Pharmacy support services report a “huge” volume increase in calls as pharmacists reach out amidst worries about health, patient conflict, staff difficulties, errors and more.
PSA hosted a webinar on Wednesday [6th May 2020], with guests Kay Dunkley from the Pharmacists’ Support Service (PSS) and Gary West from Pharmaceutical Defence Limited (PDL) joining PSA national president Chris Freeman.
A/Prof Freeman, Ms Dunkley and Mr West all reported that their respective organisations have seen a huge volume increase in the numbers of pharmacists calling for support and advice.
PDL and PSS say these calls are commonly from younger pharmacists under 30 years old, who have less experience in the field and are more likely to be frontline workers in community pharmacies.
Professional officer Mr West says PDL has also seen a significant increase in notifications to registering bodies, with the ease of the online complaints process playing a factor.
Despite difficulties, A/Prof Freeman praised pharmacists for the “enormous contribution” that pharmacists have delivered – not only with COVID-19 but the bushfire crisis as well.
However he added “that persistent high level of alert and anxiety can take its toll on our profession.”
“One of the things I’ve been most worried about is the high risk of burnout to the profession and I’m glad we’ve been able to put this webinar on – with strategies to help keep yourself safe and manage conflict when it arise in your working environment,” he said.
Ms Dunkley added: “I’m proud to be a pharmacist and I’m proud of how they’ve managed everything as it’s gone on, but unfortunately many have experienced a lot of stress and they’ve found it hard to cope.
“Often they’re working with less people as the team has been split … It’s not surprising that both PDL and PSS have had an increased volume of calls and some very distressed people contacting us about their particular situations.”
Here we break down some of their advice to pharmacists regarding notifications, de-escalating conflict, and self care during these stressful times.
What are some ways to de-escalate a situation with a difficult patient?
Ms Dunkley says “the first thing to do is slow your response and not respond too quickly.
“What happens with your adrenaline levels go up you can go into amygdala hijack you can go into that fight or flight response,” she explains.
“Perhaps allow them to rant a little bit and listen, and reflect back to them what they’re saying so that it’s clear you’re getting they’re message. It’s not that easy to do and we’ve all at times snapped back at someone or responded too quickly without thinking.
“A few deep breaths – just letting it wash over you – and taking a moment to respond and keeping your voice at a very calm level… if they’re shouting, not shouting back, and just acknowledging that you’re hearing them and that this is frustrating of them, showing that empathy,” says Ms Dunkley
“Explain what action you will take to ensure you will bring about a resolution that is in their interest.
“If there is someone being a little bit aggressive, it would help if someone more experienced and more senior steps in, or to ask them to lower their voice.”
However she says if they don’t comply then asking them to leave the pharmacy is not unreasonable.
A/Prof affirmed that while tolerance and empathy towards patients is important, “what we shouldn’t tolerate is physical and verbal abuse towards pharmacists and pharmacy staff”.
Mr West encourages pharmacists to “think about what is the underlying driver behind this person’s behaviour.
“People are very anxious for themselves and their families, their financial situation, and unfortunately those feelings are bubbling to the top,” he says.
“It’s about recognising it’s not always about you, there are a lot of underlying factors driving this behaviour. Hopefully you can switch it around to empathise and support people so perhaps we can de-escalate it.
“It all comes down to communication. Good communication can help de-escalate these situations … and remaining calm. It’s not about you, it’s about the patient – their anxieties, their expectations and desires.”
How should pharmacists deal with notifications?
Pharmacists should always like to try and prevent getting to the point of receiving a notification, says Mr West.
“Our experience is that an honest and open apology – which is not an admission of liability – and providing some reassurance there is going to be a review of the situation … all those positive actions as soon as or shortly after an incident occurs can often help indicate to the patient that it’s being dealt with in a professional manner, that the pharmacist or pharmacy is willing to acknowledge and accept responsibility of the incident, and hopefully reassure people that they don’t need to jump straight to the notification process.”
He added that PDL is still seeing pharmacists making run-of-the-mill errors, and reminded them to check carefully during dispensing and make sure to identify patients correctly.
“People are wearing face masks so it’s harder to identify and hear them,” he said.
“We’ve heard of some patients getting the wrong medications because some of those issues, and these always increase when workloads and stress increases, so you’ve got to be very diligent – double check everything.”
He says pharmacists should get in touch with PDL as soon as they’re aware of an incident, and to also document everything related to the incident.
“If it does come to a notification, we strongly urge you to contact us or your PII provider,” he says. “Don’t act without assistance. Be mindful that’s what you have indemnity insurance for, so please contact us as soon as you can.”
What are people calling PSS about?
“We’ve had a range of questions come into our calls,” says Kay Dunkley.
“From ‘how do I stop people coughing into my face?’ to people worried about going home at night and having COVID on their clothes, particularly if they have a vulnerable family member. We’ve gotten questions around digital images, supply of salbutamol…
“Unfortunately we’ve had a couple of people where they’ve tried to do the right thing [with dispensing restrictions] and someone more senior to them has said, ‘no, no, you don’t need to do that, give them what they need.
“That hasn’t been helpful when that person is trying to do the right thing and they know what the requirements are, and the manager doesn’t … that can cause a few issues.
“And just people who are very stressed and worn down by what’s happening, people who are really feeling that they’re getting to the end of their tether,” says Ms Dunkley.
“A lot of those people just want to talk, they want to debrief, and have their issue actually validated – ‘yep, you did do the right thing there, I don’t agree with what your boss told you, that is the correct regulation that just came in yesterday and you did do the right thing’.”
What are some of the practical things pharmacists can do to look after themselves at this time?
It’s critical that everyone paces themselves, says Ms Dunkley.
“As Chris said, this probably isn’t going to end in a few weeks, we’ll be practising in these circumstances for a few months. So making sure you’re not pushing yourself too hard and allowing yourself to take breaks, have lunch, have plenty to drink through the day, and pacing yourself so that you’re not burnt out by the speed that everything is happening at.
“And making sure that while you’re not at work that you really relax, take good down time, allow yourself to take on other hobbies and interests when you’re not at work.”
She also encouraged pharmacists to go for walks, particularly out in nature, and to take breaks from social media and too much COVID-related news.
“Also doing little things at the pharmacy that relieves a bit of the tension … and making sure that everyone feels that they feel heard, that no one feels like they’re carrying a heavy burden.”
A/Prof also shared that his family has daily “protected time” for a couple of hours each day, “where we go for a walk or ride a bike, or sit in the same room and read a book.”
“Those times where you don’t have your phone near you, emails with the constant COVID-19 rhetoric, and just slip into a process where you don’t stop doing that.
“And also having a friend to keep yourself accountable that you’re having those breaks, checking up on each other,” he suggested.
This is a short summary of the webinar. Please watch the full webinar here.
PSS is available to all Australian pharmacists, interns and students every day of the year between 8.00 am and 11.00 pm (EST) on 1300 244 910.
PDL is available on 1300 854 838 Australia wide 24/7 for confidential advice and support.
Extensive COVID-19 resources from the PSA are available here.
The article was originally published by AJP and is reproduced with its permission.
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