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Standards
of Practice
for
Canadian
Pharmacists
A p r i l 2 0 0 3
National Association of Pharmacy Regulator y Authorities (NAPRA)
Publication supported by
National Association of Pharmacy Regulatory Authorities, 2003. All rightsreserved. No part of this document may be reproduced in any form by anyphotographic, electronic, mechanical or other means, or used in any informationstorage and retrieval system, without the written permission of the author.
The National Association of Pharmacy Regulatory Authorities (NAPRA)222 Somerset Street West, Suite 402Ottawa, ON K2P 2G3Tel: (613) 569-9658 Fax: (613) 569-9659 Email: info@napra.ca Standards
of Practice
for
Canadian
Pharmacists
Contents
General Attributes Required of Pharmacists to Fulfil the Professional Competencies Professional Competencies Required of Pharmacists • Professional Competency #1: Practise Pharmaceutical Care • Professional Competency #2: Provide Drug Information • Professional Competency #4: Manage Drug Distribution • Professional Competency #5: Apply Management Principles Optional Advanced Professional Competency #6: Undertake Research Introduction
The following Model Standards of Practice were developed by common minimum standard for all licensed pharmacists is consistent NAPRA’s National Competency-Based Standards of Practice with other health professions and with the public protection mandate Working Group, a group of practising pharmacists from across of NAPRA’s Members [9]. The Working Group also recognized, Canada (see Appendix A). Members of the Working Group were however, that individual pharmacists and the profession as a whole selected from nominations submitted by provincial and territorial aspire to continuously improve practice performance beyond the Pharmacy Regulatory Authorities (PRA) and national stakeholder standard of what all pharmacists must do to ensure public safety.
organizations in response to a campaign to recruit skillful, proficient Therefore, to assist pharmacists in identifying areas for individual practising pharmacists with various numbers of years of experience, continuing professional development, the Working Group also educational backgrounds, practice sites and geographical locations.
identified a series of guidelines for advanced and / or exemplary This selection process was meant to ensure that the Working Group practice. NAPRA offers these guidelines as benchmarks against could develop realistic standards of practice that truly represented which pharmacists might compare their own practice and what all pharmacists must be able to do in community and hospital performance when identifying strengths, weaknesses and areas for individual continuing professional development [10], [11]. Since the The Working Group met in October 2001 after having discussed range of advanced roles for pharmacists is quite broad, no attempt background information on competency-based standards of practice, was made to set exemplary practice guidelines for all potential roles.
NAPRA’s Professional Competencies for Canadian Pharmacists at Entry to Focus was maintained on common roles assumed by experienced Practice (NAPRA, 1997)[1] and NAPRA’s Model Standards of Practice practising pharmacies. The inclusion of these advanced or exemplary for Canadian Pharmacists (NAPRA, 1998) [2]. Using these two guidelines aims to both encourage and reward continuing professional documents as a starting point, a draft of the revised Model Standards of Practice was developed. Although the draft modifies the order andstructure of the competencies from that listed in the original NAPRA The following revised Model Standards of Practice for Canadian documents, all competencies detailed within the Professional Pharmacists includes five components [3]: Competencies for Canadian Pharmacists at Entry to Practice are included.
The primary change in these revised Standards limits the professional 1. a statement of the major professional responsibilities of the competencies to the roles or tasks performed by pharmacists as part of professional practice (e.g. providing pharmaceutical care, supervising 2. a description of the situations in which all pharmacists must be drug distribution). These roles differ from the general attributes (e.g. knowledge and its application, communication, professionalism 3. the steps required to successfully fulfil each competency unit (i.e.
or ethics) that are necessary to fulfil the professional competencies [3].
Although the professional competencies and general attributes are 4. the level of performance expected of all pharmacists for each defined separately, they are linked or integrated via performance competency element in order to be considered competent ( i.e.
indicators as described below. This approach has been used by a number of professions in Canada and in other jurisdictions [1, 3, 4, 5, 5. to further clarify these performance indicators, practical examples 6, 7] and there is literature supporting such an approach to the of specific pharmacist activities that could demonstrate the development of Standards of Practice [3, 5, 6, 8].
fulfilment of each required performance indicator. In February 2002 a Consultation Paper containing Working Group recommendations was circulated to 28 stakeholders including To be clear, it is not expected that pharmacists would perform each the 12 provincial and territorial licensing bodies, provincial and and every one of the examples of activities. These are included to national pharmacy advocacy organizations and national educational facilitate the understanding of the practical, realistic nature of the groups. The draft Model Standards were then revised based on the comments received from these reviewers. The final report of the Through the course of revising the Model Standards of Practice, Working Group was presented to the NAPRA Board of Directors in a number of changes to the competency units and elements listed in NAPRA’s Professional Competencies for Canadian Pharmacists at Entry Cognizant of the fact that regulatory authorities will adopt these to Practice were recommended. However, the NAPRA Board of standards, the Working Group attempted to ensure that the revised Directors agreed with the Working Group’s recommendation that the standards are realistic and will ensure patient safety. The standards Professional Competencies not be revised at this time as these
are competency-based and define the levels of achievement required Competencies are currently being used by a number of provincial and by pharmacists for competence in key areas of pharmacy practice [3].
national organizations. Instead, the Working Group provided all of Licensed pharmacists (those licensed for active practice) are expected the suggested revisions to NAPRA for future use by the National to maintain their ability to perform the five competencies to the Advisory Committee on Licensing during their review of the Professional Competencies for Canadian Pharmacists at Entry to Practice Although national review indicated that the revised Model Standards were, in general, set at an appropriate level, several Working Group members wish to thank all respondents, and reviewers expressed concern that they represented a minimum level
emphasize that all comments received were reviewed and considered of expected performance. The Working Group agreed with this for inclusion in these final Model Standards of Practice. The comment, but a key, literature-based decision had been made early in Working Group also recognized that these Model Standards will be the development process that the revised Model Standards of reviewed regularly and altered as practice responsibilities change and Practice would define what all licensed pharmacists* must be able to
do during daily practice to ensure patient safety. This use of a * All pharmacists licensed in the active part of the Register in those jurisdictions with a two-part Register Model Standards of Practice for Canadian Pharmacists
General Attributes Required of Pharmacists to Fulfil the
Professional Competencies

Knowledgeable
Proficient Communicator
Pharmacists must possess and be able to apply a broad, integrated Pharmacists effectively use the communication skills required to fulfil knowledge of the core functional information associated with the each of the required professional competencies in the expected profession of pharmacy. Such functional knowledge focuses on an situations and to the level of performance specified. understanding and ability to apply the information that is requiredduring daily practice, and does not focus on detailed facts that are easily located in references (such as doses, costs of medications, trade • consistently demonstrate respect, sensitivity and empathy when names, names of management theories). The possession of such knowledge and the ability to apply this knowledge to solve problems • consistently demonstrate appropriate verbal, non-verbal and and make appropriate decisions, is the base upon which competency as a pharmacist is built. Without knowledge and the ability to apply • routinely demonstrate effective patient-interviewing techniques it, pharmacists will not be able to fulfil their professional including: initiating a session, exploring problems, understanding the patient’s perspective, structuring the discussion, building apatient relationship, facilitating the patient’s involvement, explaining, planning, and closing the discussion [13].
• have and be able to apply functional knowledge while solving • consistently select and appropriately use communication problems and making decisions during completion of their techniques when communicating with peers, other health care professional responsibilities. This functional knowledge includes knowledge from the biomedical sciences (e.g. physiology, microbiology, pharmacology), the pharmaceutical sciences • demonstrate comprehension and fluency in written and verbal (e.g. medicinal chemistry, toxicology, pharmacokinetics and pharmacotherapeutics), the behavioural and social sciences (e.g. psychology, communications, ethics and illness behaviour),the administrative pharmacy sciences (e.g. pharmacy management Professional Competencies Required of Pharmacists:
and health care systems), and pharmacy practice (e.g. pharmaceutical care, compounding & dispensing, structuredpractical training).
1. Practise pharmaceutical care: Pharmacists in partnership with
patients and other health care providers, use their uniqueknowledge and skills to meet patients’ drug related needs and to Professional
achieve positive patient outcomes by maintaining or improving thepatient’s quality of life.
Pharmacists must function professionally when fulfilling theirresponsibilities. Professionalism is defined as altruism, accountability, 2. Provide drug information: Pharmacists assume responsibility for
excellence, duty, integrity and respect for others, thereby information retrieval, evaluation and dissemination to ensure safe incorporating the concepts of ethics, self-directed learning and and effective provision of pharmaceutical care and to promote Pharmacists must:• consistently accept responsibility for actions and decisions.
3. Educate: Pharmacists educate individuals to support optimal
• consistently demonstrate respect for others.
• consistently provide professional pharmacy care to individual patients that complies with the ethical guidelines governing the 4. Manage Drug Distribution: Pharmacists manage drug distribution
by performing or supervising the functions of acquisition, • maintain appropriate inter-professional relationships required to preparation, and distribution of drugs to ensure the safety, accuracy provide quality pharmacy care to individual patients. • consistently provide care and services that place the best interest of patients before their own self-interest.
5. Apply Management Principles: Pharmacists apply knowledge,
• continuously strive to improve professional competence through principles and skills of management as they pertain to the site of the use of appropriate learning to address areas identified for pharmacy practice with the goal of optimising pharmaceutical care • consistently demonstrate personal and professional integrity.
• undertake non-pharmacy practice-related activities that are It is assumed that in fulfilling their responsibilities as pharmacists as consistent with, and do not take advantage of the influence of, defined by the standards of practice, all activities will be performed in their status as a health professional.
accordance with relevant federal, provincial and territorial • reject the acceptance of gifts / advantages that give the appearance legislation, and regulatory authority policies and by-laws regarding Model Standards of Practice for Canadian Pharmacists
Professional Competency #1:
Practise Pharmaceutical Care

Competency unit
• for patients with actual needs or potential problems related to drugs Pharmacists in partnership with patients and other health care that are used infrequently to treat common diseases, or drugs used providers, use their unique knowledge and skills to meet patients’ to treat uncommon diseases, or uncommon or complicated ethical drug related needs and to achieve positive patient outcomes by or communication challenges, pharmacists may consult with other maintaining or improving the patient's quality of life.
pharmacists or health care providers and may use resources toacquire or review necessary drug, disease or other information.
• for patients with drug related needs or problems that are the Situations in Which All Registered Pharmacists Must Fulfil this
responsibility, or within the scope of practice, of other health care Competency:
providers, pharmacists refer for management; and • for all patients, pharmacists provide medications and/or pharmacy Pharmacists ensure that all patients have access to the care required to address their drug related needs. This means that: • for patients with actual needs or potential problems related to drugs that are routinely used to manage common1 diseases, and for those Pharmacists provide this care and these services to patients who presenting common ethical or communication challenges, desire the pharmacist’s participation in their care and who are willing pharmacists possess the functional knowledge and skills required to and able to accept the responsibilities required by this care.
provide pharmaceutical care and may use resources to confirm Pharmacists fulfil this competency in all sites where they provide the detailed or specific disease or drug information.
products and/or services that legally constitute pharmacy practice.
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Offer all patients the opportunity to engage in a The pharmacist is available and makes time to answer professional relationship by consistently patient’s questions; provides privacy for patients who desire demonstrating him/herself to be a caring health and/or require it; offers professional assistance in selecting non-prescription drug therapy & natural health products; presents a professional appearance; respects a patient’sdignity, education, culture, beliefs, interests and desires;shows unbiased behaviours regarding, for example, race,religion, sex, language, and age of patients.
Effectively use interpersonal skills to overcome The pharmacist speaks at an appropriate level to children or cognitively impaired patients; summarizes frequently toclarify information and facilitate discussion with poorhistorians; minimizes the use of jargon; calms anxiouspatients; pacifies angry patients.
Clearly establish the normally accepted roles and The pharmacist introduces self and explains that (s)he is responsibilities of him/herself and of the patient, here to teach the patient how to use a medication including explaining their common goal of ensuring appropriately; requests patients to call the pharmacist if that the patient appropriately takes the right drug in they have side effects or questions.
the correct dose and dosage form, on the bestschedule, for the appropriate duration of therapyand that side effects and / or lack of efficacy areidentified and managed appropriately Optional Performance Indicator reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Consistently develop professional relationships The pharmacist overcomes uncommon communication with patients who demonstrate uncommon or challenges (illiterate, deaf, mentally-handicapped, foreign-language only, combative patients); managesethical dilemmas; convinces reluctant patients of thevalue of a professional relationship with pharmacistsand develops such relationships.
1. The term “common” is used throughout this document in its pragmatic sense to focus on issues that are frequently occurring rather than infrequent or obscure. No attempts have been made to definecommon diseases or drugs as these will change over time.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Routinely use appropriate communication skills to The pharmacist asks if the patient is having any problems obtain a clear understanding of the patient’s with or questions about their medications; listens attentively to patient’s questions / complaints; asks clarifying questions to ensure understanding of the patient’s concerns.
Routinely collect the information necessary to The pharmacist inquires about the severity and duration of address the patient’s drug related needs or diarrhea in an infant; asks about previous use of antihistamines when recommending management for • when not obvious, the condition, symptoms or seasonal allergies; asks the age and weight of a child; signs to be treated and / or the patient’s self checks the patient’s profile for previous use of antibiotics and reactions; contacts the physician to clarify the diagnosis when a dosage does not match the indication explained by • the seriousness of symptoms, particularly when the patient; asks the patient or checks his profile for addressing problems associated with self care / additional therapies for hypertension; reviews phenytoin levels for prevention of toxicity; checks patient’s serum • the patient’s desired outcomes (implied or creatinine when reviewing aminoglycoside dosing.
• relevant patient demographics• relevant family medical history• relevant social history (e.g. alcohol or nicotine use)• the existence of relevant medical conditions • the history of current condition, particularly when addressing problems associated with self care /non-prescription drugs • known patient risk factors for adverse drug reactions, drug allergies or sensitivities • known contraindications to prescription and non- • relevant dietary restrictions• other medications or treatments that the patient has tried for this condition and effects,particularly when addressing problems associatedwith self care / non-prescription drugs • other medications or treatments that the patient is currently taking that may affect the condition orinteract with therapy Routinely acquire the information necessary to The pharmacist reviews the profile of a patient who has had determine if the patient’s needs / problems fall multiple high BP readings on several different days to see if beyond the domain or scope of pharmacy practice.
he is taking an antihypertensive; asks a patient requestingthroat lozenges if she has fever in addition to a very sorethroat; asks a patient with tooth pain and fever if he hasseen a dentist.
Collect information in an effective, professional The pharmacist reviews patient profiles for medication histories of prescription drugs; asks only relevant questionsthat provide necessary information; seeks information abouta patient’s health only when it is required to provide care to,or appropriately refer, the patient.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Routinely collect the required information in an The pharmacist uses a mixture of questioning techniques to limit excessive, unrelated discussion.
professional, caring relationship with a patient.
The pharmacist maintains knowledge about services availability of, and services offered by, health available to seniors such as Meals on Wheels, social organizations and health care professionals groups, transportation services, home care; knows of within the community, including alternative availability of physiotherapists, nutritionists, acupuncture practitioners; links patients with disease basedorganizations that provide information for public.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Effectively establish realistic therapeutic outcomes The pharmacist explains to the patient that there is no cure consistent with the patient’s desires.
for the common cold but that products are available to relieve symptoms; explains to the patient that many antidepressants take 4-6 weeks before their best effects are seen; explains to the medical team that gum hyperplasiawill not resolve with continued use of phenytoin.
Correctly identify when no confirmation of desired The pharmacist presumes that a patient with pneumonia wants it cured; presumes that a patient receivingaminoglycosides wants a therapeutic / non-toxic dose.
Optional Performance Indicator reflecting
Example of an activity that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Routinely inform long term clients of new The pharmacist informs female patients of availability of bisphosphonates as an alternative to hormone replacement therapy for post-menopausal osteoporosisprevention Effectively review every patient’s profile to identify actual and potential drug related problems prior to dispensing a prescription, including the types of drug related problems listed below 3.
Effectively use the information collected in 1.2 and1.3 above to identify a patient’s actual and potentialdrug related problems, including the types of drugrelated problems listed below 3.
• Untreated / continuing signs or symptoms For example: lack of bisphosphonate for a patient onchronic prednisone therapy; lack of aspirin therapy for apatient following a myocardial infarction; persistent fever ina patient taking amoxicillin for pneumonia (plus seeexamples requiring referral, 1.6) For example: amoxicillin for a patient with a documentedpenicillin allergy.
For example: treatment with erythromycin when takingtheophylline; treatment with ibuprofen for a patient with ahistory of gastric ulcers; the use of cotrimoxazole for apatient on warfarin.
• Inappropriate doses, or signs / symptoms of For example: acetaminophen 1000 mg q4h for more than several days; blurred vision with digoxin; increasingfrequency of seizures while on carbamazipine.
For example: diarrhea during treatment with amoxicillin; GIbleeding with NSAIDs; rash with cotrimoxazole.
For example: lack of understanding of the need to finish acourse of antibiotics; failure to remove nitroglycerin patch forappropriate period each day to prevent tolerance; asnecessary use of steroid inhalers rather than scheduled,regular use.
For example: inappropriate use of dimenhydrinate; excessiveuse of narcotics, sedatives or hypnotics; use of diuretics forweight loss.
3. The types of drug related problems that pharmacists must be able to identify independently and without the extensive use of resources, versus those for which consultation can be used, are specified in the range statements at the beginning of the competency.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Routinely use resources and / or consultation to The pharmacist uses the Internet to rapidly locate drug facilitate the timely identification of less common information; contacts the cancer treatment centre to ask about new chemotherapy dosing guidelines; contacts thepharmaceutical company for information on potentialinteractions; discusses availability of special compoundingwith ‘specialist’ pharmacist Effectively explain the mechanism / cause of a The pharmacist uses the appropriate terminology to explain patient’s drug related problem(s).
why a penicillin should not be used by a patient with adocumented penicillin allergy or why nitroglycerin patchesshould be removed for a period of time each day.
Prioritize patient’s drug related problems accurately.
The pharmacist considers patient preference, medicalsignificance and urgency; recognizes drug related problemsthat the patient believes are important; recognizes urgent orsevere drug related problems that the patient or other healthcare providers want to ignore and educates them about theimportance of these problems; recognizes drug relatedproblems that are less critical or which do not requiremanagement.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Complete full medication reviews to identify The pharmacist schedules patient appointments to complete work-ups of drug therapy; createscomprehensive patient records to facilitate identificationof drug related problems; uses a systematic approach toidentifying multiple drug related problems.
Accurately and efficiently identify multiple, The pharmacist immediately recognizes and confirms drug related problems based on extensive experience extensive knowledge base and experience.
and is able to explain the therapeutics / pharmacology /pathophysiology underlying the drug related problem.
Maintain and utilize an efficient network of The pharmacist maintains contacts with physicians, resources to facilitate identification of less pharmacists, industry and specialist treatment centres to quickly obtain information required to identifycomplex or uncommon drug related problems.
Routinely recommend appropriate non-drug therapy The pharmacist recommends the use of ice for a sprained in addition or as an alternative to, drug therapy.
ankle in addition to NSAIDs; suggests the use of a humidifier in addition to a topical decongestant.
scheduling / administration,required drug devices andcompliance aids.
When requested by a patient, provide accurate The pharmacist provides information on echinacea for information concerning efficacy, toxicity, side effects management of colds; provides information on valerian for or interactions of natural health products.
Routinely recommend the use of appropriate drug The pharmacist recommends the use of aerochambers for devices to ensure effective drug use.
Routinely develop and/or recommend the use of The pharmacist develops written summaries of daily appropriate tools and products to aid in patient medication requirements; recommends the use of dosing reminder aids (e.g. Dosettes‚); recommends the use ofspecialty lids to facilitate opening of vials; providesmedication counselling cards.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Consistently recommend therapeutic options that The pharmacist, if appropriate, recommends nitroglycerin are compatible with the patient’s desired outcomes, paste rather than nitroglycerin patches for a patient concerned about the cost of the patches.
Effectively manage routine conflicts between ideal The pharmacist contacts the physician for a change in patient care and relevant health system policy.
prescription when financial problems would prevent thepatient from taking a required medication.
Effectively consult with a patient’s other health care The pharmacist contacts a patient’s physician to manage providers regarding the patient’s therapeutic plan.
his/her drug related problem; obtains refill authorizations asnecessary; obtains changes in prescription drugs asnecessary; releases patient information only when necessaryto provide continuity of care to that patient.
Effectively justify his/her therapeutic recommendation.
The pharmacist explains the therapeutic rationale forrecommendations (e.g. pathophysiology or cause of diseaseand mechanism of action of drug); provides any referencesused to develop a recommendation.
Routinely provide continuing pharmacy care andservices to a patient who has refused arecommended change in drug therapy.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Consider emerging, appropriate therapeutic The pharmacist maintains and uses knowledge of alternatives when selecting therapeutic options.
current research and new drug therapies.
Efficiently develop accurate therapeutic plans The pharmacist immediately ‘knows’ appropriate based on extensive knowledge base and patient therapeutic recommendations based on extensive experience and knowledge and is able to justify therecommendation.
Efficiently develop therapeutic plans forcomplex, specialized drug related problemsbased on extensive knowledge base andexperience in a specialized field of practice Accurately and efficiently identify patients with The pharmacist recognizes the urgency of vomiting, diarrhea, signs/symptoms of potential medical emergencies fever and lethargy in an infant; severe, unrelenting headache and recommend they seek immediate medical in a patient with no history of migraines; unrelenting chest pain; palpitations in a patient taking high doses oftheophylline.
Accurately identify when patients’ problems are The pharmacist refers seniors having problems maintaining beyond the scope of pharmacy practice and refer activities of daily living; patients complaining of chronic them as appropriate to their family physician, back pain; consistently elevated BP readings from pharmacy dentist, optometrist, physiotherapist, nutritionist or automated BP machine in a patient not taking anti- Accurately address patients’ inquiries about the The pharmacist supports a patient’s decision to see his/her need to contact their physician if they are physician about a breast lump or excessive thirst and experiencing signs or symptoms associated with common diseases addressed in health promotioncampaigns.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Accurately identify patients whose self-diagnosis The pharmacist refers a patient requesting more appears questionable and refer them as appropriate decongestant nasal spray for congestion with purulent discharge that has worsened over the last two weeks; refersa diabetic patient requesting a topical antibiotic cream foran infected cut on foot; refers a patient requesting NSAIDsfor swelling and pain around a tooth.
Accurately identify patients whose self-care The pharmacist refers a patient with continued constipation treatment has failed to remedy a condition within with no bowel movements despite one week’s treatment with the expected time frame and recommend that they contact their primary care practitioner.
Offer accurate information to patients about the role The pharmacist provides information about the role of of family physicians, dentists, optometrists, nutritionists in the management of diabetes; explains the physiotherapists, nutritionists and social workers.
difference between optometrists and opticians.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Routinely refer patients to appropriate health The pharmacist refers seniors to Meals on Wheels, social organizations and health care professionals groups, transportation services, home care; refers within the community, including complementary patients to support or education groups; refers patients and alternative health care providers.
to appropriate acupuncture practitioners.
Develop and routinely utilize referral systems The pharmacist routinely writes referral notes forpatients to take with them to their physician; maintainsprofessional contacts and relationships with a variety ofhealth care providers and service providers availablewithin the community.
Routinely and accurately identify the amount and The pharmacist recognizes that minimal information is type of education desired / required by patients to necessary for a patient taking chronic medication and no maximize their chances of solving or preventing their new complaints; recognizes that a patient experiencing a migraine requires minimal immediate counselling (and additional information at a later point); identifies that apatient beginning hormone replacement therapy requireseducation on short term benefits relative to long term risks;recognizes that a patient with severe asthma requiresoccasional review of inhaler-use instructions.
Routinely and accurately identify the degree of The pharmacist identifies that a patient with a history of monitoring required by a patient according to the non-compliance with antibiotics may require a follow-up health risks posed by the patient’s medication, drug telephone call when prescribed erythromycin for 10 days; recognizes that a patient controlled on chronicantihypertensive medication and no new complaints requiresminimal monitoring; identifies that a patient taking longterm tamoxifen for breast cancer should be asked aboutside effects and compliance on a regular basis; identifiesthat a patient being started on warfarin requires frequentmonitoring during the stabilization phase; identifies that apatient on an aminoglycoside requires monitoring of renalfunction and possibly aminoglycoside levels; recognizes thata patient admitted with acute renal failure may needfrequent dosage adjustment of their drug therapy.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Routinely, effectively and, in consideration of theabove two statements, appropriately educatepatients on the following when dispensingprescription and non-prescription drugs, whenpatient counselling on discharge medications orwhen providing recommendations aboutmanagement of specific drug related problems:• name and class of the drug (e.g. antibiotic, • directions for use including education about drug • special storage requirements • common or important drug-drug or drug-food • the reason for the drug 4 and the intended The pharmacist discusses the use of metoprolol for therapeutic response and associated time frames prevention of a second myocardial infarction versus thelowering of blood pressure; that the frequency and pain onurination should resolve within 24 hours of startingamoxicillin for a urinary tract infection.
• common or important side effects and associated The pharmacist discusses diarrhea that could start after the end of treatment with clindamycin; transient headache thatmay develop at the start of therapy with nifedipine.
• what the patient should do to monitor his/her The pharmacist recommends that a patient keep a diary of therapeutic response or development of side headache times, intensity and duration.
• actions the patient should take if the intended The pharmacist asks the patient to call if her constipation is therapeutic response is not obtained or side not relieved in three days; recommends that the patient contact his physician if his fever has not resolved in threedays; asks the patient to contact the pharmacist orphysician if he develops diarrhea while taking or within twoweeks after completing the treatment with clindamycin.
• when appropriate, the actions the pharmacist will The pharmacist asks the patient if (s)he would like the undertake to monitor the patient’s progress pharmacist to call a week after starting antibiotics.
Consistently fulfil responsibilities for monitoring The pharmacist completes required patient contacts (as Consistently communicate with covering pharmacists The pharmacist leaves a summary of patients who should to inform them of individual patient needs for be contacted during the next shift, the reason for the Analyze monitoring data obtained to determine the The pharmacist compares patient’s status to desired success of the therapeutic plan or the development outcomes; ensures continued care if new drug related Communicate with patients’ care providers as The pharmacist contacts patient’s physician if the patient necessary regarding the results of patient experiences persistent cough after starting an ACE inhibitor 4. It is recognized that pharmacists do not always have access to the therapeutic indication for the drug.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Consistently use appropriate techniques to gain The pharmacist uses extensive knowledge to support acceptance of the therapeutic and monitoring recommendations to patients or other health care providers; facilitates monitoring by developing simple,yet effective, monitoring plans.
Create systems that facilitate patient monitoring The pharmacist uses software available to create callback lists; uses forms that specify normal monitoringparameters and time frames; uses a system fordocumenting therapeutic and monitoring plans; employsa follow-up appointment protocol as part of a diseasemanagement program; uses a liaison system betweenhospital and community pharmacies to ensure seamlesscare.
Consistently identify situations that require The pharmacist identifies the need to document the documentation to promote patient safety and / or existence of allergies; previous serious adverse drug reactions or interactions; commitments to complete follow-up contact with patients at a specific time; changes in aprescription made to prevent a drug related problem (e.g.
changes in dose, changes in drug to one covered byinsurance; changes in drug to one with fewer side effects);the refusal of a physician to change a prescription; therefusal of a patient to allow contact with his/her physician.
Document the above information in a usable, The pharmacist writes on prescription that patient has been counselled; enters allergies into patient profiles; notes onprescription or in profile that doctor was called to changethe prescription and why; documents subtherapeuticphenytoin levels and dosing recommendations in ahospitalized patient’s chart; documents clarifications of drugallergies or medications prior to admission.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
The pharmacist completes required documentation insuccinct, complete, timely fashion, including onlynecessary information; consistently uses a specificdocumentation protocol or format (e.g. SOAP) forconsistency and ease of retrieval.
The pharmacist obtains approval to insert a pharmacy document the provision of pharmaceutical care section in patient charts; develops software to record Model Standards of Practice for Canadian Pharmacists
Optional Advanced Roles:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Routinely initiate specific activities to identify The pharmacist offers brown bag sessions; offers education patients with actual or potential drug related sessions on new drugs to identify patients at risk for drug related problems; completes home visits.
Consistently complete full medication reviews, or The pharmacist schedules patient appointments to complete assessments with patients to identify their multiple work-ups of drug therapy; creates comprehensive patient records to facilitate identification of drug related problems;uses a systematic approach to identifying multiple drugrelated problems.
Accurately and efficiently identify multiple, complex The pharmacist immediately recognizes and confirms complex, multiple drug related problems based on extensive experience and is able to explain the therapeutics /pharmacology / physiology underlying the drug relatedproblem.
Efficiently develop accurate therapeutic plans based The pharmacist immediately ‘knows’ appropriate therapeutic recommendations based on extensive experience and knowledge and is able to explain the therapeutics /pharmacology / pathophysiology underlying the drug relatedproblem to justify the recommendation Routinely initiate follow-up contact with patients to The pharmacist schedules follow-up appointments at monitor their progress towards predetermined pharmacy; completes regular rounds on hospital patients; reserves specific time each week to contact patients forfollow-up by telephone.
Routinely and efficiently document the provision ofcare and patient outcomes.
Routinely summarize data on patient managementto ensure continuity of care and to document thevalue of pharmacy services.
Accept referrals of patients for management of drugrelated problems related to specific disease states.
Complete focussed medication reviews to identify The pharmacist participates in ‘clinic’ days for specific drug related problems in patients with specific diseases in order to identify patients who require more intensive review; schedules patient appointments to completework-ups of drug therapy; creates comprehensive patientrecords to facilitate identification of drug related problems;uses a systematic approach to identifying multiple complex Accurately and efficiently identify multiple, complex The pharmacist immediately recognizes and confirms complex, multiple drug related problems based on extensive knowledge base in a specialty area of practice.
experience in a specialty area and is able to explain thetherapeutics / pharmacology / pathophysiology underlyingthe drug related problem.
Maintain and utilize an efficient network of resources The pharmacist maintains contacts with physicians, in a specialty area of practice to facilitate pharmacists, specialist treatment centres and industry to identification of drug related problems.
quickly obtain information required to identify drug relatedproblems in a specific disease or practise area.
Efficiently develop therapeutic plans for complex,specialized drug related problems based onextensive knowledge base and experience in aspecialized field of practice.
Model Standards of Practice for Canadian Pharmacists
Optional Advanced Role:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Establish and utilize systems to efficiently The pharmacist manages drug treatment according to implement therapeutic and monitoring plans.
disease state guidelines; accepts appropriate and lawfulresponsibility for delegated medical acts; obtains requiredtraining / certification for actions required for disease statemonitoring (such as diabetic counselling, blood pressuremonitoring, asthma monitoring); establishes a follow-upappointment protocol as part of a disease managementprogram; creates or leads support groups for clients withspecific disease states.
Encourage the appropriate management of specific The pharmacist develops and uses systems to provide disease states by relevant health care professionals.
physicians with information to ensure appropriateprescribing according to evidence-based principles.
Routinely and efficiently document the provision ofcare and patient outcomes.
Routinely summarise data on patient managementto provide continuity of care and to document thevalue of pharmacy services.
Professional Competency #2:
Provide Drug Information

Competency Unit
• information about commonly recommended, evidence-based Pharmacists assume responsibility for information retrieval, disease prevention and health promotion strategies.
evaluation and dissemination to ensure safe and effective provision ofpharmaceutical care and to promote health.
Pharmacists use appropriate, readily accessible secondary and tertiary6medical and pharmaceutical resources, Internet-based information Situations in Which All Registered Pharmacists Must Fulfil this
and / or consultation with other pharmacists or health care Competency 5:
professionals when fulfilling this competency. Pharmacists fulfil thiscompetency in all sites where they provide the products and services In response to requests from individual patients or individual health that legally constitute pharmacy practice, or where they are identified as pharmacists when providing such information or • information about all drugs, including herbal therapies; • recommendations concerning commonly used drugs in the Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Accurately determine the depth of information The pharmacist accurately differentiates between a physician’s request for a standard dose of an antibiotic and a physician’s request for recent changes in the treatment ofchoice for otitis media; differentiates between a patient’sand a physician’s question as to how Zyban® works in thetreatment of smoking cessation.
Accurately identify whether tertiary, secondary or The pharmacist differentiates between a patient’s request for primary literature is necessary to appropriately information on new antibiotics for treating urinary tract respond to the request for information or infections and a physician’s request for information on investigational antibiotics for managing chronic urinary tractinfections.
5. This competency differs from the provision of information to individual patients as part of patient counselling during the provision of pharmaceutical care (Competency #1). It also differes fromCompetency #3 which relates to the education of students or groups regarding drugs, drug use and health promotion.
6. Although pharmacists are encouraged to use primary literature, they must, at a minimum, use appropriate secondary and tertiary literature.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Accurately identify and name the tertiary and The pharmacist assesses whether the Compendium of secondary resources available to appropriately Pharmaceutical Specialties, American Hospital Formulary respond to the request for information or Service Drug Information or Therapeutic Choices provides appropriate information; determines if reference must bemade to provincial antibiotic guidelines; identifies ifinformation should be accessed from drug information orgovernment web sites.
Accurately manage requests for information or The pharmacist identifies other pharmacists or health care recommendations that are beyond their capabilities.
professionals available to provide required information;consults with the appropriate experts or refers the requestorto the appropriate source of information.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Accurately and efficiently locate relevant The pharmacist refers to specific studies that address the request; maintains a network of contacts in extensive knowledge base and experience in a Consistently recognize and respond appropriately to The pharmacist responds rapidly to physician’s request for the time frame requirements for a question or information required to prescribe for a patient in his/her office; considers workload and time available before promising a time frame for a response for more complicatedinformation.
Systematically access reliable information in a The pharmacist obtains the appropriate information from tertiary resources, the Internet, pharmacists or other healthcare professionals.
Regularly use professional judgement to determine The pharmacist does not rely on a single, general text when when sufficient, appropriate information has been newer references or DI bulletins are available; acknowledges when sufficient reliable information is not available torespond accurately to the request.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Routinely and efficiently retrieve the information The pharmacist has an extensive knowledge of sources necessary to provide recommendations about and types of drug information and selects the all drugs, including herbal and complementary appropriate source; employs a structured systematic approach for responding to requests; utilizes astructured systematic approach for documentingquestions and responses and makes use of such asystem to facilitate responses to similar questions;completes primary literature searches appropriately andefficiently.
Obtain the required information in an efficientmanner.
Maintain an up-to-date and complete collectionof primary literature relevant to his/her practice.
Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Critically review information to ensure its The pharmacist provides an assessment of the relevance, appropriateness prior to responding to a request.
applicability and accuracy of an article located by a patient; provides only relevant, accurate information to patients.
Place information in perspective to current practice.
The pharmacist explains why therapy cannot be based onsuggestions made in popular magazines or un-referencedresources; explains why a single, well done study may not beapplicable to a particular patient’s case.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Critically analyze primary or basic science The pharmacist assesses the adequacy of research literature as it applies to the provision of drug design, relevance, applicability, accuracy, reliability, validity and generalizability of primary literature.
Consistently present relevant, accurate information The pharmacist within several days provides a verbal in a usable form and in a timely manner.
summary and copies of information located to a physician asking for information about the use of a new antibiotic forcommunity acquired pneumonia; provides an immediateverbal recommendation to a mother asking about the use ofaspirin for fever in her infant.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Proactively identify and fulfil drug information The pharmacist prepares and distributes DI newsletters to patients or other health care providers.
Provide recommendations about all legal drugs, The pharmacist uses his/her drug information skills to including herbal and complementary medicines.
participate in the development of formularies or drug usepolicies.
Support health promotion campaigns related to The pharmacist makes available appropriate pamphlets or recognition and management of common, critical other prepared information regarding these conditions; when diseases such as diabetes, cardiac disease, stroke, requested, provides verbal summaries of information contained in such pamphlets or other prepared information.
Provide accurate information to patients inquiring The pharmacist explains appropriate safe storage of household products, medications, non-prescription drugsand vitamins around children.
Optional Performance Indicators reflecting
advanced or exemplary practice:
Provide recommendations on disease
prevention and health promotion
Model Standards of Practice for Canadian Pharmacists
Optional Advanced Roles:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Actively seek or assume leadership roles in policy The pharmacist volunteers for membership in policy-making making regarding appropriate drug use.
committees; accepts responsibility for developing keyrecommendations regarding reimbursement.
Routinely use evidence-based principles to make The pharmacist uses primary literature to assess the therapeutic and pharmacoeconomic benefits of one drugrelative to another for inclusion in a formulary or coverage ina drug program.
Use complex forms of analysis to discover issues The pharmacist analyses drug use patterns within the requiring the provision of drug information or drug practice setting (from various data sources including surveys, data bases); analyses documentation completedfor management of individual patient’s drug relatedproblems; completes surveys of clients to identify need forinformation or recommendations.
Actively promote their role in the provision of drug The pharmacist creates linkages with other pharmacies to information and recommendations by identifying identify issues in drug use; completes surveys of clients to needs in populations (communities) beyond their identify needs for information or recommendations.
Prepare and present routine sources of drug The pharmacist writes review articles, education articles or continuing education articles; prepares and distributes newdrugs bulletins or newsletters; offers drug informationcolumns in newspaper or advice shows on TV, radio, orInternet.
Undertake specialty employment in a druginformation or related centre.
Routinely assess the outcomes of drug informationprovided to individual clients.
Routinely work with patients to plan and attain The pharmacist discusses the value of good nutrition and health goals related to health promotion.
exercise for an overweight patient and refers him/her to adietician if appropriate; addresses the requirement forbicycle helmets for children.
Regularly offer educational events that focus ondisease prevention and general health promotion.
Model Standards of Practice for Canadian Pharmacists
Professional Competency #3:
Educate

Competency Unit
students, interns, or residents is considered to be outside the Pharmacists educate individuals to support optimal patient care and expectations for initial and continuing registration, as is educating groups of patients, peers or health care providers.7 Situations in Which All Registered Pharmacists Must Fulfil this
Competency:

Pharmacists participate in the instruction of individual pharmacystudents and interns, however serving as a preceptor to pharmacy Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicator

Routinely support the instruction of pharmacy The pharmacist is receptive to requests for assistance from students / interns / residents assigned to the pharmacy; functions as a role model for students / interns / residents assigned to the pharmacy; shares experience with students / Optional Performance Indicator reflecting
advanced or exemplary practice:
Function as a preceptor for students / interns /
residents from pharmacy or other health
professions
Optional Advanced Role:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Actively seek opportunities to teach about drugs The pharmacist volunteers as a speaker for support groups and drug use to various individuals or groups.
for patients; offers to provide a continuing education / in-service program for nurses; regularly submits papers orposters at pharmacy or other health care conferences;inquires at pharmacy or other health care Faculties orlicensing bodies about opportunities for teaching orpreceptoring students; offers to participate in career nightsat local schools.
Obtain and maintain expertise in teaching and The pharmacist attends conferences on teaching of health Consistently and effectively use structured The pharmacist identifies the learning needs of participants; approaches to design, implement and evaluate an selects educational methods that are appropriate for the learners; implements an educational plan for individual orgroups; assesses outcomes.
7. Education of individual patients as part of patient counselling is addressed in Competency #1 relating to the provision of pharmaceutical care. Education of individual patients regarding druginformation or health promotion is addressed in Competency #2, By elimination, this leaves the remaining area of education of students or groups about drugs, drug use and health promotion for consideration for inclusion in Competency #3.
8. Each Faculty / College uses different terms for such faculty members. This role is meant to encompass all of these titles.
Model Standards of Practice for Canadian Pharmacists
Professional Competency #4:
Manage Drug Distribution

Competency Unit
pharmaceuticals in response to a prescription for an individual Pharmacists manage drug distribution by performing or supervising patient. This includes the compounding or preparation (or the functions of acquisition, storage, preparation, and distribution of supervision of) of common dosage forms such as powders, ointments, drugs to ensure the safety, accuracy and quality of supplied products.
creams and oral solutions and referral of the patient to an appropriatepharmacy or other provider of less common dosage forms such as Situations in Which All Registered Pharmacists Must Fulfil this
sterile products, chemotherapy or suppositories. Pharmacists Competency:
undertake this competency in all settings that utilize common drugdistribution systems.
Pharmacists take responsibility for the actual functions or delegationof the functions, of the preparation and distribution of Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicator

Fulfil established drug distribution policies and review drug preparation anddistribution activities.
Appropriately identify and perform professionalfunctions associated with drug distribution, including: – providing assistance with the selection of unscheduled* non-prescription drugs whenrequested; – offering assistance with the selection of – providing professional information and advice regarding selection and use of Schedule II* drugs; – completing professional functions outlined in Competency #1 when providing pharmaceuticalcare as part of the drug distribution process; – identifying and resolving problems related to professional functions, delegated drug preparationor distribution functions that may prevent thepatient from attaining the desired effects of themedication such as: • interpretation of prescription medication orders;• bioequivalency & interchangeability of multi- • ability to pay (drug plan or formulary issues);• pharmaceutical calculations;• selection of ingredients;• acquisition and supply of pharmaceuticals;• compounding or preparation; • product packaging, storage, handling, stability – ensuring accuracy and quality of delegated distribution functions, including maintenance ofrecords of drug distribution – ensuring safe and proper disposal of drugs and – correcting dispensing errors as soon as detected, contacting the patient and patient’s prescriber asrequired to correct the error and managesubsequent problems with the patient’s health,and – reporting adverse drug reactions that have caused 9. The preface to this document states that all activities undertaken by pharmacists are in accordance with all relevant laws and regulations.
* According to NAPRA’s National Model Drug Schedules Model Standards of Practice for Canadian Pharmacists
Competency Element
Required Performance Indicators
Examples of activities that might prove fulfilment of
Required Performance Indicators

Appropriately delegate technical and non- The pharmacist appropriately delegates pre-packaging of unit professional preparation and distribution functions dose medications; repackaging of medications; data entry as necessary and as according to provincial into computer; selection, counting, transfer, labelling of Rx regulations, while maintaining responsibility for the products; billing; and compounding according to standard accuracy and quality of these functions.
Ensure that patients have access to all required, The pharmacist locates stock of uncommon drugs; refers the appropriate medications that are prescribed in patient to a different pharmacy that can prepare specialty accordance with relevant policies and that are products; contacts the prescriber for a change in prescription for a drug not available or not readily available.
Optional Performance Indicator reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Use formal processes to identify and resolve The pharmacist compiles and analyses drug error reports systematic problems in drug preparation and/or to identify patterns and develops projects to investigate / Routinely identify and address problems with The pharmacist immediately calls the patient when it is individual prescriptions that require immediate discovered that a wrong medication was dispensed; immediately informs the patient’s physician if a higher strength of a medication was dispensed and the patient Consistently attempt to resolve problems that havebeen identified by pharmacists or technicians fromprevious shifts.
Systematically identify and communicate problem The pharmacist flags concerns with specific prescriptions; prescriptions to subsequent pharmacists.
completes a summary of issues that need to be addressed atshift change.
Identify and address situations that have the The pharmacist addresses a lack of documentation regarding potential to create distribution problems.
checking of filling of dosettes; pre-packaging / advancedpreparation of unlabelled syringes by allied healthprofessionals.
Identify issues in the preparation or distribution of The pharmacist recognizes that if a technician dispenses a individual prescriptions that may represent a prescription before a pharmacist has checked it, this may represent the lack of a consistent plan for checking ofprescriptions.
Accurately identify situations involving potential drug The pharmacist identifies double doctoring; polypharmacy; excess prescription quantities; overly frequent refills; forged or Investigate, document and report such situations The pharmacist contacts the doctor to confirm authenticity of prescription or prescription quantity; reviews stolen triplicateprescription reports, pharmacy alerts and fan outs; initiatesfan outs as appropriate; contacts police where appropriate.
Optional Performance Indicators reflecting
Examples of activity that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicator:
Develop and utilize expertise in management of The pharmacist provides information to a patient caught in a cycle of abuse so they can obtain professional help.
Complete analyses of patient profiles /prescription records to identify areas of drugdiversion or misuse.
Model Standards of Practice for Canadian Pharmacists
Optional Advanced Role:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Maintain ready access to appropriate facilities, The pharmacist has laminar flow hoods installed for sterile equipment and ingredients required for specialty preparation; purchases moulds for suppositories; establishes appropriate, designated compounding areas;maintains an inventory of products necessary for home IVantibiotic or specialty compounding.
Establish and routinely utilize programs to test, The pharmacist obtains any specific certification suggested report and assure the quality of compounded Maintain a ‘library’ of resources required to supportquality specialty compounding.
Professional Competency #5:
Apply Management Principles

Competency Unit
environment that ensures patients have access to the services and Pharmacists apply knowledge, principles and skills of management as products required to meet their drug related needs. They ensure that they pertain to the site of pharmacy practice with the goal of all staff members for whom they are directly responsible perform in optimizing pharmaceutical care and professional relations. accordance with these same requirements. Pharmacists fulfil thiscompetency in all sites where registered pharmacists provide the Situations in Which All Registered Pharmacists Must Fulfil this
products or services that legally constitute pharmacy practice.
Competency
Pharmacists apply the basic principles of human, financial andphysical resources management required to maintain a safe practice Required Competency Elements
Required Performance Indicators
Examples of pharmacist activities that could prove
fulfilment of Required Performance Indicators

Consistently demonstrate the basic interpersonal The pharmacist demonstrates respect for personnel; listens attentively to their concerns or problems; is open to suggestions from staff; facilitates discussion among staff as necessary; demonstratse appropriate non-verbal behaviour; deals sensitively with embarrassing or disturbing topics;gives information regarding responsibilities in a clear, well-organized, complete manner; ensures an understanding ofdelegated responsibilities (also see Competency #4).
Constantly demonstrate a clear knowledge of, andadherence to, policies, standards, and requirementsrelated to delegated functions (see Competency #4).
Consistently encourage a professional environment The pharmacist accepts responsibility for medication errors within the pharmacy that places the safety and the (including errors committed by support personnel); deals well-being of the patient as a priority.
immediately with medication errors that pose a risk to a patient;ensures that patient confidentiality is explained, expected andpromoted within the pharmacy; places products with potentialrisks or questionable benefits in a manner to discourage selfselection; clearly explains the risks and ramifications ofsubstance abuse by staff; maintains appropriate professionalrelationships with staff and co-workers.
Optional Performance Indicators reflecting
Examples of activities that might prove fulfilment of
advanced or exemplary practice:
Optional Performance Indicators:
Function as an advocate for other employees to The pharmacist identifies professional, social and interpersonal activities that contribute to the optimal relationships in a practice setting.
performance of staff as a team meeting a common goal.
Model Standards of Practice for Canadian Pharmacists
Required Competency Elements
Required Performance Indicators
Examples of pharmacist activities that could prove
fulfilment of Required Performance Indicators

Routinely recognize staff and staffing limitations that The pharmacist identifies that pharmacist coverage is strain the ability to fulfil professional competencies inadequate during peak prescription times; recognizes that related to drug distribution and the provision of a technician has been inadequately trained to fulfil pharmaceutical care, drug information and Regularly identify and suggest or implement The pharmacist offers to have a prescription delivered once solutions to staff and staffing limitations.
time is available to address problems with the prescription;encourages the legal use of fax or electronic transfer ofprescriptions to minimize technical distribution time duringpeak hours; suggests hiring of part-time staff to cover peaktimes.
Complete professional responsibilities in an The pharmacist completes searches for information during efficient, appropriately prioritized order.
off peak times and when no patients are waiting; avoidscompleting chart reviews during nursing shift changes; usesquiet times to complete all authorized refills (e.g. doesn’twait to prepare refills for all five prescriptions if only oneneeds an authorization from the doctor).
Effectively and routinely resolve interpersonalproblems that affect the workflow of the pharmacy.
Demonstrate authority in prioritizing short-term The pharmacist assigns telephone-answering workflow issues to ensure smooth and consistent responsibilities to a specific technician during peak times.
Optional Performance Indicator reflecting
Examples of activities that might prove
advanced or exemplary practice:
fulfilment of Optional Performance Indicator:
The pharmacist investigates and proposes the purchase of robotics; develops and implementsa policy to see pharmaceutical representativesby appointment only; develops and organizes apatient appointment system to provide more in-depth care.
Identify and report to management the lack of legally required resources (references, texts, space, facilities, equipment, storage systems) or records Appropriately identify and obtain resources required The pharmacist identifies tertiary references relevant to the to fulfil the professional competencies related to the needs and interests of the practice population (e.g. herbal therapies texts); documents the need for access to computerized or Internet based information sources.
Ensure financial accuracy of individual prescriptions.
The pharmacist ensures that medication costs areconsistent, accurate and competitive with the market place;ensures that prescription prices are appropriate; ensuresthat prescription accounts are responsibly submitted whenadjudicated by a third party payer.
Optional Performance Indicator reflecting
advanced or exemplary practice:
Develop or modify a policy and procedure
manual for the workplace.
Model Standards of Practice for Canadian Pharmacists
Required Competency Elements
Required Performance Indicators
Examples of pharmacist activities that could prove
fulfilment of Required Performance Indicators

Consistently provide prescription drugs in The pharmacist refuses a request to inappropriately bill accordance with terms of third party payers and third party payers for non-prescription items.
and pharmacoeconomicspolicies of health carefacilities and agencies, andfederal, provincial and thirdparty drug insurance plans.
Consistently and appropriately follow relevantpolicies for generic substitution and therapeuticsubstitution.
When requested or necessary, explain in generalterms the concept of a professional fee and theservices to which it applies.
When requested or necessary, explain in generalterms the concept of co-payments and deductiblelimits.
The pharmacist dispenses trial prescriptions; 100 day versus prescriptions in accordance with prescription 30-day supplies; adequate supplies for ‘snowbirds’.
Optional Performance Indicators reflecting
advanced or exemplary practice:
Maintain active involvement in development of
formularies.
Seek alternate / additional forms ofreimbursement for required, appropriateprescriptions not covered by routine third partypayers.
Optional Advanced Role:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Ensure the availability of all legally required The pharmacist has installed laminar flow hoods for sterile resources (space, facilities, equipment, storage preparation; purchases moulds for suppositories; systems, references, texts) or records within the establishes appropriate, designated compounding areas; maintains an inventory of products necessary for home IVantibiotic or specialty compounding.
The pharmacist ensures the appropriate removal and disposal of out of date inventory; ensures the appropriatestorage, checking and record keeping of narcotics andcontrolled substances.
Ensure the appropriate staffing of the pharmacy.
The pharmacist schedules appropriate numbers and types ofstaff; hires part-time staff to cover peak times; ensures thata registered pharmacist is working during all hours ofoperation of the dispensary; ensures that staff areappropriately trained or certified to perform their jobresponsibilities; identifies and manages/reports problems inprofessional competency.
Resolve any systematic problems in the preparationor distribution of individual prescriptions that havebeen identified by pharmacy staff.
10. Modified from Association of Faculties of Pharmacy of Canada Educational Outcomes Model Standards of Practice for Canadian Pharmacists
Optional Advanced Role:
Possible Performance Indicators
Examples of activities that might prove fulfilment of
Possible Performance Indicators

Develop a customized marketing plan for a specific The pharmacist proposes specific short or long term marketing objectives (such as increasing consumer awareness, increasing prescription demand, developing newservices, altering market segments of customers); delineatesspecific and strategic initiatives based on marketingprinciples to achieve objectives.
Apply the components of a marketing strategy The pharmacist documents and describes the value of drug (price, product, place and promotion) in an information or pharmacist monitoring services to counter The pharmacist assesses the financial health of an enterprise and gives an estimate of the valuation of the management, accounting methods and indicators of business; calculates the real cost to dispense a prescription financial performance, budgeting, property and in a particular pharmacy and compares it with industry liability insurance and risk management.
Apply a detailed knowledge of purchasing and The pharmacist prepares the specifications for tendering the purchase of drugs from several potential suppliers.
Apply a detailed knowledge of strategic planning.
The pharmacist prepares an annual business plan for apharmacy operation; prepares a strategic plan.
Optional Advanced Professional Competency #6:
Undertake Research11

Advanced Competency Unit
projects as part of a group of investigators or organise group research Pharmacists apply the principles of scientific inquiry to address projects. At an advanced level they undertake formal research projects with external funding, peer / ethics review, and publicationof results. Situations in Which Pharmacists Might Fulfil this Competency:
At the initial level, pharmacists initiate research using their owndatabase / patient population. At an intermediate level they complete Optional Advanced
Possible Performance Indicators
Examples of activities that might prove
Competency Element
fulfilment of Possible Performance Indicators
Use scientific method of inquiry to plan an The pharmacist identifies a practice problem; suggests investigation of a pharmacy problem encountered in appropriate research questions and hypotheses; suggests methodology for evaluation of a hypothesis; suggestspossible analyses of data; provides valid interpretations ofthe results of data analysis.
Develop research plans to investigate pharmacy The pharmacist determines ethical principles that are practice problems that comply with all major ethical relevant to a particular pharmacy practice research proposal; includes fundamental principles such as informedconsent, ethical selection / exclusion / randomisation ofparticipants, ethical methodological designs, confidentiality,seeking of project approval.
11. Modified from Association of Faculties of Pharmacy of Canada Educational Outcomes Model Standards of Practice for Canadian Pharmacists
Optional Advance
Possible Performance Indicators
Examples of activities that might prove
Competency Element
fulfilment of Possible Performance Indicators
Prepare a complete, succinct report of a research The pharmacist includes all required details of the project; organises the report properly and in accordance withrequirements of journals; follows the scientific method.
Present a research project in an appropriate, The pharmacist follows the scientific method when scientific manner to faculty and peers.
organizing the presentation; uses appropriatecommunication and educational strategies; usesappropriate technology to enhance presentation.
Present results of research projects completed to The pharmacist presents research projects and results toexternal audiences; local pharmacy meetings; regulatoryauthority committees.
Prepare written reports that meet publishablestandards.
References
Professional Competencies for Canadian Pharmacists at Sadler, D.R. Specifying and Promulgating Achievement Entry-to-Practice. Ottawa, Canada: NAPRA 1997 Standards. Oxford Review of Education. 1987; 13(2):191-209 Model Standards of Practice for Canadian Pharmacists. Ottawa, Cunnington, J.P.W., Norman, G.R. Certification and re- certification: are they the same thing? Academic Medicine.
2000; 75(6): 617-9 Gonczi, A., Hager, P., Oliver, L. Establishing Competency-basedStandards in the Professions. Research Paper No. 1. National 10. Boud, D. Enhancing Learning Through Self-Assessment.
Office of Overseas Skills Recognition. Canberra, Australia: Australian Government Publishing Service 1990 11. Bennett, N.L., Davis, D., Easterling, W.E., Friedmann, P., Green, Association of Faculties of Pharmacy of Canada. Educational J.S., Koeppen, B.M., Mazmanian, P.E., Waxman, H.S.
Outcomes and Levels of Performance Expected of Pharmacy Continuing Medical Education: a new vision of the professional development of physicians. Academic Medicine. 2000; 75:1167-1172 Masters, G.N., McMurry, D. Competency-based Assessment inthe Professions. Research Paper No.2. National Office of 12. American Board of Internal Medicine. Project Professionalism.
Overseas Skills Recognition. Canberra, Australia: Australian Philadelphia, USA: American Board of Internal Medicine, Heywood, L., Gonczi, A., Hager, P. A Guide to Development 13. Calgary-Cambridge Observation Guide. In: Teaching and of Competency Standards for Professions. Research Paper No.7.
Learning Communication Skills in Medicine. Kurtz, S., National Office of Overseas Skills Recognition. Canberra, Silverman, J., Draper,J. Oxon, UK.: Radcliffe Medical Press Australia: Australian Government Publishing Service 1992 Kiely, P.M., Chakman, J., Horton, P. Optometric therapeuticcompetency standards 2000. Clinical and ExperimentalOptometry. 2000; 83(6): 300-314 Model Standards of Practice for Canadian Pharmacists
Appendix A
Working Group Members

Nominated by Canadian Pharmacists Association Nominated by the Alberta College of Pharmacists Nominated by the College of Pharmacists of British Columbia Nominated by the Manitoba Pharmaceutical Association Nominated by the Manitoba Pharmaceutical Association Nominated by the Nova Scotia College of Pharmacists Nominated by the New Brunswick Pharmaceutical Society Nominated by the Ontario College of Pharmacists Nominated by the Department of National Defense and NAPRA Nominated by the Saskatchewan College of Pharmacists Zebrina Suleiman, BScPhmConsultant PharmacistToronto, ONNominated by Canadian Association of Chain Drug Stores Consultant
Nancy Winslade, BScPhm, PharmD, MHPE
Consultant in Health Professions Education and Assessment
The Netherlands
(now Montreal QB)
NAPRA Liaison and Project Director
Barbara Wells, BScPhm
Executive Director, NAPRA
Ottawa, ON
Model Standards of Practice for Canadian Pharmacists

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