and common considerations for treatment.
 

mAb = monoclonal anti-body; LVEF = left ventricular ejection fraction; HF = heart failure; PPE = Palmar-plantar erythrodysesthesia;  

 

Resistance

With the current treatments, most patients with advanced HER2+ gene amplified breast cancer can relapse after treatment, suggesting that the gene acquired or has intrinsically possessed mechanisms that prevent HER2 inhibition13. Many of these potential resistance mechanisms to anti-HER2 therapy have been described to reactivate the HER2 pathway or its downstream signaling, through redundancy or stimulation of alternative survival pathways13. Figure 1 demonstrates the multiple pathways where current novel medications target the cell and where resistance can take place that can cause treatment failure3. By incorporating an additional medication that can suppress or alter the resistance mechanism itself, it gives us a chance to bypass the resistance14. An example of this was demonstrated in the CLEOPATRA study where patients were randomized between pertuzumab vs placebo14-17.

Figure 1: Depiction of the tumor cell where resistance can occur and general mechanism of action of the targeted therapy. Adapted from Ferrario et al (2022).



Both the intervention and comparator arms incorporated the standard use of trastuzumab and docetaxel14-17. Trastuzumab is an anti-HER2 antibody that binds only to the HER2 protein and resistance to this medication is apparent, whereas pertuzumab is a monoclonal antibody that inhibits the HER2/HER3 dimerization 14-17. By adding pertuzumab to the combination therapy, the authors demonstrated how pertuzumab will complementarily provide a more complete blockage of HER2 signal transduction; ergo, bypassing the trastuzumab resistance 14-17. However, resistance to general antibody medications has been growing stronger and the need for novel therapy surges.

 

Overall resistance

As resistance evolves, so does the standard treatment of care. Antibody-drug conjugates (ADCs) have been introduced and have changed the treatment paradigm of HER2+ breast cancer (see Table 2 for a summary)18-20,26. These medications incorporate a monoclonal antibody, a linker and a cytotoxic payload26. Trastuzumab emtansine (T-DM1) was the first of its kind and is now a second/third-line treatment26. It is a HER2 monoclonal antibody, with a non-cleavable thioether linker and a cytotoxic payload called emtansine (DM1, a microtubule inhibitor)26. Once trastuzumab binds to HER2 receptors, internalization and lysosomal degrading occurs, resulting in delivering DM1 to malignant cells to bind to tubulin and cause cell arrest and apoptosis26. In the EMILIA and TH3RESA trials, T-DM1 showed significantly improved PFS compared to lapatinib + capecitabine or physician’s choice, respectively18-20,26. EMILIA was a randomized, open-label, multicenter study with a statistically significant progression-free survival of 9.6 vs 6.4 months18. The comparator arm (comprised of lapatinib + capecitabine) arm demonstrated more events of any grade diarrhea (N = 389 vs 114) and palmar-plantar erythrodysesthesia (N = 283 vs 6); however fewer events of any grade of thrombocytopenia (N = 12 vs 137)18. TH3ERiSA was a randomized, multicenter, open-label study with a statistically significant progression-free survival of 6.2 vs 3.3 months. T-DM1 demonstrated fewer neutropenic events at any grade (40% and 22% respectively) and only one grade 5 event occurred that resulted in a pulmonary embolism (only in the comparator arm)19-20.


More recently, a new medication has been introduced in the market, trastuzumab deruxtecan (T-DXd), that can potentially replace T-DM1 in second/ third-line treatmenty21-23. This ADC consists of a human anti-HER2 monoclonal antibody linked to topoisomerase I inhibitor payload through a tetrapeptide-base cleavable linker21-23. It delivers a potent cytotoxic payload that is internalized and selectively cleaved by lysosomal enzymes that are overexpressed in cancerous cells21-23. This results in DNA damage, leading to apoptosis of the tumor cell21-23. The deruxtecan is also membrane soluble, this allows the molecule to diffuse out of the cell and conduct its cytotoxic effect on surrounding HER2 tumor cells, also known as the “bystander effect”21-23. In 2021, the DESTINY-Breast-03 trial, a multi-center, open-label, randomized trial compared the efficacy and safety of T-DM1 and T-DXd in a total of 524 patients that demonstrated a statistically significant 12-month progression-free survival rate of 75.8% vs 34.1%, respectively21. Drug-related interstitial lung disease (ILD) occurred in 10.5% of patients (0.8% grade), but no deaths were reported21. The DESTINY-Breast-03 trial also had 82 patients with stable brain metastases, where T-DXd demonstrated a reduction in risk of disease progression or death by 75% relative to T-DM121. In June 2022, Health Canada approved T-DXd indicated for patients with unresectable or metastatic HER2+ breast cancer who have received at least one prior anti-HER2-based regimen either in a metastatic setting or in a neoadjuvant or adjuvant setting that developed disease recurrence during or within 6 months of completed neoadjuvant or adjuvant therapy21-23.

Table 2: Summary table of the ADC targeted therapy and common considerations for treatment


mAb = monoclonal anti-body; LVEF = left ventricular ejection fraction; HF = heart failure; PPE = Palmar-plantar erythrodysesthesia;
GFR = glomerulus filtration rate; T-DM1 = trastuzumab emtansine; T-DXd = trastuzumab deruxtecan.

Pharmacist's Role

In a multidisciplinary team, pharmacists have a crucial role in helping patients with breast cancer to acquire the best treatment outcomes, reduce the impact of adverse events, prevent medication toxicity, monitor drug interactions, increase adherence and improve patient quality of life28-30. As the number of options for treating metastatic breast cancer grows, the need for pharmacists arises with it28-30. Pharmacists are often the first healthcare providers to identify and manage the adverse effects of treatment and maintain their patients to be compliant28,30. Some common adverse effects and toxicities include myelosuppression, nausea, vomiting, neurotoxicity, and diarrhea28. Monitoring these parameters can include routine check-ins, laboratory assessments and other specific markers such as the need for cardiac evaluation in patients receiving trastuzumab. Prior to taking medications for breast cancer, patients may be required to take pre-medications to mitigate the adverse effects experienced by the medications themselves28. Ordering appropriate pre-medications include antiemetic drugs and medications that prevent hypersensitivity reactions13. This can increase the chances of drug interactions. Pharmacists play a vital role to determine both pharmacodynamic and pharmacokinetic interactions and how to best modify the dose or toxicity given the interaction. In addition, pharmacists are also involved in conducting medication reconciliation and educating other healthcare providers and patients about medications28.

In 2017, Dong et al developed a randomized, prospective study where patients were randomly distributed in an intervention arm and received pre-chemotherapy counseling 28-30.  The counseling session included pharmacist-led pre-chemotherapy counseling that followed a consistent checklist30.  In the session, patients raised several common queries that include “can I take a supplement?”, “Will these side effects be permanent?” and were answered appropriately30. The study found significant improvement in the understanding of the chemotherapy regimen and its side effects in the intervention arm30. Dong et al demonstrated that pharmacist-led pre-chemotherapy counseling improves patient knowledge and understanding30. Prior surveys have shown that less than 70% of the information given to cancer patients was understood despite the prior discussion with their physicians31. Pharmacists have been suggested to be the ideal bridge of information between physicians and patients30. Therefore, incorporating a pharmacist through interprofessional collaboration provides added value to patient-centered care28-30.
 

References

1. Canadian Cancer Society Breast Cancer Statistics. [(accessed on October 10 2022)]. Available online: https://cancer.ca/en/cancer-information/cancer-types/breast/statistics
2. Tesch M.E., Gelmon K.A. Targeting HER2 in Breast Cancer: Latest Developments on Treatment Sequencing and the Introduction of Biosimilars. Drugs. 2020;80:1811–1830. doi: 10.1007/s40265-020-01411-y. [PubMed] [CrossRef] [Google Scholar]
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4. BC Cancer Agency [Internet]. Trastuzumab. [(accessed on October 14 2022)]. Available online: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Trastuzumab_monograph.pdf
5. Lexi-Drugs [Internet]. Trastuzumab. [(accessed on October 14 2022)]. Available from: https://online.lexi.com 
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7. Lexi-Drugs [Internet]. Pertuzumab. [(accessed on October 14 2022)]. Available from: https://online.lexi.com 
8. BC Cancer Agency [Internet]. Tucatinib. [(accessed on October 14 2022)]. Available online: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Tucatinib_monograph.pdf
9. Lexi-Drugs [Internet]. Tucatinib. [(accessed on October 14 2022)]. Available from: https://online.lexi.com 
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11. Lexi-Drugs [Internet]. Lapatinib. [(accessed on October 14 2022)]. Available from: https://online.lexi.com 
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14. Lavaud, P., Andre, F. Strategies to overcome trastuzumab resistance in HER2-overexpressing breast cancers: focus on new data from clinical trials. BMC Med 12, 132 (2014). https://doi.org/10.1186/s12916-014-0132-3
15. National Comprehensive Cancer Network NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 2.2022. 2022. [(accessed on October 13 2022)]. Available online: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1419
16. Gennari A., André F., Barrios C.H., Cortés J., De Azambuja E., DeMichele A., Dent R., Fenlon D., Gligorov J., Hurvitz S.A., et al. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann. Oncol. 2021;32:1475–1495. doi: 10.1016/j.annonc.2021.09.019. [PubMed] [CrossRef] [Google Scholar]
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21. Cortes J., Kim S., Chung W., Im S., Park Y.H., Hegg R., Kim M.H., Tseng L., Petry V., Chung C., et al. Trastuzumab deruxtecan (T-DXd) vs trastuzumab emtansine (T-DM1) in patients (Pts) with HER2+ metastatic breast cancer (mBC): Results of the randomized phase III DESTINY-Breast03 study. Ann. Oncol. 2021;32:S1287–S1288. doi: 10.1016/j.annonc.2021.08.2087. [CrossRef] [Google Scholar] [Ref list]
22. Schlam, I.; Tarantino, P.; Tolaney, S.M. Overcoming Resistance to HER2-Directed Therapies in Breast Cancer. Cancers 2022, 14, 3996. https://doi.org/10.3390/ cancers14163996
23. Enhertu Product Monograph, June 15, 2022.
24. BC Cancer Agency [Internet]. Trastuzumab emtansine. [(accessed on October 14 2022)]. Available online: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Trastuzumab%20Emtansine_monograph.pdf
25. Lexi-Drugs [Internet]. Trastuzumab emtansine. [(accessed on October 14 2022)]. Available from: https://online.lexi.com 
26. BC Cancer Agency [Internet]. Trastuzumab deruxtecan. [(accessed on October 14 2022)]. Available online: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Trastuzumab%20deruxtecan_interim%20monograph.pdf
27. Lexi-Drugs [Internet]. Trastuzumab deruxtecan. [(accessed on October 14 2022)]. Available from: https://online.lexi.com 
28. Barbour SY. Caring for the treatment-experienced breast cancer patient: the pharmacist's role. Am J Health Syst Pharm. 2008 May 15;65(10 Suppl 3):S16-22. doi: 10.2146/ajhp080090. PMID: 18463328.
29. Puspitasari, A. W., Kristina, S. A., Satibi, & Prabandari, Y. S. (2022). Effect of Pharmacist Interventions on Medication Adherence to Capecitabine in Cancer Patients: A Systematic Review. Indonesian Journal of Pharmacy, 33(1), 22-33. https://doi.org/10.22146/ijp.2284
30. Dong el al. (2017). An emerging role of Pharmacist in Pre-chemotherapy Counselling Among Breast Cancer Patients. Indian Journal of Pharmaceutical Sciences. 79(2):294-302
31. Hershman D, Calhoun E, Zapert K, Wade S, Malin J, Barron R. Patients' perceptions of physician-patient discussions and adverse events with cancer therapy. Arch Drug Inf 2008;1:70-8.

Latest News

October 21, 2022
Clinical Pearls: Targeted Drug therapies for HER2+ Advanced Breast Cancer

Supporting pharmacy technicians year-round

October 18, 2022


A sample of the CSHP resources available to you:  

Type Resource  Description  Availability  
Webinar 

The emerging role of Pharmacy Technicians in Leadership

Presenter: Annik MacLeod  

A virtual webinar describing how pharmacy technicians can develop leadership skills and seek opportunities to participate in operations management.

 

Date: October 20, 2022.

Open access 
 Webinar
The Pharmacy Technician’s Role in Medication Reconciliation 


Presenter: Christa Ng 

This webinar recording discusses the tools and strategies technicians can use to complete accurate BPMHs in a hospital setting.





Date: March 29, 2022 
 Members only
 Webinar
Unit-Based Pharmacy Technician Practice Model: A Pilot Project at Mount Sinai Hospital

Presenter:
Clarence Lam 

This webinar highlights a pilot project completed at Mount Sinai Hospital aimed at exploring the impacts of leveraging the expanded scope of pharmacy technicians in hospital practice. 





Date: August 01, 2021 
 Members only
Webinar 
COVID-19: Coping and Resilience for Pharmacy Professionals  

Presenter: Dr. Karen Cohen

In this webinar, Dr. Karen Cohen, CEO of the Canadian Psychological Association, provides evidence-based tips for caring for our own mental health as frontline workers. 



Date: June 29, 2021  
 Members only
 CJHP Article

 

Best Possible Medication Histories by Registered Pharmacy Technicians in Ambulatory Care

By:  Ida-Maisie Famiyeh, Neil Jobanputra, and Lisa M McCarthy

This article describes the implementation process of a RPhT-conducted BPMH program at Women’s College Hospital in Toronto. It highlights how the role of pharmacy technicians can be leveraged to improve medication reconciliation programs in the context of ambulatory care.






Publication date: April 19, 2021 

 Open access
 HP 101 
Learning Module

 Hospital Pharmacy 101 – Module 7: The basics of aseptic compounding 


This module provides participants with an understanding of what aseptic compounding is, provides information on standards of aseptic compounding, and explains the role of pharmacy technicians in aseptic compounding practices. 

 Paid resource
PSN   Compounding
The Compounding PSN invites discussions on sterile, non-sterile, hazardous and non-hazardous compounding. These include topics such as compounding formulations, beyond-use dating, drug-drug and drug-material stability and compatibility, sterility testing, primary and secondary engineering controls, air and surface microbial sampling and speciation, compounding technique, garbing technique, cleaning technique, volumetric and gravimetric compounding, material disinfection and handling, gloved fingertip sampling, media fill testing, quality assurance, IV workflow management systems, compounding-related drug information resources, and any other issues that arise with interpreting and implementing NAPRA compounding/USP 797/795/800 standards. As compounding is a cross-disciplinary specialty, we invite discussions and resource-sharing from all pharmacy professionals including pharmacists and pharmacy technicians.
 
 Members only
PSN  Medication Safety 
The Medication Safety PSN assists pharmacists by confirming the changes that are needed to ensure safe practice and therefore safe patient care. Through online dialogue, safety focused pharmacists share their experiences in addressing the change management of impacted staff. They share the broader viewpoint of ALL impacted parties eg physicians, patients and nurses in addition to the impact on the pharmacy environment. As the accreditation standards shift their focus towards patient centered safe care, the Medication Safety PSN supports Canadian pharmacists as they review their current practices, compare their practices to the accreditation standards and identify any gaps that may need to be addressed. The members of the Medication Safety PSN freely share their knowledge, skills and experiences to advance patient
safety across Canada. 

Members only  
PSN Medication Distribution 
The Medication Distribution PSN discusses best practices related to medication distribution functions. Pharmacy technicians and pharmacists share practice resources related to medication distribution, and connect with each other to share ideas on how the scope of a pharmacy technician is influencing medication distribution being utilized to its fullest potential. Practice areas such as final medication checking, repackaging practices and handling drugs that are on the NIOSH list as hazards are all areas of interest and discussion for this PSN. 

Members only 
PSN Parenteral Services 

 

The Parenteral PSN is a forum to network, discuss and share information on a wide variety of issues related to aseptic services and parenteral drug administration. The scope of topics can be broken down into five (5) broad categories:

  • Drug specific questions
  • Policy/Standard Operating Procedures/Standards of Practice/Equipment to Support
  • Sterile Compounding / Formulas
  • Smart pumps
  • Parenteral nutrition 

Members only 
PSN  Small Hospital
The purpose of the small hospitals PSN is to link together pharmacists working in small hospitals, in order to share learnings and discuss issues that are common to these practice sites. Since there are often only 1 or 2 pharmacists working in a small hospital, the opportunities for networking are limited within the practice sites. The PSN provides a forum by which pharmacists can gain additional knowledge or information to help them meet best practice recommendations at their sites. 

Members only 
Compounding Resource

Compounding Briefing Series 
 
 
This six part series provides members with an overall view of the key tools needed for ensuring safe, high-quality compounding.
Members only 
 Compounding Resource Assessment Tool for Aseptic Compounding
This aseptic compounding assessment tool was created in collaboration with ISMP to help strengthen the medication-use system at practice sites. It consists of 11 key elements that have been deemed to influence aseptic compounding practices and provides organizations with summary results of their assessment that can help identify areas for improvement. 
 
 Paid resource
 Resource Spotlight
Clinical resources and creating safe spaces for 2SLGBTQ+ patients 

By: Jessica Sheard

Learn more about the 2SLGBTQ+ community, how to integrate inclusive strategies into their practice to create safe and welcoming spaces for 2SLGBTQ+ patients, and access clinical guidelines important for transgender patient care.  



Publication Date: July 27, 2022
 Open access
 Clinical Pearls
Clinical considerations and creating safe spaces for 2SLGBTQ+ patients

By: Jessica Sheard

This Clinical Pearl covers the clinical considerations the pharmacy team can make to help 2SLGBTQ+ patients feel comfortable and safe during their interactions in hospitals. 



Publication Date: June 15, 2022
Open access 

Want to take advantage of these resources, on top of other membership perks? Register to be a Pharmacy Technician member.

Join or Renew today!
 



Latest News

October 18, 2022
Supporting pharmacy technicians year-round

Latest News

Resource spotlight: Sepsis

October 11, 2022

 

Written by Eric Katula

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca


Background

Sepsis is a life-threatening medical emergency that affects neonatal, pediatric, and adult patients worldwide. It results from the body’s overwhelming response to infection and can lead to tissue damage, organ dysfunction, and death. This “Resource Spotlight” contains links to associations, guidelines, and studies that will help pharmacists learn more about Sepsis, how to manage it, and recommended treatments. To read more about sepsis, check out CSHP’s recent Clinical pearls article on Management of Sepsis and Septic shock – Updated recommendations.

 

CSHP Resources 

 

CSHP National Webinars

To further boost your hospital pharmacy skills through practical instruction, please watch CSHP’s national webinars: ICU 101 for Pharmacists – Crash Course in Critical Care (Part 1) and ICU 101 for Pharmacists – Crash Course in Critical Care (Part 2)

QID – Community page 

The Canadian Society of Hospital Pharmacists has a Critical Care Pharmacy Specialty Network (PSN) that can be found in QID. This community can be used by pharmacists to share educational content on sepsis and ask questions about caring for patients with sepsis or septic shock. 

 

External Resources 

Unless otherwise noted, the Canadian Society of Hospital Pharmacists (CSHP) does not endorse or imply endorsement of the resources provided here. These resources are provided without warranty of any kind, either expressed or implied. It is the responsibility of the user of the resource to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall CSHP or any persons involved in providing the resource be liable for damages arising from its use. Resources are free unless otherwise indicated. 

 

Royal College of Physicians and Surgeons

The college has an interactive e-book that presents emergent clinical situations and the essential tasks required of all healthcare professionals needing to recognize, navigate and safely manage critically ill patients. Some of the main topics discussed in the book include infection prevention and control, antibiotics, and COVID-19 pneumonia.  

 

BC Patient Safety and Quality Council 

The council has key sepsis resources for clinicians, patients, and families. These resources include up-to-date emergency department guidelines and inpatient toolkits that may provide hospital wards with information, resources, and tools to successfully initiate, implement, and spread best practices for sepsis.  
https://bcpsqc.ca/

 

Sepsis Canada 

Sepsis Canada is a nationally coordinated research network that focuses on furthering the understanding of sepsis, improving its prevention, detection, and management. Sepsis Canada also support the recovery and rehabilitation from sepsis. They have free infographics on raising awareness for sepsis in addition to guidelines, links to other organizations, and communication tools. 
https://www.sepsiscanada.ca/ 

Canadian Sepsis Foundation (CSF

The Canadian Sepsis Foundation focuses on educating the public about the severity of sepsis and how to prevent it. Their website has a section where patients may share their stories and experiences with sepsis.  
https://canadiansepsisfoundation.ca

 

Action on Sepsis Research Cluster 

Action on Sepsis Research Cluster is a transdisciplinary group based at the University of British Columbia that brings together clinicians, researchers, public end users, and health care policymakers to engage in impactful research, create innovative therapeutics, and to increase visibility of sepsis as a critical local and global health issues. They have links to other Canadian and international websites containing  information for researchers, patients, and their families including overviews of what sepsis is, how to recognize it, and what its long-term impacts can be. They also have a patient-led podcast, Action on sepsis, that focuses on showcasing a diverse collection of patient stories and sharing knowledge from research and clinical fields.  
https://sepsis.ubc.ca/home

 

Surviving Sepsis Campaign (SSC)

Sepsis and septic shock are leading causes of death worldwide. The Surviving Sepsis Campaign is part of the international effort to reduce sepsis mortality and morbidity. They have information for patients and families, guidelines for health care providers, and educational tools such as podcasts, webinars, and journals about sepsis. They also have an application that offers easy access to guidelines and screening tools to assist with identifying patients with sepsis. 
https://www.sccm.org/SurvivingSepsisCampaign/Home 

 

Society of Critical Care Medicine (SCCM) 

SCCM is a nonprofit organization that focuses on promoting excellence and consistency in the practice of critical care. SCCM has sepsis guidelines for both children and adults. SCCM also has resources for health care professionals responding to the COVID-19 pandemic. These resources include the COVID-19 guidelines, training materials for non-ICU clinicians, COVID-19 journal articles, and the COVID-19 Rapid Resource Center which has over 1000 educational materials for clinicians. 

 

Internet Book of Critical Care

This is an excellent free resource for hospital pharmacists needing a jumping-off point for further study. The Internet Book of Critical Care can be used to train new pharmacists in ICU or those reassigned to the ICU department. The book covers interesting and common ICU problems and each chapter in the book contains links to references, podcasts, and articles for more information and additional opinions. 

 

World Sepsis Day

On September 13 each year, World Sepsis Day, an initiative by Global Sepsis Alliance, promotes countless events that raise awareness of sepsis globally. The events range from medical education to information for lay people, sport activities, fundraising events like pink picnics, and more. Their website has free infographics that can be used to educate patients. 
https://www.worldsepsisday.org 

 

French Sepsis Association

The association has educational videos and blog posts for French speaking patients and clinicians. 
https://www.francesepsisassociation.com/

October 11, 2022
Resource spotlight: Sepsis

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