Look Alike/Sound Alike

President¡¯s Bulletin

NOVA SCOTIA COLLEGE OF PHARMACISTS

Paul Tibbo, President

President, Zone 4

Paul Tibbo

Past President, Zone 1

Sujay Khiroya

Vice President, Zone 1

Deb Barnhill

Secretary/Treasurer

Zone 1

PIPEDA: Effective January 1,

2004

Included with this Bulletin is a memo to

pharmacists about PIPEDA, the new federal

privacy legislation that takes effect January 1,

2004.

Please ensure that you have read and

understand the federal legislation before it

becomes effective so that you will be

prepared to fulfill your responsibilities as

outlined in PIPEDA.

Carol Ann Chaddock

Councillor, Zone 2

Ruth Shea

Councillor, Zone 3

Sandeep Sodhi

Councillor Zone 5

Theresa Hurley

College of Pharmacy

Rita Caldwell

Lay Representatives

Charles LeBlanc

Jean MacDougall

Verified Internet Pharmacy

Practice Sites (VIPPS)

NAPRA is pleased to announce the launch of

the Canadian VIPPS program, a certification

program for pharmacies with online services

designed to help Canadian patients navigate

among the increasing number of Canadian

Internet pharmacies and choose sites that

have demonstrated compliance with the

VIPPS standards.

The VIPPS Seal of Approval will provide a

way for Canadian consumers to identify

legitimate Canadian pharmacies offering

services through the Internet. Note that

pharmacies exporting drugs and services to

US citizens will not qualify for VIPPS

certification.

December 2003

Susan Wedlake, Registrar

Health with the federal government regarding the

issue of the export of Canadian drugs and

services to the US. In the letter, Ms. Gorman

expresses the government¡¯s concern with the risks

inherent with this practice, including the potential

for drug shortages domestically. She advises

pharmacists that they must meet the requirements

of their respective provinces with respect to

¡°internet pharmacy¡±.

In Nova Scotia it may be considered professional

misconduct if a pharmacist/pharmacy knowingly

enters into an arrangement where Canadian drugs

are shipped to US citizens.

Note that, although Ms. Gorman refers to the issue

of concern as ¡°Internet Pharmacy¡± practice, she

actually is referring to the exportation of Canadian

drugs and pharmacy services. The Internet is only

one of a number of electronic mechanisms used

for the exportation of Canadian drugs.

The

Internet may be the medium but it is the cross

border exportation that is the issue.

The Nova Scotia College of Pharmacists supports

Internet Pharmacy in and of itself, given the

advances in health technology and the growing

role of the Internet in health care. We also confirm

support for NAPRA¡¯s VIPPS program which offers

Canadians a way to identify accredited Canadian

pharmacy websites.

Methadone

Frank Burgoyne

Registrar

Susan Wedlake

Canadian Publication

Agreement #40777563

The Nova Scotia College of Pharmacists

supports the Canadian VIPPS program and

encourages pharmacies to apply for VIPPS

certification.

Shipping Canadian Drugs/

Services to the US

Pharmacists are encouraged to familiarize

themselves with the NSCP Methadone document

distributed this summer. The office continues to

receive

complaints

from

physicians

that

methadone patients are unable to receive their

methadone prescriptions from their home

pharmacies.

Included with this Bulletin is a letter signed by

Diane C. Gorman, Assist. Deputy Minister of

Nova Scotia College of Pharmacists 1464 Dresden Row, Halifax, N.S. B3J 3T5 Phone (902) 422-8528 Fax (902) 422-0885

ATTENTION!

This Bulletin is forwarded to every

licensed pharmacist and active

certified dispenser in Nova Scotia.

Decisions of the Nova Scotia

College of Pharmacists regarding

matters such as regulations, drug

schedules, pharmacy practice, etc.,

are published in this Bulletin. The

Nova Scotia College of Pharmacists

therefore assumes that all

pharmacists/certified dispensers

are aware of these matters.

Standards of Practice for Canadian

Pharmacist

Included with this Bulletin is a document entitled ¡°Model

Standards of Practice for Canadian Pharmacists¡±. These

Standards are the same as those distributed three years

ago to Nova Scotia pharmacists, however the new

document now includes performance indicators and

examples of activities that might demonstrate fulfillment of

the required performance indicators.

For example,

Standard 1.3 states that a pharmacist must identify a

patient¡¯s desired therapeutic outcomes.

The required

performance indicator is that the pharmacist must

effectively establish realistic therapeutic outcomes

consistent with the patient¡¯s desires. An example of an

activity that demonstrates fulfillment of this indicator is the

pharmacist explaining to the patient that there is no cure for

the common cold but that products are available to relieve

symptoms. To be clear, it is not expected that pharmacists

perform each and every one of the examples of activities.

These are included to facilitate the understanding of the

practical nature of the requirements.

Nefazodone Market Withdrawal

Health Canada is overseeing the market withdrawal of

nefazodone in response to a safety evaluation that found

nefazodone poses a risk of causing serious liver-related

adverse effects. Health Canada advises patients on

nefazodone to consult with their physicians to make

arrangements for alternate therapies. Nefazodone patients

should also contact their physicians if they have

experienced any of the following adverse effects: jaundice,

brown urine, nausea, vomiting, unusual tiredness,

weakness, abdominal pain, loss of appetite. For more

information contact Health Cananda at (613) 957-2991.

Heparin Injection

Despite the applicability of Schedule I factors, heparin

injection is in Schedule II due to the need for patients and

homecare staff to have access to it for flushing dialysis

lines. This need for ¡°ready yet controlled public access¡±

can be considered similar to the Schedule II status of

epinephrine pens for anaphylaxis, therefore, it is expected

that pharmacists would not give this out until they were

satisfied that is was for the proper indication and to be used

appropriately.

Fatality Investigations Act

Pharmacists should be aware of the new Fatality

Investigation Act of Nova Scotia which states, in part, that a

medical examiner or an investigator acting under the

medical examiner¡¯s authorization, may, when investigating

suspicious deaths, without a warrant, inspect and make

copies of a diagnosis, a record or information relating to a

person who has received diagnostic or treatment and may

take possession of anything that they reasonably believe to

be directly related to a death.

The items seized may only be used to establish the

identification, cause and manner of death. Where a peace

officer requests the above items or the course of a criminal

investigation, a warrant must be provided.

Pharmacists are required to comply with the provisions of

the Fatality Investigations Act, but care should be taken to

ensure that the person requesting the information is

authorized to do so. The medical examiner or an

investigator authorized by the medical examiner should

provide some identifying pieces of information to satisfy the

pharmacist of the validity of the request.

The complete Fatality Investigations Act can be viewed on

the Nova Scotia government website at .ns.ca

Health Canada Advisories

Health Canada wishes to advise pharmacists of important

information regarding the following drugs.

The full

advisories are posted on the NAPRA website

() or can be found directly on the Health

Canada website at hc-sc.gc.ca. If you do not have

access to the Internet either at home or at work, please call

the Nova Scotia College of Pharmacists and we will print

copies for you. It is important that all pharmacists

review these warnings/advisories.

Lipitor

Topomax

Paxil-for children under 18 years

GlucoNorm-(repaglinide) and gemfibrozils

Serevent

D-TRON plus Insulin Pumps

H-TRON and H-TRON plus Insulin Pumps

Effexor, Effexor HR

ReFacto

3TC (lamivadine), Ziagen (abacavir) and Viread (tenofovir)

Nefazodone/Serzone

Gleevec

Clozapine

Casodex 150mg

Panomat Infusion Pump

Dahedi Insulin Pump

Zenapax

Diskus Inhalers (letter to Pharmacists and Wholesalers)

Medical Marijuana

Recently, the Superior Court of Justice in Ontario ruled that

the current program permitting authorized patients to

possess marijuana for medical purposes is unconstitutional

because it does not provide for a safe and legal supply of

the product.

Therefore, the federal government has

adopted an interim policy for the distribution of marijuana

produced by Prairie Plant Systems Incorporated under a

contract with Health Canada. The distribution system that

has been implemented is short-term and it does not involve

pharmacists.

Although pharmacists are not part of the distribution system

at this time, you might find the information posted on the

Health Canada website regarding current policies and

procedures useful when answering patients¡¯ questions.

The information for health professionals is available at

hc-sc.gc.ca/hecssesc/ocma/publication/marijuana/toc.htmT

In August, federal Health Minister Anne McLellan held

discussions with pharmacy organizations, including

NAPRA, to commence the process of determining whether

community pharmacists will distribute medical marijuana.

Further meetings are planned in the new year.

Important

Safety

regarding Clozapine

Information

Included with this Bulletin is an important message from

Health Canada regarding the dispensing of clozapine.

More than one company now manufactures and distributes

clozapine. Because of the unique nature of the drug and

the need to carefully monitor each patient¡¯s hematological

status, Health Canada has established certain

requirements:

? Each manufacturer must have a national database

to monitor the hematological status of patients

being treated with its brand of clozapine.

? The database must have the ability to identify

patients who have been assigned ¡°nonrechallengeable status¡±. Within 24 hours of

receiving a written request, a manufacturer must

confirm with other manufacturers the patient¡¯s

hematological status and that the patient is not the

non-rechallengeable category. This must be done

before a prescription is dispensed.

?

The monitoring program is expected to provide

timely feedback (within 24 hours of receipt of blood

test results) to the treating physician and

pharmacist or pharmacy.

Please keep in mind the following important points when

dispensing clozapine:

? The pharmacy and prescriber must be registered

with the appropriate monitoring program(s).

According to Health Canada, this requires the

completion of a full registration form by the

prescriber when a brand switch is made.

? The patients must be registered with and approved

by a monitoring program.

? The pharmacist must ensure that a CBC and

Differential Count have been performed within the

appropriate timeframe.

-reprinted with permission from the ¡°Bulletin¡±, College of

Pharmacists¡¯ of British Columbia.

Nicotine Products: Conditions of Sale

Nicotine chewing gum containing no more than the

equivalent of 4mg of nicotine per unit is unscheduled (can

be sold from any retail outlet).

Nicotine transdermal patch with a delivery rate of not more

than the equivalent of 22mg of nicotine is unscheduled.

Nicotine oral inhalers delivering no more than 4mg or less

of nicotine per dose are in Schedule III (licensed pharmacy

sale only).

In making its decision to place nicotine patches and gum in

the unscheduled category, the National Drug Scheduling

Advisory Committee reviewed published literature that

supports the theory that wider availability of nicotine

replacement products increases the likelihood of a smoker

attempting to quit smoking.

DM: Revisited

Dextromethorphan, in oral dosage forms in package sizes

of no more than 300mg DM base, is unscheduled.

Dextromethorphan, in oral dosage forms in package sizes

of more than 300mg DM base, is in Schedule III.

Note that, currently, all DM products in Canada are DM

hydrobromide. Since 300mg of DM base is approximately

equivalent to 409mg of DM hydrobromide, packages

containing 409mg or less of DM hydrobromide can be sold

as unscheduled.

The Virtues of Independent Double

Checks-They Really are Worth Your

Time!

This column was prepared by the Institute for Safe

Medication Practices (ISMP). ISMP is an independent

nonprofit agency that analyzes medication errors, near

misses, and potentially hazardous conditions as reported by

pharmacists and other practitioners.

Has your double check system ever failed, leading to a

medication error that escaped your detection and ultimately

reached a patient? If you answered ¡°yes¡± to this question,

you¡¯re not alone. Here¡¯s one recent example.

A pharmacist correctly calculated the dose and volume of

interferon for an infant, but entered 0.68mL into the

computer instead of the correct volume of 0.068mL (a

common mistake documented in the literature). A second

pharmacist double-checked the calculation. He arrived at

the correct volume of 0.068, but misread the computer entry

of 0.68 by the first pharmacist as 0.068 due to ¡°confirmation

bias¡±-seeing only what one expects to see and overlooking

any disconfirming evidence.

As this example shows, there¡¯s no question that double checks carried out by people fail at times. But have these

failures led you to doubt the overall value of double check

systems? Given how busy pharmacists and other health

care professionals are, do you wonder if this error reduction

strategy is even worth your time to carry out? We asked

Dr. Anthony Grasha, Professor of Psychology at the

University of Cincinnati, to offer comment on this issue.

Research shows that people find about 95% of all mistakes

when checking the work of others. Mathematically, the

benefit of double checks can be demonstrated by

multiplying this 5% error rate during the checking process

and the rate in which errors occur with the task itself (the

checking error rate x the task error rate). For example, if a

pharmacy dispensing error rate is 5% (based on research

findings), and a double-check occurs before medications

are dispensed, then the actual chance of a dispensing error

reaching the patient is 5%, or only 0.25%. Human factors

suggest that double checks are more effective if they are

performed independently.

For example, an error in

prescription computer order entry will be detected more

often if a second person independently checks the printed

prescription label against the doctor¡¯s original prescription

to verify what was entered into the computer. Sharing prior

calculations or performing a double check together with the

person who originally completed the task is fraught with

problems. In these instances, if a mistake is present, the

person checking the work is more easily drawn into the

same mistake, especially if it appears to be correct at first

glance (e.g. numbers correct but decimal point placement

wrong or correct drug but wrong concentration selected).

Dr. Grasha also points out that the effectiveness of double

check systems depends on training staff to carry them out

properly-as an independent cognitive task, not a superficial

routine task.

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