BASE#3 Midterm Review Sheets PDF

Lecture 1 – HealthCare Resources Describe the mechanisms by which and the organizations involved in the regulation of healthcare delivery in Canada. Regulation of HealthCare Delivery Constitution Act ○ FEDERAL responsibilities: Transfer payments (Canada Health Act...

Lecture 1 – HealthCare Resources Describe the mechanisms by which and the organizations involved in the regulation of healthcare delivery in Canada. Regulation of HealthCare Delivery Constitution Act ○ FEDERAL responsibilities: Transfer payments (Canada Health Act) Provide health care services Indigenous communities & Inuit Canadian forces & veterans Federal Inmates Refugees Regulation of pharmaceuticals, medical devices, food & consumer products ○ PROVINCIAL responsibilities Administration of healthcare – management/delivery of health services Publicly funded health care system Funded partially by the Federal Government (Canada Health Act) - Canada Health Transfer Canada Health Act: Sets standards for the P&T to obtain the Canada Health Transfer Tenants required which facilitates the transfer of money from federal → provincial: a. Publicly administered (not for profit/ public authority) b. Comprehensive = all medically necessary services provided by hospital, physicians, dentists (in hospital) c. Universal = covers all residents d. Portable = covers residents travelling in Canada e. Accessible – reasonable access to medically necessary services Is pharmacist prescribing including under the canada health act? If in AHS hospital environment then YES but NOT in an community SINGLE PAYER for → hospitals & physicians (payments for services outside of these is up to provincial) PRIMARY PAYER for →day surgery, diagnostic services laboratories, primary care clinics long term care Regulation of Health – ALBERTA (provincial legislation) Self-governing health professionals under the HPA (health professions act– AB) → require council w/ appointed & public representation (minister appointed) Regulate practice of their profession (regulation & discipline) i.e. ACP ○ Code of Ethics & standards of practice ○ Entry to practice & continuing competence ○ Complaints Accreditation Canada – not for profit organization Voluntary (stand alone organizsation) → EXCEPTION AB health facilities Set standards, evaluate, report & assess how facilities operate (i.e. hospitals, care facility home care, labs, clinics, physician's office) Affiliate of Health Standards Organization (HSO) – international College of Physicians & Surgeons – Facility Accreditation (only for the following sites): Cardiac stress testing Diagnostic imaging Diagnostic laboratory testing Hyperbaric oxygen therapy Neurodiagnostics  Psychedelic-Assisted Psychotherapy Pulmonary Function Diagnostics Sleep Medicine DIagnostics Surgical facilities (outside of hospitals) Describe the mechanisms by which patient involvement and empowerment occurs within the healthcare system. Accountability: Hospitals → AHS Health professionals → regulatory bodies (ex:ACP) Unfair treatment → Alberta Ombudsman Privacy Concerns → office of the information & privacy commissioner Health Advocate → Alberta Health Charter Public Involvement: public elects officials who must be accountable to the people for delivering/ providing healthcare services Alberta Health Act & AHS Advocacy Organizations Public representation on regulatory body councils/boards Describe the various resources used by the healthcare system and develop an understanding of the trends associated with them and the financing mechanisms that support these resources HealthCare Spending: Public healthcare spending mainly goes towards hospitals (92.27%) & physicians (97.82%) ~71% public spending (taxpayer & gov’t) ~29% private spending Lecture 2: Provision of Healthcare Services Describe the mechanisms by which patients in the Alberta health care system can access the various resources available to them. → mental health resources/numbers on slide 37 Describe the various healthcare services in the Alberta and Canadian health systems. Federal & provincial have a shared responsibility to provide: Population health assessment Health promotion Disease & injury prevention Health protection Surveillance & emergency preparedness Epidemic response Public Health Agency of Canada (PHAC) Promote healthy Education about disease Health emergency responses & infectious disease Chronic disease prevention & control Emergency Health services → 911 (NOT covered under HCA) Ground Ambulance (AHS responsibility) & air ambulance EMS practitioners = emergency medical responder, primary care paramedic, advanced care paramedic COSTS → $250 for treatment @ scene/ $385 transport to hospital ○ FN, seniors & sometimes social supports are COVERED Emergency Rooms  Urgent Care centres (non-life threatening but immediate need for care) Primary/ Ambulatory Care Services Primary care = first point of contact with healthcare services Ambulatory = non-acute/ not in institutional bed Typical entry into the healthcare system → MD visits, referrals, diagnostic lab work, discharges etc. Healthlink → 811 Primary Care Networks (PCNs) → think Auntie D Inpatient/ Specialized Care Secondary services – specialist (consultant to primary) Tertiary services – specialist (specialist refers – or inpatient) Board provision of services – additional opioid dependency, mental health, oncology, seniors health, obstetrics, diagnostic services, bone & joint etc. ContinuingCare = designed to support health & independence of Albertans Mix b/w privately & publicly owned facilities Chronic care facilities = 24 hour dau nursing supervision EX: dressing, meal prep, eating, bathing, wound care, med administration, respite (relief for family caregivers) Home & Community Care (aka Home Care) ○ Public funding (outside CHA) ○ Health care in a private residence & help with ADLs → goal is to keep the pt in their home! ○ Self-referral or health care provider initiated (ex: physician or pharmacist etc.) AHS responsibility to provide services → RHA employee, contracted or client hired Case manager assigned/ assessment ○ Services = assessments, treatments, rehabilitation, med administration, pt education, personal hygiene, transfers (depending on needs of the individual) ○ Medication Assistance Program (MAP) = guidelines (outlines roles/ responsibilities/ expectations) Health Care Aide Role in Medication Assistance = expanded guidance of role/ examples HCA supervision → direct, indirect, indirect remote ≤ once daily = administered up to 2 hours before/after scheduled time > once daily = administered within 1 hour before/after scheduled time Critical medications = within 30 mins Level 1 (reminder) – verbal reminder, NO supervision of PRN meds (managed by pt) Level 2 (partial assistance) – needs help using meds but self-manages medication use Level 3 (full assistance) – helps pt prepare/take/use & supervises sue Pharmacy Requirements: Single pharmacy provider preferred Package meds in controlled dosage system (PRN/ separate controlled dosage system) Tamper resistant packages Provide a up to date med list Med documentation record (if in living facility) REFILLS are pt/family responsibility NOT HCA ○ Assistance = Pt CANNOT take own meds safely GOAL = help take meds as prescribed INCLUDES: reminders, opening vials/BP, assisting w/ inhalers, applying patches etc. Pt consents to assistance w/ help with their meds  ○ Administration = physical act of administering meds; REQUIRES assessment, clinical decision making, monitoring effect. Supportive Living ○ Resident is as independent as possible – long term residency ○ Accommodation & support/care ○ Operators determine who chooses who lives there, rent, services provided etc. ○ Operators subject to continuing care act & regulations/standards Low income residents need to apply to alberta supports for income support assistance Must provide @ least one meal per day or housekeeping services Continuing Care Homes – 24 hour health/personal services ○ Licensed, operated by AHS or contracted provides ○ Access to these facilities are determined by AHS ○ Operators subject to continuing care act & regulations/standards ○ Type A – INCLUDES accommodations, meals, 24 hr access to professional nursing/personal care & on site consultative services (aka case management, doctor visits, physio etc.) ○ Type B – INCLUDES accommodations, meals, 24 hr access scheduled/unscheduled health/personal care, LPN access & type B (secure space) level for dementia specialty care ○ Type C – INCLUDES accommodations, meals, access to 24 hr scheduled/unscheduled health/personal care; hospice care Palliative Care Available at home, hospital, continuing care, hospice Self-referral OR referral from provider 24/7 support available including EMS (assess, treat, refer – instead of leaving home) Palliative coverage program → rx meds, laxatives, hydration solutions etc. ○ No co-payment ○ Ambulance services ○ Max $2400 per year towards diabetes supplies MAID → Medical Assistance in Dying Coordinated via AHS (physician, NP, 811 can all be involved) Contemplation phase → determination phase (10 day reflection period) → action phase → care after death Alberta Aids to Daily Living → assistance for those with long-term disabilities, chronic/ terminal illness Copay = 25% max of $500/individual or family per year Respiratory benefits & seniors orthotics/prosthetics do not have a copay Low income expectations Other services (publicly or privately funded) = audiology, PT, OT, speech language pathology, respiratory therapy, complementary & alternative med (mainly private) → midwives, chiro, acupuncture, massage therapy, NHP Lecture 3: Health System Organizations List the names of and describe the function of the organizations that support the health care system Health Canada FUNDING → Canada Health Transfer b/w provinces; FN community health services & grants REGULATE → medical, consumer & environmental products PROVIDES healthcare to veterans, FN, incarcerated individuals Drug review process Review clinical trial applications  Evaluates new drug submissions Special access program – access to non-marketed drugs Biologic & radiopharmaceutical therapies directorate ○ Each lot is reviewed unlike other small molecule meds (ex: ramipril) Natural & non-prescription health products directorate ○ Vitamins, minerals, homoeopathic meds, probiotics etc. & licence theses sites Canada Drug Agency INDEPENDENT from gov’t but funded by federal/provincial gov’t ROLE = provides objective evidence to help make informed decisions regarding drugs, diagnosis test, medical/dental & surgical procedures Provinces can choose whether or not they want to include a drug on their formulary NOT mandatory to follow Reimbursement reviews → determines public drug plan listings, reimbursement recommendations, pharmacoeconomic Health Quality Council of Alberta Mandated to promote & improve pt safely, person-centred care & health service quality Survey Albertans – safety & quality System focus (more on performance) – NOT FOR INDIVIDUAL COMPLAINTS EX: physicians can request evaluation of how they are performing compared to peers & pt satisfaction List the names of and describe the function of the organizations that support the provision of pharmacy services National Canadian Pharmacists Association The Indigenous Pharmacy Professionals of Canada Neighbourhood Pharmacy Professionals of Canada Canadian Society of Hospital Pharmacists Canadian Association of Pharmacy Technicians Alberta Alberta Pharmacists Association (RxA) Canadian Society of Hospital Pharmacists – Alberta branch Pharmacy Technician Society of Alberta Lecture 4 & 5 – Medication Use Process in the Hospital Setting Where do pharmacists work in a hospital? Mainly clinically on a pt care unit w/ team ○ EX: Critical care, surgery, medicine, transplant, cardiology, psychiatry, oncology etc. Large sites work 24/7 Usually 3 out of 4 weeks clinical w/ 1 distribution (ex: dispensary, TPN etc) Clinical pharmacy provide: Expertise on appropriate drug therapy/ management Education about appropriate drug use Promote medication quality & safety Active participants on many key medication related organizational priorities ○ Backorders & shortages Other roles: ○ Medication & safety team Accreditation (med management)  Good catch reporting – errors that were caught before leaving the department High alert meds Hazardous med handling Infusion pumps Standardized med conc. Tall man lettering ○ Drug Utilization & Stewardship (Hospital formulary) ○ Drug information ○ Administration (Management & leadership) ○ Pharmacy Informatics BPHM/Medication Reconciliation: 1. Admission ○ Obtain BPMH ○ How are they ACTUALLY taking medications? (DO NOT assume Netcare is correct!!) ○ Medications are reconciled >> discontinue, continue, hold 2. Transfer 3. Discharge Medication Distribution within Hospitals: Getting the drug to the pt (involves 35 steps) ○ Med order review ○ Inventory control ○ Packaging ○ Labeling ○ Compound & dispensing Drug distribution services are provided to most acute care & mixed facilities Medication Order – rx in hospital: Written by: physician, NP, resident, RPh, dietician OLD system: ○ Physician order sheets – “Pink order sheets” (kept in pt chart – like a binder) ○ Orders are handwritten, scanned, faxed or carbon copy sent to the pharmacy via porter/ pneumatic tube ○ Technician or pharmacist will enter the order ○ Pharmacist will verify the order ○ Once verified the order will appear on the MAR (if the site is using computerised MARs) MAR – Medication Administration Record, tells nurse what to give and when and they will document administration on the MAR (paper or electronic) NEW system (Connect Care/Epic): ○ CPOE – Computerised Physician Order Entry prescribers will directly enter orders into the computer system & pharmacist will verify ○ Removes o/e function from pharmacy & moves it to the ordering prescriber ○ All medications are entered & verified ○ No more paper, electronic charting system ○ Comprehensive integrated health record Procurement – Starting Point Wholesalers ○ McKesson (owns stock) >>> most stock comes from here ○ CPDN (drug companies own stock) Direct Buy from Manufacturer Other Hospital Pharmacy Departments ○ RAH operates as a repackaging facility from Edmonton zone  Batching IV products Repackaging oral dose solid from bulk bottles into individual packages Distribution Journey Options: Wardstock (cupboardstock, unit stock) ○ Meds available on pt care unit/ward, operating room or ambulatory clinic ○ Qualified nursing staff selects meds ○ Extensive wardstock = critical care areas ○ Limited wardstock = ambulatory clinic ○ ADC (automated Dispensing Cabinets) >>> Pyxis & Omnicell Medication distribution system we are preferentially putting into new hospital builds Cost $$, initial cost, maintenance fees, planned obsolescence Profiled = cabinets contain wardstock but the machine is “profiled” to the MAR Users can only remove meds that have been verified by pharmacy for that pt If they “override” & take out the medication it generates reconciliation activities later Only certain medications can be taken out as an override Non-profiled = More access, fewer checks, improved traditional wardstock system Pt specific dispensing – dispensed to that specific pt & only that pt ○ Products that are unavailable as ward-stock are sent on a pt specific basis from main pharmacy ○ 24 hour supply is typically sent → goal is to limit amount of stock available ○ Oral medications are individually packaged per tablet Narcotic & control drugs ○ Specialized type of ward-stock → Stored in locked/secured area of Pharmacy & Pt Care Areas ○ Governed by federal legislation ○ Perpetual inventory, regular inventory counts & signatures required at all stages (signature chain) ○ Shift balance & count reconciliation, including administration & waste → end of shift narcotics counts – “Keys to the desk” ○ Automated narcotics vault → typically in hallway of pharmacy Sterile compounding (sterile products, CVA) ○ Pharmacy prepared parenteral products, intravitreal, intrapleural, also cytotoxics, PN, gene therapy etc. ○ Almost always sent patient specific to the care unit (typically 24 hr supply is sent at a time) Non-sterile compounding → creams, ointments etc. Barcoding: Consist of 5 parts = quiet zone, start character, data characters (including an optional check character), stop character & another quiet zone Barcoding = the process of encoding data into a symbol to allow for accurate & rapid collection of data in real-time (automatic identification technology) Barcode Symbology: ○ 1D (one-dimensional) or linear = retail stores ex: UPC, ISBN, Code 128, GS1 Databar ○ 2D (two-dimensional) = symbols, shapes & represent more data for unit area than D1 ex: QR code, datamatrix & aztec Medication Barcoding CURRENT: ○ No national medication barcode mandate from Health Canada ○ No requirement for a medication barcode on any package level in Canada ○ No consistency in format used by manufacturers (symbology) ○ No complete viable data source for the barcode info (content) ○ Medications (including vaccines) may have zero to many barcodes on them  ○ Those meds with a barcode are at a package level to support retail pharmacy operations; not for healthcare specifically Vaccines ○ Barcode Standard for Vaccine Products in Canada – 2014-2015 ○ Vaccine products in Canada will use the Global Trade Identification Number (GTIN) ○ Primary package level (single or multi dose vials, pre-filled syringes or sprayers of vaccine products) should have a barcode containing the GTIN & Lot Number ○ Still some vaccine products which lack a barcode or with this information at the primary package level ○ Challenging items: ampules & insulin Medication Barcoding FUTURE: ○ All meds barcoded – at min med barcodes will be encoded with GTIN, lot number & expiry date ○ Challenges = ampules, ventolin, septra (no barcode), insulin (multiple barcodes), Closed Loop Medication Management: Reducing medication errors CPOE = computerized provider order entry CDS = clinical decision support ○ Allergy & drug interaction altering Med Reconciliation (admission, transfer & on discharge) Fully integrated electronic order entry system (epic) Standardized med catalogue RPh verification queue Automated Dispensing System (ADS) i.e. Pyxis Dispense Queue → prioritize work Dispense Preparation → scanning barcodes during dispensing Dispense Checking Unit Dose Packaging Barcode Patient Identification Electronic Medication Administration Record (eMAR) Barcoded Medication Administration (BCMA) PURPOSE: Improved patient safety due to decreased potential med errors & potential drug-drug interactions Lecture 6: How to Relate & Respond to Pt in the Hospital What is Pt & Family Centered Care: Respect & Dignity → Pt & family knowledge, diversity, strengths, values & beliefs are listened to & included in planning/delivery of care Information Sharing → receiving timely, complete & accurate info in a way they understand Participation → Pt & family are essential members of the care team Collaboration → Pt & families collaborate in development, implementation & evaluation of care services Pt & families may feel vulnerable & scared … Unfamiliar territory Complex equipment “Hospital speak”  Staff in uniforms Questions being asked Confusing, intrusive procedures RELATE = proactive approach to creating positive relationships R– respect Greet pt by name Introduce yourself Explain your role in the pt’s care Demonstrate interest in, concern for the pt as a person E – explain Give pt info about: ○ What you plan to do? ○ How it will be done? ○ Why is will be beneficial to them? L – listen Every pt’s experience is unique – don't assume you know Allow pt to tell their story w/o interruption Give pt time A – ask Ask questions to clarify what you are hearing Summarize your understanding of what the patient is saying What matters to you? Get down to pt level if lying in a bed – help them be a participant T – try (alternatives) Engage pt in decision-making Offer choices where choice is possible Look for workable solutions Make suggestions rather than directives E – empathize Look at situation through the pts eyes Communicate understanding of pt feelings & predicament Offer encouragement “Not a Problem Here” Hard to recognize when someone doesn’t understand >>> often hide it & don’t let anyone know Highly educated people can struggle with health jargon/technical terms, or remembering info, especially if they are ill, distracted, worried, or in pain > 60% of adults lack the health literacy skills needed Consider your own feelings when being told something outside your expertise RESPOND = handling the concerns of Pt & families R – Recognize complainant perspective Everybody deals with situations differently. Acknowledge what the person is experiencing and his/her reaction to it. Try to understand their viewpoint even if you do not necessarily agree. E – Establish rapport Listen & show that their concern matters to you. Paraphrase what the person is saying to be sure that you understand what they meant. S – Single out the real issue Ask questions to identify the specific things that the person is concerned about. Check to see what they would like to see done to improve their situation. P – Provide information If the solutions to the concern are within your area of responsibility, explain what steps you will take to resolve If the concern deals with issues outside of your job responsibilities, explain to whom you will refer the concern. Be as specific as possible. O – Operationalize a plan Follow through on any action in your area of responsibility Talk to your supervisor or manager to inform them of details of concern & your involvement so far N – Notify complainant Report back to the person on the action you have taken Keep them up to date even if you were unable to complete all the steps you said you would take D – Discuss and document Clarify specific details as necessary Give an update on the results of any action taken towards resolving any of the issues raised in the concern Document details related to the concern as requested by your manager or according to policies. Strategies Handout - AC.pdf Lecture 7: Hospital Pharmacists Role as an Educator Describe the purpose and types of group education provided by pharmacists Group Education = two or more patients about medications and/or issues related to use of medications Content tailored to the needs of the group Predominantly formal programs that are highly structured and deliver a predetermined curriculum Separate from individual patient education provided at the time the patient receives medication Patient Needs: Medication adherence, changes in daily routine (Behavioural) Knowledge regarding medication treatment (Cognitive) Expectations for outcomes of medication therapy (Cognitive, Affective) Accepting reality of a chronic condition, making meaning of a situation (Affective) EX: Cardiovascular → risk reduction, rehabilitation Mental Health Geriatrics Smoking cessation Pulmonary → COPD/asthma Oncology etc. Identify skills and knowledge required to provide group education Provide effective education to others Employ appropriate teaching approaches Deliver effective feedback Use appropriate learning assessment and evaluation strategies Knowledge of the material presented Group process & dynamics Critical thinking & communication Developing an education plan Identify benefits of group education Lead to greater pt satisfaction with treatment Group-based approaches typically invite greater interaction & interpersonal dynamics Fosters social modelling or problem based learning better than the individual setting Cost effective, decreased ER visits & re-admissions Improve pt outcomes, including lifestyle behavioural changes, reduce AE Discuss challenges associated with group education Group vs individual needs Developing education that is general & specific Dealing with pt emotions especially anger Managing group dynamics Lecture 8: Supporting your role as Educator Define learning theory Learning Theory = explanation of what happens when learning takes place Aristotle = learning through 5 senses Plato = learning through introspection Confucius = learning as becoming Relate education design to theoretical frameworks for learning: behavioural, cognitive, constructivist 1. Behaviorism = learning is a change in behaviour 2. Humanism = learning is about the development of the person 3. Cognitive = learning is a mental process 4. Social cognitive = learning is an environment with others 5. Constructivism = learning is a social process & involves creating meaning from experience SMART Objectives = Specific Measurable Achievable Relevant Time-based Design Element Behavioural Cognitive Constrictive Objective Learn to do a skill Create new cognitive Search for meaning/ structures/ develop understanding knowledge Learning Activities Lecture, demonstrate, Active, solve problems Experience mentorship practice & feedback Assessment Observation Exam Writing & speaking Explain how theory supports a pharmacist’s role as educator Constructivism ○ What can I do? ○ What can I do with support? (zone of proximal development) ○ What I cannot do? Experiential Learning theory ○ Experience (concrete) ○ Reflection on experience – what happened, who was involved, why did that happen? ○ Concepts (abstracts) – talking to peers, reading a paper etc. ○ Plan future action Lecture 9: Designing & Evaluating Education Describe components of the ADDIE model Instructional Design: 1. Analysis of the setting & learner needs 2. Design specifications → objectives, learning activities & assessment 3. Development of all materials 4. Implementation of instructional strategies 5. Evaluation of the development Explain the concept of alignment (objectives, activities, assessment) Alignment Objectives – tells learners what to expect ○ Addresses the purpose of the program ○ All elements of the plan map back to the objectives ○ Selecting verbs Domain Mode of learning Examples Cognitive thought/thinking Remembering, understanding, explaining, applying … Affective emotions/feelings Valus, feelings, motivations, attitudes … Psychomotor actions/doing Physical movement, coordination, motor skills… Activities → Does the learning activity reflect the objective? Assessment → What is the appropriate type of assessment? Distinguish summative from formative assessment or evaluation Formative assessment: Purpose is for growth, improvement Takes place during the learning process Often not graded Feedback to learner and teacher/facilitator on progress to date Opportunity to revisit learning Summative Assessment Purpose is to make a judgement Takes place at the end of a course or learning experience Usually associated with marks or certificate Often no feedback provided No opportunity to revisit learning Evaluation = systematic approach for collecting, analyzing & using info to answer question about programs Focused on education plan Summative evaluation → is to gather info at the conclusion of the educational program ○ Did the education (plan) achieve its goal Formative evaluation → is to gather info throughout the development & teaching ○ How can the education plan be improved? Model for Program Evaluation = learner satisfaction, learning, application, outcomes, economic Lecture 10: Japan’s Healthcare System & Pharmacy Practice Challenges in Japan’s Healthcare System: Aging population & low birth rate Financial sustainability Human & material resources (shortages of healthcare workers) Public Health Insurance System: Employer-based health insurance → emploees of medium-large companies National Health Insurance (NHI) → self-emploted, unemployed & under 75 Medical Care system for the Advanced Elderly (+75) Long-term care insurance (nursing care services) Cost Structure of Healthcare: Standard co-payment rate ○ Most pt pay 30% of medical costs (outpatient & inpatient care, rx meds) Reduced rates for specific groups ○ Children under 6 = 20% co-payment ○ Adiults 70-74 = 20% co-payment (30% w/ higher incomes) ○ Adults 75+ = 10% co-payment (30% w/ higher incomes) High-cost medical care expenses system ○ Cap on monthly out-of-pocket expenses (varies based on age & income) ○ Once cap reached –only pay 1% of costs exceeding cap Healthcare delivery System: Hospitals (~8156 in Japan) – medical facilities w/ 20+ beds Clinics (~105,182 in Japan) – medical facilities with < 19 bends or no beds Community pharmacies (~60,951 providers in Japan) Education & Licensing = 6 year program + national pharmacist examination Community Practice: Dispensing Medications ○ PRIMARY responsibility of community pharmacists ○ NO pharmacy technicians Patient Counseling – Medication use, potential AE, drug interactions & answer questions (no private rooms) Medication Management ○ Conduct medication reviews, collaborate w/ doctors, & maintain pt medication histories Health Promotion & Disease Prevention – no vaccinations; no diagnosising OTC Recommendations Home HealthCare Support ○ Medication delivery & guidance on medical equipment use Chronic Disease Management Technology & innovation ○ Utilizing electronic rx systems, med management software & remote pharmacy services Future Directions Focusing more on pt services, differentiation of pharmacy fxn (health support vs speciality), increasing pharmacy education, increasing hospital pharmacists, & reducing healthcare costs (appropriate drug selection) Lecture 11: Introduction into the legal system/ The Alberta court system Define law and explain why studying it is relevant to pharmacy education and practice Important to understand how the profession is governed & professional obligations Helps improve clinical practice & patient care HP’s Role in Malpractice Litigation: Treating professional (fact witness) Defendant Expert consultant (opinion witness) Expert consultant (trail witness) Reasons Pt initiate civil proceedings: Find out what happened vindicatio/validation of suspicions Punishment or Deterrence Meet financial burden resulting from harm Describe how law relates to other kinds of rules, such as ethical codes Describe the main features of the Canadian legal system & the different sources & institutions of law in Canada. Sources of Law: 1. Constitution & Charter of Rights and Freedoms Separation of federal provincial spheres of power ○ Civil (provincal) vs crimminal (federal) Interpreted as a “living tree/document” capable of growth & expansion; recognizes need for flexibility 2. Legislation & Regulations: Health Profession Act (HPA) – guides professional regulations Freedom of Information & Protection of Privacy Act (FOIP) Health Information Act (HIA) 3. Common Law Judge-made cases Interpretation of legislation acts, regulations & prior cases Predictability for litigations, stability & coherence in laws Promotes efficiency of legal & judicial resources Almost all malpractice cases will exceed $75,000 limit >>> tried at court of kings’ bench Areas of Law: Criminal law = deals w/ intentional harms committed against certain individuals, but are also considered offences against the public ○ Deter, denounce & punish individuals; prevent others from committing similar crimes; reinstitute  Civil law = deals w/ disputes among private parties; focuses on compensation or validation fo rights rather than punishment Administrative law = deals w/ delegation of power (by gov’t) to administrative bodies to carry out the establishments, implementation & decision making of law ○ EX: Colleges (ACP, CSP) >>> develop code of ethics, standards, reprimands, continuing education etc. EXAMPLE: - Criminal – a pharmacist is accused of stealing medications for personal use. - Civil – a patient sues the pharmacist for dispensing a higher dose of medication than prescribed by her physician causing an adverse health reaction. - Administrative – a complaint is made by the patient to theACP for professional misconduct as the pharmacist failed to adhere to the ACP’s Standards of Practice and Code of Ethics. Facts = what the pt/bystander remembers; what the chart says/ doesn’t say; what a caregiver admits Opinions = what the “experts” say in their reports; how their opinions hold up in court Standard of proof = balance of probabilities (50%+) Anatomy of a Civil Proceeding: 1. Investigation 2. Pleadings (SofC – statement of claim, SofD, third parties) 3. Document Discovery (Affidavit of Records) – exchange of records 4. Oral Discovery (Questioning from both sides) 5. Case assessment 6. Expert opinions 7. ‘End game’ 8. Trial – takes years (system backlogged) 9. Appeal Lecture 12: Constructive negotiations Describe the characteristics of negotiation 2+ parties involved Anticipate a better outcome as a result of the negotiation Prefer mutual agreement involving give & take Tangible & intangible components involved Differentiate between positional & principled negotiation Positional/ distributive negotiation Competitive = win-lose Focus on claiming value Negotiators goal are in conflict → relationship not important & resources limited Disadvantages: ○ Creates unwise agreements that don’t meet needs ○ Inefficiency = extreme positions → increase length, # of concessions & not reaching settlement ○ Endangers relationship Hard vs soft negotiator BATNA = Best Alternative To a Negotiated Agreement ○ “Plan B” → what you are left with if the negotiation falls apart; negotiation power ○ EX: if I cannot sell my care for a certain private price I can always sell it to the dealership for a bit less Reservation Value = walkaway price ○ Least favourable point at which you will accept a deal → prevents you from accepted a bad deal  ○ Gives you a way to measure how much better an offer is than your least favourable outcome ○ EX: the minimum price you would sell your car for Aspiration value = your goal for the negotiation → must be reasonable & optimistic Zone of Possible Agreement (ZOPA) = bargaining zone; overlapping zones between seller/buyer Principle negotiation Focus on multiple issues at once → allows creativity & helps with more difficult issues Give your partner several options → ensures an optimal outcome & promotes willingness to be cooperative Provide trusting & cooperative environment Understand the methods and rationale for applying principled negotiation Identify the key elements of principled negotiation process 1. Separate people from problem Deal w/ people problems upfront Don’t assume or play the blame game Give people a stake in the outcome Active listening 2. Focus on interests not positions Interests define the problem Behind opposed positions lie shared/compatible interests & conflicting ones Probing 3. Invent multiple options looking for mutual gains before choosing an option Bridging → allows for agreement based on contingency & expectations to be diff b/w parties bundling/unbundling 4. Insist that the results be based on some objective standards Factual info Independent of negotiation parties EX: HIA legal requirements, employment standards, etc. Lecture 13:ADR in Hospital Describe the reporting requirements of Vanessa’s Law (Mandatory Reporting for Hospitals Vanessa’s Law: protects canadians from unsafe drugs & devices Created after Vanessa Young died of a cardiac arrhythmia after being prescribed cisapride New Post-market authorities added to food & drug act include: 1. Power to require information, tests or studies 2. Power to require a label change/package modification 3. Power to recall unsafe therapeutic products 4. Ability to require and disclose information in certain circumstances 5. Tougher measures for those that do not comply 6. Mandatory reporting of serious adverse drug reactions and medical device incidents by health care institutions WHO is Required to Report – HOSPITALS Regulations define a hospital as a facility that: ○ is licensed, approved or designated as a hospital by a province or territory, in accordance with the laws of the province or territory, to provide care or treatment to persons suffering from any form of disease or illness; ○ or is operated by the Government of Canada & that provides health services to in-patients. WHEN must Hospitals Report? → Within 30 calendar days of 1st documentation of the rxn/incident within the hospital which is then forwarded to Health Canada WHAT events are reportable? 1. Serious ADR = noxious unintended response to a drug dosing at any dose causing: hospitalization or prolongation of existing hospitalization congenital malformation persistent or significant disability/incapacity threat to life, or death important medical event (as per medical judgement) 2. MDI: Incident related to: ○ failure of a medical device ○ deterioration in its effectiveness ○ inadequacy in its labelling or directions That led to: ○ death ○ serious deterioration in health of a pt, user, or other person ○ Recurrence Required Data Elements: Serious ADR : ○ Reporter = contact info ○ Suspect product = drug name, DIN, #/code, concomitants ○ Pt info = age, sex, PMHx ○ Serious ADR info = description, date, start & end date of therapy & ADR, outcome MDI: ○ Reporter = contact info ○ Suspect product = name, manufacturer name, lot/serial # ○ MDI info = description, date, contributing factors, outcome * BLUE = minimal essential info that must be required on a report* Recognize which health product & what types of suspected ADRs you should be reporting on 1. Does your report involve a drug within the scope of the federal regulations for mandatory reporting? 2. Is the adverse drug reaction considered serious? (criteria above) 3. Was the ADR documented within the hospital? 4. Does your facility meet the definition of a hospital? Describe the process for reporting serious ADRs AHS = 2 options to report sADR: 1. Epic – integrated into the pt’s electronic medical record 2. RLS (AHS reporting & learning system) If the answer to the “what was the med problem?” is “adverse drug rxn” then this causes a new section of SADR question to appear on the reporting form MQST (Medication Quality & safety Team) Receive & review all sADR reports submitted through usual AHS processes Report reviews include: ○ Determines if the report meets Health Canada's definition of serious? ○ Contacts the reporter if any essential elements are missing or if any other missing elements could enhance learning form the events Lecture 14: Legal Obligations Identify the differences between courts and regulators such as the Alberta College of Pharmacy. Courts = obtain authority from statutes & regulations enacted by the legislature: EX: Provincial court act, court of king’s bench act, court of appeal, etc. Civil disputes b/w members of public Family disputes Wills, states, trusteeships Criminal court Traffic court Appeals Regulators: ACP obtains authority entirely from other statutes & regulations enacted by alberta legislature: ○ EX: HPA, Pharmacist & pharmacy tech profession regulation, pharmacy & drug act, pharmacy & drug regulation, scheduled drugs regulation , pharmaceutical equipment control regulation Corporations created by statute for a specific purpose “College” is a corporation that… (according to HPA) ○ created/continued in a schedule to this act ○ Consists of regulated members ○ Has capacity & subject ot this act the right, powers & privilege of a natural person No inherent legal authority – only authority delegated to them by legislature that may be implied by necessary implication to carry out their purpose PRIMARY purpose of professional regulatory is to protects & serve the public interest PRIVILEGE of professional self-regulation – gives responsibility for enforcing professional discipline & adequate protection for public; maintain integrity of the profession Describe the regulatory tools that the Alberta College of Pharmacy has to govern pharmacy practice. Elected “Council” – board of directors Code of ethics Standards of Practice Continuing competence program rules  Appointed officials ○ Registrar = determines applications for registration & annual renewal Clinical Pharmacist register Provisional Pharmacist register Courtesy Pharmacist register Student Pharmacist register ○ Competence Committee ○ Complaints Director – initiates & investigates complaints; refers warranted complaints to discipline hearing ○ Hearing Tribunal – conducts discipline hearings; hears allegations, views evidence & determines whether unprofessional conduct occurred & sanctions Clinical Pharmacist title protection ○ EX: pharmacist, clinical pharmacist, pharmaceutical chemist, druggist, apothecary, registered pharmacist, Ph.C., R.Ph. Provisional Pharmacist title protection – EX: pharmacy intern, pharmacist intern Student Pharmacist title protection – EX: pharmacy student, pharmacist student Restricted Activities ○ EX: dispense, compound, sell/provide to sell Sch 1 or 2 drugs, compound blood products etc. ○ EX: WITH ADDITIONAL AUTHORIZATION … prescribe, adapt, injections Compliance Audits & practice visits Incapacity Assessment – Complaints director can require examinations (medical or psychological tests) Access to regulated members info ○ Public availability of info on college website (name, location, APA etc.) ○ Discipline information, hearing info, hearing tribunal decisions (10 years) ○ Sexual misconduct – posted indefinitely Explain actions that can lead a pharmacist to encounter the regulatory system. 1. Good character and reputation 2. Professional liability insurance 3. Continuing competence program compliance 4. Breach of standards of practice 5. Drug diversion 6. Record keeping and insurance claims * see slide deck for trial examples* Lecture 15: Privacy Law pt 1 Define and describe the meaning and scope of health information Describe the various laws governing health information across Canada Explain the difference between health information & medical records; Distinguish health information from other types of personal information; Personal info = information about an identifiable individual EX: name, home address, business address, race, age, sex, marital status, medical hx, employment hx etc. Freedom of Information & protection of Privacy Act (FOIPPA) Public body may collect, use & disclose personal info from individuals ○ Includes: office of the gov’t of Alberta, municipalities, police services, school boards, regional health authorities, & universities/public colleges/technical institutes. Collect info if: ○ Authorized by legislation ○ purpose of law enforcement ○ Info related directly to & is necessary for a program/activity of public body Collection should be directly from the individual to who the info belongs to & notify purpose of collection MUST use & disclose purpose of collecting personal info EX = UofA collecting high school grades for prospect scholarships & bursaries Personal Information Protection Act (PIPA) Governs collection, use, & disclosure of personal info by private organizations recognizes both the right of an individual to have their personal info protected & need for organizations to access this info for reasonable purposes May collect info: ○ w/ individual’s CONSENT ○ w/o individuals consent in specific circumstances EX = london drugs collects customer address to administer customer loyalty benefits Health Information Act (HIA) Governs collection, use, & disclosure of health info by custodians & affiliates Custodians = who has custody/controlled over the health info ○ Regional Health Authorities/Hospitals (EX: AHS) ○ Nursing home operators ○ Ambulance operators ○ Regulated professionals including pharmacists,physicians, registered nurses, dentists, & opticians Affiliates = employees, appointees, volunteers etc. Includes diagnostic, treatment & care info as well as registration info (demographics, residence, billing info) Use of health info (section 27): ○ Providing health services ○ Determining eligibility. ○ Conducting investigations, disciplinary proceedings, practice visits. ○ Internal management purposes, including quality assurance. Disclosure (consent generally required) HOWEVER no consent is needed when: ○ Another custodian needs it for purpose under s.27 ○ Family member if they must express request of pt under certain circumstances ○ Quality assurance ○ Court proceedings After a family member passes – family doesn’t automatically get access to their information EX = AHS collects pt PMHx for triage at emergency department Explain the rationales for legal protection of health information Safeguards must address the risks associated with electronic records & proper disposal of records. Breach Notification (HIA) = MANDATORY reporting of breaches to the OIPC is required when there is a loss of unauthorized personal info that is in the control of the custodian ○ Must consider if there is a “risk of harm” to individuals whose info was breached ○ What is the chance this info will be misused & what is the sensitivity level? Who was it accessed or disclosed to?  Can the info be used for identify theft or to commit fraud? Will it cause embarrassment, mental, physical or financial harm, damage reputation? Was the info encrypted or secured? ○ Commissioner determined highly sensitive info as … SIN, DOB, driver’s license number, credit card, certain medical info notes Compliance & Enforcement ○ Individual who believes info has been collected, used or disclosed which violates HIA can ask OIPC (Office of the Information & Privacy Commissioner) for a review ○ Commissioner conducts an investigation ○ Offenses & penalties include: Attempt to gain access to info in violation of HIA Obstruct investigation Fail to report breach GUILTY = $200,000 (individual) fine or up to $ 1 million (organization/custodian) Risks of Non-Compliance w/ Privacy Legislation ○ Complaints to OIPC ○ Professional discipline ○ Civil claim (breach of privacy) – intrusion upon seclusion, public disclosure, statutory cause of action ○ Reputation risk Lecture 16: Privacy Law pt2 Artificial Intelligence & Privacy: POTENTIAL USE = streamline management of meds, ID drugs, interactions/AE, monitor prescribing patterns No legislation currently in place Areas of risk: ○ Violation of collection limitation principle ○ ↑ risk of frequency & scope of privacy breaches ○ Lack of proper consenting Describe fully the main provisions of Alberta’s Health Information Act Explain the rules governing collection, use and disclosure of health information Access to Info Individual has the right to access any record containing health info about themselves in custody of custodian MUST be granted within 30 days of request Extension of 30 days possible under certain circumstances OIPC may authorize custodian to disregard request – under their discretion Applicant may seek & review access decision before OIPC EXCEPTIONS: ○ Granting access = immediate & grave harm to the applicant, another individual or the public ○ Reveals standardized diagnostic tests used by a custodian & would prejudice the test EX: questionnaire used by psychiatrist Correction of Info if individual believes there is an error or omission in their health info – response within 30 days (extensions are possible) Describe the legal consequences of breaching or violating privacy laws; and apply knowledge gained from the lecture to case studies. Privacy Torts Intrusion upon seclusion (not yet recognized in Alberta) ○ Needs to be intentional & invaded w/o lawful justification ○ Reasonable person would consider intrusion highly offensive, causing distress, humiliation or anguish Public disclosure of private facts  ○ Significant psychological damage typically Review example in Slides Lecture 17: Consent & Informed Consent Explain why consent is an essential feature of the provision of healthcare; Describe the fundamental principles of consent law; “Everyone has the right to life, liberty and security of the person and the right not to be deprived there of except in accordance with the principles of fundamental justice.” Distinguish between consent and informed consent; Consent = pt’s agreement to any type of interference with the security of their person i.e. body Required for all treatments; EXCEPTIONS: ○ Person unconscious – emergency medical treatment required ○ Pt involuntarily committed for psychiatric treatment 2 ways consent can be given: 1) EXPRESS = pt either verbalizes agreement or signs document 2) IMPLIED = consent is implied by pt actions or by operation of law Who can give consent? ○ Any capable person or person w/ capacity no matter age ○ Minors (under age 18 y.o.) are able to consent to meds/treatment; case-by-case basis assessed by minors maturity level Pt must NOT be coerced or pressured by anyone to make a decisions, must exercise their free will Documentation: ○ Discussion w/ pt & their responses ○ Underlying treatment options ○ Concerns pt has ○ Final decision ○ Standard 18.4 Informed Consent = full disclosure based on the premise that pt should have control over decisions concerning their healthcare & be provided medically relevant info Aware of all risks/benefits, alternative treatments, right to refuse treatment at any time (even if it puts their health at risk) viewed with the lens of a reasonable person taking into account the magnitude of the risk, the likelihood of any side-effect or adverse reaction and the severity of any injury. ○ Objective = reasonable person consideration ○ Subjective = examining context of the specific circumstance A person alleging lack of informed consent has to show: ○ A reasonable person wouldn't have undergone the procedure or taken the drug had the risk been disclosed. ○ The resulting damage is linked to the failure to disclose the risk that occurred. Standard 11.12 (d) Explain the legal consequences of a failure to obtain consent versus a failure to obtain informed consent; Torts that can be alleged: Negligence = civil wrong; breaching the standard of care expected from a healthcare provider Battery = civil wrong; intentionally interfering with a person w/o their consent Assault = criminal wrong Explain the role of capacity determinations in the context of consent law; Capacity is understanding what healthcare provider is saying about a treatment but also understanding the consequences with that decision If consent is in question – assessment is performed; determined by 2 independent healthcare providers for the purposes of a personal directive Describe the role of supported decision-making in establishing consent for persons who lack capacity to consent. Alternative Decision Makers If a person is not capable of making a decision, a number of individuals could be appointed to make decisions either ahead of time by the person of by the court EX: Representative, Attorney, Public guardian or trustee, Substitute decision maker etc. Attorney = a person that is legally appointed through a Power of Attorney document to speak on a patient’s behalf. The legal document outlines their scope of decision-making or responsibilities. Public Guardian & Trustee = a person appointed by the Court when a patient has no capacity , when the patient does not have a decision maker designated and family members disagree about the care. Substitute Decision Maker = a person chosen as a medical proxy (can also be known as a health representative or agent) who can agree to or refuse treatment and can withdraw treatment on patient’s behalf when they are not capable of doing so. Advance Directives (aka living wills) a list of ones healthcare preferences, refusals & requests that all healthcare providers will need to adhere to. Includes decisions regarding life-prolonging measures, requests for withdrawing treatment, info regarding a person they have appointed that will serve as their proxy, if need be etc. Seminar #3 – Virtual Care & health informatics CASE 1: Virtual Venting – refer to google drive for details on the case - Always exercise common sense & professional judgement - Using Social Media Opportunities: - Professional branding - Professional networking - Professional development - Scholarly activity - Pharmacy education - Patient advice/education – general info - Using Social Media Challenges: - Risk of patient privacy - Misinformation - Professional reputation - Echo chamber for people with similar information - Sarah's action’s = unprofessional & potentially a breach of privacy for the pharmacy (not necessarily the pt) - Possibly impact her relationship with her employer, future employers or classmates CASE 2: HealthCare Apps – refer to google drive for details on the case - Apo-mediation = “agents” (i.e. people or digital tools) which “stand by” to guide a consumer to high quality info & trustworthy services/resources - EX: consumer ratings on Amazon - EX: Choosing a medical app based on app store star rating - EX: Online patient community moderated by peers or health care professionals - EX: Pt saw (-) info regarding HPV vaccine on facebook and isn't sure what to do – pharmacist directs them to a reliable source (myhealthalberta.ca) - Digital Therapeutics = evidence based software that may prevent, manage or treat a health condition w/ or w/o hardware - EX: platform that provides virtual CBT to treat depression  - EX: Medication adhere apps - EX: Smart pill bottles, inhalers, injection devices (digital medicines) - How to determine which app is recommended? Which app is the best? - Framework for evaluating an app = difficult; many criteria - MARS (mobile application rating scale) – rate engagement, functionality, aesthetics, information quality & subjective rating about the app - AHS recommendations – EX: mental wellness apps CASE 3: Virtual Care – refer to google drive for details on the case - Virtual Care = any interaction between patients &/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care - INCLUDES: phone calls, video conferencing, mobile applications, electronic communication (in real time or asynchronous) - Providing restricted activities & professional services via technology is considered virtual care. - Assessment for prescribing, to dispense, performing follow-up about efficacy or side effects. - Phoning a patient to book an appointment is not “Virtual care” - APPROPRIATE: - Assess & treat mental health issues - Assess & treat skin problems - Assess & treat urinary, sinus & minor skin infections - Provide sexual health care, including screening & treating STI & hormonal contraception - Provide travel medicine - Review lab, imaging & specialist reports w/ pt - Assess & treat conditions monitored w/ home devices or lab tests - Conduct any other assessments that don’t require palpitations ro auscultations - NOT APPROPRIATE - Emergency sx: SOB, chest pain, loss of neurological function, ear pain, cough, GI sx, musculoskeletal injuries - Physical examination is required Lecture 18: MAID Describe the laws governing medical assistance in dying in Canada; Amended Criminal Code to define medical assistance in dying: a) The administering by medical practitioner or nurse practitioner of a substance to a person, at their request that causes their death or b) Prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person at their request so that they may self-administer the substance and in doing so cause their own death MADI criteria Eligible for health services funded by gov’t in Canada At least 18 y.o. & capable of making healthcare decisions Grievous & irremediable medical conditions causing enduring physical or psychological suffering (mental illness excluded) Voluntary request for MAID Informed consent after being informed of other means to relieve suffering including palliative care Must give informed consent at time of request & immediately before MAID is provided unless special circumstances apply Parliament originally included “ reasonable foreseeability of natural death” as one of the MAID criteria – 2 tracks: Natural death is foreseeable; or Natural death in not foreseeable RATIONAL – address diverse nature of suffering; ensures sufficient time & expertise is spent assessing MAID request from person who natural death is not reasonable foreseeable Reporting MAID: Monitoring of MADI administration – to collect data to provide comprehensive picture of how MAID is implement Provides transparency & public trust Data includes capturing age groups, all requests received, all assessments completed, as well as, number of administrations, drugs used etc. Describe the pharmacist’s legal role in facilitating medical assistance in dying; Pharmacist section 241(4) No pharmacist who dispenses a substance to a person other than a medical practitioner or nurse practitioner commits an offence... if the pharmacist dispenses the substance further to a prescription that is written by such a practitioner in providing medical assistance in dying … Informing pharmacist 241(8) The medical practitioner or nurse practitioner who, in providing medical assistance in dying, prescribes or obtains a substance for that purpose must, before any pharmacist dispenses the substance, inform the pharmacist that the substance is intended for that purpose. Filling Information – pharmacist & pharmacy technicians 241.31(2) Unless they are exempted under regulations made under subsection (3), a pharmacist who dispenses a substance in connection with the provision of medical assistance in dying, or the person permitted to act as a pharmacy technician under the laws of a province who dispenses a substance to aid a medical practitioner or nurse practitioner in providing a person with medical assistance in dying, must, in accordance with those regulations, provide the information required by those regulations to the recipient designated in those regulations [Ministers of Health for Canada and Alberta]. Explain the basic framework of health decision-making at the end of life; and Safeguards: Medical or Nurse Practitioner must be of opinion that patient meets criteria Ensure proper documentation of informed consent for MAID Ensure a second, independent medical or nurse practitioner provides written opinion that criteria are met Ensure reliable means of communicating with patient Immediately before the MAID, give the patient the opportunity to withdraw their request & verify express consent for MAID Medical or nurse practitioner must be or consult with someone with expertise in the patient’s condition Ensure patient has been advised of other means to relieve suffering & offered consultations for appropriate caregivers Ensure they have discussed with the patient the available means to relieve suffering and the patient has given serious consideration to them 90 clear days from the first assessment of eligibility to the date of MAID unless the loss of capacity to consent is imminent MAID Process according to AHS Policy: Most responsible practitioner is a Physician or Nurse Practitioner (who can prescribe MAID) Pt must receive a diagnosis about their condition from a Physician or NP. 2 independent Physicians or NPs must determine that the patient is eligible. Diagnosis includes the finding that: ○ Pt has a serious & incurable illness, disease or disability; ○ Pt is in advanced states of irreversible decline in capability;Illness, disease, disability or state of decline causes the patient enduring physical or psychological suffering that is: Intolerable to the patient, and,  Cannot be relieved under conditions with treatment [Mental illness is specifically excluded] MUST be in writing, & done voluntarily Individual must have capacity to provide informed consent (alternative decision maker cannot) Must give expressed informed consent & all forms signed by Pt Requests must be signed by an independent witness Pt must be advised they can withdraw request at any time Safeguard will be applied depending on where natural death is reasonable foreseeable or not NO ONE IS OBLIGATED TO ASSIST WITH MAID – unwilling then you must notify employer Once all safeguards & protocols are met – pharmacist will compound/dispense the medication ○ Pharmacists cannot repscribe drugs for MAID ○ Pharmacists can only dispense drugs for MAID from a list of drugs developed & maintained by ACP ○ Pharmacist must report required information Pt can choose to self-administer & may make arrangements in writing with a practitioner who will be present to take over & administer MAID in situations where complications arise during sled-administration Explain the role of law in planning for end of life care. MAID developments in the future: Gov’t considering whether mature minors should be eligible Considering implementing advance requests for MAID Mental health exclusions —------------------------------------------------MIDTERM CUTOFF —-------------------------------------------------