acpnews - alberta college of pharmacy

Rick Siemens new ACP president

Rick received his BSc Pharm from theUofA in 1996. He went on to practice inBeaverlodge and Grande Prairie. Rick isnow pharmacy manager of Lethbridge’sLondon Drugs. He is a Certified DiabetesEducator, one of the first 15 pharmacistsin Canada to be granted additionalprescribing authorization, and one of thefirst 30 to receive authorization toadminister drugs by injection. Rick isserving his third year on the college’scouncil.

Under Rick’s leadership, the collegewill pursue the regulation of pharmacytechnicians, facilitate increasedpharmacist use of the electronic healthrecord, and expand the number ofpharmacists granted additional

prescribing privileges so that Albertansare better supported when they requiredrug therapy.

In his inaugural address, Siemensencouraged pharmacists to collaboratewith other health professionals andseize the opportunities presented bypharmacists’ new scope of practice tostrengthen the healthcare system andhelp patients experience betteroutcomes.

acpnews – July/August 2008 1

In this issue...3 • Notes from Council

Competence

3 • Retiring committee member• What can you claim as

accredited learning?4 • Learning Portfolio audit results

• Tips when compiling your CPDLog

Patient Safety

5 • Two medication safety concernsto note

6 • Transition Times

Partners in Practice

9 • From the faculty10 • Celebrating the Class of 2008

• HQCA survey results11 • In memory…

Quality Pharmacist Practice

11 • Adjudicator finding re: HIA• Retaining pharmacist-prescribed

prescriptions• Termination for unprofessional

conduct12 • Professional declarations

• Adapting reminders13 • Don’t default to “Dr.”

• Check those fax numbers• Conference coverage

14 • ACP no longer forwarding MedEffect messages

16 • ACP launches updated website

acpnews

safeeffective

responsiblepharmacist practice

July/August 2008

Rick Siemens was installed as the new president of the Alberta College ofPharmacists for the 2008/09 year at the college’s annual general meeting onMay 24, 2008.

acpnewshas a new look.

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acpnewsis published six times per year by the Alberta College of Pharmacists.Send submissions for publication to:

Karen Mills, Communications [email protected]

The deadline for submissions is August 5, 2008 for the September/October2008 issue. Information about content andlength of articles can be obtained from Karen.

Alberta College of Pharmacists1200 - 10303 Jasper Avenue NWEdmonton AB T5J 3N6780-990-0321Toll Free: 1-877-227-3838 Fax: 780-990-0328

President: Rick SiemensPresident Elect: Merv BashforthVice President: Donna GalvinPast President: Dianne Donnan

Councillors:Wilson Gemmill, District 1Rick Siemens, District 2Catherine McCann, District 3Jeff Whissell, District 3Krystal Wynnyk, District 3Dianne Donnan, District 4Anjli Acharya, District 5Kaye Andrews, District 5Donna Galvin, District 5Merv Bashforth, District 6

Public members:Joan PitfieldPat Matusko

Councillors and our public members canbe reached by email via our website atpharmacists.ab.ca under About ACP/Council, or by using the search feature tolocate them by name.

Staff DirectoryAll staff are available at 780-990-0321 or 1-877-227-3838 or by fax at 780-990-0328.

Their email addresses are available onour website at pharmacists.ab.ca underContact Us.

Registrar: Greg EberhartDeputy Registrar: Dale CooneyCompetency Director: Roberta StasykComplaints Director: James KrempienQuality Pharmacy Operations Director:

Jill MoorePharmacy Practice Consultants:

E. Randy FrohlichVic Kalinka

Business Manager: Lynn PaulitschRegistry Leader: Linda HagenCommunications Leader: Karen Mills

Krystal WynnykCouncillor, District 3 (Edmonton)

Krystal received her BSc Pharm from theUofA in 2002. Since graduating, she haspractised in hospital, community, andextended care settings, currently servingas a consultant pharmacist in home care.She is an integral part of theinterdisciplinary team and is devoted toher patients and their health. Krystalenjoys reviewing continuing educationprograms for CCCEP to ensure they areof high quality. Students from the UofAFaculty of Pharmacy benefit from hercontributions as a teaching assistant andpreceptor.

Krystal is excited to have the opportunityto provide patient-centered care in thedawn of a new era in pharmacy. Sheencourages all pharmacists to embracethe expanded scope of practice and fullyuse their expertise in medicationmanagement. Krystal is committed toensuring pharmacists have the toolsnecessary to allow them to adopt thenewly granted privileges into theirprofessional practice to ensure thegreatest benefit for patients.

Kaye AndrewsCouncillor, District 5 (Calgary)

Kaye graduated from the UofA in 2003and then completed a hospital residencyprogram in the Calgary Health Region.In 2004, Kaye joined the Anticipatoryand Preventive Team Care or APTCareproject in Carp, ON near Ottawa, as theclinical pharmacist. This project testedthe integration of nurse practitioners anda pharmacist into a primary care practiceto focus on chronic illness management.During this time, Kaye also worked as acommunity pharmacist. In 2006, Kayereturned to her Alberta roots to workwith the Calgary Rural Primary CareNetwork where she is the Lead forPharmacist Project Services. She ishelping to integrate pharmacists into theprimary care setting, specifically linkingpharmacists with family physicians’offices. Kaye divides her time betweenclinical pharmacist duties at the FoothillsFamily Medical Centre in Black Diamondand administrative and clinicalleadership within the PCN. This May,

she was awarded the CPhA NewPractitioner Award for her leadership inthese innovative projects.

Kaye enjoys being active in herprofession and is optimistic for theexciting times ahead. There are a lot ofopportunities currently available forpharmacists and Kaye looks forward toher work on council to help furtheradvance the foundation that has beencreated.

Vic Kalinka ACP Pharmacy PracticeConsultant

Vic is a familiar face in a new role at thecollege. Formerly a deputy registrar atACP, Vic left the college to pursue otheropportunities, most recently as pharmacymanager with Calgary Co-op in Airdrie.He has now returned to the college as afull-time pharmacy practice consultant.He will be covering southern Albertawhile Randy Frohlich continues to serveas the consultant for the northern half ofthe province. Randy and Vic will conductpharmacy assessments as part of ACP’scommitment to patient safety and qualitypharmacy practice.

Whitney Tushingham ACP Customer Service Agent Quality Pharmacist Practice

Whitney just received her Bachelor ofArts degree from the U of A. While shemajored in Cultural Anthropology andminored in Psychology, her stronginterpersonal skills and flair for problemsolving make her a good fit for thecompetency department at the ACP. Shewill be assisting with components of theRxCEL Competence Program, onsiteassessments, learning portfolio, andaccreditation.

So far Whitney has enjoyed working aspart of the additional prescribingauthority assessment team. She is alsolearning the ropes for the CEUapplication process and looks forward toensuring that all of Alberta’s pharmacistscontinue to be held to a standard ofexcellence.

pharmacist.ab.ca

Other new faces at ACP


Council priorities� Public safety and public benefit

from quality pharmacy practice havebeen reaffirmed as the two primarythemes for ACP’s strategic direction.

• Public safety efforts will focus onensuring pharmacists, licensees, andowners comply with the requirementsof legislation, standards, and our codeof ethics.

• Initiatives expanding public accessto quality pharmacist practice willincorporate strategies for practicechange, with an increased focus onachieving appropriate drug therapyand patient care. This focus includesemphasizing health promotion,disease prevention, and patient well-being.

Council has directed the pursuit oflegislative amendments to bolster thecollege’s ability to monitor andremediate pharmacist performancearound prescribing and dispensingdecisions. ACP will work with othercolleges to secure an appropriatelegislative framework which supportsimproved performance of regulatedregistrants, so as to improveappropriate drug therapy.

� Working toward stricter legislationgoverning the provision ofinducements or incentives bypharmacies in exchange for goods orprofessional services provided by apharmacist was set as a high priority.Members of the public and thecollege’s key stakeholders haveindicated that this practice isinappropriate. Other colleges are alsoexpressing concern over similarloyalty/marketing schemes amongsttheir registrants.

� Council reaffirmed the importance ofincreasing the number ofpharmacists achieving additionalprescribing privileges and

authorization to administer drugs byinjection. Gaps in patient care existthat pharmacists with these privilegescan fill. It is imperative that Albertapharmacists take advantage of thenewly legislated practiceopportunities, as they are leading thecountry into a new scope of practiceand a new understanding of theprofession.

Endorsement ofnational planCouncil has supported the Blueprint forPharmacy’s vision “Optimal drug therapyoutcomes for Canadians through patientcentered care” and remains committed tothe development and implementation ofthe national plan being crafted byprovincial and national pharmacyorganizations. Therefore, ACP’sstrategies and business plans will alignwith needs that have been identified inthe blueprint.

Proposed standardsrevisionConsultation will begin in early July on aproposed amendment to Section 11.10 ofthe Standards for Pharmacist Practice thatrequires all pharmacists to enterprescribing decisions into the electronichealth record on Oct. 1, 2008. AsNETCARE is not yet able to provide asystem-to-system interface withpharmacy practice managementsoftware, the effective date for thisstandard requires deferral.

Mark your calendarThe 2009 Annual General Meeting willbe held on Thurs., May 21 immediatelyprior to the opening ceremonies of thesecond tri-profession conference at theBanff Springs Hotel. The APEX AwardsCelebration will be held at the BanffSprings Hotel on the evening of Sat.,May 23, following the conference.

Notes fromCouncil Competence

Retiring committeememberThanks go to retiring CompetenceCommittee and Practice Review Panelmember Sandra Leung. Sandra servedon this committee for six years. Herinsight and dedication were real assets tothe group. We wish Sandra all the best inher future endeavours.

What can you claimas accreditedlearning?Alberta pharmacists may only claim asaccredited learning those programsaccredited by a recognized pharmacyaccrediting body. Those are theCanadian Council on ContinuingEducation in Pharmacy (CCCEP),Alberta College of Pharmacists (ACP),Accreditation Council on PharmaceuticalEducation (ACPE) and other provincialpharmacy accrediting bodies such as theOntario College of Pharmacists.

You may have noticed that several CEproviders are now offering continuingeducation courses for both pharmacistsand technicians. In particular, in the USmany providers are offering ACPE-accredited programs for pharmacists andtechnicians. Please note thatpharmacists may only claim coursesthat have been accredited forPHARMACISTS as accredited learning.Be sure to check the course description.If it says “Technician Education”, has anACPE file number in the format

“XXX-000-08-XXX-H01-T” (the T denotes “technician”),

or a CCCEP file number in the format

“CCCEP# NA-TT00XX” or “CCCEP# 001-1007 Tech”

you may not claim it as accreditedlearning. It is also likely not appropriateto claim technician continuing educationas non-accredited learning as it probablynot at a level appropriate forpharmacists.

Council met June 11 to 13 to continue the review of ACP’s strategic directionand conduct council’s regular business. Following is a summary of some of themore significant decisions.

Learning Portfolioaudit resultsAudits of learning portfolios for the 2006-2007 registration year have now beencompleted. Out of 738 audits, 733 met allaudit criteria and received letters ofcompliance - a 99.5% compliance rate.Congratulations and keep up the greatwork! The five pharmacists who did notcomply with the audit criteria are notable to renew their registrations for the2008-2009 year.

In September we will commence auditsof learning portfolios for the 2007-2008registration year. This year we willundertake approximately 750 audits, sowatch your mail!

Tips when compilingyour CPD LogWe have completed our review ofpharmacists’ continuing professionaldevelopment logs submitted forregistration renewal in May 2008.Overall, pharmacists are doing a goodjob documenting their learning activities.

Here are some tips that may speed upyour next registration renewal:

� All hard copy CPD logs must besigned by the registrant. Since aminimum continuing education (CE)requirement is a condition under thelegislation for registration renewal,your signature is required on the CPDlog as confirmation of your CEentries.

� All accredited learning activities muststate the accreditation file number sowe can confirm accreditation status.

� All learning activities must bedocumented individually with theapplicable accreditation file number.That is, you cannot write“Pharmacists Letter Jan-Dec 2007 12 CEUs”.

� All non-accredited learning activitiesmust be supported by a non-accredited learning record.


University of AlbertaPractice Development/Continuing Pharmacy Education

Fall ProgramsAnnouncement of Workshop DatesThe Faculty of Pharmacy and Pharmaceutical Sciences announcesthe following programs for Fall 2008:

Anticoagulation – On the Road to Practice Change

Interpreting Laboratory Values – An Introductory Course for Pharmacists

Programs involve pre-workshop assignments, participation at the workshop, threedistance learning sessions, and a final assignment. Further details, including datesfor distance learning sessions and registration fees are available atwww.pharmacy.ualberta.ca/conted.

Enrollment is limited to 35 participants for each program. Registration for theprograms will open on July 15 at 12 pm. Please note that our office will be closedAugust 5-15, 2008. If you have any questions, please call 780-492-2393.

Workshop Date: Saturday, September 13, andSunday, September 14, 2008

Location:Radisson Hotel Edmonton South4440 Gateway BoulevardEdmonton AB780-437-6010

Guest room rates:$124 and $139 (until August 14)Based on availability

Workshop Date: Friday, September 19, andSaturday, September 20, 2008

Location:Radisson Hotel Edmonton South4440 Gateway BoulevardEdmonton AB780-437-6010

Guest room rates:$139 (until August 20)Based on availability


Patient Safety

1. Use of bromocriptinefor lactation suppression

The Alberta Medical AssociationCommittee on Reproductive Care hasidentified a patient safety concernregarding the use of bromocriptine[Parlodel®] for lactation suppression forwomen experiencing a stillbirth orneonatal death. It has become apparentthat some health care providers havebeen prescribing the medicationbromocriptine [Parlodel®] to thesewomen in order to suppress breastengorgement and initiation of lactation.

Although previously used for thispurpose, due to reports of seriousadverse reactions including stroke,seizures, myocardial infarction, severehypertension, hypotension andpostpartum psychosis the United StatesFDA in 1989, taking the view that there isno need for the pharmacologicalsuppression of lactation, recommendedthat medicinal agents should no longerbe used for lactation suppression. Thepharmaceutical manufacturer withdrewthe indication for postpartum lactationsuppression in 1994.1

The use of a well fitted support bra wasfound to be the most comfortablesolution for women not breastfeeding ina recent study by Swift and Janke2

comparing breast binding to use of asupport bra. There is no supportingevidence for the use of diuretics forengorgement or suppressing lactation.3

The best recommendation for thesepostpartum women appears to be:

1. Use of support for 7-10 days post-delivery until involution has occurredrecognizing that there may still besmall amounts of leakage until returnof menses;

2. If the breasts become extremelyengorged and warm, the use of localice packs may be helpful;

3. If the breast become extremelyengorged and tender, the use of anappropriate analgesic may be helpful;and,

4. Ensuring that when they aredischarged home, they will have asupportive environment available tothem.

For women who need to stopbreastfeeding abruptly, pumping withgradual decrease in frequency mayprovide relief. Suppression of lactationusing this method may take one to twoweeks.3

2. PEG 3350 Non-electrolyte daily laxative

The Alberta Children’s Hospital hasbrought it to the college’s attention thatPEG 3350 is still being frequentlyconfused with PEG electrolyte bowelevacuants such as Colyte, Golytely orPegLyte. PEG 3350 is an ingredient inColyte, Golytely and PegLyte. Althoughall are polyethylene glycol products,they are prescribed differently.

PEG 3350 does not contain electrolytes. Itis used as a daily laxative in children to

treat chronic constipation.

Colyte, Golytely and PegLyte containmineral salts in combination and areused to evacuate the bowel inpreparation for intestinal procedures orother purposes. These solutions are notappropriate for the management ofconstipation in the outpatient setting inchildren.

It is important that the child receive anadequate daily fluid intake for PEG3350 to work effectively. This must beemphasized to parents as it often is thereason the children do not have anappropriate response.

The Alberta Children’s Hospitalnormally gives patients two alternativesfor treatment:

� Order Pegflakes (Miralax equivalent)through Pegflakes.com; or

� Acquire a prescription for PEG 3350and obtain the product from acommunity pharmacy.

For pharmacists, PEG 3350 is availablefor order through McKesson Canadausing item #772624 for the 500 g size.Please dispense with a med cup formeasuring (e.g., 15 g = 20 mL).

Any questions or concerns can bedirected to the Alberta Children’sHospital Outpatient Pharmacy 403-955-7303.

Two medication safety concerns to note

1 Merck Manual – On-Line Edition, 2008. 2 Swift K, Janke J. Breast Binding …Is It All That It’s Wrapped Up To Be?. J Obst Gyne Neonatal Nursing 32;332–339:20033 Consultation with Dr. S Gross, Physician Lactation Consultant

acpnews has a new look.Tell us what you think of it. Reader survey on page 15.


TransitionTimes

Assess your readiness

Other pharmacists are receiving theauthorization. Is your time now? Taketime to consider your practice:

� Do you participate in “prescribing”based on protocols or delegation?Now that additional prescribingauthorization is available, this is nolonger appropriate.

� Would additional prescribingauthorization enhance the care youprovide to your patients?

� Would the authorization increaseyour job satisfaction?

If you answer yes to these questions,start working on your applicationnow. The process for receivingadditional prescribing authorization isopen and underway.

� The next two deadlines forapplications are July 31st andAugust 29th.

� Each application is individuallyassessed by a team of practisingpharmacists using a pre-determined set of criteria to ensurethorough, unbiased, fairevaluation.

� Results will be provided as soon aspossible, but it may take up toeight weeks for you to receive theresult of your assessment.

� The 2008 application fee is $350+GST.

Follow the guide carefully

The Guide to Receiving AdditionalPrescribing Authorization provides youwith all the information you need tocomplete an application, including aself-assessment tool for you todetermine your readiness. It alsodetails the criterion by which you willbe assessed. Review this guidecarefully. Clearly and explicitly

address each and every criterion inyour application.

Look to ACP’s website for moreinfo

Our website displays the most currentinformation about the applicationprocess for additional prescribingauthorization.

Visit http://pharmacists.ab.ca/college/resource.aspx?id=6340 to download a copy of the Guide toReceiving Additional PrescribingAuthorization.

To obtain a hard copy of the guideor to ask a question not addressedon our website, email [email protected].

The website also features anadditional prescribingauthorization frequently askedquestions section (access underRegistration & Licensure/Pharmacists/Additional PrescribingAuthorization). We will updatedthis feature regularly toprovide answers to questionsand offer tips for completingyour application based oncomments from otherapplicants and assessors.

Start now to make yourpractice all that it can be.The application you submitwill be comprehensive andwill take time to compile.However, it will be worthit as you:

� affirm your good practices,

� reinforce theaccomplishments you’vealready achieved,

� re-ignite your passion forhigh-quality practice andpatient care,

� clarify the focus of your practice,

� boost your confidence, and

� realize you are participating insomething pharmacists in the restof the country can only dream of!

Planning to apply for additionalprescribing authorization?Follow these steps to make the process simpler.

“Advancing” ISprescribingAdvancing medications, even for afew doses or a few days, is nowconsidered adapting a prescription. Ifyou adapt a prescription, you havemade a prescribing decision. You arethe prescriber of a new prescription. You must:

� reduce your prescription towriting,� include a reference to the originalprescription,

� retain a copy of both prescriptions, � sign and enter the prescriptionwith you as the prescriber, and � notify the original prescriber.Refer to Standard 12 of the Standardsfor Pharmacist Practice for full details.

Jennifer joined the Cross CancerInstitute’s Pain and Symptom Consultteam in 1992. Eight years ago, the teamexpanded to include a Palliative Carephysician consultant. This had a markedeffect on Jennifer’s practice. “Having theprivilege to work with a physician whonot only embraced a multidisciplinaryapproach, but encouraged independentpractice, I found myself continuouslyinvolved in initial triage, assessment,recommendation and ongoing follow-upfor patients referred for symptommanagement.”

When the College began pursuingadditional prescribing authority, Jenniferbegan thinking about how thisopportunity could enhance the servicesher practice currently provided as well ascut down on the amount of time that herteam spent on patient discussions. “Oftenthere were pharmaceutical modificationsrequired, but the process would bedelayed if the physician consultant wasnot available due to conflicting meetingsand other responsibilities, and even moreso when they were on vacation.” WhenACP requested volunteers for the pilot,Pharmacy Management contactedJennifer to encourage her to apply andshe leapt at the opportunity.

Jennifer received the application packagejust before leaving for an out-of-townfamily vacation and debated whether toopen the package or to relax for threeweeks and then tackle it. In the end, shechose to relax first, enjoy her familyvacation, and get down to business onceshe had returned – well rested andrefreshed. After reading through thematerials, she was initially worried thatshe wouldn’t be able to complete theprocess in the three remaining weeks, butas she began to do the check lists,

everything began to flow smoothly andshe thought, “this is me, this is what Ido.” She began to relax as she realizedthat over the past fifteen years, she hadnaturally started to incorporate many ofthe criteria that were being reviewed andevaluated.

When asked how prescribing authorityhas changed her practice, Jennifer says,“One of the unique features of themultidisciplinary team that I work withis that we all share the office spacetogether. We have frequent updatesbetween me, the nurses and physicianregarding new and follow up patients.That hasn’t changed with the additionalprescribing authorization, and remains akey function in sharing information andproviding the best patient care possible.What has changed is the ability to assessa patient, identify the cause of asymptom and implement a care planindependently and proceed with thewriting of the prescription to completethe process in a timelier manner. This hasresulted in decreased wait times for thepatients in receiving their prescriptions.It has also decreased the number of timesthat I have to interrupt the physician.”

The reactions from other health careprofessionals and Jennifer’s patients havebeen very positive. “Since receiving myadditional prescribing authorization, Ihave had many of the oncologists in theinstitute ask if I am one of “the fifteen”and offer their congratulations,” Jennifersays. “I was initially a little nervous onhow patients would react, but myconcerns were unfounded. Afterexplaining that I had additionalprescribing authorization and couldprovide them with a prescription, all mypatients have been very open.”

What Jennifer found challenging aboutthe process was going back and trying toidentify care plans that would beappropriate. Because narcotic andcontrolled drugs were exempt, Jenniferwanted to find cases where herinvolvement was focused on either usingadjuvant analgesics or addressinganother symptom. “Unfortunately, realpatients don’t experience only onesymptom at a time, so it became verychallenging! At one point, the entiredepartment, including our secretary, wastrying to come up with names of patientswho might be appropriate for my careplan.” Jennifer cites this as yet anotherexample of the support andencouragement that her colleagues andthe Pharmacy Department at the CrossCancer Institute provide.

Words of advice from this drivenpharmacist: “We never stop learning; wenever stop trying to improve ourselves.Complete the checklists in theapplication package—you will surpriseyourself at how much of it you arealready doing in your practice. Don’t bescared to try and implement one or twothings that you may not be doing now. Itis easier than you think to make thosechanges, and the outcome will haveoutstanding results for you, your team,and your patients.”


This month, we continue our profile of the first 15 pharmaciststo earn additional prescribing authorization.

Jennifer Dutka, BSPConsult Pharmacist, Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton


As president ofthe AlbertaCollege ofPharmacists in2001, GladysWhyte wasinstrumental inthe wholeprocess ofinitiatingpharmacist

prescribing in the province. When thepilot for additional prescribingauthorization was announced, she wascurious to see what would be requiredand whether a “small town” pharmacistlike herself would qualify – and qualifyshe did!

Going through the application process,Gladys felt very fortunate to have herbackground in anticoagulation. “I hadexperience in documentation forindividual patient charts. I felt that if itweren’t for my experience andbackground in documentation with theanticoagulation management service thatI provide, I may not have found theapplication process quite so straight-forward.”

Although Gladys hasn’t implementedher additional prescribing authorizationto the fullest extent at this point, she hasmany plans for the future. “As thingsevolve, I see myself having my ownclinical practice and havinganticoagulation patients makingappointments to see me for morepersonalized care.”

Gladys recalls a situation that aptlydemonstrates her definition of“personalized care”. She had a long-termParkinson’s patient who wasexperiencing symptoms that Gladysattributed to the patient’s drug therapy.She collaborated with the patient’s doctorand made suggestions and

recommendations based on herknowledge. At discharge, the physiciangave the approval for her to manipulatethe patient’s meds – ordering,monitoring, and collaborating with thehome care nurse. “I continue to contactthis patient twice a week and am happyto report that she feels that herParkinson’s symptoms are now bettercontrolled than ever. I think she is alsovery happy because she feels thatsomeone cares about her and her well-being – and that she is receiving trulypersonalized care.”

In addition to her patients, the physiciansand other health care professionals atTofield have had a very positive responseto Gladys’ new authorization. “I havebeen acknowledged in the Quicknewsnewsletter and continue to assure mycolleagues that I am applying myknowledge in a step-wise fashion,ensuring that everyone I work withbecomes familiar with what I can do.” Inaddition to placing her into the Medi-Tech system as a provider/prescriber, theTofield Health Centre will also begincapturing statistics about theanticoagulation patients Gladys cares for.

Gladys affirms that the number of hoursof reading and information gathering shespent preparing for the additionalprescribing authorization process wereworth it. “Don’t be intimidated by theform itself,” she says, “but do take thetime to do the charting and thedocumentation – it is incrediblyimportant.” So from the beginnings ofpharmacist prescribing in 2001 to beingone of the first fifteen to obtain heradditional prescribing authorization in2008, Gladys continues to be a leader and“pioneer” in the profession of pharmacy.

TheAnticoagulationManagementService is anoutpatient clinicat the UofAHospital thataccepts referralsfrom physiciansto managepatients’

anticoagulation therapy. This specializedservice aims to optimize patients’anticoagulation therapy bysystematically evaluating and monitoringpatients, providing ongoing education,and serving as a valuable resource. ReneBreault has been with theAnticoagulation Management Servicesince 2003.

Originally, although Rene knew thathe would eventually seek additionalprescribing authorization, he plannedon waiting until the pilot project wascompleted. But after speaking withhis director at the anticoagulationclinic, he decided that this would be afantastic opportunity for him to takefor his role as a pharmacist, for theprofession, and most importantly, forthe patients he cares for. “I wanted tobe part of this groundbreaking stepfor the pharmacy profession inAlberta.”

Rene says that when he first reviewedthe application, he was a littleintimidated by the amount of detailrequired, despite his confidence in hisknowledge, skills, and ability toprescribe. “Once I started completingthe application process, things reallyfell into place. As I was describing mypractice setting, the collaborative

Gladys Whyte, BSc Pharm (with distinction)Pharmacist, Tofield Health Centre, Tofield

Rene Breault, BSc PharmClinical Pharmacist, Anticoagulation Management Service,University of Alberta Hospital, Edmonton

continued on page 9

This year theUniversity ofAlbertacelebrates acentury oflearning,discovery and

citizenship. Please join us! Learn more atwww.100 years.ualberta.ca

The Dean’s Tournament of Golf washeld on June 3 under perfect skies. Over140 golfers enjoyed the opportunity tobeat Dean Pasutto on the putting contestand double their bet on the UniGlobeTravel Hole-in-One. The facultyappreciates the support of the sponsors;please check the website(www.pharmacy.ualberta.ca) for acomplete list.

The Sandoz Cup was won by BarryPeachment, Rick Provencal, TerryDobson and Doug Koffski. The EspressoCup trophy for the best score in theTexas Scramble was claimed by LisaHolan, Omer Ghutmy, Rose Seneka andRudy Seneka.

Next year’s tournament will be June 9 atBlackhawk.


From thefaculty…

relationships I have with otherprescribers, and providing my patientcare plans, I knew that obtainingadditional prescribing would be anatural extension of my currentpractice.”

For the most part, Rene limits hisprescribing to medications related toanticoagulant therapy includingwarfarin, low molecular weightheparin, Vitamin K, and hemostaticagents. “Being authorized to prescribeallows me to take full responsibilityfor my patients’ drug therapy. Whileprescribing really only encompasses asmall portion of what I do as apharmacist, it is a necessary tool inorder for me to provide optimal andefficient care for my patients.” Renestates an example being when he hada patient with a critical INR result thatneeded reversal with Vitamin K. Aftercompleting his initial assessment ofthe patient, without the ability toprescribe, Rene would have had totrack down a physician to obtain aprescription. If the physician couldnot be contacted, the only otheroptions to obtain the Vitamin Kwould be to send the patient to theemergency room or to wait in a walk-in clinic which, in the majority ofcases, wouldn’t be necessary andwould result in lengthy waiting timesand inefficient use of those resources.“Now I can provide this urgenttherapy in a timely, efficient mannerto those patients who need it,” saysRene.

Rene says that most of his prescribingis done behind the scenes, contactingpharmacies with refills and newprescriptions and that the majority ofhis patients haven’t noticed adifference. “But I think that’s thepoint,” he says. “One of the benefitsof prescribing has allowed continuityof the drug therapy that patientsreceive. I also think the healthprofessionals that I work closely withappreciate the efficiency that my

prescribing authority provides – I nolonger have to track them down, orinterrupt them when they are withother patients, to obtainprescriptions.”

Rene suggests to other pharmacistsconsidering applying for additionalprescribing authorization that,“prescribing is merely a tool to helpfacilitate the pharmaceutical careprocess – in isolation it won’t help ourpatients unless all of the otheressential steps of the process areimplemented. That is what theapplication procedure is trying todetermine. I would encouragepharmacists applying to examinetheir practice and if everything isthere, then go for it! If somefundamentals are missing, find outwhat needs to be done to fill thosegaps, or spend some time with apharmacist who has additionalprescribing authority to see how theypractice. In the end, each individualpractice is unique; however, I thinkevery pharmacist has the potential toelevate their practice to the pointwhere they can obtain additionalprescribing authorization.”

Partnersin Practice

Dean Pasutto, Sara Houlihan, recent grad, and Stan Dyjur, APSA president.

Rene Breault continued from page 8

�


Nearly 300 people attended the gradluncheon, hosted by ACP on June 6 tocelebrate the class of 2008. Although atthe Shaw Centre and not a classroom,there was still learning as speakersimparted their wisdom. Deputy Ministerof Advanced Education Annette Trimbeeencouraged the graduates to seize theopportunities that have newly opened topharmacists in Alberta and to embrace aspirit of entrepreneurship.

Dean Pasutto thanked the class for theirenthusiasm and noted the legacy theyhold as the first class to have graduatedusing the new curriculum. He offeredwords of encouragement and advicethrough a quote from William Bötcker:

“Your greatness is measured by yourkindness,

“Your education and intellect by yourmodesty,

“Your ignorance is betrayed by yoursuspicions and prejudices,

“And your real caliber is measured by theconsideration and tolerance you have forothers.”

President Rick Siemens chargedattendees to never settle for mediocrity—from others or from themselves. He alsostressed the importance of relationshipsthroughout a pharmacists’ career, withpatients, peers, and other healthprofessionals.

He then had the privilege of announcingthe winners of two major awards:Aleasha Grattan, recipient of the ACPGold Medal, and Judi Lee, recipient ofthe APSA Past President award.

In addition, Jayne Quan from theFoothills Medical Centre and RickSiemens from London Drugs #38(Lethbridge) were recognized as HospitalPreceptor of the Year and CommunityPreceptor of the Year respectively.

Congratulations to the award winnersand best wishes to the Class of 2008!

Celebrating the Class of 2008

The Health Quality Council of Alberta(HQCA) recently released the results ofits first provincial survey of patientexperience in Alberta’s emergencydepartments. Overall, 90% of rural and84% of urban respondents ranked theiroverall care as excellent, very good orgood. Wait times in the emergencydepartment, especially the time it took tosee a doctor, clearly affected patients’overall emergency departmentexperience. However, what matteredmost to patients, and what most

influenced their overall rating, was thecare and communication they ultimatelyreceived.

The survey results clearly show thatregardless of overcrowding and wait-time issues, from the patient’sperspective, health care providers needto develop strategies that provide anoptimal environment for communicationso that patients can fully shareinformation about their condition, haveenough time to discuss their healthconcerns and receive information about

treatments, test results and dischargeinstructions.

The report is available at: www.hqca.ca.For more information about the HQCA’semergency department patientexperience survey, please contact PamBrandt at 403-297-4091 [email protected].

Albertans most concerned about quality of care and communication

Judi Lee, APSA Past President with RickSiemens, ACP President

Billy Wunarto presenting CommunityPreceptor of the Year to Rick Siemens

Grace Chan presenting Hospital Preceptor ofthe Year to Jayne Quan


�In memory…� George Wyllie ofEdmonton passed away onApril 25th, 2008 at the ageof 79 years.

Born in Brock, Saskatchewan,George completed a BSc inPharmacy from the University ofSaskatchewan in 1951. Hemarried Anne Mady; they movedto Rimbey in 1955 where Georgeowned and operated Wyllie’sPharmacy and later also co-operated Alpine Drugs in RockyMountain House. He retired inEdmonton in 1984. George hadmany diverse interests and wasvery engaged in the AlbertaPharmaceutical Association andhis community, committing to thework of the Chamber ofCommerce, Town Council, LionsClub, the Masonic Lodge and theUnited Church.

George is survived by his lovingwife Anne and will be missed byhis sons, daughters and manyother family and friends. Hiseldest daughter, Elaine, followedin her father’s profession,graduating as a pharmacist fromthe UofA. She currently practisesin B.C.

QualityPharmacistPractice

Did you know that if, because of conductthat in the opinion of the employer isunprofessional conduct, the employmentof a regulated member is terminated orsuspended or the regulated memberresigns, the employer must give notice ofthat conduct to ACP’s complaintsdirector? Section 57of the HealthProfessions Act requires it.

The Act goes on to say that, once havingreceived notification, the complaints

director must treat the employer as acomplainant and notify the employerand the regulated member as he wouldfor any other complaint.

This duty to report applies for registrantsengaged to provide professional serviceson a full-time or part-time basis as a paidor unpaid employee, consultant,contractor, or volunteer.

An adjudicator with the Office of theInformation and Privacy Commissioner(OIPC) determined that a pharmacy wasnot in violation of the Health InformationAct (HIA) when it asked a customer forphoto identification.

The complainant was picking up drugsfor his wife and the pharmacy said itrequired photographic identificationbecause the drugs were Schedule 2 drugsand they needed to confirm the husbandwas within the circle of care.

The complainant felt the pharmacy wasnot allowed to ask for photo ID under

terms of both the HIA and the PersonalInformation Protection Act (PIPA).

The adjudicator ruled that thepharmacist had viewed but not recordedthe photo ID. She determined thatbecause the pharmacy had viewed butdid not record the information, there wasno breach of HIA. The adjudicator alsoruled she had no jurisdiction to deal withthe complaint under the terms of PIPA.

To obtain a copy of the orders from thiscase (H2007-002 or P2007-015), visit theOIPC’s website at www.oipc.ab.ca.

Standard 73(b) of the Standards forOperating Licensed Pharmacies requiresthat written prescriptions (no matterfrom which authorized prescriber)and transaction records for allSchedule 1 drugs dispensed areretained for at least two years past thecompletion of therapy with regard tothe prescription or for 42 months,whichever is greater.

Standard 78 of the Standards for OperatingLicensed Pharmacies says that patientrecords must provide a history of allinteractions required to be documentedfor a patient under the Standards forPharmacist Practice and must bemaintained for a period not less than 10years after the last pharmacy service ortwo years past the age of majority,whichever is greater.

Termination for unprofessional conductmust be reported

Adjudicator finds pharmacy did not breach HIA

How long do you retain pharmacist-prescribed prescriptions?


You are required to sign two professionaldeclarations as part of the pharmacistregistration renewal process: oneregarding continuing competency andone regarding professional liabilityinsurance. What happens if theinformation you declare is inaccurate oryou don’t sign the declaration?

� Your registration renewal may be delayed.

Without signed declarations, yourrenewal cannot be processed. If youdon’t receive a new practice permit byJune 30, 2008 when the old oneexpires, you may not practice untilyou are issued a new practice permit.This could mean unscheduled time offfor you in July and inconvenience foryour employer.

� You may be investigated.

Both declarations include theunderstanding that any false ormisleading statements concerning

learning activities or liability coveragemay result in a referral to theComplaints Director for furtherinvestigation.

� Your practice permit may becancelled.

The Professional Liability InsuranceDeclaration includes theunderstanding that if you wish to beon the clinical register but do notmaintain valid professional liabilitycoverage, and if you can not provideproof of this insurance, your practicepermit will be cancelled.

� You jeopardize the profession’sself-regulation privilege.

As a self-regulating profession theAlberta College of Pharmacists relieson the professional undertakings andthe ethical commitment of itsregistrants as a means of ensuringsafe, effective and responsiblepharmacy practice. The privilege of

self-regulation comes with increasedpersonal responsibility.

Professional declarations are key todemonstrating to Albertans that theirpharmacists are not only competent,but possess the requisite liabilityinsurance in the event of any damagessuffered as the result of an error.During our recent efforts to gainexpanded practice privileges,government recognized that key togranting this authority was the abilityto ensure protection of the publicthrough maintenance of competencyand liability insurance.

As a professional, you must confirm youragreement to take responsibility for youractions by signing the declarations. ACPrecognizes that this is a moderately newregistration process and remainscommitted to working with pharmaciststo ensure that they understand andcomply with these professionaldeclarations.

1. Indicate an adaptation

If you work in a hospital, clinic orother non-dispensing environmentand you adapt prescriptions, pleaseindicate that the prescription is infact an adaptation. Otherwise, acommunity pharmacist willassume that it is an initialprescription and will not fill it ifyou do not have additionprescribing authorization.

2. Document your adaptations

Standard 12.8 in the Standards forPharmacist Practice outlines theduty to document the adaptation.A pharmacist who adapts aprescription must:

(a) create a new prescription in writingsigned by the pharmacist;

(b) provide a clear reference on the newprescription to the originalprescription, and

(c) retain both the new prescription andthe original prescription whereapplicable.

We have received reports that, duringaudit, third party payers have beendisallowing claims if the writtenprescription does not include areference to the original prescription.

3. Inform the original prescriber

Standard 12.9 outlines the duty toinform the original prescriber and

describes the information that must beincluded in that notification. A pharmacist who adapts a prescriptionmust communicate to the originalprescriber the following informationregarding the adaptation and the rationalefor it as soon as reasonably possible:

(a) that the pharmacist has adapted theprescription for the patient;

(b) the type and amount of the drugprescribed;

(c) the rationale for prescribing the drug;

(d) the date the drug was prescribed; and

(e) instructions given to the patient, ifapplicable.

Professional declarations – what are they all about?

Reminders when adapting prescriptions


This conference was an event thatcelebrated many firsts:

� the first Alberta pharmacy conferenceco-hosted by ACP and RxA;

� the first presentation of the APEX(Alberta Pharmacy Excellence)Awards, the new province-wideprogram created by ACP and RxAto recognize excellence inpharmacy practice;

� the first conference to includepharmacists with authorization toadminister drugs by injection;

� the first conference to includepharmacists with additionalprescribing authorization; andfinally

� the first conference to be devotedentirely to helping pharmacistspersonally clarify and reach theirpractice goals.

Three world-renowned experts onchange in pharmacist practice –William Zellmer, Ross Holland andChristine Nimmo – were broughttogether to help Alberta pharmacistsmake the most of the newopportunities available. Pharmacists

and pharmacy managers left with asense of professional revitalization,collaboration and inspiration.

Conference highlights

APEX Awards and presentation toadditional prescribers

Friday, May 23 was a very special nightfor Alberta pharmacy. This was anopportunity to celebrate theachievements of the 2008 APEX Awardwinners and Alberta’s first fifteenpharmacists with additional prescribingauthorization. Each individual hasdemonstrated leadership andexcellence within the profession andtheir community. Deputy Minister ofHealth and Wellness Paddy Meadepresented the awards. She commendedAlberta pharmacists for taking the leadon the new practices that will nowexpand across Canada.

Learn more about the APEX Awards andthe deserving recipients by viewing theaward videos at www.pharmacists.ab.ca.You’ll be inspired by the work of theseindividuals and moved by their stories.Nomination forms for next year’s awards

A physician reported, “A patient ofmine recently faxed her own triplicateprescription to a pharmacy. Thepharmacy phoned me to ask if I hadfaxed the prescription. I had not. Onlythen did it occur to me that it waspossible for patients to fax the sameprescription to several differentpharmacies.” Although this scam wasnew to this physician, it is notuncommon.

Please ensure that faxed prescriptionsare originating from a physician’s office. Refer to Ensuring Safe & EfficientCommunication of Medication Prescriptionsin Community and Ambulatory Settings(http://pharmacists.ab.ca/Downloads/documentloader.ashx?id=4990) for best practice tips.

If you have any suspicion that a faxedprescription did not come directlyfrom the physician, please follow upwith the physician’s office to confirm.

“Thought-provoking, motivational,inspiring” Pharmacists on theTightrope conferencebalances personalsatisfaction and professional change

Over 150 pharmacists have a better understanding of new opportunities forgreater professional satisfaction and better patient care thanks to thePharmacists on the Tightrope conference, co-hosted by the Alberta College ofPharmacists (ACP) and the Alberta Pharmacists’ Association (RxA) this pastMay in Edmonton.

Check those faxnumbers

Don’t default to “Dr.”It’s not just doctors that writeprescriptions anymore; pharmacists,nurse practitioners and dieticians arewriting them too. Be sure that yourpharmacy labels don’t imply that thesepractitioners are doctors by a labelingdefault to “Dr. _________”. This canconfuse patients and health carepractitioners alike. Ask your softwarevendor for assistance to apply thecorrect designation to prescriber namesin your computer system.

continued on page 14


will be made available soon. Do youknow someone who deserves an APEXAward?

Unique session layout encouragedinteraction and collaboration

Rather than the typical lectures,conference planners designed three“hands-on” interactive sessions. Oneparticipant summed it up by saying,“The interactive breakout sessions werevery valuable – the opportunity tointeract with peers and learn more aboutwhat others are doing in their practicewas very important as well as inspiring!”

Four people who “went first”, paneldiscussion

Attendees were inspired by the storiesshared by four pharmacists who havepursued opportunities never beforeopen to pharmacists in Alberta.Thanks to Anjli Acharya (achievedauthorization to administer drugs by

injection), Erin Albrecht (achievedadditional prescribing authorization),and Margaret Wing and KristineVeillette (participants in the UofAmentorship pilot project) for showingthe way from theory to practice.

What’s next?

We hope to see you next year at the2009 Strengthening the Bond Tri-Profession conference from May 21-23in Banff. This conference is jointlyhosted by ACP, the AMA, RxA,CARNA and CPSA. Its theme will beCulture, Collaboration and Change.

Joint conference continued from page 13 ACP no longerforwarding Health CanadaMedEffect notices As of July 31, ACP will no longer beforwarding advisories, warnings orrecalls issued through Health Canada’sMedEffect program. Many registrantshave let us know that they subscribedirectly to this service and do not needthe message again from the college.

If you have not already subscribed tothis free service, you may do so bylogging on to Health Canada’s website athttp://www.hc-sc.gc.ca/dhp-mps/medeff/subscribe-abonnement/index-eng.php#subscribe.

We will continue to post the advisorieson the Safety Advisories section of thecollege’s website (pharmacists.ab.ca).You can also check current and archivedadvisories on Health Canada’s site.

First 15 pharmacists granted additional prescribing authorization, with Paddy Meade, Deputy Minister, Alberta Health and Wellness. Back row, left toright: Rami Chowaniec, Christine Hughes, Erin Albrecht, Glen Pearson, Rick Siemens, Rene Breault, Paddy Meade. Front row, left to right: Gladys Whyte,Nese Yuksel, Jodi Wilkie, Jennifer Dutka, Sheri Koshman, Kim Mettimano, Tammy Bungard. Missing recipients: Jeff Kapler and Renette Bertholet.


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Your input is important to us. As writers, editors, and designers, our primary purpose is to serve you. Thank you for your help!

Readersurvey

Please take a moment to tell us what you think about acpnews. We’ve made changes recentlyand want your feedback. Please complete this survey online at pharmacists.ab.ca, or completeand fax this paper copy to Karen Mills at 780-990-0328.

It has been an eventful year forpharmacy in Alberta. In keeping withthe new developments, ACP hasgiven its website a facelift andretooled it to make it more user-friendly and better accommodate allof the news, information, and eventssurrounding these exciting times inpharmacy practice.

You’ll see a new “For the Public”section, where you can send patientsto learn more about what you do andthe services you provide. The searchfunction has moved to the top righthand corner of every page, and alongthe left hand side of the homepageyou’ll see a list of “Quick Links” –areas of the website that you visitmost frequently and need the quickestaccess to. These links includeRegistrant Email, Registrant Profile,the TPP Program, the PhysicianPrescriber List, and the Alberta DrugSchedules. Instead of drop downmenus, you’ll now find your menuoptions displayed on the left side ofeach page.

Thanks to all who took part in thewebsite surveys and focus groups –your input has been invaluable! Wewill continue to work diligently toimprove and enhance the information,efficiency, and usefulness of the ACPwebsite and your continued feedbackis important. Take some time toexplore and get to know the new siteand if you have suggestions forimprovements please let us know.

Canadian Publication Agreement Number: 40008642

Return undeliverable Canadian addresses to:Alberta College of Pharmacists1200 -10303 Jasper Avenue NWEdmonton AB T5J 3N6


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