There is an unmistakable energy that radiates from pharmacists Jaclyn Tran and Jo-Anne Wilson as they talk about their work with patients suffering from Chronic Kidney Disease. They work on a multidisciplinary team that includes nephrologists, nurse practitioners, dieticians, and social workers in Halifax as part of the Renal Program.
Jo-Anne, a Dalhousie pharmacy graduate, did a general practice hospital residency at the Victoria General Hospital, and went on to complete her Doctor of Pharmacy at the University of South Carolina. She worked in a variety of settings and had areas of interest that included anticoagulation, thrombosis, cardiovascular, nephrology, and diabetes (the number one reason patients start dialysis due to kidney failure). Although not a planned progress, it was a logical one, and not surprising Jo-Anne ended up working with the Renal Program in Halifax, which she has been doing for the past five years.
For most of those years she has been the sole pharmacist working in the Renal Program. She was joined last May by Jaclyn, who has been working at NSHA since she completed a hospital pharmacy residency program in 2012. Jaclyn worked in a variety of departments, including medicine and surgery, until Jo-Anne recruited her to work in nephrology.
"I was looking for a home, a place to set up roots," says Jaclyn. "I wanted to find an area where I could develop clinical skills and focus my pharmacy practice.”
The duo's compassion for their patients is evident as they talk. The majority of patients that they follow are dialysis patients. Many of these patients have complicated medical histories and also have significant pill burden. It is not uncommon for patients to take more than 10 medications daily.
Just before the interview for this profile, Jaclyn had met with a patient to help arrange medication management during international travel. Earlier, Jaclyn did a medication review with another patient who was confused about several medication changes that occurred over a short period of time. Jo-Anne was working on a presentation that she was giving later that afternoon to her colleagues on optimizing anemia management in the renal program.
Education is a strong component of the work of both pharmacists. They educate patients, family members, health care professionals, and students who are completing the hands-on experience portion of the pharmacy training. Jo-Anne is an Associate Professor at Dalhousie University. She teaches at the College of Pharmacy and also mentors pharmacy students by involving them in research projects. Jaclyn added that Jo-Anne is one of the leading pharmacists pursuing research at the Nova Scotia Health Authority (NSHA). An accomplished and well published, yet humble pharmacist, Jo-Anne quickly diverted attention away from herself by talking about an important initiative Jaclyn has instituted.
"Jaclyn is the immunization Queen," says Jo-Anne.
One of Jaclyn's focuses is ensuring her patients have received all the appropriate immunizations, including those for hepatitis B, pneumonia, and the flu. Contracting anyone of these illness could be fatal for a patient with kidney disease.
Patients who are experiencing a decrease in function, or complete failure, of their kidneys have unique issues beyond the need for dialysis. There are different types of dialysis and some patients can have it at home and others may attend a clinic three times a week to receive it. Some medications can build up in the body and cause further harm to the patient when they are not having the medications removed by their kidneys on an ongoing basis. Jaclyn and Jo-Anne watch for this.
It is important to have the Best Possible Medication History (BPSM) created, which both pharmacists compile and share with other medical professionals, including patients' community pharmacists. Completed in a process called Medication Reconciliation, it is the most accurate list of all possible medications a patient is taking. It includes the drug name, dosage, frequency, and method of delivery of the medication. The pharmacists compare the list against physicians' admission records, transfers, or discharge orders so that the patient receives the correct medications at all transition points within the hospital and once they are discharged from the hospital and the community pharmacist takes over care of the patient.
Other Drug Therapy Problems that are specific to patients with Chronic Kidney Disease that the pharmacists watch out for are Anemia, Mineral and Bone Disease, Cardiovascular Risks, Diabetes, Pain, Gastrointestinal Issues, Depression, Gout, and more. As the experts on medications and the effects of those drugs on the body, Jo-Anne's and Jaclyn's expertise and advice provides a vital resource for the health care team.
Working as the "Power of Two," both pharmacists say the best parts of their job are the people they work with: the patients and the amazing health care team that makes up the Renal Program.
"The people who come in for dialysis lead diverse lives," says Jo-Anne. "Right now, we have patients of all ages who range from university students to retirees.”
Working together, Jo-Anne and Jaclyn are helping their patients optimize their medications to meet their individual needs.
Jaclyn says happy to be working in nephrology and that she feels lucky to work with Jo-Anne.
"I don't know what I would do without Jo-Anne," says Jaclyn. "She really has a vision for pharmacy practice. Not many people have mentors in their day-to-day life, I am excited to see what we can do."
Jo-Anne and Jaclyn are a pretty powerful combination.
Pictured: Pharmacist Jaclyn Tran with a patient.
Pharmacist Jo-Anne Wilson with a patient.