Grace Hayes, Pharm.D., BCPP, APh

Pharmacy Services Manager – Department of State Hospitals Atascadero, California

CPhA had been a big part of my life as a student and a young pharmacist. When I had my second child, I needed to shift my priorities, and stopped traveling to attend CPhA events. During this time, I worked as a staff pharmacist at Atascadero State Hospital, an 1150 bed maximum security psychiatric hospital, much of this part-time to be more active in my children’s lives. When our pharmacy manager retired, no one else was willing to apply for the manager position. By this point, I had one child in college and my younger one was in high school.  Someone needed to take the manager position, and I decided that with my children being older that I could go back to a full-time position and take on more responsibility, while the flexible hours of the manager would allow me to continue facilitate my younger daughter’s extracurricular activities.

Becoming a manager was a difficult transition for me. I had never planned to be a manager, I had no mentor to give me insights, and the hospital provided minimal training and support. Due to unusual circumstances, the pharmacy management positions paid lower than staff pharmacist positions, so the two assistant manager positions for the pharmacy had been unfilled for so long that the hospital eliminated the positions. With years of inadequate staffing of pharmacy supervisors for a large department, there were many legal requirements that were not being met and needed correction.  I quickly learned that I had some remarkable manager skills, but there were areas where I clearly needed more tools. I also needed to be more efficient to be successful when trying to meet requirements of several jobs. When I saw a CPhA email advertising the Leader Development Institute (LDI), I decided to take advantage of the opportunity to gain some of the training that I felt I was missing.

LDI has been a remarkable experience for me. I was able to reconnect with old friends within CPhA, made new friends, and quickly developed strong bonds with classmates that are also committed to personal growth and understand my challenges as a pharmacist. This deep level of support and connectedness has given me more resiliency and removed my sense of isolation as a lone manager.  I developed a better understanding and framework for leadership that has led me toward making subtle but powerful shifts in my approach to daily challenges. I have gotten better at catching myself when I am feeling victimized and seeing my own choices and responses so that I usually feel more mastery of my life, despite continuing to feel overwhelmed by the volume of what needs to be done. I have felt inspired by my classmates’ struggles and achievements, and have more self-confidence knowing that these remarkable individuals feel the same way about me.

When the course ends, I will miss the regular meetings with my LDI class. Yet, the amazing thing about LDI is that I know that this does not end when the course ends. Yes, there are built in facilitative roles to work with a future LDI class that can take it a step further. But even if not participating at that level, there is much that allows for ongoing leadership growth and support…the framework for understanding leadership, the resources to continue developing leadership skills, and the deep friendships where I know that over the years ahead that my classmates and I will be able to count on each other as resources and support.

I chose a leadership project that was a challenge for me at work. I have been trying to develop a meaningful Medication Variance Reporting (MVR) program with pharmacist participation. At our hospital, we had an MVR reporting program that occurred through nursing and our standards compliance department, but pharmacists were not participants in this program. How can you expect to reduce medication errors in a hospital without including the medication experts?  Reporting was robust and nursing did a great job addressing procedural issues for medication administration errors.  Standards Compliance did a great job turning all the collected data into complex statistical reports with fancy bar graphs that convinced surveyors that we were doing a good job. But nowhere in that process did it list drugs involved so that we could look for global patterns to identify where we might be able to make system changes that could help prevent repeated errors in the medication use process, missing a huge opportunity to improve patient safety.

My first step was to get pharmacy involved in this process. The system was resistant to making changes, especially since we had not received any citations. Why change something that had not been identified by outside agencies as a problem?  After many attempts and approaches at getting pharmacists involved in the process, a multidisciplinary committee was formed to look at MVRs.  This started off with Standards Compliance just showing the committee all their graphs, and took some further effort to get pharmacists able to see the raw data to learn what the specific errors were and what drugs were involved. A turning point was the development of a new statewide MVR database shared by all state hospitals that made large global changes in the reporting process and data availability, creating an opening for a real transition in the process. At this point the oversite of the entire MVR process has now been turned over to pharmacists, changing the challenge from being allowed to participate to how to handle primary responsibility for this process well with the limited resources of our department.

We are still working with this new transition to MVR oversight. The statewide database had some glitches and there had not been any pharmacist input in its development, so we are working with other hospitals to mutually agree to refinements in the programming. Database entries are made throughout the hospital. Nursing continues their role in correcting administration procedural problems. We have a small team of pharmacists working on the MVR process with the team leader now looking at all MVRs and working with reporting tools in the computer application to try to look for patterns.  We have created deadlines for monthly reporting validation to generate required reports for P&T, other committees, and key staff that need the information. After we work with the new MVR database long enough to feel some mastery, we have plans for other ways to improve the MVR process. This will include better documentation of errors within the pharmacy, and incorporating data from separate data repositories, such as prescribing errors, into the MVR computer application to have all MVRs data included in the same process.