May/June 2010

Pharmacy Technicians on the Road to Regulation page 12 Focus on Registration page 22 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 Joseph Hanna PM Joinal Abdin Statutory Committees 2 Elaine Akers PM Thomas Baulke • Executive 3 Sherif Guorgui PM Corazon dela Cruz • Accreditation 4 Tracey Phillips PM Babek Ebrahimzadeh • Discipline 5 Donald Organ PM James Fyfe • Fitness to Practice 6 Zita Semeniuk PM David Hoff • Inquiries Complaints & Reports 7 Tracy Wiersema PM Margaret Irwin • Patient Relations 8 Saheed Rashid PM Javaid Khan • Quality Assurance 9 Bonnie Hauser PM Lewis Lederman • Registration 10 Gerald Cook PM Aladdin Mohaghegh Standing Committees 11 Christopher Leung PM Gitu Parikh • Communications 12 Peter Gdyczynski PM Joy Sommerfreund • Finance 13 Sanjiv Maindiratta U of T Henry Mann • Professional Practice 14 Stephen Clement U of W Jake Thiessen 15 Jon MacDonald Special Committees 16 Doris Nessim • Standards of Practice Working Group 17 Shelley McKinney • Pharmacy Technicians Working Group

College Staff

Office of the Registrar x 2244 Registration Programs x 2250 Pharmacy Openings/Closings, [email protected] [email protected] Pharmacy Sales/Relocation [email protected] Office of the Deputy Registrar/ Structured Practical Training Programs x 2297 Director of Professional Development [email protected] Registration and Membership Information: Pharmacy Connection Editor x 2241 [email protected] [email protected] Investigations and Resolutions x 2274 [email protected] Pharmacy Technician Programs Office of the Director of [email protected] Professional Practice x 2241 Continuing Education Programs and [email protected] Continuing Competency Programs x 2273 Publications x 2229 [email protected] [email protected] Office of the Director of Finance and Administration x 2244 [email protected] contents

Interested in Serving on a College Committee? 10 Pharmacy Technicians on the Road to Regulation 12 Improving care for the elderly 15 Take a trip back to the beginnings of Pharmacy at The Niagara Apothecary 19 Focus on Registration 22

regular features Serve on a College Committee – page 10 Registrar’s Message 4 Editor’s Message 5 Council Report 6 Pharmacy Technician Q&A 14 Health Canada Notices 17 Did You Know... 20 Practice Q&A 21 Registration Q&A 24 The Road to Regulation – page 12 SPT Q&A 25 Bulletin Board 26 Update on Technology 27 Deciding on Discipline 28 Focus on Error Prevention - Prescription Transfers 29 CE Resources 30 Laws & Regulations 31

Visit the Niagara Apothecary – page 19 pharmacyconnection May/JuneJuly 2010 • August Volume 2008 17 • Number Volume 315 • Number 4

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. Anjali Baichwal ISSN 1198-354X President Associate Editor © 2010 Ontario College of Pharmacists [email protected] Canada Post Agreement #40069798 Deanna Williams, R.Ph., B.Sc.Phm., C.Dir., CAE Undelivered copies should be returned to the Registrar Agostino Porcellini Ontario College of Pharmacists. Not to be reproduced Production & Design / Webmaster in whole or in part without the permission of the Editor. Della Croteau, R.Ph., B.S.P., M.C.Ed. [email protected] Editor, Deputy Registrar, Director of Professional Development Neil Hamilton [email protected] Distribution 10% [email protected] Cert no. SW-COC-2036 registrar’s message

Deanna Williams, R.Ph., B.Sc. Phm., C.Dir., CAE Registrar

n many of my messages over the education on common subjects such have been trained- that of experts in years, I speak about the “chal- as anatomy, physiology and pathol- medication therapy, monitoring and Ilenges and opportunities” facing ogy is now routine, it’s a fact that no management. our profession. Amidst recent gov- other health professional receives the So, amidst the current challenges, ernment announcements respecting extensive education and training in you ask where is there opportunity? changes to Ontario’s Public Drug Sys- bio-pharmaceutics, pharmacokinet- The business of pharmacy once again tem, it’s hard to look for opportunities ics, pharmacology, or drug therapy is facing new challenges but what when all you can see in front of you management that you do. does or should that have to do with are challenges. But I believe that The days where pharmacy gradu- the health profession of pharmacy? opportunities do indeed exist—the ates were content, first after two, The business model may need to be changed, but as you know, nothing The College trusts that amidst current challenges, all has ever precluded pharmacists from pharmacists will be true to their professional roots charging a reasonable fee for the ser- and do what is in the patient’s best interest. vices they provide. As the new scope of practice real challenge is recognizing where and then after four years of educa- for pharmacists unfolds this year they exist and then taking them. tion and training, to “count and pour, with pharmacists gaining five new Over the past decade the Col- lick and stick”—as we fondly referred controlled acts, perhaps this is the lege—with member support—has to dispensing—are gone. Today’s opportunity for you to demonstrate worked towards gaining an expanded new pharmacists are graduating after to the public and other health profes- scope of practice for pharmacists to at least five years of university, al- sionals that, business challenges aside, enable all pharmacists to practice to though many of these folks enter the pharmacists are first and foremost the full extent of your education and pharmacy programs with full degrees. health care professionals. This means training. No other health professional The undergraduate curricula fulfilling the public expectations that possesses the unique body of know- across Canada have undergone sever- they—and their care—come first ledge or the expertise in drug therapy al revisions over the years, and today no matter what. Being professional that a pharmacist does. Every health are based on new outcome-based means that quality patient care is at care professional in Ontario has a and patient centered competencies. the forefront of every decision you profession-specific body of know- These new pharmacists are ready to make on behalf of patients and the ledge that positions them to fulfill a embrace recent changes to legislation College trusts that amidst current necessary and vital role in the health that will permit registered pharmacy challenges, that all pharmacists will care system. As pharmacists, your technicians to responsibly assume be true to their professional roots and expertise, knowledge and training most of the technical aspects of dis- do what is in the patient’s best inter- sets you aside from other health pro- pensing so that as pharmacists, they est. The future of pharmacy—as a fessionals. While inter-professional can embrace the role for which they health profession—depends on it.

4 pharmacyconnection • May/June 2010 editor’s message

Della Croteau, R.Ph., B.S.P., M.C.Ed. Deputy Registrar/Director of Professional Development

pring is here and the stu- training for those coming into the preceptors in this province who dents are finishing exams, profession. Some pharmacists con- have provided opportunities for Slooking forward to working sider it an essential part of their students and interns. More than for the summer--or not. Students own continuing education. One 300 of them currently have stu- and faculty members at both our pharmacist told us “ I learn just as dents and interns with them in faculties of pharmacy are worried much as the student–I am not sure practice, and several more will be about the effects of the current who is teaching whom.” attending preceptor workshops in issues between pharmacies and The students are telling us that the next few weeks. We want to the government on the training it’s difficult to focus on those final thank those of you who are step- and development of future phar- exams when they are unsure as to ping up to provide placements for U of T and Waterloo students as well The profession of pharmacy has a long tradition of as the many students and interns apprenticeship and training for those coming into the who come to us from other parts of profession. Some pharmacists consider it an essential Canada, the U.S. and around the part of their own continuing education. world. In the face of uncertainty, you are providing them opportun- macists. Right when students whether or not they will be able ities to receive valuable training and should be settling down for their to get jobs once they complete all for some, to complete internship final exams, they got news of po- this university training. As one stu- and receive their license to prac- tential cuts to their training sites. dent put it, “I better get studying tice. Thank you for your continued Some pharmacies are taking a because if I don’t pass medicinal support in the professional develop- wait-and-see attitude. Some phar- chemistry, I wont have a future in ment of pharmacy. macists would like to take a student pharmacy to worry about!” but are unsure of the impact of the But I shared these statistics proposed changes and want to see with some of them: Close to 13 how it all plays out. per cent of the population is over And although this is a difficult 65. Every seven seconds, a baby time for pharmacists, many of you boomer turns 60. Life expectancy remember the opportunity given is 79 years. By the time all the baby to you by a pharmacist when you boomers retire, 38 per cent of the were a student or intern, and are population will be over 65. In other fulfilling your commitment to train words, we need these new pharma- students and interns. The pro- cists with their advanced skills to fession of pharmacy has a long keep us well and healthy. tradition of apprenticeship and There are 1,996 trained

pharmacyconnection • May/June 2010 5 council report - March 2010

Legislation Updates by mid May but indicated that Min- the Professional Practice and Ac- Ms. Allison Henry, Manager, Regu- istry staff would continue to work creditation Committees before June latory Programs Unit at the Ministry diligently to obtain final approval by Council. The College considers it of Health and Long-Term Care, late spring or early summer. critical that all regulatory amend- was invited to attend the meeting Council noted that drafting of ments, including those to enable to provide Council with an update remote dispensing regulations is pro- remote dispensing, are incorporated respecting the Ministry’s progress ceeding with anticipated review by into one consolidated regulation so with regard to the College’s Regis- tration Regulation which was submitted to the Ministry on Octo- Council Approves Audited Statements for College ber 5, 2009. Operations in 2009 The proposed Registration Regu- As prepared by Clarke Henning LLP, Chartered Accountants lation was amended last summer in Statement of Operations – Year Ending December 31, 2009 response to the Ministry’s request to ensure the College’s compliance Budget Actual with the requirements under the Revenues proposed labour mobility legislation Member fees $ 6,223,627 $ 6,179,268 (Bill 175) and to address concerns Pharmacy fees 2,773,030 2,831,983 expressed by the Office of Fairness Registration fees and income 878,169 1,011,675 Commissioner with regard to the Investment Income 230,000 53,192 non-exemptible requirements for $10,104,826 $10,076,118 international pharmacy graduates. Expenses Council noted that Bills 175 (the Council and committees 2,805,518 2,575,524 Ontario Labour Mobility Act) and Administration 7,808,839 7,556,544 179 (Regulated Health Professions Property 283,228 250,841 Statute Law Amendment Act, 2009) $10,897,585 $10,382,909 both of which received Royal As- sent on December 15, 2009 resulted Excess (deficiency) of revenues over in shifted priorities for the Ministry expenses from operations for year, (792,759) (306,791) and impacted the regulatory ap- before depreciation proval processes for all regulatory colleges. The Ministry recognizes Depreciation - 424,683 that the Registration Regulation is critical to enable the College to Excess (deficiency) of revenues support the registration of phar- over expenses for the year (792,759) $ (731,474) macy technicians, and Ms. Henry acknowledged the efforts of Col- The audit and resulting financial statements were prepared in accordance lege Council and staff in meeting all with Canadian generally accepted accounting principles. Of note is that deadlines in a timely manner and be- of the $2.1 million approved by Council for the telecommuting initiative, ing available to consult and answer approximately $375,000 of the expenditure ($200,000 in expense and questions respecting the intent and $175,000 capital) will not be incurred until 2010. Taking into account this purpose of the proposed regulations. deferral of expenditure, the statements reflect a deficit of revenue over ex- She cautioned that it was likely that penditure of $506,000 vs. the budgeted deficit of $792,000. the Regulation may not be approved

6 pharmacyconnection • May/June 2010 that areas of potential “disconnect” and legislative changes, should these remain drugs when the definition regarding the regulation of pharma- occur later. of a drug was revised in 2007, both cies may be avoided. Accordingly, Council ratified the by-laws parties consider it important to enabling provisions respecting re- which became effective immedi- provide greater clarity since these mote dispensing are being written ately. The new by-law, and the products are now also designated into these consolidated regulatory schedules, can be accessed on the as natural health products. Provi- amendments to the DPRA (Drug College website at www.ocpinfo. sion (f) of the definition of a drug and Pharmacies Regulation Act). com. will ensure that they are sold in It is the College’s intent to intro- a manner which protects against duce these as a complete package Council Ratifies proposed diversion and illicit use to the government. In addition, amendments to the Drug - A change in wording to the sec- stakeholder consultations and inter- and Pharmacies Regulation tion concerning the knowledge professional health college meetings Act of the designated manager of the have begun on the enhanced Subsequent to Council’s considera- specifics of any agreement where scope of practice. Focus groups of tion and preliminary approval in a pharmacy discloses non patient front-line practitioners will also be December 2009 of proposed identifiable information to a third conducted around the province to amendments to the Drug and Phar- party. A copy of such an agree- inform the drafting of regulations macies Regulation Act (DPRA) to ment would not necessarily be regarding scope. consolidate Regulations 551/90 required to be provided to the and 297/96 and to amend certain designated manager, but they must By-law amendments portions of the Regulations, the be made aware of its existence Ratified consolidated version of the Regula- and be assured of the fact that no Following circulation of a new gen- tions, together with a comparison patient identifiable information eral operating by-law, which amends chart, was circulated to members would be included various sections of the current by- for comment. - definition of “benefit” as it relates law to incorporate changes to the Following the review of received to conflict of interest is clarified to elections procedures, integration of comments, some of which required exclude those permitted by law technician members and other mis- simple clarification and others which - clarification of section 40.(2) to cellaneous matters to bring it in line repeated past submissions, five addi- include “all prescription records” for with current procedures and reflect tional amendments were made: maintenance of records as opposed best practices, the by-law was also - Replacing the definition of “elec- to “written” prescriptions. further re-examined internally by tronic signature” with that in the legal counsel to determine how to Electronic Commerce Act: (i.e. U of T’s Satellite IPG Pilot address implementation in the event “electronic information that a receives approval that proclamation of the registra- person creates or adopts in order Council approved the University of tion regulation and Pharmacy Act to sign a document and that is in, Toronto’s proposal for a one-time changes enabling registration of attached to or associated with the pilot delivery of a satellite IPG Pro- pharmacy technicians was not re- document”) gram in Egypt in spring 2010. ceived in time for elections. To that - clarification that pseudoephe- The faculty at the University of end, changes were proposed to sev- drine and ephedrine are drugs Toronto has been considering strat- eral sections to enable the by-law in Ontario. Although it was the egies to improve access to the IPG to come into force with provisions intention of both the College and program both geographically and for election of technicians to take the Ministry of Health and Long- financially and this program is be- place upon passage of the regulatory Term Care that these substances ing offered as a one time pilot, with

pharmacyconnection • May/June 2010 7 council report

the intent to evaluate the program international applicants pursuing Pharmacy Regulatory Authorities) for achievement of student learning registration as a pharmacy techni- and the corresponding advisory outcomes, feasibility of delivery and cian. The proposal was to design notice sent to all pharmacists in improved access to the profession of a program that would be approved Ontario reminding them that, in pharmacy in Canada. by the College and could be ac- accordance with the long standing Admission criteria are the same cessed and sustained through the position of the College, pharma- as for those students applying locally Community College system in On- cists should not sell products that and access will be open to anyone tario over the long term. have not been approved by Health who meets the entry criteria and International graduates apply- Canada and/or obtained from has the legal authority to attend ing for a certificate of registration bona fide sources. the program in Egypt (i.e. students as a pharmacy technician, like the Although Council was made from other jurisdictions are eligible international pharmacist gradu- aware that Health Canada is provided they have the authority to ates, will need to complete an working to address this matter study in Egypt.) Students will also approved program that will provide through regulatory proposals, be required to complete the last four them with the learning opportun- Council remains concerned that weeks of the program in Toronto. ities needed to ensure they achieve permitting unapproved products to Applicants will need to have com- the knowledge, skills and judgment be sold does not provide adequate pleted the PEBC evaluating exam at least equivalent to the graduates assurance that such products are and fluency prior to enrolling in the of CCAPP accredited pharmacy safe to be sold in pharmacies. pilot program, but would still be re- technician programs. This Bridg- Without such assurances from quired to meet all of the remaining ing Program will include language Health Canada, Council agreed entry-to-practice requirements, in- training and orientation to the that the College’s advice to phar- cluding studentship, internship, the Canadian health care system, in macists should remain unchanged. jurisprudence exam and the PEBC addition to the knowledge and Accordingly, Council unani- qualifying exam. skills needed for practice as a phar- mously affirmed the College’s long There was recognition of the macy technician in Ontario. standing position that in order to need to ensure that graduates of the In order to be eligible, appli- assure public safety and protec- program achieve the same learning cants must have either completed tion, pharmacists only purchase outcomes as students in the local the OCP certification exam or, and sell products that have been program and that a pilot such as this have completed an international approved by Health Canada and would assist in determining the feas- pharmacy or pharmacy techni- obtained from bona fide sources. ibility of offering such a program on cian academic program and 2000 This means that pharmacists an ongoing basis. hours of eligible pharmacy practice should not sell a marketed health experience in any jurisdiction (cre- product without a Drug Identi- Council approves Pilot dentials and practice experience to fication Number (DIN), Natural Pharmacy Technician be assessed by PEBC). Health Product Number (NPN) Bridge Training Program or Drug Identification Number for Internationally trained Sale of Non-Approved for Homeopathic Medicine (DIN- individuals Marketed Health Products HM), and further, should not Centennial College, in response to Council reviewed all information purchase or accept for sale any a call for proposals, has received and correspondence received to marketed health products, includ- funding from the Ontario Ministry date arising from the recently ing natural health products, that of Citizenship and Immigration to released position statement by do not possess a DIN, NPN or develop and pilot a program for NAPRA (National Association of DIN-HM.

8 pharmacyconnection • May/June 2010 Grants Approved care providers using eHealth solu- NAPRA/PEBC Council endorsed the Executive tions in Ontario. Participation Representatives Appointed Committee’s recommendation that involves providing eHealth Ontario Council confirmed Ms. Tracy the College sponsor an education with specific information about Wiersema’s appointment as the Col- session at OPA’s Annual Confer- each of its members for validation lege’s representative on the NAPRA ence to be held June 17-19, 2010. purposes. (National Association of Pharmacy This year, the sponsorship, in the The majority of the information Regulatory Authorities) Board. Ms. sum of $2,500, is being provided is public in that it is contained in Wiersema’s appointment is effective for the session entitled, “Intra- the College’s register. Some of the February 2010 to December 2011. professional collaboration: Engaging information however, is not pub- Council also affirmed Mr. Gdy- pharmacists and technicians in the lic, namely: date of birth, date of czynski’s appointment to PEBC. new scope of practice model”. Regis- death, gender, email address and Mr. Gdyczynski was appointed for trar Williams has also been invited language of choice. The College a three-year term beginning in 2009 by the OPA to participate in panel undertook a legal review to deter- and was recently elected PEBC’s discussions at the Conference. mine the appropriateness of sharing President. Both representatives this information with eHealth for will report to Council following the ePrescribing purposes of the Registry Data Feed annual general meetings of these Demonstration Project Project. The review looked at the organizations. Extension Approved issue from the perspective of au- Following receipt of correspond- thority, and interests of the College ence from the physician and and its members. pharmacist leads of the two pilot Council was satisfied that the Council Meeting sites for ePrescribing in Ontario, collection and disclosure of this Dates for 2010 this College, together with the Col- information is supported by the lege of Nurses of Ontario and the College’s By-law as it relates to the June 7 & 8, 2010 and College of Physicians and Surgeons professional characteristics and September 13 & 14, 2010. of Ontario, agreed to support the activities of its members that may extension of the pilot project for a assist the College in carrying out its For information, please contact period of 6 months (to end of June objects - namely that the Registry Ms. Ushma Rajdev at 2010). The extension will allow all is part of a province-wide effort to [email protected] the Colleges access to a more com- provide for greater collaboration and plete evaluation and will help in the information sharing between health development of the Provincial Drug profession colleges and others, and Information System. to respond to technological and other changes in practice environ- eHealth Provider Registry ments. Disclosure of the information Update for validation of identity in the As reported previously, the Col- Registry is also in the interests of lege has been asked to participate members as the development of a in the eHealth Ontario Provider harmonized eHealth system for On- Registry Data Feed Project. The tario is intended to improve patient purpose of the Registry is to serve care and safety by facilitating the as a comprehensive source for the sharing of information among health positive identification of all health care providers.

pharmacyconnection • May/June 2010 9 non-council committees

Pharmacists and Pharmacy Technicians: Interested in Serving on a College Committee? Consider participating as a non-Council Committee Member

nder the Regulated Health Profes- by field staff where the pharmacy has failed to comply sions Act, the College committee with the requirements for maintenance, record keeping structure requires the appointment and ownership. of members who are not elected The Communications Committee is a standing com- members of Council to its various mittee of the College. It is charged with dealing with all committees. In addition, members with particular experi- matters supporting public education and outreach, includ- ence or expertise are also required from time to time to ing, but not limited to, raising awareness of the value of serve on various special committees, working groups and both the profession and the College. task forces. The statutory and standing committees that re- The Discipline Committee*, through selected panels, quire participation by a non-council member are listed hears allegations of professional misconduct against mem- below, together with a brief description of their terms of bers as referred by various Committees of the College. reference. Upon finding the member guilty of professional miscon- Both pharmacists and pharmacy technicians are en- duct, the panel has the authority to revoke, suspend or Ucouraged to apply (pharmacy technicians see page 11 for limit a member’s registration, impose a fine, or reprimand details). the member.

The Accreditation Committee is a statutory com- The Fitnesso t Practise Committee considers incapa- mittee that considers matters relating to the operation city matters referred by the ICRC. of pharmacies in Ontario. These matters include oper- ational requirements, ownership, supervision and the The Inquiries, Complaints and Reports Committee* distribution of drugs in the pharmacy. The Committee also (ICRC) screens matters related to public complaints or reviews issues relating to pharmacy inspections conducted information the College receives through reports. The

10 pharmacyconnection • May/June 2010 Committee reviews written materials and determines to serve on panels to consider the matters presented and whether a hearing is required, or if some other action panels are convened approximately once a month. would address the public interest. To be eligible for consideration for appointment, you must: The Patient Relations Committee’s legislative re- • h old a valid Certificate of Registration as a pharma- quirements are to develop and monitor a Sexual Abuse cist or as a pharmacy technician (Those pharmacy Prevention Plan as well as to monitor the College’s Pa- technicians who have met the requirements of licen- tient Relations Program and make recommendations to sure and are awaiting the passing of the legislation are Council on ways to enhance relations between members encouraged to submit their resumes for consideration) and patients. • either practise or reside in Ontario • not be in default of payment of any fees prescribed in The Quality Assurance Committee is responsible for the By-Laws developing and maintaining the College’s Quality Assurance • not be the subject of any disciplinary or incapacity Program, which includes such components as continuing proceeding education, a two-part register, minimum practice require- • not have your Certificate of Registration revoked or ments and a practice review process. The goal of the Quality suspended in the six (6) years preceding the date of Assurance Program is to support continued competence the appointment and to encourage continuing professional development of • not have your Certificate of Registration subject to a registered pharmacists and pharmacy technicians. term, condition or limitation other than one prescribed by regulation and The Registration Committee* establishes the • not have a conflict of interest in respect of the Com- conditions and qualifications for registration. The mittee to which you are to be appointed Committee reviews, through panels, the eligibility of applicants when the registrar has doubts about their You will need to submit a letter of interest stating the ability to meet the requirements. A panel of the Regis- committee(s) on which you would like to serve, along tration Committee may exempt an applicant from a with a brief resume and any other information you deem portion of the entry-to-practice requirements when the useful. Non-council committee members are required to applicant provides sufficient assurance to the commit- serve a one-year term and the President, in conjunction tee that they have the appropriate level of knowledge with the chairs of the committees, makes committee ap- and skills. pointments at the beginning of each Council year. You will be contacted after the Council meeting has taken place The number of days required by members to serve (September 13 and 14, 2010) if you have been appointed to on each committee varies according to the frequency of serve on a Committee. meetings and agenda. If you are interested in being considered for an appointment to a committee, or for more informa- * The Discipline, ICRC and Registration Committees tion on non-Council Committee representation, contact all operate using panels comprised by alternating commit- Ms. Ushma Rajdev, Council & Executive Liaison, at tee members. Members of the committee will be selected 416-962-4861, ext. 243; email [email protected].

pharmacyconnection • May/June 2010 11 pharmacy technicians Pharmacy Technicians on the Road to Regulation

Pharmacy technicians on the regulation route agree that the challenges will be worth it

by Stuart Foxman

racy Wills has had an accom- plished career as a pharmacy Ttechnician, working at Hô- tel-Dieu Grace Hospital in Windsor and part-time for Shoppers Drug Mart. Still, she says, “no matter how much experience you have, there’s so much more to know.” Wills, one of two pharmacy tech- nician observers on the Ontario College of Pharmacists council, has spent the past two years pursuing regulation. She is one of the many pharmacy technicians currently completing the required courses and exams, with a view to becoming part of the first round of registered phar- Patricia Hayton and Tracy Wills macy technicians later this year. “With all the changes in the pro- employers view the process? technician regulation came about, fession, the more knowledgeable “I’ve been waiting for this a long she jumped at the chance to finally you are, the more valuable you time,” says Mary Bozoian, business pursue the educational requirements. become,” says Wills. She should integrity consultant with ESI Can- “If you can expand your knowledge, know. Not only is Wills a student, ada, a Mississauga-based pharmacy learn new skills, and better under- she also instructs in the pharmacy benefits management company, and stand the pharmacy practice,” says technician program at Windsor’s St. interim president of the Canadian As- Bozoian, “why wouldn’t you do it?” Clair College. sociation of Pharmacy Technicians. Bozoian feels that becoming regu- As Wills and her counterparts She recalls discussions about lated will bolster her credibility and travel along the road to regulation, regulation dating back to the early accountability. Employers agree how do pharmacy technicians and 1990s, so when word of pharmacy that regulation advances the field.

12 pharmacyconnection • May/June 2010 Christine Donaldson, regional pharmacy director at Windsor-Essex Hospitals, says that as pharmacists Upcoming dates are assuming greater responsibilities, regulation helps pharmacy technicians to keep pace. for Pharmacy “It allows both of us to keep moving forward. These Technicians: are exciting developments for the entire profession,” says Donaldson. Technicians pursuing regulation admit that at times, PEBC Evaluating Exam seeing the long-term benefits to your career (and to Next exam: September 18, 2010 the profession overall) can be difficult when you’re Registration deadline: June 28, 2010 focused on the short-term demands of balancing Note: Individuals currently in the profession education with a job. But the pharmacy technicians who wish to pursue regulation in Ontario and who’ve already done so encourage their colleagues to require this exam must do so by Jan. 1, 2012 take on the challenge. That means there are only three “It wasn’t easy, but it was manageable,” says Pa- opportunities left! tricia Hayton, a pharmacy technician with the Rouge Valley Health System, Centenary Site, in Scarbor- PEBC Qualifying Exam ough. “The growth that technicians have achieved, Next exam: Aug 28, 2010 (written exam), and are about to embark on, will welcome more Aug 29, 2010 (performance exam) opportunities to showcase our abilities in this new Registration deadline: June 4, 2010 expanded role. Regulation validates the dedication Note: applicants may choose to write one or both and hard work that pharmacy technicians perform parts of the Qualifying exam within the same session on a daily basis.” Applications and exam details are available on For Linda Sparrow, coordinator of professional the PEBC website (www.pebc.ca) practice at Dell Pharmacy, a chain in the Hamilton- Niagara area, regulation “adds strength and more Jurisprudence Exam responsibility to the role.” Next exam: July 21, 2010 Sparrow reports that 25 per cent of Dell’s pharmacy Registration deadline: June 1, 2010 technicians are engaged in the bridging program. In Registration opens: May 17, 2010 the health care delivery model, she says the pharmacy Note: applicants must be CCAPP graduates or have as a whole is playing an increasingly central role, and passed the OCP certification exam or PEBC that, with regulation, pharmacy technicians will only evaluating exam. Completion of the Bridging enhance their standing. Program is strongly recommended prior to sitting Wills agrees. She says that every course she took the exam. gave her more confidence and a greater understanding This exam must be completed within three years of pharmacy practices and the reasons behind them. As of meeting all the requirements for registration as a someone who works in a hospital and a retail setting, pharmacy technician. she knows that becoming a regulated pharmacy tech- See the OCP website for registration details. nician will help her to fulfill her primary duty in both. “Patient safety should be our first concern,” she says. “The only way to do that is by being up-to- date on how things are changing in our profession and scope of practice.”

pharmacyconnection • May/June 2010 13 pharmacy technician Q&A

Susan James, BScOT, MPA Manager, Registration Programs

Understanding the role of the un-regulated technician

In the January/February 2010 issue of Pharmacy As stated previously, many hospitals are requiring QConnection the College stated that there will be their staff to become registered with the College and in some people who choose not to become regulated making this decision, many of them have considered the and that in many of those cases they will still be able risk management issues related to using regulated and to perform the same job that they are currently in. non-regulated workers. Requiring the use of regulated My employer has told me that if I do not choose to professionals not only means they have demonstrated become regulated, they can not allow me to continue that they have the necessary knowledge, skill and ability doing the same job. Who is correct? to perform their job, but also ensures that their practice This is a complex issue. Many pharmacy technicians, par- will be held to the standards of the profession and that ticularly those working in a hospital setting, have been they will be required to demonstrate their continued performing aspects of the controlled act of “selling, dis- competence over time. pensing and compounding a drug” under a delegated model There are a number of factors that employers need of practice. Under the Regulated Health Professions Act, to review when determining not only if they will require controlled acts are only to be performed by professionals registration, but also the tasks that non-regulated per- with the legislated authority to do so. When delegation sonnel will be able to perform. As a transition measure is used, the professional who transfers the authority to some employers may continue to use the delegation perform the act remains accountable for the performance model while their staff prepares to become regulated. of the person to whom they have delegated it. At a future point however, it is reasonable to expect In the past, this mechanism of transferring authority that employers will restrict performance of the con- allowed many pharmacy technicians to perform their job trolled act of dispensing and compounding to regulated without requiring direct supervision and double check- professionals. ing by the pharmacist. The government has always been clear however, that delegation should not be used to bypass regulation where it exists. Once the legislation to regulate pharmacy technicians is in effect, it will al- low pharmacy technicians (i.e. those registered with the College) to perform the technical aspects of dispensing and compounding with greater independence, as a re- sult of being accountable for their own practice. In fact, one of the reasons the government decided to regulate pharmacy technicians was the fact that many of them were already performing this task without the safeguards that regulation of the profession provides to the public.

14 pharmacyconnection • May/June 2010 geriatric report Improving care for the elderly

Chief Coroner’s Geriatric and Long Term Care Review Committee makes recommendations concerning the use of drugs in the elderly

he Geriatric and Long Term Care Review Com- mittee reports to the Chief Coroner for the TProvince of Ontario. Cases are referred to this committee from a variety of sources, including local cor- oners. The committee conducts an independent review of the available records relevant to the specific case and prepares a final report which includes recommendations aimed towards the prevention of future deaths in similar circumstances. In 2008, the Geriatric and Long Term Care Review Committee reviewed a total of 18 cases which resulted in 46 recommendations. The recommendations are intended to promote discussion and initiate change. The recommendations focused on issues and concerns relating to: medical and nursing management, communi- cation and documentation, use of drugs in the elderly, admissions, discharge and transfer procedures, and the acute care and long term care industry in Ontario. Below are the recommendations concerning the use of drugs in the elderly. Pharmacists who are part of a team working in long term care of geriatrics may also wish to review the other recommendations which apply to all health professionals. Within the areas of concern, there are rec- ommendations which tend to be repeated yearly and may indicate a systemic risk to the elderly.

Recommendations concerning the use of drugs in the elderly: in the management of the side effects or antipsychotic • Health care professionals should be reminded that the medications prescribed for elderly demented patients. decision to prescribe antipsychotic medications for de- Rather, discontinuation of the medications or alternative mented patients requires careful consideration of the medication strategies should be pursued. benefits of using these medications and the potential • All acute and long term care institutions in the Prov- for the development of side effects. Rarely, if ever, are ince of Ontario should have a policy and procedure to dopaminergic or anticholinergic medications of value calculate the appropriate dosing of medications for ill

pharmacyconnection • May/June 2010 15 geriatric report

elderly patients with renal impairment. The importance required in the elderly, toxic side effects may still occur. of utilizing a pharmacist in establishing and adjusting the • Health care professionals should be reminded that the dosages of medications for ill elderly patients cannot be commonly prescribed oral hypoglycaemic medication Gly- overemphasized. buride may cause hypoglycaemia in the elderly even in the • The hospital should develop and institute a professional presence of frequently high blood sugars. practice policy to identify medications requiring careful • Health care professionals should be reminded that the clinical monitoring at the time of discharge from the in- abrupt discontinuation of beta blockers should be done tensive care unit. The importance of direct physician to with extreme caution. physician communication as part of this policy cannot be overemphasized. The complete list of recommendations and case reviews • Health care professionals should be reminded of the are available on the website of the Ontario Ministry of Com- importance of monitoring medications prescribed in the munity Safety and Corrections at www.mcscs.jus.gov.on.ca elderly. Even when medications such as analgesics are Select “Chief Coroner” then “Publications and Reports.”

16 pharmacyconnection • May/June 2010 health canada advisories & notices

April 9, 2010 Health Canada, in consultation with GlaxoSmithKline, has revised the provisional expiry date of the adjuvanted H1N1 vaccine (Arepanrix). This revision is not safety–related but is due to a decline in strength of the H1N1 antigen in specific lots. April 9, 2010 Further to the recent regulatory recommendations in the United States and European Union to not approve Zeftera due to concerns regarding the conduct of clinical trials, Janssen-Ortho Inc., in collaboration with Health Canada, decided to issue a Notice to Hospitals regarding the discontinuation of sale of Zeftera (ceftobiprole medocaril) on April 16th, 2010. March 31, 2010 Health Canada is warning Canadians that an unauthorized health product, “West Pharm Therma Lean Fat Burner Energizer” was found on the Canadian market. West Pharm Therma Lean Fat Burner Energizer contains Ephedrine and caffeine, which combined together, may cause serious and possibly fatal adverse effects. Canadians suffering from heart conditions, high blood pressure and diabetes are among those particularly at risk. The product was distributed across Canada via the internet by Nutrition First (www.nutritionfirst.ca), a company located in Nova Scotia. March 25, 2010 Health Canada is warning Canadians that an unauthorized health product, “Herbal Diet Natural” has been found on the Canadian market and contains an undeclared pharmaceutical ingredient similar to the prescription drug sibutramine. Sibutramine may pose serious health risks, particularly to people with heart problems. March 25, 2010 WinRho SDF (Rho(D) Immune Globulin (Human)) Association with Intravascular Hemolysis in the Treatment of Immune Thrombocytopenic Purpura (ITP)- Important New Prescribing Information - Cangene Corporation. Resulting from the analysis of reports of intravascular hemolysis, changes to the prescribing information for WinRho SDF for the treatment of immune thrombocytopenic purpura (ITP) have been made. These changes include new contraindications and conditions of use. March 23, 2010 Health Canada is advising consumers that Ratiopharm Inc., of Mirabel, Quebec, has voluntarily recalled all units from two lots (Lot HF26 and Lot HF27) of the prescription drug Ratio-Prednisolone Ophthalmic Solution (DIN 00700401) in 1.0% strength because some bottles may contain particles that could lead to increased eye irritation. March 22, 2010 Health Canada is informing health care professionals and Canadians of changes to the labelling information for the prescription antibiotic Avelox (moxifloxacin). The updated labelling incorporates important safety information related to the rare risk of severe liver injury. March 20, 2010 LifeScan has initiated a voluntary recall of specific lots of OneTouch SureStep Test Strips because they may provide false low test results when blood glucose is greater than 22.2 mmol/L. Customers are asked to contact LifeScan immediately to find out if their test strips are affected. March 15, 2010 Health Canada would like to remind the thousands of Canadians who rely on medical devices or systems with internal clocks to check these devices to ensure they switch from Standard Time to Daylight Savings Time on Sunday, March 14, 2010 at 2:00 a.m. March 11, 2010 There are new changes to the Dose Conversion Guidelines - Janssen-Ortho Inc., Cobalt Pharmaceuticals Inc., Teva Canada Limited, Ranbaxy Pharmaceuticals Canada Inc., ratiopharm inc., Sandoz Canada Inc. and Pharmascience Inc. The morphine dose conversion ratio (parenteral versus oral) is now of 1:3. The conversion doses of IV/IM morphine to Fentanyl Transdermal Systems (patch strengths of 75, 87 and 100 mcg/ hour) were revised to “not applicable” to reflect the insufficiency of data available for guidance. March 8, 2010 Health Canada is warning Canadians that an unapproved health product, “Power-Max” contains sildenafil, a prescription medication was found on the Canadian market in Ontario. Sildenafil may pose serious health risks, particularly to people with heart problems. March 1, 2010 Health Canada is advising consumers not to use the following foreign health products due to concerns about possible adverse reactions: 2H & 2D, Products distributed by Atlas Operations Inc., Products distributed by Bodybuilding.com, STRO Emperor Capsules and Tian Yang Xu Huo Oral Ulcer Capsule. February 16, 2010 Accutane has been associated with cases of severe skin reactions (e.g. toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme). February 11, 2010 Dana Douglas Inc. has initiated a voluntary recall of certain neXus I, II and III rollators which may break during use resulting in the user falling and suffering serious injury including bruising, broken bones or death. February 9, 2010 Health Canada is advising consumers that the unauthorized product “Complete 7-Day Cleanse” is being recalled because it contains a number of active ingredients with a combined effect that may pose serious health risks.

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

pharmacyconnection • May/June 2010 17 PROPOSED CHANGES TO ONTARIO’S PUBLIC DRUG SYSTEM Feedback Shows Another Side to the Debate

ver the past several weeks, the College has received many letters, e- mails and phone calls from members about the provincial government’s proposed changes to Ontario’s public drug system. Many members have told us how they fear these proposed changes will affect their practice and their ultimate role as a healthcare provider. While much of what we have heard – and indeed what is reflected in the public domain – focuses on the negative impact the proposed changes will have on pharmacies, particularly those outside of the GTA, the College has also heard from members who are truly trying to recognize and seize opportunities and to view the situation as a positive step forward.

Here are some examples of the positive feedback the College has received:

“The funding and business model aside, pharmacists should be poised to make the most of the impending increases to our scope of practice. It is the biggest O opportunity the profession has ever seen.” “In all of this debate, we have not considered the opportunities provided through the licensing of pharmacy technicians – just doom and gloom, with the scenario of the pharmacist hidden in the back of the dispensary checking prescriptions. Licensing technicians may free up more time for the pharmacist to interact with patients and prescribers—regardless of the business model.”

“I don’t think pharmacists should be using patient interaction as a bargaining tool. I don’t think removing consultation in the interest of profits should even be up for discussion.”

“I really think our expanded roles as pharmacists in the future and payment for such services will keep our profession strong. I look forward to the changes OCP has for us and our patients.”

“I’m extremely pleased with the College’s forethought and work into shaping the future of pharmacy. If pharmacy staff put as much effort into counselling patients as they have in getting petitions signed, we have absolutely no concerns about the future of pharmacy!”

18 pharmacyconnection • May/June 2010 niagara apothecary

History Re-Opens for the Season Take a trip back to the beginnings of Pharmacy at The Niagara Apothecary

pring is here and there’s never medicines, “miracle cure-alls” for 1971.Today it is a museum showcasing been a more perfect time to everything from hair loss to tuber- mid-Victorian architecture and au- Sgo to Niagara-on-the-Lake culosis are on the shelves. The only thentic 19th century pharmaceutical and visit the origins of pharmacy at restorative ingredients in most pat- materials such as bottles and jars im- The Niagara Apothecary. The Na- ent remedies of the time were opiates ported from Britain during the 1830s, tional Historic site is operated by the and alcohol, so pharmacists were and original show globes, which were OCP and is open from Mother’s Day handy with a mortar and pestle to placed in windows to indicate that to Labour Day. custom-make prescriptions. the building was a pharmacy. Once inside the doors of the The Apothecary is the only sur- The original interior fittings of Apothecary, visitors are taken back viving building in the region from the Apothecary, all in use until 1964, to the way pharmacists practiced the 19th century and was a working have been painstakingly restored. over 100 years ago. Liquor by the pharmacy between 1820 and 1964. The hub of the Apothecary was the barrel or the bottle (and even by It operated for over 100 years under ornately carved dispensary, which the glass), flavourings, paints, dyes, a succession of six owners, closing in dominates the rear of the museum. leeches, tobacco and snuff–these 1964. The Ontario Heritage Trust With the exception of certain propri- were the stock-in-trade of a 19th- acquired the property, led its restora- etary drugs, even pills were made at century pharmacy. Rows of patent tion and opened it as a museum in the dispensary.

Farewell Ernie Curator Ernst (Ernie) Stieb retiring after 40 years After 40 years as a volunteer curator for the Niagara Apothecary, Ernie Stieb is retiring. A Registered Pharmacist in Ontario since 1953, Ernie has managed the facility since opening day in 1971. Over the years, he has overseen the restoration of the professional practice aspects of the 1866 building as well as the exhibits and maintenance of historical archives. Ernie graduated from the University of Toronto in 1952 with B.Sc.Phm, before obtaining an M.Sc.Phm in 1955 and Ph.D from the University of Wisconsin in 1959. There, he served as Associate Professor of pharmacy until 1967 when he returned to U of T’s pharmacy faculty. From 1967 to 1995, Ernie held a variety of positions as the faculty, including professor, assistant, associate and acting Dean. A Kitchener resident, Ernie has been married to his wife, Cathy, for more than 50 years and has two children. Under Ernie’s direction, the Apothecary has been a must-see attraction in Niagara-on-the-Lake, offering Ernie and his wife Cathy, visitors a glimpse into the origins of the profession. On behalf of the College, at the Niagara Apothecary we wish Ernie all the best and thank him for his dedication and time!

pharmacyconnection • May/June 2010 19 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 focusing on issues and incorporating best practices into Ontario pharmacies.

DID YOU KNOW …

… that the Point of Care sign should be displayed in are cluttered, messy and disorganized, this could lead to such a way that it can be viewed from outside the phar- health and safety issues, as well as increasing the potential macy? The main entrance or window are good locations. for dispensing errors. Refer to the article, “Maintaining a Professional Workplace Environment” in the January/ … that the Regulations under the DPRA require that February 2007 Pharmacy Connection. no e food b kept in the fridge where medications are stored? All food and drink for consumption must be stored …that plans for building a pharmacy within a medical in a separate fridge. clinic must allow for a physically separate space be- tween the dispensary and the clinic? The square footage … s that, a a designated manager, you are responsible of the medical clinic is NOT included in the total square for ensuring that all stock in the pharmacy, dispensary footage of the pharmacy. Only the portion of the prem- and front shop, is checked regularly for expiry dates? ises which contains the dispensary (within the enclosure) will be considered. The space must be continuous and … that maintenance of the pharmacy is important and inaccessible to anyone other than dispensary staff. Please can affect how the public perceives the professional- refer to Guidelines for Subdivided Pharmacies on the OCP ism of the pharmacist? If the dispensary and front shop website.

April 25, 2010

20 pharmacyconnection • May/June 2010 practice Q&A

Shakti Sawh Practice Advisory Officer

Can “Request for Refill” or “Re-authorization” Is there a difference between the classes of drugs Qforms be considered new prescriptions? Can Qwhich Chiropodists and Podiatrists can prescribe? these forms be used for narcotics, controlled The College of Chiropodists of Ontario regulates both substances and non-narcotics? Chiropodists and Podiatrists. A chiropody and podiatry Provided that there are no changes to the information on class member holding a general of academic class cer- the form, and that the form is signed and dated by the tificate of registration may prescribe a drug set out in prescriber, they may be considered as a new prescription. Schedule 2 or Schedule 3 respectively to this regulation, This also applies to narcotics, controlled substances and if the member complies with their standards of practice. non-narcotics. Use the web link below to access the Chiropody Act, Reminder: a “controlled substance” is defined in the Con- which identifies the specific drugs within each category trolled Drug and Substances Act (CDSA), and refers to stated below. any substance listed in Schedules I, II, III, IV and V of the http://www.e-laws.gov.on.ca/html/regs/english/ela- Act. These schedules include controlled drugs, narcotics, ws_regs_940203_e.htm. For more information, refer to benzodiazepines and targeted substances. Once signed the College of Chiropodists of Ontario, http://www.co- and dated, the information on the form meets all of the coo.on.ca/. requirements of a new prescription.

Regulation 203/94 made under the Chiropody Act, 1991 Last amendment 338/08, September 26th 2008

Prescribing Scope of Chiropodists Prescribing Scope of Podiatrists Schedule 2 of Chiropody Act Schedule 3 of Chiropody Act

antibiotics for topical use antibiotics for topical use antifungal for topical use antifungal for topical use analgesics for topical use analgesics for topical use astringents for topical use astringents for topical use corticosteroids for topical use corticosteroids for topical use caustics for topical use caustics for topical use immune response modifiers for topical use immune response modifiers for topical use wound healing agents/dressings for topical use wound healing agents/dressings for topical use antibiotics for oral use antibiotics for oral use NSAIDS for oral use NSAIDS for oral use anxiolytics for oral use

pharmacyconnection • May/June 2010 21 fairness commissioner Focus on Registration

College’s annual report to the Fairness Commissioner highlights accessible information and consultation for registrants.

n accordance with the Fair Access to Regulated Pro- International Pharmacy Graduate (IPG) Program and fessions Act and the Regulated Health Professions Act, the Pharmacy Examining Board of Canada. At the IOntario’s Office of the Fairness Commissioner exists session, attendees receive handouts that are updated to require certain professions to review registration prac- from feedback from previous participants. Questions tices, submit reports about them and undergo compliance and answers in both a group and individual setting are audits to ensure that registration is fair for all applicants. also provided. In accordance with the College’s annual requirement to • The College’s Client Services department is able do so, OCP recently submitted the 2009 Fair Registration to answer phone calls and e-mails during business Practices Report. hours. Each day, a Client Services staff member available to meet with individuals for walk-in or Highlights of the 2009 Report: scheduled appointments at the College office. These In general, OCP’s Registration information is accessible staff members are trained to address questions about and nimble: the registration requirements and process or to pro- • The Registration Program staff are responsible for cess applications. updating the licensing portion of the website and en- • Registration fees for international graduates are the suring it is current, accurate and presented in a user same as domestic graduates. friendly manner. Changes to the information are made • The average time to complete registration does not if a requirement changes or when improvements are differ greatly from domestic graduates, but timings of identified based on questions and feedback received the required examinations play a part in the timing of by the College from applicants, members or other the process. stakeholders. • The top five countries from which International Phar- • OCP has a robust series of information sessions for macy graduates originate are Egypt, India, Philippines, international pharmacy graduates (IPGs) who are just Pakistan and the U.K. beginning the registration process or considering regis- tration in Ontario. The College reported on the two The full report to the Fairness Commissioner is avail- live presentations that were held in 2009 in conjunc- able on OCP’s website at www.ocpinfo.com and search tion with staff from Health Force Ontario(HFO), the “reports and statistics”

22 pharmacyconnection • May/June 2010 OCP Registration – some highlights International Pharmacy • Over the past five years, there has been a 12 per cent Graduate Program – increase in the number of pharmacists licensed in Ontario a great resource for • In 2009, consistent with past years, 30 per cent of international graduates licensed pharmacists were internationally-trained • Over the past five years, OCP has seen a 40 per cent Over the past ten years, more than 525 increase in the total amount of registered students international pharmacists and students have taken and interns advantage of the International Pharmacy Graduate • Of this number, there has been a 55 per cent increase Program (IPG) at the University of Toronto. in Canadian registered students and interns primarily A unique “best practices” bridging program, the due to increased enrolment at the University of Toronto IPG program is designed to assist pharmacists and the opening of a new program at the University trained in countries outside Canada and of Waterloo international graduates to meet Canadian entry-to- practice standards. The university-based curriculum means graduates have access to practical courses delivered by an experienced faculty. The IPG Program is comprised of two modules: Canadian Pharmacy Skills (CPS) I and II. Drawing upon material from courses offered in the undergraduate program, the content provides enculturation to Canadian pharmacy practice and training for entry-level competence. Therapeutics, law, practice management, pharmaceutical care, drug information and the Canadian health care system are just a few of the content areas covered. Students also gain critical language, workplace, and practice skills necessary for licensure in Canada. The IPG program boats a 92% success rate in licensing examinations. Various links to the IPG Program website are available from the College’s website.

pharmacyconnection • May/June 2010 23 registration Q&A

Susan James, BScOT, MPA Manager, Registration Programs

I have heard that the OCP Pharmaceutical Is it true that the government provides bursaries QJurisprudence Exam is changing from having a Qfor students attending the International four year expiry date to a three year expiry date. Is Pharmacy Graduate (IPG) program at the University of that true and when would the change happen? Toronto? Yes this is true. The proposed Registration Regulation Yes. As stated on the Ministry of Training, Colleges and (available on the OCP website) states that when an ap- Universities website (at http://www.edu.gov.on.ca/eng/ plicant applies to become a pharmacist they must have tcu/adultlearning/faqs.html) “The Ontario Bridging Par- successfully completed the jurisprudence exam within ticipant Assistance Program (OBPAP) provides bursaries three years of when they have met all of the other require- of up to $5,000 to cover direct education costs (tuition, ments for the issuance of a certificate of registration. This books and equipment) for participants attending non- requirement also applies to the jurisprudence exam for OSAP approved, Ministry of Citizenship and Immigration pharmacy technicians. (MCI) funded bridge training programs offered by Ontario The shift from four years to three years for currency colleges or universities”. of the exam is due to the frequency with which the laws The IPG program at U of T is one of the approved affecting pharmacy practice have been changing. For programs under this new bursary program. Individuals example, over the last couple years there have been sig- currently registered in the program or who plan to register nificant changes to the Regulated Health Professions Act, in the program before March 31, 2011 should request an the Drug and Pharmacies Regulation Act, the Pharmacy application for the bursary from the Financial Aid Office Act and the regulations under each of these Acts; and of the university or speak with the program administrator more changes to these regulations are anticipated over of the IPG program. Funding is based on student financial the next few years. need, as defined by the policies of the university. This is This change in the currency of the exam will occur currently a pilot program and it is not known if funding when the proposed Registration Regulation takes effect. will continue beyond the above date. More information The regulation is currently in the final stage of approval is available on the Ministry website. with the government and while we cannot predict exactly when it will be approved, we do expect it will be within the next few months (by fall 2010). It is therefore im- portant to consider if you will be able to complete all of the registration requirements to become a pharmacist (or pharmacy technician) within three years of completing the jurisprudence exam.

24 pharmacyconnection • May/June 2010 spt Q&A

Deanna Yee, R.Ph., BScPhm, MSc Registration Advisor

Why doesn’t the OCP give us the references to studentship activities and internship activities are the Qcomplete each activity in the SPT program? same for all students and interns, respectively, regardless The Structured Practical Training (SPT) activities are of your place of graduation or previous work experience. designed to standardize the studentship or internship Since knowledge and skills differ among students or in- rotation. The experiential nature of the training is struc- terns based on their education and previous training, tured by the activities. By completing the activities in a the ease with which they complete an activity will also pharmacy practice site where you will be providing pa- differ. For this reason a standardized, comprehensive tient care, you will have opportunities throughout your competency-based assessment is required. For example, rotation to demonstrate the competencies for which you students and interns who have worked extensively as a will be assessed by your preceptor. Finding information pharmacy assistant or as a pharmacist in another country from appropriate references is a competency itself, and may be able to demonstrate some of the competency an activity that you will likely repeat throughout your elements in the Drug Distribution and Management pharmacy career. Knowledge and Skills competencies earlier in the rota- The fourth entry-to-practice competency developed tion. The flexibility of scheduling activities within the by NAPRA (the National Association of Pharmacy SPT studentship or internship program enables the stu- Regulatory Authorities), Drug, Therapeutic and Practice dent or intern to demonstrate the competencies he/she Information, states that “Pharmacists assume responsibil- is familiar with early in the rotation, while placing greater ity for accessing, retrieving, evaluating and exchanging focus on the remaining competencies for the rest of the relevant information to ensure safe and effective patient rotation. care.” Three of the elements for this competency that pharmacists are expected to demonstrate at entry-to- What is the purpose of a reflection in the SPT practice are the ability to: Qactivities? 4.2 Identify appropriate sources of relevant information, Many of the activities require you to complete a task, using evidence-informed approaches where possible. develop a process or manage a situation that is likely 4.3 Retrieve information from relevant sources. to be new to you. Since it is highly unlikely that you 4.4 Evaluate scientific information. would master an activity after one attempt, consid- ering what you did well and what you would change the Providing references to complete the activities would next time you are faced with a similar activity allows not allow you to demonstrate to your preceptor or the you to continuously improve your skills. This ability to OCP your competency in this area. critique yourself to discern your strengths and areas for improvement will be applicable throughout your Some of the activities in the program seem so pharmacy career as you engage in self-directed learning. Qeasy. Why? When asked to complete a reflection for an SPT activ- The SPT activities are designed to provide opportun- ity, your documentation should focus on your strengths ities for you to demonstrate to your preceptor all of the and areas for improvement rather than simply summar- NAPRA entry-to-practice competencies. The SPT izing what you did.

pharmacyconnection • May/June 2010 25 bulletin board

The College would like to extend their best wishes to the Sarahe d Sousa has been hired as the Meeting and Events following staff as they move on to new adventures out- Services Clerk with Facilities and Office Services. Sarah side of the College: Kaiva Sukse, Administrative Services brings several years of progressive customer service and Clerk; Pauline Rosenbaum, Discipline Case Coordin- administrative experience to the College. She has an edu- ator; Carla Babb, Business Analyst/Project Manager and cational background in Community and Justice Services. Shelliann Sterling, Receptionist. Donna Ortolan recently joined the College as Recep- We welcome the following new staff members: tionist. Donna brings a number of years of reception and administrative experience to the role, most recently in the Tina Perlman has been hired as the newest member insurance industry with a small brokerage firm. of the College’s management team in the role of Man- ager, Pharmacy Practice Programs. Tina is an Ontario Patti Clayton has been promoted to the role of Investiga- pharmacy graduate with a long history of serving the tor in the Investigations and Resolutions department. Patti profession of pharmacy through membership and leader- has been with the College since 2004 as the Complaints ship on local and provincial committees and boards, and Officer and has over 24 years experience in pharmacy. most recently served as Chair of the Board of Directors, Ontario Pharmacists’ Association. She has practiced in Announcements a variety of community pharmacies as well as consulting and facilitating pharmacy practice independently. She 2010 Innovation Award was most recently involved in several projects such as the In March, the University of Waterloo School of Phar- Narcotic Advisory Panel (MOHLTC) and the Prescrip- macy was honoured with the 2010 Innovation Award tion Tracking Working Group (CPSO). by the Greater Kitchener-Waterloo Chamber of Com- merce. The award recognizes creativity and innovation Barbara Cadotte has recently joined the College as in products or processes by an outstanding organization. Senior Policy Advisor. Barbara has worked in several pos- Waterloo Pharmacy was noted for creating the institu- itions at the Ministry of Health and Long-Term Care, tion, and the campus, of the future – built on partnerships, most recently with the Assistive Devices Program and dynamic and flexible, and engaged with community on has extensive experience in the field of mental health and multiple levels. Judges noted the school’s co-op experi- primary health care. Barbara holds a degree in Communi- ential model, personalized student selection process, and cations and a Masters degree in Health Administration community outreach activities. “To be recognized for in- (Health Policy) and recently achieved her Certified Health novation in a region like ours, and with such competitors, Executive designation. is a tremendous honour,” said Laura Manning director of advancement at the school. Anna Amin has joined the College as Complaints Of- ficer in the Investigations and Resolutions department. University of Toronto 8T0 Pharmacy Reunion Anna is a Pharmacy Technician enrolled in the bridging Yes, hard to believe but it has been 30 years!!! program at Sheridan College and is also a member of When: September 10-12, 2010 Sheridan’s Advisory Board for Pharmacy Technicians. Where: Eganridge Inn & Spa, Fenelon Falls, She comes to us from Loblaw Companies Limited where http://www.eganridge.com/rates.shtml she worked as the Senior Coordinator, Managed Care Book now 1-888-452-5111 and has extensive experience in drug insurance claims For more info contact: and remittance. Sue Gates - [email protected] Tina Perlman - [email protected]

26 pharmacyconnection • May/June 2010 update on technology

In every issue of Pharmacy Connection, we report to you Wallet Cards – We Heard You! some of the ways the College embraces technology to In the last Technology Update, we reported a plan to phase improve and refine our everyday processes, eliminating out wallet cards given that the on-line public register unnecessary paper-based transactions. provides up-to-date information about the status of a Here is the latest update on OCP technology projects: pharmacist or pharmacy. However, we heard from you. Many members expressed the need for a physical wallet Add us to your e-mail list card as a means of identification. Given this demand, the As we continue to grow our e-mail based communications College will provide a printable wallet card with electronic to members, it is important to add OCP as a trusted mail receipts each year that can easily be printed on any home recipient. This will ensure that correspondence we send— printer. More information to come. especially time-sensitive material such as fee notices—does not end up in your junk e-mail, costing you unnecessary late Pharmacy Connection In Brief penalties. Simply add Ontario_College_of_Pharmacists@ and Online xmr3.com to your address book. If the College has your e-mail address, you will have already received Pharmacy Connection In Brief —a Electronic Elections are preview version that arrives by e-mail, with easy access to almost here the complete publication. Many members have opted to Last issue, we reported on our plan to move forward with forgo receiving the print copy in favour of the electronic an exclusively web-based voting system. This is especially version and we encourage more of you to take on this important given that the new boundaries will make our green initiative. Watch for a notice on how to opt-out electoral districts significantly larger. See page 13 for details of your print copy with the next version of Pharmacy on the call for nominations and our new electronic system. Connection In Brief.

pharmacyconnection • May/June 2010 27 deciding on discipline

Case 1 and that the Member was at no risk 3. A suspension of Mr. Hallett’s cer- to reoffend. Criminal charges against tificate of registration for three Submitting forged prescription the Member relating to the forged months, with one month to be slips prescriptions were resolved with an remitted on condition that the absolute discharge. Member complete the remedial Member: Darcy Hallett training exercise specified above. Hearing date: March 5, 2010 Decision and Reasons The period of suspension shall The Panel acknowledged the Mem- start on the date the Member is Facts ber’s difficult circumstances but confirmed to be capable of re- This case proceeded by way of stated that personal hardship is never turning to work. Agreed Statement of Facts and Joint an excuse or justification for engaging 4. Costs to the College in the Submission on Penalty. in professional misconduct. Regard- amount of $2,000, payable within The Member pled guilty to one al- less of one’s personal circumstances sixty days of the date the Mem- legation of professional misconduct or health condition, compliance with ber is confirmed to be capable of in that he engaged in conduct or per- standards of practice and protection returning to work. formed an act relevant to the practice of the public remains of paramount of pharmacy that, having regard to all concern. In this case, the Member Reprimand the circumstances, would reasonably was also the public. In forging the It was clear that the Member had be regarded by members of the pro- four prescriptions, the Member gone through a very difficult and fession as disgraceful, dishonourable committed a serious breach of eth- emotional time and is now facing or unprofessional with respect to the ics and placed himself at serious risk these challenges head on. However, presentation of fraudulent prescrip- of harm. The Member did not have this did not excuse his actions which tion slips written by the Member. the authority to self-prescribe, nor reflect very poorly on the profession. The Member was on medical leave does any healthcare professional, As a member of the College, the from his employment when he pre- regardless of how sad their personal Member was well aware of the laws sented four forged prescription slips to circumstances may be. The Mem- and regulations regarding the prescrib- Pharmacy M. Each of the forged pre- ber’s behaviour does constitute ing of medications. He should have scriptions named the Member as the misconduct and must be addressed. known better. The Panel noted that patient, and Dr. K as the prescribing The Panel accepted the Joint Sub- the Member had moved to correct his physician. Each of the forged pre- mission on Penalty. behaviours and hoped he continued to scriptions contained what purported seek the help he required. The Panel to be Dr. K’s signature. Order wished the Member all the best in the The Member admitted that he 1. A reprimand. future in the profession and hoped personally forged each of the forged 2. Specified terms, conditions, or that he would not appear before the prescriptions. None of the medica- limitations on Mr. Hallett’s Cer- committee again. tions listed in those prescriptions were tificate of Registration requiring authorized by a prescribing phys- him to complete successfully, ician. Dr. K was not the Member’s at his own cost, the course and The full text of the Discipline physician. evaluation in Applied Ethics in Committee’s decision can be The Member has no prior disciplin- Pharmacy Practice within twelve found by searching the database ary history. A forensic psychiatrist months of the date the Member at www.canlii.org, under provided a report indicating that the is confirmed by a physician to be Ontario/Boards and Tribunals. Member’s offence was in the context capable of returning to work as a of severe pain and a major depression, practicing pharmacist.

28 pharmacyconnection • May/June 2010 focus on error prevention

Ian Stewart, R.Ph., B.Sc.Phm Toronto Community Pharmacist

Prescription Transfers

When receiving a new prescription from a patient, the Possible Contributing Factors pharmacist carefully reviews all aspect of the prescrip- • The patient forgot her medication at home and needed tion to ensure that the drug and dosage is appropriate. an emergency supply from a rural pharmacy that did not The patient’s medication profile is also used as a key tool stock Verapamil SR 180 mg on a regular basis. to identify any change in drug therapy or potential pre- • Being rural, the number of pharmacies available to the scribing error. Similarly, prescription transfers must be patient was likely limited. carefully reviewed for appropriateness. • The pharmacist at the rural pharmacy changed the pa- tient’s dose and prescription record. Case: • The dispensing pharmacist at her regular pharmacy, failed to identify the change in dose. A 55 year old patient has been taking Verapamil SR 180 mg once daily on a regular basis. One day while out of town, Recommendations the patient needed an emergency supply of her tablets. • If a drug is unavailable, consider referring patients to an- She visited a local community pharmacy and made the other pharmacy before making changes to the prescribed request. The prescription for Verapamil SR 180 mg was dose or drug. Consider contacting another pharmacist therefore transferred from her regular pharmacy. or your drug information service for a second opinion. On receiving the transfer, the pharmacy noticed that • If a change must be made to the patient drug therapy, they did not have the Verapamil SR 180mg tablets in stock. contact the patient’s physician at the earliest opportunity. In an effort to meet the urgent need of the patient, the • If a temporary change must be made, ensure that the pharmacist decided to dispense four Verapamil SR 240 record reflects a temporary change only. mg tablets with the instructions to take “half a tablet • Document fully the decisions made, actions taken and once daily”. That is, 120 mg daily instead of the 180 mg reasoning. as prescribed. • Review all prescription transfers carefully for appro- A few days later, the patient returned to her regular priateness. If necessary, request a copy of the original pharmacy and requested a refill of her Verapamil tablets. prescription. The pharmacy staff identified that the prescription had • If available, use the patient medication profile as a tool been transferred and contacted the out of town pharmacy to confirm that the prescription is appropriate and to to have the prescription transferred back. identify any changes in drug therapy. The pharmacy therefore transferred the Verapamil SR 240mg tablets that were dispensed to the patient. Not be- Please continue to send reports of medication errors ing aware of what had previously transpired, her regular in confidence to Ian Stewart at: ian.stewart2@rogers. pharmacist processed and dispensed the Verapamil SR com . 240 mg tablets instead of the originally prescribed 180 mg SR tablets. Fortunately, the patient was aware of the prescribed dose and pointed out the error.

pharmacyconnection • May/June 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 June 24, 2010 August 7 – 10, 2010 Root Course Analysis Workshop Summer Educational Sessions (for- May 14-16, 2010 for Pharmacists merlyGM) A Cardiovascular Patient Care Institute for Safe Medication Practi- Canadian Society of Hospital Phar- Ontario Pharmacists Association ces Canada (ISMP) macists (CSHP) BMO Institute for Learning, 3550 Toronto Marriott Halifax Harbourfront Pharmacy Avenue, Toronto Contact: [email protected] Halifax, Nova Scotia Contact: Penny Young www.cshp-ns.com/ 416-441-0788 ext. 2209, November 14-16, 26-28, 2010 [email protected] Certified Geriatric Pharmacist ON-LINE/ WEBINARS www.opatoday.com/live.asp Preparation Course - Part 1 & 2 Ontario Pharmacists Association www.camh.net/education/ Tuesday, May 25, 2010 BMO Institute for Learning, 3550 Online_courses_webinars/odt_cer- Using Evidence in the Real World Pharmacy Avenue, Toronto tificate_program.html (live and webcast) Contact: Penny Young On-line courses with live workshops Canadian Agency for Drugs and 416-441-0788 ext. 2209, in subjects including mental health, Technologies in Health (CADTH) [email protected] opioid dependence, substance Register by May 18, 2010 www.opatoday.com/CE_Geritric- abuse, addiction, withdrawal,legal [email protected] PC2010.asp issues(various dates). Canadian Association for Mental June 9-11, 2010 NATIONAL Health (CAMH) OSCE-ology Leslie Dan Faculty of Pharmacy, May5 1 - 18, 2010 www.opatoday.com/web.asp University of Toronto Annual National Conference Vitamin D in Osteoporosis Contact: Ryan Keay 416-978-7562 Canadian Pharmacists Associa- Drug Information and Research http://cpd.phm.utoronto.ca/osceol- tion (CPhA) Centre (DIRC) ogy.html Telus Convention Centre & the Hyatt Regency Hotel www.opacti.org June 17-19, 2010 Calgary, AB Online Clinical Tobacco Interven- Ontario Pharmacists Association www.pharmacists.ca/function/ tions for Health Care Professionals (OPA) Conference 2010 meetings/index.cfm Niagara Falls www.canadianhealthcarenetwork.ca Contact: Penny Young June7 1 – 19, 2010 On-line CE lessons 416-441-0788 ext. 2209, Interventional Cardiology [email protected] Symposium www.rxbriefcase.com www.opatoday.com Montreal Heart Institute On-line CE lessons Historic Centaur Centre Montreal, PQ http://cpha.learning.mediresource. http://mhi.interv.org com/select_catalog.asp CE lessons on the CPhA Home Study Online Learning Centre

30 pharmacyconnection • May/June 2010 laws & regulations

Drug and Pharmacies Regulation Act (DPRA) * s Controlled Drugs and Substances Act (CDSA) & December 15, 2009 Regulations ** ' Regulations to the DPRA: Act current to March 31, 2010 Regulation 545 – Child Resistant Packages All regulations current to March 31, 2010 Regulation 297/96 Amended to O.Reg. 173/08 Benzodiazepines and Other Targeted Substances Regulations Regulation 551 Amended to O.Reg. 172/08 Marihuana Medical Access Regulations Narcotic Control Regulations Drug Schedules ** Precursor Control Regulations Summary of Laws Regulations Exempting Certain Precursors and Controlled Substances June 2007 OCP from the Application of the Controlled Drugs and Substances Act National Drug Schedules (NAPRA) March 17, 2010 (or later) Food and Drugs Act (FDA) & Regulations ** ' NDSAC Meeting – June 2010 Act current to March 31, 2010 Request for Unscheduled status for polyethylene glycol 3350 All regulations current to March 31, 2010 indicated for occasional constipation Cosmetic Regulations Scheduling status finalized by NDSAC – April 2010 Food and Drug Regulations Diclofenac diethylamine in preparations for topical use on the skin Marijuana Exemption (FDA) Regulations in concentrations of not more than the equivalent of 1% diclofenac Medical Devices Regulations – Unscheduled (from Schedule III). Final approval of the initial Natural Health Products Regulations recommendation was made by NAPRA’s Executive Committee, in Processing and Distribution of Semen for Assisted Conception consideration of comments received during the 30-day review period. Regulations The National Drug Schedules will be revised accordingly. Safety of Human Cells, Tissues and organs for transplantation Regulations Regulated Health Professions Act (RHPA) * s To Schedule F: Pre-notifications December 15, 2009 Project #1621 Addition of Dirlotapide, Firocoxib, Ibafloxacin and Regulations to the RHPA: Maripotant and its salts (Feb 2010) Regulation 39/02 - Amended to O.Reg. 666/05 Project #1624 Addition of Eculizumab, Olmesartan medoxomil, Regulation 107/96 – Amended to O.Reg. 97/10 Romiplostim, Ustekinumab (Jan 2010) Regulation 59/94 – Funding for Therapy or Counseling for Patients Project #1652 Notice of Intent to Amend Schedule F (L-asparaginase) Sexually Abused by Members (Dec 2009) Project #1659 Addition of Dronedarone (Dec 2009) Pharmacy Act (PA) & Regulations * s Project #1659 Addition of Medicinal Degarelix (Dec 2009) December 15, 2009 Project #1659 Addition of Clofarabine (Dec 2009) Regulations to the PA: Project #1659 Addition of Ingredient Azacitidine (Dec 2009) Regulation 202/94 Amended to O.Reg. 270/04 Project #1659 Addition of Urokinase (Dec 2009) Regulation 681/93 Amended to O.Reg. 122/97 Project #1658 Addition of Doripenem and its salts and derivatives (Dec 2009) Standards of Practice s Project #1658 Addition of Besifloxacin and its salts (Dec 2009) Model Standards of Pratice, effective January 1, 2010 Project #1658 Addition of Alitretinoin and its salts and derivatives Standards of Practice for Pharmacists, 2003 (Dec 2009) Standards of Practice for Pharmacy Managers, 2005 Project #1658 Addition of Saxagliptin and its salts (Dec 2009) Standards for Pharmacists Providing Services to Licensed LTC Facilities, 2007. OCP By-Law No. 2 – March 2010 s OCP By-Laws – December 2006 Drug Interchangeability and Dispensing Fee Act (DIDFA) Schedule A: Code of Ethics for members & Regulations * s Schedule B: “Code of Conduct” and Procedures for Council and June 2007 Committee members. Regulations to the DIDFA: Regulation 935 Amended to O.Reg. 354/08 Reference s Regulation 936 Amended to O.Reg. 205/96 OCP Required Reference Guide for Pharmacies in Ontario, January 2010 Ontario Drug Benefit Act (ODBA) & Regulations * s March 15, 2010 Regulations to the ODBA: Regulation 201/96 Amended to O.Reg. 104/10

* 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 • May/June 2010 31

Volume 17, Number 3

www.ocpinfo.comand 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. The College is incorporating some social media tools into its on dailyTwitter activities.and through RSS You canfeeds. now Whatfollow doesOCPinfo this mean? You will be able tonews, receive updatesContinuing to theEducation latest information and Health Canada Advisories directly through our site. Go to Follow us on Twitter and subscribe to our RSS Feed! RSS our to subscribe and Twitter on us Follow