newsMay / June 2015

Healthy Albertansthrough excellencein pharmacy practice

IN THIS ISSUE...3 n APEX Awards recipients

Quality Pharmacy Practice

5 n Lessons learned – Don’t letperceived business expedienciestrump professional obligations

n Lessons learned – Compliancewith the ACP ContinuingCompetence Program is yourprofessional obligation

Registration & Licensure

6 n Renewal reminders forpharmacists and pharmacies

Continuing Competence

7 n The final step: Submitting yourprofessional portfolio

n Audit of professionalportfolios

8 n Go digital with aφnews

Message from the Registrar

Just because you can, doesn’tmean that you should!Privileges provided to pharmacists andpharmacy technicians through “restrictedactivities” approved in the Pharmacistsand Pharmacy Technicians ProfessionRegulation must not be read andperformed in isolation. They must beread in context with the role statementsfor each profession under Schedule 19 ofthe Health Professions Act. The authorityto perform a restricted activity must notbe viewed as an entitlement; but ratheras enabling authority to use a particularintervention in a manner that complieswith our Code of Ethics, and theStandards of Practice for Pharmacists andPharmacy Technicians. “Just because youcan perform an activity, it doesn’t meanthat you should!”

Further guidance is provided throughbest practices and guidelines that spanmultiple professions.

Underlying all is your responsibility tohold the health and well-being of eachpatient as your primary consideration,and to understand your personallimitations and restrict your practice toactivities and decisions that you arecompetent to perform. Theseconsiderations all need to be made incontext with one and other. As a healthprofessional you must apply judgement.“Just because you can perform an activity,it doesn’t mean that you should!”

When you determine it is appropriateto proceed, you should be mindful toinclude patients in decisions abouttheir care, and ensure that your

decisions must be made in context withthose of other members of patients’health teams. Decisions you make andactions you take affect the patient; butyou must remember that yourdecisions and actions may also affectdecisions previously made by otherhealth professionals and may impactfollow-up care that is required.Therefore, depending on the situation,you must determine the level ofcollaboration or communication that isnecessary. Collaboration versuscommunication alone improves care,and improves relationships amongsthealth team members.

continued on page 2

Collaborativerelationship ...means a relationship betweentwo or more regulated healthprofessionals that is developed to:

i. facilitate communication,

ii. determine mutual goals oftherapy that are acceptable tothe patient,

iii. share relevant healthinformation, and

iv. establish the expectations ofeach regulated healthprofessional when workingwith a mutual patient

All pharmacists are permitted to“adapt” prescriptions. ACP providesseveral resources and references thatoutline the requirements whenadapting a prescription.

n The Code of Ethics

• Principle One – “Hold the well-being of each patient to bemy primary consideration”Visit the ACP website atpharmacists.ab.ca/code-ethics

n The Standards of Practice forPharmacists and PharmacyTechnicians

Visit the ACP website atpharmacists.ab.ca/standards-practice

• Standards 3 – consideringappropriate information (page 16)

• Standard 11- comply withregulatory framework ifprescribing (page 31)

• Standard 12 – procedures whenadapting a prescription (page 33)

n Chat, Check and Chart toolsincluding “Vital to Chat, Checkand Chart”

Visit the ACP website atpharmacists.ab.ca/print-materials-tools

You can adapt a prescription if youfollow the direction provided in thesereferences, but as described above, youmust apply judgment to considerwhether you should. Adapting alwaysrequires that another health professionalhas made a prescribing decision. Theassessments and decisions of pharmacistsare equally important, butsupplementary to this. You mustdetermine mutual goals of therapy thatare in the best interests of the patient andin doing so you must not makeassumptions. Contrarily, should youassume any information important to aprescribing decision, you expose patientsand yourself to risk.

Just because you can adjust a dose, itdoesn’t mean that you should!Sometimes a better practice would be tocontact the original prescriber, anddiscuss the merits of a change in dose,before doing so. This demonstratescollaboration, as compared to simplecommunication through notification. If aprescriber is unavailable and/or youdetermine that, based on the merits of allthe information you have considered itmakes sense to proceed, you can do so.However, by exercising the diligence tostop and consider whether you shouldproceed, you will make better decisions,your patients and you will be exposed tofewer risks, and your relationships withother prescribers will improve.

“Just because you can, it doesn’t meanthat you should!” What do you think?Please forward your thoughts toexecutiveassistant@pharmacists.ab.ca

aφnews – May / June 2015 2

aφnews is published six times per yearby the Alberta College of Pharmacists.

Editor in Chief: Greg EberhartManaging editor: Shirley Nowicki

Please send comments or submissionsfor publication tocommunications@pharmacists.ab.ca.

The deadline for submissions for theJuly/August 2015 issue is June 4.

ACP Council ExecutivePresident: Brad Willsey President Elect: Rick HackmanExecutive Member at Large:

Taciana PereiraPast President: Kelly Olstad

Councillor email addresses are posted onour website under About ACP/Council.

Staff DirectoryRegistrar: Greg EberhartDeputy Registrar: Dale CooneyOperations and Finance Director:

Lynn PaulitschCommunications Director: Shirley NowickiCompetence Director: Debbie LeeComplaints Director: James KrempienPharmacy Practice Consultants:

Tim Fluet, Chantal Lambert, Monty Stanowich, Jennifer Voice

Professional Practice Director: Shao LeeRegistration Manager: Linda Hagen

Staff email addresses are posted on ourwebsite under Contact Us.

Alberta College of Pharmacists1100, 8215 - 112 Street NWEdmonton AB T6G 2C8T 780-990-0321TF 1-877-227-3838F 780-990-0328

pharmacists.ab.ca

news

Vital behaviorscritical to yourdecision to adaptinclude ... n Connect with patients – Engage

patients at every encounter andcreate an opportunity for patientsto collaborate in their care

n Confirm and documentindication – Confirm theindication so that you knowwhat needs to be assessed

n Access Netcare – Use Netcareroutinely as part of yourassessment, care plan, andfollow up

n Assess at refill – Reconnectwith patients and find out howtheir medications are workingfor them.

Just because you can, doesn’t mean that you should!

Adapting prescriptions

Roberta StasykManager, Pharmacy Services, Royal Alexandra Hospital, Alberta Health Services; Edmonton

Roberta’s passion lies in adult educationand in the pursuit of excellence inpharmacy practice. In her currentleadership role as Manager of PharmacyServices at the Royal Alexandra Hospital,Roberta is an advocate, teacher, manager,and collaborator with colleagues,pharmacy teams, and multi-disciplinarystakeholders. She counsels and providesopportunities for other pharmacists toexpand their scopes of practice, andsupports a team of over 140 individualsto deliver exceptional pharmacy serviceto the patients of the Royal Alex.

Prior to her current position, Robertawas a community pharmacist, hospitalpharmacist, and regional pharmacysupervisor before taking on the role ofCompetence Director at the AlbertaCollege of Pharmacists where she spent

12 years leading change in thepharmacy profession. Here, shedeveloped and rolled out theframework and processes for theRxCEL Competence Program.

Roberta’s leadership in promotingcontinuing professional developmentraised the bar not only for what thepublic should expect of pharmacists,but also for the care they shouldreceive from them. Her role inestablishing the additional prescribingauthorization framework wasessential in helping pharmacists totake on new levels of responsibilityand provision of patient care.

aφnews – May / June 2015 3

Pinnacle category recipients

The APEX awards recognizeexcellence in pharmacy practicein Alberta. On behalf of everyonehere at ACP, congratulations tothis year’s recipients. We areproud to celebrate youroutstanding contributions to thepharmacy profession.

The APEX Awards are jointlyfunded, promoted, and presentedby the Alberta Pharmacists’Association (RxA) and the AlbertaCollege of Pharmacists (ACP).

Over the next few issues ofaφnews, it will be our pleasure toprofile this year's award recipients.

W.L. Boddy Pharmacy Team AwardAwarded to a healthcare team who, byvirtue of their collaboration skills and use ofthe pharmacist’s full scope of practice,positively impact the health of individualsin their community.

Ryan StempfleVP Clinical and Pharmacy Strategy,Pharmacare Clinical Pharmacist Team;Edmonton

Autonomy, access to cutting edgetechnology, professional development,and having influence in making decisionsis what Ryan Stempfle, Pharmacare’s

M.J. Huston Pharmacist of Distinction Awarded to a pharmacist who has demonstrated leadership and advanced the pharmacistprofession through a long-time commitment to innovation, continual professional development,and quality patient care.

Pharmacare Clinical Pharmacist Team (L to R): Jayson Lee, Tyler Watson, Gillian Hansen, RyanStempfle, Travis Featherstone, Michael Paulsen, Ashley Young, Andrew Fuller, Ron Marcinkoskicontinued on page 4

aφnews – May / June 2015 4

Vice President of Clinical and PharmacyStrategy, feels makes a great team andgreat work environment.

Ryan leads the Pharmacare team – adynamic and high performing group ofprofessionals who place an emphasis onworking to their full scope of practice. In

fact, pursuing additional prescribingauthorization has become the team’s topstrategic initiative, along with acquiringtraining in disease state management,and developing capacity to preceptpharmacy students.

“Ultimately our team brings access tocare into the community, bringing a fullscope of practice to offer timelyassessment, intervention, and follow-up

to improve health outcomes, reduce risksof hospitalization, and enhance quality oflife for our patients,” explains Ryan.

Ryan believes in the massive power ofteam work. “Everyone’s input is valuedand we are all part of the idea process.Not only is it a privilege to be part of thisteam, but also to serve our patients in thecommunity, and to provide them withpositive health outcomes.”

Michelle BerresheimClinical Practice Leader, Queen Elizabeth II Hospital, Alberta Health Services; Grande Prairie

\

Andrew FullerClinical Operations Manager,Pharmacare Specialty Pharmacy;Edmonton

Tyler WatsonClinical Operations Manager,Pharmacare Specialty Pharmacy;Edmonton

Ann VlahadamisNurse Practitioner, Cross CancerInstitute, Alberta Health Services;Edmonton

Robert Mattice Pharmacist/Owner, Grand Centre Value Drug Mart; Cold Lake

W.L. Boddy Pharmacy Team Awardcontinued from page 3

Future of Pharmacy

Friend of Pharmacy Pfizer Consumer Healthcare Bowl of Hygeia

Peak category recipients

aφnews – May / June 2015 5

A recent hearing tribunal issued writtendecisions on the merit and subsequentorders regarding the conduct of apharmacist, who was a pharmacylicensee, during the period of the allegedmisconduct. Amongst the allegationsconsidered was that the pharmacistfailed to create and maintain appropriateand required patient records.

A licensee’s “business decision” was notaccepted by the hearing tribunal asjustification to not fulfill the licensee’srecord keeping responsibilities. Rationalefor the tribunal’s decision is reflected inits following statements:

If the evidence established that there wereonly one or two missing documents, or oneor two triplicates that were dispensed latewithout documentation, then the evidencewould not be sufficient to prove theallegations, or to demonstrate that theintegrity of the profession was impacted by[the pharmacist’s] conduct. But, that is notthe case here. [The pharmacist] was auditedin the past and should have learned from hispast audit results and changed his practice.Instead, he chose to make a businessdecision to not worry about it and just paya penalty. This is definitely damaging to theintegrity of the profession.

Other lessons that can be learned fromthis matter include:

n Repetitive practice doesn’t necessarilymake for good or acceptable practice.

n Licensees must ensure that allrequired pharmacy records are notonly created, but are also maintainedin a manner that allows for effective,systematic retrieval.

n Records must be created properly.Records must be complete, clear,concise, and comprehensible.

n The ability to retrieve patient recordsis an important element in providingproper care and maintaining thepublic’s trust in our profession. Intheir decision on orders, the hearing

tribunal stated: “Record keeping anddocumentation is fundamental toprotecting the public.”

Pharmacy licensees –incorporate these lessons intoyour practice1. Review the Pharmacy and Drug Act

(Section 10), the Pharmacy and DrugRegulation (Sections 12 and 12.1), andthe Standards for the Operation ofLicensed Pharmacies (Standard 8) inrelation to your pharmacy’s standardoperating procedures.

2. Review your professionalobligations and the correspondingresources needed to meet theseobligations with your pharmacy staffand owner.

3. Continuously challenge yourpharmacy’s “old way” of recordkeeping. Review current practices andyour corresponding professionalobligations to ensure you are meetingyour responsibilities.

4. Discuss the record keepingrequirements with your peers andimplement better practices.

5. Seek the assistance of others (regionalpharmacy personnel, ACP pharmacypractice consultants) to identifysolutions to any resource shortfallsand to improve record keepingefficiencies within the pharmacy.

For the complete written decision, go to:https://pharmacists.ab.ca/sites/default/files/Porzoni-merit2014.pdf

A recent hearing tribunal issued itswritten decision on the merit and ordersregarding the conduct of a pharmacistfailing to meet an established documentsubmission deadline prescribed by ACP’scompetence committee.

A pharmacist’s initial decision to stoppracticing and contemplate “walkingaway” from the profession was notaccepted by the hearing tribunal asjustification to ignore deadlinesprescribed by the competencecommittee while on the clinicalpharmacist register. Even though thehearing tribunal heard informationabout the pharmacist’s medical issuesand stressors as partial response for notcomplying with an ACP establisheddocument submission deadline, thehearing tribunal affirmed the necessityfor pharmacists to fully comply withthe requirements of the CompetenceProgram while on the clinicalpharmacist register.

In a nut shell: As a pharmacist, if youare unable to comply with thedeadlines and requirements of theCompetence Program, then you likelyshould not be on the clinical register,whether you’re actively engaged inpractice or not.

Rationale for the tribunal’s decision isreflected in its following statement:

An expectation of safe and effectivepharmacy practice is for all pharmacists toremain current with clinical best practicesand up-to-date medication knowledge. TheAlberta College of Pharmacists’Competence Program is a necessary part ofensuring that pharmacists continue todemonstrate their clinical skill and ongoingcompetence to practice pharmacy.Compliance with this program is arequirement for all pharmacists, and [thepharmacist’s] repeated failure to do sodemonstrates conduct that undercuts thebasic duties and obligations of pharmacists.

QualityPharmacyPractice

Lessons learnedDon’t let perceived business expediencies trump professional obligations

Compliance with the ACP Continuing CompetenceProgram is your professional obligation

continued on page 6

Pharmacists – incorporate theselessons in approaching ACP’sCompetence Program:Review your professionalresponsibilities for complying with theContinuing Competence Program andin responding to ACP. Principles 9, 10,and 11 of the Code of Ethics willprovide you with valuable guidance inthis respect.

1. Review and understand all aspects ofACP’s Competence Program.Excellent information about the CCPcan be found in recent editions ofaφnews, on the ACP website in thecompetence sections, and through theCCP online tutorial.

2. Proactively respond to and completeall requirements of the CCP. Don’twait until the last minute to respond,especially if you think you may not beable to fully respond to a requirementof the CCP.

3. If you think you need helpunderstanding or complying with theCCP, ask for, and accept assistance.

4 Discuss the CCP requirements withyour peers.

For the complete written decision, go to:pharmacists.ab.ca/sites/default/files/Ebied_3717_2015.pdf

Pharmacist practice permitrenewals due by May 31

In April, ACP emailed renewal notices toall pharmacists. Complete details onrenewing practice permits can also befound on ACP’s website under “BulletinBoard” located on the homepage –“Pharmacist online renewal now open.”

Pharmacy licence renewalsdue before June 16

Pharmacy licence renewals have beenmailed to each pharmacy. Be sure tocontact ACP if you have not receivedyour package.

What if someone else ispaying fees?

Pharmacists: If your employer ispaying your fees, you are stillresponsible for ensuring ACP receivespayment before May 31. Practicepermits will not be issued until ACPreceives payment, and as you areaware, pharmacists cannot practicewithout a valid permit.

Licensees and proprietors: If yourpharmacy is paying renewal fees foryour employees and your pharmacy,please note payment for yourpharmacists must be received byACP no later than May 31.

Pharmacist renewals –Authorization to AdministerDrugs by Injection

If you currently hold Authorization toAdminister Drugs by Injection, andintend to retain authorization (effectiveJuly 1), you will be required to re-certifyupon renewal of your practice permit.The process involves completing aprofessional declaration indicating you:

i. have taken action to maintain bothyour clinical and technicalcompetencies required foradministering injections;1

ii. have and will maintain valid CPR(minimum level C);

iii. have and will maintain valid First Aidcertification (minimum standard oremergency); and

aφnews – May / June 2015 6

Registration& Licensure

1 To see NAPRA’s Competencies on Injection for Canadian Pharmacists, go to http://napra.ca/Content_Files/Files/Supplemental_Competencies_on_Injection_for_Canadian_Pharmacists2012.pdf

Renewal reminders for pharmacists and pharmacies

If you plan to renew your2015/2016 practice permit, youare required to complete all therequirements of the newContinuing CompetenceProgram (CCP) prior to renewal.Only exemption: pharmacistswho register on the clinicalregister for the first time inAlberta between January 1, 2015and June 30, 2015.

Lessons learnedcontinued from page 5

iv. have administered an injection withinthe past three years.

Pharmacists who are unable to completethis professional declaration because theyhave not maintained the requiredcompetence, or have not administered aninjection within the past three years, cancomplete their online practice permitrenewal – however their authorizationto provide drugs by injection will expireon June 30. These pharmacists mustcontact the ACP office if they wish toregain this authorization.

Professional declarations audit

If you hold Authorization to AdministerDrugs by Injection and are selected toparticipate in a professional declarationsaudit, you will be required to submit:

n proof of holding a minimum $2million personal professional liabilityinsurance policy;

n proof of holding current First Aid(minimal standard or emergencycare level); and

n proof of holding CPR (minimalLevel C).

You may be requested:

n to provide information regardingyour last injections; and/or

n to provide information to indicatehow you maintained yourcompetence.

Questions? Contact us:Pharmacist reinstatement requests:statuschange@pharmacists.ab.ca

Pharmacist renewal questions:registrationinfo@pharmacists.ab.ca

Pharmacy renewal questions:pharmacyinfo@pharmacists.ab.ca

Competence Program questions:competence@pharmacists.ab.ca

Tel: 780-990-0321TF: 1-877-227-3838Fax: 780-990-0328

Thank you pharmacists for continuingto work on the new CompetenceProgram. We hope you are finding it tobe a rewarding experience. Your laststep is to submit your professionalportfolio to the college. You will needto complete this step before you canrenew your practice permit online as aclinical pharmacist for 2015/2016.

Where do I find thesubmit button?One of the most commonly askedquestion we have received is, “Where isthe submit button?”

The submit button is located on thehome page of the CCP portal, along theleft-hand side, and is only accessibleduring the online registration renewalperiod (end of April-May 31). Once youhave completed all of the program’srequirements, then you are able tosubmit your portfolio by clicking on thesubmit button. (Please note, once youhave submitted your portfolio, you will nolonger be able to make changes to thesubmitted records.)

If you are unable to submit yourportfolio online, it may be that some ofthe requirements were not fullycompleted. Checkmarks above thesubmit button identify sections of theCompetence Program you’ve completed.If a checkmark is missing, please refer tothe corresponding section and competethe requirement.

Portfolio submission help guideFor additional support and information,please refer to our new help guide onhow to submit your professionalportfolio. The help guide is located onthe ACP website under Resources –Competence – CCP Requirements.

Feedback requestNow that you have completed theCompetence Program, we wouldappreciate your feedback on therevised program. Upon submittingyour portfolio, you will be prompted tocomplete a short survey. We lookforward to using your feedback it toimprove the program.

ContinuingCompetence

The final step: Submitting yourprofessional portfolio

Audit of professional portfoliosEvery year, a percentage ofpharmacists, will be selected to havetheir professional portfolios audited. Ifselected, your portfolio will gothrough an administrative audit and

your implementation record will bepeer assessed by two pharmaciststrained in assessment.

Your portfolio may be selected for anaudit as a result of:

n random selection;

n a late or incomplete submission; or

n a request of the registrar as aresult of concerns received aboutyour practice.

Pharmacists who have successfullycompleted a competenceassessment/CCP audit within the lastfive years and pharmacists who have

continued on page 8

aφnews – May / June 2015 7

Canadian Publication Agreement Number: 40008642

Return undeliverable Canadian addresses to:Alberta College of Pharmacists1100 - 8215 112 Street NW, Edmonton, AB T6G 2C8news

aφnews – May / June 2015 8

As of the July-August aφnews issue,we’ll be defaulting all registrants’newsletter subscriptions to “email.”You’ll receive the same copy ofaφnews, but in an electronic PDFformat to the email address on file withus. You can print it, save it to your harddrive, or view it on our website at anytime. It’s the same newsletter – butmuch more eco-friendly!

Still want a paper copy?You’ll be able to update your aφnewspreference to “Regular Mail” duringregistration renewal, or by logging in to your registrant profile online atany time.

Go digital with aφnews

been granted additional prescribingauthorization within the last five yearswill not be selected for random audit.The portfolios for these pharmacists willonly be selected for an audit if there isanother reason, such as a late orincomplete submission, or a request fromthe registrar.

Implementation RecordchecklistShould your Implementation Record bechosen for audit, your peers will belooking for the following indicators:

o Are the learning activities identifiedrelevant to your implementationobjective?

o Is your implementation objectiveclearly outlined and related topharmacy practice, medicalknowledge, and/or systems-basedpractice?

o Is your rationale for choosing theimplementation objective, andhow it is relevant to your practice,clearly indicated?

o Are the steps you took to achievethe implementation objectiveclearly indicated?

o Is the outcome of the implementationclearly explained?

o Is it clearly evident that you playeda role in the implementation andthat the implementation objectivewas achieved?

o Do your records appear professional?

Because you submitted all of yourinformation when you submitted yourportfolio, you will not be notified untilthe audit has been completed. When theaudit is complete, you will receivefeedback on your portfolio. If you haveachieved the established standard, nofurther action is required. Continueyour activities within the current CEcycle. If you did not achieve theestablished standard, then you will beprovided with further instructions. Formore information about the auditprocess, please refer to the ContinuingCompetence Program Rules availableon the ACP website.

For further assistancePlease contact a member of thecompetence team atcompetence@pharmacists.ab.ca; and/orreview the FAQs on the ACP website.

Audit of professional portfolioscontinued from page 7

ACP emails and newsletters are official methods of notification to pharmacists andpharmacy technicians licensed by the college. In addition to providing you with timelyinformation that could affect your practice, college emails serve in administrativehearings as proof of notification. Make sure you get the information you need topractice legally and safely by reading college newsletters and ensuring ACP emails arenot blocked by your system.!