ASHP InterSections ASHP InterSections

July 15, 2019

Mindfulness and Medication Safety: Pharmacist Brings Calm to Hospital Chaos

Lisa Hanlon Wilhelm, BS.Pharm., R.Ph., teaches a weekly meditation session to hospital staff to help build a resilient healthcare workforce.

IT’S WEDNESDAY AFTERNOON AT PENN STATE HEALTH HERSHEY MEDICAL CENTER, in Hershey, PA. The dimly lit hospital chapel has soft music playing, but the clatter from the cafeteria next door still seeps in. The only sources of light are the many windows around the room. An assembled group of pharmacists, nurses, and other hospital employees – looking for a few moments of inner peace – sit upright on benches, cushions, and stools.

The meditation group is led by Lisa Hanlon Wilhelm, BS.Pharm., R.Ph., the medical center’s Medication Safety and Compliance Specialist, who speaks soothingly to the participants. She helps them focus first on their posture, then their breathing and heartbeat, finally linking heart and breath. She encourages them to ignore the clanking of dishes from the cafeteria, the patter of feet in the hallway – to instead focus on concentrating on their breath and heart.

“When you first enter the room, all you hear is the noise coming from the cafeteria,” said Joanne Martin, LPN, an oncology nurse and participant in the class. “As we begin to meditate and focus on our breathing, the noise remains, but your awareness of it is no longer your focus. It always amazes me because no matter how unsettled I feel when I first arrive, I always walk out with a peacefulness.”

This practice, known as Heart Rhythm Meditation (HRM), is an ancient form of meditation, which begins with mindful breathing, and then focuses on your physical heart and spiritual center. “When you get your breathing in rhythm with your heartbeat it creates physiologic coherence,” says Wilhelm, who is certified in the HRM method. “Conscious breathing helps you feel more relaxed, reduces blood pressure, and slows the heart rate.”

Joanne Martin, LPN

Studies show that meditation can help with memory, creativity, and focus. And focus is essential when it comes to medication safety. “As pharmacists, we push ourselves beyond reasonable expectations at times. Our work is very exact; errors can be catastrophic,” said Ronald Lay, M.S., R.Ph., one of Wilheim’s first meditation students. “Our responsibilities are increasing to play a more prominent role in patient care. We push ourselves to do it all. It’s important to take time for ourselves, to step back and take a deep breath.”

Creating Mindfulness
Wilhelm, who completed an ASHP Executive Residency in 1995, has spent the bulk of her career at Hershey Medical Center in the Medication Safety Officer role. As part of her job, she teaches medical students, new nurses, and advanced practice clinicians about medication safety and regulatory compliance, and she reviews medication event reports.

The role is challenging, and she has seen first-hand how stress and burnout can lead to errors. She realized that while system changes could fix many medication safety problems, there are other issues at play as well.

“Sometimes I think [healthcare providers] need to stop and look at a medication label, or stop and read a patient’s chart or medical note, or stop and pay attention to a patient, a colleague, or a situation. Basically, just stop for a moment,” she said. “Taking that moment to pause and focus can avoid accidental errors made in haste.”

Wilhelm was always interested in meditation, but it was after she had completed a 2-year training program in HRM that she decided to try leading a weekly drop-in meditation class at the hospital. With the support of the Director of Pastoral Services, Wilhelm started her Wednesday program in October of 2017.

Meditation Improves Care
Ronald Lay, who was then working as the Director of Inpatient Pharmacy at the medical center, was one of the early participants in Wilhelm’s meditation class. Lay, a member of ASHP for 41 years, has since semi-retired and works part-time as a staff pharmacist. 

Over casual conversation, he heard about her meditation class and decided to try it. “I’ve been a pharmacist for 41 years, 37 of those in management positions,” explained Lay. He found himself dealing with issues that all pharmacy managers experience: personnel issues, increased regulation, budget cuts, and the expectation to do more with less.

Ronald Lay, M.S., R.Ph.

“I was becoming more tired and irritable and experienced classic symptoms of burnout. I ate lunch at my desk every day and took work home regularly,” he said. “I was having trouble sleeping. I realized I needed to slow down and take better care of myself.”

Lay tried the class, hoping it might help his sleep problems and stress level without medication or therapy. “The result? I find it does!” he said, “The biggest surprise was the level of physical and emotional relaxation. I felt like a whole different person after the meditation – like a weight was lifted off my shoulders. I walked out so much more slowly – no longer in a rush.”

The sessions also helped him work in a more focused way. “Now that I am working as a staff pharmacist, I still experience stress from the demands of patient care. It is easy for emotions like frustration or anxiety to take over, and to rush through the work. Meditation allows for a more calm and logical approach, which should reduce the opportunity for errors,” he said.

Martin agrees that meditation can be beneficial. As an oncology nurse, her job involves working with the outpatient cancer institute triaging phone calls from patients regarding symptom management, chemotherapy side effects, and other issues. “Meditation has helped me be more present for my patients, use more therapeutic communication, and overall just be more empathetic,” she said.

Mindful Moments
In addition to her weekly meditation sessions, Wilhelm has led a continuing education program for pharmacy staff at the hospital on meditation for stress reduction. For ASHP, she conducted a webinar and a meditation for pharmacy students at the 2018 ASHP Midyear Clinical Meeting. Wilhelm incorporates simple mindfulness techniques in her medication safety lectures and plans to expand more moving forward. She and a colleague recently led a meditation class for graduating medical students at Penn State College of Medicine held immediately after their lecture on loan repayment.

For healthcare providers interested in learning to incorporate these practices in their work, Wilhelm noted that mindful moments could be tucked in throughout your day. “Walking through the threshold of a patient’s room, or washing your hands, or getting ready to program an IV pump, or verifying a prescription … these can all be mindful moments if you stop for a moment to breathe and get centered,” she said. “Taking that pause to stop, think, assess, and review can lead to better communication, clearer focus, and ultimately, improved patient care.”

 

By Ann Latner

 

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May 14, 2019

Mindfulness and Improv Help Pharmacy Students Cope with Burnout

Anne Graff LaDisa, Pharm.D., BCPS, uses improv to teach student pharmacists about effective communication skills.

IN A QUIET LOW-LIT CLASSROOM, students sit comfortably with their eyes closed and their spines straight. They bring attention to their breathing and imagine that they have a balloon in their stomachs. Every time they breathe in, the balloon inflates. Every time they breathe out, the balloon deflates. With every exhale, the students imagine their daily stresses and frustrations floating away. This isn’t a mindfulness retreat at some hideaway resort or the calming conclusion of a power yoga class. It’s a pharmacy course at the Concordia University-Wisconsin School of Pharmacy, where two professors are teaching students to use mindfulness to cope with burnout both during school and throughout their future careers.

According to Christina Martin, Pharm.D., M.S., Director of Membership Forums for ASHP, pharmacist burnout is a serious concern. A 2018 study published in AJHP reported that more than half of health-system pharmacists surveyed felt a high degree of burnout. In addition, a recent salary survey found that two-thirds of pharmacists experienced increased job stress over the previous year, and that 72 percent said workloads increased from the year before.

“When healthcare providers feel stressed, it can also have an impact on their patients,” said Dr. Martin. Burnout is associated with more medical errors and poorer patient safety outcomes, according to the Agency for Healthcare Research and Quality. “We really have to care for the caregiver and ensure that we’re providing resources and support to those who are caring for patients in very chaotic healthcare times,” she added.

Mindfulness in the Classroom

Elizabeth Buckley, Pharm.D., CDE

Elizabeth Buckley, Pharm.D., CDE, Associate Professor of Pharmacy at Concordia University-Wisconsin School of Pharmacy, often includes the balloon-in-the-stomach exercise in her classes. She first introduced it while teaching a diabetes elective for third-year pharmacy students in the spring of 2017 — and she saw immediate changes. It made a huge difference “on attitude, on calmness, on collegiality,” she said.

It worked so well that in the fall of 2018, she added it to her weekly lectures in the Applied Patient Care I course, which is for first-year pharmacy students. “The tone of the class changed in a significant way. Everyone settled down and the discussion was more robust,” she said. “The mindfulness exercise centered me, and it centered the class.”

Dr. Buckley hopes that teaching pharmacy students mindfulness now will help them avoid burnout in the future. “If you’re going to be in a career where you care for other people, you have to figure out self-care in order to be good at being a clinician,” she said.

Improv Shakes Things Up

Anne Graff LaDisa, Pharm.D., BCPS, Associate Professor of Pharmacy at Concordia University-Wisconsin School of Pharmacy, began teaching an improvisational class to first-year students to help bolster communication and teamwork skills. Improv is a theatrical technique where the characters and dialog in scene or story are made up on the spot. Communication skills learned through improv can help a student become a good pharmacist, she noted. Although she didn’t introduce improv classes for pharmacy students with combating burnout in mind, she explained that improv exercises allow students to be creative and break up a school routine.

Anne Graff LaDisa, Pharm.D., BCPS

Dr. LaDisa began taking improv classes herself in 2003. When she discovered that medical schools were using improv to teach and improve medical students’ communications skills, she became intrigued — even more so when she learned that the University of Arizona has been using improv in its pharmacy school since 2004.

She introduced improv to an existing course in 2015, then taught her first stand-alone elective course for first-, second-, and third-year students in 2017. At the beginning of every class, she reviews the rules of improv, which include always saying “yes, and …” to what your partner is trying to communicate, emphasizing the here and now, being specific, and focusing on characters and relationships.

In Dr. LaDisa’s class, a two-person scene requires the students to follow the rules of improv and may involve a scenario unrelated to healthcare. After the students complete the improv exercise, she asks them questions about how they felt about the activity – what things they found challenging and what skills they felt they had to use to be successful. Finally, the students talk about how to apply those skills to clinical pharmacy practice.

Role-playing in a healthcare or social setting can help pharmacy students improve collaboration and teamwork skills. “Improv training gives students an advantage when it comes to communication, which is a critical skill for all pharmacists,” she said.

By Jen A. Miller

 

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