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Latest News

Announcing the Availability of Research Grants in 2023

June 2, 2023
 
The CSHP Foundation is pleased to announce the opening of the 2023 Research Grant Competition. The Foundation is committed to supporting CSHP members in research that advances pharmacy practice and patient care in hospitals and other collaborative healthcare settings. It also encourages grant recipients to present and publish their findings thereby raising the profile of quality research being conducted by CSHP members. 

The CSHP Foundation has allocated $10,000 to support research project(s) for the current competition. More than one grant submission may be successful if the total funding amounts do not exceed the $10,000 allocated for this competition.  

The CSHP Foundation Research Committee will adjudicate eligible submissions based on established criteria and make recommendations for funding to the Board. Novice researchers are also encouraged to apply (see definition of novice researchers in the Criteria and Submissions Check List).

Full details on the Research Grant program and the application process are available on the Foundation website at https://cshp-scph.ca/foundation-research-grants.

New: The CSHP Foundation Research Committee have created a tool on how to prepare a grant submission which is available on the CSHP Foundation website.
 
Submissions require the following components:
  1. Criteria and Submissions Check List (template found on Foundation website) 
  2. Research Proposal
  3. Budget and Justification (template found on Foundation website)
  4. Completed Signature Page (template found on Foundation website)
  5. Proof of Institutional Review Committee/Research Ethics Board Submission
  6. CV of the applicant and each investigator

Additional information is also available on the CSHP Foundation’s website: 

  • Criteria for Evaluation of Submissions
  • Research Committee Grant Review Process
  • How to Get Started with a Research Grant Project
  • Tips on How to Prepare a Research Grant Submission (created by the Research Committee)

APPLY: To apply for a 2023 Research Grant, please submit all application documents to Rosemary Pantalone electronically  rpantalone@cshp.ca. Applications must include components 1-5 in one PDF file and item 6 (i.e., CVs) in a separate PDF file.
QUESTIONS: Please direct inquiries to the CSHP Research Grant Committee Chair, Marisa Battistella at Marisa.Battistella@uhn.ca
DEADLINE DATE: Submissions must be received by October 16, 2023.

Grant decisions will be announced in January 2024.

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




 

June 02, 2023
Announcing the Availability of Research Grants in 2023

Clinical Pearl: Student reflection on Pride Month & 2SLGBTQIA+ advocacy during pharmacy school

 
June 2, 2023
By: Holly Wingate 

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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With June being Pride Month, we have the opportunity to reflect on the history of Pride Month, and its importance in being celebrated each year. In reflecting, I hope to give my perspective as a student on Pride and share ideas on how pharmacy students can advocate for the 2SLGBTQIA+ population during school years, all year round.

Background: Pride month

Though not made official for another 30 years after, Pride Month in the USA originates with the Stonewall uprising on June 28, 1969.1 At this time, there was a law in New York City indicating a man or woman must be wearing a certain number of clothing items which matched the gender on their state-issued ID, allowing police to take advantage of the law, raid drinking establishments and arrest transgender and gender non-conforming individuals.1 On this night in 1969, police raided the Stonewall Inn, like they had many times before, clearing the bar and moving the crowd outside. On this night; however, individuals fought back against police and a riot began for 2SLGBTQIA+ rights, throwing coins, bottles, or debris at police.2 This riot continued for roughly 5 days and sparked the 2SLGBTQIA+ rights movement in the USA.2  There are conflicting stories as to who threw the first ‘brick’ at the Stonewall that night, but as we reflect on Stonewall, I feel that the brick may be better served today as a metaphor: the 2SLGBTQIA+ population will always fight back and reclaim their power, no matter how powerless they may seem in the moment. The first Pride marches were held on June 28, 1970, across cities in the USA, with thousands of 2SLGBTQIA+ members marching in commemoration of Stonewall, and to demonstrate for equal rights.3
 
In Canada, the history of Pride begins one day before the events of Stonewall, when homosexual acts were decriminalized with the passage of the Criminal Law Amendment act, and received royal assent June 27, 19694. The first Gay Rights Liberation Protest and March then occurred at Parliament Hill on August 28, 1971, where those in attendance presented a petition to the government with a list of ten demands for equal rights and protections.4 The many years following this are clouded by police raids, unjust arrests, and more, until June 1, 2016, where for the first time in Canadian history, a pride flag is raised on Parliament Hill in Ottawa, ON.4
 
Understanding the history of Pride Month is just as important today as it was in 1969. Not only is it signifying one of the first major times 2SLGBTQIA+ people fought back for their rights, but it also commemorates years of struggle for these rights, and the ongoing struggle to be seen as equal under law, and in society.2 In reflecting today, I feel we cannot go forward unless we understand the years of struggle that members of the 2SLGBTQIA+ population have undergone–struggles that still persist today all over the world, including Canada. Pride is a time for individuals to own their identity and be proud of who they are.  

Why is Pride Month Important to Celebrate Each Year? 

In a time where many individuals are incredibly vocal on their beliefs, regardless of which ‘side’ they stand on, I feel we can get caught up talking about issues such as homophobia or 2SLGBTQIA+ care discrepancies, but this is often where our learning ends. While Stonewall occurred more than 50 years ago, we still celebrate Pride Month each June, and for good reason. Firstly, Pride Month is a recurring opportunity for everyone to learn about the 2SLGBTQIA+ population and see the joy in finding a community that supports one and one’s happiness. This type of learning can change lives both as an observer and as the individual who is experiencing it. For other members of the community, Pride Month allows them to be visible to those who choose to deny the truth of their existence, and to commemorate those before them that were unable to celebrate, and live authentically.5 Finally, it can be a time for some 2SLGBTQIA+ members where extreme pride replaces the feelings of shame or fear, truly impacting self-confidence and self-worth. In this way, Pride Month can be life changing. As I reflect on my own experiences, I have always felt Pride Month to be extremely joyful. Each year, it reminds me that we’re still here, no matter how invisible some may want us to be. It gives me the confidence to be honest and open with those around me. It is also a time to showcase the issues 2SLGBTQIA+ members experience, such as conversion therapy, the right to marry, and health discrepancies. Though it may feel that these issues are far removed, I will remind readers that Bill C-4, which banned conversion therapy in Canada, was only passed in 2021 and took three attempts to be approved.6 It is incredibly important to keep one-self up to date with 2SLGBTQIA+ challenges, and Pride Month is a great time for such learning to occur. I feel Pride Month is incredibly important to celebrate, especially for those who do not identify as a member of the 2SLGBTQIA+ population. In celebrating Pride Month as a heterosexual person, one is creating a space in the community of support for 2SLGBTQIA+ members for yourself and others. You are in a unique position where you can offer a safe space to members when they need it most.  

As health care providers, I believe we have a duty to all our patients to ensure we are entering care without biases and ready to treat equitably, regardless of who is in front of us. While some individuals today may feel homophobia has ‘quieted’ in health care, I reflect that it may be quite contrary. In Jessica Sheard’s Clinical Pearl: Clinical considerations and creating safe spaces for 2SLGBTQ+ patients, we see care discrepancies that may occur from homophobia are still rampant in today’s health care system. I highly recommend readers refer to this Clinical Pearl to see the impact those discrepancies have on individuals accessing health care. I feel as a healthcare provider, it is important to stay active in educating oneself to provide culturally safe and up-to-date care. Celebrating Pride Month as a health care provider may allow one to confront unconscious biases, which is an important part of being able to provide equitable care. In my early days of pharmacy education, I learned that it is “okay” to have biases, but it is “not okay” to do nothing to change them. Health care providers are the people who individuals turn to address their health needs, and we must be able to care for them as best we can. 

A Students Perspective: Pride and Advocacy during Pharmacy School  

During my years in pharmacy school, I have been fortunate enough to learn about gender-inclusive care. Even though the medications used for transitioning were not new to me, I am grateful to have had a specific lecture on transitioning, as it gave me the ability to think about the big picture with transitioning. This includes costs from medications, insurance delays or personal costs if surgery is to be done privately, wait times for publicly funded surgeries, stigma and access to affirming health care. To supplement this health care focused lecture, we listened to a patient talk about their specific care experiences. A man who had previously transitioned spoke to us about the care he has received throughout his life, but more importantly, how transitioning had saved his life and changed his relationships for the better. Patient stories such as this one have been so impactful in the development of my own Pride, as it makes everything seen on paper real. This is why I feel celebrating Pride is so important for students. Having real world experience with patients can shape how we deliver care because we see the entire person, not just the prescription. This, in turn, can impact how we advocate for 2SLGBTQIA+ patients to other health care providers and those in our personal lives. 

As 2SLGBTQIA+ care becomes more engrained in the pharmacy curriculum, students are in a unique position to educate others and advocate for 2SLGBTQIA+ care. Pharmacy students can advocate in many different areas for 2SLGBTQIA+ patients, however it is important that we put the onus on ourselves to close any knowledge gaps. I feel the history of the 2SLGBTQIA+ community and staying current on 2SLGBTQIA+ news are my knowledge gaps. While school provides us with a good baseline of knowledge, it is not our patient’s responsibility to educate us in our knowledge gaps –we must be self-directed to learn about 2SLGBTQIA+ care discrepancies, gender-inclusive care, Pride Month history, and more. Once educated, we will be in a better position to advocate for the 2SLGBTQIA+ population in whatever professional environment we may practice (community, hospital, and other patient care positions such as industry or research).  

Below are some examples on ways to stay up-to-date and advocate for our 2SLGBTQIA+ patients. For specific resources to use, please stay tuned for the Resource Spotlight coming soon. 
  • Check in with your internal biases, and self-direct to online materials to stay educated. This can include courses, readings, or webinars. I recommend looking into national associations such as the CPhA, as they often offer free resources to supplement learning and are trustworthy sources.  
  • Subscribe to online 2SLGBTQIA+ news outlets to stay up-to-date on 2SLGBTQIA+ issues. These online news outlets are great for providing bite-sized news on the go, or you can take the time to read through entire articles on their websites.  
  • Use social media to advocate for care discrepancies and gender-inclusive care, as it is highly impactful in accessing 2SLGBTQIA+ youth. Use your platform to promote local resources, such as pharmacies, 2SLGBTQIA+ community centers, and more. 
  • As you work in pharmacy, keep resources available for patients to take, such as brochures or information sheets of nearby community resources. Be aware of which local resources are near your pharmacy for your patients. 
  • Keep 2SLGBTQIA+ care discrepancies in the forefront of our minds at students, and respectfully offer to educate preceptors and managers on 2SLGBTQIA+ issues, and ways to continue delivering gender-inclusive, safe and equitable care in the workplace. Some ways to provide this care include asking about and using correct pronouns, avoiding dead-naming, and more.  

References

  1.  The First Pride Was a Riot: The Origins of Pride Month. American University, College of Arts & Sciences News; 2022 Jun 10 [cited 2023 May 29]. Available from: https://www.american.edu/cas/news/the-first-pride-was-a-riot.cfm 
  2. Why Is Pride Month Celebrate in June? Encyclopedia Britannica; 2022 May 27 [cited 2023 May 29]. Available from: https://www.britannica.com/story/why-is-pride-month-celebrated-in-june 
  3. The History of Pride: How Activists Fought to Create LGBTQ+ Pride. The Library of Congress; n.d. [cited 2023 May 29]. Available from: https://www.loc.gov/ghe/cascade/index.html?appid=90dcc35abb714a24914c68c9654adb67 
  4. History of Canadian Pride. Queer Events; 2021 [cited 2023 Jun 1]. Available from: https://www.queerevents.ca/canada/pride/history  
  5. Celebrating Pride Month: We asked readers to define why celebrating Pride is important to them. Here is what they said. The Washington post; 2021 Jun 23 [cited 2023 May 29]. Available from: https://www.washingtonpost.com/nation/2021/06/11/pride-month-2021-celebration/ 
  6. Proposed changes to Canada’s Criminal Code relating to conversion therapy. Government of Canada; 2021 Nov 29 [cited 2023 May 29]. Available from: https://www.justice.gc.ca/eng/csj-sjc/pl/ct-tc/index.html 

Latest News

June 02, 2023
Clinical Pearl: Student reflection on Pride Month & 2SLGBTQIA+ advocacy during pharmacy school

Latest News

CSHP Foundation welcomes inaugural Pharmacy Technician Trustee Bal Dhillon 

June 1, 2023
 
 
 

The CSHP Foundation is proud to announce the appointment of the Foundation’s inaugural Pharmacy Technician Trustee, Bal Dhillon. The Pharmacy Technician Trustee position was added to the Foundation Board to represent the perspectives of the growing number of CSHP pharmacy technician members. 
 
With nearly 30 years of pharmacy experience, Bal has been a leader in hospital pharmacy among her team members in British Columbia where she is currently the Director, Inventory & Order Management with Provincial Health Services Authority. She is particularly inspiring for pharmacy technician colleagues, as she was instrumental in the formation of the Pharmacy Technician Society of BC (PTSBC) and served as their Events Coordinator and held the position of President of the Canadian Association of Pharmacy Technicians of BC Chapter. Nationally, Bal is a member of the Hospital Pharmacy in Canada Survey Board.
 
Welcome on board, Bal! We look forward to your insights! 

 

About Bal

  Bal Dhillon has more than 25 years of experience in the pharmacy profession. After completing a BSc. at SFU, she pursued her RPhT training, completed her Provincial Instructor diploma from the province of British Columbia, completed her Master of Business Administration focusing on process and project management and recently completed her Project Management Designation from PMI.  
 
Bal also designs, develops and delivers pharmaceutical compounding education for health care professionals in the topics of sterile and non-sterile compounding and is the Director of Education with the Pharmacy Technician Society of BC (PTSBC). Bal continues to be involved in various initiatives, promoting education and personal growth for pharmacy personnel in British Columbia.  She currently works with the Provincial Health Services Authority as Director, Inventory and Order Management.
 



June 02, 2023
CSHP Foundation welcomes inaugural Pharmacy Technician Trustee Bal Dhillon

Latest News

Announcing the Availability of Education Grants in 2023

May 30, 2023



The CSHP Foundation is now accepting applications for education grants in the following categories:

  • Thematic Conferences Development: organization of a targeted group that will focus on issues in pharmacy practice and/or education.
  • Educational Programs or Materials Development for Pharmacists:  development of resources for pharmacists with a focus on optimizing pharmacotherapy.

Two education grants, maximum $5,000 each have been allotted for 2023.

Eligible education proposals will reflect CSHP members’ innovative approaches to identifying or developing opportunities for professional education, dialogue, and knowledge transfer for pharmacists. The ultimate goal of each program will be to advance pharmacy practice and patient care in hospitals and other collaborative healthcare settings.

Education Grant Applicant Criteria
The principal applicant must be a CSHP Member, Member-in-Training, or Student Supporter and have been a CSHP member for at least 12 months at the time of the grant application.  Only one grant application may be submitted each year, and the principal applicant may only be awarded a grant every two years. See Criteria and Submission Checklist for further criteria.
 
Full details on the education grant program and the application process are available on the CSHP Foundation website at: https://cshp-scph.ca/foundation-education-grants.
 
Submissions for the Education Grants require the following components:

  1. Criteria and Submissions Checklist (checklist document on Foundation website)
  2. Title page (see Checklist document for details on what the title page should contain)
  3. Written proposal (see Checklist document for details on what the written proposal should contain)
  4. Grant Budget and Justification (budget template on Foundation website)
  5. Curriculum vitae of the Principal Applicant
  6. Letter(s) of support from applicant’s employer(s).

Additional information is also available on the CSHP Foundation website:

  • Criteria for Evaluation of Submissions
  • Education Grant Program Description

APPLY: To apply for a 2023 Education Grant, please submit all application documents in PDF format to Rosemary Pantalone electronically at rpantalone@cshp.ca
QUESTIONS: Please direct inquiries to Rosemary at the above-noted e-mail address.
DEADLINE DATE: Submissions must be received by October 16, 2023.

Grant decisions will be announced in January 2024.

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.

May 30, 2023
Announcing the Availability of Education Grants in 2023

Latest News

2023 CAPSI-CSHP Evidence-Based Practice Competition 

May 25, 2023
 

 

CSHP is the proud sponsor of the CAPSI-CSHP Evidence-Based Practice Competition 

Each year this competition aims to provide pharmacy students with an opportunity to enhance their critical thinking, scientific reasoning, problem-solving, decision-making, time management, and communication skills. The goal was to help students recognize the importance of these skills in advanced pharmacy practice and incorporate evidence-based medicine into their patient care approach.   

Pharmacy students take part in a nationwide competition to review a patient case, identify drug therapy problems, and make recommendations based on primary literature searches and/or existing guidelines. As part of the competition, student teams’ written submissions are judged based on a marking key. The team with the highest score is awarded a prize sponsored by CSHP. 

CAPSI and CSHP student representatives from 10 universities played a crucial role in organizing the competition and ensuring widespread participation across the country. The competition took place in both English and French, and a total of 15 entries were received, with teams consisting of 2-4 students from the following 8 Canadian universities made a submission: 

  • Dalhousie University (1 team) 
  • Memorial University of Newfoundland (1 team) 
  • University of Alberta (3 teams) 
  • University of British Columbia (1 team) 
  • University of Manitoba (2 teams) 
  • University of Saskatchewan (1 team) 
  • University of Toronto (3 teams)
  • University of Waterloo (3 teams) 

After a thorough evaluation by the judges, we are pleased to announce that the entry submitted by the Dalhousie University team has emerged as the competition winner and they’ve earned a $500 prize! 

CSHP wants to extend our appreciation to the students and the judges involved in this year’s competition, in addition to a massive thank you to our partners at CAPSI for letting us be a part of this cornerstone CAPSI competition. 

May 25, 2023
2023 CAPSI-CSHP Evidence-Based Practice Competition

Latest News

Call for CSHP student member stories 

May 19, 2023

 

Apply for your profile to be featured on CSHP social media, CSHP.ca, and in CSHP newsletters!

Throughout your studies, you accumulate not just a wealth of knowledge, but also a wealth of stories– and CSHP wants to hear them. Was there a CSHP event that made you rethink what you knew about hospital pharmacy? Perhaps there was a CSHP resource that made passing an exam easier. Or maybe you took advantage of our student programs like Pharmacy Residency Application Roadmap. 

No matter what it was, we want you to let us know in 200 words or less how being a CSHP student member has boosted your education or career. We’ll handpick applications from across the country to tell their full story in a series of articles that’ll be shared across all of CSHP’s channels.  

Interested? Take a few minutes to tell us why your story should be featured!  

Apply now

 

May 23, 2023
Call for CSHP student member stories

Latest News

Fellows Recognition Committee accepting applications for Fellow status - 2023

May 18, 2023
 

CSHP Fellow status is a peer recognition that is conferred upon CSHP members who have demonstrated noteworthy, sustained service in CSHP and excellence in pharmacy practice in a hospital or other collaborative healthcare settings.

The Fellows Recognition Committee is currently inviting qualified candidates to apply to be considered for Fellow status.

If you wish to apply to the program, please consult the program overview and criteria.

Applicants are encouraged to perform a self-assessment and consult with a colleague who has recently been conferred with Fellow status before deciding to complete and submit an application. Please take note that the application process takes time. Interested candidates are encouraged to begin filling out the Fellows Application Form well in advance of the deadline. All requests for information and completed applications are strictly confidential.   

Any questions can be forwarded to Pamela Saunders by email at fellows@cshp.ca

The application deadline is July 31, 2023.

May 18, 2023
Fellows Recognition Committee accepting applications for Fellow status 2023

Latest News

Resource Spotlight: Environmental sustainability of Inhalers

May 16, 2023
Written by Layne Liberty
 
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

Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common respiratory diseases with 3.8 million Canadians over the age of one living with asthma and two million living with COPD.1 Both conditions require the use of inhaler therapies to reduce morbidity and mortality.2 Many medications for these conditions are delivered using a pressurized metered dose inhaler (pMDI) which contain potent greenhouse gases (GHG) called hydrofluoroalkanes (HFA), or also known as hydrofluorocarbons (HFC).2 The GHG emitted from pMDI devices contribute to the carbon footprint of healthcare, which is estimated to be responsible for 4.6% of Canada’s total GHG emissions (equivalent to over thirty-three million tonnes of carbon dioxide equivalents).3  Other options for inhaled medications include dry powder inhalers (DPI) and soft mist inhalers (SMI), which both do not contain HFCs, and therefore, have a lower carbon footprint.2 While reducing the use of pMDIs may have positive impacts on the environment, changing therapies has implications for patients; thus, considerations such as inspiratory flow rate, handling capabilities, individual preference and financial constraints must be kept in mind. This resource spotlight aims to provide awareness, evidence and education about the environmental impact of inhalers to help pharmacists begin implementing environmentally sustainable practices. To learn more about the environmental impact of inhalers, check out the Canadian Society of Hospital Pharmacist (CSHP) recent Clinical Pearl article here

External Resorces

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 Resources

Creating A Sustainable Canadian Health System In A Climate Crisis (CASCADES) 

CASCADES is a national collaborative project supporting the transition to a net zero carbon emission and climate resilient Canadian health care system. The website has a repository of guides, patient friendly infographics and tools regarding environmentally sustainable prescribing of inhaled therapies, such as: 

  1. The Inhaler Primer Series provides a detailed overview of the environmental impact of inhalers and outlines options to mitigate and reduce the carbon footprint of inhalers
  2. The Inhaler Playbook provides a guide to sustainable inhaler use in primary care including a prescribing pathway with considerations for switching to alternative therapies, patient education and disposal
  3. A detailed inhaler comparison chart that compares available inhalers in Canada by carbon footprint, cost prior to coverage and provincial and territorial coverage status to support ease of sustainable prescribing 
  4. A quick reference chart to support the switch to alternative low carbon footprint inhalers for adults 
  5. A webinar on the climate impact of inhalers that provides education on proper asthma diagnosis, current guidelines, appropriate patient specific inhaler prescribing and logical switches to lower carbon footprint inhalers 

Health Product Stewardship Association (HPSA) 

HPSA runs a free medication return program through community pharmacies in BC, Manitoba, Ontario and PEI. It provides guidance for community pharmacies on how to implement these programs and guidance to consumers on safe disposal practices. This program is not available for hospitals or long-term care facilities; however, it is a useful resource for hospital pharmacists to refer patients to when counselling on inhaler medications and discussing proper disposal practices.  

European Resources

National Institute For Health And Care Excellence (NICE) 
NICE provides guidance and develops evidence-based recommendations to support best practices for the National Health Services (NHS) in the United Kingdom (UK). NICE has published a patient decision aid to help healthcare professionals and patients with asthma choose an appropriate inhaler while also considering the carbon footprint of treatment. It provides answers to common questions about switching inhaler treatments and is meant to support the shared decision making between the patient (over 12 years old) and healthcare professional.

Prescribing Always Includes Consideration OfQuality, Innovation, Productivity And Prevention (PrescQIPP

PrescQIPP is a not-for-profit social enterprise with the aim of supporting quality prescribing in the NHS. PrescQIPP has a repository of information on Bulletin 295: Inhaler carbon footprint such as: 

  1. A guidance document that provides suggestions for inhaler optimisation and support for healthcare professionals to start or switch patients to low carbon footprint inhalers. It also provides education around the impact and importance of proper inhaler disposal.  
  2. A tool designed for patient understanding that compares the carbon footprint of inhalers using easy to understand symbols and visuals.

Inhaler Life Cycle Assessment  
A sustainability evidence review of Carbon Footprints and Life Cycle Assessments of Inhalers was published in 2022. This paper provides an overview of the carbon footprint of pMDIs, DPIs and SMIs from creation of the active primary ingredient (API) all the way to end of life and disposal phase. The results show that the carbon footprint varies depending on which DPI is used and that the carbon footprint from DPI and SMIs is primarily due to the API and manufacturing stages of the life cycle, while pMDI is from the use and end of life phase.  

References

  1. Public Health Agency of Canada. Report from the Canadian chronic disease surveillance system: asthma and chronic obstructive pulmonary disease (COPD) in Canada [Internet]. Ottawa: Government of Canada Publications; 2018. 61 p. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018/pub-eng.pdf 
  2. Pernigotti D, Stonham C, Panigone S, Sandri F, Ferri R, Unal Y et al Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries. BMJ Op Resp Res. 2021;8(1):1-11. Available from: doi: 10.1136/bmjresp-2021-001071 
  3. Eckelman MJ, Sherman JD, MacNeill AJ. Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLOS Medicine. 2018;15(7):1-16. Available from: https://doi.org/10.1371/journal.pmed.1002623  

 

May 16, 2023
Resource Spotlight: Environmental sustainability of Inhalers

Latest News

Call for National Student Delegate 2023 - 2025

May 9, 2023
 

Are you a first, second or third year pharmacy student? If you are, CSHP is calling on YOU to be the Student Delegate on the CSHP National Board, representing pharmacy students across the country.

The Benefits

You will have an opportunity to:

  • Help shape and lead the future of hospital pharmacy in Canada. 
  • Gain access to up-to-date information about the challenges and opportunities facing CSHP, the profession of pharmacy, and healthcare.
  • Exchange ideas and perspectives with leaders in hospital pharmacy across Canada. 

Are You Qualified?

Candidates must be:

  • A CSHP Student Supporter (in good standing).
  • A CAPSI National member at the time of application.
  • Full-time student pharmacist during at least the first year of the Student Delegate term and enrolled in an academic program in Canada.

Student Delegate Responsibilities

  • Be the voice of pharmacy students and a voting member on the CSHP National Board.
  • Be the voice of CSHP on CAPSI Council.Fully participate virtually or in-person in all four CSHP board meetings annually (January, April, June, and October). The April & October meetings typically occur in-person, though a hybrid meeting option may be available.
  • Fully participate virtually or in-person in all four CSHP board meetings annually (January, April, June, and October). The April & October meetings typically occur in-person, though a hybrid meeting option may be available.
  • Participate virtually or in-person in all four CAPSI National meetings in a year as a non-voting liaison. The CPhA and PDW meetings are typically held in June and January respectively and the virtual meetings are typically held in the fall and winter semesters.
  • Attend Professional Development Week (PDW), typically held in January.
    • Communicate with CAPSI’s PDW Planning Committee to approach CSHP with respect to establishing a hospital pharmacy-specific talk during each annual PDW conference.
    • Attend the PDW Awards Ceremony and present the CSHP/CAPSI Hospital Pharmacy Student Award to the recipient.
    • Assist the representative from the Canadian Pharmacy Residency Board in staffing the CSHP booth at the PDW Health Fair.
    • Represent CSHP at the CAPSI Council Meeting and report issues to the CSHP Board at the Mid-term Board Meeting in April.
  • Act as scrutineer for CAPSI National elections.
  • Prepare semi-annual reports to the CSHP Board and CSHP branch student representatives (typically in April and October)
  • Prepare quarterly reports to the CAPSI Council.
  • Promote hospital pharmacy practice and CSHP to pharmacy students.
  • Be an active collaborator with other communications and membership volunteers and the CSHP National Office staff.
  • Liaise with the CSHP National Office staff and local CSHP & CAPSI student reps to lead the Evidence Based Practice (EBP) competition across all participating schools of pharmacy.
Hold a leadership position as the Chair of the CSHP Student Network, liaising with local CSHP student representatives at each pharmacy school through written communication and semi-annual virtual meetings.  

Term and Logistics

This is a two-year term which begins immediately after the 2023 CSHP national Annual General Meeting (AGM) in October to the close of the 2025 national AGM in October. The incoming delegate will be invited to observe all CSHP Board meetings prior to their term beginning. The student delegate’s term with CAPSI initially commences with CAPSI’s Board Meeting in June 2023. 

CSHP will support the cost of attendance for in-person CSHP meetings and for participation at CAPSI’s Professional Development Conference.

Note: The 2023 CSHP AGM, Fall Board Meetings and Sessions will be held in Montreal from Oct 20-22. 

How Do You Apply

Please submit:

  • A letter of intent documenting why you are an ideal candidate or contact us to arrange a telephone/videoconference declaration.
  • A letter of support (i.e., reference letter), or contact us to arrange a telephone/videoconference with the reference.
  • Your curriculum vitae.

Please send your application documents or reach out to request a telephone/videoconference declaration to Hira Tauqeer by e-mail at htauqeer@cshp.ca by May 31st, 2023.

Questions? Feel free to contact Hira Tauqeer by e-mail at htauqeer@cshp.ca  or the CAPSI President at pres@capsi.ca if you have any questions about this position.

 

May 09, 2023
Call for National Student Delegate 2023 - 2025

Latest News

Call for CPRB Subgroup Members 

May 2, 2023
  
The Canadian Pharmacy Residency Board (CPRB) is seeking expressions of interest from persons interested in joining one of their two key subgroups: the Standards Group and the Surveyors Group. 

Members of the Standards Group work under the direction of the CPRB to regularly review and propose updates to the CPRB Accreditation Standards. The group meets monthly for 1hr (teleconference), with one to two months off in the summer. For more information, contact the Group Chairs, Henry Halapy and Debbie Kwan

Members of the Surveyors Group work under the direction of the CPRB. The group meets quarterly for 1hr (teleconference) to review and update accreditation survey documents and policies, and to identify any opportunities for clarification in the Accreditation Standards, based on survey findings. Members are expected to attend a minimum of one accreditation survey every two years and may attend up to a maximum of two surveys in one year if their schedule permits. For more information, contact the Group Chair, Leslie Manuel
May 02, 2023
CPRB - Call for CPRB Subgroup Members

Clinical Pearls: The environmental impact of inhalers 

May 9, 2023
By: Layne Liberty

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

According to the 2018 report from the Canadian Chronic Disease Surveillance System, there are 3.8 million Canadians over the age of one living with asthma and two million living with chronic obstructive pulmonary disease (COPD).1 Both of these conditions are large burdens on the healthcare system due to medical costs and resource use.  Additionally, asthma is more prevalent in younger working age groups, it has a major economic impact due to productivity loss2 The prevalence of these chronic conditions is expected to rise as the Canadian population ages and as air quality continues to deteriorate.3 Climate change is a defining challenge of the 21st century and one of the largest contributors to the emission of greenhouse gases (GHG) is the healthcare system.4 The Canadian healthcare sector is responsible for 4.6% of the total GHG emissions and over 200,000 tons of pollutants primarily coming from hospitals, pharmaceuticals and physician services.5 Climate change poses a great risk to respiratory disease because it causes increased concentrations of outdoor ozone (often seen as ‘smog’) and particulate matter at ground level.6 In addition, increased global temperatures cause increased amounts of pollen produced by each plant, as well as an earlier and longer pollen season and higher rates of mold proliferation.6 These environmental factors all aggravate respiratory disease leading to uncontrolled symptoms, inhaler overuse and higher risk of asthma and COPD exacerbations.7,8

The pressurized metered dose inhalers (pMDI) and breath actuated inhalers (BAI) contain hydrofluorocarbon (HFC) propellants. These propellants are used to atomize the medication containing droplets in order to deliver it to the patients respiratory system.9 These propellants are potent greenhouse gases (GHG) with high global warming potential (GWP), a metric used to examine a GHG ability to trap heat in the atmosphere compared to carbon dioxide (CO2), and depending on the type of HFC used, are 1400-3200 times more potent than CO2.9,10 The other inhaler devices such as dry powered inhalers (DPI) and soft mist inhalers (SMI) do not contain these propellants and therefore have a lower carbon footprint (CFP).10 The active primary ingredient(s) (API) in DPIs are dispersed into the respiratory system by the patient’s own inspiratory rate while the SMI device, also known as Respimat, utilizes a spring to create the force to drive the aqueous medication into the lungs.10

A CFP can be quantified and assessed by how much greenhouse gas (often described in CO2 equivalents (CO2eq)) is emitted during a product's life cycle (e.g., from manufacturing to distribution to use to destruction).12 A CO2eq is a unit used to allow direct comparison to COby expressing the potential global warming effect of all GHG emissions relative to CO2.12 When selecting inhaler therapies, pharmacological factors such as the safety and efficacy of the medication and patient factors such as finger dexterity and inspiratory rate and volume are key factors; however, the environmental impacts of inhaler treatments are becoming an increasingly important consideration.10 Asthma and COPD carry a significant economic burden due to hospital admissions, physician visits and resource utilization.2 In addition, poor disease management, patient adherence issues, incorrect inhaler use, and misdiagnosis all contribute to increased healthcare spending and poor environmental outcomes.2,3,11,12 Applying the information presented in this article along with shared decision making with patients will help healthcare providers select a drug regimen that is environmentally conscious, safe and effective.

Role Of The Pharmacist

Pharmacists are leaders in healthcare and with Canada’s recently updated nationally determined contribution to reduce emissions by 40-45% below 2005 levels by 2030 and to reach net zero carbon emissions by 2050, its essential that pharmacist begin advocating and incorporating environmental sustainability into their practice.13 There is a growing number of resources and education available to aid healthcare providers in transitioning to prescribing and suggesting alternative low carbon inhalers, one being the primer and playbooks supplied by Creating A Sustainable Canadian Health System In A Climate Crisis (CASCADES).  Pharmacists are in a unique position to educate prescribers, colleagues, and patients on environmentally sustainably practices including the proper use and disposal of inhalers, and alternative therapies available. Pharmacist led interventions in the hospital such as initiating smoking cessation, conducting medication reviews, inhaler technique training, and reviewing asthma and COPD action plans have all been proven to improve disease management, adherence, and quality of life outcomes.14,15,16 COPD and asthma are often primarily managed in the community; however, a patient admitted to the hospital presents an opportunity for the hospital pharmacist to make appropriate interventions.17Acute exacerbations of COPD, which are the main reason for unscheduled hospital admissions, exert a significant impact on patients’ quality of life as it accelerates disease progression and leads to increased mortality.17 Asthma exacerbations also have a negative impact on quality of life, as it contributes to lung function decline, systemic effects, and mortality.18 Pharmacists have the knowledge and ability to make interventions like education and training on inhaler technique and could take it one step further by implementing environmentally conscious practices like education on proper medication disposal, suggesting alternative low carbon inhalers and promoting de-prescribing where clinically appropriate. 

Pharmacist led interventions to reduce the environmental impact of inhalers include the following:

Life Cycle Assessment of Inhalers and Ensuring Proper Disposal
Life cycle assessments have been completed on the different inhaler devices to determine the amount of GHG emitted during each phase from manufacturing to patient use to disposal. As mentioned, the GHGs emitted from the propellants in pMDIs are very potent, and from data presented in Table 1, an inhaler regimen for one patient over one year (3 salbutamol pMDIs and 12 Advair pMDIs) can be estimated to be the same as driving a gas car 1498km (that’s equivalent to a roadtrip from Banff, AB to Winnipeg, MB).19 The use and the disposal phase for a pMDI makes up approximately 85% of the total CFP, while the main contribution to the CFPs for the DPI/SMI inhalers are from the API and during the manufacturing stages of the life cycle20. If the manufacturing phases are the only contributing factor considered, then on average, the inhalers with the largest CFP are still pMDIs.20 In a study that compared the CFPs of tiotropium bromide (Spiriva®) Respimat® (both disposable and reusable devices) and ipratropium bromide (Atrovent®) pMDI, it was noted that ipratropium had a CFP that was 20 times greater than the disposable Respimat® device.21 The disposal phase of the Respimat® is the largest contributor to its CFP, so refill cartridges have been introduced to help mitigate the impact.22 The reusable Respimat® device can be refilled up to 6 times before the device needs to be replaced.22For example, if a patient is prescribed the Spiriva Respimat®, then this would translate into reducing the number of inhalers per year per patient from 12 to 2. 

Improper pMDI disposal causes the residual propellants to be released into the atmosphere which increases its negative impact on the environment.9 The most common disposal process for pMDIs is by incineration as the HFCs require thermal degradation to be destroyed.10 When pMDIs are disposed of correctly, it translates to an estimated CO2 emission savings of 3 to 17 kg per inhaler.9 In Manitoba, British Columbia, Prince Edward Island and Ontario, there is a health product stewardship program that operates medication return programs through community pharmacies.23 Hospital pharmacists, in provinces where this service is offered, can further their environmental advocacy by educating and providing resources for patients and other health care providers around proper medication recycling in their community. Pharmacists have a role in promoting environmental initiatives and can help push for changes in practice, therapeutic guidelines, and organizational policy (e.g. purchasing practices and formulary choice).
 
Ensuring Proper Inhaler Technique
Incorrect inhaler technique reduces the delivery of medication into the patients' lungs which is associated with poor disease outcomes, increased hospital admissions, increased healthcare costs and medication waste, all contributing to a larger environmental impact.15 Assessing a patient's appropriate inhaler technique allows pharmacists to assess therapeutic safety and efficacy and provides an opportunity to suggest environmentally conscious alternatives. Pharmacist led inhaler training has been proven to be effective with improvement in patient disease management and maintenance of proper technique.24,25,26 Although study results on improper inhaler technique vary, a study conducted in Canada found that 59% of study participants made critical errors (removing cap/lid/opening mouthpiece before administration, shaking MDI before use and inhaling properly depending on type used), while using their inhalers.27 Patients using pMDIs were also more likely to make critical errors in administration (93%) compared to patients using DPIs/SMIs (39%).27 The main critical errors in pMDI use were the actuation of the device and proper inhalation, which are common mistakes as patients are consistently unable to coordinate these two steps.27Assessing a patient's inspiration ability and hand dexterity are essential as a major component of a pMDIs CFP comes from the patient use phase. Incorrect pMDI inhaler technique not only leads to uncontrolled disease, it also causes an excess in propellant outflow and a higher requirement of reliever and maintenance canisters per year, both contributing to pMDIs environmental impact.9 Utilizing a spacer device with a pMDI in patients that have difficulty inspiring at the correct speed and depth can help mitigate this issue by slowing down drug delivery and reducing medication waste.9 Another issue with pMDI that affects patients and the environment, is the lack of a dose counter on the device. Without a dose counter, patients are more likely to throw away half full canisters or continue to use empty inhalers.9  Many patients use methods to test for the presence of medication like spraying into the air to see if medication comes out, which is incorrect, as the spray may just be leftover propellant.28 Education and counselling on proper dose counting methods such as keeping track of the doses administered for maintenance inhalers (dividing the total doses in the inhaler (found on the box) by the total number of doses per day), and reliever inhalers (write down the doses used after every administration) can help mitigate these issues.28
 
Recommend Alternate Inhaler Therapies
The National Health Services (NHS) in the United Kingdom (UK) has done extensive research on the environmental impact of inhalers and is aiming to reduce the carbon impacts of inhalers by 50% by 2030.29 0The Canadian healthcare system and health care providers can learn from this plan and join the NHS in making strides towards reducing healthcare’s environmental impact. Metered dose inhalers comprise 75% of the total amount of inhalers prescribed in Canada and the United States.9 Reliever medications like salbutamol (short-acting beta-2 agonist (SABA)) and ipratropium (short-acting muscarinic-antagonist (SAMA)) come in pMDI canisters and are commonly prescribed due to their treatment versatility (e.g. used for symptom management caused by conditions other than asthma and COPD) and low cost. Reliever and maintenance therapy metered dose inhaler prescriptions account for approximately 0.03% of annual global GHG emissions.and the carbon footprint of two doses of a salbutamol pMDI has been estimated to be approximately 500 g CO2e.19 In comparison, the CO2e emissions of a nine-mile car trip (approximately 14km) is estimated to be 2610 g CO2eq (only 5 puffs of a salbutamol pMDI).19 When these values are scaled up to a population level, one can understand how patients with uncontrolled respiratory disease are significantly contributing to GHG emissions. Metered dose inhaler use is a double-edged sword, because although it helps patients maintain control of their respiratory symptoms and disease, it also contributes to deteriorating air quality. Poor air quality is known to be a significant trigger for patients with respiratory disease and leads to increased risk of exacerbations and poor symptom control. Recommending alternative therapies is not as simple as just switching to a more environmentally conscious choice, there are other considerations to keep in mind such as commercial availability, economic burden, drug coverage and patient preference (e.g. ease of use, hand dexterity and strength of lungs). DPI and SMI devices carry a significantly lower environmental burden so switching to these devices when clinically appropriate is recommended.19 For example, fluticasone propionate/salmeterol combination is available as a pMDI and a DPI, so depending on the patients’ dose, this switch could help lower the carbon footprint. Other examples of switching to low carbon inhaler alternatives are described in Figure 119 and the CFP of commonly prescribed inhalers is found in Figure 2.19,20
 
Ensure Proper Diagnosis And Promote De-prescribing Where Clinically Possible
COPD requires spirometry testing before definitive diagnosis with a post-bronchodilator forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio < 70%.30 Diagnosing COPD just based on symptoms contributes to unnecessary treatment, patient psychological stress and overprescribing of inhalers.30 Asthma is diagnosed based on respiratory symptoms in addition to evidence of variable expiratory airflow limitation, tested by either peak flow or spirometry.31  A Canadian study of 613 patients with an asthma diagnosis in the last 5 years were re-tested with home peak flow and symptom monitoring, spirometry, and serial bronchial challenge tests.32 It was discovered that 33% of the participants did not have asthma and after 12 months of follow-up, 30% patients still showed no clinical or lab evidence of asthma.32  Similarly, overdiagnosis of COPD is common and it has been estimated that 1 in every 3 patients do not have COPD.33,34,35 A population-based cohort study found that of 1403 randomly selected patients from Ontario (taken from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study) 5.1% of patients did not have COPD, while only 3.7% had correctly diagnosed COPD.36  Additionally, the over diagnosed COPD patients had significantly higher rates of hospitalizations, emergency department visits and ambulatory care visits.36 Another study in Ontario from 2000-2010 of 491,754 patients with newly diagnosed COPD found that only about one-third received spirometry prior to diagnosis.37 The Canadian Thoracic Society emphasizes the importance of de-prescribing inhaler therapies if the patient has not had a clinical benefit or confirmation of reversible airflow limitation through spirometry or peak flow testing.30The misdiagnosis and overprescribing of inhaler treatments increases risk for patient adverse effects and contributes to the use of healthcare resource and waste production. Focusing on more thorough diagnosis practices, gathering in-depth patient medical history and inquiring about inhaler effectiveness to the patient can all contribute to decreasing the CFP of the healthcare sector. 
 

Summary

The prevalence of asthma and COPD is expected to increase as the population ages and people are exposed to more environmental pollutants due to climate change. Asthma and COPD carry a significant environmental burden due to pMDI use, misdiagnosis and incorrect inhaler use. The use and disposal phase for pMDIs make up approximately 85% of the total pMDI CFP, so switching to inhalers mentioned in this article that have a lower CFP, and ensuring proper medication disposal, will contribute to mitigating the environmental impact of inhalers. In addition, pharmacists should ensure proper inhaler techniques through education and training and question the diagnosis of COPD and asthma when clinically appropriate. Utilizing this information during practice and consistently considering the environmental impact of medications will help push for changes in practice, therapeutic guidelines, and organizational policy (e.g. purchasing practices and formulary choice).

Figure 1. Examples of common inhalers and their low carbon alternatives. Switching from one inhaler to another is only suggested when clinically appropriate and through patient shared decision making. All data presented below is adapted to Canadian equivalents from information provided in the NHS Devon Formulary Guide.19

Image designed by Layne Liberty using free access to canva.com

 

Figure 2. Carbon footprint comparisons of commonly prescribed inhalers. 

All data presented below is adapted to Canadian equivalents from information provided in the NHS Devon Formulary Guide19 and PrescQUIPP21   

Image designed by Layne Liberty using free access to canva.com


 

References

  1.  Public Health Agency of Canada. Report from the Canadian chronic disease surveillance system: asthma and chronic obstructive pulmonary disease (COPD) in Canada [Internet]. Ottawa: Government of Canada Publications; 2018. 61 p. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018/pub-eng.pdf
  2. Ehteshami-Afshar S, FitzGerald JM, Doyle-Waters MM, Sadatsafavi M. The global economic burden of asthma and chronic obstructive pulmonary disease. The International Journal of Tuberculosis and Lung Disease. 2016;20(1):11-23. Available from: https://doi.org/10.5588/ijtld.15.0472
  3. Hurst JR, Siddiqui MK, Singh B, Varghese P, Holmgren U, de Nigris E. A systematic literature review of the humanistic burden of COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2021;16:1303-14. Available from: https://doi.org/10.2147/copd.s296696
  4. Starup-Hansen J, Dunne H, Sadler J, Jones A, Okorie M. Climate change in healthcare: exploring the potential role of inhaler prescribing. Pharmacology Research & Perspectives [Internet]. 2020;8(6). Available from: https://doi.org/10.1002/prp2.675
  5. Eckelman MJ, Sherman JD, MacNeill AJ. Life cycle environmental emissions and health damages from the Canadian healthcare system: an economic-environmental-epidemiological analysis. PLOS Medicine. 2018;15(7):e1002623. Available from: https://doi.org/10.1371/journal.pmed.1002623
  6. D'Amato G, Cecchi L, D'Amato M, Annesi-Maesano I. Climate change and respiratory diseases. European Respiratory Review. 2014;23(132):161-9. Available from: https://doi.org/10.1183/09059180.00001714
  7. Jiang XQ, Mei XD, Feng D. Air pollution and chronic airway diseases: what should people know and do? J Thorac Dis. 2016;8(1):E31-40. doi: 10.3978/j.issn.2072-1439.2015.11.50
  8. Keeley D, Scullion JE, Usmani OS. Minimizing the environmental impact of inhaled therapies: problems with policy on low carbon inhalers. European Respiratory Journal. 2020;55(2):2000048. Available from: https://doi.org/10.1183/13993003.00048-2020
  9. CASCADES Canada. Environmentally sustainable opportunities for health systems: Primer Series Inhalers. [Internet]. 2020 [updated 2021 Oct; cited 2023 Feb 22]. Available from: https://view.publitas.com/5231e51e-4654-42c2-accd-b722e21f3093/environmentally-sustainable-opportunities-for-health-systems-primer-series-inhalers/page/12-13
  10. Woodcock A, Beeh KM, Sagara H, Aumônier S, Addo-Yobo E, Khan J, Vestbo J, Tope H. The environmental impact of inhaled therapy: making informed treatment choices. European Respiratory Journal [Internet]. 2022:60 (1) 2102106. Available from: https://doi.org/10.1183/13993003.02106-2021
  11. Lindh A, Theander K, Arne M, Lisspers K, Lundh L, Sandelowsky H, Ställberg B, Westerdahl E, Zakrisson A. Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care. Nursing Open [Internet]. 2019;6(4):1519-27. Available from: https://doi.org/10.1002/nop2.357
  12. AL-Jahdali, H, Ahmed, A, AL-Harbi, A, Khan M, Baharoon S, Salih S, Halwani R et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Asth Clin Immun 2013:9(8) Available from: https://doi.org/10.1186/1710-1492-9-8
  13. Environment and Climate Change Canada. Government of Canada [Internet]. Canada’s enhanced nationally determined contribution; 2021. Available from: https://www.canada.ca/en/environment-climate-change/news/2021/04/canadas-enhanced-nationally-determined-contribution.html
  14. Bridgeman MB, Wilken LA. Essential Role of Pharmacists in Asthma Care and Management. Journal of Pharmacy Practice. 2021;34(1):149-162. doi:10.1177/0897190020927274
  15. Hudd TR. Emerging role of pharmacists in managing patients with chronic obstructive pulmonary disease. American Journal of Health-System Pharmacy. 2020;77(19):1625-30. Available from: https://doi.org/10.1093/ajhp/zxaa216
  16. Jia X, Zhou S, Luo D, Zhao X, Zhou Y, Cui Y. Effect of pharmacist‐led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: a systematic review and meta‐analysis. Journal of Clinical Pharmacy and Therapeutics [Internet]. 2020 Feb 27 [cited 2023 Feb 23];45(5):904-17. Available from: https://doi.org/10.1111/jcpt.13126
  17. Lin G, Zheng J, Tang PK, Zheng Y, Hu H, Ung COL. Effectiveness of Hospital Pharmacist Interventions for COPD Patients: A Systematic Literature Review and Logic Model. Int J Chron Obstruct Pulmon Dis. 2022;17:2757-2788.
  18. Rennard SI, Farmer SG. Exacerbations and progression of disease in asthma and chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):88-92. doi: 10.1513/pats.2306026
  19. North and East Devon Formulary and Referral. Northeast Devon Formulary Guidance NHS [Internet]. The environmental impact of inhalers. Available from: https://northeast.devonformularyguidance.nhs.uk/formulary/chapters/3.-respiratory/the-environmental-impact-of-inhalers#:~:text=Carbon%20footprint,can%20contribute%20to%20global%20warming.
  20. Fulford B, Mezzi K, Aumônier S, Finkbeiner M. Carbon footprints and life cycle assessments of inhalers: a review of published evidence. Sustainability. 2022;14(12):7106. Available from: https://doi.org/10.3390/su14127106
  21. PrescQIPP; Homan K. Inhaler carbon footprint 2.2 [Internet]. [place unknown: publisher unknown]; 2021;24 p. Available from: https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=/media/5719/295-inhaler-carbon-footprint-22.pdf
  22. Hänsel M, Bambach T, Wachtel H. Reduced Environmental Impact of the Reusable Respimat® Soft Mist™ Inhaler Compared with Pressurised Metered-Dose Inhalers. Adv Ther. 2019 Sep;36(9):2487-2492. doi: 10.1007/s12325-019-01028-y
  23. Health Product Stewardship Association. Health Products Stewardship Association [Internet]. Returning Medications - Health Products Stewardship Association. Available from: https://healthsteward.ca/consumers/returning-medications/.
  24. Nguyen TS, Nguyen TLH, Pham TTV, Hua S, Ngo QC, Li SC. Pharmacists' training to improve inhaler technique of patients with COPD in Vietnam. Int J Chron Obstruct Pulmon Dis. 2018;13:1863-1872
  25. Katsurada, M., Nagano, T., Nakajima, T., Yasuda, Y., Miwa, N., Sekiya, R., Kobayashi, K., Hojo, D., & Nishimura, Y. Retrospective analysis of the effect of inhaler education on improvements in inhaler usage. Respiratory investigation. 2021; 59(3): 312-319 . 
  26. Capstick TG, Burnley M, Higgins H. P234 Improving in inhaler technique: a community pharmacy service. 
  27. Batterink J, Dahri K, Aulakh A, Rempel C. Evaluation of the use of inhaled medications by hospital inpatients with chronic obstructive pulmonary disease. Can J Hosp Pharm. 2012 Mar;65(2):111-8. doi: 10.4212/cjhp.v65i2.1118
  28. Gerald L, Dhand R. Patient education: Inhaler techniques in adults (Beyond the Basics). In: Basow, DS editor. UpToDate. Waltham, MA: UpToDate; 2021.
  29. NHS Greater Glasgow and Clyde Area Drug and Therapeutics Committee. GGC Medicines: Home [Internet]. GGC Medicines: sustainability: reducing the environmental impact of inhalers; 2021. Available from: https://ggcmedicines.org.uk/blog/medicines-update/sustainability-reducing-the-environmental-impact-of-inhalers/.
  30. Canadian Thoracic Society. Choosing Wisely Canada [Internet]. Respiratory Medicine- Seven Tests and Treatments to Question. Available from: https://choosingwiselycanada.org/recommendation/respiratory-medicine/.
  31. Reddel HK, Bacharier LB, Bateman ED, Brightling C, Brusselle G, Buhl R, et al. Global Initiative for Asthma (GINA) Strategy 2021 - Executive summary and rationale for key changes. Eur Respir J 2021; in press (https://doi.org/10.1183/13993003.02730-2021)
  32. Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and Overdiagnosis of Asthma. Am J Respir Crit Care Med. 2018 Oct 15;198(8):1012-1020. doi: 10.1164/rccm.201804-0682Cl
  33. Walters JA, Walters EH, Nelson M, Robinson A, Scott J, Turner P, Wood-Baker R. Factors associated with misdiagnosis of COPD in primary care. Prim Care Respir J. 2011;20(4):396-402. doi: 10.4104/pcrj.2011.00039
  34. Zwar NA, Marks GB, Hermiz O, Middleton S, Comino EJ, Hasan I, Vagholkar S, Wilson SF. Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. Med J Aust. 2011;195(4):168-71. doi: 10.5694/j.1326-5377.2011.tb03271.x.
  35. Starren ES, Roberts NJ, Tahir M, O'Byrne L, Haffenden R, Patel IS, Partridge MR. A centralised respiratory diagnostic service for primary care: a 4-year audit. Prim Care Respir J. 2012;21(2):180-6. doi: 10.4104/pcrj.2012.00013. 
  36. Gershon AS, Thiruchelvam D, Chapman KR, Aaron SD, Stanbrook MB, Bourbeau J, Tan W, To T. Health services burden of undiagnosed and overdiagnosed COPD. Chest. 2018;153(6):1336-46. Available from: https://doi.org/10.1016/j.chest.2018.01.038
  37. Gershon AS, Hwee J, Croxford R, Aaron SD, To T. Patient and physician factors associated with pulmonary function testing for COPD. Chest. 2014;145(2):272-81. Available from: https://doi.org/10.1378/chest.13-0790
     

Latest News

May 02, 2023
Clinical Pearls: The environmental impact of inhalers

Latest News

Resource Spotlight: PTSD and trauma-informed care

April 21, 2023
 

Written by CSHP Student

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

Canada has one of the highest rates of post-traumatic stress disorder (PTSD) in the world, with 8% Canadian adults meeting the criteria for probable PTSD. PTSD can have significant consequences on patients’ mental health, quality of life, and mortality. As a result of a growing awareness on the effects of trauma and PTSD, trauma-informed care (TIC) has emerged in recent years as a principle-based framework that aims to improve support and outcomes for those living with trauma. This “Resource Spotlight” contains links to associations and guidelines that help pharmacists learn more about PTSD and trauma informed care, along with helpful resources to share with patients. To learn more about PTSD and trauma informed care, check out CSHP’s recent Clinical Pearls article on PTSD and trauma-informed care.

External Resorces

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.  

CAMH

The Centre for Addiction and Mental Health (CAMH) located in Toronto, is Canada’s largest mental health and addictions teaching hospital. Their website features a wealth of resources for PTSD patients and healthcare providers including clinical and self-assessment tools, a summary of pharmacotherapies for PTSD, trauma resources (Ontario based), and mental health resources for healthcare workers. This webinar posted on their site also offers a great introduction to trauma informed care and provides some strategies for healthcare providers on how they can be implement TIC in their practice. 

CMHA

The Canadian Mental Health Association (CMHA) is a non-profit organization that aims to advocate for and provide mental health resources and support for Canadians nationwide. Their website offers many resources for those struggling with PTSD and other mental health problems including links to national crisis services, online mental health courses, programs such as Resilient Minds™, which is a peer-to-peer skills development program that educates fire fighters on resilience and provides them with the skills to respond to trauma in their workplace, and information on various mental health conditions, including one on PTSD.

Government of Canada

This webpage on the Government of Canada website can direct patients with PTSD to resources across the country. Some of the notable resources include a help line for Indigenous peoples seeking mental health support or crisis intervention, substance use and harm reduction services, provincial and territorial resources for mental health support, and Wellness Together Canada, a 24/7 support program funded by the Government of Canada for people with concerns regarding mental health or substance use.

Alberta Health Services TIC Training Modules

The Trauma Informed Care (TIC) e-Learning Series is a series of seven self-study online modules developed by Alberta Health Services (AHS) for their Trauma Training Initiative. Each module can be completed in 30 minutes or less and covers foundational topics relevant to TIC such as how to understand and recognize trauma and how to implement TIC. Non-AHS staff can obtain a certificate of participation by completing all the modules, required pre- and post-competency surveys, and certificate request form. A second part of the Trauma Training Initiative exists as a series of five three-hour online workshops that serves to enhance healthcare providers’ knowledge of TIC and provide additional strategies for how they can better support patients living with trauma. These three-hour workshops are currently only available to AHS staff.

Trauma-informed.ca

The Manitoba Trauma Information and Education Centre has put together a useful trauma informed toolkit made for service organizations and providers. It features extensive information on trauma-informed practices and PTSD, offers guidelines, and shares links to provincial trauma resources. 

Federal Framework on Posttraumatic Stress Disorder (PTSD)

In 2019, the Government of Canada published the first Federal Framework on Posttraumatic Stress Disorder (PTSD) to recognize the great impact that PTSD has on Canadians. The document is extensive and guides future direction for how the government can support those affected by PTSD. Some useful information embed within the document include background information on PTSD in the Canadian context, insight on PTSD initiatives currently underway to support high-risk populations and individuals, and links to clinical practice guidelines, including the latest national guidelines for PTSD published by the Anxiety Disorders Association of Canada in 2014.

PTSD Coach

PTSD Coach Canada is a free mobile app developed by Veterans Affairs Canada. While originally designed for veterans and military service members, anyone affected by PTSD may find the education, Canadian based resources, and tools to help manage symptoms within the app beneficial. It is not a meant to be a substitute for psychotherapy or medication for PTSD; however, it can be recommended as a convenient resource to supplement professional care.  

April 21, 2023
Resource Spotlight: PTSD and trauma-informed care

Latest News

CPRB News - April 2023

April 20, 2023
 
 
PRAMS Statistics 2023

The Pharmacy Residency Application Matching Service (PRAMS) successfully matched 134 residents to residency programs for the 2023-24 year. Applications to residency programs continue to be competitive. The chart below provides the residency match statistics for the last six years.

CPRB wishes to thank those who provided feedback in the recent PRAMS Survey.  We are working to implement changes based on the feedback provided to further improve the matching process.
 

 
April 20, 2023
CPRB News - April 2023

Latest News

CSHP Foundation: Announcing the 2022-23 Education Grant & PLA scholarship recipients 

April 25, 2023
 

The CSHP Foundation Trustees are pleased to announce the recipients of the Foundation’s 2022-23 Education Grants and Pharmacy Leadership Academy (PLA) Scholarship.

2022-23 Education Grant Recipients

Congratulations to...

Shirin Abadi

BSc(Pharm), ACPR, PharmD, DPLA, MBA, FCSHP, RPh

Pharmacy Clinical & Education Coordinator, BC Cancer – Vancouver
Clinical Professor, Faculties of Pharmacy and Medicine, UBC

BC Cancer Pharmacy’s Oncology Drug Interactions Module   
  
Facility: Provincial Health Services Authority, BC Cancer

Dr. Shirin Abadi has over 25 years of experience in the health sector, most recently as the Pharmacy Clinical & Education Coordinator for BC Cancer-PHSA in Vancouver. In this capacity, she has been responsible for overseeing clinical and educational pharmacy services, while teaching as a Clinical Professor for the Faculties of Pharmaceutical Sciences and Medicine at UBC. Shirin has recently completed six years of Executive Leadership experience with the Canadian College of Health Leaders – BC Lower Mainland Chapter. She has extensive board experience and has participated in strategic planning, and patient and staff engagement initiatives throughout the past few years.

Shirin is actively involved in research and has more than 50 academic papers/posters to her credit. She has been an invited speaker to more than 100 local, provincial and national events, on clinical, research and leadership topics. Shirin is recognized locally, nationally and internationally with more than 30 prestigious awards for her commitment to patient care, service, and effective leadership.

Shirin holds a post-graduate Doctor of Pharmacy degree, an Executive Master of Business Administration degree, a Graduate Certificate for conducting Business in the Americas, a Diploma in Pharmacy Leadership Academy, an Accredited Canadian Pharmacy Residency certificate, and a Bachelor of Science in Pharmacy degree with Honours distinction. She is also a Fellow of the Canadian Society of Hospital Pharmacists.

Congratulations to...

Melanie MacInnis

BSc(Pharm), PharmD

Residency Program Coordinator, Clinical Coordinator & Professional Practice Leader, Clinical Pharmacy Specialist, Pediatric Emergency Medicine, IWK Health

Women’s & Children’s Pharmacotherapy Primer for Pharmacy Professionals
Facility: IWK Health Centre, Halifax, NS

Melanie is a Dalhousie BScPharm graduate 2003 and University of Florida 2010 PharmD. She worked for 2 years for Pharmasave Ontario in Professional Practice after graduation, making the transition to hospital pharmacy practice at Hamilton Health Sciences in 2005.

With a short stint at Horizon Health in Moncton NB, Melanie returned home to Nova Scotia in 2013 assuming the role of professional practice chief, clinical coordinator, and clinical pharmacy specialist in pediatric emergency medicine at IWK Health.  In 2015 she established the first collaborative practice for independent prescribing in the community in NS; and developed the IWK pharmacy residency program with first intake of resident in the 2018-2019 academic year.

2022 Pharmacy Leadership Academy (PLA) Scholarship Recipient

Congratulations to...

Ginny Cummings

BSc(Pharm), ACPR, PharmD

Pharmacy Clinical Practice Leader, Alberta Health Services (AHS)

Ginny works in Calgary at a community hospital, caring for both inpatient and ambulatory internal medicine patients. She has worked in many clinical areas during her career including internal medicine, cardiology, and critical care. As a Clinical Practice Leader, she supports over 20 pharmacists at the Peter Lougheed Center, providing leadership, coaching and practice development support.  Most recently, Ginny has been heavily involved in the development and implementation of a province-wide electronic health record system known as Connect Care (Epic® based). 

Ginny’s superpower is her ability to connect with people - she leads with authenticity and empathy to find ways to relate to and motivate others. Ginny’s leadership style is based in collaboration and curiosity – she believes that “the true value of a leader is not measured by the work they do. A leader’s true value is measured by the work they inspire others to do” (~Simon Sinek).  

Outside of work, her life is full of volunteering, dog walks, and enjoying time outdoors with her three boys.

April 18, 2023
CSHP Foundation: Announcing the 2022-23 Education Grant & PLA scholarship recipients

Clinical Pearls: PTSD and trauma-informed care 

April 11, 2023
By CSHP Pharmacy Student

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

Trauma is widespread globally and in Canada.1,2 Results from the World Mental Health Consortium revealed that around 70% of respondents reported having experienced a traumatic event at least once in their lifetime, while recent findings from the national Survey on Mental Health and Stressful Events found this to be true for 64% of Canadians.1,2 Although there is growing awareness of a broader definition of trauma (e.g., intergenerational, historical, interpersonal),3 the term most found in literature is one that describes the psychological response that manifests after experiencing or witnessing a distressing event.4 When this response persists, a person can develop post-traumatic stress disorder (PTSD), which is a potentially debilitating mental condition characterized by the following possible symptoms:  
 
  • Recurrent distressing memories, nightmares, and flashbacks related to the traumatic event(s).5
  • Intense feelings of distress and/or physiological reactions to internal or external reminders of the traumatic event(s).5
  • Avoidance of distressing thoughts or the avoidance of external reminders of the traumatic event(s) (e.g., people, locations, objects, situations) that arouse distressing memories, thoughts, and feelings.5
  • Negative changes to cognition and mood (e.g., persistent negative beliefs of oneself, others, or the world, feelings of detachment, or inability to experience positive emotions).5
  • Changes in arousal and reactivity (e.g., hypervigilance, exaggerated startle response, and insomnia).5

PTSD symptoms may vary in frequency and severity between individuals; however, prior to obtaining a formal diagnosis of PTSD, all individuals must have experienced their symptoms for at least one month, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).5

Canada has one of the highest rates of PTSD in the world, with 8% of Canadian adults meeting the criteria for probable PTSD.2,6 Worldwide, the prevalence of PTSD differs among certain populations. Some populations that may be at higher risk of PTSD include survivors of sexual violence, women, younger adults, military veterans, and racially and culturally marginalized individuals.2,3,7-10 Furthermore, PTSD has been associated with an increased risk of substance use disorders, chronic diseases, co-morbid mental health conditions, accelerated aging, hospitalization, and suicide.1,11,12 Despite this, a cross-national survey found that only half of respondents reported seeking any kind of treatment.1 

Treatments

Currently, there is no specific treatment, psychological or pharmacological, that promises a cure for PTSD. However, there are several different treatments available that can help alleviate symptoms and make PTSD more manageable for affected individuals. Initial treatment of PTSD usually involves the use of trauma-focused psychotherapy, as recommended by national guidelines.11,13 Meta-analyses of over 30 randomized controlled trials (RCTs) of psychotherapies have found trauma-focused cognitive-behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR) therapy, stress management, and group TFCBT to be effective for managing PTSD compared to control.11,14,15 Other approaches include prolonged exposure (PE) therapy and cognitive processing therapy (CPT).11 Efficacy between psychotherapies are comparable; thus, the choice of psychotherapy should be a shared decision between the patient and the healthcare provider.11,16

Although psychotherapy is the recommended first-line treatment for PTSD, depending on availability, patient preference and circumstances, pharmacotherapy may also be considered as first-line treatment.13,17 For example, patients with comorbid conditions such as depression may start with pharmacological treatment until their symptoms are stable.13,16 Following improvement of symptoms, psychotherapy may be introduced; however, the benefit of combining the use of psychotherapies and pharmacotherapies requires further research.11, 13,16 One RCT found there to be no difference in efficacy between combination therapy of sertraline plus PE therapy and PE therapy plus placebo.18

The mechanism by which PTSD manifests itself physiologically is not entirely clear; however, studies have linked the dysregulation of neurotransmitters, reduced hippocampal volume, and genetic differences, to its pathophysiology and susceptibility in individuals.19, 20 First-line pharmacologic treatments for PTSD attempt to reduce the total severity of core symptoms (e.g., intrusive memories, avoidance, and hyperarousal) by targeting neurotransmitter imbalances.13 Currently, there is evidence from RCTs and meta-analyses to support the use of the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine, and sertraline and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine as first-line agents.11 See the table below for an overview of the current pharmacologic recommendations. 

Table 1. Examples of recommended pharmacologic therapies for PTSD 11

Antidepressants such as mirtazapine, fluvoxamine, and phenelzine have shown evidence of efficacy in reducing the total severity of the core intrusion, avoidance, and hyperarousal symptoms of PTSD in smaller RCTs and are considered second-line agents accordingly.11 For patients with suboptimal responses to first-line options, providers can consider the addition of second-generation antipsychotics such as aripiprazole, olanzapine, and quetiapine to treatment plans.13Furthermore, providers can consider augmenting first-line agents with medications such as prazosin and trazadone: Several studies have shown evidence for the use of the alpha1-adrenergic antagonist prazosin in reducing traumatic nightmares, and the antidepressant trazadone is recommended in a number of PTSD clinical guidelines to treat insomnia.11,13  

Despite evidence to support the use of these therapies for PTSD, many patients do not find success in available treatments.30 In one meta-analysis comparing psychotherapies and pharmacotherapies for PTSD, researchers found that the average drop-out rate across all 55 studies included in their search was 29%.30 Reasons for treatment discontinuation vary greatly, ranging from difficulties to tolerating the use of traumatic images in trauma-focused psychotherapy31, to adverse events in SSRIs.17,32 Because of these potential challenges to current treatments, there has been a push in recent years to explore different agents as possible alternatives.13,33,34 Cannabis has been proposed as an alternative treatment for PTSD for its ability to increase serotonin and dopamine levels in the brain.13,35 Similarly, MDMA, which is the active ingredient in the illicit drug Ecstasy/Molly, has been proposed for its ability to reduce activity in the amygdala, the structure in the brain that processes fearful memories and emotions, and increase serotonin release.33,34 However, due to the limited evidence to support these two agents, they currently cannot be recommended to treat PTSD.13,33 Benzodiazepines (BZDs), while not a newly explored agent in PTSD research, has historically been widely prescribed to treat anxiety and insomnia.36 However, like cannabis and MDMA, BZDs are not recommended; this is due to their lack of efficacy in improving core PTSD symptoms37, sleep disturbances38, and their addictive properties.13

What is trauma-informed care?

Trauma-informed care (TIC) is a term that has recently risen in popularity in various mental health and addiction, medical, educational, and correctional settings.3,39 TIC relies on the concept that integrating the knowledge of the impact of trauma into all levels of care and services leads to improved support and outcomes for people living with trauma.3,39 Essentially, TIC provides a way for understanding how trauma affects people which can then be used to create policies and programs that promote a culture of safety and empowerment for those affected by trauma.12 The four key elements of TIC, as outlined in a 2014 initiative by the Substance Abuse and Mental Health Services Administration, include: realizing the widespread impact of trauma, recognizing the common reactions to trauma in both patients and staff, and responding by integrating knowledge about trauma into all levels of organizational structure to resist re-traumatization.40

In the hospital pharmacy setting, one example of TIC could include recognizing how trauma can affect medication adherence.41 A recent meta-analysis found that PTSD is associated with increased non-adherence, especially within the context of medical-event induced traumas such as those stemming from stroke or cancer diagnoses.42 A TIC framework can aid pharmacists in realizing when trauma may be affecting treatment outcomes and help them work with patients to adjust their treatment plans and goals accordingly.39,43 In a real-world example outlined in the American Journal of Health-System Pharmacy, clinical pharmacist Jennifer Cocohoba at the University of California, Women’s HIV Program, shared how she approached developing a treatment plan for a patient whose husband had died from an adverse drug reaction.44 Because of the patient’s trauma regarding taking medication, instead of starting them on an optimal medication regimen, Cocohoba had them start with small doses until they were be comfortable with introducing the optimal antiretroviral therapy at a later date.44 Other examples of TIC that are non-exclusive to hospital pharmacy could include having a list of referral sources to trauma services readily available to all patients, using welcoming and inclusive language on all signage, and encouraging self-care practices among staff.39,45

Despite the rise in popularity of TIC3,12, evidence to support its role in improving patient outcomes to date has been limited.39,46 Nonetheless, it is well known that trauma and PTSD can have significant consequences on patients’ mental health, quality of life, and mortality.11 It is important that policymakers and pharmacists alike are aware of emerging trauma frameworks like TIC so that evidence-based best practices can be developed that will achieve positive patient outcomes.   

References

  1. Koenen KC, Ratanatharathorn A, Ng L, et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med. 2017;47(13):2260-2274. doi:10.1017/S0033291717000708 
  2. Statistics Canada. Survey on Mental Health and Stressful Events, August to December 2021. Published May 20, 2022. Accessed January 16, 2023. https://www150.statcan.gc.ca/n1/daily-quotidien/220520/dq220520b-eng.htm 
  3. Lee E, Kourgiantakis T, Lyons O, Prescott-Cornejo A. A trauma-informed approach in Canadian mental health policies: A systematic mapping review. Health Policy. 2021;125(7):899-914. doi:10.1016/j.healthpol.2021.04.008 
  4. Trauma. Centre for Addiction and Mental Health. Accessed January 13, 2023. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/trauma 
  5. Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association; 2013. Accessed January 13, 2023. https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 
  6. Dückers MLA, Alisic E, Brewin CR. A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. The British Journal of Psychiatry. 2016;209(4):300-305. doi:10.1192/bjp.bp.115.176628 
  7. Scott KM, Koenen KC, King A, et al. Post-traumatic stress disorder associated with sexual assault among women in the WHO World Mental Health Surveys. Psychol Med. 2018;48(1):155-167. doi:10.1017/S0033291717001593 
  8. Public Health Agency of Canada. Federal framework on posttraumatic stress disorder: recognition, collaboration and support. Published January 22, 2019. Accessed January 16, 2023. https://www.canada.ca/en/public-health/services/publications/healthy-living/federal-framework-post-traumatic-stress-disorder.html#s1-3 
  9. Jude Mary Cénat, Rose DD, Wina PD, Kogan CS, Guerrier M. Prevalence of current PTSD symptoms among a sample of black individuals aged 15 to 40 in canada: The major role of everyday racial discrimination, racial microaggresions, and internalized racism. Can J Psychiatry. :07067437221128462. https://doi.org/10.1177/07067437221128462. doi: 10.1177/07067437221128462 
  10. Bennett A, Crosse K, Ku M, Edgar NE, Hodgson A, Hatcher S. Interventions to treat post-traumatic stress disorder (PTSD) in vulnerably housed populations and trauma-informed care: A scoping review. BMJ Open. 2022;12(3):e051079. http://bmjopen.bmj.com/content/12/3/e051079.abstract. doi: 10.1136/bmjopen-2021-051079. 
  11. Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14 Suppl 1(Suppl 1):S1. doi:10.1186/1471-244X-14-S1-S1 
  12. Alberta Health Services. Trauma-Informed Care. Published August 5, 2022. Accessed January 24, 2023. https://ahamms01.https.internapcdn.net/ahamms01/Content/AHS_Website/tms/amh/if-amh-tic-module-1-an-introduction-to-trauma-informed-care/story_content/external_files/if-pspp-tic-module-1-introduction.pdf 
  13. Richardson JD, Marlborough M. Post-traumatic stress disorder. In: Compendium of Therapeutic Choices. Canadian Pharmacists Association. Updated April 16, 2021. Accessed January 13, 2022. https://www.myrxtx.ca 
  14. Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S. Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British Journal of Psychiatry. 2007;190(2):97-104. doi:10.1192/bjp.bp.106.021402 
  15. Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;(3):CD003388. Published 2007 Jul 18. doi:10.1002/14651858.CD003388.pub3 
  16. Stein MB. Management of posttraumatic stress disorder in adults. In: Roy-Byrne P, ed. UpToDate. UpToDate; 2022. Accessed January 16, 2023. https://www.uptodate.com/contents/management-of-posttraumatic-stress-disorder-in-adults 
  17. Martenyi F, Soldatenkova V. Fluoxetine in the acute treatment and relapse prevention of combat-related post-traumatic stress disorder: Analysis of the veteran group of a placebo-controlled, randomized clinical trial. European Neuropsychopharmacology. 2006;16(5):340-349. doi: 10.1016/j.euroneuro.2005.10.007. 
  18. Rauch SAM, Kim HM, Powell C, et al. Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2019;76(2):117-126. doi:10.1001/jamapsychiatry.2018.3412 
  19. Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13(3):263-278. doi:10.31887/DCNS.2011.13.2/jsherin 
  20. Sareen J. Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis. In: Stein MB, ed. UpToDate. UpToDate; 2022. Accessed January 24, 2023. https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis 
  21. Antidepressant, selective serotonin reuptake inhibitors. In: Lexi-Tox. Lexi-Comp, Inc. Updated December 13, 2021. Accessed January 17, 2023. https://online.lexi.com 
  22. Jensen B, Regier L. Anxiety disorder medication: Drug comparison chart. August 2021. Accessed January 17, 2023. Available from www.rxfiles.ca 
  23. Venlafaxine. In: Lexi-Drugs. Lexi-Comp, Inc. Updated January 19, 2023. Accessed January 19, 2023. https://online.lexi.com 
  24. Mirtazapine. In: Lexi-Drugs. Lexi-Comp, Inc. Updated January 19, 2023. Accessed January 19, 2023. https://online.lexi.com 
  25. Phenelzine. In: Lexi-Drugs. Lexi-Comp, Inc. Updated January 19, 2023. Accessed January 19, 2023. https://online.lexi.com 
  26. Phenelzine product monograph. Montreal (QC): Searchlight Pharma Inc; October 4, 2022. https://pdf.hres.ca/dpd_pm/00067659.PDF 
  27. Aripiprazole product monograph. Sain-Laurent (QC): Otsuka Canada Pharmaceutical Inc; February 11, 2021. https://pdf.hres.ca/dpd_pm/00060025.PDF 
  28. Quetiapine. In: Lexi-Drugs. Lexi-Comp, Inc. Updated January 19, 2023. Accessed January 19, 2023. https://online.lexi.com 
  29. Trazodone. In: Lexi-Drugs. Lexi-Comp, Inc. Updated January 19, 2023. Accessed January 19, 2023. https://online.lexi.com 
  30. Lee DJ, Schnitzlein CW, Wolf JP, Vythilingam M, Rasmusson AM, Hoge CW. PSYCHOTHERAPY VERSUS PHARMACOTHERAPY FOR POSTTRAUMATIC STRESS DISORDER: SYSTEMIC REVIEW AND META-ANALYSES TO DETERMINE FIRST-LINE TREATMENTS. Depress Anxiety. 2016;33(9):792-806. doi:10.1002/da.22511  
  31. Lewis C, Roberts NP, Gibson S, Bisson JI. Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1709709. Published 2020 Mar 9. doi:10.1080/20008198.2019.1709709 
  32. Friedman MJ, Marmar CR, Baker DG, Sikes CR, Farfel GM. Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting. J Clin Psychiatry. 2007;68(5):711-720. doi:10.4088/jcp.v68n0508 
  33. Smith KW, Sicignano DJ, Hernandez AV, White CM. MDMA-Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta-Analysis. J Clin Pharmacol. 2022;62(4):463-471. doi:10.1002/jcph.1995 
  34. Feduccia AA, Jerome L, Yazar-Klosinski B, Emerson A, Mithoefer MC, Doblin R. Breakthrough for Trauma Treatment: Safety and Efficacy of MDMA-Assisted Psychotherapy Compared to Paroxetine and Sertraline. Front Psychiatry. 2019;10:650. Published 2019 Sep 12. doi:10.3389/fpsyt.2019.00650 
  35. Rehman Y, Saini A, Huang S, Sood E, Gill R, Yanikomeroglu S. Cannabis in the management of PTSD: a systematic review. AIMS Neurosci. 2021;8(3):414-434. Published 2021 May 13. doi:10.3934/Neuroscience.2021022 
  36. Lader M. Benzodiazepines revisited--will we ever learn?. Addiction. 2011;106(12):2086-2109. doi:10.1111/j.1360-0443.2011.03563.x 
  37. Braun P, Greenberg D, Dasberg H, Lerer B. Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment. J Clin Psychiatry. 1990;51(6):236-238. 
  38. Cates ME, Bishop MH, Davis LL, Lowe JS, Woolley TW. Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder. Ann Pharmacother. 2004;38(9):1395-1399. doi:10.1345/aph.1E043 
  39. Raja S, Hasnain M, Hoersch M, Gove-Yin S, Rajagopalan C. Trauma informed care in medicine: current knowledge and future research directions. Fam Community Health. 2015;38(3):216-226. doi:10.1097/FCH.0000000000000071 
  40. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of trauma and guidance for a trauma-informed approach. Published July 2014. Accessed January 24, 2025. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4884.pdf 
  41. Kronish IM, Edmondson D, Li Y, Cohen BE. Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart study. J Psychiatr Res. 2012;46(12):1595-1599. doi:10.1016/j.jpsychires.2012.06.011 
  42. Taggart Wasson L, Shaffer JA, Edmondson D, et al. Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis. J Psychiatr Res. 2018;102:102-109. doi:10.1016/j.jpsychires.2018.02.013 
  43. Fernandes O, Toombs K, Pereira T, Lynder C, Bjelajac Meijia A, Shalansky S, et al. Canadian consensus on clinical pharmacy key performance indicators: quick reference guide. Published 2015. Accessed January 17, 2023. https://www.cshp.ca/docs/pdfs/CSPH-Can-Concensus-cpKPI-QuickReferenceGuide_June_2017.pdf   
  44. Traynor K. Clinic views patients through trauma-informed lens. Am J Health Syst Pharm. 2019;76(19):1454-1455. doi: 10.1093/ajhp/zxz177.  
  45. Center for Health Care Strategies. Key ingredients for successful trauma-informed care implementation. Published April 2016. Accessed Feb 2, 2023. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf 
  46. Han HR, Miller HN, Nkimbeng M, et al. Trauma informed interventions: A systematic review. PLoS One. 2021;16(6):e0252747. Published June 22, 2021. doi:10.1371/journal.pone.0252747 

     
     

     

Latest News

April 11, 2023
Clinical Pearls: PTSD and trauma-informed care

Latest News

CSHP is searching for our next CPRB Coordinator

April 3, 2023
 
 

Coordinator, Canadian Pharmacy Residency Board

 
 

Position Summary

 

The incumbent will coordinate the work of the Canadian Pharmacy Residency Board (CPRB) and CPRB-accredited pharmacy residency programs which operate within the Canadian Society of Hospital Pharmacists. The Coordinator is responsible for the operations of the CPRB Board and committee meetings; the workflows of the accreditation, standards and the Pharmacy and Residency Application and Matching Service (PRAMS) programs; and the information system and communications functions required. This role reports directly to the Chief Pharmacy Officer, but requires close collaboration with the Chair, as well as other CPRB members and sub-committee members.

 

Responsibilities

  • Administer and support the operations of the Canadian Pharmacy Residency Board, its members and committees.
  • Organize the workflow of pharmacy residency program support, including accreditation, standards-setting, and the residency matching program.
  • Handle communications with a variety of internal and external stakeholders and be responsible for the relevant information systems.

 

Partial list of duties

CPRB board and committee operations

  • Manage all meeting logistics, including developing board and committee work plans and calendars, timely preparation and distribution of agendas, notifications, and advance reading material.
  • Attend and serve as a recording secretary for board and as required, committee meetings, preparing and maintaining minutes, policies, and other public and confidential documents of the board and its committees in a timely manner.
  • Communicate all decisions, actions, directives, and important information following board and committee meetings to the appropriate individuals or stakeholders.
  • Anticipate and follow up on outstanding agenda items, taking action to ensure information is provided to the board and committee members.
  • Liaise with CSHP Board administration to support CPRB’s Chair’s participation in meetings and draft written report and PowerPoint presentations for CSHP Board meetings.

Program Management

  • Compile and report key metrics regarding residency programs (e.g., number of programs, residency programs, and ratio of applicants to matched applicants)
  • Annually update CPRB documents, in collaboration with CPRB members (e.g., CPRB Accreditation Standards, Policy and Procedures, Strategic Business Plan) and coordinate translation
  • Accreditation Surveys
    • Maintain and update survey schedule and documents as required
    • Act as liaison between residency programs and CPRB surveyors on survey processes and accreditation
    • Ensure that accreditation decisions are communicated promptly and accurately through program survey letters and formal final survey reports
  • Liaise with external information services provider regarding enhancements and updates to PRAMS program
  • Communicate with applicants and programs on application and matching process
  • Contribute to the resolution of issues that arise during the application-matching process
  • Standards
  • Accreditation Surveys
    • Maintain strict version control and updates for CRPB Accreditation Standards
    • Ensure annual updates are translated and published to the CPRB website

Communications and Information Systems 

  • Act as the CSHP office point of contact for accredited pharmacy residency programs, program applicants, and CPRB members
  • Maintain the CPRB section of the CSHP website
  • Manage Sharepoint site for CPRB and committees, including membership rosters, documents, permissions, etc.
  • Liaise with appropriate CSHP staff on material for Interactions, Avenues for Education, Annual Reports, event scheduling, publicity, and promotions. 

Administrative

    • Assist with and verify travel expense claims for volunteers and staff
    • Liaise with finance for invoicing and payments
    • Handle logistical arrangements and/or liaise with other CSHP staff for webinars and special events, such as the Student and Residency Networking event

     

    Education

    • Postsecondary education required. Equivalent experience will also be accepted.  

     

    Skills and Experience

    • 5 years of senior administrative roles including specialized knowledge of board governance procedures and project management experience, ideally in a non-for-profit organization
    • Extensive computer and software skills, especially in Excel, PowerPoint, Sharepoint and database programs
    • Accurate, detail-oriented, and high-quality outputs
    • Multi-tasking skills and ability to be flexible when priorities shift
    • Excellent oral and written communication skills
    • Proactive problem-solving skills
    • Ability to work with confidential and sensitive matters
    • Fluency in both official languages an asset

     

    Location and travel

    • The position can be housed in the CSHP National Office in Ottawa or staffed remotely.
    • Occasional travel within Canada is required.

    Applications will be accepted on a rolling basis until the position is filled.

    About the CPRB:
    An affiliated board of the Canadian Society of Hospital Pharmacists, the Canadian Pharmacy Residency Board (CPRB) establishes standards and conducts accreditation surveys of pharmacy residency training programs in Canada. It also establishes policies and procedures that support those processes and develops education and research initiatives related to residency programs and residency training.

     

    April 03, 2023
    CSHP is searching for our next CPRB Coordinator

    Latest News

    CSHP is searching for our next Chief Pharmacy Officer

    March 31, 2023
     
     
     
    CSHP's inaugural Chief Pharmacy Officer Christina Cella is stepping down at the end of April after nearly four years in the job. Christina has distinguished herself and CSHP by setting a high standard for the position. We are coming to the end of our first strategic plan for the renewal and future sustainability of the Society and it has been an unqualified success. Christina has played a large role in this. 

    CEO Jody Ciufo says, “Christina made significant contributions during her time with us – the creation of an instant webinar program during the first crucial months of COVID, the establishment of a formal professional practice team and her eloquent media presence in advocacy efforts surrounding COVID, drug shortages and US importation. CSHP members celebrated seeing hospital pharmacy reflected widely in Christina’s comments across the county.” 

    “I’ve been a dedicated CSHP volunteer from my earliest days at school,” says Christina. “CSHP will always be a part of my career and my love of hospital pharmacy.”

    The search for CSHP’s next CPO has begun. Details on the position are below and the application deadline is April 28. 


    Chief Pharmacy Officer

     
     

    Position Summary

     

    CSHP is seeking a leading pharmacist to become its next Chief Pharmacy Officer. This senior leadership position is instrumental in shaping the future of pharmacy practice in hospitals and other related healthcare organizations in Canada. Reporting to the Chief Executive Officer, the Chief Pharmacy Officer (CPO) will be responsible and accountable for meeting the pharmacy and professional practice objectives within CSHP’s strategic plan. You will have autonomy and authority to deliver professional practice services, products, and initiatives within the policy framework established by the Board and the CEO. The CPO will be the in-house go-to for all things pharmacy.

    You will lead the Professional Practice team and be responsible for the development of our suite of professional resources for CSHP members, policy positions, continuing education, best practices, consultations, research and knowledge translation. Your team supports a variety of CSHP committees and task forces, as well as the work of the affiliated Canadian Pharmacy Residency Board and the Hospital Pharmacy Survey in Canada Board. 

    As the successful candidate, your leadership skills will ensure excellence in the delivery of projects that are of strategic importance to CSHP. You have a demonstrated record of inspiring and supporting your team and volunteers to higher levels of performance and excellence in patient care and safety. You understand issues that are relevant to practice, from the grassroots level of hospital pharmacy to those at the highest levels of the healthcare system. Collaborative and connected, you will be comfortable representing CSHP on external committees/advisory groups, in the media, with industry and to government departments and elected officials.

    Licensed to practice pharmacy in Canada, you are a senior pharmacist who has practiced in a hospital or collaborative setting, along with management experience in a hospital, association, regulatory authority, government, health administration or academic institution. Volunteer experience demonstrating your interest in giving back to the pharmacy profession is a definite asset.

    Major Job Responsibilities

     

    Practice Advancement

    • Leads and coordinates organization-wide efforts to advance pharmacy practice and address critical practice issues, such as scope of practice, standards, guidelines, competencies, etc
    • Monitors health care and pharmacy practice trends to present issues to the Board and relevant committees and implement resulting strategic direction
    • Manages the implementation of the Canadian Pharmacy Residency Board strategic objectives 
    • Oversees the operation of the Pharmacy Specialty Networks and realizing gains in usage, relevance and functionality; advancing specialty areas prioritized by the Board 
    • Operationalizes CSHP’s expanded membership value for registered pharmacy technicians by creating targeted programs and services in this area. 
    • Enables data-driven policy development by ensuring the collection of statistics on workforce, licensure, graduates, residencies and other relevant metrics for the profession and managing all practice-related surveys

     

    Professional Development

    • Grows CSHP’s professional development program into a comprehensive educational enterprise that meets member needs in content, relevance and delivery options
    • Analyzes current offerings of CSHP and other providers in education and training and develops new content to fill gaps
    • Oversees pharmacy elements of the annual national conference including volunteer committees, thematic programming, speaker selection, research integration, etc; collaborates with other staff on various elements of the conference

     

    Policy & Advocacy

    • Monitors federal legislation, regulations and policy that affect pharmacy in hospitals and other collaborative settings
    • Coordinates response to formal consultations on federal government legislation and regulations through CSHP committee and member feedback
    • Leads CSHP’s consultation process to solicit input from members and stakeholders to ensure representation from across the country
    • Tracks trends in provincial legislation, regulations and policy; coordinating national responses and assisting provincial efforts as appropriate
    • Represents CSHP on various external boards, committees, task forces as required 
    • Supports CSHP advocacy campaigns through policy advice, professional content, external outreach

    CSHP Innovation
    • Supports the CEO in strengthening CSHP’s shift toward increasing non-dues revenue by improving the returns on existing programs and exploring new entrepreneurial options 
    • Integrates a member-centric vision throughout professional practice programs and views future initiatives through this lens 
    • Develops business plans for new offerings and tracks progress in achieving targets.

    Functional responsibilities
    • Prepares annual budgets for the professional practice department and initiatives and is responsible for budgetary performance
    • Acts as a key contributor to the CSHP strategic plan, prepares goals and objectives for professional practice, and is accountable for performance in these areas 
    • Responsible for setting employee performance objectives, clearly defining duties, and conducting performance reviews for direct reports
    • Identifies information technology requirements for program initiatives
    • As a senior leader, contributes to the positive, productive and supportive office environment
    • As part of the management team, advises the CEO on policies, overall budgets, organizational structure, capital decisions, and technology.

     

    Qualifications

    • Licensed to practice pharmacy in Canada and in good standing with relevant regulatory college. 
    • Five or more year of pharmacy practice in a hospital or collaborative setting.
    • Management experience in a hospital, association, government, health administration or academic institution.
    • A master’s degree in administration or advanced degree in pharmacy. 
    • Completion of a hospital pharmacy practice residency is an asset.
    • Superior written and oral skills in English.
    • Fluency in French is an asset.

     

    Considerations

    • This position is remote 
    • Travel is required approximately four times per year.
    • CSHP will consider candidates on a leave of absence from an existing position for a minimum of two years.

     

    Remuneration

    • CSHP offers a substantial salary and benefit package including:
      • Dental care
      • Extended health care
      • RRSP match
      • Employee assistance program
      • Disability and life insurance
      • Work from home

       

    How to apply

    We hire top talent, recognizing that our accomplishments are achieved through the commitment of dedicated individuals. Please email your cover letter and résumé to Jody Ciufo, Chief Executive Officer, at jciufo@cshp.ca at your earliest convenience, but no later than April 28, 2023. 

    About the Canadian Society of Hospital Pharmacists
    The Canadian Society of Hospital Pharmacists is the national voluntary organization of pharmacists and pharmacy technicians committed to patient care through the advancement of safe, effective medication use in hospitals and other collaborative healthcare settings. CSHP supports its 3700-plus members and individual supporters through advocacy, education, information sharing, promotion of best practices, facilitation of research, and recognition of excellence.

    Please note: We thank all applicants for their interest in this position. However, only those selected for an interview will be contacted. 

     Apply now




     

     
     
    March 31, 2023
    CSHP is searching for our next Chief Pharmacy Officer

    Pharmacy Specialty Networks (PSNs): Stay connected to your pharmacy peers and real-world learning on QID

    March 23, 2023
     
     
     
    CSHP has been a long-standing partner with QID, an online network for pharmacy professionals that hosts thousands of scientific discussions and expert-led learning events to help advance their clinical skillset. As a part of this partnership, CSHP has built over 30 online groups called “Pharmacy Specialty Networks (PSNs)” where pharmacy professionals connect, learn, and share educational material in a secure forum.

    No matter your specialty or interests, QID has something for every pharmacy professional. Here are some examples of the top PSNs and upcoming discussions on QID that are available for you to join today for free:

    Compounding 

    What is it: The Compounding PSN invites discussions on sterile, non-sterile, hazardous and non-hazardous compounding.

    Who can join?: The Compounding PSN is available to all CSHP pharmacy professionals, including students, technicians, and pharmacists.

    What topics are discussed: Members participate in discussions on a variety of compounding topics including but not limited to:
    • Compounding formulations
    • Beyond-use dating
    • Drug-drug and drug-material stability 
    • Sterility testing
    • And much more
     
    Quality Improvement 

    What is it: Quality Improvement PSN invites members to foster engagement and collaboration in quality improvement initiatives.

    Who can join: The Quality Improvement PSN is available to all CSHP pharmacy professionals, including students, technicians, and pharmacists.

    What topics are discussed: The purpose of the Quality Improvement PSN is to provide a practical introduction to important topics in Qi. Members can:
    • Discuss quality gaps in different health care settings
    • Share quality improvement ideas to address the gaps
    • Foster engagement and collaboration in quality improvement initiatives
     
     
    Extend Cancer Pharmacy Network

    What is it: The Extend Cancer Pharmacy Network (ECPN) is a hub designed to provide timely education and support for community pharmacists in delivering care to their patients with cancer.

    Who can join?: This PSN is available to all pharmacy professionals, including students, technicians, and pharmacists.

    What topics are discussed: The ECPN is facilitated by expert oncology pharmacists and serves to equip frontline pharmacy professionals  with clinical knowledge, tips and tricks, and practical guidance for providing safe and exceptional cancer care in a busy pharmacy practice setting.
    Check out ECPN’s most recent events below:
    • Supporting Pharmacists Providing Breast Cancer Care
    • Supporting Pharmacists Providing Prostate Cancer Care
     
    Infectious Disease

    What is it: The Infectious Disease PSN is chaired by Anna Lee and invites those interested in or specializing in Infectious Diseases pharmacotherapy to come together to share resources.

    Who can join?: The Infectious Disease PSN is available to all pharmacy professionals, including students, technicians, and pharmacists.

    What topics are discussed: Any topics related to Infectious Diseases pharmacotherapy.
     

    Drug Information 

    What is it: The Drug Information PSN’s purpose is to promote and enhance networking and communication among pharmacists interested in drug information.

    Who can join?: The Drug Information PSN is available to all pharmacy professionals, including students, technicians, and pharmacists with an interest in drug-related controversies and questions. 
     
    What topics are discussed: The CSHP’s Drug Information PSN covers a very broad scope of hospital pharmacy practice related to the provision of current, accurate and reliable drug information to healthcare professionals. Members participate in discussions on a variety of topics including but not limited to:
    • General drug information requests
    • Drug therapy topic reviews
    • Drug-related policies and procedures
     
    If you would like to start your own community in QID or have any general questions about the platform, please reach out to alex.erb@qid.io.
     

    Latest News

    March 23, 2023
    Pharmacy Specialty Networks (PSNs): Stay connected to your pharmacy peers and real-world learning o

    Latest News

    Resource Spotlight: Schizophrenia

    March 21, 2023
    Written byMaria 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

    Bacground

    Schizophrenia is a mental disorder that can negatively alter the trajectory of an individual’s emotional, cognitive, and social development and manifest in adolescence. The course of schizophrenia can vary among individuals, but symptoms can range from hallucinations and delusions to reduced expression and cognitive impairment. This “Resource Spotlight” contains links to associations, guidelines, and foundations that help pharmacists learn about the schizophrenia spectrum and its management, and additional resources required to support patients. To get a summary of schizophrenia, check out CSHP’s recent Clinical Pearls article on Schizophrenia: An Overview

    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. 

    Keep in mind, some resources are not Canadian and may not be translated into Canadian practices.

    The Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders gives an in-depth view of the schizophrenia spectrum. It dives into diagnosis and presents recommendations within this patient demographic. It used the ADAPTE1 process and takes into consideration of the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network, the European Psychiatric Association, and the American Psychiatric Association in order to highlight the national interventions that can be implemented in Canadian practice. 

    The Guidelines for the Pharmacotherapy of Schizophrenia in Adults outlines the recommendations based of the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network, the European Psychiatric Association, and the American Psychiatric Association via the ADAPTEprocess. It elaborates on the selection of antipsychotics, acute treatment, antipsychotic continuation, antipsychotic dose/ trial duration, acute exacerbation, relapse prevention, and treatment-resistant schizophrenia given specific symptoms.

    The Canadian Guidelines for the Pharmacological Treatment of Schizophrenia Spectrum and Other Psychotic Disorders in Children and Youth summarizes the main international and local guidelines focused on adolescents. Similar to the previous resources, it used the ADAPTEprocess and takes into consideration of the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network, the European Psychiatric Association, and the American Psychiatric Association. It expresses the general principles of care, the first exposure of psychosis, and hospital care within the children and youth population.

    The Clinical Handbook of Psychotropic Drugs is a textbook written by Ric M. Procyshyn et al. that highlights the psychotropic medications currently available. Published in 2019, it has a dedicated chapter on antipsychotics, where it elaborates on the pharmacology, dosing, switching medications, warnings, precautions, monitoring parameters and patient-related issues within this medication class. It goes into depth of explaining extrapyramidal symptoms caused by antipsychotics and their management. This textbook is also available online through a subscription here.

    A Canadian website called SwitchRx is a practical tool used by healthcare professionals to guide clinical practice and adjust a patient’s psychotropic treatment regimens. This tool was developed by PsychedUp, a company where programs are certified by the College of Family Physicians of Canada. This tool develops tapering and titration schedules, clinical tips, and additional pharmacokinetic properties related to the medications. Keep in mind, you need to register for free and set up an account first before accessing their resources. It is a tool that allows switching between antipsychotics, and antidepressants and combining strategies between medications. It also has a tool that helps guide healthcare professionals in weight management and switching hypnotics. In addition, it gives access to psychiatric scales and treatment guidelines.

    The Schizophrenia Society of Canada started as a non-profit, charitable organization in Toronto and now has grown in order to support research related to schizophrenia and early psychosis (biological, psychological, spiritual, and social determinants of health). They provide educational content for patients and provide support in cannabis and psychosis, family recovery journey, and have a podcast called Look Again: Mental Illness Re-examined to shine a light on the voices in the mental illness community.

    Early Psychosis Intervention is an online tool that includes representatives from BC Health Authorities, the Ministry of Health, and family/caregivers to provide a resource for the community. It provides educational content that explains the definition of psychosis, the importance of early intervention, diagnosis and associated issues, what family members need to know, and the recovery process. It also has various informational pamphlets for patients that range from connecting to people, stress management to taking care of your health.

    The Psychiatric Survivors of Ottawa is a non-profit member-driven platform located in Ottawa that offers Peer Support Programs. These include the Wellness Recovery Action Plan sessionspeer support groups, walking groups, and much more. They also cater to caretakers and incorporate Family Peer Support Programs which include Family Peer Support Group seminars, and Family Wellness Recovery Action Plan. They also have online workshops for non-local caretakers called Family Dialogue about Communication.

    1 - ADAPTE process is a systematic approach to adapting guidelines from one cultural and organizational context to another. The overall aim of the process is to take existing guidelines and enhance them to ensure the final recommendations address specific health questions relevant to the context. Click here for more information on ADAPTE.

     

     

     

    March 21, 2023
    Resource spotlight: Schizophrenia

    Latest News

    CPRB News - March 2023 

    March 21, 2023
     
     
    Welcome, everybody, to the first post in our new series – CPRB News! 
     
    This series will replace the Residency Board newsletter (RB News) and will feature monthly posts on a variety of residency-related topics.
     
    This month, we will be focusing on CPRB-accredited programs, highlighting the programs we surveyed last season, as well as the programs we will be visiting in Spring 2023.
     
    In Fall 2022, CPRB surveyors visited a total of six programs, including: Hamilton Health Sciences (Hamilton, ON), St. Joseph’s Healthcare (Hamilton, ON), Sunnybrook Health Sciences Centre – Year 1 General Program (Toronto, ON), Sunnybrook Health Sciences Centre – Year 1 Ambulatory Program (Toronto, ON), Women’s College Hospital (Toronto, ON), and Nova Scotia Health Authority (Halifax, NS). 
     
    All programs were successful in securing renewed accreditation status. Congratulations to these programs on their achievements!
     
    In Spring 2023, CPRB surveyors will be visiting another six programs, including: Interior Health (Kelowna, BC), Saskatchewan Health Authority (Regina, SK), University of Waterloo / Centre for Family Medicine Family Health Team (Kitchener/Waterloo, ON), Island Health (Victoria, BC), Horizon Health Network (Moncton & St. John, NB), and Northern Health Authority (Prince George, BC).
     
    We would like to thank the directors and coordinators of these programs for all the work they and their teams have devoted to preparing for the surveys. The Board appreciates your time, effort, and commitment to residency training, and we look forward to visiting you soon! 
     
    Be sure to stay tuned for next month’s edition of CPRB News, where we will share some key statistics and upcoming changes to the Pharmacy Residency Application & Matching Service (PRAMS).
     
    March 21, 2023
    CPRB News - March 2023

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