March/April 2010 - Ontario College of Pharmacists

Transcription

March/April 2010
New Electoral Boundaries
Coming in June
page 8
Pharmacy Technicians:
Staying on Track
page 10
President Stephen Clement at
U of T Induction Ceremony
Page 5
ontario college of pharmacists
483 Huron Street, Toronto, Ontario M5R 2R4 • Tel (416) 962-4861 • Fax (416) 847-8200 • www.ocpinfo.com
The mission of the Ontario College of Pharmacists is
to regulate the practice of pharmacy, through
the participation of the public and the
profession, in accordance with standards of
practice which ensure that our members
provide the public with quality
pharmaceutical service and care.
Council Members
Council Members for Districts 1-17 are listed below according to District number. PM indicates a public member appointed by the
Lieutenant-Governor-in-Council. U of T indicates the Dean of the Leslie Dan Faculty of Pharmacy, University of Toronto.
U of W indicates the Director, School of Pharmacy, University of Waterloo.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Joseph Hanna
Elaine Akers
Sherif Guorgui
Tracey Phillips
Donald Organ
Zita Semeniuk
Tracy Wiersema
Saheed Rashid
Bonnie Hauser
Gerald Cook
Christopher Leung
Peter Gdyczynski
Sanjiv Maindiratta
Stephen Clement
Jon MacDonald
Doris Nessim
Shelley McKinney
PM Joinal Abdin
PM Thomas Baulke
PM Corazon dela Cruz
PM Babek Ebrahimzadeh
PM James Fyfe
PM David Hoff
PM Margaret Irwin
PM Javaid Khan
PM Lewis Lederman
PM Aladdin Mohaghegh
PM Gitu Parikh
PM Joy Sommerfreund
U of T Henry Mann
U of W Jake Thiessen
Statutory Committees
• Executive
• Accreditation
• Discipline
• Fitness to Practice
• Inquiries Complaints & Reports
• Patient Relations
• Quality Assurance
• Registration
Standing Committees
• Communications
• Finance
• Professional Practice
Special Committees
• Standards of Practice Working Group
• Pharmacy Technicians Working Group
College Staff
Office of the Registrar x 2244
[email protected]
Registration Programs x 2250
[email protected]
Office of the Deputy Registrar/
Director of Professional Development
Pharmacy Connection Editor x 2241
[email protected]
Structured Practical Training Programs x 2297
[email protected]
Office of the Director of
Professional Practice x 2236
[email protected]
Office of the Director of Finance
and Administration x 2244
[email protected]
Investigations and Resolutions x 2274
[email protected]
Continuing Education Programs and
Continuing Competency Programs x 2273
[email protected]
Pharmacy Openings/Closings,
Pharmacy Sales/Relocation
[email protected]
Registration and Membership Information:
[email protected]
Pharmacy Technician Programs
[email protected]
Publications x 2229
[email protected]
contents
Enhancing MedsCheck, improving outcomes
7
New Electoral Boundaries to come into effect in June
8
Pharmacy Technicians: Staying on Track
10
New Summer Experience Course for U of T Students
13
Interprofessional study of transfer of care
14
Pharmacy Accreditation Renewals 2010
20
Best Practices for Dispensing Oral Liquids
26
Top 20 Continuing Education Topics
29
Pharmacy Technicians – page 10
regular features
Editor’s Message
4
President’s Message
5
Health Canada Notices
16
Did You Know... 17
Registration Q&A
18
SPT Q&A
19
Practice Q&A
22
Bulletin Board
24
Update on Technology
25
Focus on Error Prevention - Millilitres or Milligrams?
28
CE Resources
30
Laws & Regulations
31
Transfer of Care – page 14
Dispensing Oral Liquids – page 26
pharmacyconnection
July
• August
200817 • Number
Volume215 • Number 4
March/April
2010
Volume
The objectives of Pharmacy Connection are to communicate information on College activities and policies; encourage dialogue and to discuss issues of
interest with pharmacists; and to promote the pharmacist’s role among our members, allied health professions and the public.
We publish six times a year, in January, March, May, July, September and November. We welcome original manuscripts (that promote the objectives of the
journal) for consideration. The Ontario College of Pharmacists reserves the right to modify contributions as appropriate. Please contact the Associate Editor
for publishing requirements.
We also invite you to share your comments, suggestions or criticisms by letter to the Editor. Letters considered for reprinting must include the author’s
name, address and telephone number. The opinions expressed in this publication do not necessarily represent the views or official position of the Ontario
College of Pharmacists.
Stephen Clement, R.Ph., B.Sc.Phm.
President
Deanna Williams, R.Ph., B.Sc.Phm., C.Dir., CAE
Registrar
Della Croteau, R.Ph., B.S.P., M.C.Ed.
Editor, Deputy Registrar,
Director of Professional Development
[email protected]
Anjali Baichwal
Associate Editor
[email protected]
Agostino Porcellini
Production & Design / Webmaster
[email protected]
ISSN 1198-354X
© 2010 Ontario College of Pharmacists
Canada Post Agreement #40069798
Undelivered copies should be returned to the
Ontario College of Pharmacists. Not to be reproduced
in whole or in part without the permission of the Editor.
Neil Hamilton
Distribution
[email protected]
10%
Cert no. SW-COC-2036
Cover Photo by Lisa Sakulensky
editor’s message
Della Croteau, R.Ph., B.S.P., M.C.Ed.
Deputy Registrar/Director of Professional Development
Can we transform the pharmacy culture?
A
s we begin meeting with
stakeholders and members
about the new scope of
practice, the article by Rosenthal,
Austin and Tsuyuki (Are pharmacists
the ultimate barrier to pharmacy
practice change?, CPJ, Vol 141,
January-February 2010, pp.37-42)
resonates. Rosenthal et al have described our pharmacy culture as
having a lack of confidence, fear of
new responsibilities, paralysis in the
face of ambiguity, need for approval
and risk aversion. They suggest that
this is the barrier in shifting from the
dispensing and technical functions to
those focused on patient outcomes.
During our discussions with pharmacists, when we outline the new
scope of practice, and ask them
whether they can do this now, most
of them nod their heads and agree.
They tell us that except for giving
injections, they are already doing, or
are able to do, the things outlined in
the new scope. But then concerns
arise as pharmacists worry about
making these decisions without calling the physician, or wonder what
they are liable for or where they
might get into trouble. Much as it
might be a hard pill for many of us
to swallow, we have seen evidence
4
pharmacyconnection • March/April 2010
of the culture described by Rosenthal et al as we try to advance the
role of the pharmacist. While a few
brave souls have truly advanced
their practice, the rest of us have
played it safe, doing the things that
are familiar to us. We have complained that the legislation doesn’t
allow us to, doctors are too difficult
to work with, we don’t have access
to the patient chart, our employers
don’t support us in these activities,
we don’t get paid for that or that
we are just too busy doing what we
have always done.
The truth is that we have never
before been at such a great place
to advance the profession. Legal
authority, which we never thought
would happen, is being given to pharmacists across the country to provide
a greater level of patient care. And
though payment schemes are not
where we would like them to be,
governments across the country are
in discussion about payment to pharmacists for cognitive services. Our
universities are revising their curricula to be equivalent to an entry-level
Pharm D program. The quality of
continuing professional development (CPD) programs for improving
pharmacy practice has never been
greater, or more available to all
pharmacists through advanced technology. And, this year will also see
the introduction of regulated pharmacy technicians who have been
trained to be our responsible partners in the drug distribution systems.
It is going to be difficult not to move
forward with all this going for us.
Rosenthal et al suggest that our
“high flyers” have already advanced
their practice and will be successful,
while those at the opposite end of
the spectrum are only carrying out
the technical aspects of dispensing
and will be replaced by pharmacy
technicians. It’s the majority of us
who are muddling around in the middle, who can really make a difference
here! Can we overcome the culture
in which we have always practiced?
I never thought I would see pharmacists prescribing in my practice
lifetime. Would it be too much to see
a transformation of the pharmacy
culture too?
president’s message
Stephen Clement, R.Ph., B.Sc. Phm.
President
The future is in our hands
R
intelligent, polite, and brimming
with enthusiasm at their future;
anxious to roll up their sleeves and
start down the path to a career in
pharmacy. At both those events,
the most common question asked
by the students was, “What should
I do to best prepare for my career?”
Oh, if I only I could capture 30-plus
years of experience in one compact
answer! How would I ever convey that to them? What I did say
was that their career choice is not
only rewarding and challenging, but
changing. It donned on me then,
Photo by Lisa Sakulensky
ecently, I had the privilege
of attending the induction
ceremonies for first year
pharmacy students at both the
University of Toronto and the University of Waterloo. Each provided
me with a most amazing opportunity to witness the future of our
profession. The actual ceremony
at both institutions was outstanding, combining tradition and ritual in
modern, state-of-the-art settings.
But what impressed me most and
stayed with me were the students I
met. Each of them was so incredibly
University of Toronto White Coat Ceremony
more than ever, that we, as a council and profession, are at a crucial
moment in time. The decisions we
make today as a Council will shape
not only the future of those young
members of the Class of 2013, but
the future of pharmacy in Ontario.
By decisions, of course I am referring to those we are making as
we draft regulations supporting
the Health Professions Statute
Law Amendment Act (which was
passed as Bill 179 in December)and
the Ontario Labour Mobility Act
(passed as Bill 175). Now they have
both been proclaimed, the College
is drafting regulations to bring them
into practice.
With the Ontario Labour Mobility Act, which provides for mobility
of professionals, including pharmacists, between provinces, we don’t
anticipate that the regulations will
have a significant impact on our
registration processes. The College
has been involved for some time in
discussions nationally around mutual
recognition and the registration panels have been making decisions in
the spirit of labour mobility.
The Health Professions Statute
Law Amendment Act (Bill 179) is
more complex. The Act enables
5
several things, including the new
scope of practice for pharmacists
and other health professionals,
and those regulations under the
Drug & Pharmacies Regulation Act
(DPRA) that will enable remote
dispensing. Combined with this is
the authority to register and regulate pharmacy technicians in 2010
which will become a reality upon
the government’s acceptance of the
registration regulations.
As we draft these regulations and
await acceptance of others, Council
is mindful that the Act (Bill 179) encompasses all components, and that
all the regulations developed must
compliment each other. We are,
therefore, developing these regulations together, not one at a time.
Each initiative—scope of practice,
remote dispensing and registered
pharmacy technicians— will fit with
the next so that there are no areas
of disconnect. The result will be
an effective context in which these
new roles, responsibilities and activities can come to life.
At every step along the road to
developing these regulations, there
will be consultation with the government, stakeholders and members to
ensure that what we develop under
the new legislation is aligned. As
eager as we are to get these regulations drafted, circulated and passed,
we are equally aware of the need to
take the necessary time to ensure
that they are developed thoroughly,
in the full context of our mandate—
acting in the best interests of public
safety. The task before us bears
responsibility we have not seen in
many years; responsibility that will
affect not only you and I both, but
all future graduates and beyond. I
look forward to working with you in
these efforts.
The College recently hosted colleagues from Ireland who were here to gain insight into OCP’s Continuing Competency
Programs, and especially the Quality Assurance Practice Review Process. Observation of the Practice Review weekend, and the
ensuing dialogue served not only to inform the Irish delegation, but provided useful feedback on the OCP process.
From left to right: Dermot O’Flynn of the Royal College of Surgeons in Ireland (RCSI), Sandra Winkelbauer, OCP’s Manager of
Continuing Competency Programs, Registrar Deanna Williams, Lorraine Horgan of the Pharmaceutical Society of Ireland (PSI),
Dr. Paul Gallagher, PSI Council Member and RCSI lecturer, Hugh Carroll of RCSI, Professor June Nunn, PSI council member and
Dublin Dental School and Hospital faculty, Deputy Registrar Della Croteau, and OCP President Steve Clement.
6
MedsCheck
Enhancing MedsCheck,
improving outcomes
New workshop aimed at Best Possible Medication History a great success
Lindsay Yoo, BScPhm Candidate
School of Pharmacy, University of Waterloo
Co-op Student, Research Analyst Assistant, ISMP Canada
S
tudies have shown that medication reconciliation—through
conducting a best possible medication history or
BPMH— in hospitals can help prevent the incidence of
medication discrepancies. In Ontario, community pharmacists have been offering MedsCheck, a medication review
service, to patients since 2007. MedsCheck provides an
opportunity for community practitioners to perform a
BPMH which can catch medication discrepancies, potentially preventing adverse drug events.
In 2009, with the support of the Ontario Ministry of
Health and Long-Term Care, ISMP Canada delivered 14
educational workshops entitled “Enhancing MedsCheck:
Conducting a Best Possible Medication History and Resolving Medication Discrepancies” to 667 pharmacists,
pharmacy technicians and students throughout various
continuing education (CE) regions in Ontario. This workshop has been accredited with two CE units by the Ontario
College of Pharmacists. The workshops were aimed to
help prepare healthcare providers to conduct an efficient,
accurate, and comprehensive BPMH during MedsCheck
within their workplace. Further information on MedsCheck,
medication review and creating the best possible medication history can also be found in the September/October
2007 and November/December 2007 issues of Pharmacy
Connection (available at www.ocpinfo.com).
Feedback from the workshop shows that pharmacists
are aware of the importance of conducting a BPMH to
Certina Ho, BScPhm, MISt, MEd
Project Manager, ISMP Canada
support seamless care across the
different interfaces of healthcare.
Two suggestions were consistently brought up during the
sessions:
1. Incorporating BPMH tools or MedsCheck documentation forms into the technology or dispensing system in
community pharmacies. Participants said such a system
would be helpful for communicating patient information
and ensuring legible and up-to-date information being
transferred properly at various points of care.
2. I ntroducing a standardized BPMH or MedsCheck
documentation form. At a minimum, introducing such
a form among health services organizations within the
same neighbourhood would assist healthcare practitioners in transcribing information as patients move from
one health care setting to another.
These education seminars would not have been possible
without the support of OCP’s Continuing Competency
Department and the commitment of the CE Regional
Coordinators. Their dedication and efforts for taking the
time to organize and coordinate these events were greatly
appreciated. The authors would also like to acknowledge
contributions to the workshop by Olavo Fernandes, BScPhm, ACPR, PharmD, FCSHP of the University Health
Network, Roger Cheng, BScPhm, PharmD, Margaret
Colquhoun, BScPhm, and Alice Watt, BSc (Pharm) of
ISMP Canada.
7
electoral boundries
New Electoral
Boundries
to come
into effect
in June
A
s you are aware, the College has been
working hard to effect the regulation
of pharmacy technicians in 2010. One
of the pieces relates to the governance of the College and how those
new members will have a voice at the Council table.
A special working group convened in 2007 to amend
electoral boundaries and districts to accommodate two
new pharmacy technician seats on Council. The College has been working on revising by-laws to effect
the changes necessary so that this new electoral system can be in place for this June 2010. The changes
can be summarized as follows:
8
p
n
l
m
k
• Legislation prescribes that the total number of seats
on Council will remain the same: 17 elected
members, plus up to 16 appointed members
and the Deans of each Faculty of Pharmacy in
Ontario.
• Currently two of the elected seats are represented
by members who declare hospital pharmacy as their
place of practice and 15 seats from the membership
at large representing 15 distinct geographic districts.
• Under the new system, two seats will be represented
by hospital pharmacists (as is the case now, but from
anywhere in Ontario).
• Two seats will be represented by pharmacy technicians (one each from hospital and community
practice).
• Thirteen seats will be represented by pharmacists at
large, with three seats elected from each of Postal Code
district L, M and N, and two seats from each of Postal
Code district K and P.
To transition from our current electoral boundaries, the
terms of office for members elected in 2008 and 2009 will
expire in Summer 2010.
Elections will be held across the province for all new
districts in 2010.
Terms of office will initially be staggered with some
districts serving one or two year terms until all future
elections will again settle into our current pattern of three
year terms (see chart above for details). This will ensure
continuity of Council with approximately one-third of
Council seats coming up for election each year.
More information on elections will be sent to members
as the dates for nominations and elections draw nearer.
9
pharmacy technicians
Staying on Track
There continues to be a lot of activity regarding the regulation of
pharmacy technicians. Here is a summary of the recent accomplishments and
upcoming opportunities to complete the registration requirements.
10
PEBC Evaluating Exam
Now offered twice annually, the next available exam is fall
2010. This exam is the first step for individuals currently
working in pharmacy (except for new CCAPP graduates)
and must be completed by January 1, 2012, to move forward. Go to www.pebc.ca for details.
Bridging Program
• A ll four Bridging courses have been implemented for
classroom delivery in a growing number of communities. Registration for spring Bridging courses has begun
– check the OCP website for details.
• O nline delivery of the Bridging courses has started.
Professional Practice has 250 students enrolled for the
winter semester. Pharmacology and Drug Distribution
will be added this spring. The next session of on-line
delivery for all three of these courses will begin May
14, 2010. Registration has begun.
• T he Prior Learning and Assessment challenge exams
for Pharmacology and Drug Distribution have been
introduced. Registration details are available at each
community college.
PEBC Qualifying Exam
• A second pilot of the PEBC Qualifying Examination for Pharmacy Technicians will be held in March
with approximately 160 eligible pharmacy technicians.
The first regular sitting of this exam will be offered
August 28th and 29th for all eligible candidates.
Go to www.pebc.ca for details.
Structured Practical Evaluation (SPE)
and Training (SPT)
• T he SPE (which is an evaluation of the technician’s
11
pharmacy technicians
ability to accurately complete an “independent double
check” of 500 prescriptions/orders) is being piloted with
candidates from the first and second PEBC pilot qualifying examination. Full implementation for all eligible
technicians is anticipated by summer 2010.
• T he SPT program (12 weeks of supervised practice) is
also being piloted with the CCAPP graduates involved in
the first and second PEBC pilot qualifying examination.
Three pharmacy technician preceptor training workshops
have been held, with 40 pharmacists now qualified to fulfill
this role. Additional workshops will be offered as the need
increases. The activities and evaluations are all available
and completed through an on-line portal. Full implementation for all eligible technicians is anticipated in fall 2010.
New Legislation Changes
Liability Insurance
Requirements for
Pharmacy Technicians
Jurisprudence Exam
pharmacy technicians to hold personal
• A second pilot of the Jurisprudence Exam will be offered
to individuals who were accepted to complete the second
PEBC Pilot Qualifying Exam. If the pilot results are positive then it is anticipated that this exam will become
available to all eligible candidates for the July sitting sitting with pre-registration in May. This exam will then
continue to be available four times a year.
they become registered members of
On December 15th, 2009 the Ontario
Government passed the Regulated
Health Professions Statute Law
Amendment Act (Bill 179) which
amends many pieces of legislation
affecting health professions. One of
the changes introduced in this Act
has resulted in a new requirement for
professional liability insurance when
the College.
Although the College had previously
indicated that pharmacy technicians
would not require their own liability
insurance since they would reasonably
be covered by policies held by their
employer (in the same way pharmacists
used to be), the new Act amends
the Regulated Health Professions
Act to require that all members of
any regulated health profession
hold personal professional liability
insurance. As a result, the College
will have to implement this new
requirement by December 15th, 2010. In
preparation for this change, the College
will engage in discussion with insurers
and the professional associations
representing pharmacy technicians to
ensure that the appropriate insurance
policies are made available. More
information will be provided when the
details are available.
12
Student programs
New Summer
Experience Course
for U of T Students
Hands-on course links students and practice community
T
his summer, second year
students from the Leslie
Dan Faculty of Pharmacy
at the University of Toronto will
participate in a new mandatory
early practice experience (EPE)
course as part of the Bachelor of
Science in Pharmacy program. The
purpose of this course is to provide
students with practice experience
so they can build on the knowledge acquired in the classroom.
The course has three goals for students: learning to participate as
part of a team, understanding the
patient safety systems in place in
pharmacy practice, and developing
proficiency in drug distribution and
patient-care skills. The course is
similar to the previous Ontario College of Pharmacists’ Structured
Practical Training program where
undergraduate students were
required to find their own sites
for a one-month practice experience during the summer of their
second or third year of study.
The EPE course includes 140
hours of hands-on practice site
experience. To ensure that they are
prepared for this experience, students will be required to pass (with
a minimum grade of 75%) a pre-test
that demonstrates understanding of
core concepts (for example, ODB
, Jurisprudence and Drug Information) that they have been exposed to
during the first two years of the program. Additionally, pre-site lectures
will ensure that students are familiar
with the mandatory activities that
they will be expected to complete as
part of the course requirements.
At the practice site, under
the supervision of their pharmacist supervisor or delegated staff,
students will participate in the dayto-day activities that contribute
to the delivery of patient care at
the level appropriate for entry into
the third year of the undergraduate program. This will include
processing prescriptions, providing
patient education on medications,
answering routine drug information
questions, providing assistance in
the selection of self care products
(where appropriate) and conducting
MedsCheck (in community practice)
or Best Possible Medication Histories (in hospital practice). Students
will also be required to present a
Patient Safety report based on the
Canadian Patient Safety Institute’s
competency domains.
As part of this course, students
will also participate in a Faculty-run
e-learning component moderated by
a faculty facilitator. This e-learning
component will support students
while they are at their sites and allow them to provide evidence of
completion of their site activities.
The faculty is very excited about
this new course as it will provide
important learning opportunities for
students. It will also increase the
links between academia and practice and enhance the relationship
between the faculty and practitioner
community. If you are interested in
accepting a student to precept as
part of this course, please contact
Debra Moy, PHM 234 Early Practice Experience Course Coordinator
at [email protected] or
416-946-7975.
13
Interprofessional Care
The article below first appeared in Dialogue, the magazine of the College of Physicians and Surgeons of Ontario.
Interprofessional study
of transfer of care
CNO-led study examines role of health professionals in hospital care
D
uring an episode of disease
or period of care, a patient can potentially
be treated by a number of
health-care practitioners and specialists in
multiple settings. Additionally, patients will
often move between
areas of diagnosis,
treatment, and care on
a regular basis and may
encounter three shifts of
staff each day – introducing
a safety risk to the patient at
each interval.
And yet despite the reality that many
patients are discharged from health-care settings
quicker and sicker, requiring complex treatment protocols from multiple providers across multiple settings, little
attention has been paid to understanding effective mechanisms for transferring information at these boundaries
of care.
Several health-care regulatory colleges decided that
further insight into the challenges of transferring patient care among multiple healthcare professionals and
settings was necessary. That decision set in motion
a research project – called the Transfer of Accountability Knowledge Translation Fellowship – to further
explore the issue and identify any associated regulatory
implications.
14
Interprofessional Care
It was important that the project,
which was led by the College of
Nurses of Ontario, and supported by OCP, the College
of Physicians and Surgeons
of Ontario (CPSO), and
staff at St. Michael’s
Hospital and Sunnybrook, had representation
from a number of different health-care providers.
“A number of health-care
practitioners are involved in
handover activities. An increasing emphasis on interprofessional care
and collaboration supports examining these
processes with colleagues from other professions,” said
Dr. Rayudu Koka, CPSO President.
The project leaders conducted a double-pronged research initiative: a literature search and interviews with
a number of different healthcare providers about their
experiences in transfers of accountability. It became clear
that a successful transfer of accountability must involve
effective communication and collaboration. Examples of
positive and successful experiences demonstrated universal features across settings and providers, including the
involvement of the patient and family in decision making
and planning, comprehensive and concise patient information, opportunity for questions and follow-up by the
patient and family as well as health care providers.
Patients, it was reported, are placed at risk when there
are interruptions during the exchange of information,
when there are insufficient human resources to conduct
the transfer, when the transfer is unplanned and unprepared, when there is a lack of respect between providers
and when there is a lack of understanding about issues of
patient privacy and confidentiality.
Regulatory Implications
All regulatory bodies establish expectations through policies, position statements, practice standards, guidelines
and/or other documents, for how members do what they
do in an effective, safe and ethical manner. This project
demonstrated that these expectations provide the basis
and support for sound clinical judgment.
Given the complex and context specific nature of transfers and the importance of clinical judgment for patient
safety outcomes, the project’s participants determined
that the development of a standard of practice and/or
standardized guideline from regulatory bodies to support
transfer of accountability in all clinical settings is not necessary nor would it likely be meaningful. Instead, there
were reports from the participants that they did indeed
incorporate existing regulatory policies (e.g., Confidentiality and Privacy – Personal Health Information) and other
tools into their transfer activities.
Furthermore, it illustrated that these expectations support healthcare providers in their work to continue to be
vigilant in identifying and addressing exceptional patient
care situations – situations that require innovative approaches to the transfer process.
Dr. Koka said that important observations can be realized by this study. “When we develop policy we strive to
offer guidance while at the same time permitting enough
flexibility to allow for the exercise of professional judgment. This study demonstrates that we have achieved
that balance with respect to transfer of care: that the
regulatory scheme permits the evolution and growth of
true interdisciplinary teamwork and problem-solving,”
he said.
The full report, entitled “Transferring Clients Safely:
Know Your Client and Know Your Team” is posted at
www.cno.org/transferring_clients.
The regulatory scheme permits the evolution and
growth of true interdisciplinary teamwork and problemsolving.
5, 2010
April 2
15
health canada advisories & notices
February 5, 2010
Notice to Hospital: Health Canada is informing health care professionals of complications associated with the transvaginal implantation of
surgical mesh for the treatment of stress urinary incontinence and pelvic organ prolapse.
February 1, 2010
Health Canada is advising Canadians that natural health products containing the ingredient glucomannan in tablet, capsule or powder form,
which are currently on the Canadian market, have a potential for harm if taken without at least 8 ounces of water or other fluid. The risk to
Canadians includes choking and/or blockage of the throat, esophagus or intestine, according to international adverse reaction case reports.
It is also important to note that these products should NOT be taken immediately before going to bed. Health Canada has authorized some
products containing glucomannan for the purposes of appetite reduction, weight management, treatment of constipation, management of
cholesterol levels.
January 30, 2010
Health Canada is advising consumers not to use any unauthorized health products sold under the brand names Natural Choice Vitamin B-17,
Natural Choice Kava Kava and Natural Choice Lithium Orotate.
January 28, 2010
Two Canadian companies that manufacture and/or distribute medications for Parkinson’s Disease have posted information on their websites
concerning the availability of some of the drugs they manufacture and/or distribute.
January 18, 2010
Rolaids antacid tablets packaged in bottles of 150 and 100 counts are being voluntarily recalled in Canada by the distributor, McNeil
Consumer Healthcare (Canada), Division of Johnson & Johnson Inc. The recall comes in light of reports in the U.S. of an unusual mouldy,
musty, or mildew-like odour that was, in some cases, associated with nausea, stomach pain, vomiting and diarrhea.
January 14, 2010
Health Canada is warning consumers not to use the unauthorized product “The Slimming Coffee,” which was previously sold as “Lose
Weight Coffee,” because it was found to contain the undeclared prescription drug sibutramine and may pose serious health risks.
January 12, 2010
From August 15, 2006 to October 15, 2009, a total of 93 reports of NSF have been reported in association with the use of Optimark
(gadoversetamide injection) worldwide. Tyco Healthcare/Covidien has submitted additional product labelling changes to Health Canada
including a contraindication for use in some patients with kidney problems. Also, Optimark will not be recommended for use in children
below the age of two years.
January 11, 2010
Canadians are advised not to Use “Stiff Nights” or any unauthorized product promoted for erectile dysfunction. Health Canada is advising
consumers not to use the unauthorized product “Stiff Nights” after the U.S Food and Drug Administration (FDA) found that this product
contains an undeclared substance similar to the prescription drug sildenafil and may pose serious health risks, particularly to people with
heart problems.
January 7, 2010
Consumers are advised not to use the foreign health products due to concerns about possible adverse reactions: Full Contact Max Potency,
M-Action, RockHard Weekend, Pai You Guo, Ku Xiu Ba Xiang Jian Fei Wan, Super Slim (Yani), SHoufsy and MIGAC (sic) FAT BURMING (sic)
FACTOR. These products are not authorized for sale in Canada and have not been found in the Canadian marketplace, but they may have
been brought into the country by travellers or purchased over the Internet.
January 5, 2010
Bristol-Myers Squibb Canada has initiated a voluntary recall of the BiCNU (carmustine for injection) Combo kit Lot number 8K4218A (vial
Lot number 1486494C) - expiry date Dec. 2011. This recall is being conducted as a precautionary measure due to a sterility assurance
concern.
January 4, 2010
Consumers are advised not to use the following foreign health product(s) due to concerns about possible adverse reactions. TYLENOL®
Arthritis Pain Caplet 100 count bottles, with the distinctive red EZ-OPEN CAP. The U.S. Food and Drug Administration informed consumers
to stop using TYLENOL® Arthritis Pain Caplet 100 count bottles purchased in the United States. The manufacturer has recalled this product
after consumer reports of an unusual mouldy, musty, or mildew-like odour that was associated with nausea, stomach pain, vomiting and
diarrhea.
December 29, 2009
In January 2010, Genzyme Canada expects to begin shipping Cerezyme (imiglucerase for injection) to all patients who experienced
treatment interruptions due to a temporary shortage of product. Information on supply, as well as recommendations and precautions for
restarting treatment are provided.
December 24, 2009
Consumers are advised not to use “RevolutionDS Weight Loss”, an unauthorized health product promoted for weight loss, because it
contains benzylpiperazine (BZP), and may pose serious health risks.
December 23, 2009
Healthcare professionals should be aware that cases of pure red cell aplasia (PRCA) have been reported in patients treated with Myfortic
(mycophenolate sodium) in combination with other immunosuppressive agents.
December 23, 2009
Do not use the following foreign health products due to concerns about possible adverse reactions. The Singapore Health Sciences
Authority issued a recall notice for Power-Plus P (expiry date 03/03/2011) after it was found to contain undeclared tadalafil. The Hong
Kong Department of Health warned consumers not to buy or consume Show Party [shou-shen pai] after it was found to contain undeclared
sibutramine and phenolphthalein. The Hong Kong Department of Health warned consumers not to buy or use Zeng Da Yan Shi Wan after it
was found to contain undeclared sildenafil.
For complete information & electronic mailing of the Health Canada Advisories/Warnings/Notices subscribe online at:
http://www.hc-sc.gc.ca/dhp-mps/medeff/index_e.html
MedEffect e-Notice is the new name which replaces Health Canada’s Health_Prod_Info mailing list.
The content of the e-notices you receive will remain the same and are now part of MedEffect, a new Health Canada Web site dedicated to adverse
reaction information. MedEffect can be visited at www.hc-sc.gc.ca/dhp-mps/medeff/index_e.html
Health Canada Notices are also linked under “Notices” on the OCP website: www.ocpinfo.com
16
professional practice
Did You Know?
Jessie Dufour, R.Ph. and Nadia Sutcliffe, R.Ph.
Did You Know? is a regular feature in Pharmacy Connection. It’s a series of quick pointers
reminding pharmacists and technicians of their legal and practice obligations from an
inspector’s perspective, aimed at getting you to think about the issues and incorporating
best practices into your pharmacies.
DID YOU KNOW …
… that there is a specific policy regarding the labeling of multi-compliance packs? The label must include
everything found on a regular label, plus a description of the
tablet or capsule for easier identification. This label must
be changed with each dispensing. The same label cannot be
used week after week. For more information go to www.
ocpinfo.com and search “Compliance Aids”.
… that narcotic and controlled drugs should be stored
in a secure manner? It is recommended that they be kept
locked in an alarmed safe. Other ways to store them include inside a locked cupboard or cabinet, or on the shelves
intermixed with regular medications. Grouping narcotic and
controlled drugs together on shelves is not advisable as they
are easily identifiable in the case of a robbery or break-in.
… that OTC narcotics, like Tylenol No.1® or 222®, must
be kept out of the public view behind the dispensary
counter? In addition, like any other Schedule II product,
pharmacists must make the decision whether or not to sell
the product. The patient or agent should be counselled on
their proper use, side effects and potential for abuse, and
the pharmacist should suggest alternatives, if appropriate.
... that it is best practice to have a system in place to
prevent errors which could cause a patient to receive
the wrong medication? Many pharmacies use a basket
system, where each patient has a separate basket and medications are not bagged until the pharmacist has checked
that basket. Review your system for preventing dispensing
errors and ensure it is working.
… that it is very important to have a process in place
to document errors and how they have been dealt
with? An incident form is available on our website. All
staff should be aware of the pharmacy’s process for dealing with dispensing errors when they occur. Pharmacists
need to be accountable and are required to investigate why
a dispensing error happened and how a similar error can
be prevented in the future. Refer to the Focus on Error
Prevention section of Pharmacy Connection, November/
December 2004, “Dispensing Errors” and “Handling Dispensing Errors” in Pharmacy Connection, March/April 1995
on our website, www.ocpinfo.com.
... that a labeling error is when a pharmacist puts a
different medication, strength, direction, quantity,
or prescriber’s name on the prescription label than
what the prescription states? It is important to check
the prescription against the hard copy closely and sign the
hard copy before dispensing a medication. A pharmacist
cannot change the meaning of the prescriber’s directions.
See Pharmacy Connection May/June 2009, “Labeling errors: Why they happen, and how to prevent them”.
... that a pharmacist should check that the prescriber’s
address on the prescription matches the pharmacy’s
record on the hard copy? Prescribers often work out of
different clinics, and pharmacists need to document exactly
where the authorization for the prescription came from.
17
registration Q&A
Susan James, BScOT, MPA
Manager, Registration Programs
Ontario Labour Mobility Act
Q
I have heard that the Ontario Labour Mobility
Act, 2009 (OLMA) has been passed and therefore
pharmacists from other provinces can now
become licensed automatically in Ontario. Is
this true? Can Ontario pharmacists also become
licensed in other provinces automatically?
Yes the OLMA was passed in December 2009. It will
make movement from one province to another province
much easier, but it does not allow for automatic licensure
as you suggest. The government passed OLMA to support its commitment to Chapter 7 of the Agreement on
Internal Trade (AIT) which is intended to eliminate or
reduce measures that serve to restrict mobility from one
province to another. While no additional material training or assessment is permitted, demonstration of some
registration requirements is still permitted.
Pharmacists who hold a license in another province are
able to apply for an equivalent certificate of registration in
Ontario under the AIT. The new legislation requires that
the College accept the entry-to-practice requirements in
the jurisdiction in which the individual is currently licensed.
18
This includes education, training, language proficiency and
entry-to-practice exams (where required). The College
still requires these individuals successfully complete the
OCP jurisprudence exam, as well as provide evidence
of good character and good standing from their existing
jurisdiction. Pharmacists moving from Ontario to another
province could expect similar requirements to apply, but
should confirm these with the regulatory authority of the
province to which they are moving.
As stated, the legislation works on the premise that
each province has the same or similar entry-to-practice
requirements and once these have been demonstrated
in one province it should not be necessary to demonstrate them again as you move to a new province. The
National Association of Pharmacy Regulatory Authorities (NAPRA) has been working to achieve a common
licensing model across the country and despite some
continued differences, all of the provinces, including
Quebec, have recently signed a new Mutual Recognition Agreement. NAPRA will continue to work toward
common entry to practice requirements for all applicants which will support the new mobility legislation
across the country.
spt Q&A
Diana Spizzirri R.Ph., B.Sc.Phm., M.Ed.
Registration Advisor
Q
I would like to be an SPT preceptor for a graduate
of an accredited pharmacy technician program.
Since I am already trained and have served as an
SPT preceptor for pharmacy students and interns,
am I eligible?
In order to serve as a preceptor for a pharmacy technician graduate, a pharmacist (and in the future pharmacy
technicians) must meet the SPT Preceptor Criteria for
Pharmacy Technician Applicants. Attending the new Preceptor Orientation Workshop that focuses on the SPT
program for pharmacy technicians is required. Preceptors need to understand the registration requirements
for pharmacy technicians, the terms and conditions of
their registration, their scope of practice and the entryto-practice competencies upon which SPT is based. The
SPT program for pharmacy technician applicants is being
piloted in 2010. A new portal system was created to enable online access and documentation of SPT activities
and assessments by both the pharmacy technician applicant and their preceptor.
Given that active preceptors for pharmacy students and
interns have already attended an orientation workshop,
they may choose to be exempted from a portion of this new
workshop. The workshop has been designed with this in
mind. The first half of the workshop focuses on the background of SPT, the registration requirements and scope
of practice for technicians, and the SPT activities and assessments including a demonstration of the online portal
system. The second half of the workshop covers preceptor skills including feedback and assessment. Although this
portion of the workshop is exemptible for pharmacists who
have served as preceptors for pharmacy students or interns,
there is value in reviewing these important skills.
We encourage pharmacists and current preceptors
to consider becoming a preceptor for a pharmacy technician applicant. The Preceptor and Site Criteria along
with dates of workshops for technician preceptors will
be posted on our website once the pilot SPT program is
complete and opens to all eligible applicants. Please see
our website for updates.
Q
an a preceptor take responsibility for the
C
Structured Practical Training of both a student
and intern at the same time?
Given the range of an SPT Preceptor’s responsibilities in
guiding a student’s or intern’s transition to practice, OCP’s
Registration Committee believes it is necessary to maintain a one-to-one preceptor to student ratio for optimal
learning. Preceptor responsibilities include supervising a
student/intern’s pharmacy practice, planning and assessing SPT activities, and completing regular assessments.
The one-to-one ratio provides a better context in which
a preceptor can provide a valid assessment of a student’s
entry-to-practice competency. However, a preceptor may
take responsibility for training the same individual through
their studentship, followed then by their internship.
One exception to this one-on-one rule is with respect
to undergraduate students. While training one SPT
student or intern, preceptors can train an undergraduate pharmacy student at the same time. The onus is on
preceptors to carefully consider what is involved when accepting responsibility for simultaneously serving as an SPT
preceptor and mentoring students for other programs. It
is important to note that preceptors must directly supervise pharmacy students in performing the controlled acts
of a pharmacist. Having an undergraduate student in the
practice site training alongside one SPT student or intern
may promote learning where knowledge and diverse experiences are shared.
The revised 2009 SPT Preceptor Criteria – Registered
Pharmacy Student/Interns that outlines these changes can
be found on our website under Licensing/Training and
Assessments / SPT.
19
Pharmacy Accreditation
Your annual pharmacy accreditation renewal fee of
$860.00 plus applicable taxes* is due no later than May 10, 2010.
Renewal forms will be mailed to each pharmacy by mid-March.
What’s New for this Year’s Renewal?
FEE PAYMENTS
ver the coming months we will be designing and
building an online pharmacy accreditation renewal
process with a targeted launch date of March 2011.
The first step of this initiative is to establish an
owner representative for each pharmacy. Accordingly,
this year’s paper renewal requires each pharmacy
owner(s) to appoint one pharmacist director who
will act as the liaison on matters relating to the
College.
The director representative will receive a login ID
and password to access the business profile of the
accredited pharmacy. He or she will then be able to
conduct business related to their accredited pharmacy online, including verifying the pharmacists and
regulated technicians practicing at the pharmacy and
completing and paying for the pharmacy’s annual accreditation renewal on-line.
Moving the pharmacy renewal process on-line
supports our continued effort to become more environmentally responsible by reducing the use of paper.
It is also in keeping with the College’s strategic plan
to achieve operational efficiency through technology
and innovation.
Annual Pharmacy Fees due May 10, 2010
Pharmacy fees of $860.00 plus applicable taxes* must be
received and/or postmarked no later than May 10 2010.
O
20
Paying by Cheque
Make sure your cheque is signed and made payable to
the Ontario College of Pharmacists or OCP. Please write
your Pharmacy Accreditation number and Invoice number on the front of your cheque.
NSF cheques are treated as late and incur both a late
penalty fee and a $20.00 NSF service charge. All unsigned cheques will be returned for signature.
Paying by Credit Card
We accept payment by VISA, MasterCard or American
Express. Enter your credit card number and the expiry date of your credit card in the box under Payment
Information on your renewal form. Please be sure to
sign the credit card section giving us authorization to
process the credit card payment.
Once processed, the certificate of accreditation and
income tax receipt will be mailed to the Pharmacy.
Renewals 2010
LATE PAYMENTS
Late payments are subject to a late payment fee of
$100.00 plus applicable taxes (if paid within 30 days after
the due date) or $150.00 plus applicable taxes (if paid
more than 30 days after the due date). Late payments
include cheques that are received early but postdated
after May 10, 2010. Late payments are not processed
until the late payment fee has been received.
download the Acknowledgment/Change of Designated
Manager form by clicking on the “college forms” link
at the bottom of our home page at www.ocpinfo.com
*Please
note that transition rules relating to the
implementation of the Ontario Harmonized Sales Tax
(HST) are being reviewed to determine what impact they
may have on the accreditation renewal fee. Once we are
clear on the implications, the appropriate tax will be
RECORDS UPDATE
reflected on the pharmacy renewal forms and a notice
Updates are required for the following:
• Which pharmacists (with and without signing authority) practice at the pharmacy
• Lock and leave practices
• Methadone dispensing
• Pharmacy website information
• Indication of which of the College-approved Drug Information Services the pharmacy subscribes to
placed on the College website.
For further information contact Client Services at:
416-962-4861 ext. 3300,
toll free 1-800-220-1921 ext. 3300,
or email: [email protected]
Every director and the designated manager of each
pharmacy must acknowledge their understanding of
the standards of the profession at annual renewal and
when reporting a designated manager change. You
can update this information on the renewal form or
21
practice Q&A
Greg Ujiye, R.Ph.
Professional Practice Advisor/Inspector
Finding Answers to your Most
Common Questions
Every day, OCP’s Practice Advisory staff manage a large
of number of calls from members, the public and other
stakeholders, with the majority of calls coming from
members. The following provides answers to the most
commonly asked questions, topics and issues. A reminder:
answers to most questions can be found on the OCP website by using the search function (see information on the
opposite page for search tips).
Q
Can Ontario pharmacists accept out of
province prescriptions?
Yes. The DPRA changed the requirements for accepting
prescriptions and prescription refills in 2007. A number of
Q&As and articles were written in past issues of Pharmacy
Connection to inform pharmacists of those changes.
Q
Can you explain medical directives?
Q
Do prescriptions have an expiry or end date?
In Ontario, the only type of prescription that has an expiry
date is that of a benzodiazepine or targeted substance.
Prescriptions for this class of drugs expire one year from
the date the doctor prescribed the medication as legislated
in the Benzodiazepine and Targeted Substances Regulation
of the Controlled Drug and Substances Act. For all other
prescriptions, there is no provincial or federal legislation
about the expiration date. The decision, therefore, to fill a
prescription or a refill is left to the professional judgement
of the pharmacist.
Q
Where do I find information about
drug schedules?
Ontario follows the National Drug Schedules that are
maintained by the National Association of Pharmacy
Regulatory Authorities (NAPRA). These schedules are
embedded into the provincial Drug and Pharmacies Regulation Act (DPRA). Ontario follows what is called rolling
incorporation, meaning that once NAPRA approves the
scheduling of a drug by the National Drug Scheduling
Advisory Committee, that schedule immediately takes
effect in Ontario. Pharmacists are encouraged to go to
22
the NAPRA website www.napra.ca to better understand
the scheduling process as well as familiarize themselves
with the national drug schedules.
In 2007 the Federation of Regulated Health Colleges of
Ontario (FRHCO) agreed to the use of formal Medical
Directives for all Colleges. This allowed for the implementation of orders as well as a method to delegate a
controlled act from health professional to another. Up
to this point, medical directives were used exclusively in
hospitals and had no authority beyond the boundaries
of the hospital. Information about the College policy on
medical directives and a link to the Federation website
can be found in Pharmacy Connection, July Aug 2007.
In addition to these questions, pharmacists often ask for
information and clarification on the following topics.
Comprehensive answers can be found by using the search
function on the College’s website.
• Suboxone® (buprenorphine – naloxone)
• Professional Judgement
• Crystal Meth (Methamphetamine)
• Logged Prescriptions
• Expiry Dates on Prescription Drugs
• Physician Prescription Status
Search Tips for Finding Information on
www.ocpinfo.com
Our website contains valuable information that can help you
in your everyday practice. Here are some tips for searching
for information:
• in the search box on the upper right side of each page,
type the keyword you are searching for and press the
‘Search’ button
• you can narrow your search by adding more than one
term, for example if you are looking for a document
about narcotics and safety, type: narcotics AND safety
• you can refine your search by indicating words you do
not want included in your search, by using ‘AND NOT’
before the word you want to omit. For example, if you
want to search for a document about narcotics and
safety but not about methadone, you would type:
narcotics AND safety AND NOT methadone
Pharmacy Connection In Brief
Don’t forget to check your e-mail for
Pharmacy Connection In Brief – a new,
online version of this publication.
If you prefer that we not send you a print
copy in the future, please send an e-mail to
[email protected] with your name and
OCP number.
23
bulletin board
STAFF NEWS
The College bid farewell to Kathy Vesterfelt, Senior
Policy Advisor. Kathy had been with the College since
2008 and accepted a position as Manager, Professional
and Regulatory Affairs at NAPRA.
The College also said goodbye to Penny Tsang, Registration Advisor. Penny had been with the College since
April 2008 and left at the end of her contract term.
The College staff would like to extend its best wishes
to both Kathy and Penny as they move on to new
adventures!
Joanne Addesi has recently joined the College as
Executive Assistant to the Registrar and Director, Finance and Administration. Joanne comes to us from
HealthForceOntario where she spent the last 4 years
supporting the Executive Director, Corporate Affairs
Director and the Board of Directors. Prior to HealthForceOntario, Joanne held various administrative roles
with LexisNexis for over eight years.
Courtney Campbell has joined the College as Decisions Coordinator in the Investigations and Resolutions
department. Courtney is a lawyer who has been
practicing in labour and employment law firms. After
obtaining her LLB at Osgoode Hall Law School, she
obtained her LLM at the University of Toronto Law
School in 2009.
Moses Lee has recently joined the College as Reprographics Clerk. Moses comes to us with a recent
background in graphic design and reprographics experience, and has also spent a number of years working as a
pharmacy assistant.
SooJeen Park who was originally hired as Reprographics Clerk, has transferred into our Accounting
department to fill in for Preeti Khurana’s maternity
leave. SooJeen is currently pursuing accounting courses
at the University of Toronto.
And the College welcomes back Carol Culhane as Administrative Assistant in the Continuing Competency
department to replace Rahila Ovais while she is on
maternity leave.
REUNIONS
University of Toronto Pharmacy 9T0 Class Reunion
- plan on joining your former classmates to celebrate
the 20th anniversary of the class of 1990! We will meet
on Saturday, May 29th for a reception and tour of the
Leslie L. Dan Pharmacy Building, to be followed by dinner. For details, please e-mail Kelly Avey at kellyavey@
carolina.rr.com to be added to the contact list, or join
our alumni group on Facebook.
To list your upcoming reunion, please e-mail
Anjali Baichwal at [email protected]
Stay informed about other health professionals and prescribers
Expanding legislation for the health professions has
other health professionals such as midwives, dentists,
resulted in an increased scope of practice for many
optometrists and nurse practitioners. If pharmacists have
health practitioners in the province. This changing pace
any reason to question the validity of a new prescriber,
of regulation may therefore result in more requests
they should go to the website of the college in question
to dispense or distribute drugs from new prescribers.
for clarification. A list of these colleges can be found
As a result, for pharmacists, it is more important than
on the website of the Federation of Regulated Health
ever to keep informed of the changing regulations for
Colleges of Ontario (FRHCO) at
prescribing and purchasing authority given to
www.regulatedhealthprofession.com
24
update on technology
Embracing technology and
going green!
Electronic Elections
As noted on page 8 of this issue, we are preparing for
In every issue of Pharmacy Connection, we report to
elections in newly defined postal code districts. Along with
you some of the ways the College has been embracing
this initiative, we will move forward with an exclusively
technology to improve and refine the way we manage our
web-based voting system. This is especially important given
everyday work in support of our mandate and objectives.
that the new boundaries will make our electoral districts
This approach not only allows us to evaluate our work
significantly larger. On-line voting improves the timeliness
processes, it makes us more environmentally friendly by
and eliminates the need for printing and mailing notices
helping us eliminate unnecessary paper-based transactions.
of elections, nomination forms and ballots.
Following are some recently completed initiatives and some
that will be introduced in the coming year.
Coming Soon…
Virtual Boardroom
Pharmacy Accreditation Renewal for 2011
Over the coming months we will be designing and building
Although not related to the general membership, Council
an online pharmacy accreditation renewal process with
has demonstrated its commitment to technology by
a targeted launch date of March 2011 (See page 20 for
embracing a virtual boardroom concept for receiving and
details). Moving the pharmacy renewal process on-
viewing their council information. All council information
line supports our continued effort to become more
is loaded onto an electronic boardroom which council
environmentally responsible.
members can access through a secure network to prepare
themselves for council discussions. When attending council
Wallet Cards/Electronic receipts
meetings, instead of paper packages, council members
In 2010, the College will be issuing wallet cards and tax
view the material on line thereby eliminating the need to
receipts as usual. In future years, however, we will phase out
print, copy and transmit large paper packages. Committee
the paper processes. Electronic receipts for tax purposes
material is managed in a similar way.
are now an accepted practice among organizations and
On-line Publications
charities and wallet cards are redundant given that the
on-line public register provides the most up-to-date
information about the status of a pharmacist or pharmacy.
Since last fall, we have been encouraging members to opt
out of print copies of Pharmacy Connection by providing a
As we continue to evolve many other College processes to
preview version by email, with easy access to the complete
an on-line format, we will keep members advised through
web based copy of the publication. To date, many members
Update on Technology about these achievements. Please
have asked to receive an electronic copy only and we
note that members will be advised of specific changes as
encourage more to take on this green initiative.
they are implemented and provided with instructions on
how to incorporate them.
25
patient safety
Measuring Up:
Best practices for
dispensing oral liquids
A
Oral medication doses require particular attention
— especially when it comes to children
By Kathy Vesterfelt, R.Ph.
recent Coroner’s investigation
of the death of a five year-old
girl found the cause of death
to be aspiration pneumonia
due to hydrocodone toxicity.
Subsequently, the Chief Coroner recommended that the
Ontario College of Pharmacists require prescriptions for
medications with a narrow therapeutic index to be written indicating specific units of measurement only, i.e. mL
or mg, rather than teaspoons.
Pharmacists are required by law to label a prescription
with the directions for use as prescribed. Therefore, if the
prescriber writes for teaspoon or tablespoon, this must be
included on the label. However, it is recommended that
the metric volume should also be included on the label
(i.e. 5 mL or 15 mL).
26
An excerpt from an Institute for Safe Medication Practices (ISMP) Newsletter states:
Label: Shake well and give 1 teaspoonful (5 mL)
“Although parenteral syringes are not designed for oral
three times daily.
administration, healthcare practitioners may provide
Exercising professional judgement means pharmacists
them to patients or caregivers to measure oral liquids
should provide important information to facilitate the
without realizing how dangerous this practice may be.
proper use of the medication. In the above example, inSome syringe manufacturers place the small, transcluding auxillary information on the label and attaching
lucent caps on parenteral syringes packaged without
appropriate labels to the medication container; for this
needles as a protective cover. However, practitioners
example, a “Keep in Refrigerator” label
may not realize the cap is there or may
Common kitchen
and “Do not use after X days” label,
not inform patients or caregivers of the
would be beneficial.
measuring spoons vary need for its removal prior to use. The
Furthermore, it is a standard of care
danger arises due to the fact that the
widely in the volume
that pharmacists ensure an appropriate
cap does not provide a good seal. Subthey deliver which can sequently, medications can be drawn
measuring device is provided or availresult in giving either into many of these syringes without
able when dispensing a prescription for
oral medication, especially for children.
removing the caps. If not removed betoo much or too little
fore administration, the force of pushing
medication.
What constitutes an appropriate
the plunger can eject the cap and cause it
measuring device?
to lodge in a child’s trachea.”
Some manufacturers provide devices for measuring and
– Institute for Safe Medications Practice, Comadministering their products. These devices include calimunity/Ambulatory Care edition, November 2005.
brated droppers, molded plastic cylinders and measuring
(www.ismp.org)
caps. These devices are designed for use only with a
particular product and do not guarantee accurate delivery
When providing counseling, pharmacists should demof the dose if another product is used.
onstrate how to correctly measure the proper dose of
Oral syringes are preferred for administering liquid
medication with the measuring device. To ensure that
medication, particularly in young children. Oral syringes
the patient or caregiver understands, a useful technique is
are constructed in such a manner that they will not acto ask them to show you how they would use the device
cept a needle, and are available in a variety of sizes to
following your demonstration.
guarantee more accurate measurement. Their tips are
Advise patients and parents to avoid using household
designed to resist breaking off in the child’s mouth, and
teaspoons or tablespoons in measuring liquid medication.
the plunger assembly of the syringe allows total expression
These common kitchen measuring spoons vary widely in
of the measured doses.
the volume they deliver which can result in giving either
The use of injectable syringes to administer oral liquids
too much or too little medication.
is not acceptable practice.
Example: Rx: Amoxil 250mg, 1 tsp tid
27
focus on error prevention
Ian Stewart, R.Ph., B.Sc.Phm
Toronto Community Pharmacist
Millilitres or Milligrams?
Physicians often prescribe oral liquid dosages as millilitres
or milligrams. This inconsistency has in some cases led to
the erroneous interchanging of millilitres and milligrams.
This can be especially problematic when dispensing drugs
with a heightened risk of causing patient harm.
Case:
Following a successful tonsillectomy, a seven-year-old
boy was prescribed codeine syrup for pain. The following
prescription was given to the child’s parent:
The prescription was taken to a local community pharmacy and given to a pharmacy technician for processing.
The dosage and instructions for use were entered into
the computer as “give 30 mls when needed for pain.”
Upon checking the prescription, the pharmacist identified that a 30 ml dose would be equivalent to 150 mg, since
the concentration of the codeine syrup is 5 mg/ml. The
pharmacist also considered the patient’s age and weight
and determined that a dose of 150 mg would be excessive.
The pharmacist therefore attempted to contact the doctor
to discuss the dosage.
Upon contacting the hospital, the pharmacist was advised that the prescriber was in surgery and unavailable.
The pharmacist was also told that the written record at
the hospital also indicated 30 mls and was likely correct.
28
Being aware of the potential for harm, the pharmacist refused to dispense the prescription as written and decided
to wait to discuss the issue with the prescriber directly.
Approximately two hours later, the surgeon did return
the pharmacist’s call and was surprised to learn that he
had written 30 cc instead of the intended dose of “30
mg (6 mls) every 4 hours if necessary.” Fortunately, the
pharmacist was not easily convinced that the dosage as
prescribed was correct. His persistence likely prevented
patient harm.
Recommendations:
• If a drug or dosage is suspected to be potentially harmful, gather supporting factual information and clearly
communicate your concerns to the prescriber. Pursue
the matter until you are satisfied or the prescription
changed. If necessary, contact a peer for guidance.
Remember to document details of a verbal exchange.
• When dispensing oral liquids, be alert for the potential
interchanging of mg and ml.
• A lways double-check pediatric dosages for appropriateness. Use the child’s age and weight to confirm that
the correct dose has been prescribed.
• Ensure that the child’s parent is aware of the appropriate dose and dosing interval.
• Provide an appropriate measuring device when dispensing oral liquids. Place a mark on the device to
clearly identify the volume of liquid to be administered.
• Discuss with your software vendor the possibility of
establishing dosage limits in the computer system,
thereby alerting staff to the potential of excessive dosages. This is especially important for drugs with a high
potential for causing patient harm.
Please continue to send reports of medication errors
in confidence to Ian Stewart at: ian.stewart2@rogers.
com .
quality assurance
Continuing Education Top 20
The Continuing Professional Development (CPD) Portal, which encompasses the Self-Assessment Tool and Learning
Portfolio, has been in operation since May 2008. To date, approximately 5,000 pharmacists have completed the SelfAssessment and an Education Action Plan as part of that Self-Assessment. From the aggregate data derived from the
Education Action Plans, the top 20 areas of interest for continuing education for this cohort of pharmacists in Ontario
have been identified as follows:
1. Diabetes
11. Otitis Media
2. Herbal remedies / Homeopathy / Natural Products
12. Vitamins / Nutritional Supplements
3. Osteoporosis
13. Lice / Scabies
4. Asthma
14. Constipation
5. Migraine
15. GERD
6. Smoking Cessation
16. Breast Cancer
7. Arthritis
17. Pneumonia
8. Geriatrics
18. Pain
9. Allergic Rhinitis
19. Obesity
10. Hypertension
20. Compounding
29
CE resources
Visit the College’s website: www.ocpinfo.com for a complete listing of upcoming events and/or
available resources. A number of the programs listed below are also suitable for pharmacy technicians.
For local live CE events in your area, contact your regional CE coordinator by going to
www.ocpinfo.com and serching on “Regional Coordinators”
GTA
March 26-28, 2010
Diabetes Level 2 CDE Preparation Course
Ontario Pharmacists Association,
Toronto
Contact: Penny Young
416-441-0788 ext. 2209,
[email protected]
www.opatoday.com
March 30 and April 10, 2010
(webinar & classroom setting)
Motivational Interviewing for
Primary Care
Canadian Association of Mental
Health (CAMH) and University of
Toronto
Toronto
Contact: Robyn Steidman
416-535-8501 ext 6640
www.camh.net/education
April 9, 2010
Geriatric Psychopharmacology
Day
CAMH, Toronto
Contact: 416-535-8501 ext 6017
www.camh.net/education
April 23-25, 2010
Women’s Health/North American Certified Menopause
Practitioners Prep Course
Ontario Pharmacists’ Association,
Toronto
416-441-0788 ext. 2209,
[email protected]
www.opatoday.com
30
May 14-16, 2010
Cardiovascular Patient Care
Toronto
416-441-0788 ext. 2209,
[email protected]
www.opatoday.com
May 2010 (date TBD)
Asthma and COPD Patient Care
Toronto
416-441-0788 ext. 2209,
[email protected]
www.opatoday.com
June 17-19, 2010
OPA Conference 2010,
Niagara Falls
416-441-0788 ext. 2209,
[email protected]
www.opatoday.com
NATIONAL
ON-LINE/ WEBINARS
www.ismp-canada.org/index.htm
March 10,2010 (12 Noon):The Canadian Pharmaceutical Bar Coding
Project: Its importance to improving
the medication system and enhancing patient safety
April 26,2010 (12 Noon):Canadian
Medication Incident Reporting and
Analysis
ISMP Canada
Contact: [email protected]
www.camh.net/education/
Online_courses_webinars
On-line courses in subjects including
mental health, substance abuse, addiction, withdrawal and legal issues
(begins April 26, 2010)
Canadian Association for Mental
Health (CAMH)
www.opatoday.com/web.asp
Vitamin D in Osteoporosis
Drug Information and Research Centre (DIRC)
May 15-18, 2010
Canadian Pharmacists’
Association
Annual National Conference
Calgary, AB
www.pharmacists.ca/conference
www.opacti.org
Online Clinical Tobacco Interventions for Health Care Professionals
INTERNATIONAL
www.rxbriefcase.com
On-line CE lessons
April 25, 2010
University of Toronto
Primary Practice
Prado, Italy
Contact: Ryan Keay
[email protected]
www.pharmacygateway.com
On-line CE lessons
http://cpha.learning.mediresource.
com/select_catalog.asp
CE lessons on the CPhA Home
Study Online Learning Centre
laws & regulations
Drug and Pharmacies Regulation Act (DPRA) * s
December 15, 2009
Regulations to the DPRA:
Regulation 545 – Child Resistant Packages
Regulation 297/96 Amended to O.Reg. 173/08
Regulation 551 Amended to O.Reg. 172/08
Drug Schedules **
Summary of Laws
June 2007 OCP
National Drug Schedules (NAPRA)
January 20, 2010 (or later)
Scheduling status finalized by NDSAC (Dec 2009):
Fluconazole when sold in a concentration of 150 mg per
oral dosage unit and indicated for the treatment of vaginal
candidiasis, in package sizes containing no more than 150 mg
of fluconazole – Schedule III status (Pursuant to removal from
Schedule F of the Food and Drug Regulations and the issuance
of a Notice of Compliance by Health Canada for the nonprescription product formulation)
Oral purgatives containing sodium picosulphate 10 mg per pack
(when found in preparations with magnesium oxide 3.5g and
citric acid 12g) – Schedule II status
NDSAC Meeting – March 2010
Request for Unscheduled status for diclofenac diethylamine in
preparations for topical use on the skin in concentrations of not
more than the equivalent of 1% diclofenac.
Regulated Health Professions Act (RHPA) * s
December 15, 2009
Regulations to the RHPA:
Regulation 39/02 - Amended to O.Reg. 666/05
Regulation 107/96 – Controlled Acts
Regulation 59/94 – Funding for Therapy or Counseling for
Patients Sexually Abused by Members
Pharmacy Act (PA) & Regulations * s
December 15, 2009
Regulations to the PA:
Standards of Practice s
Model Standards of Pratice, effective January 1, 2010
Standards of Practice for Pharmacists, 2003
Standards of Practice for Pharmacy Managers, 2005
Standards for Pharmacists Providing Services to Licensed
LTC Facilities, 2007.
Drug Interchangeability and Dispensing Fee Act
(DIDFA) & Regulations * s
June 2007 Regulations to the DIDFA:
Ontario Drug Benefit Act (ODBA) & Regulations * s
December 15, 2009
Regulations to the ODBA:
Controlled Drugs and Substances Act &
Regulations (CDSA) **
Act current to January 31, 2010
All regulations current to February 1, 2010
Benzodiazepines and Other Targeted Substances Regulations
Marihuana Medical Access Regulations
Narcotic Control Regulations
Precursor Control Regulations
Regulations Exempting Certain Precursors and Controlled
Substances from the Application of the Controlled Drugs and
Substances Act
Food and Drugs Act (FDA) & Regulations ** '
Act current to January 31, 2010
To Schedule F: Pre-notifications
Project #1652 Notice of Intent to Amend Schedule F
(L-asparaginase) (Dec 2009)
Project #1659 Addition of Medicinal Ingredient Dronedarone to
Schedule F (Dec 2009)
Project #1659 Addition of Medicinal Ingredient Degarelix to
Project #1659 Addition of Medicinal Ingredient Clofarabine to
Project #1659 Addition of Medicinal Ingredient Azacitidine to
Project #1659 Addition of Medicinal Ingredient Urokinase to
Project #1659 Addition of Medicinal Ingredient Certolizumab
Pegol to Schedule F (Oct 2009)
Project #1597 Addition of 3 medicinal ingredients (Idebenone,
Idursulfase, Nesiritide) to Schedule F (Oct 2009)
OCP By-Laws By-Law No. 1 – June 2009 s
Schedule A - Code of Ethics for Members of the Ontario
College of Pharmacists - December 2006
Schedule B - “Code of Conduct” and Procedures for Council
and Committee Members - December 2006
Schedule C - Member Fees - January 2009
Schedule D - Pharmacy Fees - January 2007
Schedule E – Certificate of Authorization – January 2005
Schedule F - Privacy Code - December 2003
Reference s
OCP Required Reference Guide for Pharmacies in
Ontario, January 2010
* Information available at Publications Ontario (416) 326-5300 or 1-800-668-9938 www.e-laws.gov.on.ca
** Information available at www.napra.org
' Information available at Federal Publications Inc. Ottawa: 1-888-4FEDPUB (1-888-433-3782)
Toronto: Tel: (416) 860-1611 • Fax: (416) 860-1608 • e-mail: [email protected]
s Information available at www.ocpinfo.com
31
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Volume 17, Number 2
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March/April 2010 - Ontario College of Pharmacists

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