Performing a Procedure on Tissue Below the Dermis Guideline

Purpose:

This guideline outlines legislative requirements for performing a procedure on tissue below the dermis as defined in the Pharmacy Act. It is meant to be used alongside the Standards of Practice, Standards of Operations, Code of Ethics and O. Reg. 202/94.

Guideline:

All of the requirements when administering a substance by injection or inhalation also apply when performing a procedure on tissue below the dermis, as appropriate.

Pharmacists, pharmacy students and interns and pharmacy technicians under the direction of a Part A pharmacist who is physically present on the premises are authorized to perform a procedure on tissue below the dermis.

Training, educating and counselling patients or informal care givers on chronic disease management and the appropriate use of monitoring devices is a core competency of pharmacy practice. With the consent of the patient or his or her authorized agent, the pharmacy professional may pierce a patient’s dermis to demonstrate the proper use of lancet-type devices for the patient’s self-care and education or for the patient’s self-monitoring of his or her chronic disease.

The pharmacy professional will only consider performing the procedure if he/she has an understanding of the value and limitations of self care devices and monitoring tools and is able to educate the patient on how to self-monitor and when to contact a health professional.

A pharmacy professional must still provide the patient with sufficient information for the patient to provide informed consent, but the pharmacy professional can assume that consent is implied3, 4 when a patient extends his or her finger to allow the pharmacist to use a lancing device to obtain a blood sample in the context of demonstrating the use of the device.

A pharmacy professional is required to use professional judgement regarding the clinical significance of performing a procedure and may choose not to notify the primary prescriber about performing the procedure. Where the pharmacy professional feels that notification is required for continuity of patient care, he or she may provide information to the prescriber.

Legislative References:
Additional References:

Standards of Practice for Pharmacists

Standards of Practice for Pharmacy Technicians

Administering a Substance by Injection or Inhalation

Implementation

Published: December 18th 2020
Version #: 1.00
College Contact: Pharmacy Practice

Revision History
Version # Date Action
1.00 December 18th, 2020 Removed from Administering Substance by Injection or Inhalation policy and turned into stand alone guideline.