Nova Scotia
College of Pharmacists
Like pharmacists, the NSCP itself must continu-
ally evolve to meet its regulatory obligations in
an every-changing healthcare envi-
ronment. The NSCP‘s primary pur-
pose is to govern the practice of
pharmacy in the interest of Nova
Scotians. Through the Pharmacy
Act, the government gives the
NSCP the authority and the re-
sponsibility of self-regulation. In
exchange for this privilege, the
NSCP is expected to develop and
enforce standards that are designed
to protect the public by ensuring
pharmacy services are provided in
a competent and ethical manner.
In recent years, the privilege of self-
regulation has been under scrutiny
globally. There is growing concern
that self-regulation, in some in-
stances, may not be rigorous
enough to truly protect the public.
In some countries, regulatory bod-
ies face the serious risk of losing
the right to self-regulate.
In response to this concern, self-
regulation around the world is undergoing sig-
nificant transformations. Regulatory authorities
are taking steps to ensure that they are respon-
sive and accountable to the public. The NSCP
Council has also taken steps over the past year
to ensure the quality of its regulatory poli-
cies and practices. In the spring, the NSCP
Council participated in a gov-
ernance session to more clearly
define its governance responsi-
bilities and to ensure the NSCP
continues to meet its legislated
obligations to protect the pub-
lic. As a result, a new model for
governance was approved by
the Council, which included the
formation of Council govern-
ance committees and policies to
promote transparency and ac-
countability.
The Council, along with invited
stakeholders including the Dal-
housie University Health Law
Institute, also participated in a
comprehensive strategic plan-
ning session in the spring of
2009 to not only agree upon
strategic goals for the next
three years, but also clarify the
NSCP‘s core business. The
Council re-affirmed the core
business of the NSCP to be:
registration/licensure
quality assurance
practice standards
professional accountability
Message from the Registrar
the Bulletin December 2009
Governing the practice of pharmacy in Nova Scotia in the interest of the health and well being of the public
In recent years,
the privilege of
self-regulation
has been under
scrutiny globally.
In some
countries,
regulatory bodies
are losing the
right to self-
regulate.
This Bulletin is forwarded to every licensed pharmacist and certified dispenser in Nova Scotia. Decisions of the Nova Scotia College of Pharma-
cists regarding matters such as regulations, drug schedules, pharmacy practice, etc., are published in this Bulletin. The Nova Scotia College of
Pharmacists therefore assumes that all pharmacists/certified dispensers are aware of these matters.
Message from Registrar 1-2
Annual Report 2
New Staff NSCP 3
New Location Notice 3
Congratulations Dal
Grads 2009
3
Correction Notice 3
Council Membership 4
Welcome New Council
Members
5
MACP Signed 5
Online Special Interest
Groups
6-7
Warning/Advisories 8
Drug Schedule Changes 9
Natural Health Products 9
New Policies Coming 10-11
Faxed Prescriptions 12
Prescription Transfers 12
Emailed Prescriptions 12
Potential Drug Diversion
Efforts—Beware
13
Medication Errors &
Apology Act
13
Ethics in the Spotlight 14
Holiday Hours 14
Inside this issue:
Self-regulation concerns, strategic planning, and fees…
practice issues. There will also be an individual who
will work directly with the QA / Competency As-
sessment consultant in the development of the en-
hanced QA process and who will assume responsibil-
ity for this area once the program has been finalized.
The NSCP Council acknowledges that its rigorous
strategic plan and the resulting staff restructuring
comes with significant fee increases for its regis-
trants. The resulting pharmacist fee of $725, while
significantly higher than previous years‘ fees in Nova
Scotia, is consistent with fees across the country,
including our closest neighbor NB, where the annual
pharmacist fee is $880. The Council also recognizes,
however, that it must provide a regulatory frame-
work that is responsive to an evolving healthcare
environment, to consumer expectations, and to a
significantly expanded scope of practice for pharma-
cists. The NSCP understands that its‘ regulation of
the profession needs to reflect this new environment
and that its regulatory structures and processes need
to address the challenges that will arise while ensur-
ing competence, performance and safety as the pro-
fession evolves. The reputation of the profession and
the health and safety of the public depends upon the
effectiveness of the NSCP‘s regulation of the practice
of pharmacy.
The Council also approved a comprehensive strategic
plan with 10 strategic goals to be completed over the
next three years:
1. Optimal scope of practice for pharmacists;
2. Regulation of Pharmacy Technicians;
3. Quality Assurance programs for pharmacists, phar-
macy practice and NSCP governance
4. Effective and relevant legislation, regulations, stan-
dards, policies and codes;
5. Robust professional accountability system;
6. Efficient use of technology;
7. Optimal collaboration
8. Effective communication
9. Optimal input into/impact upon e-Health initiatives;
10. Maintenance of current core and administrative activi-
ties in a sustainable fashion.
Following the approval of the strategic plan, an expert
consultant helped to develop a comprehensive opera-
tional plan consistent with the NSCP‘s core business and
strategic goals. Council accepted the recommendation
that a significant restructuring of the current administra-
tion, including the addition of staff, was needed in order
to continue to satisfy the NSCP‘s regulatory obligations
under the Act, to ensure the successful fulfillment of the
strategic goals, and particularly in order to appropriately
dedicate resources to the changes in regulation as the
result of the expanded scope of practice for pharmacists
and the regulation of pharmacy technicians.
In response, a 0.6 FTE devoted exclusively to Professional
Accountability (complaints and discipline) was hired (see
page 3). In 2010, further restructuring will include a staff
member whose primary responsibility will be pharmacy
Message continued...
Page 2 the Bulletin
Annual Report—it IS a good read!
Included with this Bulletin is the Nova Scotia College of Pharmacists An-nual Report 2008-2009. All are encouraged to
read the report as it is a comprehensive source of information on the activities and undertakings of the College this
past year and as we look to the future.
After many years of ―rooming in‖ with our friends at the Pharmacy
Association of Nova Scotia, we moved into our new home in Sentry
Place in early October. Our new address is 1559 Brunswick
Street, Suite 200 (next door to Cambridge Suites).
PANS successfully sold the Dresden Row condo and have moved
their offices to Dartmouth Crossing – Suite 225, 170 Cromarty
Drive (above Backyard Veranda). We wish them the best of luck in
their new home.
The New Face of Complaints and Discipline
Have you seen our new place?
the Bulletin February 2009
Chalmers Hospital. Her community experience includes
thirteen years as pharmacy owner of St. Andrews
Pharmacy Ltd. and six years as pharmacy owner of St.
Stephen Prescription Centre Ltd. Prior to joining the
NSCP staff, Cindy was working at Pharmasea Community
Pharmacy in Hatchet Lake, NS.
Cindy has a strong interest in pharmacy legislation and its
application to pharmacy practice and professional ac-
countability, and has served on the NSCP‘s Investigation
Committee and Hearing Committee.
The Nova Scotia College of Pharmacists wel-comes
Cindy Ingersoll to the new position of Manager of
Professional Accountability. Cindy‘s key
responsibilities in this role are to direct and manage the
professional accountabil-ity processes of the College,
including com-plaints, investigations and hearings.
Cindy received her pharmacy degree from Dalhousie Uni-
versity in 1985. Upon graduation she practiced for several
years in the hospital setting, serving as Director of Phar-
macy at Charlotte County Hospital, and as Assistant Di-
rector/ Interim Director of Pharmacy at Dr. Everett
WE ARE
HERE!
Congratulations
As the year draws to a close, the NSCP would like to extend congratulations to the 2009 Dalhou-sie College of
Pharmacy Graduates for a successful first year of practice and a wish for many per-sonal and professional successes in
the future. It is indeed an optimistic time for the profession and we are confident that your practice will aptly be
guided to always serve in the best interest of the public.
Correction Notice
Our apologies to KINBURN PHARMACY. In our last issue of the Bulletin, we incorrectly listed the location of this
pharmacy at Lunenburg. The correct location is Mahone Bay.
Ever Wonder who sits at the Boardroom Table?
Page 4 the Bulletin
The NSCP congratulates Chelsea Caldwell and Mary Abriel-Sangster who were successful in the Council elections and
look forward to an exciting and productive year working together. The NSCP gratefully acknowledges the service and
contributions of our departing Council members, Sujay Khiroya and Anne Marentette, whose knowledge and wis-
dom has helped guide the successful course of the NSCP over the last number of years.
Presenting
the
NSCP
Council
for
2010
Trevor
Simmons
PRESIDENT
Zone 1 Rep (Hospital)
Tom
Mahaffey
PAST PRESIDENT
Public Rep
Deb
Barnhill
Zone 3 Rep
Janelle
Gray
Zone 4 Rep
Frank
Burgoyne
Public Rep
Craig
Connelly
VICE-PRESIDENT
Zone 1 Rep
Sarah
Murphy-Boutilier
Zone 2 Rep
Rita
Caldwell
College of
Pharmacy Rep
Cathy
Comeau
Pharmacy
Technician
Observer
Mary
Abriel-Sangster
Zone 1 Rep
Chelsea
Caldwell
Zone 1 Rep
NB: Position of SECRETARY-TREASURER to filled
NEW! NEW!
Chelsea Caldwell—Zone 1
Chelsea has worked with Lawtons since graduation from
Dal in 2004 and cur-rently manages the Duffus Street
loca-tion (since 2008). She is also is a third year skills lab
tutor and a preceptor for the Practical Experience
Program at Dal.
Chelsea is interested in the expanding role of the pharma-
cist and has successfully completed the Immunization
Training Program through Dal CPE.
Mary Abriel-Sangster—Zone 1
Mary, also a 2004 Dal grad, started her career in phar-
macy in Ottawa where she was a manager for Loblaws
DRUGStore Pharmacy. She was on the Ottawa Carle-
ton Pharmacists‘ Association Executive and served as
the membership coordinator. In 2007, she moved back
to Halifax and continued her employment with DRUG-
Store Pharmacy in Bayers Lake where she still works as
a staff pharmacist.
A closer look at our two new Council members...
Let’s begin by defining some of the “lingo”:
MACP = Mobility Agreement for Canadian Pharmacists
MRA = Mutual Recognition Agreement [for Pharmacists in
Canada]
AIT = Agreement on Internal Trade
NAPRA = National Association of Regulatory Authorities
Next some background:
The AIT (Chapter 7) was revised and came into effect early
this year. This is an intergovernmental trade agreement
with Canada‘s First Ministers to reduce and eliminate, to the
extent possible, barriers to the free movement of persons,
goods, services, and investment within Canada and to estab-
lish an open, efficient, and stable domestic market.
Significance?
This is particularly significant to those workers in Canada
who work in regulated occupations or trades. It means
qualifications of workers from one part of the country are
to be recognized and accommodated in other parts of Can-
ada, and differences in occupational standards are to be rec-
onciled as much as possible. The goal is to see people li-
censed and registered based primarily on their competency
to do the job, not on where they come from.
Response to the new AIT
The Nova Scotia College of Pharmacists is proud to be
a signatory to the new Mobility Agreement for Canadian
Pharmacists (MACP). The National Association of
Pharmacy Regulatory Authorities (NAPRA) led the
adoption of this significant
document by all Canada‘s
pharmacy regulatory
authorities. The MACP, which
was signed during a special
celebration on Sunday,
November 1, 2009 in
Montréal, replaces the Mutual
Recognition Agreement for
Pharmacists in Canada. It
captures commonly held
principles and requirements to
allow the movement of
pharmacists across Canada
without imposing unreasonable
or discriminatory
requirements – is a significant
document for pharmacists.
A copy of the agreement can
be accessed from the NAPRA
website: www.napra.ca/
Content_Files/Files/Mobilty_
Agreement_EN_May2009_
final_ samplecopy.pdf
Page 5
MACP replaces MRA:
What does that mean?
“What we achieved
is outstanding.
With the signing of
the agreement by
all of Canada’s
pharmacy regula-
tory authorities, it
recognizes the high
degree of common-
ality in our profes-
sion and provides
enhanced mobility
for our pharma-
cists,” said Dianne
Donnan,
NAPRA President.
Ever find yourself wondering what someone else would do
in your situation? What about wishing you had some
more effective tools to aid in your practice? And then
there is just wanting to talk things through with someone
else….
The good news is that you are not alone...but you probably
already knew that! The great news is that help is but a
click away.
There are many online interest groups available to practic-
ing pharmacists (and some are free!) to assist them in
their practice. Have a look at some of the options listed
below and see if you might want to answer this Want Ad!
Page 6 the Bulletin
Primary Care Pharmacy Specialty Network
(PSN)
The Primary Care Pharmacy Specialty Network is a
group of pharmacists across Canada with a common in-
terest in patient care in primary health care and family
practice. This may include pharmacists integrated into a
family medicine practice or pharmacists who are devel-
oping or providing services to individuals in a community
-based setting. This PSN is jointly sponsored by CSHP
and CPhA. The primary focus is to promote and opti-
mize the role of the pharmacist in the primary health
care setting. Objectives include:
To promote sharing of practice-based resources
and tools
To develop, support and maintain networking op-
portunities for Canadian pharmacists with an in-
terest in primary care practice, education and/or
research
To design and disseminate education and/or train-
ing initiatives for members
To advocate for the role and practice develop-
ment of the pharmacist in family practice and pri-
mary care settings
To provide an opportunity for mentorship of new
pharmacists in the practice setting.
If you have practice or research questions, your peers are
willing to give you the benefit of their experience and ex-
pertise.
To join, go to www.pharmacists.ca/primarycare. It is free
to members of CPhA and CSHP. Check out the website:
www.psnextranet.pharmacists.ca
Canadian Pharmacy Practice Research Group
CPPRG
CPPRG now has a Google Group ―CPhA-CPPRG‖ to fa-
cilitate communications among Canadian pharmacy prac-
tice researchers. As a member of this group, you will have
access to:
Archived issues of the Translator and Live Links
Funding opportunities
Description of current pharmacy practice research
(PPR) projects in Canada
Powerful search engine to find relevant PPR posted
on this Group
Chance to connect with other pharmacy practice
researchers
And much more!
If you are interested in joining this group, please contact
[email protected] to receive your invitation and
more information. Membership is free and open to any-
one interested in pharmacy practice research.
WANTED
Enthusiastic pharmacist wanting to
meet like-minded individuals who en-
joy strolling through online chat
rooms, discussion boards, and clinical
practice guidelines. Must be open-
minded and willing to engage in a
meaningful sharing relationship with
colleagues. Must be between 20-100
years old.
Governing the practice of pharmacy in Nova Scotia in the interest of the health and well being of the public Page 7
Canadian Action Network for the Advance-
ment, Dissemination, and Adoption of Prac-
tice-Informed Tobacco Treatment
As pharmacists, you are one of the most accessible
groups of health care professionals around. Giving advice
about smoking cessation on-site, where Nicotine Re-
placement Therapy (NRT) like nicotine gum or patches
can be purchased, means you can have quite an impact on
smokers‘ cessation efforts.
With National Non-Smoking Week around the corner
(January 17-23), CAN-ADAPTT is set to serve as your
source of clinical information on smoking cessation. CAN
-ADAPTT offers tools to prepare you to initiate a con-
versation with smokers and to help them find effective
ways to kick the habit.
CAN-ADAPTT is the Canadian Action Network for the
Advancement, Dissemination and Adoption of Practice-
Informed Tobacco Treatment (www.can-adaptt.net), a
project initiated by Ontario‘s Centre for Addiction and
Mental Health (CAMH). It‘s a practice-based research
network facilitating knowledge exchange among health-
care professionals and researchers in the area of smoking
cessation.
Get Involved!
Join the CAN-ADAPTT network and be part of the lar-
ger healthcare community seeking evidence-based prac-
tices that will help tobacco users to stop using. As a
member, you can:
Use the discussion board to connect/collaborate with
other pharmacists and healthcare professionals in Can-
ada;
Exchange knowledge about better smoking cessation
practices that you can implement; and
Post questions, receive feedback, disseminate infor-
mation and resources.
Access up-to-date, evidence-based clinical practice
guidelines for tobacco control; and
Contribute to the development of the first Canadian
Clinical Practice Guidelines for Tobacco Control.
Get links to smoking cessation/tobacco control re-
sources including websites, projects, literature reviews,
and articles.
Access Seed grant opportunities for practitioner-
researcher teams to address gaps in research and exist-
ing tobacco control guidelines.
Membership is free, and is open to pharmacists and
other healthcare professionals interested in contributing
to practice-based approaches to tobacco cessation.
What’s Next?
One of CAN-ADAPTT‘s main objectives is to develop
and promote the adoption of national clinical practice
guidelines (CPG‘s) for pharmacists and other health
practitioners. The dissemination and adoption of CPG‘s
will complement smoking cessation initiatives that phar-
macists already provide and will help to establish smok-
ing cessation as a standard of care in pharmacies in
Nova Scotia and across the country. CPG‘s can help
pharmacists provide the most up-to-date, evidence-
based care and interventions to help their clients quit
smoking.
As more pharmacists and other healthcare professionals
become involved with CAN-ADAPTT, the network will
continue to expand, generating new research and
knowledge and addressing gaps in the current set of
CPG‘s. This new evidence will then be incorporated,
keeping the guidelines up-to-date and clinically relevant
to those in the position to help smokers change their
behaviour.
Your involvement will help ultimately increase the ca-
pacity and commitment among Canadian pharmacy pro-
fessionals and other healthcare professionals in the area
of smoking cessation.
For more information, please contact:
Katie Hunter, Regional Coordinator, CAN-ADAPTT
Centre for Addiction and Mental Health
(416) 535-8501 x 7421
Pharmacists, especially Pharmacy Managers, are reminded that critical health/drug advisories, warnings and drug
recalls are posted on the NSCP website homepage: www.nspharmacists.ca and the Health Canada website:
www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/
It is the responsibility of every licensed pharmacist and certified dispenser to keep abreast of these safety
advisories and to advise their patients where appropriate.
See below for the latest safety advisories. To view the full advisory, please check either website noted above.
Health Canada Advisories, Warnings, and Recalls
October 28, 2009:
Type II Product Recall of Apo-Lithium Carbonate SR 300 mg
strength tablets
October 27, 2009:
Type I Product Recall of Propofol Injection, 1 g/100 mL and 500
mg/50 mL Due to the Presence of Particulate Matter - Hospira
Healthcare Corporation
October 26, 2009:
Potential Risk of Serious Adverse Health Consequences with
Inadvertent Administration of Cesamet (nabilone) Capsules 1
mg Instead of Trazorel (trazodone hydrochloride) Tablets 50
mg Due to Mislabelling
October 23, 2009:
Association of Rituxan® (rituximab) with Progressive Multifocal
Leukoencephalopathy (PML)
October 23, 2009:
Important Tamiflu Information for Health Professionals
October 20, 2009:
Health Canada issued important safey information on CEFTRI-
AXONE
October 20, 2009:
Potential Mislabelling of Trazorel and Cesamet Bottles
October 20, 2009:
Risk of Entrapment of Patients in Hospital Beds
October 19, 2009:
New Safety Information Regarding Intelence (etravirine) and
Severe Skin and Hypersensitivity Reactions
October 15, 2009:
Important Information About the Risk of Dosing Error for
Tamiflu (oseltamivir phosphate) Powder for Oral Suspension
(12 mg/mL)
October 15, 2009:
Recall Notice, Portex Uncuffed Pediatric-Sized Tracheal Tubes
October 14, 2009:
Health Canada is advising consumers not to use the following
foreign health products due to concerns about possible adverse
reactions:
- Bao Ling, Dynasty Worldwide Jinglida So Young Formula,
STEAM, Syntrax Fyre, Texiao Fengshi Gutong Ling, Kam Yuen
Brand Wan Ying Yang Gan Wan
October 7, 2009:
Important Safety Information Regarding the Use of Sleep Aid
Drugs and the Risk of Complex Sleep-Related Behaviours
October 1, 2009:
Important Safety Information on Hospira Devices that have
Defective AC Power Cords - Hospira Healthcare Corporation
December 9, 2009:
Thyrogen (thyrotropin alfa for injection): Caution with Prepara-
tion and Administration
December 9, 2009:
Cerezyme (imiglucerase for injection), Fabrazyme (agalsidase
beta), Myozyme (alglucosidase alfa) and Aldurazyme
(laronidase): Caution with Preparation and Administration
December 8, 2009:
Important Information about Acai Berry Products containing
Prescription Medication
December 4, 2009:
One Lot of Zaditen Tablets (for Asthma) Recalled Due to Po-
tential Health Risks
December 3, 2009:
Exjade (deferasirox) - Proposed Changes to the Canadian
Product Monograph
December 2, 2009:
Rapamune (sirolimus) - Blood Level Measurement Changes
November 26, 2009:
Heparin - Decreased Potency as a Result of New United States
Pharmacopeia (USP) Standards
November 26, 2009:
Important Information on Changes to Heparin Potency
November 25, 2009:
Foreign Particles Found In Certain Products From Genzyme
November 25, 2009:
Health Canada Warns Consumers Not to Use ―Once More‖
or Any Unauthorized Product Promoted to Enhance Male Sex-
ual Performance
November 16, 2009:
Authorization for Sale and Post-Market Activities for Arepanrix
H1N1 Vaccine
November 5, 2009:
Chaotic Beverages Recalled Due to Unacceptable Health Risks
to Children
November 4, 2009:
Consumers Warned Against Buying Fraudulent H1N1 Flu Virus
Products Online
November 3, 2009:
Association of Relenza (zanamivir) Dry Powder for Inhalation
with Fatal Outcome when Administered by Nebulization In-
stead of Inhalation
October 30, 2009:
Health Canada Reminds Canadians to Check Medical Device
Clocks After Switch to Standard Time
Page 8 the Bulletin
Natural Health Products
Diphenhydramine
Diphenhydramine and its salts and preparations for
topical use in concentrations of 2% or less when sold
in containers of 300 mg or less of diphenhydramine
hydrochloride – Unscheduled (from Schedule III)
Drug Scheduling Changes Page 9
Naproxen Sodium
Naproxen sodium 220 mg tablet (when sold in products la-
beled with a recommended maximum daily dose of 440 mg,
and in package sizes of up to 6,600 mg) - Schedule III
Naproxen sodium 220 mg tablet (when sold in products la-
beled with a recommended maximum daily dose of 440 mg,
and in package sizes exceeding 6,600 mg) - Schedule II
met the natural health product (NHP) definition were given six
years to come into compliance with the NHPR. These products
were given ―transitional DINs‖, and were given until December
31, 2009 to obtain a product license under the NHPR. Licensed
natural health products can be identified by the 8-digit natural
product number (NPN, or DIN-HM for homeopathic medicines)
on the product label. When a DIN is transitioned to an NPN,
the 8-digit number remains the same, - the change occurs to the
prefix before the 8-digit number (e.g. DIN 12345678 is transi-
tioned to NPN 12345678).
All NHPs for sale in Canada require a product license from
Health Canada. The NHPR includes the requirement for pre-
market review of a product‘s safety, quality and efficacy before a
product license is issued. Health Canada reviews all product li-
cense applications and issues licenses only when the information
provided by applicants supports the high quality of the product,
the safe use of the product under the recommended conditions
of use of the product under the recommended conditions of use,
and the health claim being made for that product.
Licensed Natural Health Products Database (LNHPD)
The Licensed Natural Health Products Database (LNHPD), man-
aged by Health Canada, contains product specific information on
those natural health products that have been issued a product
license by Health Canada.
The LNHPD can be found at the following address:
http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-
prod/lnhpd-bdpsnh-eng.php
Natural health product (or NHP) is a
term used in Canada to refer to a
group of health products including:
vitamin and mineral supplements,
herbal remedies and other plant-
based products, traditional medicines (such as Traditional Chinese
Medicines and Ayurvedic [Indian]
Medicines), ho-meopathic medicines,
fatty acids, pro-biotics and some
personal care prod-ucts such as
antiperspirants, shampoos and
mouthwashes.
NHPs are regulated under the Natural
Health Products Regulations (NHPR)
and are included in the definition of a
―drug‖ under the Food and Drugs Act
(FDA). They are regulated as a subset
of ―drugs‖ with a separate regulatory framework (the NHPR).
The Food and Drug Regulations (FDR) and the NHPR provide a
comparable level of regulatory oversight. Both regulatory frame-
works have premarket review of products for safety, quality, and
efficacy. Both regulatory frameworks require that good manufac-
turing practices (GMP) be met before site/establishment licenses
are issued.
When the NHPR came into force on January 1, 2004, products
which had already received market authorization in the form of a
drug identification number (DIN) under the FDR and which now
Pharmacies are
reminded that
they should not
sell Natural
Health Products or
Homeopathic
medicines that DO
NOT have a NPN
or DIN-HM on the
label
Coming soon...
The Standards of Practice Committee has been very busy with putting together important documents and standards that
will help direct pharmacy practice. This is a heads up on what will be showing on the horizon – you should be seeing the
completed documents early in 2010.
Certain pharmaceuticals need to be in an environment
that is strictly between a narrow range of temperatures
as established and labeled by the manufacturer. Some
products, including vaccines, must be kept between 2°C
and 8°C at all times to maintain their quality and integrity.
―Cold Chain‖ refers to the system for handling, storing,
and transporting pharmaceuticals within a safe cold tem-
perature, which is usually between 2°C and 8°C for
products labeled ―for refrigeration‖.
Discussions around ―cold chain‖ have been very preva-
lent of late given the H1N1 pandemic coupled with the
anticipated move towards pharmacists immunizing in
Nova Scotia. Over the last few months, a task force has
been busy working on a Cold Chain Policy, which along
with other information will include criteria for dispensary
Page 10 the Bulletin
The public expects that pharmacists will take reasonable
steps to protect drugs on their premises from loss, theft
or diversion. This expectation is reflected in federal and
provincial legislation including the Narcotic Control regula-
tions, the Food and Drug Regulations, and the Nova Scotia
Practice Regulations to the Pharmacy Act. This expecta-
tion extends to both the pharmacy manager and the phar-
macist while on duty.
Reconciliation is a careful and methodical process of audit-
ing the recorded versus actual purchased, dispensed, and
on-hand quantities of drugs. While they are not quickly
performed activities, they are important for identifying
problems which can subsequently be investigated and
addressed.
The Narcotic Reconciliation policy is intended to provide
pharmacy managers with an effective means to assist
them in ensuring that the narcotic and controlled drugs
in the pharmacy are secure from internal loss, theft and
diversion.
Narcotic Reconciliation Policy
Cold Chain Policy
refrigerators and temperature monitors. While this may
necessitate a change in equipment for some pharmacies,
owners are reminded that as pharmacists, we are required
to ensure that medications are managed in a manner that
assures the integrity of the product provided to the pa-
tient. This includes the responsibility to maintain optimal
storage conditions for drugs when they are received,
stored, in the process of being prepared for dispensing,
awaiting patient pick-up and / or delivery, and finally re-
leased to the patient.
The upcoming NSCP policy was informed largely by the
Public Health Agency of Canada Guidelines which can be
viewed at http://www.phac-aspc.gc.ca/publicat/2007/
nvshglp-ldemv/section3-eng.php.
Page 11
Given community pharmacy‘s key role in the medication
management segment of the health care process, an effec-
tive continuous quality improvement (CQI) process for
community pharmacies that is both proactive and respon-
sive, and that enables enhancement of the safety culture of
the pharmacy as well as its practices, can be expected to
have a substantial impact on patient safety.
Recognizing the importance of continuous quality improve-
ment (CQI) in enabling pharmacies to provide optimal pa-
tient care, the 2003 Practice Regulations to the revised
Pharmacy Act includes a requirement for pharmacies in
Nova Scotia to establish and maintain a continuing, docu-
mented quality assurance program.
In consideration of the existing evidence on best practice
in the area of CQI, including the results from the
SafetyNET project, the NSCP has identified the required
components of an effective quality assurance program,
and community pharmacies in Nova Scotia will be as-
sessed for compliance with the Practice Regulations
against this standard.
Standard of Practice for Quality Assurance Programs
in Community Pharmacies
Centralized Prescription Processing Policy
The Nova Scotia College of Pharmacists defines central-
ized prescription processing (―central fill‖) as ―the proc-
essing by a central fill pharmacy of a request, from the origi-
nating pharmacy (patient contact pharmacy) to prepare a
drug order or to perform processing functions such as
packaging medication to be dispensed pursuant to a pre-
scription‖.
The NSCP can foresee where this arrangement may be
desirable in cer-tain community settings provided the
services are based upon an approved policy that would
ensure public safety and maintain the provision of optimal
care to the patient.
Position on Currency of Patient Profiles
The NSCP is of the position that a current and accurate
medica-tion profile is a critical compo-nent of medication
management and an essential component for providing
optimal patient care and supporting seamless care. Members of a patient‘s health care team expect that
pharmacy will be the primary steward of a patient‘s
medication profile.
The standards of practice for pharmacy practice require
that a pharmacist gather all relevant patient information
and assess its relevance to patient care. This includes rou-
tinely collecting and documenting information about a pa-
tient's other medications or treatments that that may af-
fect the patients medical condition or interact with their
therapy.
The Currency of Patient Profiles policy is intended to clarify
the NSCP‘s expectations of the minimum standards for
ensuring that patients‘ medication records are current,
comprehensive, and accurate.
Faxed Prescriptions...the right way!
Page 12 the Bulletin
Faxing represents an effective and efficient means of re-
laying prescription information from prescribers to phar-
macies. Indeed, it can help streamline workflow and allow
medications to be prepared in advance of the patient‘s
arrival thereby reducing the amount of time a patient is
required to wait for their prescription. However, prac-
tice standards cannot be sacrificed for the sake of con-
venience or avoidance of dialog with the physician.
In order for a faxed prescription to be considered a legal
prescription, the necessary requirements as listed in the
―Council Policy: Facsimile Transmission of Prescriptions‖(found
on website) must be fulfilled. Pharmacists are asked to
particularly note that not only must the prescription in-
clude the prescriber’s name, address, telephone number, fax
number and signature, but also certification statements by the
prescriber that:
i) the prescription represents the original of the pre-
scription drug order,
ii) the addressee (i.e. pharmacy) is the only intended
recipient and there are no others, and
iii) the original prescription will be invalidated by
marking it in such a way that it cannot be reissued.
A Model Prescription Form (found with policy) can be dis-
tributed which may help the prescriber to successfully
meet all requirements of a faxed prescription. Prescribers
may choose to develop their own form but it MUST con-
tain ALL the elements found on the Model Form.
The Nova Scotia College of Pharmacists has been made
aware that some pharmacies are continuing to accept
inap-propriate faxed prescriptions. This not only
contravenes the requirements set out by the NSCP and
the federal gov-ernment, but upon audit, the prescription
could be considered invalid by third party insurers. Additionally this practice creates problems for those pharmacists who are following the policy. Inconsistencies
in practice are perceived by prescribers which then make
it difficult for pharmacists to enforce the requirements.
Pharmacists are reminded that the responsibility to ensure
that the policy is being followed lies both with the pharma-
cist filling the prescription and the pharmacy manager.
Pharmacy Assistants and Prescription Transfers
Pharmacists and pharmacy managers are reminded that,
by law, prescription transfers require a pharmacist‘s in-
volvement on both the sending and receiving end. Verbal
transfers must be between two pharmacists. However,
the question has arisen whether pharmacy assistants can
send or receive faxed transfers of prescriptions. The
NSCP has determined that there is nothing prohibiting
technicians from being involved in and performing the
transfer process as long as there are pharmacists on either
end overseeing the process and taking responsibility for
the accuracy of the process.
Emailed
Rx
Pharmacists are reminded that emailed prescriptions are not considered legal pre-
scriptions. Until such time that security in transmission can be assured, as will be the
case when a provincial electronic drug information system (DIS) is developed, pharma-
cists are not to accept emailed prescriptions under any circumstances.
Medication Errors—OK to say you’re sorry
Pharmacists are reminded that a new statute, the Apol-
ogy Act, was proclaimed on October 1, 2009. The
Apology Act defines an apology as ―an expression of sym-
pathy or regret, a statement that one is sorry or any other
words or actions indicating contrition or commiseration,
whether or not the words or actions admit or imply an admis-
sion of fault in connection with the matter to which the words
or actions relate‖. Nova Scotia is the sixth province to
pass such legislation, which allows pharmacists to apolo-
gize and express remorse without having that expression
used as evidence in legal proceedings to establish fault or
liability. It is, however, important to bear in mind that
although the Apology Act states that the apology itself is
not admissible in court, it does not preclude the admis-
sion into evidence of the facts that gave rise to the inves-
tigation in the first instance. The complete Apology Act
may be viewed at:: www.gov.ns.ca/legislature/legc/
bills/60th_2nd/3rd_read/b233.htm
The Pharmacy Act legislates that the primary responsibility
of pharmacists in Nova Scotia is the provision of optimal
patient care. As such, the first duty of a pharmacist
when informed of a medication error is to care for the
patient. Pharmacists are reminded of their legal, moral,
and ethical duty to fully investigate an allegation of an er-
ror, beginning with immediate consultation with the pa-
tient‘s primary health care provider in most situations.
Subsequently, the error should be documented and man-
aged in accordance with the pharmacy‘s Continuous Qual-
ity Improvement process to identify the contributing fac-
tors to the error so that action can be taken to reduce the
likelihood of a recurrence of the event. Pharmacists are
encouraged to undertake such investigations in a caring
and transparent manner. As part of the investigative proc-
ess, pharmacists may feel conflicted between their duty to
the patient and their concern regarding potential liability.
As per an order of the Hearing Committee in March 2009, pharmacists are advised that the Nova Scotia College of
Pharmacists alleged that pharmacist Ms. Tamala Fadelle breached provi-sions of the Pharmacy Act and Regulations
made thereunder, and conducted herself in a way in which a Hearing Committee properly constituted under the
Pharmacy Act could conclude that her conduct amounted to professional misconduct.
The College and Ms. Fadelle believed that a Settlement Agreement was the proper method of resolving the matter, and
agreed to a statement of facts and disposition. Information relating to the details and resolution of the matter can be
accessed on the ―Communications‖ section of the NSCP website under ―Disciplinary Decisions‖.
In consideration of the apparent rising problem of drug
diversion, the NSCP recommends that pharmacists exer-
cise vigilance when releasing narcotics, including part-fills
and balances.
Pharmacists should ensure that the individual to whom
they release the narcotics is either the patient or pa-
tient‘s agent, an individual on record as being explicitly
authorized by the patient to act on their behalf.
If the individual is unknown to the pharmacist, it is
expected that the pharmacist take steps to confirm
with certainty the individuals‘ identity, including a re-
quest for a photo id.
Pharmacists should obtain a signature for every re-
lease of a narcotic, including part-fills and balances.
Don’t be duped!
Governing the Page 13
Disciplinary Decision: Professional Misconduct
Happy Holidays to All
From the Council and Staffat theNova Scotia College of Pharmacists
Governing the practice of pharmacy
in Nova Scotia in the interest of the
health and well being of the public.
Value VI— Pharmacists observe the law, preserve high professional standards and uphold the
dignity and honour of the profession.
Included under this value statement is the notion that pharmacists do not practice under conditions which compromise their
freedom to exercise professional judgment or which cause a deterioration of the quality of their professional service or care. The
pharmacist is ultimately responsible for the safe and effective provision of pharmaceutical care and should take what-
ever steps are necessary to ensure this outcome. A poor practice environment is not an excuse for suboptimal prac-
tice on the part of the pharmacist.
1559 Brunswick Street, Suite 200
Halifax, NS
B3J 2G1
Phone: 902-422-8528
Fax: 902-422-0885
E-mail: [email protected]
www.nspharmacists.ca
Nova Scotia
College of
Pharmacists
Ethics under the Spotlight The Code of Ethics provides guidance to pharmacists making ethical decisions. It educates phar-macists about their
ethical duties and obligations. As the practice of pharmacy evolves, factors such as economic restraints and increased
technol-ogy challenge the ability of pharmacists to practice ethically. The Code provides pharmacists with direction
for ensuring ethical decision making.
HOLIDAY HOURSAlong with mistletoe, eggnog, and merrymaking, ‗tis also the season for Ho-Ho-Holiday hours. The NSCP office will
be closing on the regular statutory holidays December 25, 28, and Jan 1. The office will be closing at noon on Dec 24,
29, 30, and 31. Please keep this in mind if you have business to do with the College before year end. We will be
checking our voice mail during this time so as to respond to any urgent matters.