This document serves as a supplement to the Ministry of Health guidance document Testing of Asymptomatic Persons in Pharmacies, outlining College expectations and resources for pharmacists and community pharmacies that are opting to facilitate COVID-19 testing for asymptomatic individuals eligible for testing, to ensure the continued safety of all individuals entering the pharmacy premises. Pharmacies provide essential healthcare services, and the choice to perform elective COVID-19 testing must not impede or limit the public’s accessibility to, or the safe delivery of, those services.
For community pharmacies involved in this program, ensuring the protection of everyone within the premises is paramount, including pharmacy personnel and all patients—especially those who may be part of a vulnerable population, such as seniors or those with chronic illnesses.
The College expects pharmacists delivering elective COVID-19 testing to follow all relevant legislation, standards of practice, Code of Ethics and policies and guidelines, as well as the requirements set out in the Chief Medical Officer of Health’s Directive #2 and Ministry of Health guidance Testing of Asymptomatic Persons in Pharmacies. In addition, pharmacy owners and Designated Managers (DM) must ensure all public health measures and protocols related to reducing the spread of COVID-19 are maintained at all times.
Community pharmacies that have opted to facilitate COVID-19 specimen collection for asymptomatic individuals eligible for testing are expected to comply with all program requirements from the Ministry of Health (MOH).
Pharmacy owners, directors and DMs are accountable for continuing to meet the Standards of Operation. The community practice environment must support quality patient-centered care and enable the safe provision of all pharmacy services at all times.
Before planning to participate in asymptomatic COVID-19 specimen collection, DMs must use their professional judgment to assess the suitability of the premises, availability of personnel and other essential resources (e.g., PPE, cleaning supplies), and the patient population they serve. Testing should only be offered when the pharmacy has the capacity to do so in accordance with these expectations.
To ensure essential healthcare services are maintained in pharmacies that opt to deliver COVID-19 testing, pharmacies are required to ensure their physical space conforms to all public health measures to prevent the spread of COVID-19. To achieve this, the owner and Designated Manager is expected to follow all measures outlined in the Ministry guidance including:
- Informing the public if they are providing asymptomatic COVID-19 testing through the use of signage and other modes of communication. (Also, pharmacies that are not providing asymptomatic COVID-19 testing may wish to inform the public of such through the use of signage and other modes of communication.)
- Making it clear to all patients who want to be tested how to arrange an appointment.
- Ensuring that there is a suitable separate space designated for the purpose of specimen collection, that is clearly marked for patients to know where to go for testing
- Physical barriers or other appropriate methods to separate the designated area from the rest of the premises, as described in the Ministry guidance
- The area is easy to clean, safe, and protects the privacy and dignity of patients being tested
- Having clear policies and procedures in place to promote compliance with public health measures amongst all patients and staff including:
- Mitigating the risk of COVID-19 spread by establishing optimal workflow and adequate staffing to minimize the number of patient-personnel interactions and movement to other areas of the pharmacy.
Infection Prevention and Control (IPAC) and Environmental Cleaning
- The following resources may be used in conjunction with the Ministry guidance to ensure robust IPAC measures are maintained:
- Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Care Settings (Public Health Ontario)
- Patient Safety and Infection Prevention and Control (Winter 2020 Pharmacy Connection article)
- A Pharmacist’s Guide to Pandemic Preparedness, see Environmental Cleaning section (Ontario Pharmacists Association)
- All persons entering the pharmacy premises have access to, and are advised to use, alcohol-based hand rub (ABHR) approved by Health Canada
- DMs ensure pharmacists collecting specimens and personnel interacting with patients have access to soap and water, or an adequate supply of ABHR, for proper hand hygiene in between testing patients and when donning/doffing PPE;
- After every test is completed, all patient-contact surfaces (i.e., areas within 2 metres of the patient, including specimen collection area) should be cleaned and disinfected as soon as possible and in between patients, allowing for sufficient contact time for the disinfectant used.
- If the area used for specimen collection is also used for other purposes, it is thoroughly cleaned and disinfected between patient visits, as per MOH Guidelines and Public Health recommendations.
- Common areas and surfaces such as plexiglass barriers are frequently cleaned
Personal Protective Equipment (PPE)
- Pharmacies should continue to support policies made by provincial and municipal authorities requiring the wearing of masks (e.g., wearing a procedural/surgical mask, cloth covering, or other appropriate face covering) while on the premises
- Appropriate PPE is worn by staff based on Public Health Ontario, occupational health and safety requirements, and MOH recommendations
- All staff are trained to properly don and doff PPE
- Pharmacists collecting specimens wear the PPE recommended for testing – a surgical/procedure mask (medical grade), protective eyewear, gloves and gowns are required for droplet/contact precautions
- IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 (Public Health Ontario)
- N95 respirators are not required as swab collection is not an aerosol generating medical procedure, but masks must be medical grade
- Proper hand hygiene and changing of gloves and gowns must occur between patients
Providing patient care
Pharmacists in Ontario are expected to provide patient-focused care in accordance with established legislation, standards of practice, code of ethics and policies and guidelines relevant to pharmacy practice. They must utilize their knowledge, skills and judgment to actively make decisions that provide patient-centered care and optimize health outcomes for patients.
Pharmacies must have written policies and procedures to support COVID-19 specimen collection in accordance with guidance from the MOH and the College. The DM ensures that staff are trained to properly implement these measures prior to engaging in the service. Appropriate supervision and quality assurance mechanisms should be in place to monitor ongoing compliance and support the delivery of safe and effective patient care.
To ensure safe delivery of healthcare and protection of all patients, the following is expected:
- Designated Managers are responsible for determining appropriate operational processes to screen and schedule asymptomatic patients for testing, to ensure only those eligible for testing are scheduled as outlined guidance provided by the Ministry.
- All health care providers and workers who work at pharmacies that will be facilitating COVID-19 specimen collection must be actively screened every day before entering the workplace as per O. Reg 364/20: Rules for Areas in Stage 3.
Performing the Test
- Pharmacists ensure they have the knowledge, skills and competence to safely and accurately collect anterior nasal and/or throat specimen(s), seeking additional training as required
- Only pharmacists have the authority to collect specimens; pharmacy technicians, registered pharmacy students and interns do not, as set out in regulation.
- The pharmacist explains what the test entails prior to inserting the swab into the nasal and/or throat passage
- Testing kits and specimens are procured, handled, stored and transported as per MOH Guidelines and the direction of the partner laboratory
Notification of test result
- Pharmacists educate patients on infection control and preventative measures and self-isolation protocols
- Pharmacists explain how the patient can obtain (or will be notified of) the test result (positive or negative) and how follow-up will be communicated as outlined in guidance provided by the Ministry.
- Directive #2 for Health Care Providers (Regulated Health Professionals or Persons who operate a Group Practice of Regulated Health Professionals) – Issued under Section 77.7 of the Health Protection and Promotion Act (HPPA), R.S.O. 1990, c. H.7
- R.R.O. 1990, Reg. 683: Specimen Collection Centres (under Laboratory and Specimen Collection Centre Licensing Act, R.S.O. 1990, c. L.1), s. 9
- O. Reg 364/20: Rules for Areas in Stage 3.
- Model Standards of Practice for Pharmacists
- Standards of Operation for Pharmacies
- Ministry of Health: Guidance for the Health Sector
- PPE: Suggested Best Practices for Pharmacies During the COVID-19 Pandemic (Canadian Pharmacists Association)
- OPA Asymptomatic COVID-19 Testing in Pharmacy Professional Development module
- Health Canada
Published: September 2020
Revised: November 2020