Pharmacy Regulatory Authorities Research Articles

The COVID conversations: A content analysis of Canadian pharmacy organizations' communication of pharmacists' roles and services during the COVID-19 pandemic.

The COVID-19 pandemic presented a unique challenge for pharmacists as they navigated information scarcity on the frontlines while being identified as information experts. Alberta pharmacists looked to their professional organizations for direction regarding what their roles should be in a crisis. The objective of this study was to explore pharmacists' roles and services and how they were communicated by pharmacy organizations during the first year of the COVID-19 pandemic. The study used a conventional content analysis method to explore the online communication of relevant pharmacy organizations for Alberta pharmacists. Five organization websites (National Association of Pharmacy Regulatory Authorities, Canadian Pharmacists Association [CPhA], Canadian Society of Hospital Pharmacists [CSHP], Alberta College of Pharmacy [ACP] and the Alberta Pharmacists' Association [RxA]) were examined to identify and catalogue publicly accessible documents that communicated pharmacists' roles and services during the first year of the pandemic for Alberta pharmacists. A total of 92 documents were collected from CPhA (60), CSHP (2), ACP (26) and RxA (4). While most documents communicated information about pharmacists' roles in public health, patient care and drug and personal protective equipment supply, more than one-third of the documents (32/92, 34.8%) required contextual information to interpret the communication. There was an observed shift in the communication after the first 6 months, becoming more direct in its messaging and context. These pharmacy organizations communicated information for pharmacists' roles and services to provide direction and guidance in the ever-changing context of the COVID-19 pandemic for Alberta pharmacists. Their communication became clearer and more direct as the pandemic progressed, requiring less inference to understand the intended message.

Safe handling of hazardous drugs.

Background: This evidence-based practice guideline was developed to update and address new issues in the handling of hazardous drugs including being compliant with NAPRA (National Association of Pharmacy Regulatory Authorities) and USP 800 (United States Pharmacopeia) standards, the use of personal protective equipment and treatment in diverse settings including in the home setting. Methods: This guideline was developed from an adaptation and endorsement of existing guidelines and from three systematic reviews. Prior to publication, this guideline underwent a series of peer, patient, methodological and external reviews to gather feedback. All comments were addressed and the guideline was amended when required. This guideline applies to and is intended for all health care workers who may come into contact with hazardous drugs at any point in the medication circuit. Results: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize the opportunity for accidental exposure. These recommendations are not limited to just the point of care, but cover the entire chain of handling of cytotoxics from the time they enter the institution until they leave in the patient or as waste. Conclusions: Decreasing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from previous guidelines due to new evidence.

Demonstrating institutional trustworthiness: A framework for pharmacy regulatory authorities.

Self-regulation is well suited for health care providers as the distinctive knowledge requirements can be effectively managed by those with the specific knowledge base compared to national or provincial/state governments. Despite their prevalence and long history in health care, self-regulating professions have become a topic of increasing debate as a result of evidence of declines in trust in a number of institutional contexts. It is important that Pharmacy Regulatory Authorities (PRAs), as the regulating body for a critical health profession, can demonstrate and proactively respond to issues related to public trust. Such capabilities are needed to address an overall decline in trust in self-regulated professions and allow PRAs to quickly address issues that may impact public trust within their own jurisdiction. However, a process and best practices that allow PRAs to demonstrate institutional trustworthiness to the public is lacking. Given the need from both a research and practice perspective, this research develops a conceptual framework of how PRAs can demonstrate institutional trustworthiness to the public. The literature was reviewed to identify dominant themes associated with regulatory practice that would serve to demonstrate institutional trustworthiness of PRAs to the public. Eight best practice themes emerged: public interest objective, transparency, engagement, accountability, independence, collaboration, adaptability, and awareness. The conceptual framework is comprised of six key steps, related to defining public interest orientation, implementing trust-related best practices, developing a communication strategy to increase public awareness of PRA activities, monitoring symbolic capital, assessing public trust in registrants (interpersonal trust), and assessing public and registrant trust in the regulator (institutional trust). Future research should develop pharmacy-focused instruments related to trust, establish baseline measures of registrant and public trust in pharmacy regulatory authorities, and explore issues of public trust in PRAs between different cultures and developed and developing countries.

Developing wipe sampling strategy guidance for assessing environmental contamination of antineoplastic drugs.

Surveillance for environmental contamination of antineoplastic drugs has been recommended by authoritative bodies such as the United States Pharmacopeia and the National Association of Pharmacy Regulatory Authorities. Clear guidance is needed on how to develop sampling strategies that align with surveillance objectives efficiently and effectively. We conducted a series of simulations using previously collected surveillance data from nine cancer treatment centers to evaluate different sampling strategies. We evaluated the impact of sampling 2, 5, 10, or 20 surfaces, at monthly, quarterly, semi-annual, and annual frequencies, while employing either a random or sentinel surface selection strategy to assess contamination by a single antineoplastic drug (AD) or by a panel of three ADs. We applied two different benchmarks: a binary benchmark of above or below the limit of detection and AD-specific hygienic guidance values, based on 90th percentile values as quantitative benchmarks. The use of sentinel surfaces to evaluate a three-drug panel relative to 90th percentile hygienic guidance values (HGVs) resulted in the most efficient and effective surveillance strategy.

Media Generation and Pharmacy Regulatory Authority Awareness.

Background: Professional regulatory authorities play a critical role in protecting public interest. Yet, there is a growing view that trust in regulatory authorities may be on the decline. Objective: Awareness has been identified as important for maintaining trust. However, research that examines public awareness and trust in pharmacy regulatory authorities (PRAs) is lacking. This research explores public awareness and trust of PRAs and presents recommendations to enhance PRA communication strategies. Methods: An online survey was conducted with the Nova Scotia (Canada) public in 2020. Adopting classifications from the Communications literature, 3 media generations were explored: newspaper, television, and the Internet. The χ2 test of independence and Kruskal-Wallis H test were adopted to explore differences between the generations. Results: Six hundred sixty-two usable surveys were obtained. Over 80% of those surveyed were aware of the existence of the PRA. Those who had heard of the PRA were most aware of its operational responsibilities and less aware of its governance. The Internet Generation was more aware that the PRA includes members of the public in its decision making than expected and showed increased trust toward the PRA versus the other media generations. Conclusion: The findings should help inform PRA communication plans and set baselines to assess whether such plans enhance awareness. Future studies should explore additional aspects of PRA awareness and trust, perform comparisons across pharmacy jurisdictions, and develop and test models of the relationship between PRA awareness and various dimensions of institutional trust.

Sterility testing using a closed system transfer device in oncology medication compounding: a novel method for testing partially used vials

BackgroundThe National Association of Pharmacy Regulatory Authorities (NAPRA) Model Standards for non-hazardous sterile preparations and the model standards for pharmacy compounding of hazardous sterile preparations, calls for partially used single dose vials to be used or discarded within six hours of first access. This may lead to significant wastage, particularly with less utilized and expensive medications like oncology treatments. If demonstrated that sterility of these partially used vials can be maintained through a compounding procedure, there may be an opportunity to consider their re-uses.ObjectiveThe primary objective is to determine the ability of a compounding procedure, including a closed system transfer device (CSTD), to maintain sterility for partially used vials at two compounding centres at Trillium Health Partners. A secondary objective was to evaluate a novel method for verifying sterility.MethodsA CSTD was incorporated into the standard compounding methods at two hazardous compounding centres. Using growth media to detect any bacterial or fungal contamination that might have occurred during compounding, storage, and repeated access, the vials were tested in various growth conditions.ResultsThere was no growth noted in all compounded samples. The CSTD, when used in our environment with certified personnel, maintained sterility for 14 days, even with repeated access.ConclusionsThis study demonstrates that under our local compounding procedure using CSTD we were able to maintain vial sterility when stored under typical conditions and accessed several times for up to 14 days. This method may be considered to assess a facility’s local compounding procedures and provide valuable information regarding storage and utilization of partial vials, which may result in reduced waste and cost avoidance for the health care system.

Medical assistance in dying: Examining Canadian pharmacy perspectives using a mixed-methods approach.

Background:Canada legalized assisted dying with the passing of Bill C-14, Medical Assistance in Dying (MAiD), in June 2016. This legislation has implications for health care professionals participating in MAiD. This research aims to understand the effect that MAiD has on pharmacists and pharmacy technicians in Canada.Methods:We conducted a thematic document analysis of pharmacy guidelines, position statements and standards of practice from pharmacy regulatory authorities across Canada. In addition, the Ontario Pharmacists Association surveyed its members (including pharmacists, pharmacy technicians and pharmacy students) about their perceptions of MAiD.Results:Our thematic analysis of the reviewed documents resulted in 3 major themes: pharmacists’ role in quality assurance, practice considerations when implementing MAiD and resources for pharmacy staff involved in MAiD. Survey responses illustrated that most (68%) pharmacy staff would dispense MAiD medications. Nonetheless, many respondents perceived that they lacked knowledge or comfort with different aspects of the MAiD process. Overall, 80% of participants reported a desire for professional development about MAiD.Conclusion:Despite the rapidly changing landscape surrounding medical assistance in dying within the past year, most pharmacy regulatory authorities have provided direction and resources to their pharmacists. Ontario pharmacists and pharmacy technicians are willing to dispense MAiD medications; however, additional support in the form of professional development may be necessary based on participants’ desire for education coupled with their perceived lack of knowledge. Future research may focus on the efficacy of provincial guidelines in supporting pharmacists’ participation in MAiD.

Assessing the evidence based medicine educational needs of community pharmacy preceptors within an experiential program in Qatar

IntroductionObservations have shown a lack of evidence-based medicine (EBM) knowledge and skills among community pharmacy preceptors in Qatar. These skills are important when delivering evidence-based recommendations to healthcare providers and patients. The aim of this study was to explore the community pharmacy preceptors’ knowledge and understanding of EBM and to identify challenges in applying this approach to community practice. MethodsA survey instrument was developed to assess the knowledge of community pharmacy preceptors related to EBM. Knowledge-based questions were mapped according to National Association of Pharmacy Regulatory Authorities professional competencies for practicing pharmacists. The survey tool was administered to community pharmacy preceptors involved in mentoring Qatar University College of Pharmacy students. ResultsTwenty-six community pharmacy preceptors completed the survey with a response rate of 65%. The knowledge-based questions linked to drug information resulted in 18%, 36%, and 46% of correct, incorrect, and unsure responses respectively while the critical appraisal questions showed 18%, 27%, 55% of correct, incorrect, and unsure responses respectively. Major barriers to practicing EBM included lack of EBM training (81%) and interpreting study results (80%). ConclusionsCommunity pharmacy preceptors showed poor knowledge and understanding of EBM. These results and expressed needs by pharmacists support the development of a supplementary course to improve EBM skills.

Take-home naloxone.

In 2016, naloxone was removed from the federal Prescription Drug List, and the National Association of Pharmacy Regulatory Authorities reclassified the drug as Schedule II, meaning pharmacists can dispense it without prescription.[1][1],[2][2] It is available in commercial formulations, including

Can Source Triangulation Be Used to Overcome Limitations of Self-Assessments? Assessing Educational Needs and Professional Competence of Pharmacists Practicing in Qatar.

Continuing professional development activities should be designed to meet the identified personal goals of the learner. This article aims to explore the self-perceived competency levels and the professional educational needs of pharmacists in Qatar and to compare these with observations of pharmacy students undergoing experiential training in pharmacies (students) and pharmacy academics, directors, and managers (managers). Three questionnaires were developed and administered to practicing pharmacists, undergraduate pharmacy students who have performed structured experiential training rotations in multiple pharmacy outlets in Qatar and pharmacy managers. The questionnaires used items extracted from the National Association of Pharmacy Regulatory Authorities (NAPRA) Professional competencies for Canadian pharmacists at entry to practice and measured self- and observed pharmacists' competency and satisfaction with competency level. Training and educational needs were similar between the pharmacists and observers, although there was trend for pharmacists to choose more fact-intensive topics compared with observers whose preferences were toward practice areas. There was no association between the competency level of pharmacists as perceived by observers and as self-assessed by pharmacists (P ≤ .05). Pharmacists' self-assessed competency level was consistently higher than that reported by students (P ≤ .05). The results suggest that the use of traditional triangulation might not be sufficient to articulate the professional needs and competencies of practicing pharmacists as part of a strategy to build continuing professional development programs. Pharmacists might have a limited ability to accurately self-assess, and observer assessments might be significantly different from self-assessments which present a dilemma on which assessment to consider closer to reality. The processes currently used to evaluate competence may need to be enhanced through the use of well-designed rubrics or other strategies to empower and to better inform respondents and subsequently improve their ability to self-assess their competencies.

Understanding the financial impact of beyond use date in a publicly funded cancer system.

13 Background: According to USP 797 and the National Association of Pharmacy Regulatory Authorities standards, the Beyond Use Date (BUD) based on sterility for single-dose vials is 6 hours, after which the contents must be discarded. In Ontario, centres have traditionally based BUD on stability data, not sterility data. This change presents concern about potential drug waste so an analysis was done to estimate the financial impact to the 76 systemic treatment facilities in Ontario. Methods: Using an administrative database that records the daily total dose of drugs administered by facility, annual drug waste cost was calculated using daily dose administered, cost per milligram, and available vial size(s) for 26 publicly funded drugs. Two different methods were used to determine the amount of drug waste. Method 1 used the largest vial size matched to the closest amount of drug required. Method 2 used the optimal vial size mix, when there are multiple vial sizes, to minimize wastage across all configurations of vial size. Some assumptions made include: 1) each facility had access to all available vial sizes, and 2) single-dose vial contents were true to the stated quantity as per the manufacturer. Results: The 10 facilities with the highest waste estimates are summarized in the table. The total waste estimates for all facilities are $25,927,861 (method 1) and $12,945,353 (method 2). Waste estimates were also calculated by drug, with rituximab, bevacizumab and pemetrexed having the highest waste costs. These drugs are only available in vials with a large range in size (100 and 500 mg), but could waste more than drugs with more size options or less variance between sizes. Conclusions: Assigning a BUD based on 6 hour sterility standards will have significant financial implications to facilities in Ontario. Development of mitigation strategies should be explored to provide guidance to Ontario and other jurisdictions on how to curtail the budget impact.[Table: see text]

Pharmacy awareness: a continuous process.

JCPH – Vol. 68, no 2 – mars–avril 2015 182 of Pharmacy Regulatory Authorities, the Canadian Pharmacists Association, the Canadian Association of Pharmacy in Oncology, the Association des pharmaciens des etablissements de sante du Quebec, the Canadian Patient Safety Institute, the Institute for Safe Medication Practices Canada, and the Canadian Association of Pharmacy Technicians. CSHP’s advocacy efforts at both the National and Branch levels are necessary and appropriate, but advocacy at the grassroots level is crucial. At the front line, dealing with the daily workload and patient care demands, individual practitioners often find it difficult to see how they personally can be advocates for change and for the profession. I would invite you to consider the possibility that each and every interaction that a pharmacist has with either a health care professional or a patient is a moment of advocacy, not just for the profession, but also for the patient. What a powerful combination.

Uptake of Quality-Related Event Standards of Practice by Community Pharmacies

Quality-related events (QREs), including medication errors and near misses, are an inevitable part of community pharmacy practice. As QREs have significant implications for patient safety, pharmacy regulatory authorities across North America are increasing their expectations regarding QRE reporting and learning. Such expectations, commonly encapsulated as standards of practice (SoP), vary greatly between pharmacy jurisdictions and may range from the simple requirement to document QREs occurring within the pharmacy, all the way to requiring that quality improvement plans have been put in place. This research explores the uptake of QRE reporting and learning SoP and how this uptake varies based on pharmacy characteristics including location, prescription volume, and pharmacy type. Secondary data analysis of 91 community pharmacy assessments in Nova Scotia, Canada, was used to explore uptake of QRE standards. Overall, pharmacies are performing relatively well on reporting QREs. However, despite initial success with basic QRE reporting, community pharmacy uptake of QRE learning activities is lagging.

Reflections on the role of the pharmacy regulatory authority in enhancing quality related event reporting in community pharmacies

Given the demanding nature of providing pharmacy services, coupled with the expanded scope of practice of the professions in jurisdictions around the world, greater commitment to continuous quality improvement through adoption of quality-related event (QRE) reporting is necessary to ensure patient safety. Pharmacy regulatory authorities (PRAs) are in a unique position to enhance QRE reporting and learning through the standardization of expected practice. This study was aimed to gain a better understanding of the perceived roles of PRAs in enhancing QRE reporting and learning in community pharmacies, and identifying regulatory best practices to execute such roles. A purposive case sampling approach was used to identify PRA staff members from two groups (Deputy registrars and pharmacy inspectors) in 10 Canadian jurisdictions to participate in focus groups in the fall of 2011. Focus groups were used to explore perceptions of the role of PRAs in enhancing and promoting QRE reporting and learning, and perceived barriers to effective implementation in practice. Thematic analysis was used to analyze the qualitative data. Two focus groups were conducted, one with seven Deputy registrars/Practice managers, and one with nine pharmacy inspectors. Five themes were identified, including (1) defining QRE reporting and compliance, (2) navigating role conflict, (3) educating for enhanced QRE reporting and learning, (4) promoting the positive/removing the fear of QREs, and (5) tailoring QRE reporting and learning consistency. Overall, participants perceived a strong role for PRAs in enhancing QRE reporting and learning and providing education for pharmacies to support their compliance with reporting standards. However, PRAs must navigate the conflict inherent in both educating and promoting a process for achieving a standard while simultaneously inspecting compliance to that standard. Ensuring pharmacies have autonomy in operationalizing standards may help to mitigate this conflict. Finally, greater education for PRAs themselves to better inspect compliance and in order to better communicate the benefits of QRE reporting and learning to pharmacies would be beneficial.

Pharmacists not Part of Current Regulatory Change on Prescribing Controlled Substances

The federal government is proposing regulations to allow nurse practitioners, midwives and podiatrists to prescribe medications containing legal controlled substances, provided they are authorized to do so by their provincial/territorial regulators. The proposed regulations, published in May 2012, would expand the list of health professionals eligible to prescribe under the Controlled Drugs and Substances Act, which currently includes physicians, dentists and veterinarians. Pharmacists are not included in the new list and the government is not open to expanding that list in the current regulations. However, the National Association of Pharmacy Regulatory Authorities (NAPRA) is building the case for pharmacists' inclusion in the future. “Health Canada has indicated that it is not going to add other health professionals to the list in this current regulatory process, but it is aware of the desire of NAPRA and other pharmacy organizations to have pharmacists designated under this act,” says Carole Bouchard, executive director of NAPRA. “We are leading discussions and work among our members to prepare information needed for a submission to the government.” Health Canada is going to provide NAPRA with more details about what documentation is required to put forward a request to add pharmacists. “We do know that the government will require us to demonstrate provincial/territorial support for having pharmacists conduct certain activities with controlled substances,” Ms. Bouchard says. “Definitely some level of support will be needed and our members will facilitate discussions with their provincial/territorial governments.” Work to develop the regulations for nurse practitioners and the 2 other health groups has been going on for several years; however, the government has indicated that the new expected framework that will guide the application process for adding other professionals should be helpful, according to Ms. Bouchard. “Health Canada… is aware of the desire of NAPRA and other pharmacy organizations to have pharmacists designated under this act” Gaining the authority to prescribe controlled substances is not a policy priority for the Ontario Pharmacists' Association (OPA), says executive director Dennis Darby. The OPA is, however, interested in the impact of expanding the list of prescribers in this area. “As more professionals gain these rights, it's important that we have the proper registries in place so that pharmacists have access to information on who is authorized to prescribe these substances.”

Plan B comes out from behind the counter

Canada has become the fifth country in the world to approve the off-the-shelf sale of levonorgestrel (Plan B), the emergency contraception drug, after the National Association of Pharmacy Regulatory Authorities recommended it come out from behind the pharmacy counter. “It's a good day for

Pharmacists and Natural Health Products: A systematic analysis of professional responsibilities in Canada.

PURPOSE: Natural health products (natural health products) such as herbs, vitamins and homeopathic medicines are widely available in Canadian pharmacies. The purpose of this paper was to conduct a systematic analysis of Canadian pharmacy policies and guidelines to explore pharmacists' professional responsibilities with respect to natural health products. METHODS: Legislation, codes of ethics, standards of practice and guidance documents that apply to the practice of pharmacy in each Canadian jurisdiction were systematically collected and examined to identify if, and how, these instruments establish professional duties in regard to natural health products. RESULTS: The majority of Canadian jurisdictions now include some explicit reference to natural health products in standards of practice policy or guideline documents. Often natural health products are simply assumed to be included in the over-the-counter (OTC) product category and thus professional responsibilities for OTCs are relevant for natural health products. A minority of provinces have specific policies on natural health products, herbals or homeopathy. In addition, the National Association of Pharmacy Regulatory Authorities' Model Standards of Practice specifically refers to natural health products. Most policy documents indicate that pharmacists should inquire about natural health product use when counselling patients and, when asked, should provide accurate information regarding the efficacy, toxicity, side effects or interactions of natural health products. Public messaging also indicates that pharmacists are knowledgeable professionals who can provide evidence-based information about natural health products. CONCLUSIONS: Explicit policies or guidelines regarding pharmacists' professional responsibilities with respect to natural health products currently exist in the majority of Canadian jurisdictions.

A 3-Year Commitment–Adventure

The first time a person is approached to run for a leadership position in a charitable or professional organization, he or she is compelled to think, “How much of a commitment will this be?” When one becomes involved on the presidential track at the national level of our organization, CSHP, the commitment is 3 years of service on the Executive Committee — as President-Elect, President, and Past President. The term “commitment” is defined in the Concise Oxford Dictionary as follows: • an engagement or obligation that restricts freedom of action • a pledge or undertaking. I’m sure that many of my predecessors (Kelly Babcock, Donna Pipa, Bob Nakagawa, Robin Ensom, Nancy Roberts, and Larry Legare, among others) would concur that the first definition does occasionally hit us smack between the eyes during that 3-year CSHP executive term. However, I know that they all accepted the commitment and responsibility because of the second definition — the “pledge”. People who follow the path of becoming CSHP President do so as a pledge to the membership, to the profession, and to the Society. Each individual who takes on this role wants to better our professional practice. Becoming involved at this level of leadership provides the opportunity to “make a difference”, and taking this pledge introduces one to a 3-year adventure complete with expected and unexpected challenges. In view of the recent changes in our executive “line-up”, it may be helpful for CSHP members to learn about the responsibilities that your executive officers carry for their 3-year terms. Each new presidential officer is assigned a portfolio that is carried throughout the 3 years of service on the Executive Committee. These 3 portfolios are designed to even out the workload that was once assigned primarily to the President. The portfolios also reflect CSHP’s Vision and keep responsibilities directed toward achieving the Vision. The Vision Liaison Officer is responsible for all initiatives directed at achieving CSHP’s Vision. Committees, task forces, and initiatives that fall under the guidance of this portfolio include Educational Services, Pharmaceutical Care Advisory, Resolutions, Strategic Planning, Pharmacist Prescribing, Seamless Care, Home Health Care, and, most recently, coordination of the decision process for a potential change in the Society’s name. The External Liaison Officer is responsible for all CSHP activities that occur in collaboration with government, faculties of pharmacy, professional organizations, and patient groups with which CSHP may collaborate. The presidential officer responsible for this portfolio must always ensure that CSHP’s external activities are in tune with CSHP’s Vision. Committees, task forces, and CSHP representatives and liaisons falling under the guidance of this portfolio include Drug Labelling and Packaging, Government and Health Policy Planning, Public Relations, Pharmacy Specialty Networks, Pharmacy Technicians, Medication Error Reporting System, Entry-Level PharmD Program, CAPSI–CSHP Poster Competition, and representatives and liaisons to more than 20 organizations, committees, and boards outside of CSHP (e.g., Canadian Pharmacists Association, American Society of HealthSystem Pharmacists, Association of Faculties of Pharmacy of Canada, National Association of Pharmacy Regulatory Authorities, Canadian Association of Pharmacy Students and Interns, Canadian Association of Pharmacy Technicians, and Pharmacy Examining Board of Canada). The Internal Liaison Officer is responsible for all internal CSHP activities that directly or indirectly bring the Society closer to achieving the goals set out in its Vision. Committees, task forces, and representation that fall under the guidance of this portfolio include Awards, Bylaws, Branch Web Site Development, Membership, Standards and Publications, Research, Bulk Compounding Guidelines Review, Standards of Practice Review, Latex Allergies, Review of CSHP National Committee/Task Force Structure and Method of Business, Board of Fellows, and the Canadian Hospital Pharmacy Residency Board. The “pledge” made by all volunteers who take on this level of CSHP leadership is fulfilled within the particular officer’s portfolio but also involves sharing in the decisionmaking of the other officers on the Executive Committee. Although the presidential officers’ responsibilities differ in nature, the Executive Committee (which includes the Executive Director, the Director of Finance, and the 3 presidential officers) always works as a team. This creates, as Kelly Babcock frames it, “a ton of email”; however, the end result is coordinated actions and initiatives that benefit the membership, the profession, and the Society. Restriction of freedom? Yes, sometimes. A pledge? Always. An adventure? You’d better believe it!