Pharmacist Myths

October 25, 2016

October is American Pharmacists Month and we are excited to present to you a series of videos throughout the month by our very own, Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Our next video in the series, Pharmacist Myths, will help expand your understanding of the field and unveil upcoming news in pharmacy.

Pharmacist Myths

Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care

Hospice of Southern Illinois

Pharmacy is a field of medicine that is continually growing into new areas. Their new roles expand past the traditional roles of counting pills behind a counter. Now-a-days, even pharmacists who do work in chain or community pharmacies rarely count pills. Oftentimes it is the job of the technician to measure the appropriate amount of medication whether it is measuring a liquid or counting the accurate number of pills. It is then the pharmacist’s job to verify the right medication and count is in each prescription bottle. There are exceptions to these rules depending on the pharmacy site, usually having to do with controlled substances. Since these medications are much more regulated by the FDA and DEA, pharmacists may be the individual counting and verifying these particular instances.

Outside of the community/chain pharmacy world, pharmacists have begun to find new niches for their careers. There are so many areas where pharmacists work that the community just does not have the opportunity to see. For example, there are pharmacists who work with radioactive materials in order to perform diagnostic scanning in the hospital (if you ever had intravenous dye (contrast dye) put into your body then you know an example). These medications are prepared by a pharmacist to ensure appropriate dosage of medication and radiation. There are also pharmacists who work much like a physician’s assistant or nurse practitioner under the supervision of a medical doctor. These pharmacists are able to increase or decrease medication doses, start new medications, or stop existing prescriptions.

Delving deeper into pharmacists authority, there are states who are allowing pharmacists to prescribe certain medications without a medical doctor. For example, most states now allow pharmacists to give immunizations to patients within a certain age range. Also, naloxone, a life-saving medication in opioid overdose, can be prescribed by pharmacists in ~ 14 states at the moment.

There are dozens of areas of medicine where pharmacists are able to be employed. These jobs range from the above listed occupations, to working in a pharmaceutical company, to being a veterinary pharmacist. As time passes and the overall health burden of our country increases, the roles and responsibilities of mid-level practitioners will increase, including pharmacists. Currently there are many areas in the United States that are lacking the appropriate amount of primary care physicians. While the government is trying to help solve the problem by incentivizing physicians to go into that field, the other way they are improving access to care is by expanding the roles of other health care workers.

Common Hospice Medication Questions

October 18, 2016

October is American Pharmacists Month and we are excited to present to you a series of videos throughout the month by our very own, Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Hospice of Southern Illinois is very proud to have the honor of hosting the only PGY-2 (post-graduate, year 2) in Pain and Palliative Care Pharmacy Residency Program fully funded a hospice, in the United States. So, we present to you our next video in the series on Common Questions pertaining to a pharmacists specialty, hospice medications.

Common Questions

Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care

Hospice of Southern Illinois

Being a pharmacist on a healthcare team is as fulfilling as it is rewarding. Since pharmacists have training not many other healthcare professionals have, often they receive questions pertaining to their specialty, medications.

The questions receiving vary from patient to patient. Often pain control is a question I am asked to assess and fix. The management of the pain a patient is experiencing is multi-faceted. The first assessment that should be completed is the root cause of their pain. Different types of pain have different mechanisms on how they develop, leading to a variety of optimal treatment options. For example, most times people think the best option for treatment of pain would be an opioid like hydrocodone. However, if the patient is experiencing neuropathic pain, such as stinging, tingling, and burning, then opioids are not first line agents. There are a multitude of medications that can be used to treat pain outside the world of opioids. As with any medication it is important to assess the entire patient and factors which may influencing the efficacy or toxicity of a medication. Such factors typically include other medications that could cause a drug interaction, a patient’s organ function (particularly renal and liver), body fat percentage of a patient, swallowing capability and allergies. All of these must be assessed not only when making recommendations for pain medications, but also for any other medication.

Other questions commonly asked are the use of medication outside their typical or expected use. For example medications are much like a teeter-totter. On one side you have the beneficial effects of a medication, and on the other you have the adverse effects that are possible. Sometimes when all typical treatments have failed, the next step is to use the possible adverse effects of a medication as a treatment. One example would be the use of opioids. Most people think the primary use of them is for treatment of pain, which is correct. But in some settings, especially in hospice, we use the adverse effect of opioids to help with breathing in patients who are short of breath. Another example of this is the use of trazodone. Trazodone was produced originally as an antidepressant, but was also found to cause sedation at lower doses. More often than not, when patients are prescribed trazodone now-a-days it is for the adverse effect of drowsiness helping with sleep, and not for the treatment of depression. The possibilities of medication use are endless and new indications for use are described in literature often. Keeping up to date with medications and their potential uses is important in maintaining competence as a pharmacist.

35th Anniversary Car Raffle Winner

October 14, 2016

Thank you so very much to all those involved in Hospice of Southern Illinois, INC.s 35th Anniversary Car Raffle sponsored by Watermark Auto Group, First Southern Bank, Huck’s General Store, and Simple Solutions Printing Inc. We appreciate your donations and contributions to support our mission! Purchasing a ticket helped so many patients!

Now without further ado… the winner of the BMW was LINDA MARTIN from Marion, Illinois! Congratulations and we hope you enjoy your new BMW!!!

Hospice Goals of Care

October 10, 2016

October is American Pharmacists Month and we are excited to present to you a series of videos throughout the month by our very own, Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Hospice of Southern Illinois is very proud to have the honor of hosting the only PGY-2 (post-graduate, year 2) in Pain and Palliative Care Pharmacy Residency Program fully funded a hospice, in the United States. So, we present to you our next video in the series on Goals of Care.

Goals of Care

Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care

Hospice of Southern Illinois

The goals of care in hospice are much different than in other areas of the healthcare field. In hospice, the goal is to help comfort both the patient and the patient’s family. This is done through medication use and spiritual guidance of patient and family, if requested. Treatment transitions from disease oriented care into symptomatic management.

Many times the medications used to treat a patient’s disease prior to admittance into hospice are no longer required after acceptance. There are an innumerable amount of medications which this applies to, but that is why often we tell the family medication A and B are no longer required, while we may add medication C for control of different patient symptoms. In the end, discontinuation of medications is a families right and they have the final say. Clinical recommendations can be made, but that does not mean the families do not have the right to counter the recommendation.

Often, the problem comes up when a medication is recommended to be discontinued but the family wants to continue it. What are the real problems with this scenario? Well it fully depends on the patient, the medication, and any other patient specific variable. Sometimes the recommendation comes from the fact that the medication may have no clinical trials demonstrating palliative benefits to patients. So just because it has no palliative benefits that means it needs to be discontinued? Not necessarily, however, we must assess the whole situation.

While admitted on hospice many times patients slowly lose their ability to swallow, not only food and liquids, but also medications. Pill burden at this time becomes a problem not only for patients, but also for the families. Trying to get their loved ones to swallow pills or liquid can be cumbersome. This results in a problem from a hospice side of trying to improve the quality of the patients remaining life. Taking one extra pill may not seem like much, but what about if its 4 extra pills needing to be given at three different time intervals each day?

Like anything, each patient is unique and treated on a case-by-case basis. Yes exceptions to the “normal” rules can be made, however the end goal of hospice is to increase the quality of life of both the patients and families.

Seasonal Allergies Got You Down? Your Wellness Tip is Here!

October 4, 2016

October is American Pharmacists Month and we are excited to present to you a series of videos throughout the month by our very own, Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Hospice of Southern Illinois is very proud to have the honor of hosting the only PGY-2 (post-graduate, year 2) in Pain and Palliative Care Pharmacy Residency Program fully funded a hospice, in the United States. So, we present to you our first video in the series on a Wellness Tip!

Allergic Rhinitis

Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care

Hospice of Southern Illinois

An allergy is defined as a particle that causes a reaction in someone which does not normally inconvenience people. This involves the particulate being introduced inside the lining of the nose. This leads to release of chemicals which cause contraction (making smaller) of the blood vessels in the nose. The end result is fluid escaping and the nasal passages swelling leading to nasal congestion. Allergic rhinitis is a systemic disease affecting an estimated 20% of adults and 40% of children in the United States.¹ This condition leads to a large burden, and cost, to both families all over. Signs and symptoms of this disorder typically begin after 24 months and usually fade after the age of 64.²

The signs and symptoms of allergic rhinitis vary from patient to patient. Typically they include sneezing (with running or clogged nose), coughing, watering eyes, and itching eyes, nose, and throat. Triggers for developing signs and symptoms of allergic rhinitis come from both indoor and outdoor environmental particulates. Common outdoor triggers include pollen and mold which vary in amounts depending on the season and weather. Pollen is usually produced by trees, grasses, and weeds. They produce small, lightweight grains and are transported by the wind. Common indoor triggers include house dust mites, food, and animals. Keeping the house clean is one of the best ways to prevent many indoor triggers. In severe cases, or when allergens or mold are extremely high, some find benefit in wearing face masks to prevent pollen/mold from reaching the nasal passages.³

There are doctors who specialize in allergic diseases (allergists) who can use skin tests to determine what particulate a particular person is allergic to. This involves applying a small amount of allergen under a person’s skin and waiting to see if a small, raised, reddened area appears.

Medications are often used to treat allergic rhinitis. Antihistamines effectively reduce the signs and symptoms of allergic rhinitis. There are two classes of antihistamines available, the first generation and second generation. First generation antihistamines like diphenhydramine (Benadryl®) are typically taken multiple times per day and have the common side-effect of drowsiness. The second generation antihistamines are typically taken once daily and are less likely to induce lethargy. These include loratadine (Claratin ®), cetirizine (Zyrtec®), and fexofenadine (Allegra®). Fluticasone nasal spray (Flonase®) has recently been approved by the FDA to move to over-the-counter status. This medication was previously only obtained by prescription, but now can be bought at your favorite pharmacy. This medication can also be used to help treat and prevent the signs and symptoms of allergies. It is important to ask your doctor or pharmacist before starting any new medication. It could interact with current medications and cause an adverse effect.

References

Schoenwetter WF, Dupclay L Jr, Appajosyula S, et al. Economic impact and quality of life burden of allergic rhinitis. Curr Med Res Opin. 2004;20:305-17.
National Center for Health Statistics. Summary health statistics for U.S. adults: national health interview survey, 2009. Vital Health Stat. 2010 Aug;10)249):19-21.
National Institute of Allergy and Infectious Disease. Airborne Allergens- Something in the Air. NIH Publication No. 03-7045. 2003 April.

PGY-2 in Pain and Palliative Care Pharmacy Residency Program

August 16, 2016

Hospice of Southern Illinois Announces Pharmacy Residency Program

Hospice of Southern Illinois is very proud to have the honor of hosting the only PGY-2 (post-graduate, year 2) in Pain and Palliative Care Pharmacy Residency Program housed in a hospice, in the United States. We are pleased to introduce and welcome the full-time, on-staff, PGY-2 Pharmacy Resident, Brad Rea, PharmD. Our patients, families and organization will directly benefit from this very special program, which is 1 of 15 in the country and the only 1 fully funded by a hospice. Dr. Rea will play a critical role in delivering the highest quality end-of-life care to patients and families we serve. He will also help us grow and continue providing top-notch, end-of-life care as your local, not-for-profit hospice. Brad shares in our excitement, “I am so fortunate to be the first pharmacist employed by Hospice of Southern Illinois. Passion and empathy are two words I have found to be excellent descriptors of the employees at this organization. This innovative position, in addition to Hospice of Southern Illinois’ mission, to enhance the quality of life of individuals and their loved ones touched by a terminal illness, helps to ensure patients are treated with the highest level of care. Hospice is a program that changes the lives for all parties involved and I am ecstatic to be a part of the hospice family.”

“We have collaborated with Southern Illinois University of Edwardsville’s School of Pharmacy to implement a niched program to benefit Hospice of Southern Illinois’ patients and organization; additionally, the experience, knowledge and education our Pharmacist will receive has been customized to provide a genuine learning experience and specific end-of-life care training to implement into future programs or settings,” shares Dr. Ellen Middendorf, Medical Director of Hospice of Southern Illinois. The specialized support this program offers to Hospice of Southern Illinois includes direct patient benefits by ensuring safe and effective medication use, cost containment and education to our staff, patients, and families. Our pharmacist will help manage patient profiles for streamlined symptom management to reduce side effects and control medication interactions; offer expertise from the pharmacy field to improve our ability to reduce medication costs, including monitoring regulation changes and determining “related” and “unrelated” medications; and finally, the access to one-on-one education for staff, patients and families, and healthcare professionals is invaluable.

Chris Herndon, PharmD., associate professor at the SIUE School of Pharmacy, and PGY-2 Residency Program Director added, “this novel training program will prepare pharmacists to integrate seamlessly into the hospice interdisciplinary team and directly impact the care of those at the end of life. As medication regimens become more complex, it makes perfect sense to add the pharmacist to the hospice clinical team.”

“PGY2 pharmacy residency programs build on Doctor of Pharmacy (PharmD) education and PGY1 pharmacy residency programs to contribute to the development of clinical pharmacists in advanced or specialized practice. PGY2 residencies provide residents with opportunities to function independently as practitioners by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care that improves medication therapy. Residents who successfully complete an accredited PGY2 pharmacy residency should possess competencies that qualify them for clinical pharmacist and/or faculty positions and position them to be eligible for attainment of board certification in that practice area (when board certification exists).

The HSI PGY-2 is an immersive, structured, post-graduate training program designed to facilitate the resident in obtaining the knowledge and developing the essential skills to provide pain management and palliative care pharmacy services.”

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(Photographed L to R: Chris Herndon, PharmD., associate professor at the SIUE School of Pharmacy, Brad Rea, PharmD., Hospice of Southern Illinois’ Pharmacy Resident,

and Dr. Ellen Middendorf, Hospice of Southern Illinois’ Medical Director)

Hospice of Southern Illinois is your community not-for-profit hospice program serving 27 counties in southern Illinois since 1981. Our commitment at Hospice of Southern Illinois is to be with our patients and their loved ones through the changing needs of the end-of-life process and the grief experience. For more information about Hospice of Southern Illinois, visit our website, www.hospice.org, or contact Lisa Phillipson, 618-235-1703 or lphillipson@hospice.org.

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A Personal Story

June 28, 2016

This is the first year after losing my Father, December 2015. My first birthday without waking up to the telephone ringing and Dad singing “Happy Birthday.” The first Father’s Day without my Father. As a social worker, I know most special days of the first and consequent years after the death of a loved one are difficult. Now it is personal; grief is hard! Let Hospice of Southern Illinois help you.

At Hospice of Southern Illinois, we have available a Newsletter to Help in Bereavement: Journeys. Copies of the Newsletter for our hospice families and members of our grieving community are available free because of a grant from a former patient’s family! If you would like a copy mailed to you, please give our office a call to request a copy or to give a donation: 618-235-1703.

In Gratitude, Rebecca Wisdom, President and CEO

June is PTSD Awareness Month

June 6, 2016

Remembering those who served and are serving.

IMG_1963_blue Many Americans do not realize that 1 in 4 of all deaths in the U.S. are Veterans. Veterans with a life-limiting illness have unique care needs physically, emotionally and spiritually. Specifically, Post-Traumatic Stress Disorder (PTSD), affects many Veterans at the end-of-life. We work to ensure Veterans get the care they need and deserve, especially those with PTSD.

Hospice of Southern Illinois’ team is a proud Level III partner in the We Honor Veterans Program. Benefits of this program for our Veteran Patients Include:

Providing specialized care to meet the unique needs of Veterans facing a life-limiting illness
Veteran-to-Veteran volunteer program for grateful acknowledgement and compassionate listening
Honoring Veterans and welcoming them home
Accompanying and guiding Veterans for a more peaceful ending
Additional Resources: www.va.gov and www.wehonorveterans.org

Volunteer Legacy Continues On: Susan Relfe Retirement

May 26, 2016

Susan Relfe, Volunteer Services Supervisor at Hospice of Southern Illinois, is set to retire late June. This is a bittersweet moment when such a dedicated and person-centered employee, who is very passionate and knowledgeable, closes a chapter with us. We are not too disappointed, because Susan has reassured us she will continue to volunteer and participate in the legacy she leaves behind.

Susan joined us in 1999 when a friend said she needed to be in a position at Hospice of Southern Illinois that just opened. She was not looking for a new job. In fact, she really didn’t want to apply because she was happy with her current position, also in the healthcare field. She interviewed to please her friend, and was offered the job. Despite her reservations, she accepted the position, to find three months later she was diagnosed with cancer. She added, “It seemed like I was supposed to be at Hospice of Southern Illinois. My new job kept my mind busy and focused on new and positive things. The people I worked with were so caring and supportive. They answered my questions and treated me like a person, what they do every day.”

In her 17 years of work with us, Susan has enjoyed meeting all the volunteers with a variety of skills, interests, and talents. She genuinely enjoys the variety of people she has come to know! Susan has helped to establish, recruit, maintain and grow our outstanding volunteer team. She created the volunteer manual to ensure quality, history and consistency of our volunteers continues for years to come. Additionally, she participated in many other community projects and events which she hopes to continue in her volunteering with us.

After her last day at Hospice of Southern Illinois, she will not kick back and relax as you might assume. Susan will be starting a company, Friends and Family Connected. It will connect friends and families using media, technology, resources and the arts to offer one-on-one access to better communication and personal relationships. However, she does plan to do some traveling and continue her 2nd “bucket list” which some include: visiting the Peeps Factory on New Year’s Eve and seeing the 85 lbs. peep they drop, OZtoberfest in Kansas, and visit Strayboots Spots, an online scavenger hunt community with food and sightseeing recommendations, across the country. Susan wanted to leave us with one thing as she opens this new chapter, “Never forget the people. It always needs to be about the people. Yes, for sure the patients and their families, but also your co-workers, strangers, and anyone. Always make it about people.” We wish her the very best, only to say, “see you later,” as we know we will be seeing her often after her retirement. Congratulations Susan!

Retirement after 20 years of service: Nancy Reed

May 26, 2016

Reed of Swansea - 20 Nancy Reed, Administrative Secretary for Hospice of Southern Illinois, has decided to retire after 20 years of service with us. While it is not easy to see Nancy retire, she warms our blues as she has agreed to continue her dedication and service to Hospice of Southern Illinois as a volunteer. For this reason, we easily cheer Nancy along as she enters retirement knowing we will always know where to find her to share her spirit and knowledge!

Nancy, originally from East St. Louis, lived in New Orleans with her husband. She worked as a secretary for LSU School of Medicine, always working in the medical field. While in New Orleans, Nancy’s husband became ill and passed away. After the loss of her husband, she decided to move back to her roots. Former President and CEO of Hospice of Southern Illinois and friend, Merle Aukamp, contacted Nancy’s sister-in-law regarding an opening with Hospice of Southern Illinois knowing she was searching for work upon returning back home. Nancy had a positive hospice experience with her husband being in a program in New Orleans. So she decided to apply. Her secretarial experience and history in the medical field landed the position she retires from today. Her experience and skills as a secretary will be missed, but even greater; her appreciation for people and knowledge of Hospice of Southern Illinois are rare.

Nancy has always appreciated the people she worked with and for, the stable work environment, and exceptional care Hospice of Southern Illinois provides. She enjoyed the variety in her day and has been involved with most departments throughout the organization. She was very skilled at her job, contributing to the stability of administration, the mission of the organization, and the support of the leadership throughout her 20 years. Reflecting on her commitment to her work, we asked her some advice for those who have to follow in her shoes. Much to the testament of her spirit she added a quote she once heard, “Listen to others not to respond, but to understand.”

We asked Nancy what was next and she replied, “I don’t think you know till you get there!” Although she isn’t sure of everything she wants to do, she has a few things on her to-do list. She leaves for an extended and well-deserved trip abroad to visit her son, one of three children. Upon returning home, she has plans to do more traveling, enjoying time with her 3 children and 8 grandchildren, volunteering, getting more involved at church, and maybe even selling a little real estate. We wish Nancy the very best and congratulate her on her next journey!

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