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Standard 1
The pharmacist, using unique knowledge and skills to meet a patient’s drug-related needs, practices patient-focused care in partnership with patients and other health care providers, to achieve positive health outcomes and/or to maintain or improve quality of life for the patient. Refer: Operational Components 1.1 - 1.8

Operational Component 1.1
The pharmacist develops professional relationships with patients and/or patients’agents and/or health care providers:
a. To determine the patient’s needs, values, desired level of care and desired outcomes regarding drug therapy, and
b. To establish the mutual responsibility of each participant.

1.1.1 The pharmacist establishes and maintains rapport by using effective communication skills. Effective communication includes:

• Listening, speaking and writing skills
• Sensitivity to nonverbal forms of communication
• Sensitivity to language barriers and
• Sensitivity to diversity in the community

1.1.2 The pharmacist demonstrates a caring and professional attitude.

1.1.3 The pharmacist elicits the needs, values, desired level of care and desired outcomes of the patient.

1.1.4 The pharmacist considers the impact of life style factors on the health of individual patients.

1.1.5 The pharmacist discusses with the patient the role of the pharmacist and the responsibilities of the patient.

1.1.6 The pharmacist encourages patients to participate in decisions about their health and supports the patient’s right to make choices.

Operational Component 1.2
The pharmacist ensures that appropriate patient information is gathered and recorded to establish a profile for the provision of patient-focused care and that the information is maintained in a manner which ensures ease of use for patient care activities and confidentiality for the patient. The pharmacist reviews relevant information from the patient profile with each new prescription, change of prescription, and repeat prescription.

The profile shall include demographic information about the patient as articulated under the Drug and Pharmacies Regulation Act and Regulations or the CSHP Standards of Practice and may also include, where appropriate, other information that is considered important for continuity of care and achievement of an optimal therapeutic outcome. This could include known patient risk factors for adverse drug reactions, drug allergies or sensitivities; known contraindications to prescription drugs, nonprescription drugs, natural health products, and complementary or alternative medicines, and other medications or treatments the patient is currently taking that may contribute to their condition or interact with suggested therapy.

Operational Component 1.3
Prior to dispensing any medication, the pharmacist shall review the prescription to ensure that it is authentic, accurate, appropriate, and complete. In a hospital, when the review of each medication order is not possible at time of dispensing or use, the pharmacist should review medication orders for appropriateness within a reasonable amount of time.

With the information available, the pharmacist evaluates the patient’s drug therapy and identifies potential and actual drug-related problems.

1.3.1 The pharmacist determines whether the drug therapy is appropriate including appropriate dosage form, route, and length of therapy.

1.3.2 The pharmacist determines if the correct amount of the drug is being received and taken appropriately.

1.3.3 The pharmacist recognizes and takes steps to avoid or minimize adverse outcomes related to drug therapy such as side effects, toxicity, adverse drug reactions, drug-disease incompatibilities, drug-drug interactions, and duplication of therapeutically similar medications.

1.3.4 The pharmacist recognizes and takes steps to avoid problems related to intravenous administration including potential incompatibilities, drug stability, volume of intravenous fluid for medication administration and rate of administration.

1.3.5 The pharmacist recognizes and addresses patterns of inappropriate use of drugs.

1.3.6 The pharmacist detects and responds appropriately to activities which would divert drugs from their intended legitimate use.

1.3.7 The pharmacist provides appropriate information to facilitate the patient’s understanding of his or her drug therapy and ability to comply with the therapy regimen.

Operational Component 1.4
If any potential or actual drug-related problems are identified, the pharmacist determines appropriate therapeutic options to solve or prevent them.

1.4.1 The pharmacist prioritizes identified problems.

1.4.2 The pharmacist proposes alternative strategies, including non-drug and drug therapies.

1.4.3 The pharmacist selects the most appropriate therapeutic option through consultation with the patient and/or other health care providers.

1.4.4 The pharmacist refers the patient to an appropriate health care provider or health care agency after determining with the patient if such a referral is necessary.

The following situations may prompt such a referral:

• Information from the patient indicating a potentially severe or worsening condition
• Uncertainty about the patient’s symptoms or condition
• Failure of treatment to remedy a condition within a predetermined period of time

1.4.5 The pharmacist explains the rationale of the proposed treatment to patients and/or patients’ agents and/or other health care providers.

Operational Component 1.5
The pharmacist ensures documentation of significant observations arising from the patient assessment, recommendations made and actions taken, in a readily retrievable format. The pharmacist shall resolve any questions regarding the order and shall document the resolution in the patient’s health record.

Operational Component 1.6
The pharmacist is clearly identifiable and is available, accessible and approachable to consult with the patient who is seeking to self-medicate with a nonprescription drug, a natural health product, or a complementary or alternative medicine.

Operational Component 1.7
The pharmacist documents and reports any unexpected adverse drug reactions* to the prescriber and other health care providers as appropriate, and complies with formal adverse drug reaction reporting programs.

* “Unexpected adverse drug reaction” is an undesirable patient effect that is inconsistent with the product information or labelling; is serious; or results from administration of a recently marketed drug whether serious or not.

Operational Component 1.8
The pharmacist takes appropriate action to acknowledge and prevent medication discrepancies* and errors**, takes the necessary steps to resolve issues arising from medication discrepancies and errors, and implements measures to prevent recurrence.

1.8.1 The pharmacist discusses the error with the patient, prescriber and other health care providers as appropriate.

1.8.2 The pharmacist documents the error according to the protocol of the workplace.

* “Medication discrepancy” - an event which does not involve the actual administration of a drug to a patient, but where an error in the medication process has been detected and corrected before reaching the patient.

** “Medication error” (may also be referred to as a medication incident) is an event which involves the actual prescribing, dispensing, delivery or administration of a drug or the omission of a prescribed drug to a patient.

Standard 2
The pharmacist practices within legal requirements and ethical principles, demonstrates professional integrity and acts to uphold professional standards of practice. Refer: Operational Components 2.1 - 2.4

Operational Component 2.1
The pharmacist complies 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 regulatory authority by-laws, standards of practice, policies and guidelines.

Operational Component 2.2
The pharmacist upholds and acts on the ethical principle that the primary accountability of the pharmacist is to the patient, with respect to:

• Patient confidentiality
• Involvement of the patient in the decision-making process, and
• the right of the patient to make their own choices

2.2.1 In the course of fulfilling the duty of care for the patient, the pharmacist has the right to refuse to provide a product or service.

2.2.2 The pharmacist has the right to dispense less than the quantity prescribed, if the proper exercise of professional judgement by the dispenser so requires (DIDFA, Reg.936, Section 3).

Operational Component 2.3
The pharmacist demonstrates personal and professional integrity.

2.3.1 The pharmacist accepts responsibility for his or her actions and decisions.

2.3.2 The pharmacist shows respect for the dignity of the patient.

2.3.3 The pharmacist collaborates with other health care professionals to enable the patient to achieve his or her health care goals.

Operational Component 2.4
The pharmacist continuously strives to gain knowledge and maintain professional competence.

2.4.1 The pharmacist identifies learning needs and seeks, evaluates and participates in learning opportunities to meet these needs to enhance practice through education and experiential learning.

2.4.2 The pharmacist recognizes and practices within the limits of his/her professional expertise.

Standard 3
The pharmacist identifies, evaluates, interprets and provides appropriate drug and pharmacy practice information to achieve safe and effective patient care. Refer: Operational Components 3.1 - 3.5

Operational Component 3.1
The pharmacist identifies and evaluates appropriate sources of relevant information.

Operational Component 3.2
The pharmacist critically evaluates drug information.

Operational Component 3.3
The pharmacist determines the critical content to be provided.

Operational Component 3.4
The pharmacist provides information in a manner suitable for the recipient’s use.

Operational Component 3.5
The pharmacist organizes and provides drug information to appropriate recipients.

Standard 4
While respecting the patient’s right to confidentiality, the pharmacist communicates and educates to provide optimal patient care and promote health. Refer: Operational Components 4.1 - 4.5

Operational Component 4.1
The pharmacist respects the patient’s rights to confidentiality and privacy by taking all reasonable steps to ensure that personal health information is communicated in a manner in which the discussion cannot be overheard by others. This may involve the use of an acoustically private area such as:

• A semi-private area with suitable traffic and/or noise barriers or
• A private counselling room

4.1.1 The pharmacist respects the confidences of the patient and protects the information received as privileged communication between a patient and healthcare provider. (Also see Principle 3 of the Code of Ethics.)

Operational Component 4.2
The pharmacist communicates using effective and appropriate communication skills while respecting the patient’s personal, cultural and educational differences. The pharmacist demonstrates flexibility in recognizing the unique qualities of each patient in order to find workable solutions.

Operational Component 4.3
Prescribed Drugs
The pharmacist takes reasonable steps to enter into dialogue with the patient or agent on all initial prescriptions in a community setting, in established programs in an institutional setting, or when made necessary by professional judgment of the pharmacist, the need of the patient or agent, or upon their request.

Hospital pharmacists should include patient dialogue in their practice. Such dialogue includes, but is not necessarily limited to:

• Confirmation of the identity of the patient
• Current medical condition(s) being treated
• Name, general description of the drug dispensed and directions for use
• The intended therapeutic response
• Common or important side effects and appropriate management, and
• Storage requirements

4.3.1 The pharmacist documents the dialogue in a readily retrievable format, including the date the dialogue occurred, with whom, and the identity of the pharmacist.

4.3.2 Should dialogue not take place in the community setting, the pharmacist documents the reason.

4.3.3 Where it is deemed important for continuity of care, the pharmacist documents any relevant information in a readily retrievable format such as the patient’s profile or health record.

Operational Component 4.4
Nonprescription Drugs
The pharmacist takes reasonable steps to enter into a dialogue with the patient or agent and offers service, assistance or advice, if the patient:

• Requests help in selecting a Schedule II, III or other nonprescription product
• Appears to be having difficulty selecting a nonprescription product
• Is perceived or observed to make frequent or repeat purchases, or to purchase inappropriate quantities of nonprescription products
• Is recognized as someone for whom self-selection and use of a nonprescription product may pose a risk (such as pregnant or nursing women, the elderly, infants or young children, and those with known medical conditions or those currently on other drug therapy)
• In an institution, requests information and advice

4.4.1 When entering into dialogue, the pharmacist interacts with the patient or agent to receive and provide information needed.

4.4.2 The pharmacist interviews the patient or agent to determine and assess as appropriate to the request:

• Condition or symptom(s) to be treated
• Current, relevant disease state(s) drug allergies or sensitivities
• Current medications
• Other medications or treatments patient may have already tried
• The need for referral to another health professional, the appropriateness of drug therapy or the advisability of non-drug therapies

As part of the patient/pharmacist dialogue, the pharmacist consults and reviews the patient profile and ensures that it is updated as appropriate.

4.4.3 The pharmacist discusses with the patient any recommended drug therapy including, where appropriate:

• Directions for proper use
• Common adverse effects
• Expected response
• When to seek the attention of another health professional

4.4.4 Where it is deemed important for continuity of care of the patient, the pharmacist documents relevant information in a readily retrievable format, such as the patient’s profile or health record.

Operational Component 4.5
Delivered Drugs
Upon a request from a patient in the community or outpatient setting, for the delivery of a scheduled product, the pharmacist takes reasonable steps to dialogue with the patient or agent.

4.5.1 If a prescribed drug is being released to a person other than the patient or for delivery to another premise, the pharmacist takes reasonable steps to:

• Inform the patient through written or electronic communication that he or she is available to provide information about the medication
• Confirm that the person is an agent for the patient
• Provide the agent for the patient with the necessary information if the pharmacist is satisfied that it is in the patient’s best interest to do so, and
• Where possible, communicate by telephone or other electronic means with the patient
• Protect patient confidentiality

4.5.2 If a Schedule II drug is being released to a person other than the patient or for delivery to another premise, the pharmacist must make the decision to sell the product and take reasonable steps to dialogue with the patient or their agent.

4.5.3 If a Schedule III drug is being released to a person other than the patient or for delivery to another premise, the pharmacist informs the patient that he or she is available for consultation.

Standard 5
The pharmacist, in collaboration with the designated manager or hospital pharmacy manager, manages drug distribution by performing, supervising, or reviewing the functions of selection, preparation, distribution, storage and disposal of drugs to ensure safety, accuracy and quality of supplied products. Refer: Operational Components 5.1 - 5.4

Operational Component 5.1
The pharmacist ensures that all pharmacy support personnel know when to refer a question or query to a pharmacist.

Operational Component 5.2 - (Applies to community practice)
The pharmacist locates drugs in the area of the pharmacy consistent with the appropriate drug schedule classification, regulations and safety consideration which reflect the level of risk of the drug for the patient.

5.2.1 Schedule I drugs must be located in the prescription services department (dispensary) or in a secure storage area accessible only to authorized personnel.

5.2.2 Schedule II drugs for sale to the public must be located in the prescription services department (dispensary) or in a secure area adjacent to the prescription services department, ensuring the area is readily accessible for the pharmacist but provides no opportunity for self selection by the patient. The pharmacist must always be involved in the decision to sell a Schedule II drug to the public.

5.2.3 The pharmacist ensures that all personnel know:

• That only a pharmacist, intern, or registered pharmacy student under the direct supervision of the pharmacist may provide information or advice respecting the use of nonprescription products, natural health products and complementary or alternative medicines
• Where Schedule II, III and other nonprescription products are located in the pharmacy
• Why these products are located where they are
• When the pharmacist is required or expected to intervene/consult
• When to refer patients to the pharmacist

5.2.4 Schedule III drugs and all other nonprescription products should be located in an area of the pharmacy adjacent to the prescription services department (dispensary) which should allow self selection of Schedule III drugs by a patient, and provide opportunities for patient/pharmacist consultation.

5.2.5 The pharmacist should endeavour to enhance patient awareness of the benefits, limitations, appropriate use and risks associated with nonprescription products through one or more of the following:

• Signage which encourages patients to consult with the pharmacist regarding the selection of nonprescription products
• Signage in particular areas to encourage dialogue between the pharmacist and the patient with respect to certain disease states, such as:
• Diabetes and foot care products
• Glaucoma and eye care products
• Hypertension and cough/cold products
• Shelf talkers
• Appropriate supplementary information
• Multimedia communication encouraging patients to consult with pharmacists

Operational Component 5.3
The pharmacist performs, supervises and reviews drug distribution activities in accordance with federal and provincial legislation, policies and guidelines, and/or institutional policies and CSHP Standards of Practice.

5.3.1 The pharmacist applies knowledge relevant to:

• Interpretation of prescription medication orders
• Bio-equivalency and interchangeability of multi-source drugs
• Formulary and drug plan management
• Pharmaceutical calculations
• Selection of ingredients
• Acquisition of pharmaceuticals
• Compounding and dispensing, including labelling according to applicable standards
• Appropriate packaging
• Preparation of sterile products
• Storage, handling conditions and stability

Operational Component 5.4
The pharmacist ensures the removal of outdated, mislabeled or deteriorated drugs and those recalled from regular stock, for storage in a separate area for appropriate disposal. The pharmacist ensures that:

• Expired and recalled drugs are not dispensed
• Drug recall policies and procedures are in place and enacted if necessary
• Dispensed drugs will not expire prior to the patient completing the course of therapy

Operational Component 5.5
The pharmacist shall not return to stock, or dispense a drug previously dispensed and delivered to the patient or the patient’s agent. In a hospital practice, a drug shall only be considered to have been dispensed and delivered to the patient when the drug has been given, or administered to the patient by a nurse or other health care practitioner.

5.5.1 In a hospital practice, the pharmacist shall ensure that medications dispensed for individual patients, but not delivered to the patient, are returned to pharmacy. Procedures for crediting and returning medications to stock shall ensure:

• Integrity of the returned drug package;
• Proper storage of the medication in the patient care area;
• Ability to identify the drug, including the lot number and expiry date

Operational Component 5.6
When the pharmacist accepts the return of unused drugs, he/she ensures the safe and appropriate storage and disposal of those drugs according to environmental regulations under written policies and procedures.

5.6.1 In a hospital practice, the following medications shall be properly discarded when returned to the pharmacy:

• Opened topical medications (e.g. creams, ointments, lotions, ophthalmic/otic/ nasal drops/ointments);
• Used inhalation products
• Undated, open multi-dose medication, e.g. vials
• Opened single-dose vials
• Medications handled by patients
• Medications returned by ambulatory patients
• Improperly stored medications

Operational Component 5.7
While cognitive functions of dispensing can not be delegated, where appropriate, the pharmacist may assign or delegate technical functions to authorized personnel.

5.7.1 The pharmacist determines whether such personnel are adequately trained and qualified.

5.7.2 The pharmacist ensures that all pharmacy support personnel know when a pharmacist is required or expected to intervene and consult.

5.7.3 In an institutional setting, the technical aspects of dispensing may be delegated to non-pharmacists provided the pharmacist meets the requirements of the Protocol for Delegating Dispensing and Compounding in Health Care Facilities.

Standard 6
The pharmacist applies 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. Refer: Operational Components 6.1 - 6.3

Operational Component 6.1
A pharmacist only practices under conditions which do not compromise his or her professional independence or judgement, and does not impose such conditions on other pharmacists.

Operational Component 6.2
The pharmacist, or the pharmacist in collaboration with pharmacy management, ensures that pharmacy operations protect the public and the people working on the premises.

6.2.1 The pharmacist uses the space, facilities, equipment and supplies available in the pharmacy to ensure patient safety through proper storage, preparation, dispensing, distribution, and disposal of drugs.

6.2.2 The pharmacist ensures that appropriate procedures for the handling and evaluation of medication discrepancies and errors are followed.

Operational Component 6.3
The pharmacist or the pharmacist in collaboration with pharmacy management takes reasonable steps to maintain adequate and appropriate staffing to ensure that pharmacy practice is in accordance with these Standards.

6.3.1 The pharmacist assumes professional responsibility for and supervision of pharmacy support personnel with whom they have direct interaction in their role and/or assigned tasks.