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
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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 ProfessionalPharmacists 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
Dr. Perlmutter’s Brain Audit Rating Your Mental Performance 1. Do you find that you have to write things down or you forget to do them? 3. Do you find it increasingly difficult to stay focused during a long meeting? 4. Do you worry that you won’t remember someone’s name shortly after being introduced? Yes 7. Do you find it more difficult to do simple mathematical calculati
Chinese Kruidengeneeskunde Westers gezien bestond er in de middeleeuwen wel verband tussen de diverse toegediende kruiden. Erwas sprake van een traditioneel systeem wat echter door de inquisitie en de westerse wetenschap werduitgebannen.Nu bestaat de westerse kruidengeneeskunde uit een grote hoeveelheid kruiden zonderverband, dit pilletje hiervoor en dat pilletje daarvoor. Hetzelfde beeld ontwi