November/December 2008 - Ontario College of Pharmacists
November/December 2008 - Ontario College of Pharmacists
November/December 2008 - Ontario College of Pharmacists
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ontario college <strong>of</strong> pharmacists<br />
483 Huron Street, Toronto, <strong>Ontario</strong> M5R 2R4 • Tel (416) 962-4861 • Fax (416) 847-8200 • www.ocpinfo.com<br />
The mission <strong>of</strong> the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong> is<br />
to regulate the practice <strong>of</strong> pharmacy, through<br />
the participation <strong>of</strong> the public and the<br />
pr<strong>of</strong>ession, in accordance with standards <strong>of</strong><br />
practice which ensure that pharmacists<br />
provide the public with quality<br />
pharmaceutical service and care.<br />
Council Members<br />
Council Members for Districts 1-17 are listed below according to District number. PM indicates a public member appointed by the<br />
Lieutenant-Governor-in-Council. DFP indicates the Dean <strong>of</strong> the Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto.<br />
DSP indicates the Director, School <strong>of</strong> Pharmacy, University <strong>of</strong> Waterloo.<br />
1 Joseph Hanna<br />
2 Elaine Akers<br />
3 Sherif Guorgui<br />
4 Tracey Phillips<br />
5 Donald Organ<br />
6 Fayez Kosa<br />
7 Tracy Wiersema<br />
8 Saheed Rashid<br />
9 Bonnie Hauser<br />
10 Gerald Cook<br />
11 Christopher Leung<br />
12 Peter Gdyczynski<br />
13 Vacant<br />
14 Stephen Clement<br />
15 Gregory Purchase<br />
16 Doris Nessim<br />
17 Shelley McKinney<br />
PM Joinal Abdin<br />
PM Thomas Baulke<br />
PM Andrea Chun<br />
PM Corazon dela Cruz<br />
PM Babek Ebrahimzadeh<br />
PM David H<strong>of</strong>f<br />
PM Margaret Irwin<br />
PM Javaid Khan<br />
PM Lewis Lederman<br />
PM Aladdin Mohaghegh<br />
PM Gitu Parikh<br />
DFP Wayne Hindmarsh<br />
DSP Jake Thiessen<br />
Statutory Committees<br />
• Executive<br />
• Accreditation<br />
• Complaints<br />
• Discipline<br />
• Fitness to Practice<br />
• Patient Relations<br />
• Quality Assurance<br />
• Registration<br />
Standing Committees<br />
• Communications<br />
• Finance<br />
• Pr<strong>of</strong>essional Practice<br />
Special Committees<br />
• Standards <strong>of</strong> Practice Working Group<br />
• Pharmacy Technicians Working Group<br />
<strong>College</strong> Staff<br />
Office <strong>of</strong> the Registrar and Deputy Registrar/<br />
Director <strong>of</strong> Pr<strong>of</strong>essional Development<br />
Pharmacy Connection Editor x 241<br />
ltodd@ocpinfo.com<br />
Office <strong>of</strong> the Director <strong>of</strong> Finance<br />
and Administration x 263<br />
bhsu@ocpinfo.com<br />
Office <strong>of</strong> the Director <strong>of</strong><br />
Pr<strong>of</strong>essional Practice x 236<br />
sjackson@ocpinfo.com<br />
Registration Programs x 250<br />
jsantiago@ocpinfo.com<br />
Structured Practical Training Programs x 297<br />
vgardner@ocpinfo.com<br />
Investigations and Resolutions x 274<br />
cfernandes@ocpinfo.com<br />
Continuing Education Programs and<br />
Continuing Competency Programs x 273<br />
lsheppard@ocpinfo.com<br />
Pharmacy Openings/Closings,<br />
Pharmacy Sales/Relocation<br />
ocpclientservices@ocpinfo.com<br />
Registration and Membership Information:<br />
ocpclientservices@ocpinfo.com<br />
Pharmacy Technician Programs:<br />
ocpclientservices@ocpinfo.com<br />
Publications x 229<br />
spark@ocpinfo.com
contents<br />
Electoral Districts & Members <strong>of</strong> Council 6<br />
Committee Appointments <strong>2008</strong>/2009 8<br />
Liability Insurance 12<br />
The MedsCheck Consult Pilot Project 13<br />
Provincial OpiATE Project 14<br />
Pharmacy Technicians’ Commitment to Regulation 15<br />
New Online Pharmacist Annual Renewal Process 20<br />
A Summer Student’s Experience at OCP 24<br />
Call for Preceptors 28<br />
HPRAC Launches Non-physician Prescribers Project 29<br />
regular features<br />
President’s Message 4<br />
Editor’s Message 5<br />
Council Report 9<br />
Health Canada Notices 18<br />
Registration Q&A 22<br />
Practice Q&A 23<br />
ISMP - Medication Incidents Report 26<br />
Deciding on Discipline 30<br />
Bulletin Board 32<br />
Focus on Error Prevention - Pediatric Dosages 33<br />
CE Resources 34<br />
Laws & Regulations 35<br />
pharmacyconnection<br />
<strong>November</strong>/<strong>December</strong> July <strong>2008</strong> • August Volume <strong>2008</strong> 15 • Number Volume 6 15 • Number 4<br />
The objectives <strong>of</strong> Pharmacy Connection are to communicate information on <strong>College</strong> activities and policies; encourage dialogue and to discuss issues <strong>of</strong><br />
interest with pharmacists; and to promote the pharmacist’s role among our members, allied health pr<strong>of</strong>essions and the public.<br />
We publish six times a year, in January, March, May, July, September and <strong>November</strong>. We welcome original manuscripts (that promote the objectives <strong>of</strong> the<br />
journal) for consideration. The <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong> reserves the right to modify contributions as appropriate. Please contact the Associate Editor<br />
for publishing requirements.<br />
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<br />
name, address and telephone number. The opinions expressed in this publication do not necessarily represent the views or <strong>of</strong>ficial position <strong>of</strong> the <strong>Ontario</strong><br />
<strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong>.<br />
Tracy Wiersema, R.Ph., B.Sc.Phm.<br />
President<br />
Deanna Williams, R.Ph., B.Sc.Phm., C.Dir., CAE<br />
Registrar<br />
Della Croteau, R.Ph., B.S.P., M.C.Ed.<br />
Editor, Deputy Registrar,<br />
Director <strong>of</strong> Pr<strong>of</strong>essional Development<br />
dcroteau@ocpinfo.com<br />
Sue Rawlinson<br />
Associate Editor<br />
srawlinson@ocpinfo.com<br />
Agostino Porcellini<br />
Production & Design / Webmaster<br />
aporcellini@ocpinfo.com<br />
Neil Hamilton<br />
Distribution<br />
nhamilton@ocpinfo.com<br />
ISSN 1198-354X<br />
© <strong>2008</strong> <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
Canada Post Agreement #40069798<br />
Undelivered copies should be returned<br />
to the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong>.<br />
Not to be reproduced in whole or in part<br />
without the permission <strong>of</strong> the Editor.
president’s message<br />
Tracy Wiersema, R.Ph., B.Sc. Phm.<br />
President<br />
I<br />
am beginning my year as President<br />
<strong>of</strong> the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
at a very exciting time for our<br />
pr<strong>of</strong>ession. This past summer we have<br />
made a submission to the Health Pr<strong>of</strong>essions<br />
Regulatory Advisory Council<br />
(HPRAC) regarding the scope <strong>of</strong><br />
practice for pharmacists, in which we<br />
have proposed several changes to advance<br />
the role <strong>of</strong> the pharmacist in patient<br />
care. The regulation <strong>of</strong> pharmacy<br />
technicians is also becoming more <strong>of</strong> a<br />
reality as we work toward introduction<br />
<strong>of</strong> legislation in 2009.<br />
Most recently, HPRAC again has<br />
called on pharmacy and other pr<strong>of</strong>essions<br />
to make submissions regarding<br />
non-physician prescribing and use <strong>of</strong><br />
medications. All <strong>of</strong> these advancements<br />
in our pr<strong>of</strong>ession and in other<br />
pr<strong>of</strong>essions which are being explored<br />
require and promote inter-pr<strong>of</strong>essional<br />
collaboration.<br />
This is not about pharmacists or<br />
pharmacy technicians finally getting<br />
the recognition they deserve. This is<br />
not about us working in isolation, or<br />
trying to compete with other pr<strong>of</strong>essions.<br />
It is about a team <strong>of</strong> health pr<strong>of</strong>essionals<br />
working together to provide<br />
better access and care to patients. The<br />
Minister <strong>of</strong> Health has asked HPRAC<br />
to “recommend mechanisms to facilitate<br />
and support inter-pr<strong>of</strong>essional collaboration<br />
between health <strong>College</strong>s be-<br />
Taking on an advanced scope <strong>of</strong> practice may seem<br />
like a big change for pharmacists and pharmacy<br />
technicians, but perhaps the biggest change will<br />
be the inter-pr<strong>of</strong>essional collaboration...<br />
ginning with the development <strong>of</strong> standards<br />
<strong>of</strong> practice and pr<strong>of</strong>essional practice<br />
guidelines where regulated health<br />
pr<strong>of</strong>essions share the same or similar<br />
controlled acts, acknowledge that individual<br />
health <strong>College</strong>s independently<br />
govern their pr<strong>of</strong>essions and establish<br />
the competencies for their pr<strong>of</strong>ession.”<br />
The Minister has also asked that<br />
HPRAC “take into account, when controlled<br />
acts are shared, public expectations<br />
for high quality services no matter<br />
which health pr<strong>of</strong>ession is responsible<br />
for delivering care <strong>of</strong> treatment”.<br />
Are we as a pr<strong>of</strong>ession ready for<br />
the next level <strong>of</strong> inter-pr<strong>of</strong>essional collaboration?<br />
If pharmacists are given<br />
an increased scope <strong>of</strong> practice, are<br />
we ready to document and collaborate<br />
with physicians, nurses, and other<br />
health care providers as to the actions<br />
we take in patient care? Are we ready<br />
to collaborate with technicians as they<br />
receive a regulated scope <strong>of</strong> practice<br />
and become our partners in dispensing<br />
<strong>of</strong> medications?<br />
It will take something on the part<br />
<strong>of</strong> all pr<strong>of</strong>essions to use our expertise<br />
in improving the outcomes <strong>of</strong> our patients,<br />
while giving up our reservations<br />
about other pr<strong>of</strong>essions, and making<br />
them part <strong>of</strong> our team.<br />
Taking on an advanced scope <strong>of</strong><br />
practice may seem like a big change<br />
for pharmacists and pharmacy technicians,<br />
but perhaps the biggest change<br />
will be the inter-pr<strong>of</strong>essional collaboration<br />
which will be required to truly have<br />
our expertise contribute to patient care<br />
and improve patient outcomes.<br />
4 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
editor’s message<br />
Della Croteau, R.Ph., B.S.P., M.C.Ed.<br />
Deputy Registrar/Director <strong>of</strong> Pr<strong>of</strong>essional Development<br />
New Brunswick and Prince<br />
Edward Island have recently<br />
passed legislation allowing<br />
an expanded scope for pharmacists<br />
in those provinces. British Columbia<br />
pharmacists will begin to participate<br />
in medication therapy management as<br />
<strong>of</strong> January 1, 2009. Alberta pharmacists<br />
have been practising with an expanded<br />
role since April 1, <strong>2008</strong>. There<br />
is a growing trend across Canada to<br />
give pharmacists a greater role in adapting,<br />
modifying and extending prescriptions<br />
to contribute to better medication<br />
therapy management outcomes<br />
for Canadians.<br />
Here in <strong>Ontario</strong>, the government is<br />
considering expanded roles for several<br />
health pr<strong>of</strong>essionals, including pharmacists.<br />
A review <strong>of</strong> the scope <strong>of</strong> practice<br />
for pharmacists was submitted to<br />
government in June. The Health Pr<strong>of</strong>essions<br />
Regulatory Advisory Committee<br />
is now conducting a review <strong>of</strong> nonphysician<br />
prescribing and pharmacy has<br />
been included in that review. It is expected<br />
that there will be a further opportunity<br />
for pharmacists to comment<br />
on this submission.<br />
At the same time, the regulation <strong>of</strong><br />
pharmacy technicians is on the horizon.<br />
We have had an overwhelming<br />
response to the last OCP certification<br />
examination and to the first bridging<br />
program. All <strong>of</strong> the pharmacy techni-<br />
There is a growing trend across Canada to give pharmacists<br />
a greater role in adapting, modifying and<br />
extending prescriptions to contribute to better medication<br />
therapy management outcomes for Canadians.<br />
cians who have passed and maintained<br />
their certification with OCP are eligible<br />
to move forward to regulation if they<br />
choose. Details can be found on page<br />
16 and 17.<br />
The synchronicity is incredible! The<br />
<strong>College</strong> has pursued the regulation <strong>of</strong><br />
pharmacy technicians in order to optimize<br />
the knowledge and skills <strong>of</strong> the<br />
pharmacist and free them up from the<br />
technical duties <strong>of</strong> dispensing. It appears<br />
that as this new regulated pharmacy<br />
technician steps up to become<br />
more accountable for the technical aspects<br />
<strong>of</strong> dispensing, that pharmacists<br />
will also be asked to step up and be accountable<br />
for adapting, modifying and<br />
extending prescriptions.<br />
It is the pr<strong>of</strong>essional responsibility <strong>of</strong><br />
pharmacists and pharmacy technicians<br />
to keep their knowledge and skills up to<br />
date, and advancing with the changes<br />
in legislation.<br />
Have you got a learning plan in place<br />
to prepare you for the future? Have<br />
you considered what documentation<br />
will be required with these expanding<br />
roles? Have you discussed in your individual<br />
workplaces what the workflow<br />
might be? Now is the time to have<br />
these discussions as the momentum to<br />
an advanced scope for pharmacists and<br />
pharmacy technicians increases.<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
5
Elected Members<br />
District 15, Gregory Purchase<br />
Thunder Bay<br />
District 14, Stephen Clement<br />
Vice President<br />
Callander<br />
District 1, Joseph Hanna<br />
Ottawa<br />
Electoral Districts<br />
&<br />
Members <strong>of</strong> Council<br />
District 7, Tracy Wiersema<br />
President<br />
Barrie<br />
District 2, Elaine Akers<br />
Peterborough<br />
District 13, TBA (Vacant)<br />
District 3, Sherif Guorgui<br />
Toronto<br />
District 4, Tracey Phillips<br />
Toronto<br />
District 5, Don Organ<br />
Aurora<br />
District 6, Fayez Kosa<br />
Mississauga<br />
Hospital Members<br />
Faculty <strong>of</strong> Pharmacy<br />
Council Observers<br />
District 9, Bonnie Hauser<br />
Dunnville<br />
District 16, Doris Nessim<br />
Mississauga<br />
District 17, Shelley McKinney<br />
Pickering<br />
Public Members<br />
Wayne Hindmarsh<br />
Dean<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Toronto<br />
Jake Thiessen<br />
Hallman Director<br />
School <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Waterloo<br />
District 11, Chris Leung<br />
Windsor<br />
District 10, Gerald Cook<br />
London<br />
District 12, Peter Gdyczynski<br />
Past President<br />
Brantford<br />
District 8, Saheed Rashid<br />
Ancaster<br />
Public Members<br />
Marissa Coruzzi<br />
Pharmacy Technician<br />
Melody Warell<br />
Pharmacy Technician<br />
Joinal Abdin<br />
Toronto<br />
Thomas Baulke<br />
Collingwood<br />
Andrea Chun<br />
Toronto<br />
Corazon dela Cruz<br />
Toronto<br />
Babek Ebrahimzadeh<br />
Woodbridge<br />
Margaret Irwin<br />
Sault Ste.Marie<br />
David H<strong>of</strong>f<br />
Oakville<br />
Javaid Khan<br />
Markham<br />
Lew Lederman<br />
Ottawa<br />
Aladdin Mohaghegh<br />
Toronto<br />
Gitu Parikh<br />
Toronto<br />
6 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong> pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong> 7
committee appointments <strong>2008</strong>/2009<br />
ACCREDITATION<br />
Elected Members:<br />
Stephen Clement<br />
Shelley McKinney (Chair)<br />
Public Members:<br />
Margaret Irwin<br />
Javaid Khan<br />
NCCM:<br />
Roger Ball<br />
Erik Thibault<br />
Staff Resource:<br />
Nicole Balan<br />
COMMUNICATIONS<br />
Elected Members:<br />
Gerry Cook (Chair)<br />
Peter Gdyczynski<br />
Saheed Rashid<br />
Public Members:<br />
Corazon dela Cruz<br />
Lew Lederman<br />
NCCM:<br />
Mayce Al-Sukhni<br />
Iana Ivanova<br />
Staff Resource:<br />
Connie Campbell<br />
COMPLAINTS<br />
Elected Members:<br />
Gerry Coock<br />
Greg Purchase (Chair)<br />
Public Members:<br />
Margaret Irwin<br />
Gitu Parikh<br />
NCCM:<br />
Gurjit Husson<br />
Staff Resource:<br />
Maryan Gemus<br />
DISCIPLINE<br />
Elected Members:<br />
Peter Gdyczynski<br />
Sherif Guorgui (Chair)<br />
Joseph Hanna<br />
Bonnie Hauser<br />
Wayne Hindmarsh<br />
Fayez Kosa<br />
Chris Leung<br />
Shelley McKinney<br />
Don Organ<br />
Doris Nessim<br />
Saheed Rashid<br />
Public Members:<br />
Joinal Abdin<br />
Tom Baulke<br />
Andrea Chun<br />
Corazon dela Cruz<br />
Bob Ebrahimzadeh<br />
David H<strong>of</strong>f<br />
Lew Lederman<br />
Aladdin Mohaghegh<br />
NCCM:<br />
Larry Boggio<br />
Erik Botines<br />
Dave Malian<br />
Vijay Rasaiah<br />
Mark Scanlon<br />
Jeanette Schindler<br />
Zita Semeniuk<br />
Dan Stringer<br />
Laura Weyland<br />
Staff Resource:<br />
Maryan Gemus<br />
EXECUTIVE<br />
Tracy Wiersema (President &<br />
Chair)<br />
Stephen Clement (Vice<br />
President)<br />
Peter Gdyczynski (Past<br />
President)<br />
Bonnie Hauser<br />
Public Members:<br />
Tom Baulke<br />
David H<strong>of</strong>f<br />
Aladdin Mohaghegh<br />
Staff Resource:<br />
Deanna Williams<br />
FINANCE<br />
Elected Members:<br />
Gerry Cook<br />
Peter Gdyczynski<br />
Bonnie Hauser<br />
Public Members:<br />
Tom Baulke<br />
Gitu Parikh (Chair)<br />
Staff Resource:<br />
Connie Campbell<br />
FITNESS TO PRACTICE<br />
Elected Members:<br />
Chris Leung<br />
Doris Nessim<br />
Greg Purchase (Chair)<br />
Public Members:<br />
Joinal Abdin<br />
Lew Lederman<br />
Gitu Parikh<br />
NCCM:<br />
Magued Hannalah<br />
Chris Mobbs<br />
Staff Resource:<br />
Maryan Gemus<br />
PATIENT RELATIONS<br />
Elected Members:<br />
Elaine Akers (Chair)<br />
Gerry Cook<br />
Public Members:<br />
Tom Baulke<br />
Margaret Irwin<br />
Javaid Khan<br />
NCCM:<br />
Chris Aljawhiri<br />
Staff Resource:<br />
Anne Resnick<br />
PROFESSIONAL PRACTICE<br />
Elected Members:<br />
Sherif Guorgui<br />
Joseph Hanna<br />
Wayne Hindmarsh<br />
Tracey Phillips (Chair)<br />
Don Organ<br />
Public Members:<br />
Corazon dela Cruz<br />
David H<strong>of</strong>f<br />
NCCM:<br />
Larry Boggio<br />
Jill Daley<br />
Iris Krawchenko<br />
Sherry Peister<br />
Staff Resource:<br />
Nicole Balan<br />
QUALITY ASSURANCE<br />
Elected Members:<br />
Shelley McKinney<br />
Tracey Phillips (Chair)<br />
Public Members:<br />
Joinal Abdin<br />
Lew Lederman<br />
Aladdin Mohaghegh<br />
NCCM:<br />
Christine Donaldson<br />
Gurjit Husson<br />
Lilly Ing<br />
Staff Resource:<br />
Sandra Winkelbauer<br />
REGISTRATION<br />
Elected Members:<br />
Elaine Akers (Chair)<br />
Stephen Clement<br />
Bonnie Hauser<br />
Chris Leung<br />
Public Members:<br />
Tom Baulke<br />
Bob Ebrahimzadeh<br />
David H<strong>of</strong>f<br />
NCCM:<br />
James Buttoo<br />
David Malian<br />
Dean:<br />
Jake Thiessen<br />
Staff Resource:<br />
Chris Schillemore<br />
PHARMACY TECHNICIANS<br />
WORKING GROUP<br />
Elected Members:<br />
Elaine Akers<br />
Gerry Cook<br />
Bonnie Hauser (Chair)<br />
Don Organ<br />
Greg Purchase<br />
Public Members:<br />
Andrea Chun<br />
NCCM:<br />
Bonnie Bokma<br />
Marissa Coruzzi<br />
Tim Fleming<br />
Catherine Graham<br />
Mark Scanlon<br />
Catherine Schuster<br />
Melody Wardell<br />
Staff Resource:<br />
Susan James<br />
STANDARDS OF PRACTICE<br />
WORKING GROUP<br />
Elected Members:<br />
Chris Leung<br />
Shelley McKinney (Chair)<br />
Saheed Rashid<br />
Public Members:<br />
Andrea Chun<br />
Javaid Khan<br />
NCCM:<br />
Zubin Austin<br />
Zita Semeniuk<br />
Jeannette Wang<br />
Staff Resource:<br />
Anne Resnick<br />
NCCM=Non-Council<br />
Committee Member<br />
8 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
council report<br />
SEPTEMBER <strong>2008</strong><br />
Council Approves 2009<br />
Capital And Operating<br />
Budget<br />
At the September <strong>2008</strong> Council meeting,<br />
<strong>College</strong> Council voted in favour <strong>of</strong><br />
approving the proposed capital and<br />
operating budget for 2009. The budget<br />
reflects the additional resources required<br />
to address the needs <strong>of</strong> an ever<br />
growing and complicated membership<br />
base. These include:<br />
• Diverse streams <strong>of</strong> technicians seeking<br />
regulation;<br />
• Increased scrutiny on entry to practice<br />
fairness;<br />
• HSIA (Health Systems Information<br />
Act) and its impact on complaints and<br />
adjudication;<br />
• Increased investigation demands;<br />
• Higher discipline case load;<br />
• Compliance costs for members’ liability<br />
insurance requirement;<br />
• Technology support for increasingly<br />
complex on-line services;<br />
• Call volume increases <strong>of</strong> 40%.<br />
Although there are no increases<br />
budgeted for annual fees for pharmacists<br />
or pharmacies or for accreditation<br />
or registration processes, there<br />
are some changes to the fee by-law. Effective<br />
January 1, 2009, annual fees for<br />
pharmacists electing into Part B <strong>of</strong> the<br />
Register will be reduced to half that <strong>of</strong> a<br />
Part A fee. In addition, anticipating that<br />
Pharmacy Technicians will commence<br />
registration with the <strong>College</strong> in 2009,<br />
the budget provides for Technician annual<br />
fees to be equal to two thirds that<br />
<strong>of</strong> Part A Pharmacist fees. There is also<br />
Approved 2009 Budget Summary<br />
Member Fees .............................$ 6,223,627<br />
Pharmacy Fees ........................... $ 2,741,230<br />
Health Pr<strong>of</strong>ession Corporation. ...............$ 31,800<br />
Registration Fees and Income. ................$ 878,169<br />
Investment Income . ........................$ 230,000<br />
Total Projected Revenue . ...............$10,104,826<br />
Expenses<br />
Council, Committee & District Meetings ....... $ 2,805,518<br />
<strong>College</strong> Administration. .................... $ 7,476,639<br />
Property ..................................$ 267,459<br />
Total Expenses . .......................$10,549,616<br />
Excess <strong>of</strong> Revenue over Expenses ............. $ (444,790)<br />
Capital Expenditures. ...................... $ (150,000)<br />
Surplus (Deficit) after Capital ..........$ (594,790)<br />
a new fee for Reinstatement that will<br />
support changes to proposed entry to<br />
practice regulations. The projected excess<br />
<strong>of</strong> operating expenses over revenue<br />
<strong>of</strong> $445,000 and the IT capital<br />
spending <strong>of</strong> $150,000 is to be covered<br />
by accumulated reserves.<br />
Council noted that over the past several<br />
years, due to growth in membership,<br />
the <strong>College</strong> has accumulated reserves<br />
projected to exceed $4 million<br />
by year end <strong>2008</strong>. As reported in previous<br />
years, the excess reserves were allocated<br />
for facilities to address the anticipated<br />
increase in space required to<br />
accommodate growth in staffing. Consultations<br />
are currently underway, facilitated<br />
by an outside Real Estate/Design<br />
firm; to determine how the current facilities<br />
owned and operated by the <strong>College</strong><br />
could be reconfigured to increase<br />
the utility and efficiency. Accordingly,<br />
Council agreed to defer approval <strong>of</strong> a<br />
capital budget for building, leaseholds<br />
and furniture to <strong>December</strong> <strong>2008</strong>.<br />
Council Approves<br />
Appointment Of Clarke<br />
Henning Llp As Auditors For<br />
<strong>2008</strong><br />
In keeping with the Finance policy that<br />
external services be tested against the<br />
market every five years, the Financial<br />
and Audit services were taken to the<br />
market in the spring <strong>of</strong> this year. Following<br />
a comprehensive analysis, the<br />
Finance Committee recommended<br />
that the firm Clarke Henning LLP,<br />
Chartered Accountants, be appointed<br />
as Auditors for the <strong>College</strong> for the fiscal<br />
year <strong>2008</strong>. The firm is registered<br />
with the Canadian Public Accountability<br />
Board and will be undertaking the<br />
financial audit, the required pension<br />
audit as well as the fairness audit. As<br />
well, Council noted that the appointment<br />
<strong>of</strong> Clarke Henning will result in a<br />
30% cost saving in financial audit fees<br />
and the firm has committed to not raising<br />
their fees beyond the CPI for three<br />
years.<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
9
council report<br />
Registration Regulations<br />
Ratified<br />
As required under subsection 95 (1.4)<br />
<strong>of</strong> the Health Pr<strong>of</strong>essions Procedural<br />
Code, and as directed by Council at<br />
the June <strong>2008</strong> meeting, a consultation<br />
process was initiated with stakeholders<br />
on the Proposed Registration<br />
Regulation. Feedback was requested<br />
from the members, certified pharmacy<br />
technicians, regulatory organizations,<br />
national and provincial pharmacy and<br />
pharmacy technician associations, and<br />
the Office <strong>of</strong> the Fairness Commissioner.<br />
The <strong>College</strong> received feedback<br />
from a small number <strong>of</strong> individuals and<br />
from those regulatory authorities and<br />
organizations most directly concerned<br />
with the Regulation (e.g. Office <strong>of</strong> the<br />
Fairness Commissioner, Pharmacy<br />
Examining Board <strong>of</strong> Canada, Canadian<br />
Council for Accreditation <strong>of</strong> Pharmacy<br />
Programs). The <strong>College</strong> carefully<br />
considered all feedback that was<br />
received prior to the Council meeting<br />
and, although no material changes<br />
were made, the consultation resulted in<br />
some changes to ensure clarity <strong>of</strong> the<br />
original intent. The ratified regulations<br />
can be found on the <strong>College</strong>’s website<br />
(www.ocpinfo.com). Comments or<br />
questions about the changes are welcome<br />
and may be directed to Susan<br />
James (sjames@ocpinfo.com)<br />
Council Ratifies Issuance<br />
And Renewal Regulations<br />
Following Council’s consideration and<br />
preliminary approval <strong>of</strong> the proposed<br />
regulation under the Drug and Pharmacies<br />
Regulation Act providing for the<br />
issuance <strong>of</strong>, suspension, revocation,<br />
expiration or renewal <strong>of</strong> Certificates<br />
<strong>of</strong> Accreditation, the regulation was<br />
circulated to members for comment.<br />
Following receipt <strong>of</strong> responses from organizations<br />
such as the <strong>Ontario</strong> <strong>Pharmacists</strong>’<br />
Association and the <strong>Ontario</strong><br />
branch <strong>of</strong> the Canadian Association <strong>of</strong><br />
Chain Drug Stores as well as from corporations<br />
owning pharmacies in <strong>Ontario</strong>,<br />
the <strong>College</strong> held a meeting with<br />
the respondents to provide clarification<br />
<strong>of</strong> the <strong>College</strong>’s purpose and intent<br />
as well as to further understand their<br />
concerns. As a result <strong>of</strong> this meeting,<br />
several changes were made to the proposed<br />
regulation and Council ratified<br />
the regulations which can be found on<br />
the <strong>College</strong>’s website www.ocpinfo.<br />
com. Council noted that <strong>College</strong> processes<br />
respecting these matters have<br />
yet to be defined and that appropriate<br />
Committees will be tasked to deal with<br />
specific details.<br />
E-Health In <strong>Ontario</strong><br />
Council heard a presentation by Mr.<br />
Doug Tessier and Mr. Nick Zamora on<br />
<strong>Ontario</strong>’s e-health program. The Program<br />
objective is to help ensure that<br />
information and information technology<br />
are used to improve and modernize<br />
<strong>Ontario</strong>’s health care system, and<br />
to improve the quality <strong>of</strong>, and access<br />
to, health care services. Four immediate<br />
priorities were highlighted in the<br />
presentation and Council was particularly<br />
pleased to note that members <strong>of</strong><br />
this <strong>College</strong> are well-placed to play an<br />
active and integral role in the Ministry’s<br />
e-health initiatives as noted below:<br />
<strong>Ontario</strong> Diabetes Registry<br />
• Comprehensive tool for diabetes<br />
management and self-care<br />
• Accessible to providers, case managers,<br />
patients and their families to<br />
support health promotion, disease<br />
prevention and better care<br />
• Provides information to health planners,<br />
LHINs and system stewards to<br />
enhance system management<br />
Portals/Integrated Clinical View<br />
• Integrates patient information from<br />
different clinical systems – Labs,<br />
Drugs, Diagnostic Imaging, Public<br />
Health<br />
• Provides a single access point for<br />
to securely view a patient’s clinical<br />
results<br />
• Builds upon current electronic medical<br />
record systems in physician <strong>of</strong>fices<br />
and EHR repositories, including<br />
eCHN<br />
e-Prescribing and Drug Systems<br />
• Provides complete drug history and<br />
dispensing information ensuring appropriate<br />
prescribing and improved<br />
patient safety<br />
• Provides drug interaction tools for<br />
providers and ensures accurate and<br />
complete information for dispensing<br />
EMR/Computers for Physicians<br />
• Development <strong>of</strong> a program to support<br />
the funding and distribution <strong>of</strong> computers<br />
to <strong>Ontario</strong> Physicians<br />
• Multiple models to match the different<br />
needs <strong>of</strong> <strong>Ontario</strong> Physicians<br />
• Linked to performance and outcome<br />
aligned with other health system<br />
priorities<br />
Support For Blueprint For<br />
Pharmacy<br />
Following the launch at the CPhA conference<br />
in June <strong>2008</strong>, the Blueprint for<br />
Pharmacy – the Vision for Pharmacy<br />
document was distributed to all national<br />
and provincial pharmacy organizations,<br />
faculties <strong>of</strong> pharmacy and corporate<br />
pharmacy head <strong>of</strong>fices. The<br />
10 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
Task Force invited these pharmacy<br />
stakeholders to support the Vision for<br />
Pharmacy and asked that they commit<br />
to work collaboratively with the Blueprint<br />
Task Force and working groups as<br />
they develop the implementation plan.<br />
Council endorsed the decision to support<br />
the concepts and principles embedded<br />
in the Blueprint and the commitment<br />
that the document will become<br />
an integral part <strong>of</strong> Council’s discussion<br />
as the <strong>College</strong> enters the next<br />
strategic planning cycle in 2009.<br />
New Pharmacy Technician<br />
Observers Welcomed At<br />
Council Table<br />
Council welcomed Ms. Marissa Coruzzi<br />
and Ms. Melody Wardell to their<br />
inaugural Council meeting. Both pharmacy<br />
technicians have been appointed<br />
by the President to sit as observers at<br />
the Council table for the <strong>2008</strong>-2009<br />
Council term and will also serve on the<br />
Pharmacy Technicians Working Group<br />
<strong>of</strong> the <strong>College</strong>.<br />
Office Of The Fairness<br />
Commissioner/Labour<br />
Mobility<br />
In accordance with the Fair Access to<br />
Regulated Pr<strong>of</strong>essions Act and the Regulated<br />
Health Pr<strong>of</strong>essions Act, the Office<br />
<strong>of</strong> the Fairness Commissioner requires<br />
certain pr<strong>of</strong>essions to review<br />
the registration practices, submit reports<br />
about them and undergo compliance<br />
audits to ensure that registration<br />
is fair. This <strong>College</strong> will participate in<br />
the first round <strong>of</strong> audits which will be<br />
conducted as a pilot and accordingly,<br />
an audit <strong>of</strong> this <strong>College</strong>’s registration<br />
practices from July 16, 2007 to July 15,<br />
<strong>2008</strong> will occur between January and<br />
March 2009.<br />
On a related matter, Council also<br />
noted the significant work currently<br />
underway by the federal/provincial/<br />
territorial agencies as well the regulatory<br />
authorities respecting revisions<br />
to Chapter 7 (Labour Mobility) <strong>of</strong> the<br />
Agreement on Internal Trade. It is to be<br />
noted that all areas are working collaboratively<br />
in order to meet the Premiers’<br />
commitment that, “any worker certified<br />
for an occupation by a regulatory authority<br />
<strong>of</strong> one province or territory shall be<br />
recognized as qualified to practice that<br />
occupation by all other provinces and territories.”<br />
Council further noted that the<br />
<strong>College</strong> will participate in the review<br />
for the MRA for Pharmacy in Canada<br />
process that is organized through NA-<br />
PRA in late October.<br />
Health Canada Grants A<br />
Further Extension Of S. 56<br />
Class Exemption<br />
Health Canada has granted a further<br />
extension to their Section 56 Class<br />
exemption. The exemption, which<br />
permits the pharmacist to dispense<br />
methadone and to transfer custody<br />
<strong>of</strong> such doses in a secure manner to<br />
physicians or their delegates, will end<br />
<strong>December</strong> 31, <strong>2008</strong>. Health Canada<br />
has advised that it is now in receipt <strong>of</strong><br />
the final Evaluation Report, “Methadone<br />
Interim Policy Evaluation: Study<br />
Report” and that these recommendations,<br />
along with all other information,<br />
will be taken into consideration during<br />
the review and analysis <strong>of</strong> this nontraditional<br />
model for the provision <strong>of</strong><br />
methadone in <strong>Ontario</strong>.<br />
Conference Of The <strong>Ontario</strong><br />
<strong>Pharmacists</strong>’ Association<br />
Sponsorship<br />
Council endorsed the Executive<br />
Committee’s recommendation that<br />
the <strong>College</strong> sponsor an education session<br />
at OPA’s <strong>2008</strong> annual conference.<br />
This year, the sponsorship, in the sum<br />
<strong>of</strong> $5,000, was provided for the session<br />
entitled “Methadone Education for<br />
<strong>Pharmacists</strong>” by Mary Nelson.<br />
Practice Guide Project<br />
In 2007, the Pr<strong>of</strong>essional Practice<br />
Committee identified the need to begin<br />
a process <strong>of</strong> reviewing all existing policies<br />
and guidelines currently available<br />
on the <strong>College</strong>’s website, in order to<br />
both facilitate access by members <strong>of</strong><br />
the <strong>College</strong> and members <strong>of</strong> the public,<br />
and to increase understanding by<br />
members <strong>of</strong> the complex network <strong>of</strong><br />
legislation, regulations, by-laws, standards,<br />
policies and guidelines by which<br />
they are expected to practice. Council<br />
noted the progress made with respect<br />
to this project and was advised that a<br />
legal review will also be conducted to<br />
ensure that by categorizing as standards,<br />
policies or guidelines, the intent<br />
<strong>of</strong> each document will be clear with respect<br />
to providing guidance to members<br />
and for purposes <strong>of</strong> enforceability.<br />
It is anticipated that over the next<br />
few Council meetings, the Pr<strong>of</strong>essional<br />
Practice Committee will bring forward<br />
recommendations (i.e. reaffirmation or<br />
deletion) for Council’s consideration.<br />
Council Meeting Dates<br />
<strong>2008</strong> -2009 Term<br />
• Thursday 11th and Friday 12th <strong>December</strong>,<br />
<strong>2008</strong><br />
• Sunday 8th, Monday 9th and Tuesday<br />
10th March, 2009<br />
• Monday 8th and Tuesday 9th June,<br />
2009<br />
• Monday 14th and Tuesday 15th September<br />
2009<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
11
liability insurance<br />
Update on Pr<strong>of</strong>essional Liability Insurance<br />
It has been almost a year since the <strong>College</strong> introduced the requirement<br />
for all Part A pharmacists to maintain personal pr<strong>of</strong>essional<br />
liability insurance. The first year was full <strong>of</strong> questions. The questions<br />
came from insurance underwriters, brokers, pharmacy corporations<br />
and pr<strong>of</strong>essional groups – both community and institutional, and<br />
<strong>of</strong> course, from individual members.<br />
What we learned in this first year is that words can be interpreted<br />
differently no matter how clearly we believe they are stated. The insurance<br />
requirement was put in place to ensure that members <strong>of</strong> the<br />
public who are harmed as a result <strong>of</strong> a medical misadventure involving<br />
a practising pharmacist or an intern can make a claim that could be covered<br />
through insurance.<br />
To ensure that happened, the <strong>College</strong> explored models <strong>of</strong> mandated<br />
coverage ranging from simply stating a minimum limit <strong>of</strong> coverage<br />
to developing a compulsory, coordinated program through the <strong>College</strong>.<br />
Given the model for services in <strong>Ontario</strong>, the <strong>College</strong> believed a<br />
more prescribed approach was appropriate. However, despite prescribing<br />
very specific criteria, there was quite a range <strong>of</strong> products and<br />
options out there. In some cases, what was intended was not exactly<br />
being delivered. Insurance brokers were marketing products that,<br />
while on the surface appeared compliant, were not fully meeting the<br />
expectations.<br />
To even the playing field and ensure that the public has protection if<br />
and when they need it, we have worked closely with our insurance consultant,<br />
the broker community and insurance companies to determine<br />
which policies can and will meet the intention <strong>of</strong> the <strong>College</strong>’s registration<br />
requirement, while assuring costs to the pharmacist associated with<br />
the appropriate coverage is reflective <strong>of</strong> the insurance marketplace.<br />
Presently there are still a large range <strong>of</strong> products available and at the<br />
suggestion <strong>of</strong> our insurance consultants we will be streamlining the process<br />
and product availability to ensure consistency.<br />
At this time, we can confirm that the insurance products and broker<br />
organizations listed on this page satisfy the criteria prescribed in <strong>College</strong><br />
by-law.<br />
We urge members to be cautious if considering any other insurance<br />
products. We also caution members who are relying on their employer<br />
to arrange insurance on your behalf. Any policy that terminates if your<br />
employment terminates DOES NOT meet the <strong>College</strong>’s requirement.<br />
It is the member’s responsibility to ensure that they have compliant insurance<br />
and that the insurance is fully portable regardless <strong>of</strong> their employment<br />
status.<br />
<strong>Ontario</strong> <strong>Pharmacists</strong>’ Association<br />
Broker: AON Reed Stenhouse<br />
Contact: Eija Kanniainen, OPA<br />
Phone: 416-441-0788 ext 4226<br />
Toll Free: 1-866-903-3780<br />
www.opatoday.com<br />
Canadian Society <strong>of</strong> Hospital <strong>Pharmacists</strong><br />
Broker: The Insurers Financial Group<br />
Contact: Dianne Leibold<br />
Phone: 905-707-5141 ext 1202<br />
Toll Free: 1-800-563-7283 ext 1202<br />
dianne.leibold@ifgcanada.com<br />
Aviva Canada<br />
This product is available through multiple insurance<br />
brokers across <strong>Ontario</strong> and through specific<br />
agreements with various pharmacy groups/networks.<br />
Pharmaguard Individual MalPractice Liability<br />
Broker: Gary McCaslin<br />
McCaslin Horne Insurance Brokers Inc.<br />
Phone: 905-877-8738<br />
Toll Free: 1-800-668-4830<br />
mchorne@bellnet.ca<br />
www.pharmaguardins.com<br />
Gellatly Insurance Limited<br />
Broker: Ben Malik<br />
Phone: 416-236-2321, ext 121<br />
Toll Free: 1-800-381-4092 ext 121<br />
bmalik@gellatlyinsurance.com<br />
www.gellatlyinsurance.com<br />
Pottruff and Smith<br />
Broker: Leo Adragna<br />
Toll Free: 1-800-263-2369 x 309<br />
ladragna@pottruffsmith.com<br />
www.pottruffsmith.com<br />
12 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
The MedsCheck <br />
Consult Pilot Project<br />
MedsCheck Consult – An expansion <strong>of</strong> the<br />
MedsCheck program<br />
As a result <strong>of</strong> conducting the MedsCheck Annual or<br />
MedsCheck Follow-Up medication review many pharmacists<br />
are identifying drug related problems (DRP) and medication-related<br />
issues that require the collaboration with the<br />
patient’s prescriber; hence the reason we are expanding to<br />
the MedsCheck Consult program.<br />
What is the difference between the<br />
MedsCheck Annual or the MedsCheck<br />
Follow-Up and the MedsCheck Consult?<br />
Whereas the MedsCheck Annual and MedsCheck Follow-<br />
Up medication review program focused on the relationship<br />
between the pharmacist and the patient or caregiver, the<br />
MedsCheck Consult is a program that promotes collaboration<br />
and follow-up between the pharmacist, patient and patient’s<br />
prescriber towards the goal <strong>of</strong> optimizing a patient’s<br />
drug therapy.<br />
The main objectives <strong>of</strong> the MedsCheck Consult are to<br />
promote healthier patient outcomes; and improve and optimize<br />
drug therapy by promoting inter-pr<strong>of</strong>essional collaboration<br />
in patient care.<br />
How does the MedsCheck Consult work?<br />
The MedsCheck Consult builds on the MedsCheck medication<br />
review process. Should a pharmacist identify a DRP,<br />
he/she will communicate with the patient’s prescriber using<br />
a standardized form and outline the DRP or medication concern<br />
including the nature <strong>of</strong> the drug related problem, the<br />
desired outcome, a recommended option(s) to the physician<br />
and possible follow-up action.<br />
The physician and pharmacist, together, agree on the<br />
collaborative action that is best for the patient. The standardized<br />
form, signed and dated by both practitioners is returned<br />
to the pharmacist as the agreement to proceed with<br />
one <strong>of</strong> the following responses: no further action required; a<br />
change to a patient’s medication therapy; or a request by the<br />
prescriber that additional information or further analysis <strong>of</strong><br />
the possible recommended option be considered.<br />
PILOT implementation <strong>of</strong> MedsCheck<br />
Consult program<br />
The MedsCheck Consult program will be piloted to identify<br />
strengths and weaknesses <strong>of</strong> the program and to test the use<br />
<strong>of</strong> the standardized form that will be required for purposes<br />
<strong>of</strong> documentation and communication <strong>of</strong> the process.<br />
The MedsCheck Consult pilot study will include a minimum<br />
<strong>of</strong> 30 pharmacy practice sites from across the province<br />
including urban, rural and remote; and from different<br />
pharmacy practice sites such as independent owner,<br />
chain, banner, mass merchandiser, medical clinic pharmacy,<br />
family health team, hospital out-patient and walk-in clinic<br />
operations.<br />
Interested pharmacists will receive a one-time honourarium<br />
for their participation in the pilot study and are asked<br />
to complete an application that includes a commitment to<br />
approximately 3 months <strong>of</strong> activity and one month <strong>of</strong> follow-up<br />
communication and assessment with the ministry.<br />
In selecting pharmacists, inherently, the physicians in their<br />
vicinity will also be selected and included in the plans.<br />
For more information on the MedsCheck Consult program<br />
please refer to: www.medscheck.ca<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
13
opiATE<br />
Reprinted (modified) from CHAMPLAIN LHIN - with permission.<br />
Ottawa Participating in<br />
Provincial OpiATE Project<br />
FOCUS ON METHADONE MAINTENANCE TREATMENT<br />
The OpiATE (Awareness, Treatment and Education)<br />
Project was created after a 2007 provincial<br />
task force made recommendations on how to improve<br />
methadone maintenance treatment.<br />
Methadone is an effective and legal substitute for<br />
opioid drugs such as heroin, codeine, morphine, Dilaudid®,<br />
and Percodan®. People who are dependent on<br />
opioid drugs can take methadone to help stabilize their<br />
lives. The dose is usually mixed with orange juice and<br />
taken daily. It has been used in treatment programs<br />
since the early 1960s.<br />
The use <strong>of</strong> methadone maintenance treatment has<br />
increased substantially over the past decade in <strong>Ontario</strong>,<br />
and the provincial task force noted three main<br />
challenges:<br />
• Access to services in a timely and equitable manner<br />
• Ensuring methadone maintenance treatment services<br />
are safe and effective<br />
• Responding to concerns <strong>of</strong> local communities<br />
where methadone maintenance treatment is<br />
provided<br />
The OpiATE project, which received $2 million<br />
in provincial funding, has three strategies: a) raising<br />
awareness b) community engagement and c) training/pr<strong>of</strong>essional<br />
supports. Partners include the <strong>College</strong><br />
<strong>of</strong> Physicians and Surgeons <strong>of</strong> <strong>Ontario</strong>, <strong>Ontario</strong><br />
<strong>Pharmacists</strong> Association, Registered Nurses Association<br />
<strong>of</strong> <strong>Ontario</strong>, and the Centre for Addiction and<br />
Mental Health.<br />
Four jurisdictions - Ottawa, Thunder Bay, Halton,<br />
and Chatham – were chosen to play a key role in the<br />
project. The aim is to create a strong community coalition,<br />
and encourage physicians, pharmacists, and<br />
other health and social service pr<strong>of</strong>essionals to get involved.<br />
An important objective is to reduce the marginalization<br />
<strong>of</strong> clients with addictions.<br />
On July 23, <strong>2008</strong>, the Centre for Addiction and<br />
Mental Health held a meeting with 15 health pr<strong>of</strong>essionals<br />
at the Champlain LHIN <strong>of</strong>fice to share information<br />
about the OpiATE project. Attendees discussed<br />
new mentoring and training opportunities in<br />
opioid dependence assessment and treatment for<br />
nurses, physicians, pharmacists, case managers and<br />
counsellors.<br />
The group also spoke about awareness strategies<br />
for allied pr<strong>of</strong>essionals and the community.<br />
Ottawa Area <strong>Pharmacists</strong>: There will be a C.E. workshop<br />
on this topic coordinated by the Ottawa Carleton<br />
<strong>Pharmacists</strong>’ Association on Wednesday, January 21, 2009<br />
from 6:30 to 9 pm at the Hampton Inn.<br />
14 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
pharmacy technician regulation<br />
Pharmacy Technicians<br />
Demonstrate Tremendous<br />
Commitment for Regulation<br />
In the last couple <strong>of</strong> months there have been strong indicators<br />
that pharmacy technicians in <strong>Ontario</strong> are not only engaged, but ready and<br />
eager to pursue registration with the <strong>College</strong>.<br />
The enthusiasm for regulation is remarkable; in fact it far exceeds<br />
expectations – and capacity!<br />
W<br />
hile the degree <strong>of</strong> early commitment is exciting<br />
and confirming, it has also created<br />
an unexpected situation. Technicians are<br />
ready and waiting to complete the steps for registration,<br />
even before the process is fully developed and<br />
widely available. Some technicians have reported frustration,<br />
as they find themselves competing to gain entry<br />
to programs that presently, have limited capacity.<br />
On the bright side, the transition plan is on track and<br />
allows ample time for those wishing to pursue registration<br />
to complete the process. In the next while, access<br />
to education programs will increase as on-line courses<br />
are developed and classroom delivery becomes available<br />
in local communities and even some workplaces.<br />
Examinations will also expand to accommodate more<br />
people in more places, once fully implemented. So, although<br />
many <strong>of</strong> the activities are under development<br />
and will have limited availability through 2009, by the<br />
end <strong>of</strong> the year, full implementation will allow those<br />
technicians in transition to complete the process over<br />
the next five years.<br />
Although momentum is growing and many pharmacy<br />
technicians are keen to move through the required<br />
steps as soon as possible, there are many others<br />
who feel uncertain and undecided about what regulation<br />
will mean to them; this is understandable. In these<br />
early days, many questions are yet to be answered;<br />
about the process, the cost, the time and the effort<br />
that will be involved. Even as these details emerge,<br />
an inability to predict the future impact <strong>of</strong> regulation<br />
on individual technicians and workplaces continues to<br />
make the decision a difficult one. The <strong>College</strong> would<br />
like to reassure pharmacy technicians, pharmacists<br />
and employers that there is no need to feel pressured<br />
to act immediately. There is plenty <strong>of</strong> time to consider<br />
the issues and plan for the transition. Whether you<br />
choose to move forward now, wait for increased availability<br />
<strong>of</strong> programs, extend the costs over a few years,<br />
or see how the marketplace responds… the choice is<br />
yours. Take your time, consider all <strong>of</strong> the aspects <strong>of</strong><br />
regulation, and make the choice that is right for you<br />
and your career.<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
15
pharmacy technician regulation<br />
16 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong> pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
17
health canada advisories & notices<br />
Oct 29, <strong>2008</strong><br />
Oct 28, <strong>2008</strong><br />
Oct 28, <strong>2008</strong><br />
Oct 17, <strong>2008</strong><br />
Oct 17, <strong>2008</strong><br />
Oct 15, <strong>2008</strong><br />
Oct 8, <strong>2008</strong><br />
Sept 23, <strong>2008</strong><br />
Sept 22, <strong>2008</strong><br />
Sept 3, <strong>2008</strong><br />
Aug 22, <strong>2008</strong><br />
Aug 22, <strong>2008</strong><br />
Do not use Eros Fire, a product promoted to enhance sexual performance, as this product may pose serious<br />
health risks. The product was found to contain xanthoanthrafil (also known as benzamidenafil), which is not<br />
indicated on the label.<br />
Published retrospective studies have reported that venlafaxine overdosage may be associated with an<br />
increased risk <strong>of</strong> fatal outcome compared to that observed with Selective Serotonin Reuptake Inhibitor (SSRI)<br />
antidepressants, but lower than that for tricyclic antidepressants.<br />
Health Canada is warning Canadians, especially expectant mothers, not to use two vitamin C products<br />
sold under the brand names New Roots Herbal Vitamin C8 and Vitazan Pr<strong>of</strong>essional Vitamin C Advanced<br />
Ascorbate. These products were improperly manufactured using vitamin A instead <strong>of</strong> vitamin C, exposing<br />
consumers to potential risks <strong>of</strong> adverse events.<br />
Swissmedic warned consumers not to buy or use the product Powertabs because it was found to contain an<br />
unauthorised substance with a structure similar to sildenafil.<br />
Sildenafil is a prescription drug used in the treatment <strong>of</strong> erectile dysfunction and should only be used under<br />
the supervision <strong>of</strong> a health care practitioner.<br />
The Hong Kong Department <strong>of</strong> Health warned consumers not to buy or use the product Sweet Energizer<br />
Vitality Candy because it was found to contain an unauthorised substance with a structure similar to tadalafil<br />
(aminotadalafil).<br />
Tadalafil is a prescription drug used in the treatment <strong>of</strong> erectile dysfunction, and should only be used under<br />
the supervision <strong>of</strong> a health care practitioner.<br />
Physio-Control, Incorporated, a division <strong>of</strong> Medtronic, Incorporated is notifying customers <strong>of</strong> a recall for<br />
LIFEPAK CR Plus and/or LIFEPAK EXPRESS automated external defibrillators (AED) manufactured between<br />
<strong>November</strong> 2006 and March <strong>2008</strong>. These AEDs contain a specific internal flex cable that may be susceptible<br />
to failure and could cause a short, preventing the AED from powering on. Failure to power on will prevent<br />
delivery <strong>of</strong> therapy to a patient.<br />
Teleflex Medical has issued a voluntary recall for Weck brand ligating clips including Hem-O-Lok, Horizon,<br />
Hemoclip Traditional and Hemoclip Plus products because holes were detected in the therm<strong>of</strong>ormed tray <strong>of</strong><br />
certain sterile packaged units meaning the sterile integrity cannot be guaranteed.<br />
Health Canada is advising the public, especially nursing mothers, about the very rare but serious health risk<br />
to breastfed babies posed by codeine use in mothers. Once ingested, codeine is converted by the body into<br />
morphine. Some people convert codeine into morphine more rapidly and completely than others. The babies<br />
<strong>of</strong> nursing mothers who rapidly metabolize codeine may be at increased risk for morphine overdose due to<br />
higher-than-expected morphine levels in breast milk.<br />
Health Canada is advising consumers not to use 6 foreign health products due to concerns about possible<br />
side-effects: Dr. Life, Chong Cao Ju Wang, Hanguo shoushen yihao (meiti xing), One Korean Slimmer (Body<br />
Enhancer Brand), Liquimax Complete Nutrition, Multivitamin Formula, ARMA - sin Gang San and New ARMA<br />
- Sin Gang San.<br />
The Hong Kong Department <strong>of</strong> Health warned consumers not to buy or use Lover Liquid Nutriment Herbal<br />
Supplement and Onyo because they were found to contain undeclared pharmaceutical ingredients. Lover<br />
Liquid Nutriment Herbal Supplement was found to contain sildenafil while Onyo was found to contain<br />
sildenafil, as well as unapproved substances with structures similar to sildenafil and vardenafil. The U.S. Food<br />
and Drug Administration warned consumers not to use the product Rose 4 Her because it was found to<br />
contain an undeclared ingredient similar to the prescription drug sildenafil. The product has been voluntarily<br />
recalled by the manufacturer in the U.S.<br />
Health Canada is advising consumers not to use any unauthorized health products sold under the brand<br />
names Life Choice, Healthy Choice, Doctor’s Choice and Your Choice as well as other products without a<br />
brand name. All <strong>of</strong> these unauthorized health products have the same identifying image on their label.<br />
Health Canada is advising consumers not to use 8 foreign products due to concerns about possible sideeffects.<br />
Natural (Xin Yi Dai) and Lasmi, AA Qu Feng Shu Jin Wan, Energy II, Apisate, Obat Asam Urat and<br />
Asam Urat, Slim 3in1 (Xiao Nan zhi Bao)<br />
Health Canada is warning consumers not to use the two unauthorized natural health products, Life Choice<br />
Ephedrine HCL and Life Choice Kava Kava because they are not approved by Health Canada, and may cause<br />
serious adverse health effects including death.<br />
18 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
Aug 21, <strong>2008</strong><br />
Aug 20, <strong>2008</strong><br />
Aug 19, <strong>2008</strong><br />
Aug 18, <strong>2008</strong><br />
Aug 14, <strong>2008</strong><br />
Aug 12, <strong>2008</strong><br />
Aug 11, <strong>2008</strong><br />
Aug 11, <strong>2008</strong><br />
Aug 8, <strong>2008</strong><br />
Aug 7, <strong>2008</strong><br />
Aug 7, <strong>2008</strong><br />
Aug 1, <strong>2008</strong><br />
Health Canada would like to assure Canadians that the Viracept product now available on the Canadian<br />
market has the acceptable ethyl methanesulfonate limits so that the precautions relating to its use in nonpregnant<br />
HIV infected adults and children no longer apply.<br />
Liko issued a safety notice for the Universal SlingBar. An unanticipated fatigue may lead to the sling bar to<br />
detach from the patient lift resulting in the patient falling. The letter contains important safety information<br />
regarding the inspection <strong>of</strong> the SlingBar to detect any problem.<br />
Precipitate formation has been observed in Accusol 35 haemodialysis solutions for acute renal therapy when<br />
used for treatment modes other than haemodialysis. SOL35K0 and SOL35K4 solutions are only to be used<br />
for haemodialysis and should not be used for haem<strong>of</strong>iltration and haemodiafiltration<br />
Health Canada is advising consumers not to use 9 foreign health products due to concerns about possible<br />
side-effects: Dan Bai Shou Shen Su, Karntien, Karntien Easy to Slim, Armstrong Natural Herbal Supplement,<br />
Enhanix New Extra Men’s Formula, Power 58 Extra, and Platinum Power 58 Extra, More Slim and Soloslim.<br />
Further to a communication issued August 8, <strong>2008</strong>, Health Canada is advising Canadians with milk allergies<br />
<strong>of</strong> two additional acidophilus-containing health products labeled as “non-dairy” that have been found to<br />
contain trace amounts <strong>of</strong> milk protein from dairy ingredients used in the production process.<br />
Health Canada Recalled damaged Curlin infusion pumps. Curlin Medical, Inc. issued a safety notice for<br />
specific ambulatory infusion pumps. The affected pumps may exhibit over-delivery medication when<br />
physically damaged. The letter contains important safety information regarding testing the pump and<br />
updates <strong>of</strong> the User’s Manual instructions.<br />
Health Canada is advising consumers that serious hypersensitivity/infusion adverse events have occurred in<br />
patients treated with TORISEL (temsirolimus).<br />
Health Canada is advising consumers not to use 5 foreign health products due to concerns about possible<br />
side-effects: Oyster Extract Caps, Xiadafil VIP Tabs, Herb Vigour, Natural Vigour and China Vigour.<br />
Health Canada is warning Canadians with milk allergies not to use several brands <strong>of</strong> unauthorized<br />
acidophilus-containing health products labeled as “non-dairy” because they contain trace amounts <strong>of</strong> milk<br />
protein from dairy ingredients used in the production process.<br />
Desmopressin nasal sprays (including Apo-Desmopressin Spray) are associated with an increased risk <strong>of</strong><br />
serious side effects involving water retention and decreased blood sodium levels (hyponatremia). Canadian<br />
healthcare pr<strong>of</strong>essionals, patients and hospitals are advised that intranasal formulations <strong>of</strong> desmopressin<br />
(including Apo-Desmopressin Spray) are contraindicated for treatment <strong>of</strong> Primary Nocturnal Enuresis<br />
(bedwetting) due to increased risk <strong>of</strong> hyponatremia.<br />
Health Canada is warning consumers not to use Rize 2, The Occasion capsules (Rize2), an unauthorized<br />
product promoted for the treatment <strong>of</strong> erectile dysfunction, because it may pose serious health risks. Rize<br />
2 contains an undeclared pharmaceutical ingredient similar to the prescription drug sildenafil which should<br />
only be used under the supervision <strong>of</strong> a health care pr<strong>of</strong>essional. The product may pose serious health risks,<br />
especially for patients with pre-existing medical conditions such as heart problems, those who may be taking<br />
heart medications, or those who may be at risk for strokes.<br />
Health Canada is advising consumers that Ceftriaxone monographs are being updated to address the risk <strong>of</strong><br />
fatal interaction <strong>of</strong> ceftriaxone with calcium.<br />
For complete information & electronic mailing <strong>of</strong> the Health Canada Advisories/Warnings/Notices subscribe online at:<br />
http://www.hc-sc.gc.ca/dhp-mps/medeff/index_e.html<br />
MedEffect e-Notice is the new name which replaces Health Canada’s Health_Prod_Info mailing list.<br />
The content <strong>of</strong> the e-notices you receive will remain the same and are now part <strong>of</strong> MedEffect, a new Health Canada Web site dedicated to<br />
adverse reaction information. MedEffect can be visited at www.hc-sc.gc.ca/dhp-mps/medeff/index_e.html<br />
Health Canada Notices are also linked under “Notices” on the OCP website: www.ocpinfo.com<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
19
moving forward with technology<br />
New Online Pharmacist<br />
Fast , easy , convenient !<br />
Completing your renewal is a 2-step process ...<br />
here’s how it works<br />
Step 1: Renewing and updating your<br />
information<br />
The online process will guide you through the information<br />
requiring verification and/or updating. Information that<br />
appears with an asterisk (*) is mandatory and these fields<br />
must be completed. You will be able to review the information<br />
you have entered, save changes, and come back to<br />
complete your renewal at a later time.<br />
Once you fully complete and submit this first step <strong>of</strong><br />
your renewal, you will receive a confirmation that your<br />
updated information has been recorded on your file.<br />
Step 2: Payment <strong>of</strong> the annual renewal fee<br />
You may pay your renewal two ways; by online payment,<br />
or by mailing your payment to the <strong>College</strong> with a printed<br />
copy <strong>of</strong> the confirmation . If you pay online you will receive<br />
a pop-up confirmation indicating successful payment<br />
and a confirmation number. OCP recommends that you<br />
print the payment notice to retain for your records.<br />
Your annual renewal is considered complete once<br />
BOTH steps have been completed. Your receipt and wallet<br />
card will be mailed to your “preferred mailing address”.<br />
Step One<br />
1. Getting started…you’ll need your OCP number (User<br />
ID) and your eService password.<br />
Forgot your password?<br />
Your password was originally set to the last 6 digits <strong>of</strong><br />
your Social Insurance Number. If you have changed<br />
your password and forgotten it, you can request a new<br />
password online using eService provided the <strong>College</strong><br />
has your current email address. If we do not have your<br />
current email address on file, please email ocpclientservices@ocpinfo.com<br />
so that we can update your record.<br />
2. Go to www.ocpinfo.com, click on Member Login.<br />
Enter your User ID (your OCP number) and your<br />
password.<br />
3. Once you have successfully logged in, click on Pharmacist<br />
Renewal on the left hand side <strong>of</strong> the screen.<br />
4. Because <strong>of</strong> different fees and insurance requirements,<br />
the initial page will require you to confirm that you are<br />
in Part A or Part B <strong>of</strong> the register.<br />
To elect to Part B <strong>of</strong> the <strong>College</strong> register please send an<br />
email to ocpclientservices@ocpinfo.com indicating your<br />
desire to move to Part B <strong>of</strong> the register.<br />
To elect to Part A <strong>of</strong> the <strong>College</strong> register please contact<br />
Continuing Competency at (416) 962-4861 ext. 273 for<br />
more information.<br />
5. You will be asked to verify and/or provide information<br />
as you move through the tabs. Information that appears<br />
with an asterisk (*) is mandatory and must be<br />
confirmed or changed.<br />
Personal Information<br />
• OCP number (display only)<br />
• Part – A or B(display only)<br />
• Status (display only)<br />
20 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
Annual Renewal Process<br />
• Last Name (display only)<br />
• First Name (display only)<br />
• Preferred First Name *<br />
• Title (Mr. Mrs., etc) *<br />
• Home address *<br />
• Residential Telephone Number * (at least one [residential<br />
or cell phone] must be entered)<br />
• Cell Phone Number<br />
Practice Information<br />
• Your current practice sites will be displayed<br />
• Please remove any practice sites that no longer apply<br />
• Your current declared place <strong>of</strong> practice for voting purposes<br />
will be indicated by a ● •<br />
• Please update your weekly practice hours, employment<br />
category and employment status. **<br />
Contact Information<br />
• Preferred Email<br />
• Preferred Mailing address (defaults to Home address)<br />
• Preferred Fax<br />
• Preferred Language (this is for demographic and statistical<br />
information (English or French) Note: The <strong>College</strong><br />
corresponds to members in English,<br />
Education Information<br />
• OCP Qualifying Degree (display only)<br />
• Additional Education information. **<br />
<br />
Insurance Information (required for Part A<br />
pharmacists only)<br />
• Your current policy information on file will be displayed.<br />
• If you are with the same insurance company and have<br />
renewed your policy, please update the term start and<br />
end dates.<br />
• If you have a new insurance policy please update all<br />
requisite fields.<br />
Declaration<br />
• Please read the Criminal and Drug Related Offences<br />
question and Declaration carefully to understand what<br />
is required, so that you do not inadvertently provide an<br />
incorrect response!<br />
Once you fully complete and submit this first step <strong>of</strong> your<br />
renewal, you will receive confirmation that your information<br />
has been updated and recorded on your file.<br />
Step Two<br />
Payment<br />
• Pay online by Credit Card or Interac (Debit card).<br />
You will receive a pop-up confirmation indicating<br />
successful payment and a confirmation number.<br />
OCP recommends that you print the payment notice<br />
to retain for your records.<br />
Or<br />
• Mail your cheque to the <strong>College</strong> with a printed copy <strong>of</strong><br />
your confirmation from step one.<br />
Your annual renewal is considered complete and your<br />
receipt and wallet card will be sent to you once BOTH<br />
STEPS have been completed.<br />
** This information is collected and reported to the Canadian<br />
Institute for Health Information (CIHI). CIHI is<br />
an independent, not-for-pr<strong>of</strong>it organization that provides<br />
essential data and analysis on Canada’s health<br />
system and the health <strong>of</strong> Canadians.<br />
Watch for this new process to be launched online<br />
mid-January, 2009<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
21
egistration Q&A<br />
Chris Schillemore, R.Ph., B.Sc.Phm. M.Ed.<br />
Manager, Registration Programs<br />
QMy fluency score will expire before I am licensed.<br />
What should I do?<br />
The Registration Committee has approved a policy allowing<br />
registration advisors to extend the validity <strong>of</strong> language pr<strong>of</strong>iciency<br />
test scores if you are currently enrolled in the International<br />
Pharmacy Graduate program at the Leslie Dan Faculty<br />
<strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, or are completing<br />
your Structured Practical Training at the student or intern<br />
level in <strong>Ontario</strong>. If your fluency scores expired before you<br />
started training at the student level, or if there are any concerns<br />
about your fluency, your request will be referred to a<br />
panel <strong>of</strong> the Registration Committee. The panel will consider<br />
current use <strong>of</strong> the language and decide whether it will<br />
extend the validity <strong>of</strong> your test score or require you to complete<br />
another test. Panels will consider any evidence you<br />
may wish to provide in support <strong>of</strong> your request; however,<br />
they make their decisions on a case-by-case basis.<br />
For information on the language pr<strong>of</strong>iciency tests and<br />
scores that meet OCP’s language requirements, go to<br />
www.ocpinfo.com > Licensing > Training & Assessments<br />
> Fluency.<br />
QI am making a request for an exemption from a<br />
registration requirement. When will my request<br />
go to a registration panel?<br />
The deadline for submitting your request to a specific panel<br />
is the first day <strong>of</strong> the month before the panel is to meet; for<br />
example, all documents for the February panel must be received<br />
by January 1. The Regulated Health Pr<strong>of</strong>essions Act<br />
(RHPA) Procedural Code requires the <strong>College</strong> to give applicants<br />
notice <strong>of</strong> their right to provide any documentation<br />
to support a request within 30 days.<br />
Client Services cannot forward your file to the Registration<br />
Programs department to make a request to a panel until<br />
they receive the following:<br />
• all documents required to complete your pre-registration<br />
file<br />
• the Pre-Registration form [available at www.ocpinfo.com<br />
> Licensing > Forms > Pre-Registration Form (Filing Fee<br />
Form)]<br />
• the student or intern application form<br />
• the appropriate fees<br />
• a letter explaining your request, along with documentation<br />
to support your request for an exemption.<br />
Since it may take more than the 30 days given in the notice<br />
for you to obtain documents from other jurisdictions,<br />
incomplete files will not be forwarded to the Registration<br />
Programs department until the outstanding documentation<br />
is received.<br />
Client Services staff must confirm your identity, pharmacy<br />
education, status in Canada, licensure and good standing<br />
in other jurisdictions, good character, examination results,<br />
and language pr<strong>of</strong>iciency before sending your request<br />
to the Registration Programs department. It is important to<br />
respond to requests from Client Services for outstanding information<br />
as quickly as possible so that your application can<br />
be referred to a panel.<br />
Once your pre-registration is complete, the Registration<br />
Programs Assistant will review your request and documents.<br />
You will receive a formal referral letter from the<br />
Registrar, as required by the RHPA Procedural Code, listing<br />
the reasons for your referral to a panel as well as the date<br />
<strong>of</strong> the meeting. The letter also states that you have 30 days<br />
to submit additional material to support your request. The<br />
Registration Programs Assistant may contact you to suggest<br />
specific documents that you submit to support your<br />
request to the panel.<br />
While OCP staff make every effort to forward your<br />
file to the next available panel, missing documentation can<br />
cause delays. For more information, please go to www.ocpinfo.com<br />
> Licensing > Member Registration > Registration<br />
Panel Requests.<br />
22 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
practice Q&A<br />
Greg Ujiye, R.Ph., B.Sc.Phm.<br />
Pr<strong>of</strong>essional Practice Advisor<br />
QWhat must a pharmacist report to Health Canada<br />
regarding controlled substances, specifically<br />
narcotics and controlled drugs?<br />
Both the Narcotic Control Regulations (NCR section 42)<br />
and the Regulations to the Food and Drugs Act (s.G.03.013)<br />
requires a pharmacist to report any loss or theft <strong>of</strong> these<br />
drugs within 10 days <strong>of</strong> discovering the loss.<br />
QHow do I report a loss? Are there forms to fill<br />
out?<br />
Forms can be found on the Health Canada website at:<br />
http://www.hc-sc.gc.ca/dhp-mps/substancontrol/substan/compli-conform/loss-perte/index-eng.php<br />
In addition, pharmacists can access the forms through the<br />
OCP website by clicking on the menu tab “<strong>College</strong> Forms”<br />
at the bottom <strong>of</strong> the OCP homepage, and clicking on the<br />
link “Reporting narcotic and controlled drug loss…”<br />
QWhat would be considered a loss <strong>of</strong> controlled<br />
substances?<br />
A loss can take many forms. Simply stated, a loss is anything<br />
that results in a shortage in your inventory <strong>of</strong> controlled substances.<br />
Some examples are theft or robbery, diversion or<br />
unexplained loss, spillage or wastage, damage or contamination<br />
<strong>of</strong> products, etc.<br />
QWhat about forgeries? Are they reported<br />
together with other losses?<br />
No. Although forgery is a form <strong>of</strong> loss, forgeries are reported<br />
on a separate Health Canada form. <strong>Pharmacists</strong> should<br />
download and keep copies <strong>of</strong> both the loss report and the<br />
forgery report forms with their narcotic records.<br />
QWhat if I discover a forgery that was filled in the<br />
past? Do I still need to report that?<br />
Yes. Any loss, theft or forgery must be reported within 10<br />
days <strong>of</strong> discovery.<br />
Why is it necessary to print and review the<br />
QNarcotic Sales Report?<br />
The Narcotic Sales Report is an important management<br />
tool in curbing diversion and theft, when properly reviewed.<br />
Owners and managers should use the report with the narcotic<br />
prescriptions dispensed to ensure that<br />
• all reportable narcotics and controlled drugs are properly<br />
recorded, i.e., their s<strong>of</strong>tware is up to date,<br />
• all prescriptions are accounted for, i.e., no prescription<br />
numbers are missing,<br />
• all narcotics and controlled drugs requiring a written prescription<br />
are present,<br />
• unusual patterns <strong>of</strong> drug usage are monitored or<br />
identified.<br />
QWhy is it necessary to do a narcotic inventory<br />
regularly?<br />
Narcotic inventories are necessary to provide a starting<br />
point or baseline to perform narcotic reconciliations. Narcotic<br />
inventories should be done on a regular basis, in conjunction<br />
with random reconciliations on specific narcotics.<br />
This will help to identify any shortages, possible diversion,<br />
or theft. The introduction <strong>of</strong> perpetual inventory management<br />
by s<strong>of</strong>tware providers is a useful tool for facilitating<br />
the reconciliation process.<br />
QWho do I contact to receive permission to destroy<br />
narcotics or controlled drugs in my inventory?<br />
All requests for permission to destroy narcotics must be forwarded<br />
to the Compliance, Monitoring and Liaison Division<br />
<strong>of</strong> Health Canada. No specific form is required, however<br />
all requests must be legible and include:<br />
• name <strong>of</strong> the pharmacy<br />
• name and signature <strong>of</strong> the pharmacist making the<br />
request<br />
• date <strong>of</strong> the request<br />
• detailed list with name <strong>of</strong> product, strength, dosage form<br />
and quantity as well as reason for destruction<br />
Fax your request for destruction to the Compliance,<br />
Monitoring and Liaison Division at 1-613-957-0110.<br />
For more information the <strong>of</strong>fice can be contacted by telephone<br />
at 1-613-954-1541<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
23
summer student<br />
My summer exp<br />
Laura Narducci<br />
This summer, I had the wonderful<br />
opportunity <strong>of</strong> working at<br />
the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
from May to August. I feel<br />
that my experience at the <strong>College</strong> has<br />
helped me bring together all the different<br />
pieces <strong>of</strong> my pharmacy education<br />
thus far, and has provided me with a<br />
clearer picture <strong>of</strong> the pr<strong>of</strong>ession in our<br />
province.<br />
After a short time, my initial simplistic<br />
definition <strong>of</strong> the <strong>College</strong> as the<br />
licensing and regulating body <strong>of</strong> pharmacists<br />
in <strong>Ontario</strong> was slowly replaced<br />
by a much broader and comprehensive<br />
understanding <strong>of</strong> the roles and responsibilities<br />
<strong>of</strong> all those who encompass<br />
the <strong>College</strong>; the staff, the members<br />
<strong>of</strong> Council, and the pharmacist Members<br />
in <strong>Ontario</strong>. I learned a lot about<br />
the internal structure <strong>of</strong> the <strong>College</strong>;<br />
the different departments and their<br />
respective roles, and how they are all<br />
fundamentally interconnected. I had<br />
the opportunity to attend various committee<br />
meetings and a Council meeting.<br />
At these meetings I observed how<br />
OCP staff supports committee members<br />
who come together and dedicate<br />
their time and knowledge to regulate<br />
the pr<strong>of</strong>ession and protect the public.<br />
I had the opportunity to work on a<br />
few different projects this summer for<br />
various departments. The majority <strong>of</strong><br />
my time was dedicated to a project initiated<br />
by the Pr<strong>of</strong>essional Practice Program.<br />
The goal <strong>of</strong> this ongoing project<br />
is to create a Practice Guide for<br />
pharmacists in <strong>Ontario</strong>. I found this<br />
work to be very educational as it involved<br />
researching the origins <strong>of</strong> numerous<br />
policies and guidelines which<br />
have been written by the <strong>College</strong> over<br />
the years, with some documents dating<br />
back to the seventies. Through this<br />
process, I got a glimpse into the past,<br />
and learned about the history <strong>of</strong> many<br />
elements in pharmacy practice today,<br />
and how they came to be and why. I<br />
learned that although it is important to<br />
have governing policies and guidelines<br />
in place to maintain standards across<br />
the province, it is also equally important<br />
for pharmacists to be able to apply<br />
their own knowledge and experience in<br />
their practice, as clear cut answers are<br />
not always within reach.<br />
With guidance from the Registration<br />
Program, I had the opportunity to learn<br />
more about the entry to practice requirements<br />
for pharmacists who have<br />
graduated outside <strong>Ontario</strong>. I have also<br />
gained a better understanding <strong>of</strong> the<br />
requirements for maintaining licensure<br />
as a pharmacist in <strong>Ontario</strong>, and how<br />
this varies across the country. Learning<br />
about these registration requirements<br />
and the reasons for their existence<br />
has given me a greater appreciation<br />
for the impact that they have on<br />
the public.<br />
My experience at the <strong>College</strong> has<br />
helped me further understand the<br />
context <strong>of</strong> why the <strong>College</strong> and pharmacists<br />
are important in our province.<br />
The OCP is important because<br />
it serves to protect the public, and ensure<br />
that all patients receive the same<br />
standard <strong>of</strong> care when they walk into a<br />
pharmacy, or receive care from a pharmacist<br />
anywhere in <strong>Ontario</strong>. <strong>Pharmacists</strong><br />
and other health care providers<br />
are important because they take on<br />
the responsibility <strong>of</strong> providing this care<br />
to their patients, building relationships<br />
based on mutual trust and respect, and<br />
helping to improve the health and quality<br />
<strong>of</strong> life <strong>of</strong> their patients. One <strong>of</strong> the<br />
most interesting happenings over the<br />
summer would have to be the <strong>College</strong>’s<br />
submission to HPRAC on the scope <strong>of</strong><br />
practice review for Pharmacy. While<br />
working at OCP and since starting<br />
school, I have found myself explaining<br />
this topic to peers, friends, and family,<br />
24 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
erience at the OCP<br />
clarifying how pharmacists may soon<br />
have an expanded role in “medication<br />
management”.<br />
Looking back, one <strong>of</strong> the most significant<br />
observations that I made while at<br />
the <strong>College</strong> was the importance <strong>of</strong> excellent<br />
communication, good relationships<br />
and camaraderie. I saw first hand<br />
how excellent communication and good<br />
relationships not only facilitate good<br />
teamwork, but also promote and encourage<br />
more great work to develop.<br />
As I enter into my third year <strong>of</strong> pharmacy,<br />
I am excited to be able to apply<br />
these skills in my own work and interactions<br />
with my peers as we take on<br />
many educational challenges this year.<br />
In closing, I was very fortunate to<br />
have had the opportunity to meet<br />
and work with so many inspiring and<br />
experienced individuals this summer<br />
and I am very grateful to the <strong>College</strong><br />
for making this student position possible.<br />
Make a Splash!<br />
GTA Public Health Departments have<br />
launched a new falls prevention campaign<br />
entitled, “Make a Splash!” that encourages<br />
older adults to be active and use medication<br />
wisely. <strong>Pharmacists</strong> can order free posters<br />
and brochures by calling Toronto Health<br />
Connection at 416-338-7600 or visit<br />
www.toronto.ca/health for additional falls<br />
prevention information and fact sheets.<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
25
26 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
27
preceptor workshops<br />
CALL FOR PRECEPTORS<br />
Are you looking for a way to recapture the excitement <strong>of</strong> practising pharmacy? Consider becoming a<br />
preceptor in 2009. Should you decide to become a preceptor, you will be required to attend one <strong>of</strong> the<br />
Orientation Workshops that the <strong>College</strong> will be giving in <strong>Ontario</strong> during 2009. The workshop schedule, which<br />
also lists Advanced Workshops for current preceptors, appears below. For more information about becoming<br />
a preceptor, please visit www.ocpinfo.com > Licensing > Training & Assessments > SPT.<br />
DATE LOCATION WORKSHOP & TOPIC<br />
Wednesday, January 7th Toronto Orientation<br />
Thursday, February 12th Toronto Orientation<br />
Wednesday, February 18th Toronto Advanced<br />
Conflict Analysis & Resolution<br />
Thursday, March 12th Toronto Orientation<br />
Wednesday, March 25th Burlington Orientation<br />
Thursday, March 26th Burlington Advanced<br />
Conflict Analysis & Resolution<br />
Wednesday, April 8th Toronto Orientation<br />
Tuesday, April 21st Ottawa Orientation<br />
Wednesday, April 22nd Ottawa Advanced<br />
TBA<br />
Tuesday, May 5th Toronto Orientation<br />
Wednesday, May 13th London Advanced<br />
TBA<br />
Thursday, May 14th London Orientation<br />
Wednesday, May 27th Toronto Orientation<br />
Thursday, May 28th Toronto Advanced<br />
TBA<br />
Tuesday, June 16th Toronto Orientation<br />
Thursday, July 9th Toronto Orientation<br />
* Other dates for September through <strong>December</strong> will be posted later in the year.<br />
Any pharmacist actively serving as a preceptor for students or interns who has not attended a workshop in the<br />
last three years is required to attend an Advanced Workshop.<br />
To arrange a workshop in your community, please have your CE Coordinator contact<br />
Vicky Gardner at 416-962-4861 x 297 or at vgardner@ocpinfo.com.<br />
Please visit our website for regular updates.<br />
28 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
Non-physician Prescribers Project<br />
HPRAC launches<br />
Non-physician<br />
Prescribers Project<br />
The Health Pr<strong>of</strong>essions Regulatory Advisory Council<br />
(HPRAC) has recently invited several health pr<strong>of</strong>essions,<br />
including pharmacy, to make submissions regarding<br />
non-physician prescribing. The Minster <strong>of</strong> Health and Long<br />
Term Care has asked HPRAC to review the following:<br />
1. Examine the authority given to non-physician health pr<strong>of</strong>essions<br />
to prescribe and/or use drugs in the course <strong>of</strong> their<br />
practice under the Regulated Health Pr<strong>of</strong>essions Act, 1991<br />
(RHPA) and the Health Pr<strong>of</strong>ession Acts.<br />
2. Provide advice specific to each <strong>of</strong> these pr<strong>of</strong>essions respecting<br />
whether lists, categories or classes <strong>of</strong> drugs<br />
should be prescribed by regulation for the pr<strong>of</strong>ession, or<br />
whether restrictions on prescribing <strong>of</strong> drugs should be<br />
placed in regulation under the respective health pr<strong>of</strong>ession<br />
Act.<br />
3. Provide advice on a framework and process for the ongoing<br />
evaluation <strong>of</strong> requests by <strong>College</strong>s for changes to<br />
regulations in this regard to ensure that such regulations<br />
reflect efficiency, best practices <strong>of</strong> the pr<strong>of</strong>ession and<br />
provide maximum public protection.<br />
The <strong>College</strong> recently made a submission to HPRAC to<br />
expand the role <strong>of</strong> the pharmacist as part <strong>of</strong> a Scope <strong>of</strong> Practice<br />
Review. The activities <strong>of</strong> adapting, changing and renewing<br />
prescriptions (dispensing without authorization)<br />
and administering drugs by inhalation and injection were discussed<br />
in that report. A new submission is being prepared<br />
to address those activities for the Non-physician Prescribing<br />
Project. HPRAC has a very tight timeline for the submission<br />
<strong>of</strong> <strong>November</strong> 12, <strong>2008</strong>. The submissions from pharmacy and<br />
other health pr<strong>of</strong>essions will be posted on the HPRAC website,<br />
and once again pharmacists will have an opportunity to<br />
respond to the submission.<br />
Watch for the submission to be posted on the website at<br />
www. hprac.org in the later half <strong>of</strong> <strong>November</strong>.<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
29
deciding on discipline<br />
Case 1<br />
Falsification <strong>of</strong> records following a<br />
dispensing error<br />
Member: Antonio Colavecchia<br />
Pharmacy: St. Clair Pharmacy,<br />
Toronto<br />
Hearing Date: September 10, <strong>2008</strong><br />
Facts<br />
This case proceeded by way <strong>of</strong> an<br />
Agreed Statement <strong>of</strong> Facts and<br />
Joint Submission on Penalty concerning<br />
the dispensing <strong>of</strong> 30 Phyllocontin<br />
225mg for the patient on or<br />
about March 27, 2007, when only<br />
Divalproex 125mg and Adalat 60mg<br />
had been prescribed for her.<br />
The prescription in question was<br />
written as follows:<br />
Divalproex 125 mg 125 mg qam.<br />
Pt will continue in 250 mg qpm<br />
30<br />
Adalat XL<br />
60mg O.D.<br />
30<br />
On March 27, 2007 Mr. Colavecchia,<br />
based on his reading <strong>of</strong> the<br />
prescription, dispensed the following<br />
for the patient:<br />
• 30 APO-DIVALPROEX 125MG<br />
TAB 1 TABLET EVERY<br />
MORNING<br />
• 30 ADALAT XL 60MG TAB<br />
TAKE 1 TABLET DAILY<br />
• 30 PHYLLOCONTIN 225MG<br />
TAB 1 TABLET IN THE<br />
EVENING<br />
In the letter <strong>of</strong> complaint<br />
initiating the investigation in this<br />
matter, the prescribing physician<br />
indicated that the intention <strong>of</strong> the<br />
prescription had been to decrease<br />
the patient’s usual dose <strong>of</strong> Divalproex<br />
250mg twice daily to 125<br />
qam and 250 qpm, or 125 mg in the<br />
morning, with the usual 250 mg<br />
in the evening, as specified in the<br />
prescription.<br />
If he were to testify, Mr. Colavecchia<br />
would say that on or about<br />
March 27, 2007, the patient called<br />
him to obtain the pharmacy’s fax<br />
number. At that time she advised<br />
him that a new medication had been<br />
prescribed to her by her doctor. The<br />
patient then faxed the prescription<br />
to the pharmacy, and the medication<br />
was delivered to the patient at<br />
her home by the pharmacy.<br />
If he were to testify, Mr.<br />
Colavecchia would say that, in reading<br />
the prescription, he noted that<br />
the dosage <strong>of</strong> Divalproex was being<br />
changed from the previous dosage.<br />
He would testify that he read the<br />
words “Pt will continue in 250mg”<br />
as “Phyllocontin, which he believed<br />
to be the new medication referred<br />
to by the patient in her phone call.<br />
If he were to testify, Mr. Colavecchia<br />
would say that he knew that<br />
Phyllocontin did not come in 250mg<br />
dosage strength, and that he therefore<br />
called the doctor’s <strong>of</strong>fice. He<br />
would testify that it was confirmed<br />
to him by the secretary that the dosage<br />
for Phyllocontin was for 225mg.<br />
Mr. Colavecchia would testify that he<br />
made a note <strong>of</strong> this call to the doctor’s<br />
<strong>of</strong>fice on the prescription, in which he<br />
wrote: “225 mg ok called Dr”.<br />
However, the prescribing physician’s<br />
<strong>of</strong>fice has no record <strong>of</strong> any<br />
telephone call concerning the prescription<br />
from Mr. Colavecchia or<br />
anyone else at the pharmacy on or<br />
about March 27, 2007, or at any<br />
other time, which gave rise to an allegation<br />
that Mr. Colavecchia had<br />
falsified a record.<br />
Admission <strong>of</strong> Pr<strong>of</strong>essional<br />
Misconduct<br />
In response to the allegations in the<br />
Notice <strong>of</strong> Hearing (at paragraphs 1,<br />
3, 5, 6), Mr. Colavecchia acknowledged<br />
that he failed to maintain the<br />
standards <strong>of</strong> practice <strong>of</strong> the pr<strong>of</strong>ession,<br />
falsified a record relating to<br />
his practice, breached sections 155<br />
and 156 <strong>of</strong> the Drug and Pharmacies<br />
Regulation Act, and engaged in<br />
conduct that would reasonably be<br />
regarded by members <strong>of</strong> the pr<strong>of</strong>ession<br />
as disgraceful, dishonourable,<br />
and unpr<strong>of</strong>essional, with respect to<br />
the dispensing <strong>of</strong> the Phyllocontin to<br />
the patient when Divalproex 125mg<br />
had been prescribed.<br />
Decision and Reasons<br />
From the Agreed Statement <strong>of</strong><br />
Facts, it is clear that there is agreement<br />
that a dispensing error occurred<br />
and that Mr. Colavecchia<br />
took steps to conceal this.<br />
Mr Colavecchia’s admission <strong>of</strong><br />
the latter fact shows a blatant disregard<br />
<strong>of</strong> his obligation as a pharmacist<br />
to the public and to fellow<br />
members <strong>of</strong> the pr<strong>of</strong>ession.<br />
Similar violations <strong>of</strong> this nature<br />
have been dealt with by past panels<br />
<strong>of</strong> the Discipline Committee, and<br />
30 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
the Panel in this case was provided<br />
with ample precedents which demonstrate<br />
that the Joint Submission<br />
on Penalty falls well within the parameters<br />
<strong>of</strong> a reasonable disposition.<br />
The Panel saw no reason to deviate<br />
from precedent.<br />
Order<br />
1. A reprimand;<br />
2. Specified terms, conditions, or<br />
limitations on Mr. Colavecchia’s<br />
Certificate <strong>of</strong> Registration, requiring<br />
him to complete successfully,<br />
at his own expense and<br />
within 12 months <strong>of</strong> the date <strong>of</strong><br />
the Order, remedial training, as<br />
follows:<br />
a. Applied Ethics in Pharmacy<br />
Practice, <strong>of</strong>fered by Pr<strong>of</strong>essor<br />
Zubin Austin, Leslie Dan Faculty<br />
<strong>of</strong> Pharmacy at the University<br />
<strong>of</strong> Toronto;<br />
b. the Pharmaceutical Jurisprudence<br />
seminar and examination,<br />
<strong>of</strong>fered by the <strong>College</strong>;<br />
c. the Confronting Medication<br />
Errors workshop, <strong>of</strong>fered<br />
by the <strong>Ontario</strong> <strong>Pharmacists</strong>’<br />
Association;<br />
d. Canadian Pharmacy Skills 1,<br />
Module 4 – Patient Counselling<br />
Skills;<br />
e. Law Lesson 2 (The Regulation<br />
<strong>of</strong> Pharmacy Practice);<br />
f. Law Lesson 4 (Standards <strong>of</strong><br />
Practice); and<br />
g. Law Lesson 7 (Pr<strong>of</strong>essional<br />
Liability) from the Canadian<br />
Pharmacy Skills Program, <strong>of</strong>fered<br />
through the Leslie Dan<br />
Faculty <strong>of</strong> Pharmacy at the<br />
University <strong>of</strong> Toronto.<br />
3. A suspension <strong>of</strong> Mr. Colavecchia’s<br />
Certificate <strong>of</strong> Registration<br />
for a period <strong>of</strong> two months, with<br />
one month <strong>of</strong> the suspension to<br />
be remitted on condition that the<br />
Member complete the remedial<br />
training program specified above.<br />
4. Costs to the <strong>College</strong> in the<br />
amount <strong>of</strong> $4,000.00.<br />
Reprimand<br />
This case resulted from a dispensing<br />
error, This type <strong>of</strong> error generally<br />
occurs due to some type <strong>of</strong> negligence,<br />
but can be minimized if appropriate<br />
checks and balances are<br />
in place to ensure the right drug is<br />
given to the right patient in the right<br />
dose. As a standard <strong>of</strong> practice, patient<br />
counselling is required when a<br />
new prescription is dispensed to any<br />
patient.<br />
Although the Agreed Statement<br />
<strong>of</strong> Facts makes no mention<br />
<strong>of</strong> the quality <strong>of</strong> patient counselling,<br />
the Panel felt the dispensing<br />
error could have been prevented by<br />
proper dialogue with the patient.<br />
The pharmacists on the Panel were<br />
at a loss to understand why a bronchodilator<br />
was dispensed when<br />
there was no documentation <strong>of</strong><br />
asthma in the patient’s medication<br />
history.<br />
The most troublesome part <strong>of</strong><br />
this case was Mr. Colavecchia’s<br />
deliberate falsification <strong>of</strong> the record<br />
in an attempt to avoid responsibility<br />
for his actions. Members<br />
<strong>of</strong> the <strong>College</strong> are pr<strong>of</strong>essionals in<br />
whom the public places its trust,<br />
and Mr. Colavecchia’s misconduct<br />
has undermined that trust.<br />
The Panel hopes this was an isolated<br />
incident and that Mr. Colavecchia<br />
has learned from the experience.<br />
Mr. Colavecchia has been ordered<br />
to take remedial courses, and<br />
the Panel has asked him to use the<br />
knowledge he gains to practise at a<br />
higher level than his actions demonstrated<br />
in this case.<br />
Case 2<br />
Appeal <strong>of</strong> Discipline Penalty<br />
Member: Mr. Roshdy Boshara<br />
Pharmacy: Bay-Wellesley Pharmacy,<br />
Toronto<br />
Appeal Hearing Date: Sept. 12, <strong>2008</strong><br />
Facts<br />
The facts <strong>of</strong> the discipline hearing<br />
are summarized in the January/<br />
February 2007 Pharmacy Connection.<br />
Mr. Boshara appealed one <strong>of</strong><br />
the penalty terms imposed by the<br />
Discipline Committee. This term<br />
prohibits Mr. Boshara from having<br />
any proprietary interest in a pharmacy,<br />
and from working at a pharmacy<br />
in which a family member has<br />
a proprietary interest for a period <strong>of</strong><br />
three years.<br />
Mr. Boshara’s appeal was heard<br />
by the <strong>Ontario</strong> Superior Court <strong>of</strong><br />
Justice Divisional Court on September<br />
12, <strong>2008</strong>. The Court dismissed<br />
his appeal.<br />
The Court noted that the decision<br />
<strong>of</strong> the Discipline Committee was<br />
based upon an Agreed Statement <strong>of</strong><br />
Facts and a guilty plea by Mr. Boshara<br />
to allegations <strong>of</strong> misconduct related to<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
31
deciding on discipline<br />
fraudulent billing practices in respect<br />
<strong>of</strong> one patient. By agreement, the decision<br />
also imposed five other penalty<br />
terms on Mr. Boshara. These aspects<br />
<strong>of</strong> the Order were not challenged.<br />
Mr. Boshara sought to have the sixth<br />
penalty term <strong>of</strong> the Order regarding<br />
the three-year ban set aside or, alternatively,<br />
to have the sixth penalty<br />
term substituted with a spot audit<br />
requirement.<br />
The Court rejected Mr. Boshara’s<br />
submission that the Discipline Committee<br />
considered the lateness <strong>of</strong> his<br />
acknowledgement <strong>of</strong> guilt to be an<br />
aggravating factor when it imposed<br />
its sanctions stating that Counsel<br />
for the <strong>College</strong> had made this clear<br />
in his submissions at the discipline<br />
hearing, and nowhere in the Discipline<br />
Committee’s Reasons for Decision<br />
could the Court find anything<br />
from which to infer that the Committee<br />
punished Mr. Boshara for the<br />
lateness <strong>of</strong> his plea.<br />
The Court also rejected Mr.<br />
Boshara’s submission that the minor<br />
dollar amount <strong>of</strong> the fraud involved<br />
made the Discipline Committee’s<br />
sanction unduly harsh and<br />
disproportionate.<br />
The Court concluded that the<br />
Discipline Committee was moved<br />
by the number <strong>of</strong> individual false<br />
claims, together with Mr. Boshara’s<br />
efforts to conceal his wrongdoing by<br />
falsifying records, even while the investigation<br />
was ongoing.<br />
Further, the Court rejected Mr.<br />
Boshara’s submission that the Committee’s<br />
decision punishes his wife,<br />
who owns a pharmacy. The Court<br />
noted that the proscription against<br />
the appellant working for his wife<br />
was consistent with the Discipline<br />
Committee’s concerns. In<br />
view <strong>of</strong> the sustained level <strong>of</strong> misinformation<br />
in the form <strong>of</strong> falsified<br />
prescriptions, the Committee determined<br />
that protection <strong>of</strong> the<br />
public was required, and that Mr.<br />
Boshara’s access to a pharmacy<br />
as an owner was not in the public<br />
interest.<br />
The Court concluded it was reasonable<br />
to ensure that Mr. Boshara<br />
not benefit indirectly from his involvement<br />
in his wife’s business. The<br />
Court noted that the character <strong>of</strong> Mr.<br />
Boshara’s wife was not an issue but<br />
that Mr. Boshara’s character was.<br />
In sum, the Court found the<br />
Discipline Committee’s decision to<br />
be reasonable, in that nineteen separate<br />
acts <strong>of</strong> dishonesty were followed<br />
by ongoing attempts to conceal<br />
them, right up to the time <strong>of</strong><br />
the hearing.<br />
In dismissing Mr. Boshara’s appeal,<br />
the Court ordered him to pay<br />
costs <strong>of</strong> $15,000 to the <strong>College</strong>.<br />
bulletin board<br />
Eric Bruce joined the <strong>College</strong> at the beginning <strong>of</strong> September<br />
as the Acting Decisions Coordinator in the Investigations<br />
and Resolutions department to fill a maternity leave.<br />
Eric was called to the Bar this year and has been awarded<br />
many honours <strong>of</strong> distinction that include the Justice M.J.<br />
Moldaver/Carswell Prize in 2007and the James Jefferson<br />
Prize in Health Law in 2007. He has also served in the Office<br />
<strong>of</strong> the Chief Justice, Superior Court <strong>of</strong> Justice.<br />
Jocelyn Dipaling, who has been providing services on<br />
a temporary basis, has recently joined the <strong>College</strong> in a<br />
permanent staff position in the Client Services department.<br />
Jocelyn had previously covered a maternity leave at<br />
the <strong>College</strong> and brings many years <strong>of</strong> administrative experience.<br />
32 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
focus on error prevention<br />
Ian Stewart, R.Ph., B.Sc.Phm<br />
Toronto Community Pharmacist<br />
A few days later, the child returned to the Heart Failure<br />
clinic with her medication for a follow up. The error in dosing<br />
was therefore discovered. Fortunately, the child did not<br />
experience any long-term ill effects.<br />
Pediatric dosages<br />
Many drugs widely used in infants and children are<br />
not commercially available in oral liquid dosage<br />
forms. Since infants and young children are unable<br />
to swallow solid dosage forms, pharmacists are <strong>of</strong>ten<br />
challenged to provide a suitable extemporaneous oral liquid<br />
for these patients.<br />
Information on the formulation and stability <strong>of</strong> many extemporaneous<br />
preparations is <strong>of</strong>ten lacking. In some instances,<br />
the pharmacist may not have access to the information,<br />
may lack a required ingredient, or lack the experience and<br />
confidence in preparing a suitable final product. As a result,<br />
the pharmacist may choose to dispense the adult solid dosage<br />
form with the instructions to split the tablet into smaller<br />
pieces to obtain the required pediatric dose. This practice<br />
can introduce the potential for error as the following case<br />
illustrates.<br />
Case:<br />
A nine-year-old patient was admitted to hospital with heart<br />
and renal failure. She was treated with a regimen <strong>of</strong> ACE<br />
inhibitors, beta-blockers and diuretics. The beta-blocker<br />
carvedilol was started at a dose <strong>of</strong> 0.1mg/kg/day in two<br />
divided doses. Since the child weighed 20kg, a daily dose <strong>of</strong><br />
1mg twice daily was required. An oral suspension was extemporaneously<br />
compounded in the hospital pharmacy and<br />
the appropriate dose administered.<br />
Upon discharge, a prescription for carvedilol 1mg BID was<br />
given to the child’s parent. The prescription was subsequently<br />
taken to a local community pharmacy for processing. On<br />
reading the prescription, the pharmacist decided to dispense<br />
the 3.125mg tablet with the label instruction to give one-third<br />
<strong>of</strong> a tablet twice daily. The parent either misunderstood the<br />
instructions or encountered difficulty in cutting the tablets<br />
into thirds. As a result, the child was given one whole tablet<br />
twice daily or more than three times the prescribed dose.<br />
Possible Contributing Factors:<br />
• Lack <strong>of</strong> a commercially available oral dosage form appropriate<br />
for pediatric patients.<br />
• The dispensing <strong>of</strong> tablets which required cutting into thirds.<br />
The tablets dispensed are small and not scored making it<br />
difficult to accurately cut into three equal parts.<br />
• Possible miscommunication between the pharmacist and<br />
parent.<br />
Recommendations:<br />
• Whenever possible, avoid the need to spilt tablets into<br />
smaller segments to obtain a specific pediatric dose. This<br />
practice can lead to the administration <strong>of</strong> an incorrect dose<br />
due to the difficulty in splitting tablets accurately. 1 Uneven<br />
breaking <strong>of</strong> tablets can result in fluctuations in the administered<br />
dose. This can be clinically significant in the pediatric<br />
population.<br />
• Avoid rounding <strong>of</strong>f dosages whenever possible as this can<br />
lead to the administration <strong>of</strong> an incorrect dose with the potential<br />
for harm in the pediatric population. In the above<br />
example, even if the tablets were split precisely into thirds,<br />
the dose would still be incorrect.<br />
• Whenever a prescription is received for a unique pediatric<br />
dosage not available commercially, seek out and access an<br />
appropriate resource for published formulas. This may include<br />
The Hospital for Sick Children Department <strong>of</strong> Pharmacy<br />
website at www.sickkids.ca/pharmacy .<br />
• Adhere to the published formula for which there is adequate<br />
stability data.<br />
• If unable to extemporaneously prepare the product, consider<br />
referring the patient to another pharmacy with the<br />
expertise or contact the hospital pharmacy from which the<br />
patient was discharged for guidance.<br />
• Take steps to confirm that the parent understands and will<br />
administer the correct dose to pediatric patients.<br />
References:<br />
1. Marriott JL, Nation RL, Splitting tablets. Australian Prescriber,<br />
25(6): 133-135, 2002.<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
33
CE resources<br />
Visit the <strong>College</strong>’s website: www.ocpinfo.com for a complete listing <strong>of</strong> upcoming events and/or available<br />
resources. A number <strong>of</strong> the programs listed below are also suitable for pharmacy technicians.<br />
ONTARIO<br />
January 21, 2009<br />
<strong>Pharmacists</strong> Role in Methadone<br />
Maintenance Treatment<br />
Ottawa, ON<br />
Center for Addiction and<br />
Mental Health<br />
Contact: Peter Williams<br />
Tel: (613) 569-6024<br />
Email: Peter_Williams@camh.net<br />
GTA<br />
Nov 5-7<br />
Thrombosis Management<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Toronto<br />
Contact: cpd.pharmacy@utoronto.ca<br />
<strong>November</strong> 15, <strong>2008</strong><br />
Canadian Society <strong>of</strong> Hospital<br />
<strong>Pharmacists</strong> <strong>Ontario</strong><br />
Branch Annual General Meeting<br />
and Educational Sessions<br />
Educational Sessions &<br />
Awards Evening<br />
University <strong>of</strong> Toronto<br />
Contact: Susan Korporal<br />
Email: skorporal@cshp.ca<br />
<strong>November</strong> 15, <strong>2008</strong><br />
Obesity Certificate Program<br />
<strong>Ontario</strong> <strong>Pharmacists</strong> Association<br />
Contact: education@dirc.ca<br />
<strong>November</strong> 24-25, <strong>2008</strong><br />
http://www.camh.net/education/<br />
Online_courses_<br />
webinars/safe_baby_webinars.html<br />
Webinar series continuation:<br />
Exposure to psychotropic<br />
medications and other substances<br />
during pregnancy and<br />
lactation: Mid-late <strong>November</strong> <strong>2008</strong>:<br />
alcohol, antipsychotics,<br />
tobacco, anti-epileptic drugs<br />
Register: online<br />
Contact: Robyn Steidman<br />
(416) 535-8501, extension 6640.<br />
<strong>November</strong> 15, <strong>2008</strong><br />
Caring for Children after a Heart<br />
Transplant: A Symposium for<br />
Health<br />
Pr<strong>of</strong>essionals<br />
The Hospital for Sick Children<br />
Contact: Anne Dipchand<br />
Email: anne.dipchand@sickkids.ca<br />
<strong>November</strong> 24 - 25, <strong>2008</strong><br />
E-Health and Medical Records<br />
150 King St West, Toronto<br />
Contact: www.insightinfo.com<br />
1 888 777-1707<br />
<strong>December</strong> 3, <strong>2008</strong>-09-25<br />
Root Cause Analysis Workshop -<br />
Intermediate Level<br />
<strong>Ontario</strong> Hospital Association<br />
Contact: gfernandes@oha.com<br />
(416) 205-1398<br />
ON-LINE CE<br />
http://www.rxcertified.ca<br />
Online fee-based certificate courses<br />
developed by the<br />
Drug Information and Research<br />
Centre (DIRC) and rx-<br />
BriefCase.com. Currently <strong>of</strong>fering:<br />
- Diabetes Patient Care Level 1<br />
- Obesity Program<br />
http://209.200.99.173/CTI2/default.asp<br />
Online Clinical Tobacco Interventions<br />
for Health Care Pr<strong>of</strong>essionals<br />
CE FOR PHARMACY<br />
TECHNICIANS<br />
February 2009<br />
27th Pharmacy Technicians<br />
Conference<br />
Humber <strong>College</strong> North Campus,<br />
Toronto<br />
Register online @ pharmacy.humber.ca<br />
Contact: Irene Van Vliet<br />
(416) 675 6622 ext. 4691<br />
34 pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong>
laws & regulations<br />
Drug and Pharmacies Regulation Act (DPRA) * s<br />
Amended June 4, <strong>2008</strong><br />
Regulations to the DPRA:<br />
DPRA R.R.O. 1990, Regulation 545 – Child Resistant Packages<br />
DPRA <strong>Ontario</strong> Regulation 297/96 Amended to O.Reg. 173/08 – General<br />
DPRA R.R.O. 1990, Regulation 551 Amended to O.Reg. 172/08 – General<br />
Drug Schedules **<br />
Summary <strong>of</strong> Laws Governing Prescription Requirements,<br />
Transfers, Refills, Prescription Drug Ordering and Records<br />
June 2007 OCP<br />
Canada’s National Drug Scheduling System –<br />
August 27, <strong>2008</strong> NAPRA (or later)<br />
Regulated Health Pr<strong>of</strong>essions Act (RHPA) * s<br />
Amended 2007<br />
Regulations to the RHPA:<br />
<strong>Ontario</strong> Regulation 39/02 -Certificates <strong>of</strong> Authorization Amended to<br />
O.Reg. 666/05<br />
<strong>Ontario</strong> Regulation 107/96 – Controlled Acts Amended to O.Reg. 296/04<br />
<strong>Ontario</strong> Regulation 59/94 – Funding for Therapy or<br />
Counseling for Patients Sexually Abused by Members<br />
Pharmacy Act (PA) & Regulations * s<br />
Amended 2007<br />
Regulations to the PA:<br />
<strong>Ontario</strong> Regulation 202/94 Amended to O.Reg. 270/04 – General<br />
<strong>Ontario</strong> Regulation 681/93 Amended to O.Reg.<br />
122/97 – Pr<strong>of</strong>essional Misconduct<br />
Standards <strong>of</strong> Practice s<br />
Standards <strong>of</strong> Practice, January 1, 2003 OCP<br />
Standards <strong>of</strong> Practice for Pharmacy Managers, July 1, 2005<br />
Drug Interchangeability and Dispensing<br />
Fee Act (DIDFA) & Regulations * s<br />
Amended 2007<br />
Regulations to the DIDFA:<br />
R.R.O. 1990 Regulation 935 Amended to O.Reg. 321/07 – General<br />
R.R.O. 1990 Regulation 936 Amended to O.Reg. 205/96 – Notice to Patients<br />
Food and Drugs Act (FDA) & Regulations ** '<br />
Updated as <strong>of</strong> <strong>December</strong> 31, 2006<br />
Amendment 1478 & 1491 – Addition <strong>of</strong> two medicinal ingredients<br />
to Part I <strong>of</strong> Schedule F. Reg. SOR/2007-224, Oct 25/07<br />
Amendment 1476, 1502, 1511 and 1512 –<br />
Addition <strong>of</strong> nine medicinal ingredients to Part I <strong>of</strong><br />
Schedule F. Reg SOR/2007-234, Oct 25/07<br />
Regulations Amending the Food and Drug Regulations (Project 1551<br />
- Lanthanum salts) (February 7, <strong>2008</strong>)<br />
Controlled Drugs and Substances Act (CDSA) **<br />
Current as <strong>of</strong> July 27, <strong>2008</strong><br />
Regulations to the Controlled Drugs<br />
and Substances Act (CDSA) **<br />
All regulations updated August 13, <strong>2008</strong><br />
Benzodiazepines & Other Targeted Substances Regulations<br />
Marihuana Medical Access Regulations<br />
Precursor Control Regulations<br />
Regulations Exempting Certain Precursors and<br />
Controlled Substances from the Application <strong>of</strong><br />
the Controlled Drugs and Substances Act<br />
Narcotic Control Regulations **<br />
OCP By-Laws By-Law No. 1 – <strong>December</strong> 2007 s<br />
Schedule A - Code <strong>of</strong> Ethics for Members <strong>of</strong> the<br />
<strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong> - <strong>December</strong> 2006<br />
Schedule B - “Code <strong>of</strong> Conduct” and Procedures for<br />
Council and Committee Members - <strong>December</strong> 2006<br />
Schedule C - Member Fees - Effective January 1, 2007<br />
Schedule D - Pharmacy Fees - Effective January 1, 2007<br />
Schedule E – Certificate <strong>of</strong> Authorization – Jan. 2005<br />
Schedule F - Privacy Code - Dec. 2003<br />
Reference s<br />
OCP Required Reference Guide for Pharmacies<br />
in <strong>Ontario</strong>, August, <strong>2008</strong><br />
<strong>Ontario</strong> Drug Benefit Act (ODBA) & Regulations * s<br />
Amended 2007<br />
Regulations to the ODBA:<br />
<strong>Ontario</strong> Regulation 201/96 Amended to O.Reg. 264/18 – General<br />
* Information available at Publications <strong>Ontario</strong> (416) 326-5300 or 1-800-668-9938 www.e-laws.gov.on.ca<br />
** Information available at www.napra.org<br />
' Information available at Federal Publications Inc. Ottawa: 1-888-4FEDPUB (1-888-433-3782)<br />
Toronto: Tel: (416) 860-1611 • Fax: (416) 860-1608 • e-mail: info@fedpubs.com<br />
s Information available at www.ocpinfo.com<br />
pharmacyconnection • <strong>November</strong>/<strong>December</strong> <strong>2008</strong><br />
35
Nov./Dec. <strong>2008</strong> • Volume 15, Number 6<br />
<strong>2008</strong>/2009<br />
Left to Right: President Tracy Wiersema,<br />
Registrar Deanna Williams,<br />
and Vice President Stephen Clement