BULLETIN V o l . 2 9 N o . 3 M a y / J u n e 2 0 0 4

C o l l e g e o f P h a r m a c i s t s o f B r i t i s h C o l u m b i a

www.bcpharmacists.org

In this issue

Pharmacy-to-pharmacy 2inventory transfers

Changes to registration 4renewal

PDAP update 5

People news 6

E-link: Canadian pharmacists 11get connected

Pharmacists hit the road to advance our profession

Most people dont volunteer to write exams - let alone travel thousands of kilometres for the privilege. But thats how Annette Robinson of Chilliwack, BC and Janet Vanyo of Duncan spent two days in March. Their objective was to nd ways to adapt the U.S. National Institute of Standards in Pharmacy Credentialing (NISPC) exams to meet the needs of Canadian pharmacists.

One of the barriers to developing Advanced Practitioner Credentialing (APC) in Canada has been the relatively small number of pharmacists likely to pursue certication, explains Deputy Registrar Brenda Osmond. Its too expensive to design exams suited to Canadian needs. The only existing exams are designed for the U.S. healthcare system.

Annette and Janet are two of nine pharmacists from across Canada who travelled to Chicago to write three-hour NISPC exams and brainstorm ways to modify them to suit Canadian requirements.

Janet, who received National Respiratory Training Centre (NRTC) Certication as an asthma specialist in 1998, says, I went to Chicago because Im curious about the standards and patterns of pharmacy practice in the U.S. and how they compare to those in Canada. Although it took a while to adjust to U.S. drug names and questions about drugs that arent

Prime Minister supports IPG program

By the end of this year about 30 pharmacists from more than 14 countries are expected to qualify to practise in British Columbia, thanks to collaboration between the UBC Faculty of Pharmaceutical Sciences and the University of Toronto.

Pioneered in 2001 by the University of Toronto, the 16-week International Pharmacy Graduate (IPG) program uses a combination of classroom instruction, prior-learning assessment, mentorship and in-pharmacy experience to help pharmacists educated outside North America meet Canadian practice standards and licensing requirements. IPG graduates also need to complete the Pharmacy Examining Board of Canada (PEBC) exam and BCs jurisprudence exam before they can practise in BC.

This years intake of pharmacists come from Eastern Europe, Egypt, Ethiopia, Ghana, India, Japan, Jordan, Korea, Nigeria, Pakistan, Palestine, Phillipines, Russia and Syria. Their professional background includes hospital and community practice, experience in academia and work in the pharmaceutical industry.

Over 300 people have taken the International Pharmacy Graduate program in Ontario and more than 90 percent of

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COUNCILLOR CONTACT LIST

COLLEGE M I S S I O NTo ensure British Columbia pharmacists provide safe and eective pharmacy care to help people achieve better health.

Wayne Rubner, President District 1 - Metropolitan Vancouver tel: 604-730-7928 email: Wayne_R@shaw.ca

Amin Bardai District 2 - Fraser Valley tel: 604-241-9115 fax: 604-241-9115 email: aminbardai@shaw.ca Howard Rose District 3 - Vancouver Island/Coastal tel: 250-592-4541 fax: 250-370-9149 email: hojoro@telus.net Erica Gregory District 4 - Kootenay/Okanagantel: 250-368-3790 fax: 250-368-3513email: ericagregory@look.ca Rita Thomson District 5 - Northern BCtel: 250-564-0910 fax: 250-562-7369email: mezcalmike@telus.net

John Hope District 6 - Urban Hospitals tel: 604-587-3721 fax: 604-587-3720 email: John.Hope@fraserhealth.ca Carol Gee District 7 - Community Hospitals tel: 250-565-2318 fax: 250-565-2888 email: Carol.Gee@northernhealth.ca Robert Sindelar, Dean Faculty of Pharmaceutical Sciences tel: 604-822-2343 fax: 604-822-3035 email: sindelar@interchange.ubc.ca Jo Ann Groves Government Appointee, Smithers tel: 250-847-2214 fax: 250-847-2171 email: coastm@bulkley.net

Marina Ma Government Appointee, Vancouver tel: 604-657-9802 fax: 604-261-0082 email: mma@uniserve.com

Peter Rubin Government Appointee, Vancouver tel: 604-631-3315 fax: 604-631-3309 email: peter.rubin@blakes.com

Pharmacy-to-pharmacy inventory transfers

Any pharmacy manager who provides drugs to another pharmacy should be aware that he or she must have a federal Establishment Licence. Although this is not a new regulation, it has not always been enforced by Health Canada, says Registrar Linda Lytle.

Many small pharmacies traditionally group together to meet a manufacturers minimum order requirement and then divide the drugs amongst the various pharmacies. However, with the growth of International Prescription Services, Health Canada is reviewing stricter enforcement of Establishment Licensure.

According to Health Canadas Drug Inspection Unit, all persons who sell drugs to customers other than the nal retail customer must have an Establishment Licence. This applies to pharmacies involved in:

Fabricating Packaging/labelling Testing

Obtaining a licence is not onerous, says Linda. A pharmacy manager must demonstrate compliance with Good Manufacturing Practices.

You can locate more information by checking the links below, or by telephone from James Bellis, Acting Manager of

Importing Distributing Wholesaling

Product selection clarications

Streamlined drug interchangeability decision-making procedures were introduced in an FYI in October 2003. Pharmacists are now able to exercise professional judgment regarding the interchangeability of drug products. They can make decisions based on Health Canadas Declaration of Equivalence, and they can obtain this information from each generic products manufacturer.

Pharmacists can also rely on their knowledge that two products meet the denition of interchangeable drug as described in provincial pharmacy legislation.

Questions have been raised about two groups of products that were approved prior to 1995 and were not based on comparative data. Declarations of Equivalence do not exist for these two groups of products.

5-ASAAn abstract published in Gastroenterology

in 1999 found that three 5-aminosalicylic acid products available in Canada had dierent pH-dependent release characteristics. In the absence of other data demonstrating that the products are the same, patients should remain on the product they are on at the moment.

If additional scientic information becomes available, pharmacists should evaluate the new information and reach a professional judgment about interchangeability based on the new information. If a pharmaceutical manufacturer has information that will assist a pharmacist in making this decision, it is free to provide it to pharmacists.

Conjugated estrogens

The currently available conjugated estrogen products were not approved by Health Canada based on direct comparisons between the products. There is evidence in the medical literature that women taking

these products experience dierent clinical responses. Women should remain on the product they are on at the moment.

If a pharmaceutical manufacturer has information that will assist pharmacists to reach a dierent conclusion, it is free to provide that information to BC pharmacists.

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DRUG ADVISORIES

Permax (pergolide mesylate): sudden onset of sleep

Patients receiving treatment with Permax have reported suddenly falling asleep while engaged in activities of daily living, including driving a car, which has sometimes resulted in accidents. Although some patients reported somnolence while on Permax, others perceived they had no warning signs, such as excessive drowsiness, and believed that they were alert immediately prior to the event.

Episodes of falling asleep while engaged in activities of daily living have also been reported in patients taking other dopaminergic agents, therefore, symptoms may not be alleviated by substituting these products.

T a m i f l u ( o s e l t a m i v i r phosphate): not indicated for patients less than one year old

Based on new preclinical data with juvenile rats, Tamiu should not be used for treatment or prophylaxis of inuenza in patients less than one year of age. Tamiu is indicated for the treatment of acute illness due to influenza in pediatric patients one year and older who have been symptomatic for no more than two days. Tamiu is also indicated for the prophylaxis of inuenza illness in adult patients and adolescents 13 years and older following close contact with an infected individual.

T a z o c i n ( p i p e r a c i l l i n /tazobactam): Bio-Rad aspergillus assay interaction

There have been reports of false positive test results using the Bio-Rad Laboratories Platelia Aspergillus enzyme immunoassay (EIA) test in patients receiving

available in Canada, overall she feels that the NISPC asthma exam is a good starting point to formulate a standardization exam for Canada.

Annette, who is involved with the Canadian Diabetes Association at both the local and national level and is a Certied Disease Manager, says, I felt the NISPC exam (in diabetes) was an excellent knowledge exam. I feel my experience will, through discussion with other committee members, allow us to decide if this is the type of exam we want to use for the credentialing process.

The nine exam reviewers came up with four recommendations. From the perspective of content (not cost or logistics) they agreed the NISPC exams could be used as part of a Canadian specialty certication program provided that:

1. Accommodation is made with respect to U.S. brand names (i.e. either include both Canadian and U.S. brand names, or generic names);

Pharmacists hit the roadcontinued from pg 1

continued on pg 9

piperacillin/tazobactam injection who were subsequently found to be free of Aspergillus infection. Cross-reactions with non-Aspergillus polysaccharides and polyfuranoses with the Bio-Rad Laboratories Platelia Aspergillus EIA test have been reported. Therefore, positive test results in patients receiving piperacillin/tazobactam should be interpreted cautiously and confirmed by other diagnostic tests. The safety and efficacy of Tazocin remain unchanged.

Viramune (nevirapine): risk factors for severe, life-threatening and fatal hepatotoxicity

Viramune is a non-nucleoside reverse transcriptase inhibitor indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents. Women with CD4+ counts >250 cells/mm3 at initiation of therapy, including pregnant women receiving chronic treatment for HIV infection, are at considerably higher risk (12-fold) of hepatotoxicity, which in some cases has been fatal.

The greatest risk of severe and potentially fatal hepatic events (of ten associated with rash) occurs in the first six weeks of Viramune treatment. However, the risk continues after this time and patients should be closely monitored for the first 18 weeks of treatment. In some cases, hepatic injury progresses despite discontinuation of the drug.

Zyprexa (olanzapine): not approved for elderly patients with dementia-related psychosis

Cerebrovascular adverse events have occurred in elderly patients with dementia-related psychosis treated with Zyprexa (olanzapine) in clinical trials. Zyprexa is not approved for use in elderly patients with dementia-related psychosis.

the Establishment Licensing Unit at Tel: 613-954-6790, Fax: 613-957-4147.

Link to Establishment Licence application form:http://www.hc-sc.gc.ca/hpfb-dgpsa/inspectorate/del_app_v4_nov2003_e.pdf

Link to Establishment Licensing guidance document:http://www.hc-sc.gc.ca/hpfb-dgpsa/inspectorate/gui_doc_el_elf_tc_e.html

Link to Food and Drug Act:http://laws.justice.gc.ca/en/F-27/

Link to other relevant information:http://www.hc-sc.gc.ca/hpfb-dgpsa/inspectorate/establishment_licences_e.html

F o r f u l l d e t a i l s p l e a s e check the College website, www.bcpharmacists.org.

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COUNCIL HIGHLIGHTS

continued on pg 5

Council to raise awareness of pharmacy

Raising the prole of our profession - thats one of the key commitments made by President Wayne Rubner and Council. We want to reach out to our communities, meet local pharmacists and increase public awareness of the vital role pharmacists play in health care, says Wayne.

Starting this fall, Councillors will donate their time to give presentations to health consumer groups based on the Ministry of Healths BC HealthGuide Program. Our goal is to promote the special role of pharmacists in supporting the Pharmacist Network and BC NurseLine and to recognize the work of pharmacists within their communities, says Wayne. Were currently working to identify target groups.

Councillors will also provide information about BC HealthGuide OnLine, a website that expands on the BC HealthGuide, and BC HealthFiles, a series of fact sheets about health and safety issues. We hope to reach groups in every district, says Wayne.

Councillors plan to invite local hospital and community pharmacists to attend the presentations and recognize them during each event. We want to do our part to raise the prole of pharmacists where they work - in their own communities.

For more information about Councils BC HealthGuide presentations please contact President Wayne Rubner by email: Wayne_R@shaw.ca.

April 23, 2004

International Pharmacy ServicesCouncillors reviewed recent

d e v e l o p m e n t s c o n c e r n i n g international pharmacy services (IPS), with special attention to reports of drug product shortages and prescription drug price increases. Although media reports suggest drug shortages are a growing concern, there is no evidence of a direct link between reported shortages and cross-border drug sales. Likewise, there is no evidence-based information relating recent prescription drug price increases to shipment of drugs to U.S. patients. Health Canada inspection sta will determine if unapproved drugs manufactured in other countries, or counterfeit drugs, are being used for preparing prescriptions for cross-border shipment. Its inspectors have found no problems to date.

Council Project 2004Councillors held a planning

session to determine the content, timing and format of public forums they will present in the fall. These forums will focus on the role of pharmacists in our communities, Pharmacist Network , BC HealthGuide and the role of the College. To prepare for the presentations Councillors will take part in training sessions during the next two Council meetings.

Medical marijuanaDeputy Registrar Brenda Osmond

provided Council with a medical marijuana update and answered questions. She informed Councillors that Health Canada plans to begin a pilot project after federal regulatory changes are complete (likely this fall). In the pilot, which could be conducted in BC, physicians will confirm each patients diagnosis conforms to medical conditions for which use of medical marijuana will be permitted. Trained and certied

Changes to registration renewal

If your annual registration renewal is coming up soon, dont wait to receive a reminder in the mail before remitting your fee. Were no longer sending out renewal letters because they caused confusion for so many pharmacists, says Registrar Linda Lytle. We will continue to phone pharmacists if we dont receive their fee within a few days of their renewal date.

Its common practise for employers to cover renewal fees for their pharmacists, but they often wait until the last moment before forwarding payment. However, the College database was set up to send out reminders two weeks prior to the renewal date. The result was that the system sent reminders to individual pharmacists who worried that their employers had forgotten to pay their renewal fees.

Adding to the confusion, the College also accepts post-dated cheques, which are not entered into the system until they are deposited. What weve discovered is the reminder letters caused more harm than help, says Linda. Very few pharmacists need a written reminder, but they do appreciate a personal phone call if something has gone astray. Cutting out reminder letters will also save time and postage costs, helping the College to control future fee increases.

For more information on the Colleges registration renewal policy, please contact Elsie Farkas at the College, email: elsie.farkas@bcpharmacists.org.

Wayne Rubner

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MORE COUNCIL HIGHLIGHTS

continued from page 4

95% meet PDAP standard

About 160 pharmacists in 22 communities took part in the Knowledge Assessment (KA) exam between December 2003 and February 2004. More than 95 percent met the Professional Development and Assessment Program (PDAP) standard.

These are the kind of results we expected when we developed the Knowledge Assessment component of PDAP, says Assessment Programs Director Doreen Leong.

Pharmacists who do not meet the standard in the Knowledge Assessment generally practise in areas where they are not involved in direct patient care. The KA assesses practising pharmacists underlying knowledge and their ability to apply that knowledge to solve clinical, ethical and practical problems and make sound judgments.

The College mails exam results letters to everyone who takes the KA. This information includes:

Individual score and results report Domain score showing the standard

in each domain - Pharmaceutics, Pharmacology, Professional Practice (ethics), Professional Practice (legal) and Therapeutics

Individual standing in each domain Overall assessment scores showing average

score and range of scores for all pharmacists completing the same form of the KA

Range of scores for all KA exams Disease state report indicating number

of disease state questions in each form and number answered correctly

Pharmacists can use this feedback to help set new goals for their professional development and practice enhancement. The College encourages pharmacists to assess their practice annually using the PDAP Self-Assessment Form.

pharmacists will work with each patient to determine quantity, dose, administration route and frequency.

Methamphetamine precursorsNorth American law enforcement

agencies are concerned about increased production and use of illegal methamphetamine. Due to the relative ease of methamphetamine production, they are urging greater control of the precursors, one of which is pseudoephedrine. Federal Precursor Control Regulations deal with bulk quantities and wholesaler supply of targeted substances, but there is concern that illegal manufacturers may turn to consumer products containing pseudoephedrine.

The National Drug Scheduling Advisory Committee will review current placement of the drug in the Unscheduled category to determine if a higher level of control needs to be reinstated for pseudoephedrine-c o n t a i n i n g p r o d u c t s . I n t h e meantime, pharmacists are asked to monitor large-quantity or frequent purchases of the products and to report any concerns to the national CrimeStoppers line at 800-222-TIPS.

Melatonin statusMelatonin, a hormone produced

by the pineal gland of animals, is the active ingredient of drugs that help regulate circadian rhythms and improve sleep quality related to sleep disorders or jet lag. To date, no melatonin-containing product for human use has been approved for sale by way of a product licence in Canada. Until a Natural Product Number (NPN) is granted, melatonin products are not approved for use. College staff will post updated information on the College website (www.bcpharmacists.org) when an NPN is granted (anticipated to occur in the early summer).

There are several forms of the KA, explains Doreen. Each reects the KA test blueprint. Since each form varies slightly in diculty level, we convert all scores to standardized scores on a scale of 1 to 100, following standard test protocols. The standardized score makes it possible to compare scores from one test to another.

If you plan to take the KA this summer, please register early, as site availability is limited. After you register you will receive a conrmation notice providing details of your exam location.

If you are working on a Learning & Practice Portfolio, you can receive feedback on your choice of Desired Practice Outcomes (DPOs). We encourage pharmacists to take advantage of this feedback process before they proceed with their LPP, says Doreen. It can save you time and make the process easier to complete.

For more information on the Knowledge Assessment exams or the Learning & Practice Portfolio, please contact Assessment Programs Director Doreen Leong at the College or by email: doreen.leong@bcpharmacists.org.

2004FUTURE

KNOWLEDGE ASSESSMENT

EXAMSSaturday, August 7 Application deadline July 7

Saturday, October 16 Application deadline September 15

Saturday, December 4 Application deadline November 3

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District 5 elects new councillor

And a ne pharmacist too...

Achievement awards

Joe JacobSean McKelvey

Naz Rayani

Rita Thomson

P e o p l e N e w s

Sean McKelvey, Joe Jacob - Patient Care Achievement Award

Sean McKelvey and Joe Jacob received the Canadian Pharmacists Association (CPhA) Patient Care Achievement Award for Innovative Practice at the CPhA annual conference on May 16, 2004. The award was for collaboration with the provincial government and BC NurseLine to add consulting pharmacists - known as the Pharmacist Network - to provide drug information to NurseLine callers when needed.

Tiany Ho - Centennial AwardThe CPhA recognized Tiany Ho as the

UBC recipient of the 2004 CPhA Centennial Award for playing a signicant role in Canadian Association of Pharmacists at UBC and at the national level. Tiany is active in the Community Health Initiative by University Students, Pharmacy Summer Student Research Program, Pharmagram, the Yearbook and Pharmacy Awareness Week.

Kathy McInnes - PEBC Kathy McInnes, who was rst appointed as

BCs representative to the Pharmacy Examining Board of Canada (PEBC) in October 2000, has now been elected to the Executive Committee for the 2004 year. Kathy is a pharmacist at the Drug and Poison Information Centre at St. Pauls Hospital in Vancouver.

Victoria radio station CFAX 1070 recently named pharmacist Naz Rayani Citizen of the Year - Runner up in recognition of his work building ties between Victorias Muslim and non-Muslim communities.

Fifteen years ago Naz founded the Third World Partnership Walk in Beacon Hill Park, which he continues to sponsor and organize. Last year this annual Victoria event raised $117,000 to support third world development.

Naz has also initiated a number of health promotion campaigns including the Annual Stride for Heart Mall Walk which raises funds for the BC Heart and Stroke Foundation; Senior Citizens Safety at Home Program; Adopt a School Program which invites students to visit the pharmacy; plus sport sponsorship programs for swimming, soccer and baseball.

Volunteering is a core value in Islam, and as such, its become second nature, says Naz, who has received numerous honours over the years. In 1991 the Juan De Fuca Chamber of Commerce named Naz its Business Person of the Year. In 1993 he received the Bowl of Hygiea Community Service Award. In 1995 he was nationally recognized with the Commitment to Care Award for community service in Canada. In 2002 he received University of Victorias Leadership Award and last year the Victoria Chamber of Commerce named him Business Person of the Year.

District 5s new Councillor is Rita Thomson, a Prince George pharmacist with more than 20 years experience in College activities. My involvement with the College dates back to the 1980s when I sat on a satellite committee for the Pharmacy Practice Committee, says Rita.

Since that time I have been a preceptor for the College and UBC. I am currently a co-coordinator for Continuing Pharmacy Education for Prince George. I am also the secretary for DES (Diabetes Educator Section)-CDA, Northeast Chapter.

Rita says shes come to a time in her life when shed like to devote more time to her profession. I am very pleased to be the District 5 Councillor for the College of Pharmacists. I will do my best to communicate with those in my district and am committed to meeting the obligations that come with being a College Councillor.

Over recent years Rita has contributed to her community as a founder and organizer of The Gathering of the Clans, Prince George (Highland Games) as well as the Central Interior Highland Dance Association. She has served on committees at St. Andrews United Church and is currently chairperson of the Ministry and Personnel Committee. In 1999, she was awarded the Bowl of Hygeia Award.

Rita, who graduated from UBC in 1972, has worked full time for Shoppers Drug Mart ever since. Shes very proud of her daughter, Kirsten, who graduated from UBC in Pharmacy in 2002.

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Samantha Lam

Website and work evolve

Elsie Farkas

In this issue of the Bulletin we recognize a few of the thousands of people who contribute to our profession and to the College.P e o p l e N e w s

What do you think of the College website? How would you improve it? Thats what Samantha Lam, Administrative Assistant - Registrar, needs to nd out.

Its been two years since the College redesigned www.bcpharmacists.org to make it more user-friendly for pharmacists and the public, says Samantha, who taught herself page layout and web management so she could keep the site up-to-date.

As part of a comprehensive review, the College is seeking input from members through an interactive survey similar to one posted when the College launched the redesigned site in 2002. Comparing answers to similar questions today and two years ago will enable the College to benchmark how well the website is working.

The College is considering upgrading technical aspects of the site, reorganizing some sections and improving site navigation to make the site more intuitive, says Samantha.

Since May 2002 the website has received more than ve million hits. Drug distribution remains the most popular section, with many pharmacists searching for information on schedules and updates on specic drugs. To take part in the survey, click on the survey icon on the home page at www.bcpharmacists.org.

What do those people in the College oce actually do all day? Here is the second in our series of day-in-the-life proles of College sta. We hope to demystify the College and make you feel more at home contacting us.

Back in July1985, Elsie Farkas had just completed the Medical Oce Assistant course and couldnt nd work. I started answering ads in the paper, got a call from the Colleges Oce Manager, had an interview and started the next day, she remembers.

Now, nearly 20 years later, shes the Colleges longest-standing clerical employee. Its always been good here, she says. Its a good place to work. As Administrative Assistant - Registration/Licensure, Elsie is the person who makes sure your paperwork gets done so things go smoothly - whether its opening a new pharmacy or keeping your registration up-to-date.

Elsie keeps track of documentation for a wide range of activities including:

Pharmacist registration and renewal Pharmacy change of ownership Pharmacy change of directors Pharmacy change of location Pharmacy renovations Opening a new pharmacy

She starts her day by responding to all the voicemail and email messages that have built up overnight. Surrounded by heaps of documents, she deftly handles dozens of phone calls while processing invoices and applications.

If someone calls and wants to open a pharmacy, I explain it cant happen overnight, says Elsie. The process starts with the pharmacy plan, passes through inspection, review by PharmaCare, construction, inspection of the premises and licensure. Elsie tracks the six to eight week process every step of the way.

It would really help if everyone kept us up-to-date with changes in addresses and work place, she says. The worst part of my job is having to tell someone theyve been suspended for nonpayment of fees. She tries hard to prevent that happening by personally phoning every pharmacist a couple of days before their renewal date if the College hasnt received their fees. People seem to appreciate that, she says. Pharmacists are busy and sometimes it just slips their mind.

If you wish to contact Elsie you can reach her at the College oce or by email: elsie.farkas@bcpharmacists.org.

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Communicating with prescribers

Licensed Practical Nurses (LPNs) are now included in the de nition of nurse for the purpose of transmitting prescribers medication orders that have been given to authorized sta at the licensed community care facilities.

Only LPNs who have taken updated courses in drug information and transcribing prescription orders are allowed to perform this function. The College of LPNs ensures that quali ed LPNs undertake only the roles, functions and activities for which they have demonstrated the required competencies.

The College of LPNs has also taken steps to ensure that its registrants are aware that pharmacists cannot dispense medication when transcribed by an LPN who has not taken the appropriate training. Nevertheless, pharmacists should be aware of the distinction when they are talking to facility sta and to prescribers.

The Long-term Care Committee o ers a few reminders to help during the new policys implementation phase:

Pharmacists should make sure their Medication Safety and Advisory Committees have a written policy as to who in the facility may take and transmit orders. It may be helpful to develop wording sta can use to explain to a prescriber when and why the pharmacist needs to communicate directly with the prescriber by phone or fax.

Facility sta should be aware of whatinformation must be included on an order before a pharmacist can dispense it. A list of the required points can be kept near the nursing station telephone.

Regardless of whether a Registered Nurse, Registered Psychiatric Nurse or LPN transcribes an order, pharmacists should always use their own professional judgment. If a pharmacist has any reservations, he or she should contact the prescriber by phone or fax to ask for clari cation and con rmation.

Pharmacists can dispense transcribed orders only when the facility nurse has spoken directly to the prescriber. If a facility nurse transmits an order taken from a prescribers o ce nurse, a pharmacist cannot accept it.

When a facility nurse telephones a pharmacist with an order, this can provide an opportunity for useful dialogue, but the pharmacist must receive and review the transcribed order before releasing the prescription.

The pharmacist must always communicate directly with a prescriber for narcotic and controlled drug prescriptions.

You can nd the Professional Practice Policy Direct Communication with Prescribers on the College website at www.bcpharmacists.org > Legislation > Provincial > Professional Practice Policies > Direct Communication with Prescribers. For more information about long-term care issues, please contact Margaret McLean at the College, email: margaret.mclean@bcpharmacists.org.

NAPRA REPRESENTS BC PHARMACISTS

The National Association of Pharmacy Regulatory Authorities (NAPRA) is currently consulting with federal organizations on 11 speci c policy areas, in addition to many ongoing issues. Here are some highlights.

Some scheduled drugs derived from natural sources may be exempted from the new Natural Health Products Regulations. NAPRA is collaborating with the Natural Health Product Directorate to make sure national drug schedules continue to regulate natural source therapies with questionable risk/bene ts.

NAPRA is working with the federal government to streamline registration of foreign-trained pharmacists. NAPRA represents BC interests in liaison with the Department of Human Resources and Skills Development and the Canadian Network of National Associations of Regulators.

Medical marijuana distribution through pharmacies appears to be a top federal government priority. NAPRA is monitoring t h e i r a p p ro a c h to m e d i c a l marijuana regulation and attends consultations for physicians and other stakeholders.

Improper veterinary drug use has the potential to contaminate t h e f o o d c h a i n . N A P R A i s representing BC pharmacists on a task force established by Health Canadas Veterinary Drugs Directorate to develop guidance on importing and compounding veterinary drugs.

For more information about NAPRA please contact Registrar Linda Lytle at the College, email: linda.lytle@bcpharmacists.org.

British Columbia

BC leads the country as the greatest users of the Internet, with 88 percent of pharmacy owners and managers, and 83 percent of sta accessing the Internet.

BC is in the middle of the pack when it comes to charging for cognitive services. Almost one in ve pharmacies across Canada charge fees for cognitive services, ranging from $7.00 in Newfoundland, to $8.00 in BC, to a high of $9.70 in Ontario.

Cognitive services

About two-thirds of pharmacy owners and managers across Canada report having a separate room or area for counselling.

About two-thirds of pharmacies have at least one pharmacist with specialized training. The most common area of interest is diabetes care, followed by medication management, smoking cessation, asthma care, hypertension management, cholesterol management and womens health.

About four out of ve Canadians know pharmacists can give advice on drug interactions, side eects, proper drug use and nonprescription health products. Almost half dont take advantage of these services. When they do receive or request health information at their pharmacy, two-thirds of Canadians agree it helps them make healthier living decisions.

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Pharmacists hit the roadcontinued from pg 3

2. Accommodation is made with respect to measurement units (i.e. preferably include both imperial and metric);

3. A formal mechanism is established to ensure that Canadian input is included in NISPCs future content review and item-writing processes;

4. Canadian specialty certication framework includes an additional requirement that ability to apply knowledge in a practice setting and use of judgment be demonstrated (i.e. such as in the Frameworks proposed practice portfolio requirement). This would remedy the feedback given by some reviewers that the examination did not suciently assess application of knowledge.

These recommendations echo those made by Dr. Wendy Leong, who reviewed the NISPC anticoagulation exam in 2003, says Brenda. Asthma, diabetes and anticoagulation exams based on NISPC could be available by the end of 2004.

The purpose of the APC program is to develop a voluntary process to recognize pharmacists who demonstrate advanced skills in a specic practice area. In addition to passing an exam, participants will also prepare a portfolio of their specialty area. For more information about the Advanced Practitioner Credentialing Program, please contact Deputy Registrar Brenda Osmond, email: brenda.osmond@bcpharmacists.org.

PHARMACY TRENDS * Three out of four Canadians feel services such as medication and health advice, information programs and in-store educational programs should be considered part of Canadas healthcare system and be paid by government.

The largest increase in in-store services are blood pressure monitoring devices, trial prescriptions, in-store screenings or risk assessments, and patient call-back systems. The largest decrease are patient information libraries and out-of-store educational programs.

Business

Statistics Canada reports drugstore sales across Canada are growing at a faster rate (eight percent) than the total retail market (six percent). The prescription drug market was worth $15.3 billion for the year ending August 2003, up 135% since 1995.

For the year ending August 2003, the number of prescriptions per person across Canada increased to 11.2. The average prescription cost is now $43.42. The total annual cost is $1,459.

As of August 2003, 7,377 pharmacies were open for business across Canada, compared to just over 6,500 in 1995. The average drugstore had sales of $2.7 million in 2002, compared to $1.8 million in 1994.

Food/mass pharmacies now account for 18 percent of all pharmacies, compared to eight percent in 1995. Independent pharmacies account for 22% share of all pharmacies, down from 32%.

*This information is summarized from www.Taro.ca Pharmacy Trends Report.

those who completed the program found jobs as pharmacists. Graduates say that, beyond preparing them to meet entry to practice requirements, the program fosters a culture of peer support and mutual respect.

Through exposure to practising pharmacists during the program, they aspire to a level of practice they hadnt imagined when they immigrated to Canada.

Here in BC, more than 20% of newly licensed pharmacists originally trained outside North America. Finding ways to help foreign-trained health professionals gain Canadian credentials is a national concern, says Deputy Registrar Brenda Osmond who took part in a February 2004 Roundtable on Foreign Credentialing. Prime Minister Paul Martin, whose mother was a pharmacist, attended the roundtable, saying the issue of foreign credentials is one of his top priorities because it is crucial to productivity, economic growth and social integration.

We are very excited about the International Pharmacy Graduate program, adds Robert Sindelar, Dean of UBC Faculty of Pharmaceutical Sciences, and a member of Council. Collaboration at many levels is a cornerstone of a successful pharmacy practice, so its tting that our two outstanding academic institutions partner to help meet a pressing need in the profession.

For more information about the International Pharmacy Graduate program, please contact Deputy Registrar Brenda Osmond at the College, email: brenda.osmond@bcpharmacists.org.

IPG programcontinued from pg 1

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This column prints questions and answers from the OnCall

Information Line Toll free 1.800.663.1940

Q Does Adderall XR require a Duplicate/Triplicate Prescription? A No, it does not require a Duplicate/Triplicate Prescription. It contains amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate and dextroamphetamine sulfate. Amphetamines and their salts and derivatives are classied as controlled drug, part 1. A written, verbal or faxed prescription is acceptable.

Q May I accept a prescription that has been sent to the pharmacys computer via e-mail?

A No. The prescription must either be verbal, written or faxed (depending on the classication of the drug).

Q A pharmacy called me to request a prescription transfer. The patient has been a long-standing customer of mine. Although she and I had a minor disagreement, she never told me she wanted to change pharmacies. Do I need to give the pharmacist the transfer, even though the patient has never told me she wanted to change pharmacies?

A Yes, Bylaw (39)(3) states that upon request, a pharmacist must transfer to another pharmacy licensed in Canada a prescription for a drug (provided the drug or drug product does not contain a narcotic or controlled drug and the transfer occurs between two pharmacists). You can assume that the pharmacist is asking for a transfer based on the patients request.

Q May I dispense a medication for a pet if the owners family physician wrote the prescription, rather than a veterinarian?

A According to the College of Physicians and Surgeons of BC, physicians cannot prescribe for animals. Problems may arise when a physician writes prescriptions for pets. The prescription is recorded on the owners medication history, rather than on a separate veterinary profile. As a result, incorrect information and inappropriate DUE messages are returned to all pharmacies lling prescriptions for the owner, and the claim may be paid by PharmaCare, a third-party payer, or added to the individuals PharmaCare deductible.

Q A patient has part-lls of Oxycontin at my pharmacy. While I was processing the prescription on PharmaNet, I noticed that another pharmacy had dispensed Oxycontin for him since the last time I had dispensed it. Does this mean that the Oxycontin part-lls at my pharmacy are no longer valid?

A Yes, the Oxycontin part-lls at your pharmacy are no longer valid because a more recent prescription has been dispensed for the same drug, at another pharmacy.

Q What schedule is Denorex Extra Strength Medicated Shampoo?A None. It is Unscheduled. Coal tar in concentrations of more than 10% is Schedule II. Denorex Extra Strength Medicated Shampoo contains only 10.4% coal tar solution (equivalent to 2.08% coal tar).

Questions & Answers

C o l l e g e o f P h a r m a c i s t s o f B r i t i s h C o l u m b i a M a y/ June 2 0 0 4 B u l l e t i n Page 11

BC First Nations Health Handbook Developed by the First Nations

Chiefs Health Committee and the Ministry of Health, this handbook provides a health guide reference for First Nations communities and health care providers. A companion document to the BC HealthGuide Handbook, it was distributed to all First Nations communities.

The handbook details health services available to First Nations, with particular focus on remote and rural communities. This includes socio-cultural information, a list of health resources available to First Nations and a glossary of First Nations health-related terms. You can download a copy from the College website: www.bcpharmacists.o r g > R e s o u r c e s > L i n k s > D r u g Information. For more information, or to order BC First Nations Health Handbooks, call toll-free: 800-465-4911.

Free PharmAction pamphletsAcross Canada, 85 percent of

pharmacists rate PharmAction pamphlets as useful, particularly in helping patients initiate a discussion, uncovering health or treatment-related problems and saving time in patient discussions. Currently only about 10 percent of BC pharmacies o er these pamphlets.

Topics include:- Cholesterol testing - Stomach problems - Infant nutrition - Vaccination for children - Poor leg circulation (Peripheral

Arterial Disease) - Postmenopausal health

You can order PharmAction pamphlets and a counter display which holds up to 12 pamphlets, free of charge, by calling toll-free 800-363-5634.

E-Link allows you to keep and maintain a calendar, address book, task list and notes, as well as access email. You can get into the system directly from the NAPRA homepage, www.napra.ca, by clicking on the E-Link icon. This takes you to the log-in page where you will need your diploma number to access your mail.

At the NAPRA Annual General Meeting on March 28, 2004, Registrar Linda Lytle and NAPRA Director Shawn Sandhu joined in discussions regarding aspects of E-Link with their counterparts from other provinces. Over the next few months NAPRA will promote E-Link across the country at pharmacy meetings and events. We really appreciate the Colleges support in promoting this service, says Barbara.

The success of E-Link depends on the support of pharmacy regulatory authorities and pharmacists across Canada, says Barbara. We believe E-Link can help control fee increases by reducing printing and mailing costs and saving sta time. Our goal is to have two-thirds of pharmacists from the Northwest Territories to Newfoundland, including those in BC, registered with E-Link by the end of 2005.

For more information on how you can sign on to E-Link, please contact Melva Peters at the College o ce or by email: melva.peters@bcpharmacists.org.

E-Link: Canadian pharmacists get connected

More than 10,750 Canadian pharmacists are now able to take advantage of a webmail service provided by the National Association of Pharmacy Regulatory Authorities (NAPRA). Dubbed E-Link, a name originally coined by the College, the nationwide service is designed speci cally to suit the needs of pharmacists.

E-Link o ers pharmacists free, secure email accessible any time, anywhere, from any Internet-connected computer. It provides an e ective way to distribute urgent information such as industry and Health Canada advisories, changes in drug scheduling, and information related to the regulation and practice of pharmacy.

Pharmacists in BC have been one of the most enthusiastic groups to embrace E-Link, says NAPRA Executive Director Barbara Wells. With more than 750 regular users, BC leads the country with the highest proportion of web-savvy pharmacists. Feedback from BC pharmacists really helped us enhance the system.

Users told NAPRA they appreciate the ability to automatically forward their email to a personal email account and the user-friendly set-up that makes it easy to manage and customize email folders and addresses. E-Link also guarantees automatic password-protection and encryption of all messages.

The service is physically located on the Telus network in Ottawa. The College provides regular updates of pharmacists, students and qualifying candidates that should have access to the system.

BULLETINPublished by:

College of Pharmacists of British Columbia200-1765 West 8th Avenue

Vancouver, BC V6J 5C6

Managing Editor:

Linda Lytle, Registrar

Your questions and comments about t h i s Bulletin are welcome and may be forwarded to the Registrar.

Tel: 604-733-2440 800-663-1940Fax: 604-733-2493 800-377-8129

Email: info@bcpharmacists.orgWebsite: www.bcpharmacists.org

The Bulletin newsletter provides important College and pharmacy practice information. All pharmacists are expected to be aware of these matters. Licensed pharmacies must have the last three years of Bulletin issues on le as per reference library requirements.Pri

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Check www.bcpharmacists.org or www.ubcpharmacy.org/cpe for details

College supports Community Pharmacy

The UBC Community Pharmacy Residency Program recently received a $10,000 grant from the College. We are grateful for the Colleges support, says Robert Sindelar, Dean of the Faculty of Pharmaceutical Sciences. You are helping us improve standards of professionalism in pharmacy practice, learning and research.

Event Council meeting Date Friday, June 18, 2004Location College oce, Vancouver, BCContact Samantha Lam, 800-663-1940, ext. 220

Event Council meeting Date Friday, September 24, 2004Location College oce, Vancouver, BCContact Samantha Lam, 800-663-1940, ext. 220

Event Council meeting Date Friday, November 26, 2004Location College oce, Vancouver, BCContact Samantha Lam, 800-663-1940, ext. 220

Event College of Pharmacists of BC annual general meeting Date Saturday, November 27, 2004Location Hilton Vancouver Metrotown Hotel, Burnaby, BCTopics Morning: professional development session followed by a hosted lunch Afternoon: College of Pharmacists and BC Pharmacy Association annual general meetingsContact Samantha Lam, 800-663-1940, ext. 220

No more smilesAfter nine years of operation the

UBC Faculty of Pharmaceutical Sciences Medication Information BC program, formerly known as BC SMILE, has ceased operation. The service was receiving few information requests from the public and faced ongoing funding challenges.

This has made it very dicult to operationalize and sustain Medication Information BCs strategic plan, says Dr. David Fielding, Associate Dean Academic, UBC Faculty of Pharmaceutical Sciences. The Faculty will continue to evaluate the need for an evidence-based source of drug information for the general public. UBC will reactivate the public and undergraduate education components of the Medication Information BC program in August 2004.

Home Study Programs

Brochure available at http://www.ubcpharmacy.org/cpe/programs/homestud.pdf.

This years oering includes:

Pharmat (USA) multi- and single-theme programs CCCEP 2003 and 2002 re-oers UBC CPE Conference Update 2002 Audiotapes University of Alberta courses

For updated information about UBC Continuing Pharmacy Education (UBC-CPE) programs, please call 604-822-6485, or email CPE at their new address: infocpe@interchange.ubc.ca. You can also nd information at: http://www.ubcpharmacy.org/cpe/programs/.

This website provides details on live, home study, and web-based courses. The site also includes information on contacts, accreditation, resources, Learning Centre Highlights publications (pdf format), FAQs, and links. You can discuss practice issues with colleagues from across the province by posting your comments at the RxCAFE discussion forum.

P a g e 1 2 C o l l e g e o f P h a r m a c i s t s o f B r i t i s h C o l u m b i a M a y/ June 2 0 0 4 B u l l e t i n