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Jeff Makowecki and pharmacy team initiate new pharmacy referral policy

May 29, 2019
Team learning solves a problem and leads to better care at the Edmonton Remand Centre.

The pharmacy team at the Edmonton Remand Centre (ERC) needed a solution to an issue with some of the referrals they were getting from the other health care professionals at ERC.

“We were getting referrals to see patients and treat patients for cases that were beyond our scope either legally or clinically,” said Jeff Makowecki, a pharmacist at ERC.

Jeff would often arrive at work to find that about 20 per cent of the patients referred to him were considered inappropriate referrals. These requests could range from treating injection site abscesses to a hypertensive crisis.

“It was frustrating because this was not only taking up our time for a patient that we really couldn’t do a whole lot for, but it was also delaying patient access to care,” said Jeff.

In the fall of 2017, the ERC pharmacy team discussed the issue as a group and decided on what referrals would be appropriate for them.

“It was tricky because we’re a group of eight and not all of us practise the same way, but we all practise to full scope,” explained Jeff.  “We were able to hammer out some guidelines.”

The pharmacy team also approached other ERC health care staff.

“After discussing it with them, it was clear there was a gap in what we thought we should be getting and what other staff members thought they should be sending us. So, at that point we thought we should do something about it,” said Jeff.

Over the next few months, and many meetings, the pharmacy team collaboratively created a set of guidelines. Once approved, the document was posted on an internal website and emailed to health care staff. However, it didn’t have the effect they were hoping for.

“It was at that point that we needed to do something a little bit different,” said Jeff.

He took the lead and requested permission to present at Blitz training: a multi-disciplinary training session organized by nurse educators. The premise was to facilitate connection with the other healthcare professionals and explain the guidelines. Jeff started his presentations in the spring of 2018. After multiple sessions, the pharmacy team noticed a difference.

“I found that after these sessions, after people had a chance to listen to our side of the story and to ask questions, that was what really enacted change,” explained Jeff.

Jeff was unsure if the experience would qualify for his implementation record. Most of his other implementation records were clinically related so he was hesitant. After consulting with a colleague for advice, he felt more confident about what to submit for supporting documentation and went ahead.

An implementation record, part of ACP’s Continuing Competence Program, demonstrates applying learning into your practice. That learning is often the result of working together with your team to solve a problem.

The deadline for pharmacists to submit their requirements for the Continuing Competence Program is May 31, 2019.