March/April 2010 - Ontario College of Pharmacists
Transcription
March/April 2010 - Ontario College of Pharmacists
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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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. pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 pharmacyconnection • March/April 2010 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 Contact: Penny Young 416-441-0788 ext. 2209, [email protected] www.opatoday.com 30 pharmacyconnection • March/April 2010 May 14-16, 2010 Cardiovascular Patient Care Ontario Pharmacists’ Association, Toronto Contact: Penny Young 416-441-0788 ext. 2209, [email protected] www.opatoday.com May 2010 (date TBD) Asthma and COPD Patient Care Ontario Pharmacists’ Association, Toronto Contact: Penny Young 416-441-0788 ext. 2209, [email protected] www.opatoday.com June 17-19, 2010 OPA Conference 2010, Niagara Falls Contact: Penny Young 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: Regulation 202/94 Amended to O.Reg. 270/04 Regulation 681/93 Amended to O.Reg. 122/97 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: Regulation 935 Amended to O.Reg. 354/08 Regulation 936 Amended to O.Reg. 205/96 Ontario Drug Benefit Act (ODBA) & Regulations * s December 15, 2009 Regulations to the ODBA: Regulation 201/96 Amended to O.Reg. 252/09 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 Schedule F (Dec 2009) Project #1659 Addition of Medicinal Ingredient Clofarabine to Schedule F (Dec 2009) Project #1659 Addition of Medicinal Ingredient Azacitidine to Schedule F (Dec 2009) Project #1659 Addition of Medicinal Ingredient Urokinase to Schedule F (Dec 2009) 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 pharmacyconnection • March/April 2010 31 Follow us on Twitter and subscribe to our RSS Feed! on Twitter and through RSS feeds. What does this mean? You will be able to receive updates to the latest news, Continuing Education information and Health Canada Advisories directly through our site. Go to www.ocpinfo.com and click on the Twitter or RSS feed at the bottom left of the page for more information. Please note that this service does not replace your receipt of e-blasts for important member information. Volume 17, Number 2 The College is incorporating some social media tools into its daily activities. You can now follow OCPinfo