The Apothecary Newfoundland and Labrador Pharmacy Board Spring 2009
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The Apothecary Newfoundland and Labrador Pharmacy Board Spring 2009 The Apothecary is the Continuing Professional Development Standards of newsletter of the Pharmacy Practice Now Approved for Circulation Newfoundland & Labrador Pharmacy As communicated in a recent Memo to This opens up new opportunities as well Board. It contains Pharmacists, the final draft of the revised as enhancing the pharmacist’s learning important regulatory Standards of Pharmacy Practice— experience. information that all Continuing Professional Development has As a result of feedback from pharmacists in the now been approved by the Board for pharmacists, both of the primary province of circulation. (See www.nlpb.ca/spg.html Continuing Professional Development Newfoundland & for the complete revised document.) forms have been updated: Labrador are expected to be aware of. Changes pharmacists should be aware of The Learning Portfolio Record Pharmacists are include: Sheet was updated to remove the responsible for The Standard no longer permits the word “source” and to streamline the ALL INFORMATION carry-over of CEUs from one year to form. contained within the next. However, pharmacists are The Professional Development Log including documents permitted to claim CEUs for programs has been revised to eliminate the which are made completed in December of one year in available on the NLPB need for pharmacists to transfer the the following calendar year, as long as website via links key learning ideas from the they were not used to fulfill the throughout the Learning Portfolio Record Sheets newsletter. minimum professional development over to the Professional The Apothecary is now requirement in that previous year. Development Log. Pharmacists who claim such programs circulated electronically Pharmacists are strongly encouraged to will be expected to submit both year’s and is available in hard make every effort to use these new forms. copy format only upon Professional Development Logs. Both forms are available at specific request. Due to the confusion surrounding the www.nlpb.ca/cpd.html in two versions— word “source”, the committee has one (pdf) for printing and completing by Linked in this issue... removed the requirement to complete hand and one (MSWord) for saving and programs from more than one source. Standards of Pharmacy completing electronically before printing. Pharmacists are still encouraged to use Practice—Continuing These Standards of Pharmacy Practice Professional Development multiple delivery formats and take effect immediately. Any questions or Continuing Professional providers to fulfill their professional clarification should be directed to the Development forms development requirements each year. Registration as a Pharmacy Board office. Student Change of Employment Form Are your pharmacy students registered? Report of Loss or Theft of Pharmacy students who intend to work in ANY capacity in a pharmacy in Newfoundland Narcotics Form NLPB Strategic Plan 2009- and Labrador must first be registered with the NLPB and shall not identify themselves as 2011 anything other than a “Pharmacy Student”. For more information, see the NLPB Policy— NAPRA Notes—February Registration as a Pharmacy Student, available at www.nlpb.ca/reg_&_lic.html 2009 Page 2 The Apothecary Complaints and Discipline Resolution Case #1 physician for injection. She that “Take/Use as directed” is The Complaints Authorization indicated that “Even though the Rx NOT generally acceptable with Committee considered an was refilled early, it was unknown Rx’s for injections to be allegation from a specialist to the pharmacist that the patient administered by the physician in physician regarding a prescription was going to his Dr. each month for his clinic when specific directions written for Lupron 22.5mg, to be his injection.” She indicated that have been indicated on the injected IM every 3 months for one both she and another pharmacist at prescription, and particularly year. It was alleged that the the pharmacy had refilled the when the physician administering prescription had been improperly prescription at various times. the injection is not the physician labelled at the pharmacy with The response also indicated that who ordered the prescription. The instructions “Use as directed”; that the original dispensing pharmacist original dispensing pharmacist the patient had been receiving had indicated to the prescribing should not have permitted the monthly injections of the drug; and specialist, when discussing this instructions “Use as directed” to that the prescription had been incident after the error had been have been used in recording the refilled monthly without the error discovered, that “we were refilling prescription; being questioned by the the Rx as requested by the patient that the pharmacists who pharmacist. The error was and we have no control over what authorized the refills should have apparently detected when a the patient does with that Rx once questioned the requests for request for renewal of the it leaves the store” and that the monthly refills of the prescription prescription and clarification of family physician indicated…”he on three different occasions, dosage was sent to the specialist was under the impression from the particularly since the pharmacy’s from the pharmacy since the refills patient that he was supposed to computer system indicated that were depleted and the patient get the injection each month” and the amount being dispensed said he was supposed to get this that the prescribing specialist “had represented 90 days supply and injection every month. not in the following three months that the requested refill was The response from the pharmacist- sent any follow up letters to between 55 - 63 days early in in-charge indicated that the indicate otherwise.” each case; original prescription had been Decision of the panel: that there was no evidence labelled by the pharmacy assistant The panel decided that there were provided that any of the as “Use as directed”, “which is reasonable grounds to believe that pharmacists had counseled the generally acceptable with Rx’s for each of the three pharmacists patient about the prescribed injectables to be administered by involved at some point with this dosage of the drug prescribed; the physician in his clinic”, and also prescription had engaged in had ensured that administering indicated that the pharmacist who conduct deserving of sanction. physician was aware of the had checked the original The panel directed that the dosage prescribed by the prescription for accuracy was allegation be considered as prescriber; or had questioned the satisfied “especially since a 90 constituting a complaint and that early refills or checked the day interval was indicated on the letters of caution be sent to each of original prescription to confirm hard copy of the Rx”. the pharmacists involved. the prescribed dosage; The pharmacist-in-charge indicated The panel directed that points that that the statement attributed to that the patient returned for refills should be specifically noted in the the dispensing pharmacist that each month for three months and letters of caution are: took the drug to his local family (Continued on page 3) Spring 2009 Page 3 (Continued from page 2) on the prescription label; that as a delivery logs, which are now result of this error she went into kept for a minimum of 2 years, “we were refilling the Rx as opioid withdrawal and required have been revised to show requested by the patient and admission to hospital; that she had whether the prescription was we have no control over what also been given heart medication delivered or picked up, and the patient does with the Rx prescribed for another person; and Continued on page 4) whether the once it leaves the store” is an that untrained technicians were delivery was a prescription or inappropriate and involved with the filling of her OTC; unacceptable standard of prescriptions. that all pharmacy staff have pharmacy practice. There is an The response from the pharmacist- been trained in these expectation that pharmacists in-charge indicated that one of the procedures and that a formal will question early refills of contributing factors to the error policy and procedure manual is prescriptions to determine the was that the prescribing physician being written. reason for such requests, ensure had ordered a 5mg dosage. Since Decision of the panel: that the patient understands the the product only comes in 3mg and The panel decided that there were prescribed dosage of the 6mg strengths, both the 3mg and reasonable grounds to believe that medication, and determine if 6mg tablets had been kept on the the respondent had engaged in there are any reasons why the dispensary counter awaiting conduct deserving of sanction. medication is not being used as clarification of the dosage from the The panel directed that the prescribed and take prescribing physician. allegation be considered as appropriate steps where The pharmacist-in-charge’s constituting a complaint and that a possible to address such issues. response also spoke to the training letter of caution be sent to the obtained by assistants employed in The panel directed that a report of Pharmacist-in-Charge. the pharmacy, the checking this complaint, on a no names basis, The panel directed that points that procedures used at the pharmacy, be included in the next edition of should be specifically noted in the and the changes that have been the Apothecary, so that ALL letter of caution are: made since this incident occurred, pharmacists are reminded by this that counselling and checking including: incident of their responsibilities with procedures at the pharmacy a triple check is performed on respect to labelling of (including documentation of such every prescription; prescriptions, properly counselling counselling and checking) needs pharmacy assistants and the patients on the proper use of the to be improved; pharmacist sign-off on their medication prescribed and that counselling must take place involvement at each step of the monitoring compliance with the use on every new prescription and process, of prescriptions.