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Learning as a team to solve problems

May 1, 2019
Team learning leads a pharmacy to implement a more effective pain medication delivery method.

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. One individual’s learning can often spark a discussion in the pharmacy that leads to a positive change in practice. This article highlights one individual’s learning that did just that.

Ashley Letcher is a community pharmacist in Edmonton. She had just started a new job in July 2017 when she noticed a lot of similar questions from pharmacy team members about compounding for topical pain formulas.

“They saw that it was runny and lumpy, hard to make, and the formulas were totally different,” Ashley explained. “There were also questions about the compounding process and using too much or too little wetting agent, the powder was too fluffy, and difficult to dissolve powders.”

To try to provide some clarity, Ashley reviewed the compounding recipe. She found that when making a compound with very similar ingredients, how they were making it was different each time.

This inconsistency made it difficult to determine what was working and what wasn’t. It also resulted in an excess of compounding ingredients requiring more inventory management time and shelf space.

“This is also how I discovered that we were using a base with no evidence of transdermal properties for topical pain formulations in cream form,” said Ashley.

She found that other bases would allow for the medicine to be better absorbed through the skin, making it more effective for the individual. After Ashley finished her research, she shared her findings with a pharmacy technician leader on her team, and they agreed to share the findings and seek input from other members of their pharmacy team.

“I suggested not using PLO premix given more quality concerns than with the separate products, and also suggested to not put any more than 15 per cent active ingredients (powder) in PLO due to a runny final product,” explained Ashley. “I suggested a cream base as an alternative due to superior stability.”

There were discussions with the pharmacy team, including pharmacists and pharmacy technicians, about the impacts on inventory management as well as rolling out the changes. Ashley was also able to take advantage of a co-worker’s experience.

“Another pharmacist on the team had previously worked at a compounding pharmacy, so I asked her and the supervisor to review the step-by-step implementation plan I created to see if I could change or add anything,” said Ashley.

Ashley says the pharmacy team provided positive feedback and agreed that the compound formulas at the pharmacy had been confusing for some time.

Ashley realized this was a good implementation record topic when she was halfway through her literature review in August.

“After I read the one study, I logged that as a learning record and then I had more questions, so I kind of used that as a tool to continue my research,” said Ashley.

In the end, Ashley had a thorough implementation record, and her learning led to changes that were implemented in mid-November.

“My co-workers were very thankful I took the time to look into it and was trying to streamline our processes.”

The deadline for pharmacists to submit their requirements for the Continuing Competence Program, including an implementation record, is May 31.