Pharmacy Law and Ethics - Day 13 PDF

The Role of the Pharmacist Pharmacists are the Greatest Asset in Healthcare  Pharmacists are the most accessible and most trusted of all healthcare professionals  Pharmacists do more than just fill prescriptions  Depending on the province, they might be able to administer travel vaccines, or...

The Role of the Pharmacist Pharmacists are the Greatest Asset in Healthcare  Pharmacists are the most accessible and most trusted of all healthcare professionals  Pharmacists do more than just fill prescriptions  Depending on the province, they might be able to administer travel vaccines, order and interpret lab tests, prescribe medications for minor ailments change and extend prescription refills and administer vaccines The Role of the Pharmacist Ontario Pharmacists may now prescribe drug products under certain conditions This includes:  Prescribing specified drug products for smoking cessation and minor ailments;  Renewing and adapting of prescriptions;  Perform a procedure on tissue under the dermis to support patient self-care and chronic disease monitoring;  Administer by injection or inhalation of substances listed in the regulation for purpose of education and demonstration;  And administer influenza vaccines to patients 5 years of age and older, in accordance with the Ontario’s Universal Influenza Program (UIIP) The Role of the Pharmacist Prescription Refill Authorization Requirements for Pharmacists  Pharmacists may repeat Rx’s to continue medication therapy when:  Reasonable efforts to contact the prescriber by the pharmacists has been unsuccessful, the pharmacist believes that the prescriber would have authorized the continuing of the medication therapy,  The patient has a chronic or long-term condition,  The patient has a stable history with the drug,  The medication is not a narcotic, controlled or targeted substance,  The total amount of the refill does not exceed the amount previously dispended or is a 6-month supply, whichever is less The Role of the Pharmacist Prescription Refill Authorization Requirements for Pharmacists  A refill Rx authorized by a pharmacist requires  The name of the authorizing pharmacist and the original prescriber must be recorded in the patient record,  There must be sufficient documentation within the patient record to support the decision making process,  The name of the authorizing pharmacists should also appear in the Rx label as the prescriber,  The pharmacist must provide notification of the date, drug, and quantity to the prescriber or primary care provider within seven days of refilling the Rx Prescribing for Minor ailments The Role of the Pharmacist The Pharmacist There are 4 levels of registration with the OCP: 1. Registered Pharmacy Student 2. Pharmacy Intern 3. Registered Pharmacist 4. Registered Pharmacy Technician The Role of the Pharmacist 1. Registered Pharmacy Student  A Registered Pharmacy Student is a student of Pharmacy who has not yet completed his/her degree but is registered with OCP as being accepted for in-service training The Role of the Pharmacist 2. Pharmacy Intern  A Pharmacy Intern has obtained a degree in Pharmacy from the University, but still needs to complete the requirements for licensure  Internship is the training period that provides transition from working under direct supervision as a student to working independently as a pharmacist  An intern has successfully completed a studentship training, either in their undergraduate program or through OCP’s Structured Practical Training The Role of the Pharmacist  Both the registered pharmacy student and the pharmacy intern must work under the supervision of a licensed pharmacist  A pharmacist and registered pharmacy technician can accept a verbal Rx from a practitioner  A pharmacy intern or a registered pharmacy student may accept a verbal Rx order from a practitioner, under he supervision of a licensed pharmacist The Role of the Pharmacist 3. Registered Pharmacist  In Ontario, pharmacy is a 5 year program; a pharmacist is required to completed one year in a General Science Program, plus 4 years of training at the Faculty of Pharmacy, University or Toronto, or the School of Pharmacy at the University of Waterloo, in downtown Kitchener, in order to obtain a Bachelor of Science in Pharmacy degree  Graduates of UofT are required to complete the Structured Practical Training Program (1 year) The Role of the Pharmacist The Structured Practical Training Program (SPT)  SPT complements the Structured Practical Experience Program, a component of the Fault of Pharmacy’s curriculum at the UofT  In-service-training includes 12-months-in-service divided into three four-month periods  Credit for in-service is only received after successful completion of the second year of the Pharmacy program  The first 4-month period is normally served in the summer after second year, and the second period after third year  The final four-month period is considered an internship and can only be served after successful completion of the previous 8-months inservice and graduation from the Faculty The Role of the Pharmacist The Structured Practical Training Program (SPT)  The requirements for licensure with OCP include successful completion of the Pharmacy Examining Board of Canada Qualifying Examination (PEBC) and the Pharmaceutical Jurisprudence Exam (JP)  A degree in Pharmacy does not in itself confer the right to practice pharmacy  Pharmacists are required to be registered with the College in order to practise in Ontario  In order to work as a pharmacist in another province, s/he needs to write and pass a provincial JP exam to qualify The Role of the Pharmacist The Structured Practical Training Program (SPT)  For graduates of the Pharmacy program at UofW, it is anticipated that the College’s in-service training requirement will be met by an internship period (currently 12 weeks), served after graduation  Prior to graduation, if a student intends to work in Ontario performing the controlled acts of counseling and dispensing in a pharmacy, s/he must register for the position with the College by submitting a completed “Notice of Pharmacy Work Placement: NonCredit Position” for, plus appropriate supporting documentation and required fees  Only those students registered with OCP are allowed to perform the controlled acts of a pharmacist under the direct supervision of a pharmacist The Role of the Pharmacist Requirements for Registration as a Pharmacist in Ontario The individual must:  Provide evidence of identity and legal status in Canada  Provide evidence of good character  Have an undergraduate pharmacy degree recognized by PEBC  Provide evidence of reasonable language proficiency in either English of French  Have a certificate of Qualification from PEBC  Have passed OCP’s JP exam  Successfully complete in-service training while registered as a student and/or as an intern with OCP  Make an application for registration and paid the associated fees The Role of the Pharmacist Requirements for Registration as a Pharmacist in Ontario  Some requirements, such as passing the JP exam or the PEBC Qualifying Exam, can be completed prior to, or during registration as an intern with OCP  To increase the likelihood of being successful in these examinations, it is recommended that Canadian experience is useful before attempting the exams  The PEBC certificate allows a pharmacist to practice in any province, although s/he must successfully complete a provincial JP exam  Pharmacists fees for 2014 were $600 plus $78 HST The Role of the Pharmacist OCP’s Quality Assurance Policy  Pharmacists in Part A must meet the minimum requirements of 600 hours of direct patient care over 3 years and each must maintain a portfolio or record of continuous learning and submit it to the College upon request  The College regulates the profession under the authority of the RHPA, the PA and the DPRA  In order that the public interest may be served and protected, the College’s objects are:  To regulate the practice of pharmacy and to govern the members in accordance with the Pharmacy Act, and the Regulated Health Professions Act, 1991, and its code, and the regulations and by-laws The Role of the Pharmacist OCP’s Quality Assurance Policy  In October, 1995, the Council of the OCP approved the framework for its Quality Assurance (QA) program  This framework includes a 2-part register  Each pharmacist can elect to register in Part A: ‘direct patient care’, or Part B: ‘non-direct patient care’ of the Registrar  For active service, all pharmacists, who have elected to enrol in Part A of the Register, are selected at random to undergo a Peer Review examination which involves a written examination and sessions with ‘patients’ to test their communication skills and knowledge The Role of the Pharmacist Pharm D Degree  A Pharm D (Doctor of Pharmacy) is an undergraduate, professional doctorate  The schools that offer these programs are found at several Canadian universities  These all have unique subjects: 3 schools are in Ontario: Western, UofT and Waterloo; and also in Alberta and UBC in British Colombia The Role of the Pharmacist Pharm D Degree  Graduates are prepared to:  Become strong practitioners and lead the profession by engaging in full scope of practice;  Advance their career through innovative practices;  Demonstrate a competitive advantage when applying for unique and interesting positions;  Develop the skills and knowledge to provide enhanced patient care;  Utilize evidence-based information and clinical judgement to inform decisions;  Contribute to collaborative decision-making for patients with complex pharmacotherapy;  Develop strategies for continued learning throughout their careers  Provide education for a variety of audiences including patients and professionals Responsibilities for Dispensing For the Pharmacist –  The pharmacist remains responsible and accountable for ensuring the therapeutic appropriateness of each Rx  Since dispensing of any prescription has both a technical and therapeutic component, the pharmacy technician will need to perform their new technical functions in collaboration with the pharmacist Responsibilities for Dispensing For the Pharmacy Technician –  Regulation of pharmacy technicians allows them to assume the accountability for the technical aspects of dispensing, compounding and selling a drug, including independent double check and the release of all (new and refill) Rx’s The Role of the Pharmacist Documentation of Patient Dialogue  The pharmacist is required to document all dialogue with patients concerning Rx’s  All dialogue must be documented after it occurs, including situations in which the patient refuses counselling for a new Rx  The pharmacist must identify with a unique identification, such as his or her signature, license # or initials  The person counselled (for example, the patient and or the family member or other agent  The date of counselling, if different from the date the Rx was filled The Role of the Pharmacist Pharmaceutical Care  Pharmaceutical care is patient-centered, allowing the pharmacist o come out from behind the dispensary and develop a pharmacistpatient relationship that provides drug therapy for the purpose of achieving outcomes which improve the patient’s quality of health  While patient counseling is a tool which assists the delivery of pharmaceutical care, patient counseling alone, although a valuable patient-oriented service, is not pharmaceutical care  In the pharmaceutical care model, a pharmacist and patient work together in a cooperative, trusting manner to determine what the patient’s needs are and what care should be provided by the pharmacist in order to best meet these needs The Role of the Pharmacist Pharmaceutical Care  Through this relationship, the pharmacist works with the patient to determine if any drug-related needs exist which are preventing the patient from obtaining his/her desired quality of life  If any drug-related needs are identified, then it is the pharmacist’s responsibility to ensure that these drug-related needs are met  In addition, the pharmacist and patient works with the patient’s physician to develop a therapeutic plan which will attain these specific goals  It is necessary that the pharmacist provide consistent follow-up to the patient and his/her physician, via a carefully designed monitoring plan The Role of the Pharmacist Pharmaceutical Care  This may require pharmacists to, for example, call patients at home at predetermined times or ask patients to telephone on specified dates and/ have patients return to the pharmacy at prearranged intervals  In addition, routine discussion with the patient’s physician may also be necessary  This follow-up is mandatory in order to ensure that the patient’s desired outcomes are being achieved The Role of the Pharmacy Technician Pharmacy Technicians  Are regulated health care professionals within the College of Pharmacy The Role of the Pharmacy Technician On Becoming a Pharmacy Technician  To become a registered technician, you must graduate from a College that offers the Accredited Pharmacy Technician Program  To be eligible for admission the following is needed:   Ontario Secondary School diploma or equivalent including, Grade 12 English, Math, Chemistry and Biology  Additional requirements: complete immunization record, influenza vaccine, TB test, First-Aid training and a Police Record Check There will be 2 unpaid four-week work placements under the supervision of a pharmacy setting, one in retail and the other in a hospital The Role of the Pharmacy Technician Pharmacy Technicians – Working Together – OCP Article  As regulated health professionals, pharmacy technicians work collaboratively with pharmacists under their direction or supervision  The pharmacy technician performs specific technical duties to enhance the service provided to patients including alerting the pharmacist to discrepancies in the accuracy of entering and filling Rx’s and performing a final technical check for product release  When regulated technician cannot do is supervise the pharmacy or delegate a controlled act, although a pharmacist may delegate a task to the PT, provided s/he has the necessary skills to do so The Role of the Pharmacy Technician Tasks Pharmacy Technicians are Permitted to:  Accept verbal Rx’s from a practitioner, except for narcotics, controlled drugs and targeted substances  Accept Rx transfers  Assure that a vial or bottle contains the proper amount of medication  Ascertain the information on the label is correct (name of patient, prescriber, right drug, and directions are correct and clear)  Perform a procedure on tissue below the dermis under supervision of a Part A Pharmacist who is physically present on the premises at the time the technician performs the act The Role of the Pharmacy Technician Tasks Pharmacy Technicians are Permitted to:  In general terms, technicians are accountable and responsible for the technical aspects of both new and refill Rx’s, ie. The right patient, drug dosage form, route of administration, dose and doctor  Pharmacists remain accountable and responsible for the therapeutic/clinical appropriateness of all new and refill Rxs and all therapeutic consultation The Role of the Pharmacy Technician Independent Double Checks  Whenever possible, a final check should be performed by a R.PhT (or pharmacist) who did not enter the Rx into the computer, or did not select the drug from stock  However, if another team member is not available, a final check can be completed by one professional providing there are other systems in place to ensure safe medication practices  The introduction of the Standards of Practice for technicians allows for more flexibility, positioning the ‘independent double check’ as a best practice rather than a requirement  The technician cannot release the product to the patient until the pharmacist has performed the therapeutic check The Role of the Pharmacy Technician Independent Double Checks  Technicians are accountable and responsible for the technical aspects of new and repeat Rxs  All Rxs need at least 2 clearly visible signatures, one from the technician responsible for entering and filling the Rx while the pharmacist needs to check the new Rx to assess whether the medication is appropriate for the patient, and check for any potential adverse effects with other drugs in the patient’s profile  It is important that the pharmacist’s signature is clearly visible on the Rx to allow the team to establish that this has occurred  The pharmacist needs to counsel the patient, answer any questions and document the procedure The Role of the Pharmacy Technician Liability Insurance Required for Registered Pharmacy Technicians  A change in the Regulated Health Professions statue Law Amendment Act resulted in the requirements for all members of any regulated health profession including pharmacy technicians to hold their own personal professional liability when they become registered  The Canadian Association for Pharmacy Technicians (CAPT) has arranged with 3 brokerage companies to provide liability insurance to registered pharmacy technicians (R.PhT) The Role of the Pharmacy Technician Continuing Competency Requirements for Pharmacy Technicians  With the privilege of being a professional, comes responsibilities  Although there are a number of factors that influence competence, the two primary activities are active practice and on-going learning  At this point, continuing competency requirements have yet to be determined  It will likely follow similar requirements for quality assurance as for pharmacists The Role of the Pharmacy Technician Continuing Competency Requirements for Pharmacy Technicians  Minimum requirements will likely be a quality assurance program that includes continuing education or professional development designed to:  Promote continuing competence and continuing quality improvement  Changes in practice environments, incorporate standards of practice, advances in technology,  Changes made to entry of practice competencies and other relevant issues in the discretion of Council, self-peer and practice assessments, and,  Provide a mechanism for the College to monitor members’ participation in, and, compliance with, the quality assurance program The Role of the Pharmacy Technician Continuing Competency Requirements for Pharmacy Technicians  On-going learning incorporates a number of continuing education activities: structured organized educational programs, and nontraditional continuing education, such as work-place learning, community presentations, research and student training, attendance at conferences and seminars  The technician is required to assess their learning needs, create a personal learning plan, implement the plan, evaluate the effectiveness of the educational intervention as it applies to their pharmacy practice and finally document the experience  The registered technician needs to renew their licence annually in March for $400.00 + HST The Role of the Pharmacy Technician Private Vocational Schools – Pharmacy Assistants  There are schools for pharmacy Assistants  After graduation the graduates are not called technicians (‘Technicians’ is a protected name) are able to enter Rxs into the computer and maintain inventory  Both the R.PhT and the pharmacy assistant’s role in the pharmacy will be to assist the pharmacist in all product-related dispensing functions, allowing the pharmacist to be available for patient service functions The Role of the Pharmacy Technician International Pharmacy Technicians  To practise as a pharmacy technician in Ontario, internationally educated pharmacy technician graduates will be required to hold a current Certificate of Registration with OCP  To be eligible for a Certificate of Registration, internationally educated pharmacy technicians will need to meet the following requirements: 1. Have a university degree or diploma in pharmacy, or pass a pharmacy technician program 2. Pass the PEBC Evaluating Exam for R.PhT 3. Meet the OCP English or French fluency requirements The Role of the Pharmacy Technician International Pharmacy Technicians 4. Provide proof of Canadian citizenship, Permanent Residency or authorization to work in Canada 5. Sign a declaration from OCP 6. Successfully complete an approved Structured Practical Training (SPT) program for pharmacy technicians applicants (minimum 12 weeks full time) 7. Pass the PEBC Qualifying Exam for Ph.T’s – Part I MCQ and Part II OSPE 8. Pass the OCP Jurisprudence Exam for Ph.T 9. Provide proof of professional liability insurance 10. Make an application and pay the registration fee The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants Everyone working in a pharmacy has a role to play and needs to have more than a general understanding of the overall functioning of the pharmacy, pharmacy policies, and the function of each before they can effectively perform their duties  The assistant must be familiar with the store layout, daily activities, store rules and policies and all routine operations which contribute to providing service to a customer  Some issues need to be discussed so that staff members are clear on the expectations that they must fulfill   Discussion about dispensary priorities can resolve confusion over roles and responsibilities The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants  You need to be able to assess what is most important among may concurrent demands  When a patient is waiting at the counter to drop off a Rx and the telephone is ringing at the same time, which task should be completed first?  Learn to prioritize! The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants  You also need to develop your knowledge of drugs, disease conditions and the ability to evaluate Rx’s for accuracy and completeness  You need to interpret Latin abbreviations, ‘read’ and ‘interpret’ Rx’s, check for correct dosages and strengths and have an understanding of the symbols that relate drugs to Rx status  You also need to become familiar with the laws governing the dispensing of Rxs in Ontario and their application to everyday practice The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants  Communication skills are probably the most important skill for any person involved in pharmacy  One of the most important attributes of an excellent technician is the ability to communicate effectively with a broad spectrum of people and organizations with whom you are in daily contact – patients of various ages, socioeconomic, cultural and ethnic backgrounds, other staff members, sales representatives, government officials such as inspectors, third party agents, manufacturers and distributors The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants  Communication skills cannot be readily taught in a step-by-step progression  However, it is an ability which can be learned through willingness and desire to do so and through practice and repetition  If you can learn to communicate well, you will not only serve your employer well but also yourself The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants  Communication skills are important in projecting an improved image of pharmacy, improving patient loyalty to your pharmacy, improving patient compliance, improving health care and giving you the personal satisfaction of fulfilling your role as an effective member of the pharmacy team  These skills are important in you vocation as well as in your personal life The Role of the Pharmacy Technician Pharmacy Duties for Pharmacy/Dispensary Assistants Personnel who learn how to manage inventory and maintain appropriate and accurate inventory records are a valuable asset to the ‘business’  The pharmacist does not have time to take on this task  If you do it and do it well, you become invaluable to the smooth operation of the pharmacy and you will soon discover a niche for yourself  Graduates will find traditional career opportunities in community and hospital pharmacies and some may also find employment with third-party payers, computer software companies and the pharmaceutical industry 