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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

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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.  

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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

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 
    
     

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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.

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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

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

• CSHP has lists of useful articles and studies to help preceptors improve their clinical teaching, ability to provide feedback, and helping struggling students.

• Forrester CA, Lee DS, Hon E, et al. Preceptor Perceptions of Pharmacy Student Performance Before and After a Curriculum Transformation [published online ahead of print, 2021 Aug 12]. Am J Pharm Educ. 2021;8575. doi:10.5688/ajpe8575

• Williams CR, McLaughlin J, Leadon K, Khanova J, Rodgers PT. Preceptor confidence and engagement in providing leadership activities to students in advanced pharmacy practice experiences. Curr Pharm Teach Learn. 2018;10(7):895-902. doi:10.1016/j.cptl.2018.04.006

• 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.

• Hammer D. Improving Student Professionalism During Experiential Learning. Am J Pharm Educ. 2006;70(3). Article 59. 

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. 

• Sylvia LM. A Lesson in Clinical Reasoning for the Pharmacy Preceptor. Am J Health-Syst Pharm. 2019; 76:944-952.

• Weitzel KW, Walters EA, Taylor J. Teaching clinical problem solving: A preceptor’s guide. Am J Health-Syst Pharm. 2012; 69:1588-99.

• Koons K, Sincavage S. Precepting skills for precepting challenges. J Am Pharm Assoc. 2012;52:e273-e276.  
  
   
  
   
  

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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 

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 

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

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 

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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

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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.3 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

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

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.1 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

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

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CSHP Foundation Welcomes New Trustees

November 16, 2022

 

Pharmacist Trustee

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. 

 

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"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 

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

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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. 

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. 

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.

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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

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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) 

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/.