newsletter - College of Pharmacists of Manitoba

Transcription

NEWSLETTER
www.cphm.ca
SPRING 2014
COLLEGE OF PHARMACISTS OF MANITOBA
IN THIS ISSUE...
2
Features
Winnipeg
Technical College
Now an Authorized Educational
Institution for the delivery of the
National Pharmacy Technician
Bridging Education Program
n
7
9
The College of Pharmacists of Manitoba
Annual General Meeting: April 26, 2014
n
n
n
n
NABP
Study Grant
Reminder about Prescribing Authority
InSixty: Improving the Cancer
Patient Journey
Promote
STOP! Clean your hands
Smoking
Cessation Program
day
n
Update
In Every Issue....
2
n
4
n
7
n
President’s Message
Focus on Patient Safety:
Quality Assurance in Pharmacy Practice
Canadian
Medication Incident
Reporting and Prevention System
(CMIRPS)
ractice Advisories: Safety First
P
when Compounding Clonidine
Suspension
8
n
10
n
Professional Development Update
11
n
Undergraduate Summer Employment Opportunity with the
College
12
n
2014 College of Pharmacists of Manitoba Awards
www.cphm.ca
The College of Pharmacists of Manitoba Annual General Meeting will be held during
the Manitoba Pharmacy Conference on Saturday, April 26, 2014, at the Winnipeg
Convention Centre, 375 York Avenue in Winnipeg. The meeting is scheduled to
begin at 11:00 a.m. in the 2nd Floor Presentation Theatre. Although the regulatory
body for pharmacy in Manitoba has been in place for 136 years, this is the first annual
meeting under the name of the College of Pharmacists of Manitoba. The Annual
Report and Financial Statements will be posted on the website in the coming weeks
and also available by hardcopy. (Contact the College office to request a hardcopy.)
Please review the College of Pharmacists of Manitoba AGM Agenda ,
also included as an enclosure to this newsletter, for additional meeting
information and note the following motion will be presented at the meeting:
Notice of Motion: Chris Louizos will move or cause to be moved, seconded by Sheila Ng “that
the College support the continuation of the $100.00 levy, per member’s annual license fee, to the
Faculty of Pharmacy, University of Manitba, for the 2015 licensing year.”
To register for the Manitoba Pharmacy Conference, please visit: https://www.
mbpharmacyconference.com/register_1.asp. Members do not have to be registered for the
conference to attend the Annual General Meeting.
Visit http://www.mbpharmacyconference.com/schedule.htm for the full conference
schedule or view the Vol. 39, No. 4, MSP Communication for the conference brochure.
2014 Election of Council: Voting Now Open
The College is in the midst of an Election of Council Members to serve for a two year
term, which begins immediately after the Annual General Meeting on Saturday, April
26, 2014. The voting packages were sent to the membership on Friday, March 7, 2014.
If you have not yet received your package, please contact the College at 204.233.1411.
Voting for the 2014 Election of Council is open until 4:00 p.m. Tuesday, March 25, 2014.
NEWSLETTER
THIS NEWSLETTER is pubished by the College
of Pharmacists of Manitoba and is forwarded to every
licensed pharmacist in the Province of Manitoba.
Decisions of the Manitoba Pharmaceutical Association
regarding all matters such as regulations, drug related
incidents, etc. are published in the Newsletter. The
College of Pharmacists of Manitoba therefore assumes
that all pharmacists are aware of these matters.
200 Tache Avenue, Winnipeg, MB R2H 1A7
Phone: (204) 233-1411 Fax: (204) 237-3468
E-mail: [email protected]
OFFICERS:
Kyle MacNair, President, Carman
Kristine Petrasko, Vice President, Winnipeg
Geoff Namaka, Exec. Treasurer, Winnipeg
Dr. Shawn Bugden, Past President, Morden
COUNCILLORS:
Dr. Neal Davies, Dean, Winnipeg
Jennifer Ludwig, Brandon
Glenda Marsh, Brandon
Dinah Santos, Winnipeg
Kurt Schroeder, Selkirk
Randall Stephanchew, Winnipeg
LAY MEMBERS:
Donna Forbes
Travis Giavedoni
LIAISON MEMBERS:
Lora Jaye Gray, C.S.H.P. (Mb. Branch)
Amanda Wallack, University of Manitoba-Student
Dr. Brenna Shearer, Manitoba Society of Pharmacists
Dr. Patricia Caetano, Manitoba Government
ASSOCIATION STAFF:
Ronald Guse, Registrar
Susan Lessard-Friesen, Deputy Registrar
Kim McIntosh, Assistant Registrar
Todd Mereniuk, Assistant Registrar
Kathy Wright, Executive Assistant to the Registrar
Bev Robinson, Administrative Assistant
Stacey Hjorleifson Administrative Secretary
Lita Hnatiuk, Communications & Quality Assurance Coordinator
Enclosures:
• College of Pharmacists of Manitoba AGM
Agenda
•
APRA National Drug Schedules Notice
N
Board
•
ISMP Oral Clonidine Suspension: 1000Fold Compounding Errors Cause Harm to
Children (Vol.11, No. 1, Feb.23/11)
•
Health Sciences Centre Extemporous
Compounding Manual for Clonidine 5 MCG/
ML Oral Syrup(Sept 24, 2007)
• Recreational Use of Bupropion
(Wellbutrin®; Zyban®)
•
NAPRA Notes, Vol. 9, Num. 1, Winter 2014
InSixty Communication Principles and
Guidelines
•
2
CPHM - SPRING 2014
Winnipeg Technical College now an
authorized educational institution for
the delivery of the National Pharmacy
Technician Bridging Education Program
The Winnipeg Technical College is
now offering in-person sessions of the
National Pharmacy Technician Bridging
Education Program. As mentioned
in previous newsletters, the National
Association of Pharmacy Regulatory
Authorities has developed a National
Pharmacy
Technician
Bridging
Education Program to assist individuals
already working in the role of pharmacy
assistant to upgrade their skills to align
with proposed changes in the scope of
practice of pharmacy technicians.
The Bridging Program course schedules
for Spring 2014 and beyond are now
posted on the NAPRA website: Course
and PLAR Schedules
Registration for all courses is conducted
directly with the educational institution
offering the program.
If you are interested in receiving email
updates on information pertaining to
pharmacy technicians and upcoming
regulation requirements or know of
pharmacy assistant who are interested,
please contact Stacey Hjorleifson at
VISION
Creating the framework for excellence in
Pharmacy Practice
MISSION
To protect the health and well being of the
public by ensuring and promoting safe,
patient-centred and progressive
pharmacy practice.
VALUES
The MPhA activities are based on the
following values and are the
foundation of what we do:
~Integrity ~ Respect ~Excellence
~Accountability ~ Collaboration
~ Life Long Learning~
[email protected] to be added to
our pharmacy assistant/technician email
distribution list. Please provide your full
name, email address, phone number and
workplace (if applicable). On February
18, 2014, the College of Pharmacists of
Manitoba hosted a presentation entitled,
Pharmacy Technician Update, to answer
questions
surrounding
pharmacy
technician regulation in Manitoba.
Please take the time to view this valuable
presentation under Previously Recorded
Programs on www.cphm.ca.
NABP Study Grant
The National Association of Boards
of Pharmacy (NABP)/ American
Association of Colleges of Pharmacy
(AACP) (US) District V has provided
information with respect to annual
study grants. District V of NABP/
AACP will make available grant
money, not to exceed $3,000.00 USD
per grant, to award two grants within
the District to study topics which
benefit students, pharmacy education
or pharmacy practice. Topics of interest
to the Boards and Colleges in District
Five are suggested, but researchers
will not be limited to these topics.
The Grant Recipients or designees
will present their report or findings
at the District V Annual Meeting
in the year following the award.
The study grant announcement has
been posted on www.cphm.ca.
Dear Members,
It’s been a momentous year for the College of Pharmacists of Manitoba Council, staff and members.
After eight years of work to create regulations that both the members and the Manitoba government
can support, the December 2006 Pharmaceutical Act came into effect on January 1, 2014, starting
a new era of patient-centred pharmacy practice.
PRESIDENT’S
Message
Council, College staff, Board of Examiners, Governance, Standards of Practice and Professional
Development Committees worked tirelessly on draft documents and practice directions in support of
the legislation, and regulations. The College released an Orientation to the New Practice Framework
Manual to help relay the changes in legislation to pharmacists.
As announced in the January 31, 2014, Friday Five, the College ran a transit bus advertisement
campaign in Brandon and Winnipeg, as part of a public awareness campaign. The six-week campaign
(January 27 – March 9, 2014) was part of a soft introduction of the new expanded scope of services
provided by pharmacists. In conjunction with the ad campaign the College created awebpage on
www.cphm.ca called, Health-care services provided by your pharmacist to help answer the public’s
questions around the new legislation. More public awareness of these services are planned for the
fall to coincide with the annual flu season.
Over the past few weeks, the College has been working with Manitoba Health regarding
pharmacists ordering tests. The College worked closely with the Manitoba Society of Pharmacists,
the Canadian Society of Hospital Pharmacists (Manitoba Branch) and many other stakeholders to
develop procedures in support of pharmacists ordering tests. The College has been asked to wait
for Manitoba Health to make their final decision on the insurance of tests ordered by pharmacists
before completing work on the practice direction that will guide this activity.
However, other important steps have been made to continue providing patient-centred pharmacy
practice and ensure safe pharmacy practice for the betterment of all Manitobans. Pharmacists are now
offering injections of drugs and vaccines. So far, over 200 certificates of authorization to administer
drugs and vaccinations by injection have been issued since the Application for Authorization to
Administer Drugs and Vaccinations by Injection was released January 9, 2014.
In addition, the training programs for smoking cessation and self-limiting conditions are now
available under Implementation of the December 2006 Pharmaceutical Act webpage. along with the
Application for Authorization to Prescribe a Drug Included in Schedule 3 to the Pharmaceutical
Regulation for Self-limiting Conditions and the Application for Authorization to Prescribe a Drug
Included in Schedule 3 to the Pharmaceutical Regulation for Smoking Cessation.The certificates
of authorization to perform these two expanded scope practices will be sent by the end of March.
However, other
important steps have
been made to continue
providing patientcentred pharmacy
practice and ensure
safe pharmacy practice
for the betterment of all
Manitobans.
It is important to receive feedback from pharmacists providing additional care and services
under the new legislation. Contact the College office by telephone, 204.233.1411 and ask for the
Communications Coordinator, Lita Hnatiuk, or email: [email protected] to give us your feedback.
Don’t forget, the College of Pharmacists of Manitoba Annual General Meeting will be held during
the Manitoba Pharmacy Conference at 11 a.m. Saturday, April 26, 2014, in the Presentation Theatre
at the RBC Convention Centre in Winnipeg. During this meeting, the College will present the
Annual Report and the new Council for the 2014-2016 term. To register for the Manitoba pharmacy
conference, please visit: https://www.mbpharmacyconference.com/register_1.asp
I hope to see you all there!
This is my last address for the Newsletter, as President of the College of Pharmacists of Manitoba
(College), formerly known as Manitoba Pharmaceutical Association (MPhA). And I am so very glad
that I was able to be the first President of the College, if only for a short while. This new legislation
remains a substantive and innovative piece of legislation that will allow Manitoba pharmacists to
join the wave of practice advancement sweeping the country.
Kyle MacNair, BSc.Pharm, ACPR
President, College of Pharmacists of Manitoba
3
SPRING 2014 - CPhM
FOCUS
on patient safety
Quality Assurance in Pharmacy
Practice
Building awareness for the
systems that can lead to
adverse events, changing
the culture to reporting and
learning from medication
incidents, are some of the key
factors in improving patient
The Mission of the College of Pharmacists
of Manitoba (College) is to protect the health
and well-being of the public by ensuring and
promoting safe, patient-centred and
progressive pharmacy practice. The core
function of the College therefore, is to ensure
quality standards are met in all areas that
comprise pharmacy practice and provide for
quality pharmacy care. These areas may be
seen as the layers of practice that support
safe, patient-centred and progressive
pharmacy practice.
They include the
pharmacy practice site environment,
legislation, standards and guidelines that
govern the practice of pharmacy, the
competence and performance of pharmacists
and the need to continually improve to affect
positive health outcomes for patients. For
the College, ensuring quality means
continually working to develop and assess
each of these layers of practice to create the
framework for excellence in pharmacy
practice.
safety.
Pharmacy Site Requirements
4
CPhM - SPRING 2014
The environment of the pharmacy practice
site can greatly influence the pharmacist’s
ability to provide quality pharmacy
care. Requirements for adequate space,
equipment, lighting and resources are only
a few of the site requirements that have
been established to enable the pharmacist to
practice effectively and safely.
Practice Support
Legislation, standards of practice, practice
directions, guidelines and joint statements
of practice developed with other health
professions help to guide pharmacists in the
provision of quality pharmacy care.
Pharmacists, pharmacy managers and the
College’s field office staff assess pharmacy
site requirements and practice support
through the Pharmacy Quality Assurance
Self-Assessment and onsite regular
inspection process.
Competence and Performance
Prior to initial registration and licensing
with the College, all pharmacists must
attain a successful entry to practice
qualification assessment by the Pharmacy
Examining Board of Canada. As with
all health professionals, maintaining
competence within the dynamic healthcare
system requires pharmacists to continually
upgrade their knowledge and skills through
continuing
professional
development
(CPD). Pharmacists in Manitoba rely on the
Learning Portfolio System, consisting of the
College’s Online Professional Development
(PD) Log and supporting documents, to
assist them in planning for, participating
in and reflecting on their CPD. The SelfAssessment component of the learning
portfolio is a tool to assist pharmacists in
identifying their learning needs. The onsite
regular inspection process provides an
additional opportunity for pharmacists to
identify learning needs.
There is evidence to suggest it may be
beneficial to strengthen the self-assessment
processes used by health professionals.
Therefore, the current direction is to provide
pharmacists with assessment tools that are
more informative and relevant to the actual
practice environment.
Currently, much
work is underway across the country and
in Manitoba to develop performance-based
assessment models that will more closely
mirror real life pharmacy practice and provide
an objective and perceptive evaluation of a
pharmacist’s practice to identify strengths
and areas for improvement.
Complaints Investigation and
Resolution Process
An important role of the College is to
respond to, investigate and resolve concerns
and complaints regarding a pharmacist’s
practice or the operation of a pharmacy.
Recap
The Continuous Quality Improvement
(CQI) concept is an approach to quality
that strives for excellence in practice and
improved patient health outcomes. CQI
involves examining pharmacy processes to
identify and learn from inefficiencies and
medication incidents in order to develop
efficient processes that improve patient
care and safety.
Patient engagement
and a mutual understanding of needs,
expectations, and decisions regarding their
healthcare are key in CQI to achieving
positive health outcomes and improving
patient safety.
Presently within the Canadian healthcare
system, there is a movement towards
interprofessional teams of health providers
working together in the community
and in institutional settings to provide
collaborative
patient-centred
care.
Evidence exists to support the concept that
collaborative patient-centred care improves
patient safety and health outcomes. The
College has taken a very active role
in facilitating collaborative patientcentred care through initiation of the
Interprofessional Continuing Professional
Development
(iCPD)
Manitoba
Network. The iCPD Manitoba Network
is comprised of representatives from
the provincial regulatory bodies for the
health professions, the Manitoba Institute
for Patient Safety (MIPS), Prescription
Information Services of Manitoba (PrISM)
, the Colleges of Nursing, Pharmacy and
the Interprofessional Education Initiative
at the University of Manitoba (U of M),
the Health Reciprocal of Canada, the CPD
Division of the Faculties of Medicine and
Dentistry at the U of M and the College’s
PD Program.
The learning portfolio system was
introduced in Manitoba 12 years ago.
While self-directed learning is a method by
which pharmacists maintain and enhance
competence, it is not itself a measure of
competence or performance. For this
reason the Councils of the day in 2005 and
2007 directed the PD Committee to review
performance assessments in use in other
jurisdictions and by other health professions
in order to develop recommendations on
additional performance-based assessments
that may be used to strengthen the College’s
overall Quality Assurance / Continuous
Quality Improvement Program.
At a Council retreat held in September
of 2008, the PD Committee provided
Council with recommendations on guiding
principles that would be followed in
developing recommendations as well as
information on additional assessment tools
that could be implemented. Subsequent
to this retreat, a smaller sub-group of PD
Committee members took on the task of
taking a closer look at each competency/
performance assessments to begin to
evaluate them with respect to meeting the
guiding principles.
The guiding principles are:
1. Always Improving
The need to design a program that would
support continuous quality improvement
for pharmacy professionals
2. Practice and Performance-based
Recognition of the value of assessing
pharmacist practice and performance as
compared to competency assessment alone
3. Relevant to Practice
Recognition of the impact of environmental/
external factors such as the pharmacist’s
physical
environment,
including
pharmacy systems and operations and
practice framework which, in addition to
competence, influence performance
4. Fair Assessment
Incorporating best practice models
for performance assessment that are
measurable, fair, valid and transparent
based on experience and evidence
provided by other sectors, industries and/
or jurisdictions
5. Using Existing Resources
The desire to develop a QA/CQI Program
that builds on existing infrastructure
including assessment tools and processes
in consideration of the limited resources
(financial, human resources, time) available
to both the pharmacist and the College
6. Practical
Envisioning a QA/CQI Program that would
be implemented in a staged approach as
available resources allowed
7. Meaningful
Adopting
a
communication/social
marketing
strategy
that
engages
pharmacists, the College and other
stakeholders in the initial stages and
throughout the development process to
solicit feedback and guidance that will
ensure the program effectively meets the
needs of all groups
At Council’s most recent strategic planning
session, it was determined that the College
should look at ways in which QA/CQI
Program can be improved by including
additional assessment processes that more
accurately reflect performance. It was also
suggested that the College consider a new
Quality Assurance Committee to oversee
this process and make recommendations
to Council on program improvements.
Surveying Our Members
In an effort to build on work
already completed, a survey was
developed in 2013 to
5
SPRING 2014 - CPhM
engage the membership in this process and gather feedback on the proposed guiding
principles and some potential assessment tools currently in use by other regulators.
A total of 233 (approximately17%) licensed practising pharmacists responded to the
survey. In summary, a majority of pharmacists responded that the guiding principles as
approved by Council in 2008 should not be changed (89.27%) and that there were not any
guiding principles that have been missed (93.13%).
Inter-Provincial Pharmacy
Regulatory Authority (PRA)
Quality Assurance(QA) Discussion
In 2013, two one-day interprovincial
PRA QA discussion sessions were held.
These sessions provided the PRAs with an
opportunity to discuss issues surrounding
quality assurance and continuous quality
improvement in pharmacy practice and
the performance-based assessment models
currently in use in various jurisdictions.
The two major outcomes of these
discussions were:
1.
Development of a national PRA
toolbox of assessment tools that may
be shared among the provinces; and,
2.
An initial plan for a trainer model
for the training of pharmacy inspectors
to conduct on-site performance-based
assessments of pharmacists, which will
include assessment of expanded scope
practices.
Looking Ahead
Of the seven guiding principles, a majority of pharmacists responded that the three of
greatest importance were that the program be continually improved, relevant to practice
and practical.
6
CPhM - SPRING 2014
In the coming months, the College plans
to enlist the membership’s views and
feedback on additional ways in which
performance-based assessment tools may
be used to improve the College’s QA/CQI
Program.
Pharmacy
Student/Alumni
Hockey Game
The pharmacy alumni and
students would like to thank
McKesson Canada and Shoppers
Drug Mart #542(Tuxedo) for their
support of the annual hockey
game. The game took place
Sunday, March 9, 2014, at the
Iceplex in Winnipeg. The score
sheet favored the students, but
then again, their plan is to join the
Alumni team! Congratulations to
both teams for participating and
their great team effort.
Reminder
About
Prescribing
Authority
Nurses:
The College of Registered Nurses of Manitoba
has established a register for graduate nurse
practitioners or RN(GNP). This designation
signifies that the RN has completed advanced
education (or has substantially equivalent
education and experience) and is waiting
to write an approved exam demonstrating
extended practice competencies, or has written
an approved examination and is awaiting
results. Registered nurses on the graduate
nurse practitioner register may use the title
registered nurse (graduate nurse practitioner)
or RN(GNP). However, a RN(GNP) cannot
work independently as a nurse practitioner and
must only prescribe under the supervision of
another currently registered Manitoba NP or
physician who agrees to supervise and co-sign:
•prescriptions
•
screening and diagnostic tests
•
minor surgical procedures
For more information on the register for graduate
nurse practitioners, please visit the College of
Registered Nurses of Manitoba website: http://
www.crnm.mb.ca/applicants-registers.php
The Prescribing Authority Table under
Additional Prescriber Information, on the
College of Pharmacists of Manitoba website is
an excellent resource for pharmacists and has
been updated with this new information.
Pharmacists:
Manitoba Health has informed the College of
Pharmacists of Manitoba that effective January
1, 2014, all 2014 licensed pharmacists have
been entered into DPIN as prescribers. The
individual pharmacist prescriber number has
the prefix of “X” followed by your five digit
pharmacist licence number (e.g.
X12345). A pharmacist will need to use this
prescriber number when entering a prescription
into DPIN that he or she has prescribed, when
authorizing a continued care prescription, or
when appropriate for adapting a prescription.
Canadian Medication Incident
Reporting and Prevention System
(CMIRPS)
CMIRPS is a national voluntary medication incident and ‘near miss’ reporting program founded
for the purpose of sharing the learning experiences from medication errors. Implementation of
preventative strategies and system safeguards to decrease the risk for error-induced injury and
thereby promote medication safety in healthcare is our collaborative goal.
Medication incidents (including near misses) can be reported to ISMP Canada:
(i) through the website: http://www.ismp-canada.org/err_report.htm or
(ii) b y phone: 416-733-3131 or toll free: 1-866-544-7672.
ISMP Canada guarantees confidentiality and security of information received, and respects
the wishes of the reporter as to the level of detail to be included in publications.
Institute for Safe Medication Practices Canada (ISMP Canada)
416-733-3131 or 1-866-544-7672 (1-866-54-ISMPC)
Email: [email protected]
Website: www.ismp-canada.org
ISMP Newsletter Subscriptions
ISMP Canada Safety Bulletins are designed to disseminate timely, targeted information
to reduce the risk of medication incidents. The purpose of the bulletins is to confidentially
share the information received about medication incidents which have occurred and to
suggest medication system improvement strategies for enhancing patient safety. The
bulletins will also share alerts and warnings specific to the Canadian market place.
The following ISMP Canada Safety Bulletins have been issued since the last issue of the
MPhA Newsletter.
2014 - ISMP Canada Safety Bulletins:
• Vol. 14 Issue 3 - Advancing Opioid Safety for Children in Hospitals
• Vol. 14 Issue 2 - Deaths Associated with Medication Incidents Occurring Outside
Regulated Healthcare Facilities
• Vol. 14 Issue 1 - Improving Vasopressor Safety
2014 - SafeMedicationUse.ca Safety Newsletters and Alerts for Consumers
•
•
Epipen or Epipen Jr? Your child’s weight matters.
Acetaminophen - Harm from Overdose Can Be Prevented
All issues of the ISMP Canada Safety Bulletins, including those issued in previous years, are
freely downloadable from the ISMP Canada website www.ismp-canada.org.
ISMP Canada is pleased to distribute The Medication Safety Alert! (US) newsletters along
with ISMP Canada Safety Bulletins to Canadian practitioners and corporations.
To subscribe and for more information on all ISMP Canada’s publications, events and
services visit the ISMP Canada website at www.ismp-canada.org .
If you have made changes in your pharmacy, which focus on patient safety and
that you would like to share with your colleagues, please contact Susan LessardFriesen at 204-233-1411.
7
SPRING 2014 - CPhM
PRACTICE ADVISORIES
for patient safety
Safety First when Compounding
Clonidine Suspension
Part of the Council’s
commitment to enhance the
quality of care and patient
safety in Manitoba pharmacies
was to instruct the Chair of the
Complaints Committee to issue
a report following meetings of
the Committee.
The intent of this report is
to inform pharmacists of
medication incidents thereby
providing an opportunity to
relate and reflect upon their
own practice with the goal of
improving patient safety.
8
CPhM - SPRING 2014
In the March 2011 issue of the Newsletter, we alerted pharmacists to reports of compounding
errors as a result of miscalculation during the preparation of clonidine suspension when using
clonidine powder. At that time, the Institute for Safe Medication Practices (ISMP) had just
published the ISMP Canada Safety Bulletin (Vol.11, No. 1, Feb.23/11), “Oral Clonidine
Suspension: 1000-Fold Compounding Errors Cause Harm to Children” outlining three
incidents of this compounding error. The safety bulletin suggested that contributing factors
to this compounding error include compounding the suspension from bulk powder, lack of a
pre-established written procedure and unfamiliarity with clonidine dosing, especially dosing in
children. Reports of the clonidine suspension compounding error continue and pharmacists are
requested to take note of this serious and potentially life-threatening error and change or confirm
their compounding practices accordingly.
Clonidine is being increasingly prescribed for use in pediatric patients and is usually dosed
in micrograms for pediatric patients. Clonidine powder is available in bulk bottles with a
labeled weight in grams. A miscalculation in the conversion from grams to milligrams and
then to micrograms can result in a suspension with a concentration 1,000 times greater than
prescribed. The ISMP recommends all pharmacies that dispense clonidine suspension develop
a standard written compounding procedure using commercially available tablets. The use of
clonidine tablets which are labeled in milligrams (as opposed to grams for the powder) reduces
the complexity of a calculation when converting to doses written in micrograms. The pharmacy
department at Winnipeg Children’s Hospital has provided their compounding procedure using
clonidine tablets for the preparation of clonidine 5 mcg/mL oral syrup. Further to improve
patient safety, it is suggested that pharmacies implement a system of independent double checks
to increase the likelihood of identifying calculation errors before a compounded product leaves
the pharmacy.
MPhA
Notice Board
Improving the Cancer Patient Journey
There’s a plan underway to improve the
quality and speed of service for patients
suspected of having cancer, to get through
diagnosis and into their first treatment (if
needed) in 60 days, or less. The In Sixty
initiative to improve the cancer patient’s
journey spans the entire health care system
in Manitoba. CancerCare Manitoba and all
Manitoba regional health authorities, as well
as providers such as Diagnostic Services
Manitoba, primary care physicians, health
professionals and patients are partnering
in the $ 40 M initiative to improve
cancer patient wait times in this province.
It is the responsibility of the health care
system, and all people within its employ, to
seek out the patient’s voice and to actively
hear that voice. Open communication
with patients should begin at the outset
of the patient’s journey and be sustained
throughout the patient’s journey. Every
person with cancer will have different
communication needs. Communication
approaches should be customized
to the individual patient’s needs.
Click to download PDF version of the
Cancer Patient Journey’s - “Communication
Principles and Guidelines” also included in
the newsletter as an enclosure.
For additional information on In Sixty,
visit http://www.cancercare.mb.ca/home/
health_care_professionals/cancer_patient_
journey/
If you have any questions about In Sixty, or
would like more information about getting
involved in this important initiative, please
contact:[email protected].
Promote STOP! Clean your hands day
The fifth annual STOP! Clean your hands day is Monday, May 5, 2014. Register
your pharmacy today to receive a free electronic package of materials to assist you in
promoting optimal hand hygiene practices in your organization. You can also order
additional hand hygiene and patient safety supplies through the Tools & Resources on
www.handhygiene.ca.
Your participation in STOP! Clean Your Hands Day represents
commitment to hand hygiene and reducing the spread of
to your efforts in past years, Canada is third to only the
the Philippines in terms of STOP! Clean Your Hands
Smoking
Cessation
Project
Update
The Pharmacist Initiated Smoking
Cessation Program has been working
with 15 pharmacies in the province
to recruit up to 100 Manitoba
Employment and Income Assistance
(EIA) recipients over the age of 18 to
participate in the smoking cessation
program. Following the February
28th deadline, 106 participants were
recruited into the program. Given
the short time frame, limitations of
winter, and difficulty finding people
from a specific target group, who
were not only thinking about quitting
but actually would commit to quit
with pharmacist intervention and
program supports, the professional
efforts and determination of
our
pharmacists
(and
their
colleagues and staff) was critical
for this number of participants.
The next phase of the program will
begin shortly. Stay tuned for updates
on this important initiative!
your organization’s
infection. Thanks
United States and
Day participation.
Register with the Canadian Patient Safety Institute at http://www.handhygiene.ca/English/
Events/StopCleanYourHandsDay/Pages/default.aspx to join the international movement
to promote hand hygiene and reduce the spread of infection.
9
SPRING 2014 - CPhM
Professional Development Update
Pharmacists Awarded Certificates of Life Long Learning
The following pharmacists have been awarded a Certificate of Achievement of Life Long Learning in Pharmacy in recognition of their
outstanding participation in professional development activities during the 2012- 2013 PD Year. Recognition is provided each year to
pharmacists who have participated in a minimum of 50 hours of professional development activities, of which, a minimum of 30 hours
involves participation in accredited learning activities.
The College congratulates the following pharmacists on their achievement:
Murvin Abas
Pietro Aiello
Robert Ariano
Marian Attia
Joanna Ayotte
Beth Backman
Manjit Bains
Melinda Barr
Melvin Baxter
Gail Baxter
Allison Bell
B. Marie Berry
Anwar Bhojani
Marnie Boyle
Corinne Brockman
Shawn Bugden
Traci Burke
Willson Caetano
Carolyn Capell
Dayna Catrysse
W. Gary Cavanagh
William Cechvala
Ryan Chan
Lengim Chen Ingram
Arnold Chew
Kawshik Chowdhury
Lois Clark
Leonard Clayman
Janice Coates
Cristina Concepcion
Louise Cooney
Marcin Cychowski
Sheril Cyriac
Lisa De Groot
Pritpal Dhanjal
Michael DiDomenicantonio
Betty Dong
Ryan Douglas
Ingrid Dueck
Erica Dueck
Cecile Dumesnil
Drena Dunford
James Duruaku
Brian Dusik
Akemi Ebata
Blair Einarson
David Elkin
Karin Ens
Crystal Evans
Rowena Fernando
Lindsay Filz
Evelyn Fletcher
Linda Foley
In Memoriam
10
CPhM - SPRING 2014
Rhonda Fusee
Jennifer Gibson
M. Claire Gillis
Alfred Gin
Lorraine Graham
Ronald Guse
Rebecca Hamilton
Krysten Harder
Muhammad Hasnain
Lorraine Hilderman
Tara Hoop
Lesley Hoy
Clinton Huber
Curtis Hughes
Shannon Hunter
Pamela Johnson
Russel Jose
Komal Kaler
Cheryl Kessler
Rhonda Kitchen
Meghann Klowak
Britt Kural
Conny Kwong
Danny Lee
Christine Leong
Susan LessardFriesen
Thomas Ling
Laureen Lipinski
Jugnu Lodha
Abe Loewen
Christopher Louizos
Melvin Love
Jennifer Ludwig
Dora Ma
Janice Macalino
Janice Magnusson
Amarjeet Makkar
Tara Maltman-Just
Kristopher Marcinowski
Julie Mark
Kimberly McIntosh
David McKay
Suzanne McKay
Meghan McKechnie
Anokhi MehtaSachdev
Chris Mendoza
Hajra Mirza
Stephanie Moroz
Russell Mutch
Arlene Nabong
Michael Namaka
Manuel Morry
December 20, 2013
Charlene Nikkel
Amanda Nunn
Olasumbo Ojo
Ravi Pandya
Joel Pankewich
Marie-Claude Paradis
Kimberly Perrett
Kristine Petrasko
Siegfried Pfahl
Olga Pozdirca
Mathilda Prinsloo
Sonal Bachu Purohit
Erin Ramalho
Connie Ricard
Derek Risbey
Janine Rivest
Gayle Romanetz
Jack Rosentreter
Ligy Russel
Dinah Santos
Adelaine Saria
Timothy Saunders
Chris Schellenberg
Gerri Scott
Raffaela Seed
Penny Shefrin
Adel Shenoda
R. Philip Loewen
December 30, 2013
Erika Simpson
Vishav Partap Singh
Robert L.J. Sitarz
Andrea Spillett
Barbara Sproll
Alice Studney
Chengfu Tang
Jennifer Thackeray
Meera Thadani
Tinu Thomas
Patricia Toth
Lyndsay van de Vijsel
Julia Walker
Ashley Walus
Jing Wang
Charlotte Warner
Elizabeth Wilson
Brooke Wilson
Gwen Wischnewski
Monica Wong
Horst Wuerfel
Amanda Young
Amir Youssef
Amy Yu
Osama Zaki
Anne Zoppa
George Brown
January 15, 2014
Videoconferencing
Videoconferencing is an expensive technology for program delivery owing to the high degree of technical
support necessary. One way in which costs may be reduced is to have volunteer videoconference site
coordinators trained to operate equipment and serve as the contact person to coordinate activities at the
far-end site.
We were very fortunate to have the following pharmacists agree to serve as our videoconference site
coordinators for 2013. To each of them, we extend our sincere thanks and appreciation for their time and
effort, which has allowed us to provide educational programs through videoconferencing to pharmacists
in rural Manitoba.
Kathy Adriaansen – Neepawa
Jay Boschman – Portage la Prairie/Brandon
Blaire Cairns - Grandview
Pat Cavanagh - Brandon
Lise Durand – Notre Dame de Lourdes
Victor Eyolfson - Arborg
Claire Gillis - Gimli
Joey Gwozdz – Steinbach
Brent Havelange – Russell
Melissa Jacobs - Gimli
Donica Janzen - Churchill
Chris Johnson – Killarney
Russ Keeler - Ashern
Christine Klimuk - Swan River
Ken Marek – Portage la Prairie
Martin Michaels - Hodgson
Whitney Mitchell - Roblin
Real Mulaire – St. Pierre
Spencer Reavie – Russell
Derrick Sanderson - The Pas
Trevor Shewfelt - Dauphin
Jennifer Thackeray – Thompson
Corey Thompson - Flin Flon
Dennis Walker – Portage la Prairie
Jeff Wooster – Morden/Winkler
Undergraduate Summer Employment Opportunity with
the College of Pharmacists of Manitoba
Each year, the College offers a pharmacy student the opportunity to learn more about the regulatory oversight of pharmacy
practice through a summer apprentice position. The successful candidate will be involved in research and reporting on pharmacy
practice projects, participation in Field Operations through attending onsite pharmacy inspections and contribution to projects
related to the expanded scope of practice and implementation of the new legislation. There is plenty to learn and get involved in
at the College, so apply today for this unique opportunity.
Please see the position posting,Undergraduate Summer Employment Opportunity with the College of Pharmacists of Manitoba,
or contact the College office at 204.233.1411 for more information.The deadline to submit completed letters of application is
Monday, March 31, 2014.
To apply, please forward letters of application, with an attached resume, to the Registrar, Ronald Guse, at [email protected]
11
SPRING 2014 - CPhM
2014 College of Pharmacists of Manitoba Awards
Congratulations to the following award recipients:
Bowl of Hygeia
Recipient: Janice Coates
The Pfizer Consumer Healthcare Bowl of Hygeia is in recognition of the time and
personal sacrifice devoted by pharmacists to the welfare of their respective community.
This award was established in 1958 and awarded to a pharmacist for outstanding
community service.
2013 Pharmacist of the Year
Recipient: W. Gary Cavanagh
This award is given annually to a Manitoba Pharmacist who, in the opinion of his/
her peers, has made a significant contribution to the profession during his/her career,
has been elected to office in provincial and / or national pharmacy organizations and
possesses high practice standards and innovation.
Bonnie Schultz Memorial Award for Practice Excellence
Recipient: Jennifer Gibson
The Bonnie Schultz Memorial Award for Practice Excellence is given on occasion to
a pharmacist or a group of pharmacists who demonstrate outstanding excellence in
optimizing patient care, serve as a role model, demonstrate superior communication
skills, display compassion, empathy and concern.
Patient Safety Award
Recipients: Scott McFeetors & Gayle Romanetz
This award recognizes the achievement of an individual pharmacist, a group of
pharmacists, an interdisciplinary group (that includes a pharmacist or pharmacists as
key participants) or a pharmacy organization that has made a significant and lasting
contribution to improving patient safety and health care quality through a specific
initiative or project.
Centennial Award
Recipients: Christopher Louizos, Kimberly McIntosh and Lavern
Vercaigne
The Centennial Award is presented to a pharmacist or pharmacists for a particular
project that has had a positive impact on pharmacy.
25 Year Members
1989 to 2014
Robert Ariano
T. Stuart Bellingham
Kelly Borisenko
Scott Davidson
Blondina Funk
Alan Gillis
Kevin Harris
Robert Hawkins
Nicholas Honcharik
Patricia Hunter
Stephen Khoe
Ernest Kiz
Shaun Kohut
Florence Kwok
Tan Luong
Tara Jean Martin
Michael McShane
Phuong Phan
Carla Strang
Kathryn Taback
Louise Van De Spiegle
Earl Winzinowich
Kenneth Zink
50 Year Members
1964 to 2014
J. Dexter Boyd
Barbara Cinnamon
Wayne Couling
Michael Dembinsky
Richard Stephanchew
Shirley Surbey
Awards Banquet and Luncheon:
The awards for the Bowl of Hygeia, the Pharmacist of the Year, the Bonnie Schultz Memorial Award for Practice Excellence, and
the Patient Safety Award will be presented at the Annual Awards Gala on Saturday, April 26, 2014, at the Delta Hotel, 350 St.
Mary’s Avenue, in Winnipeg, Manitoba.
The Centennial Award, 25 and 50 Year Member Pins, will be presented at the College’s Annual Awards Luncheon on Sunday, April
27, 2014, at the RBC Winnipeg Convention Centre.
Tickets for the Awards Banquet and Awards Luncheon are available from the Manitoba Society of Pharmacists at:
http://mbpharmacyconference.com/register.asp
University of Manitoba Faculty of Pharmacy Graduate Studies Awards
12
Congratulations to Jordyn Lerner, recipient of the Manitoba Pharmaceutical Association/William G. Eamer Graduate
Scholarship in Pharmacy. The scholarship was presented during the University of Manitoba, Faculty of Pharmacy
Graduate Studies Awards Reception on December 5, 2013.
CPhM - SPRING 2014
ANNUAL GENERAL MEETING
SATURDAY, APRIL 26, 2014 – 11 A.M.
Winnipeg Convention Centre
2nd Floor Presentation Theatre
375 York Avenue, Winnipeg, Manitoba
The Annual General Meeting of the College of Pharmacists of Manitoba is scheduled to
commence at 11:00 a.m. at The Winnipeg Convention Centre, in Winnipeg, at which time a
series of annual reports will be presented.
The reports will be presented for information and any issues arising from the reports will be
referred to the Issues Forum, which will occur in the afternoon.
AGENDA-ORDER OF BUSINESS
CHAIR – Kyle MacNair
1. Reading of the minutes of the 2013 Annual General Meeting
2. Business arising from the minutes
3. Executive Treasurer’s Report
4. Registrar’s Report
5. Deputy Registrar’s Report
6. President’s Address
7. Report of the Elections Committee
8. Committee and Liaison Reports (passed for information as a group)
9. New Business
10. Unfinished Business
11. Faculty of Pharmacy Report and Notice of Motion
Notice of Motion: Chris Louizos will move or cause to be moved, seconded by Sheila Ng
“that the College support the continuation of the $100.00 levy, per member’s annual
license fee, to the Faculty of Pharmacy, University of Manitoba, for the 2015 licensing
year.”
12. Omnibus Motion
13. Adjourn
The Order of Business is designed to allow the formal Annual General Meeting to complete
its mandate of closing the dealings that have been completed for the previous fiscal year.
Reports are to encompass that fiscal year only. Those issues requiring detailed discussion or
where resolution cannot be established will be forwarded to the Issues Forum to be held at
the Manitoba Pharmacy Conference.
Annual General Meeting – Rules of Procedure
1. A Notice of Meeting will be forwarded to the entire membership no less than twenty-one
(21) days prior to the scheduled meeting.
2. A quorum is required to convene a meeting and to transact any business. A quorum must
be at least 5% of the voting members in attendance.
3. A Parliamentarian will assist with parliamentary procedure as the need arises.
4. Robert’s Rules of Order will govern.
5. The Chair of the general meeting may permit discussion of motions that are for
information and do not require action by the College. Motions, either simple or by
resolution, accepted at an annual general meeting, or a special general meeting, requiring
action on behalf of the College shall be forwarded to Council for consideration and
decision.
6. All voting members must sign the attendance sign-in sheet.
7. Voting cards will be issued to all voting members.
8. All members and Council members may speak only once to any given resolution and
debate may be limited, unless permission to the contrary is given by the assembly.
9. All persons wishing to address the meeting are requested to speak at the microphone and
are further requested to identify themselves by name before speaking.
10. The Mover and Seconder can speak first, followed by other speakers. The Mover has the
option of being the last speaker to the motion.
11. Speakers must address the chair.
12. All members present are encouraged to engage in discussion, but only voting members
and Council members may make motions and vote.
13. The members of the College consist of the persons whose names are on the register and
who have paid the fees prescribed in the bylaws.
14. Every member who is a licensed pharmacist and members of Council are entitled to vote
at a meeting of the College.
15. Non-members and observers are welcome to attend, but are unable to engage in
discussion or vote.
16. Motion forms will be provided. Motions should be in writing on these forms and the
appropriate copy given to the Chair at the time of making the motion.
Clarification:
Only licensed pharmacists and Council members have the right to vote; however, all members
who are on the College register and have paid a fee for the current year can speak, but not vote.
Regarding the right to speak at meetings of the College, Robert’s Rules would apply and the
voting members (licensed pharmacists with a vote) and Council members attending the meeting
would decide in each incident whether or not an attendee at the meeting would have the right to
speak.
&
Federal Legislation
SPRING 2014
Please make all necessary changes on your copies of the National Drug Schedules and applicable
Federal Legislation. Updated copies of these documents are available on the NAPRA website at
www.napra.ca
NAPRA National Drug Schedules Notice Board
National Drug Schedules: Final Recommendation for bisacodyl 5mg tablets and 10mg
suppositories
January 24, 2014
The Initial Recommendation made by the National Drug Scheduling Advisory Committee
(NDSAC) on December 12, 2013 that:
• Bisacodyl - when sold in concentrations of 5mg or less per oral dosage unit or 10mg or less per
rectal dosage unit/suppository, in package sizes containing no more than 50mg of bisacodyl - be
granted Unscheduled status (from Schedule III)
• Bisacodyl and its salts [ except when sold in concentrations of 5mg or less per oral dosage unit
or 10mg or less per rectal dosage unit/suppository in package sizes containing no more than
50mg of bisacodyl ] - be retained in Schedule III.
was finalized effective January 21, 2014. Final approval of the initial recommendation was made
by NAPRA's Executive Committee, in consideration of comments received during the 30-day
review period. The National Drug Schedules will be revised accordingly.
NDSAC Meeting of March 9-10, 2014
March 17, 2014
A meeting of the National Drug Scheduling Advisory Committee (NDSAC) was held on March 910, 2014 to consider the following matters:
• Request for Schedule III status for minoxidil foam 5% for topical use
• Request for Unscheduled status for diclofenac and its salts, when sold as a single medicinal
ingredient for topical use on the skin in a concentration equivalent to 2% or less diclofenac for
not more than 7 days
In both cases, committee members decided to defer finalization of their interim
recommendation until additional information and clarification can be obtained and considered
by the committee. The scheduling sponsor in each case was advised of the additional specific
information and clarification requested.
The 30-day consultation period will not begin until the information and clarification requested
on these drugs is obtained and considered by the committee and a recommendation for
scheduling is finalized and forwarded to the NAPRA Executive Committee.
SPRING 2014
For a complete listing of the most recent changes to the National Drug Schedules, visit the
Drug Schedules Notice Board at www.napra.ca
-1-
The Institute for Safe Medication
Practices Canada (ISMP Canada) is an
independent national not-for-profit agency
established for the collection and
analysis of medication error reports and
the development of recommendations
for the enhancement of patient safety.
Volume 11, Number 1
The Healthcare Insurance Reciprocal
of Canada (HIROC) is a member
owned expert provider of professional
and general liability coverage and risk
management support.
ISMP Canada Safety Bulletin
February 23, 2011
Oral Clonidine Suspension:
1000-Fold Compounding Errors Cause Harm to Children
ISMP Canada has received 3 reports of children
experiencing harm because of errors during preparation of
oral clonidine suspension from clonidine powder. This
bulletin provides information about the incidents,
describes the dangers associated with clonidine overdose,
and suggests strategies to prevent recurrence of this type
of error.
Incident Reports
In each of the 3 incidents, a pharmacist working in a
community pharmacy used clonidine powder (provided in
containers labelled by weight, in grams) to prepare a
suspension for pediatric use. The prescribed doses for
clonidine ranged from 25 mcg (0.025 mg) to 125 mcg
(0.125 mg). In each case, there was a mix-up during the
conversions among grams, milligrams, and micrograms,
and the concentration of the suspensions dispensed was
1000 times greater than intended.
Each child required emergency treatment and admission
to hospital. Two of the children were admitted to the
intensive care unit, and one of these required treatment of
severe hypotension.
expert organizations that address ADHD and its
comorbidities.5,6 Clonidine is often dosed in micrograms
for pediatric use, whereas for adults, the dosing is
typically expressed in milligrams.
The therapeutic window for children is narrower than that
for adults, and compounding errors can lead to significant
harm. Among children, ingestion of 10 mcg per kilogram
body weight can result in severe overdose.7 In the 3
incidents described earlier, the children experienced
symptoms consistent with clonidine overdose, including
shallow breathing, sweating, and hypotension.
The most common signs of clonidine toxicity include
profound hypotension, bradycardia, and central nervous
system depression.8 Signs and symptoms similar to those
exhibited with narcotic overdose may also occur,
including respiratory depression (which may progress to
apnea), miosis (i.e., constriction of the pupils), muscle
flaccidity, and hyporeflexia.9 Although uncommon, early
hypertension may also occur in cases of severe clonidine
overdose because of activation of the peripheral alphaadrenergic receptors.9 Symptoms of overdose generally
arise within 30 minutes to 2 hours after ingestion, with
hypotensive effects peaking in 2 to 4 hours.8
Background
Clonidine is a centrally acting alpha2-adrenergic agonist
approved for use in Canada for the treatment of
hypertension (e.g., Catapres and generic agents; available
as 0.1 mg and 0.2 mg tablets).1 In addition to its use in
treating hypertension, clonidine (Dixarit and generic
agents; available as 0.025 mg tablet) has also been
approved for the relief of menopausal flushing in patients
for whom hormone replacement therapy is unsuitable.2
With the availability of newer and better-studied antihypertensives, however, the use of clonidine has waned
over the past couple of decades. With this less frequent
use of clonidine has come reduced familiarity with the
drug and its dosing.
Clonidine is also used for off-label treatment of several
conditions in the pediatric population.3 In particular, it is
often used as a first-line treatment option for pediatric
patients with tics.4 The use of clonidine in combination
with stimulant medications has been supported by various
Recommendations
Clonidine suspension is not commercially available, and
suspensions must be compounded individually. The
following strategies are suggested to prevent compounding
errors with clonidine:

Use a standard formula and worksheet to prepare oral
liquid clonidine, preferably one based on commercially
available tablets, such as the clonidine compounding
formulation available from The Hospital for Sick
Children in Toronto.10 This formulation does not
necessitate weighing of powder; instead, it uses a
specified number of tablets in a dose readily available
from manufacturers. The tablets are labelled in terms of
milligrams, which reduces the complexity of
converting a powder weighed in grams to a dose
prescribed in micrograms.
Ensure that effective, independent double-checks11 are
performed for critical steps in the process (identified on
1
Volume 11, Number 1

the worksheet) to increase the chance that errors are
identified.
In cases where practitioners must work alone, explore
options for independent double-checks. For example,
pharmacists who work alone can consult drug
information centres or collaborate with pharmacists in
other pharmacies for a check on calculations.
Encourage parents to bring to the pharmacist’s attention
February 23, 2011
any refill prescription that seems to differ, in terms of
appearance, taste, or instructions, from the previous
prescription.7,12,13
Other cases of clonidine overdose in children because of
compounding errors have been reported.7,12,13 It is hoped
that the sharing of information through this bulletin will
help to inform practitioners and reduce the potential for
recurrence of such incidents.
Acknowledgements
ISMP Canada gratefully acknowledges the expert review of this bulletin by (in alphabetical order):
Ross Evans BScPhm MA (Journalism), Child and Parent Resource Institute, London, ON; Elaine Lau BScPhm PharmD MSc, Drug
Information Coordinator, The Hospital for Sick Children, Toronto, ON; Ajit Ninan MD FRCPC DABPN, Assistant Professor,
Department of Psychiatry, University of Western Ontario, and Chief of Treatment, Child and Parent Resource Institute, London, ON;
Elaine Wong BScPhm, PICU/Medication Safety Pharmacist, Children’s Hospital of Eastern Ontario, Ottawa, ON; Ken Wou
BSc(Pharm), Pharmacy Consultant.
References – please refer to page 3.
Community Pharmacy Incident Reporting Program
ISMP Canada, with support from the Ontario Ministry of Health and Long-Term Care, developed the Community
Pharmacy Incident Reporting (CPhIR) Program (www.cphir.ca) to allow community pharmacies to document and
analyze factors contributing to errors in the medication-use system. Input from the Nova Scotia SafetyNET-Rx project,
and implementation across the province of Nova Scotia, has also facilitated quality improvements to the program.
CPhIR assists community pharmacy teams to develop and implement system-based strategies for improving the quality
of medication use in the community and for preventing medication-related incidents.
The program is designed to benefit provincial and national patient safety initiatives and contribute to the Canadian
Medication Incident Reporting and Prevention System (CMIRPS) (www.ismp-canada.org/cmirps.htm).
If you would like more information about the CPhIR Program, please contact ISMP Canada by email: [email protected] or by telephone: 1-866-544-7672.
Risk Assessment Program for
Medication System Safety in Community Pharmacy
The Medication Safety Self-Assessment (MSSA) for Community/Ambulatory Pharmacy was developed to assist and
guide individual community pharmacies in identifying opportunities to improve their medication-use systems. The
program’s self-assessment criteria are related to potential system improvements that have been identified through
analysis of medication incidents. Completion of this MSSA can be an important element of a community pharmacy’s
quality improvement initiatives.
The program’s web-based interface allows individual community pharmacies to compare their own results over time, thereby
tracking the impact of any changes made, as well as to compare their results with the aggregate results of other participants in
the program, both regionally and nationally. Several Canadian provinces have supported the use of this program as a
component of quality improvement. The program is also available at a reasonable cost to individual community pharmacies.
For more information about the MSSA program for community pharmacy, please contact ISMP Canada by email:
[email protected] or by telephone: 1-866-544-7672.
2
Volume 11, Number 1
February 23, 2011
Evaluation of Services Provided by ISMP Canada through
the Canadian Medication Incident Reporting and Prevention System (CMIRPS)
In 2010, ISMP Canada engaged Prairie Research Associates (PRA) Inc. to conduct an evaluation of the work that ISMP
Canada has delivered through the CMIRPS program. The evaluation (available from:
www.ismp-canada.org/download/cmirps/rptISMPC_CMIRPS_Final_Report.pdf) focuses on the impact of the products
and services offered by ISMP Canada, and the extent to which the work has resulted in changes to the healthcare system
across Canada. The evaluation identified several potential enhancements to services, which are being incorporated into
the organization’s future work plans.
ISMP Canada sincerely appreciates the time taken by the many Canadian practitioners who provided feedback and
participated in the evaluation.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Catapres [product monograph]. Boehringer Ingelheim (Canada) Ltd.; 2009 Apr 24 [cited 2011 Jan 17]. Available from:
http://webprod.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp (Health Canada Drug Product Database; search term “clonidine” as active ingredient).
Dixarit [product monograph]. Boehringer Ingelheim (Canada) Ltd.; 2007 Jan 20 [cited 2011 Jan 17]. Available from:
http://webprod.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp (Health Canada Drug Product Database; search term “clonidine” as active ingredient).
DRUGDEX evaluations: clonidine. In: MicroMedex 2.0 Healthcare Series. New York (NY): Thomson Reuters; c2002-2011 [cited 2011 Jan 31].
Available from:
http://www.thomsonhc.com/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/56DBF7/ND_AppProduct/evidencexpert/DUPLIC
ATIONSHIELDSYNC/417625/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.IntermediateToFullDocu
mentLink/docId/0069/contentSetId/31/title/CLONIDINE/servicesTitle/CLONIDINE
Srour M, Lespérance P, Richer F, Chouinard S. Psychopharmacology of tic disorders. J Can Acad Child Adolesc Psychiatry. 2008;17(3):150159.
Scahill L, Erenberg G, Berlin CM Jr, Budman C, Coffey BJ, Jancovic J, et al. Contemporary assessment and pharmacotherapy of Tourette
syndrome. NeuroRx. 2006;3(2):192-206.
Pliszka SR, Crismon ML, Hughes CW, Corners CK, Emslie GJ, Jensen PS, et al.; Texas Consensus Conference Panel on Pharmacotherapy of
Childhood Attention Deficit Hyperactivity Disorder. The Texas Children’s Medication Algorithm Project: revision of the algorithm for
pharmacotherapy of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(6):642-657.
Romano MJ, Dinh A. A 1000-fold overdose of clonidine caused by a compounding error in a 5-year-old child with attentiondeficit/hyperactivity disorder. Pediatrics. 2001;108(2):471-473.
Clonidine overdose in children. Philadelphia (PA): Children’s Hospital of Philadelphia, Poison Control Center; c1996-2011 [cited 2010 Dec 29].
Available from: www.chop.edu/service/poison-control-center/tox-talk/clonidine-overdose-in-children.html
Anderson RJ, Hart GR, Crumpler CP, Lerman MJ. Clonidine overdose: report of six cases and review of the literature. Ann Emerg Med.
1981;10(2):107-112.
Clonidine 0.1 mg/mL oral suspension. Toronto (ON): The Hospital for Sick Children, Pharmacy; [updated 2007 Apr; cited 2010 Dec 29].
Available from: www.sickkids.ca/pdfs/Pharmacy/2655-Clonidine.pdf
Lowering the risk of medication errors: independent double checks. ISMP Can Saf Bull. 2005 Jan [cited 2011 Jan 31];5(1):1-2. Available from:
www.ismp-canada.org/download/safetyBulletins/ISMPCSB2005-01.pdf
Farooqi MF, Seifert SA, Kunkel SJ, Johnson MI, Benson BE. Toxicity from a clonidine suspension. J Med Toxicol. 2009;5(3):130-133.
Suchard JR, Graeme JR. Pediatric clonidine poisoning as a result of pharmacy compounding error. Pediatr Emerg Care. 2002:18(4):295-296.
©2010 Institute for Safe Medication Practices Canada. Permission is granted to subscribers to use material from the ISMP Canada Safety
Bulletin for in-house newsletters or other internal communications only. Reproduction by any other process is prohibited without permission from
ISMP Canada in writing.
ISMP Canada is a national voluntary medication incident and ‘near miss’ reporting program founded for the purpose of sharing the learning
experiences from medication errors. Implementation of preventative strategies and system safeguards to decrease the risk for error-induced injury
and thereby promote medication safety in healthcare is our collaborative goal.
Medication Incidents (including near misses) can be reported to ISMP Canada:
(i) through the website: http://www.ismp-canada.org/err_report.htm or (ii) by phone: 416-733-3131 or toll free: 1-866-544-7672.
ISMP Canada can also be contacted by e-mail: [email protected]. ISMP Canada guarantees confidentiality and security of information
received, and respects the wishes of the reporter as to the level of detail to be included in publications.
A Key Partner in the Canadian Medication Incident Reporting and Prevention System
3
GENERIC NAME OF DRUG
CLONIDINE 5 MCG/ML ORAL SYRUP
Extemporaneous
Compounding
Manual
CLASSIFICATION
YIELD
PAGE
ANTIHYPERTENSIVE
100 mL
1 of 1
QUANTITY
# CAPS OR
TABS
INGREDIENTS
Clonidine 0.1 mg tablets
Water
Simple Syrup
5
WEIGHT OR VOLUME
(MG OR ML)
MANUF.
LOT #
EXPIRY
INITIALS
TECH/PHARM
0.5 mg (500 mcg)
2 mL
qs 100 mL
MATERIALS
mortar and pestle
graduated cylinder
amber prescription bottle - glass
METHOD OF PREPARATION
1.
2.
3.
4.
5.
6.
In a glass mortar with a glass pestle, grind clonidine tablets to a very fine powder.
Add water and mix with pestle to smooth paste.
Add 30 mL of simple syrup in 10 mL portions. Mix well with pestle to incorporate simple syrup.
Transfer the mixture to the graduated cylinder.
Rinse the contents of the mortar into the graduated cylinder with enough simple syrup to bring the final volume to 100 mL.
Transfer the solution to an amber glass prescription bottle and label.
PACKAGING
EXPIRY
120 mL amber, GLASS prescription bottle with child resistant cap
28 days refrigerated
LABEL
AUXILIARY LABELS
Clonidine 5 mcg/mL Oral Syrup
“X” mL
Batch #
Expires
Refrigerate
COMMENTS
1.
Recipe adapted from Clonidine 0.1 mg/mL Oral Suspension recipe, Reference #1. Using same stability as 100 mcg/mL conc.
Manufactured by:
Checked by:
Date:
Batch #:
Exp:
The information contained in this publication is of a general educational nature intended for the use by staff of the Winnipeg Regional Health Authority
(WRHA) and is in no way to be considered as medical or other professional advice. The authors, reviewers and publishers shall not be responsible for errors,
omissions, inaccuracies or continued completeness contained herein. The information in this publication should not be used or relied upon to replace the skill
and professional judgment required when determining appropriate patient care or treatment, to ensure compliance with any applicable laws or regulations, or
as a substitute for specific medical or professional advice from a licensed professional. The authors, reviewers and publishers disclaim all legal liability in
respect to the contents herein. The information contained in this package should be used as a guideline or for reference purposes only.
REFERENCES:
1. Calgary Health Region, Pharmacy Compounding Manual. 2006.
2. Am J. Hosp. Pharm. 1992; 49:122-5.
Last Revised: September 24, 2007
Recreational Use of Bupropion (Wellbutrin®; Zyban®)
Bupropion (Wellbutrin®; Zyban®) is an antidepressant and is used to treat a variety of
conditions including depression, other mental/mood disorders and smoking cessation.
Manufactured by GlaxoSmithKline, bupropion was first marketed as the anti-depressant
Wellbutrin®, and later re-launched as Zyban®, a smoking-cessation aid. The two (2)
drugs share an identical chemical structure and were differentiated only for marketing
reasons. http://www.cmaj.ca/content/169/11/1202.1.full
Brand names in Canada: (from “Up to Date” database available on the PCHA intranet)

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Ava-Bupropion SR;
Bupropion SR;
Mylan-Bupropion XL;
Novo-Bupropion SR;
PMS-Bupropion SR;
ratio-Bupropion SR;
Sandoz-Bupropion SR;
Wellbutrin SR;
Wellbutrin XL;
Zyban
Recreational users of bupropion crush the pills and inject or inhale the drug to achieve
what has been described as a crack cocaine-like “high”, however some individuals report
a less intense effect. The duration of the “high” is relatively brief and it is common for
other drugs to be ingested simultaneously (e.g. – mixed with crack cocaine; alcohol).
Anecdotal reports also suggest bupropion may be mixed with other medications such as
hydromorphone, as it gives an amphetamine like feeling to counter the sedative effects
of narcotics.
Injecting the crushed bupropion pills may result in a host of unpleasant side effects, and
can lead to death. The link below is an alert issued in Ontario by the Interim Chief
Coroner’s Alert to Ontario Physicians and Pharmacists:
http://www.cfpc.ca/uploadedFiles/Publications/_PDFs/130507%20Alert%20to%20Ontario%20Physicians%20and%20Phar
macists%20re%20Bupropion.pdf
This information was also summarized in a 2013 newsletter of the Nova Scotia College
of Family Physicians :
Lethal Consequences to Recreational Use of Bupropion (Wellbutrin®;
Zyban®) through inhalation and/or injection
Dr. Dan Cass, Interim Chief Coroner for Ontario, is alerting Ontario
physicians, particularly family physicians, emergency physicians,
psychiatrists, as well as pharmacists, of the potential lethal consequences of
the recreational use of bupropion through atypical routes.
The Office of the Chief Coroner is aware of at least six cases in which the
recreational use of bupropion by inhalation or injection was a causative
factor in the death. In these cases, bupropion was injected or inhaled alone
or in combination with other illicit or prescribed drugs. Injection use may be
associated with significant tissue necrosis at the injection site, leading to
death in some cases.
A public safety risk appears to be emerging. Physicians and pharmacists
should be aware of the potential for recreational use of bupropion via
inhalation or injection when considering prescribing and/or dispensing this
medication, and when treating patients presenting with complications of use
via these atypical routes.
From: http://www.nsfamdocs.com/
Injecting bupropion can cause damage at the injection site including: tissue damage;
skin abscesses; collapsed veins; and clogged arteries. This graphic photo shows the
damage at the injection site: (click to open)
Copy the link below to your browser to launch a PREZI presentation created by
Dr. James Truong, North Bay Regional Health Centre, North Bay, Ont.
http://prezi.com/i-ljzl4ofngd/wellbutrin-injection-a-novel-pattern-of-prescription-drugabuse/
Addiction Services has had reports of the recreational use of bupropion from clients in
the Withdrawal Management Unit in Pictou, as have our withdrawal management
colleagues in other areas of the province; however we have no formal data at this point.
NAPRA Notes
Highlights from the November 2013 Board meeting
The November meeting of NAPRA’s Board of Directors
always encompasses a 360 degree aspect: wrap-up of ongoing activities from earlier in the year, a review of items that
require decision to move to the next stage and an
examination of the planned activities/projects for the coming
6-12 months.
To that end, the Board concluded 2013 on a very positive
note celebrating the launch of the National Bridging Education
Program for Pharmacy Technicians™, approving the entry-topractice competencies document for both pharmacists and
pharmacy technicians and establishing two new ad hoc
committees to examine membership fees and continue
activities on compounding. The Board received a highly
interactive update on the progress of the international
pharmacy graduates (IPGs) project with a sneak peek at the
public-facing website and the enrolment screens for IPGs.
Finally, the Board conducted a prioritization exercise for their
activities in 2014. Priority will be placed on the revision of
NAPRA’s Guidelines to Pharmacy Compounding, the launch
of the Pharmacists’ Gateway Canada and the continuation of
the Bridging Program.
Vol. 9, Num. 1, Winter 2014
Welcome to 2014!
With a new year comes a
new look! NAPRA is
moving its newsletter to a
new format. This style
utilizes short, concise
articles that give you all
the news at a glance –
whether it is on your
desktop monitor, laptop or
smartphone.
National Bridging Education Program for Pharmacy Technicians™ – Program launch
and focus on the future
As NAPRA’s newest program, the Bridging Program was
developed in 2012-2013 on behalf of members to provide a
national curriculum that would assist individuals already
working in the role of pharmacy technician to upgrade their
skills to align with changes in the scope of practice of
pharmacy technicians, without returning to school to complete
a full-time training program. The program was launched
across Canada with Selkirk College (http://selkirk.ca/program/
pharmacy-technician-bridging-national-education-program)
providing the national online delivery of all course
components simultaneously with 10 additional authorized
educational institutions providing classroom program delivery.
Prior Learning Assessment and Recognition (PLAR)
examinations are also available at some authorized
institutions. Registration for all methods of program delivery in
the first semester totaled approximately 900 registrants. With
the second semester underway and two (2) new authorized
institutions delivering either classroom course or the PLAR
examinations, it is hoped that the National Bridging Education
Program for Pharmacy Technicians™ will continue its growth
in participant numbers.
Entry-to-Practice Competencies (Pharmacists and Pharmacy Technicians)
– To Be Released in 2014!
In order to reflect the significant changes in the scope of practice for both pharmacists and
pharmacy technicians since the last publication of NAPRA’s entry-to-practice competency
documents, a concurrent approach to review and update the content for both professional
groups was undertaken. Led by the National Advisory Committee on Pharmacy Practice
(NACPP), the documents underwent a process of development that included a review of
current practices in competency profile development, an environmental scan of emerging
practice trends, an examination of international competency and standards profiles for both
professions, focus group and workshop sessions with key participants and consultation with
stakeholders on draft versions of the document. The two (2) documents were approved by
NAPRA’s Board of Directors in November 2013 and are currently undergoing the final steps
prior to publication. The revised documents will be posted to the NAPRA website
(www.napra.ca) and distributed to stakeholders by the end of the first quarter of the year.
NAPRA would like to thank all of the individuals and groups who contributed to the development of these documents.
NAPRA Publishes First Ever Requirements Document for Practice Management
Systems
The National Association of Pharmacy Regulatory Authorities (NAPRA), through its advisory
committee the Council of Pharmacy Registrars of Canada (CPRC), set out to create a
document that would contain a series of essential requirements for pharmacy practice
management systems to have in order to support Canadian pharmacists in fulfilling their
standards of practice. Support for the development of this document was received from
multiple stakeholders in the profession: from practicing pharmacists to members of the
academic community as well as national/provincial representatives of e-health initiatives.
With its publication and release at the end of
2013, NAPRA’s Pharmacy Practice Management
Systems (PPMS): Requirements to Support
NAPRA’s “Model Standards of Practice for
Canadian Pharmacists” comprises 35
requirements, and supporting rationale, that
provide guidance for the tools/technology
manufactured to support pharmacists and
pharmacy technicians in their adherence to the
standards of practice and ultimately contribute to
the protection of the public. Fully cognizant that
the introduction of these requirements may have
an impact across multiple levels of pharmacy
operations, consideration was given to allow a
reasonable timeline to bring the requirements into
effect. The requirements contained in the
document will come into effect on January 1, 2016.
NAPRA’s Guidelines to Pharmacy Compounding – A Renewal
Compounding of pharmaceutical products is a fundamental and important part of pharmacy
practice. In 2012-2013, pharmacy registrars began the discussion on the revision of the
existing guidelines on pharmacy compounding. With the advent of the distressing events
surrounding the oncology under-dosing incident, the revision of the guidelines shifted to a
higher priority. Background work on the revised guidelines commenced in 2013 and now,
with the full support of NAPRA’s Board of Directors, a dedicated group of members will
continue to work throughout 2014 with a goal to produce an updated document by the end of
the year.
Pharmacists’ Gateway Canada Begins Transition to New Operational Program
With the Pharmacists’ Gateway Canada for international pharmacists set to go live in 2014, it
is necessary to ready the association for the transition from “project” to “operational
program”. As part of that transition, NAPRA recently welcomed two (2) new members to the
national office: Lance Miller and Kenty Servius joined the Gateway team in the capacity of
Client Services Agents. Lance and Kenty will provide direct client support for all international
pharmacy graduates (IPGs) utilizing this new service. They will also provide operational
assistance to the pharmacy regulatory authorities and The Pharmacy Examining Board of
Canada (PEBC). A warm welcome is extended to both Lance and Kenty.
While the new IPG team members are acclimating to their role in the project, work continues
by others to advance the rollout of the Gateway. Many elements of the project moved into the
test/validation stage. For example, the first stage of user testing of the two self-assessment
tools, with select IPGs, occurred in January 2014. The second stage of user testing, inclusive
of a broader audience of IPGs will take place in February 2014. It is anticipated that the first
IPG enrolment will occur by late spring 2014.
NAPRA Connections
Debbie McCulloch represented NAPRA at the 2013 International Pharmaceutical Federation
(FIP) Congress in Dublin, Ireland where she met with colleagues from around the globe and
attended sessions focused on the overall theme of the central role of the pharmacist in
delivering patient care in an increasingly challenging setting. Shortly after her return from
Europe, preparation was underway to continue her role as NAPRA’s representative to the
National Advisory Council on Prescription Drug Misuse. Ms. McCulloch delivered a
presentation to the attendees of a workshop sponsored by the Saskatchewan Ministry of
Health regarding the report developed by the Council and its sponsors. Most recently in
January 2014, Ms. McCulloch was an invited participant to a symposium on reducing
prescription drug abuse led by Minister of Health, Rona Ambrose, and co-hosted by the
Canadian Centre on Substance Abuse. Ms. McCulloch was encouraged by the overall
consensus among the participants to continue the forward momentum on this important issue
under the leadership of the federal government.
On the same topic of prescription drug misuse, Carole Bouchard, Executive Director,
delivered a presentation to the members of the House of Commons’ Standing Committee on
Health examining best practices and federal barriers regarding practice and training of health
care professionals as it relates to this topic. Additionally, Carole Bouchard and Susan Wedlake, Chair of the Council of Pharmacy Registrars (CPRC) met with new the new
Assistant Deputy Minister for the Health Products and Food Branch within Health Canada. This is
an important relationship for our association to maintain and foster. From this meeting a
greater understanding of NAPRA’s activities and the potential for collaboration with groups
within the Branch was explored.
Comments and suggestions are always welcome. Please send to [email protected]
Cancer Patient Journey
Communication Principles and Guidelines
Guiding Principle:
It is the responsibility of the health care system, and all people within its employ, to seek out the
patient’s voice and to actively hear that voice. All patient voices are important. Not all patients
will have the ability to self advocate in order to have their communication needs met. It is the
responsibility of the system to ensure all patients communication needs are met proactively, not
only those patients whom are able to self-advocate. Open communication with patients should
begin at the outset of the patient’s journey and be sustained throughout the patient’s journey.
Every person with cancer will have different communication needs. Communication approaches
should be customized to the individual patient’s needs.
Guidelines
Communication with patients should:
 Be individualized.
 Be truthful and transparent.
 Be consistent.
 Be in non-medical jargon – simple language.
 Be quality information.
 Be caring.
 Be active, interactive and proactive.
 Be ongoing, not one time.
 Be done in an appropriate setting and context.
 Be inclusive of patients and their families.
 Be culturally competent and responsive
In communicating with patients, providers and health care workers should:
 Listen to patients and act on the information provided by them.
 Understand what level of information the patient needs, and reflect that level of
information to the patient. Provide the big picture when required, and the specific details
when necessary.
 Ensure the patient and/or their families have the opportunity to ask questions, and ensure
that it is safe for questions to be asked. No question is irrelevant or unnecessary.
 Make an effort to ensure demonstrated understanding by the patient and / or family.
 Ensure the patient is not the conduit of information between areas of care. It is the
providers’ and health care system’s responsibility to transfer information between areas
of care, not the patient’s. Undertake the actions necessary to communicate between
areas of care.
 Take responsibility for communication to the patient and see it through to the end of an
active communication cycle by responding to questions. Do not delegate responsibility for
your communication as a provider to an alternate provider. If communications with a
patient are difficult for you, we recommend having a second person with you to support
the communication. A health care provider’s responsibility to communicate with patients
is ongoing; it does not end when you have delivered your perceived “portion” of the
information.
 Enable all communication to be two-way communication.
 Provide opportunities for patients to follow up with questions at later times.
CPJI Communication
Principles and Guidelines
-1-
Approved June 20, 2012