1. Practise Pharmaceutical Care (PC)
Pharmacists, using their unique knowledge and skills to meet patients drug related needs, practises patient-focused care in partnership with patients and other health care providers, to achieve positive patient outcomes and/or to maintain or improve quality of life for the patient.
By the end of the rotation, the intern will be able to:
1.1 Develop a trusting relationship with the patient or the patient's health care provider
1.1.1. establish and maintain rapport by using effective communication skills to initiate dialogue through:
- listening, speaking and written skills,
- sensitivity to nonverbal forms of communication,
- sensitivity to language barriers,
- sensitivity to diversity in the client population,
1.1.2. demonstrate a caring, professional attitude
1.1.3. determine the patients needs, values, and desired level of care and outcomes
1.1.4. assess the impact of factors that promote or impede the health of the patient
1.1.5. establish the mutual responsibility of each participant (discuss the importance of both the pharmacist and patient accepting responsibility to achieve the patients desired health outcomes)
1.2. Gather and record appropriate patient information
1.2.1 gather information, including but not limited to
- relevant family medical history
- relevant social history (i.e. alcohol, nicotine use)
- current condition or symptoms being treated with prescription medication and the practitioners diagnosis of the situation, or current condition or symptoms for which non-prescription therapy is being sought
- background and history of the patients condition
- history of current disease states (as they relate to the condition being treated)
- known patient risk factors for adverse drug reactions, drug allergies or sensitivities
- known contraindications to prescription or non-prescription drug use
- dietary restrictions, and
- other medications or treatments the patient is currently taking that may contribute to this condition or interact with suggested therapy
1.2.2 interpret the information provided
1.2.3 establish a database containing relevant info about the patients health
1.3 Assess the health status and concerns of the patient
1.3.1 use appropriate techniques and procedures to identify the patients health and concerns
1.3.2 apply the therapeutic knowledge needed to understand the extent of the patients health problems
1.3.3 identify factors that may impact on the therapeutic outcome
1.4 Identify the patient's desired therapeutic outcomes
1.4.1 integrate knowledge of the patient's health status with pharmacotherapeutics and non-drug options
1.4.2 encourage the patient to make informed choices
1.5 Demonstrate knowledge of pharmacotherapeutics to
1.5.1 identify actual and potential drug-related problems (DRPs)
- determine whether the patient needs the drug, requires drug therapy but is not receiving it, or is receiving the wrong drug
- determine if the correct amount of drug is being given and if it is being taken/administered appropriately (e.g., use of pharmacokinetics in hospital)
- recognize drug interactions
- recognize adverse drug reactions and toxic effects
1.5.2 explain indications, contraindications and side effects
1.5.3 appropriately answer patients questions related to prescription and nonprescription medications
1.5.4 interpret lab results and understand how they relate to drug therapy
1.6 In consultation with the patient and/or health care providers, determine the appropriate therapeutic options including non-drug, and non-prescription and prescription drugs, to solve or prevent the identified drug-related problems
1.6.1 prioritize problems
1.6.2 propose and assess possible strategies, including non-drug and drug therapies
1.6.3 establish a positive working relationship with the patients health care provider to meet the objectives of positive health care outcomes with the patient and/or in consultation with other health care providers, select the most appropriate therapeutic option
1.6.4 explain the rationale for the proposed treatment to the patient
1.7 Refer patients to appropriate health care provider(s) or health care agency, after determining if such a referral is necessary
1.7.1 identify available health care resources and agencies (local and provincial)
1.7.2 identify services, and their location, offered by emergency health care providers
1.7.3 follow necessary procedures in making referrals to other health care resources and agencies/organizations
1.7.4 access other appropriate resources and agencies
1.8 Monitor and evaluate the patients progress and the therapeutic outcomes of the intervention, including follow up
1.8.1 in consultation with the patient and/or health care professionals if required, define measurable therapeutic endpoints (e.g., for pneumonia - decrease in fever, malaise and WBC within 48 hours)
1.8.2 recognize the pertinent clinical indicators (e.g., for pneumonia - fever, malaise, cough, WBC)
1.8.3 develop an appropriate monitoring plan, considering onset, frequency and duration of monitoring (e.g., for pneumonia - initiate monitoring 24 to 48 hours after start of therapy, monitoring frequency may be every day or once a week depending on the severity of the illness (is the patient in a hospital or in the community) and complete monitoring at the end of the antibiotic regimen/resolution of infection).
1.8.4 collect and interpret pertinent information
1.8.5 assess patient outcomes
1.8.6 discuss, with the patient or health care provider, the continuing responsibilities of the pharmacist, patient and health care providers (encourage patient involvement in the implementation and maintenance of the monitoring plan)
1.9 Document significant findings of patient information assessment, recommendations made and actions taken, in a readily retrievable format
1.9.1 explain the purpose for the documentation
1.9.2 maintain a patient information database, including a medication profile and pertinent medical history
1.9.3 document the patients current problems, prioritize them for resolution and recommendations
1.9.4 document the intervention
1.9.5 document the patients outcome and follow-up
1.9.6 document communication with the patient, including referrals, and other health care providers
1.10 Document and report any unexpected adverse drug reactions to the prescriber and other health care providers as appropriate, and comply with formal adverse drug reaction reporting programs.
1.11 Assume responsibility for recognition and resolution of medication discrepancies/errors
1.11.1 discuss any errors with the patient, prescriber and other health care professionals, as appropriate
1.11.2 take the necessary steps to resolve issues arriving from medication discrepancies and errors
1.11.3 implement measures to prevent recurrence of the medication error
1.11.4 document the medication error, its resolution and outcome, as appropriate
2. Assume Ethical, Legal and Professional Responsibilities (ELP)
Pharmacists practise within legal requirements and ethical principles, demonstrate professional integrity and act to uphold professional standards of practice.
By the end of the rotation, the intern will be able to:
2.1 Comply with legal requirements and ethical principles of practice, including federal and provincial legislation governing the sale of drugs and practice as a pharmacist, and provincial pharmacy regulatory authority policies, standards of practice and by-laws.
2.1.1 apply appropriate regulations for locating, dispensing, refilling, record keeping and documenting for Schedule F, G, N drugs; Schedule I, II and III drugs and unscheduled products (refer also to Competency 5)
2.1.2 adhere to OCP Standards of Practice, policies (e.g., faxing prescriptions) , Code of Ethics, by-laws (e.g., voting); CSHP Standards of Practice
2.2 Uphold and act on the ethical principle that a pharmacists primary accountability is to the patient -ensure patient confidentiality and protect patient information received as privileged communication between a patient and a health care provider
2.2.1 involve the patient in decision-making
2.2.2 respect the right of the patient to make their own decisions
2.3 Advocate on behalf of patients or groups of patients to ensure appropriate access to products and services (interpretation: ensure that patients receive the products and services they require)[refer also to Competency element 1.7]
2.3.1 assist patients in the identification of their needs
2.3.2 in consultation with patients, develop an action plan considering outcomes, risks and costs
2.3.3 prepare rationale to support actions to meet needs
2.3.4 present information in an appropriate written or verbal format
2.3.5 provide patients with auxiliary devices, or refer to other pharmacies for products which may not be stocked in your own pharmacy
2.4 Demonstrate personal and professional integrity, professional image and attitude
2.4.1 accept responsibility for actions and decisions (e.g., arrive punctually, wear appropriate attire)
2.4.2 be readily identifiable (wear name tag), available, accessible and approachable to consult with patients
2.4.3 show respect for the dignity of the patient
2.4.4 maintain appropriate professional boundaries (e.g., admit when you don't know and research or seek assistance from colleagues)
2.4.5 demonstrate respect for colleagues and co-workers
2.4.6 practise within personal limits and abilities
2.5 Demonstrate an understanding of the role and scope of the profession of pharmacy within the Canadian health care system
2.5.1 maintain membership in professional organizations to contribute to understanding of the pharmacy profession, and understanding of opportunities and challenges in the health care system
2.6 Continuously strive to improve professional competence
2.6.1 seek and evaluate learning opportunities to enhance practice through education and experiential learning
2.6.2 maintain Learning Portfolio
3. Access, Retrieve, Evaluate and Disseminate Relevant Information (AREI)
Pharmacists identify, evaluate, interpret and provide appropriate drug and pharmacy practice information to achieve safe and effective patient care.
By the end of the rotation, the intern will be able to:
3.1. Retrieve relevant information from appropriate sources
3.1.1 use a variety of retrieval techniques to access relevant information
3.1.2 assess the suitability and reliability of these techniques
3.2. Critically evaluate drug information (e.g., professional journals, product information, textbooks, etc.)
3.3. Organize and disseminate information
3.3.1 identify key audiences for distribution (individuals or groups)
3.3.2 determine critical content (what information is the most important to be disseminated)
3.3.3 apply appropriate methods for dissemination (e.g., newsletters, journal clubs, etc.)
3.3.4 assess the impact of dissemination of the information
3.4. Retrieve new information, and collect and interpret data, to address issues in pharmacy practice, e.g., developing a documentation system; developing a follow-up system; reviewing workflow patterns;**DUR/DUE(see also competency 6.5); gathering information on a large scale for a project; Quality Assurance program/audit; collecting data, designing a study; residency project
3.4.1 identify relevant pharmacy practice issues that should be explored
3.4.2 undertake specific projects which address practice issues
3.4.3 use findings to improve practice
3.4.4 communicate results, selecting appropriate venues
** DUR is Drug Utilization Review
DUE is Drug Utilization Evaluation
4. Communicate and Educate Effectively (CE)
While respecting the patients right to confidentiality, pharmacists communicate and educate individuals and groups to support optimal patient care and promote health.
By the end of the rotation, the intern will be able to:
4.1 Respect the patients right to confidentiality and privacy by ensuring that personal health information is communicated in a manner in which the discussion cannot be overheard by others
4.2. Demonstrate effective and appropriate communication skills in diverse settings or situations
4.2.1 demonstrate clear, effective writing skills (e.g., through documentation of Activities; memos to physicians; notes in patients chart where applicable)
4.2.2 demonstrate appropriate verbal, non-verbal (gestures, eye contact) and listening skills
4.2.3 show respect for cultural, ethnic, gender, and educational variables
4.2.4 demonstrate sensitivity, respect and empathy when communicating with others
4.3 Use appropriate communication techniques with patients or patients agents
4.3.1 demonstrate effective interview techniques (use appropriate combination of open and closed-ended questions during patient interviews and dialogue)
4.3.2 use appropriate grammar, vocabulary, voice modulation, and rate of speech (e.g., translate scientific knowledge into lay terminology for patient or patients agent)
4.3.3 demonstrate clear and effective telephone communication
4.3.4 appropriately answer patients questions concerning prescription and non-prescription medication
4.4 Use appropriate communication techniques with other health care providers
4.4.1 use appropriate grammar, vocabulary, voice modulation, and rate of speech
4.4.2 demonstrate clear and effective telephone communication with other health care providers (e.g., appropriately receive and record verbal prescriptions from prescribers)
4.5 Demonstrate comprehension and fluency in written and verbal English or French
4.6 Develop health promotion strategies (e.g., smoking cessation, cholesterol control, sunscreen use, alcohol and drug abuse/misuse)
4.6.1 use knowledge base to discuss health care issues
4.6.2 identify resources that facilitate health and wellness in individuals and groups (e.g., literature, support groups, education classes)
4.6.3 collaborate with patients and other health care providers in the development of health promotion strategies
4.7 Design, implement and evaluate an education plan (e.g., presentation, nursing inservice, new staff training, patient education, news bulletin)
4.7.1 identify the learning needs of participants
4.7.2 assess personal abilities to carry out a particular education plan
4.7.3 select educational methods that are appropriate for the learner(s)
4.7.4 implement an educational plan
4.7.5 assess outcomes
5. Manage Drug Distribution (MDD)
Pharmacists manage drug distribution by performing or supervising the functions of acquisition, preparation, and distribution of drugs to ensure the safety, accuracy and quality of supplied products.
By the end of the rotation, the intern will be able to:
5.1 Perform, supervise and review drug distribution activities according to federal and provincial regulations and established policies and procedures. Apply knowledge relevant to:
5.1.1 adhering to the correct format for a prescription (i.e. documents all necessary information)
5.1.2 interpreting drug orders
5.1.3 recognizing generic and brand drug names, and manufacturers
5.1.4 recognizing normal and unusual doses, and available dosage forms of medications
5.1.5 identifying bioequivalency and interchangeability of multi-source drugs
5.1.6 performing pharmaceutical calculations, including pharmacokinetics where applicable (refer also to Competency 1.5)
5.1.7 compounding medications, including correct labeling
5.1.8 dispensing medications, including correct labeling
5.1.9 use of appropriate auxiliary labels
5.1.10 selecting quality products and ingredients
5.1.11 preparing sterile products (e.g., parenteral admixtures, TPN, chemotherapy), where applicable
5.1.12 acquiring, handling and storing of pharmaceuticals
5.1.13 recognizing and handling of forged prescriptions, where applicable
5.2 Ensure the removal of outdated, mislabeled or deteriorated drugs, and those recalled from regular stock, for storage in a separate area for appropriate disposal.
5.3 Recognize patterns of inappropriate use of drugs
5.3.1 recognize the drugs with addiction potential
5.3.2 recognize and resolve patterns of inappropriate use
5.3.3 identify and document inappropriate order quantities
5.3.4 report findings using appropriate mechanisms
5.3.5 detect and respond appropriately to drug diversion
5.4 Demonstrate ability to manage drug distribution functions
5.4.1 maintain safe and effective systems of drug distribution
5.4.2 adhere to distribution policies and procedures
5.4.3 assign or delegate controlled acts and distribution activities to authorized personnel
5.4.4 demonstrate ability to supervise support staff, where applicable
6. Apply Practice Management (APM)
Pharmacists apply knowledge, principles and skills of management as they pertain to the site of pharmacy practice, with the goal of optimizing patient care and inter-professional relations.
By the end of the rotation, the intern will be able to:
6.1 In collaboration with management, ensure that pharmacy operations are designed to protect the public and the people working on the premises.
6.1.1 maintain the pharmacy in a professional manner which inspires confidence in the pharmacy services that can be provided
6.1.2 ensure that adequate space, facilities, equipment and supplies are available to fulfil the needs of the professional, educational and administrative functions of the pharmacy service to ensure patient safety through proper storage, preparation, dispensing, distribution, and disposal of drugs.
6.1.3 ensure that procedures for the handling and evaluation of medication errors and incidents are developed and followed.
6.2 Supervise personnel such that delegated functions are carried out to meet accepted standards
6.2.1 apply management principles and skills relevant to human and physical resources
6.2.2 define accepted standards, policies and procedures
6.2.3 demonstrate the principles of effective inter- and intra-professional working relationships
6.3 Effectively manage workflow
6.3.1 demonstrate organizational skills
6.3.2 prioritize and organize workflow
6.3.3 demonstrate time management skills
6.4 Apply management systems pertaining to the site of pharmacy practice
6.4.1 apply financial resource management
6.4.2 maintain inventory management
6.4.3 discuss information resources management (computer systems, Internet access, etc.)
6.4.4 discuss change management (e.g., ODB formulary changes and how they should be handled, changing clientele, )
6.5 Interpret and apply the drug utilization (e.g., DUE, DUR), reimbursement and pharmacoeconomic policies of health care facilities and agencies, and federal, provincial and third party drug insurance plans.
6.5.1 utilize formularies (e.g., ODB, hospital formulary, third party payors)
6.5.2 identify generic substitution
6.5.3 explain the role of co-payments, deductible limits, professional fees (where applicable)
6.5.4 identify therapeutic interchangeability
6.5.5 apply prescription quantity limitations
