Managing Loss, Grief in a Pharmacy Team

Grief impacts everyone at some point in their lives and was described as the “ultimate disruptor” in pharmacy practice during a session on managing loss held at the American Society of Health-System Pharmacists’ (ASHP) virtual 2020 ASHP Midyear Clinical Meeting and Exhibition.¹

According to presenter Thomas S. Achey, PharmD, MS, BCPS, manager of pharmacy services at Princeton Baptist Medical Center in Birmingham, Alabama, the US suicide rate has increased over 20 years, since 2000 with research showing an 11% increase in workplace suicides from 2017 to 2018.¹ Additionally, health care professionals accounted for 5% of all workplace suicides over a 3-year period, 2011-2013.²

“It may not be something that we’ve seen but it certainly is something that we’re experiencing throughout our larger profession,” Achey said.¹

According to presenter John D. Hill, PharmD, MS, BCPS, division director of central pharmacy at The Johns Hopkins Hospital in Baltimore, Maryland, grief can be an emotional, psychological, and physical reaction to loss and is most commonly experienced with the death of a loved one.¹

Direct grief is a personal loss, such as bereavement, divorces, miscarriage, and loss of a job.

Indirect grief is a loss that affects a community, such as a natural disaster, global pandemic, terrorist attack, and racial violence. Subtypes of grief include disenfranchised grief of which loss is not openly acknowledged, and anticipatory grief such as an upcoming retirement.¹

“(Grief is) a universal component of life,” Hill said. “However, even though its universal, it’s still very individual. Every person moves through the grieving process differently and at a different pace.”¹

According to Hill, acute grief is the initial response that can be intense and disruptive. Typically, acute grief is experienced by 80% to 90% of individuals, and is resolved within 24 months. Integrated grief is a permanent response following adaptation to a loss.¹

Hill outlined some of the emotional and performance impacts of grief. Emotions associated with grief include sadness, loss, uncertainty, guilt, regret, anger, and denial. Grief may also impact workplace performance with loss of focus, inconsistency, lack of ambition, disorganization, and disinterest.¹

Other potential impacts include finances, time off for travel, and upheaval in an employee’s personal life, as well as health issues. According to Hill, increases in risk of cancer, risk of hypertension, suicidal ideation, depression, alcohol use and other self-medicating substances, and hospitalization, as well as decrease in quality of life, can occur with grief. Also, appetites may increase or decrease as a result of a loss.¹

“This can read like a bad set of side effects for medication,” Hill said. “Developing tools to manage (grief) can be very important.”¹

According to Achey, grief can affect an organization as well as an individual; however, there are management strategies that can be used for addressing these issues.

“The challenge is that most people don’t know what to say so they either say nothing or they fear that they may say the wrong thing,” Achey said.¹

Psychological first aid in the form of a “postvention” can help alleviate possible negative effects of a death affecting the workplace. Immediate, short- and long-term steps make up an action plan in the aftermath of a death.

Immediate steps generally occur in the first 48 hours.

“The initial response of an organization sets the tone for what’s to follow so these steps can be extremely critical,” Achey said.

The first step is to coordinate with first responders, if needed; and with leadership to devise a message. Other immediate steps are to notify staff and communicate with accurate and appropriate information, and to offer support to the grieving family.

“You want to designate a point person to determine what’s most needed by the family,” Achey said.

Short-term postvention steps occur in the first few weeks. During this time, managers will want to identify employees in need of assistance and link them to resources that can help.

“There’s no one size fits all so you may need to link employees to different resources depending on what they need,” Achey said.

Providing comfort through various means, such as allowing time off for staff to attend a funeral, while also restoring functionality to the department and taking a lead by building trust and providing reassurance through the period of crisis and healing are other short-term steps. This period is where crisis communication is needed.

Longer term steps would honor the deceased individual and sustain support for staff. Imprinting a legacy can also help such as a charity event held in a lost colleague’s name.

Overall, managers should have compassion, listen to employees, have human resources cognizance, clarity on their role, and sensitivity in dealing with grief that impacts the workplace.

“There may be certain triggers to team members that you’ll want to be mindful of,” Achey said.

If needed, experts should be called to intervene. Managers can reach out to human resources, direct staff to employee assistance programs, a chaplain, or senior leadership within the organization.

“It’s not the manager’s job to solely solve the problem of a grief-stricken employee,” Achey said.

REFERENCES

• Achey TS, Hill JD. When Tragedy Strikes: Managing a Grieving Team. Presented at: 2020 ASHP Midyear Clinical Meeting and Exhibition; virtual: December 6, 2020.
• Harris R. Suicide in the workplace. Monthly Labor Review. US Department of Labor. Published December 2016. Accessed December 8, 2020. https://www.bls.gov/opub/mlr/2016/article/suicide-in-the-workplace.htm