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SUMMER 2021 • VOLUME 28 NUMBER 2
PHARMACYCONNECTION.CA
THE OFFICIAL PUBLICATION OF
THE ONTARIO COLLEGE OF PHARMACISTS
ONGOING LEARNING
SUPPORTS ENHANCED
PATIENT OUTCOMES
Quality Assurance: Supporting
Enhanced Outcomes for
Patients Through Up-to-Date
Knowledge and Skills 34
Using Continuous Quality
Improvement to Enhance
Medication Safety 18
Tips from the College’s
Operations Advisors on
Non-Sterile Compounding
Standards Implementation 20
PHARMACY
CONNECTION
Goes Digital 10
Ontario College of Pharmacists
483 Huron Street, Toronto, ON M5R 2R4
BOARD OF DIRECTORS
T 416-962-4861 PM indicates a public member appointed by the Lieutenant-Governor-in-Council.
www.ocpinfo.com U of T indicates the Dean of the Leslie Dan Faculty of Pharmacy, University of
Toronto. U of W indicates the Hallman Director, School of Pharmacy,
QUICK CONTACTS University of Waterloo.
Office of the CEO & Registrar
registrar@ocpinfo.com
Pharmacist Directors PM Stephen Adams Statutory Committees
ext. 2245
Douglas Brown PM Randy Baker • Accreditation
OCP Board of Directors Billy Cheung PM David Breukelman • Discipline
boardofdirectors@ocpinfo.com Sara Ingram PM Tammy Cotie • Executive
ext. 2243 James Morrison PM Christine Henderson • Fitness to Practise
Tracey Phillips PM Elnora Magboo • Inquiries Complaints & Reports
Pharmacy Practice Mark Scanlon PM Rick Phillips • Patient Relations
pharmacypractice@ocpinfo.com
Siva Sivapalan PM Gene Szabo • Quality Assurance
ext. 3500
PM Cindy Wagg • Registration
Registration Programs Pharmacy PM Devinder Walia
regprograms@ocpinfo.com Technician Directors U of T Lisa Dolovich Standing Committees
ext. 2250 Goran Petrovic U of W Andrea Edginton •Drug Preparation Premises
Ruth-Ann Plaxton • Finance & Audit
Member Applications & Renewals • Governance
memberapplications@ocpinfo.com
• Screening
ext. 3400
Pharmacy Applications & Renewals
pharmacyapplications@ocpinfo.com
ext. 3600
(2019-2022/2023)*
*In September 2020, the Board reaffirmed the priorities expressed within the existing multi-year strategic framework and deferred strategic planning activities
through to 2022 or 2023.
PAGE 2 ~ SUMMER 2021 ~ PHARMACY CONNECTION
The objectives of Pharmacy Connection are
to communicate information about College
activities and policies as well as provincial and
federal initiatives affecting the profession;
to encourage dialogue and discuss issues of
interest to pharmacists, pharmacy technicians
and applicants; to promote interprofessional
collaboration of registrants with other allied health
care professionals; and to communicate our role
to registrants and stakeholders as regulator of the
profession in the public interest.
We also invite you to share your comments,
suggestions or feedback by letter to the Editor.
Letters considered for reprinting must include the
author’s name, address and telephone number.
The opinions expressed in this publication do not
necessarily represent the views or official position
of the Ontario College of Pharmacists.
PUBLISHED BY THE
COMMUNICATIONS DEPARTMENT
communications@ocpinfo.com
SUMMER 2021 • VOLUME 28 NUMBER 2
FOLLOW US ON SOCIAL MEDIA!
CONTENTS
CEO and Registrar's Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
facebook-f Board Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
www.facebook.com/ocpinfo Registrar’s Reflection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Pharmacy Professionals Play Vital Role in Ontario’s Safe Re-opening . . . . 8
Pharmacy Connection Goes Digital . . . . . . . . . . . . . . . . . . . . . . . . 10
Twitter The Code of Ethics: Accountability . . . . . . . . . . . . . . . . . . . . . . . . . 12
www.twitter.com/ocpinfo Experiencing Mental Health or Substance Use Challenges? . . . . . . . . . 13
The Role of Provider Experience in Quality Healthcare . . . . . . . . . . . . 14
Clinical Viewers Now Available to all Community Pharmacies . . . . . . . . 16
YOUTUBE
Resources for Pharmacy Professionals to Support
www.youtube.com/ocpinfo Indigenous Cultural Competency . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Using Continuous Quality Improvement to Enhance Medication Safety . . 18
Implementation of Non-Sterile Compounding Standards: Tips from the
LINKEDIN-IN College’s Operations Advisors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
www.linkedin.com/company/ Update on Opioid Use Disorder Treatment . . . . . . . . . . . . . . . . . . . . 22
ontario-college-of-pharmacists Helping Prevent Opioid-Related Harms . . . . . . . . . . . . . . . . . . . . . . 26
Practice Insight: Responsibilities of Designated Managers . . . . . . . . . . . 28
Use of CAS Registry Numbers® as Unique Identifiers in Compounding
ISSN 1198-354X
Processes has the Potential to Reduce Medication Errors . . . . . . . . . . . 30
© 2021 Ontario College of Pharmacists
Canada Post Agreement #40069798 Discipline Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Undelivered copies should be returned to the Reflect, Then Act: Implementing New Practices Requires
Ontario College of Pharmacists. Not to be Critical Self-Reflection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
reproduced in whole or in part without the
permission of the Publisher. Quality Assurance: Enhanced Patient Outcomes
Through Improving Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Knowledge Assessment: Focusing on the Knowledge and
Skills Needed to Provide Appropriate Care . . . . . . . . . . . . . . . . . . . . 36
Addressing Common Questions About Practice Assessments for Pharmacists
Working in Hospital, Long-Term Care and Family Health Teams . . . . . . . 38
Focus on Error Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
CEO AND REGISTRAR’S MESSAGE
of establishing a culture of assessment and practice
medication safety in pharmacies, assessments for pharmacists
we have launched a new feature working in hospital or other
called Eye on CQI. In our first healthcare facilities.
installment we take a look at
how each of these are vital We continue to see the
components in enhancing patient devastating effects of the opioid
safety and improving patient crisis right across Ontario,
health outcomes. Pharmacy further heightened by the impact
professionals are encouraged to that the COVID-19 pandemic
use AIMS to inform CQI initiatives has had on the population. In
in their own pharmacy practice, 2020 alone, there were 2,426
and to embrace a just culture, opioid-related deaths in our
which is essential for identifying province, representing a 60%
Nancy Lum-Wilson, risks, openly sharing learnings rise from 2019. We know that
R.Ph., B.Sc.Phm., MBA and developing actions to pharmacy professionals have an
CEO and Registrar reduce the chance of medication important role to play in helping
incidents or near misses from prevent harms to patients and
occurring or recurring. communities. In this edition, we
Dear Colleagues, asked experts from the Centre
Pharmacies across the province for Addiction and Mental Health
This edition of Pharmacy are working to fully implement the to highlight key guidance for
Connection marks the transition NAPRA Standards for Pharmacy pharmacy professionals as opioid
of the College’s print magazine to Compounding of Non-Sterile use disorder treatment options
a dynamic new digital publication Preparations before the January continue to evolve.
that will improve timely access to 1, 2022 deadline, and we asked
important information, tips, news our College operations advisors I hope you enjoy this edition of
and updates relevant to practicing to share some advice. The tips and Pharmacy Connection, and that
pharmacy professionals. It will also resources they have provided will you all have a safe, well-deserved
allow us to focus on publishing help pharmacies implement the summer break.
information that will be easy for standards and improve the health
you to find—no matter what and safety of both patients and Sincerely,
device or platform you are using pharmacy professionals.
in your busy practice.
Part of the College’s commitment
The enhanced Pharmacy to protecting the public is
Connection reflects input from helping to ensure that pharmacy
registrants who shared feedback professionals maintain appropriate
on its functionality and the type skills and knowledge throughout Nancy Lum-Wilson
of information they valued most their careers. Through the Quality
in their daily practice. I encourage Assurance (QA) Program, the CEO and Registrar
you to continue telling us what College has a mandate to ensure Ontario College of Pharmacists
you think of the digital edition so continued competence of the
that we may continue to support profession to provide safe, quality
a seamless, engaging experience care. We do this by helping those
going forward. Be sure to visit who have challenges meeting
PharmacyConnection.ca to try standards and enabling those
the new features! who are meeting standards to
continually improve. In this edition,
To show the relationship between we share more about how the
continuous quality improvement College has approached our QA
(CQI), the College’s mandatory Program, utilizing a right-touch
Assurance and Improvement and risk-based approach, and we
in Medication Safety (AIMS) focus on two key components
Program, and the importance of the Program: the knowledge
PAGE 4 ~ SUMMER 2021 ~ PHARMACY CONNECTION
BOARD REPORT
JUNE 2021
BOARD MEETINGS
These meetings were held via video and teleconference in consideration of provincial directives and
physical distancing measures recommended by Public Health Ontario due to the COVID-19 pandemic.
As recorded following the Board of Directors' regularly scheduled meeting held on June 14, 2021.
BOARD DECISIONS of the current health emergency. including those related to the
Once the emergency order has Selection of Committee Chairs,
The Board discussed and made been lifted in Ontario, the College Conduct of Board Directors
decisions on the following policies will continue to monitor the and Committee Appointees and
and By-Law amendments: status of the drug shortages and Sanctions Process, and Board
determine whether development Meeting Rules of Procedure. The
Virtual Care Policy of a permanent restocking policy amended By-Laws will come into
is warranted. The policy has been effect immediately, enabling the
The Board approved an amended posted on the OCP website, changes to be in place prior to
Virtual Care Policy to outline and additional information and the commencement of the next
the practice expectations for resources to support registrants Board year in September 2021.
registrants who choose to in the application of the policy in
provide care to patients using their practice, where appropriate, HONOURING NATIONAL
virtual approaches. The policy’s have been shared. INDIGENOUS
development was informed HISTORY MONTH
by a comprehensive review of Governance Manual policies
pharmacy regulatory authorities To mark National Indigenous
across Canada and health The Board reviewed and approved History Month, the Board
professional regulators in Ontario, policies in Sections 3, 4 and 5 of welcomed Dr. Jaris Swidrovich,
alongside a review of privacy the Governance Manual. This is Canada’s first self-identified
legislation and guidance from the final approval for a series of First Nations Doctor of
external organizations, as well as standalone policies which, once Pharmacy, who shared his
from feedback gathered during complete, will replace the current thoughts on Indigenous
a 60-day open consultation. The Governance Manual. The current Engagement, Cultural Safety,
policy has been posted on the manual, in effect since 2014, is and Reconciliation. Improving
College’s website, along with comprehensive but lengthy and Indigenous cultural competency
additional resources to guide not easily amended. The new within the College and among
registrants in their practice. policies will come into effect at registrants is a Board-supported
the start of the new Board year in commitment, and the Board
Restocking of MAiD Drugs September 2021, with orientation thanked Dr. Swidrovich for his
of new Board members centred insights about how pharmacy
Due to the pandemic, a shortage around these new policies. professionals can enhance care
of drugs used in the Medical for Indigenous patients.
Assistance in Dying (MAiD) drug By-Law Amendments
protocol has impacted a number CROSS-JURISDICTIONAL
of patients. The Board has To support improvement in SERVICES POLICY
approved a policy on Restocking governance practice and to
of Drugs Used for Medical strengthen trust in the College’s Following a 60-day open
Assistance in Dying (MAiD) During mandate to serve and protect consultation on a proposed
COVID-19, with the intent that it the public, the Board approved Cross-Jurisdictional Services
be in effect only for the duration three By-Law amendments, Policy, the College will update
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 5
BOARD REPORT
the draft with amendments of the performance of the NEXT BOARD MEETING
based on respondent input. College against the established
Feedback suggested that potential objectives for the quarter, which The next regularly scheduled
unintentional barriers to cross- are aligned with the Ministry of meeting will be held on September
jurisdictional care could result if Health’s College Performance 20, 2021. Special Board meetings
the policy was to be implemented Measurement Framework (CPMF). may be called at any time. Please
as written, and some respondents see our website for information
requested the development of an BOARD RISK REPORT on upcoming Board meetings.
accompanying practice resource Board meetings are open to the
to augment the policy and provide The CEO and Registrar also public and are typically held in the
examples around expectations. presented the Board Risk Board Chambers of the College at
Once amendments have been Report, outlining identified 483 Huron Street, Toronto, ON,
made, and a practice resource physical, financial, operational M5R 2R4. Due to public health
is developed to accompany the and reputational risks and measures currently in place, Board
policy, the College will submit an their mitigation strategies. meetings are being held virtually
amended policy for Board approval. The presentation outlined the until further notice. If you plan
College’s 2021-2022 Risk to attend an in-person meeting
STRATEGIC PRIORITIES Management Program and or for more information, please
PROGRESS UPDATE reported on the progress to contact Ms. Sharlene Rankin,
mitigate risks identified in the Board and Committee Liaison
The College’s CEO and Registrar 2021 Risk Register. To date, 82% at boardofdirectors@ocpinfo.
delivered a report to the Board of the strategies are implemented com. Links for those who wish to
highlighting activities that or underway. Throughout the fall, observe a virtual meeting will be
have taken place since the last the College will develop the 2022 posted with meeting agendas. You
meeting, as well as progress on Risk Register for consideration by can also follow highlights from the
strategic initiatives. The Registrar the Finance and Audit Committee Board meetings via Twitter.
shared the Q1 2021 Scorecard, and then the Board at the
which provides a snapshot December Board meeting.
A summary of record of the Board of Directors' meeting held on June 24, 2021.
The Board approved governance and burden • Ensuring a 50/50 balance of elected professionals
reduction recommendations in response to the and appointed public directors to the Board, while
Ministry of Health’s request for input on Regulated eliminating academic appointments. The Board
Health Professions Act, 1991 (RHPA) reform recommended ensuring academic representation be
opportunities. maintained in other ways, such as advisory groups.
In a letter to be shared with the government for • Maintaining the current model of competency
consideration in potential amendments to the based elections with aligned competency-based
RHPA, the Board expressed its continued support appointments of public Board directors.
for and approved the following governance reforms
and principles, some of which have already been • Changing nomenclature in the RHPA to refer to
implemented at the College: ‘Council’ as ‘Board’, and ‘Members’ as ‘Registrants’.
• Smaller Boards (Councils), reducing the size of The Board also expressed its support for additional
the Board to 8-12 members and eliminating the burden reduction opportunities within the RHPA
Executive Committee. in response to the Ministry’s request for feedback.
Please read the full June 24, 2021 Board Report.
• Separating the Board from statutory Committees,
except where required by statute.
PAGE 6 ~ SUMMER 2021 ~ PHARMACY CONNECTION
REGISTRAR’S Reflection
For more than a year now we have been talking about the pandemic and the many ways
in which it has altered pharmacy practice. The changes that have been implemented
to protect patients and pharmacy staff were nothing short of extraordinary, and their
effectiveness has helped maintain access to safe, quality pharmacy care for Ontarians.
Pharmacy professionals met the re-opening of businesses and technician to administer the
public health crisis head-on, and community services, and made it COVID-19 vaccine by injection.
showed remarkable resilience possible to see our friends, family Though this amendment is only
in the way they adapted to and colleagues in person once in effect until next March, it
regulatory amendments again. does demonstrate the value of
and changing public health authorizing pharmacy professionals
recommendations. Community Yet while the end of the pandemic to support the province’s COVID-
pharmacies used PPE, screening may be in sight, it is unlikely that we 19 vaccination program, and could
protocols and physical distancing will completely return to business be reinstated or extended should
to prevent the spread of as usual. We can’t predict what the Ontarians require booster doses in
COVID-19 in their locations, future may hold, but we can take the future.
establishing them as safe, the lessons we have learned to
accessible healthcare providers improve the way safe patient care The College continues to monitor
for patients. Hospital pharmacists is provided going forward. the evolution of pharmacy practice
and pharmacy technicians played and government regulation
an increasingly vital role in patient We know, for instance, that the as a result of the pandemic,
care as COVID-19 patient pandemic created a demand for and to collaboratively provide
volumes soared. And pharmacy virtual care, and that emerging registrants with ongoing guidance
professionals in all settings technology is making it easier and resources to support their
became trusted sources of reliable and safer in a pharmacy setting. safe delivery of pharmacy care.
COVID-19 information, helping As a result, the College’s Board Please refer to our COVID-19
patients make informed decisions of Directors recently approved a Information for Pharmacy
for themselves and their families. new Virtual Care policy, informed Professionals web page for the
by feedback from an open latest updates.
In addition, 16 months after the consultation on our website. This
pandemic began, we are seeing the policy sets expectations for the The COVID-19 pandemic
benefit of pharmacists, pharmacy appropriate use of virtual care has brought many challenges
technicians and other healthcare for pharmacies, and requires and placed an extraordinary
professionals supporting the that pharmacy professionals amount of stress on healthcare
government’s COVID-19 testing consider certain factors such as professionals. I want to thank you
and vaccination programs in maintaining a patient’s right to for your ongoing commitment to
communities across Ontario. privacy, the appropriateness of your patients throughout these
using a virtual approach to care, challenging times.
COVID-19 cases have declined and ensuring the same quality as
substantially, and as of August 3 in-person care is provided. Sincerely,
the number of adult Ontarians Nancy
with at least a first dose of And, while temporary, we saw the
vaccine has exceeded 80% of the provincial government amend
population, and over 70% have the Regulated Health Professions
also received their second dose. Act, 1991 (RHPA) to allow a Part
This has relieved pressure on A pharmacist, intern, registered
our hospitals, allowed a gradual pharmacy student or pharmacy
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 7
PHARMACY PROFESSIONALS PLAY VITAL ROLE IN Ontario’s Safe Re-opening
PHARMACY PROFESSIONALS PLAY VITAL ROLE IN ONTARIO’S SAFE RE-OPENING
As Ontario’s vaccination rates continue to climb and the province begins to re-open,
pharmacy professionals are playing a key role in driving province-wide progress and
improvements in health indicators. Through patient education, support and community
vaccinations, pharmacy professionals are keeping Ontarians informed and healthy.
With evolving public health During the provision of pharmacy Even if you are not providing
guidance, pharmacy professionals services, while engaging with vaccinations in your pharmacy,
continue to be an important their patients, pharmacy as a healthcare professional you
source of information and professionals are encouraged to play an important role in ensuring
education for patients, including ask patients whether they have patients have the information
addressing questions and received the first and second they need to make an informed
concerns about vaccines. It is dose of a COVID-19 vaccine. If decision and helping them
important that pharmacists and the patient has not received a navigate the vaccination process
pharmacy technicians educate vaccine, pharmacists can offer when appropriate. Patients can
themselves about the COVID-19 patient education around the also be reminded to seek out and
vaccines so that they are prepared safety and efficacy of the vaccine rely on reputable and credible
to address questions and concerns and discuss any concerns the information sources.
from patients. patient may have.
TOP FIVE COVID-19 RESOURCES FOR PHARMACY PROFESSIONALS
The College provides a host of resources pharmacy professionals can use in their daily practice to help guide
conversations with patients. The College continues to collaborate with the Ministry of Health, public health officials
and other health system partners and professional associations to inform and support pharmacy professionals.
COVID-19: Information for Immunize Canada
Pharmacy Professionals Immunize Canada is a national
The College’s dedicated COVID-19 coalition whose mission is to promote
webpage includes the latest updates on the understanding and use of
COVID-19, resources on supporting vaccines as recommended by the
vaccine confidence and visually engaging health National Advisory Committee on Immunization.
resources. Access resources on education, misinformation and
vaccine hesitancy.
Canadian Vaccination Evidence
Resource and Exchange Centre Centre for Effective Practice
(CANVax) COVID-19 webpage
Find resources focused on vaccine The Centre for Effective Practice has
acceptance and uptake in Canada, evidence-based resources, including
including COVID-19 vaccine questions and answers common COVID-19 questions from
for public health professionals. patients and key messages to use in
responding.
University of Waterloo’s School
of Pharmacy COVID-19 health
resources
Access health resources on COVID-19
vaccines, including FAQs, infographics
and videos.
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 9
PHARMACY CONNECTION GOES DIGITAL The College is excited to announce the launch of its new digital Pharmacy Connection, a web-based and mobile-friendly publication suitable for busy, on-the-go pharmacy professionals. This new digital publication will improve access to important information, tips, news and updates, and give registrants quick and easy access to practice-related information. The College’s move to digital underscores our focus on providing a more responsive and timely resource that supports our important role in delivering relevant content that pharmacy professionals can use to help them provide safe and quality patient care. Delivering content that can be quickly shared and easily updated will help registrants align their practice to the latest policies and updates.
PHARMACY CONNECTION GOES DIGITAL
Shifting to this new, flexible digital platform means
the College is retiring the current print magazine
format. This edition of Pharmacy Connection
will be the last to be printed and mailed to hard-
copy subscribers. The redesigned, user-friendly
PharmacyConnection.ca will allow readers to access
current information, issues and engage with content
anywhere, anytime. For those who prefer to read on
paper, every story on PharmacyConnection.ca has a
prominent and accessible print button, giving readers
quick and easy access to a print-friendly version of
the articles. In addition to printing articles, readers
can engage with and share the stories with their
peers via social media channels, including Facebook,
Twitter and LinkedIn, or email.
As part of our commitment to supporting a positive
reading experience, we will continue to seek feedback
from registrants and make enhancements to support
an engaging experience for readers.
Check out the new PharmacyConnection.ca for the
latest news and updates!
HOW GOING DIGITAL BENEFITS YOU
RESPONSIVE
• Access more frequently updated content and timelier posts relevant to pharmacy regulation
and practice
• Available across all devices, making it suitable for on-the-go pharmacy professionals
INTERACTIVE
• Access embedded videos and interactive content, enhancing your reading experience
• Easily share stories with your network and across social platforms
FLEXIBLE
• Digital content is not bound by a quarterly publication schedule, giving you access to news
and updates as they happen
• Articles are published when they are most relevant and timely, and can be easily updated with
new information
SUSTAINABLE
• Contribute towards an environmentally friendly initiative, eliminating the need for printing
over a million pieces of paper a year
• Support the College’s commitment to be a cost-effective and efficient regulator
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 11THE CODE
OF ETHICS:
Accountability
Pharmacists and pharmacy technicians maintain the public trust by ensuring that they act in the best interest of
their patients and society by practicing within scope, refraining from participating in unethical business practices
and avoiding conflicts of interest.
Key ethical standards, among others, require pharmacy professionals to:
Assume responsibility for all decisions and actions they undertake in professional practice,
including failure to make a decision and take appropriate action when necessary.
Be diligent in identifying and responding to red flag situations that present in practice.
Report professional incompetence or unethical behaviour by colleagues or other
healthcare professionals to the appropriate regulatory authority.
Ensure that when power imbalances exist in professional working relationships they do not
exploit these relationships for personal, physical, emotional, financial, social or sexual gain.
Recognize that their patient’s best interests must always override their own interests or the
interests of the business which they own, have a financial interest in or are employed by.
Avoid dual relationships and other situations which may present a conflict of interest and
potentially affect their ability to be impartial and unbiased in their decision-making.
LEARN MORE ABOUT ACCOUNTABILITY
•R
ead the Code of Ethics
•W
atch the e-Learning Module on Accountability
•W
atch the e-Learning Module on the Code of Ethics
•R
eview the Framework for Ethical Decision Making
The Code of Ethics articulates the ethical principles and standards that must guide the practice of pharmacists and
pharmacy technicians. As a way to draw attention to the Code of Ethics since its introduction almost five years
ago, we have been featuring one ethical principle in the past few editions of Pharmacy Connection. This is the final
installment.
PAGE 12 ~ SUMMER 2021 ~ PHARMACY CONNECTIONEXPERIENCING
Mental Health or Substance
Use Challenges?
Your mental health is just as important as your physical health. Take advantage of the free
Ontario Pharmacy Health Program (OPHP) administered by Lifemark Health.
Registrants can access OPHP directly and remain anonymous to the College. Those who participate in the program
will benefit from specialized assessment and treatment that addresses the unique needs of pharmacy professionals.
Lifemark Health provides registrants with comprehensive psychological, psychiatric
and/or substance use assessments: clear diagnostic and functional formulation
of a registrant’s condition, treatment and practice recommendations.
Recognizing the pandemic’s impact on pharmacy
professionals, Lifemark Health also has resources
on coping with COVID-19 stress, a COVID-19
self-care and resilience guide, and more.
Access frequently asked questions about the
program in Pharmacy Connection.
Learn more about the program on the
Lifemark Health website.
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 13THE ROLE OF PROVIDER EXPERIENCE in Quality Healthcare Like the focus on patient experience, measuring the experience of healthcare providers can help uncover important health system improvement opportunities.
MEASURING THE PROVIDER EXPERIENCE
There is a to identify meaningful indicators principles provide all pharmacy
well-established that will measure provider stakeholders with a foundation
link between experience. Quality indicators to guide decision making that
healthcare already exist in other areas of the supports consistent delivery of
provider health system, such as long-term safe, high quality patient care
experience and care and primary care, and a at all times within a community
patient outcomes. great deal of work has already pharmacy environment.
For example, many been done to establish indicators
studies of burnout among in hospital pharmacy. However, An implementation strategy is
clinicians and staff in healthcare it is relatively new territory for currently being developed that
have shown the negative impacts community pharmacy in Ontario, will involve each stakeholder
on patient care and outcomes. which is why it is the focus of playing an important part in the
Research demonstrates that this current indicators work. The rollout, promotion and adoption
physician burnout is associated working group has been reviewing of the principles throughout the
with an increased risk of patient existing indicators from other profession.
safety incidents and poorer quality disciplines, and will recommend
of care due to low professionalismi, a shortlist of these indicators for While the selection of provider
dissatisfied physicians are more public consultation this summer experience measures is a separate
likely to prescribe inappropriate stream of activity, the environment
medications, which can result in A list of confirmed provider that pharmacy professionals
expensive complicationsii, patient experience measures will be practice within does affect the
safety is threatened by nurse finalized based on stakeholder experience of providing care.
dissatisfaction, and many nurses feedback and presented to the Therefore, the development of
report that their workload causes Board in December 2021. The principles of shared accountability
them to miss important changes in College will also use the public will inform the selection of
their patients’ conditioniii. consultation to explore options for provider experience measures and
collecting the data going forward. contribute to the College’s efforts
Yet measuring the experience of to support safe and effective
community pharmacy professionals COMMUNITY PRACTICE patient care.
within the context of healthcare ENVIRONMENT
quality and outcomes has never Information about the Community
been done before—a literature The work to develop provider Practice Environment and the
review conducted by the College experience indicators complements Quality Indicators initiatives will
found no community pharmacy- the Community Practice continue to be shared in future
specific measures identified here in Environment Initiative, aimed at editions of e-Connect and
Canada or around the world. understanding and addressing Pharmacy Connection.
the barriers to patient safety
As part of the College’s Quality in community pharmacy. This
Indicators initiative, a working initiative resulted in a set of shared
group of frontline pharmacy accountability principles, approved
professionals, patients, and health by the College’s Board of Directors
and data experts has been formed in December 2020. These
i
Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., ... & Esmail, A. (2018). Association between physician
burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Internal Medicine, 178(10),
1317-1331.
Williams, E. S., & Skinner, A. C. (2003). Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research.
ii
Health Care Management Review, 28(2), 119-139.
iii
McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ widespread job dissatisfaction, burnout, and
frustration with health benefits signal problems for patient care. Health Affairs, 30(2), 202-210.
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 15CLINICAL
VIEWERS
Now Available to
All Community
Pharmacies
Ontario Health is now offering patient care
information to pharmacies, including laboratory
results, dispensed medications, and acute care
data, through one of two provincial clinical viewers
(ConnectingOntario and ClinicalConnect) that are
designated by region.
The viewers provide a dynamic, Sign up today and take advantage pharmacy to access these valuable
near real-time view of patients’ of Ontario Health’s new, clinical viewers, which will help
health information to support streamlined signup process. You’ll pharmacists make more informed
the delivery of pharmacy services also benefit from support every decisions and provide enhanced
such as medication management step of the way from an Ontario patient care.
and counselling, MedsChecks, Health Lead who will address any
Pharmaceutical Opinions, and questions you have and help your Questions about the clinical
other patient care services at no pharmacy complete the access viewers and sign up process can
cost to pharmacies. requirements. be directed to Ontario Health
at oh-ds_connectingontario@
With access to the clinical viewers To sign up, the pharmacy’s ontariohealth.ca.
pharmacists can make faster, Designated Manager or Director
more informed care decisions, and Liaison can complete a request
improve workflow and efficiencies on Ontario Health’s website. The
at the point of care with a more College encourages all pharmacy
complete picture of a patient’s professionals to take advantage
health profile, available 24/7. of this great opportunity for your
PAGE 16 ~ SUMMER 2021 ~ PHARMACY CONNECTIONResources for Pharmacy Professionals
TO SUPPORT INDIGENOUS
CULTURAL COMPETENCY
In 2019, the College’s Board of Directors made an Indigenous cultural competency and
safety commitment. As part of this, the College committed to sharing resources with
pharmacists and pharmacy technicians that would help them enhance the health and
well-being of Indigenous peoples living in Ontario.
The new Resources for Pharmacy Professionals to These resources have been curated from a variety of
Support Indigenous Cultural Competency webpage sources, including government websites, healthcare
provides links to a number of free resources that organizations, advocacy bodies and Indigenous-led
explore Indigenous identity and history, truth and organizations. Additional resources will continue to be
reconciliation and culturally competent healthcare. added to this page, so you are encouraged to check
Registrants are encouraged to take the time to review back regularly. If you know of any resources that the
the resources that are most relevant to their practice. College should consider including in this list, please
email communications@ocpinfo.com.
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 17USING CONTINUOUS
QUALITY IMPROVEMENT
TO ENHANCE
MEDICATION SAFETY
It is often said that all improvement requires change, but not all change results in
improvement. That’s where the concept of continuous quality improvement, also known
as CQI, comes in.
In pharmacy, the objective of CQI on both system improvements medication incidents and better
is to improve all aspects of practice as well as the tasks that individual understand why they happen and
with the goal of increasing patient practitioners perform. how they can be prevented.
safety. This may include learning
from medication incidents and How AIMS supports CQI As shown in the diagram on
implementing error prevention the next page, pharmacy
strategies to reduce the chances The College’s mandatory professionals record medication
of recurrence, such as process Assurance and Improvement in incidents and near misses in the
standardization or improvements. Medication Safety (AIMS) Program AIMS Pharmapod platform, and
is based on a CQI approach. With analyze the incident to identify
CQI is about change, and increasing the goal of reducing the risk of learnings and actions that can be
the chances that the changes made patient harm caused by medication implemented in the pharmacy to
in pharmacy result in improved incidents in, or involving, Ontario reduce the risk of harm to patients
patient safety. To achieve safer pharmacies, AIMS enables and enhance patient safety.
care for patients, CQI must focus practitioners to learn from
PAGE 18 ~ SUMMER 2021 ~ PHARMACY CONNECTIONCONTINUOUS QUALITY IMPROVEMENT
How AIMS Supports CQI from recurring and supporting meaningful, sustainable
change at the pharmacy level and, eventually, across
the health system.
It is an expectation that all pharmacy operations
are conducted in a manner that supports the AIMS
program and the requirements outlined in the
Supplemental Standards of Practice (sSOP) that
were designed to enable pharmacy professionals to
Record medication incidents meet this goal.
and near misses in the
AIMS platform
Resources to support AIMS
Creating a culture of medication safety is a journey,
and the College has compiled a number of resources
to support pharmacies on that journey as they
integrate CQI and AIMS into their workflows.
Reduce the risk of harm Identify learnings and
to patients and enhance actions to implement
•A
IMS Program e-training: Community pharmacy
patient safety in the pharmacy staff must complete the six e-Learning modules
that introduce the AIMS Program and provide
information on the expectations for pharmacy
The data recorded in the AIMS Pharmapod platform professionals and on how to use the AIMS
is then de-identified and aggregated with data from Pharmapod platform. The modules take less
other pharmacies across the province to create a than one hour to complete. After completing
snapshot of trends or opportunities for system-level each module, registrants can print a certificate of
improvements. A sub-set of this data is available completion to confirm they have reviewed the
on the OCP website as an interactive tool, and the content. This certificate of completion may be kept
College is currently working with a group of subject for your own records and does not need to be
matter experts from various environments that submitted to the College.
have experience related to medication safety, such
as community pharmacy, academia and health data •P
harmacy Safety Self Assessment (PSSA):
analysis, to support the AIMS program goals of sharing Community pharmacies are required to complete
lessons learned across the province. the PSSA for the first time by December 31, 2021.
A Pharmacy Safety Self-Assessment User Guide has
Creating a culture of medication safety been developed to support Designated Managers
and pharmacy staff in the PSSA completion.
For AIMS to effectively inform CQI, pharmacy owners
and Designated Managers must enable a just culture •P
harmacy Connection articles about AIMS:
that supports learning and a system-based approach Review past articles written about AIMS in
to incident analysis over a blame and shame culture Pharmacy Connection.
that focuses on human behaviours.
• ISMP Canada Safety Bulletin, March 30, 2021:
A culture of medication safety can be described as Review articles on Never Events for Community
shared values, norms, competencies and attitudes Pharmacy and Analysis of Findings from Safety
towards patient safety among individuals within an Assessments of Community Pharmacies.
organization.1 Members of a safety culture report
incidents without fear of blame, learn from incidents 1
https://www.ismp-canada.org/download/hnews/201802-
to make improvements, and trust their organization HospitalNews-MedSCIM.pdf
will deal with them fairly when something goes 2
https://cphm.ca/wp-content/uploads/Resource-Library/SafetyIQ/
wrong.2 A culture of medication safety encourages CPSC-Toolkit-FINAL.pdf
staff to engage in open, honest discussions about
medication incidents and near misses. It also permits
staff to identify the causes of incidents and to share
lessons learned with an emphasis on preventing errors
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 19IMPLEMENTATION
OF NON-STERILE
COMPOUNDING STANDARDS:
Tips from the College’s Operations Advisors
As pharmacies work to fully implement the NAPRA Model Standards for Pharmacy
Compounding of Non-Sterile Preparations in advance of the final Phase 3 deadline of
January 1, 2022, College operations advisors continue to engage pharmacy professionals
during pharmacy assessments on their obligations under the standards.
Pharmacy Connection asked the College operations advisors to each name one
piece of advice they would give to registrants to support implementation of the
standards and contribute to health and safety at the pharmacy for both patients
and pharmacy professionals.
READ THE STANDARDS AND RESOURCES
Read both the Model Standards and RESOURCES
the companion guidance document for
•M
odel Standards for Pharmacy Compounding of
Pharmacy Compounding of Non-Sterile
Non-Sterile Preparations
Preparations, in their entirety.
•G
uidance Document for Pharmacy Compounding of
Review the Pharmacy Connection articles addressing Non-Sterile Preparations
requirements, common questions and additional
•N
on-Sterile Compounding articles in Pharmacy
resources to support implementation.
Connection
LOOK AT YOUR PRACTICE AS A WHOLE, NOT JUST
INDIVIDUAL COMPOUNDED PREPARATIONS
Apply the risk-based approach to RESOURCES
your entire compounding practice:
•F requently Asked Questions – Risk Assessment and
identify risks, assess them and mitigate
Mitigation
them through safety measures and
administrative controls. Consider the • Non-Sterile Preparations Assessment Criteria
cumulative risk associated with all preparations being to assess gaps between current practices and
compounded by the pharmacy. requirements of the standards
•N ovember 4 Webinar Slides Part Two – Risk
Assessments and Requirements
PAGE 20 ~ SUMMER 2021 ~ PHARMACY CONNECTIONSAFETY FIRST RESOURCES
The standards are designed first and •N ovember 4 Webinar Slides Part One – Rationale
foremost to keep patients and pharmacy for Standards
personnel safe. How can you reduce the •F requently Asked Questions – Risk Assessment and
risk of errors during preparation of the prescription? Mitigation
How can you create a safe work environment and • Implementing the Non-Sterile Compounding
protect those performing the compounding from Standards: A Closer Look at Personal Protective
potential hazards? Equipment – Pharmacy Connection Summer 2019
FOCUS ON THE PATIENT: ASSESS THE PRESCRIPTION
AND EVALUATE THE NEED FOR COMPOUNDING
Ask yourself, is the compounded RESOURCES
preparation the most appropriate for
•N ovember 4 Webinar Slides Part Three – Patient
the patient? Is there a suitable manufactured product
Assessment
commercially available? Can it be safely compounded
in your pharmacy? Remember to document and • Staying on Track for Full Implementation of
defend any decision you make. Non-Sterile Compounding Standards – Pharmacy
Connection Spring/Summer 2020
REVIEW ALL OF THE COMPOUNDS YOU ARE MAKING AND
ENSURE APPROPRIATE DOCUMENTATION IS AVAILABLE
Ensure you have the appropriate RESOURCES
record for each compound that the
•M
aster Formulation Records and Compounding
pharmacy prepares. Do you have up-to-date Master
Records: What’s the Difference? – Pharmacy
Formulation Records, which include all necessary
Connection Winter/Spring 2021
information to compound the preparation, for every
specific non-sterile preparation?
KEEP PROGRESSING AND TAKE IT ONE STEP AT A TIME
Break down the required tasks into RESOURCES
smaller chunks and set timelines for
•F
illable Checklist Overview of Phases 1, 2 and 3
completion. What can you plan for this
month, next month and the month after that to move
your pharmacy forward?
WHAT ARE COLLEGE OPERATIONS ADVISORS LOOKING
FOR DURING A PHARMACY ASSESSMENT?
During assessments of pharmacies performing non-sterile compounding, College operations advisors will be
looking for completion of Phase 1 and Phase 2 activities as those deadlines have now passed.
While the College recognizes the impact of the pandemic on the pharmacy environment, it remains vital that
pharmacies and staff remain focused on meeting the requirements linked to these standards. These efforts will
allow for feedback from the College operations advisors during the assessment to outline where the pharmacy
is meeting standards as well as opportunities for improvement. College operations advisors can also help answer
questions about the Phase 3 implementation.
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 21UPDATE ON OPIOID USE
DISORDER TREATMENT
A Changing Landscape
Beth Sproule, RPh, BScPhm, PharmD 1,2
Maria Zhang, RPh, BScPhm, PharmD, MSc 1,2
1
Centre for Addiction and Mental Health, Toronto, Ontario
2
Leslie Dan Faculty of Pharmacy, University of Toronto
Opioid-related mortality continues to
increase significantly in Ontario. In 2020
alone, there were 2,426 opioid-related deaths
in our province, representing a 60% rise from
2019.1 The illicit fentanyl supply is a key
driver of the current opioid crisis as it
directly contributed to 87% of the deaths
in 2020.1 The COVID-19 pandemic has
only worsened this public health crisis,
likely related to changes in the illegal drug
supply due to supply disruptions, less access to
services and harm reduction supports, and greater
use of substances to cope with stress.2
SO HOW CAN Unfortunately, the impact may use disorder. Pharmacotherapy is
PHARMACISTS HELP? be dampened as many deaths the most effective treatment for
occur without anyone else opioid use disorder, and we know
The roots of the crisis lie, in present to intervene.1 Knowing that opioid agonist therapy (OAT)
part, in the rise of prescription this, pharmacists can ensure that saves lives. The mortality risk is
opioid availability over the last their patients who use drugs know significantly reduced for people
two decades and those risks are of local resources such as safe with opioid use disorder while in
still present.3-5 Continuing to consumption/injection sites, and OAT treatment compared to out of
advance and improve our opioid other harm reduction practices OAT treatment—even in the era
stewardship activities is critical in such as using drugs with a trusted of illicit fentanyl.7
helping to prevent our patients family member or friend, in a space
from developing opioid use where they could be found quickly, At the same time, the approach to
disorder and other iatrogenic and/or utilizing supports available, providing OAT services is evolving
opioid-related sequelae. Also, such as the National Overdose as the opioid crisis advances, and
our take-home naloxone kit Response Service hotline (nors.ca) we are experiencing fundamental
distribution efforts are vital in or technology such as Brave App change in Ontario. The most
preventing overdose-related or Lifeguard App. significant shift is the change in the
deaths. Between July 1, 2017 role of the College of Physicians
and June 30, 2018, Ontario For individuals living with opioid and Surgeons of Ontario (CPSO)
pharmacies dispensed 91,456 use disorder, there is an additional in setting the standards of practice
take-home naloxone kits, evidence-based effective method for methadone treatment. The
accounting for 62% of all kits to saving lives where pharmacists CPSO Methadone Maintenance
distributed in the province.6 play a central role—treating opioid Treatment Program Standards
PAGE 22 ~ SUMMER 2021 ~ PHARMACY CONNECTIONUPDATE ON OUD TREATMENT
and Clinical Guidelines from 2011 were rescinded or home inductions)10, the availability of new
in March 2021.8 This decision was taken because long-acting buprenorphine formulations (i.e.,
it was perceived that the exceptional status of extended release injection and subdermal implant)10,
methadone, and the high degree of oversight, modified approaches for methadone treatment for
disincentivized physicians in offering the service, people using fentanyl11, increasing acceptance of
thus limiting access for patients.8 This is similar to slow-release oral morphine (SROM) for opioid use
the rationale for Health Canada’s 2018 decision disorder12, injectable OAT treatment options (i.e.,
to remove the Section 56 exemption requirement hydromorphone, diacetylmorphine)13 and the growing
for methadone prescribers—to improve access to availability of safer supply programs.14,15 The goal
treatment.9 Other recent practice changes include of this article is to help pharmacists navigate these
the adoption of non-traditional techniques for changes by highlighting the current guidance available
initiating buprenorphine (e.g., microdosing and/ and key messages.
KEY RESOURCES FOR PHARMACISTS
Opioid Agonist Therapy: A Synthesis of Canadian Topics covered: How to initiate, titrate, and stabilize
Guidelines for Treating Opioid Use Disorder methadone treatment, balancing the risks of
Release date: May 2021 methadone toxicity with the significant dangers
associated with illicit fentanyl use if OAT is not
Developed by: Centre for Addiction and Mental
available or if treatment needs to be restarted
Health with medical regulatory authorities across
Canada including the College of Physicians and Take note: Recommendations around when and
Surgeons of Ontario how to use the upper end of the dose ranges,
add slow-release oral morphine to prioritize
Place in practice: Detailed national guideline on
engagement and retention in treatment. Likewise,
opioid agonist therapy synthesized from provincial
alternative management of missed doses is
standards and guidelines with updates and additional
suggested to avoid treatment drop-out. A webinar
expert opinion
recording and a plain language summary are also
OAT discussed: Buprenorphine, methadone, slow- available through META:PHI.
release oral morphine, and injectable OAT
Topics covered: Broad ranging (e.g., engaging patients, COVID-19 Opioid Agonist Treatment Guidance
building relationships, expectations of prescribers, how Release date: March 2020; last updated December
to choose treatments, best practice summaries) 2020
Take note: Updated guidance on the value of urine Developed by: Collaborators from CAMH, META:PHI,
drug testing and ECGs, non-traditional buprenorphine Ontario Medical Association (OMA)
induction strategies, when to use SROM
Place in practice: Helps clinicians navigate
buprenorphine and methadone treatment as it relates
Methadone treatment for people who use fentanyl:
to the COVID-19 pandemic restrictions specifically.
Recommendations
OAT discussed: Buprenorphine and methadone
Release date: June 30, 2021
Topics covered: Modified buprenorphine and
Developed by: Mentoring, Education, and Clinical
methadone take-home doses, frequency of visits
Tools for Addiction: Partners in Health Integration
(META:PHI), a provincial initiative based at Women’s Take note: Focuses on increasing the number of
College Hospital take-home doses for patients to reduce the need for
pharmacy visits. The changes during the pandemic
Place in practice: For experienced prescribers who
are being evaluated to help determine whether the
are able to apply clinical judgment when using these
take-home dose strategies should go back to usual
methadone treatment recommendations for people
after the pandemic or not. An accompanying guide for
who use fentanyl as they have uniquely high opioid
pharmacists was developed by CAMH.
tolerance
OAT discussed: Methadone only, specifically for
people who use fentanyl
PHARMACY CONNECTION ~ SUMMER 2021 ~ PAGE 23UPDATE ON OUD TREATMENT
OTHER EMERGING PRACTICES
Injectable forms of OAT (i.e., injectable supply programs in Ontario allowing expansion of
hydromorphone and diacetylmorphine) have a current programs and the development of new
well-developed evidence base over many years programs.14,18,19 These include programs that provide
supporting their use for people who have not scheduled dispensing through machines accessed
responded to oral OAT options.16 iOAT programs using biometrics (MySafe Project).20 Evaluation of
function similarly to other OAT programs, however, these programs is underway to help guide the way
patients visit the clinic multiple times per day to forward. It will be helpful to have more information
inject prescribed pharmaceutical diacetylmorphine on the benefits of these programs (reduced harms
or hydromorphone. The clinics are staffed by trained related to opioid use, improved health and social
healthcare professionals and peer support workers outcomes), as well as how to mitigate potential
who can intervene quickly in cases of overdose. unintended consequences (e.g., health complications
These programs have limited availability in Ontario, from injecting tablets, tablet diversion to new users). A
however, there is ongoing work to develop resources, guidance document is available at Safer Opioid Supply
raise awareness, provide support and identify and Programs (SOS): A Harm Reduction Informed Guiding
address barriers to this evidence-based treatment.17 A Document for Primary Care Teams. More information
significant hindrance is the limited availability of funding is available through the Safer Opioid Supply Ontario
support. Clinical and operational guidance are available Community of Practice.
for clinicians and health administrators through the
Canadian Research Initiative in Substance Misuse. Other resources that may be useful for pharmacists,
particularly those who are looking for a primer into
Safer Supply Programs function as an additional opioid use disorder include the CRISM National
response to the overdose crisis, with the goal to Guideline for the Clinical Management of Opioid
reduce the risk of overdose and overdose deaths by Use Disorder which provides high-level guidance on
providing pharmaceutical opioids as an alternative to selecting between various opioid agonist treatments,
the toxic illicit supply. This harm reduction approach without detailing exactly how to prescribe them.
is intended to support those who continue to meet
criteria for opioid use disorder despite being in OAT Additionally, the Health Quality Ontario Opioid Use
programs and/or individuals who face barriers in Disorder Quality Standard includes a strong statement
accessing OAT. Safer supply programs are generally confirming OAT as first-line treatment, and clear
offered through primary care settings (Community guidance for what people with opioid use disorder
Health Centres or primary care clinics) allowing should expect from Ontario treatment providers.
engagement in other health and social supports. Lastly, for pharmacists working with older adults, the
A common model utilized is to provide a supply Canadian Guidelines on Opioid Use Disorder Among
of SROM (daily observed dosing) in combination Older Adults make recommendations tailored to
with take-home hydromorphone immediate- this population including prevention measures and
release tablets. Health Canada is supporting safer treatment approaches.
SUMMARY
These guidance documents all speak to the CAMH guidance specifically for pharmacists (Opioid
importance to improving access to OAT for people Agonist Maintenance Treatment: A Pharmacist’s Guide
with opioid use disorder, as well as ensuring quality of to Methadone and Buprenorphine for Opioid Use
care to meet their needs. The focus on engaging and Disorder21) is being revised to continue to support
retaining people in treatment is a direct response to practice. Many of the same tenets still apply, but
the current, still worsening opioid crisis. Understanding clinical judgement and decisions tailored to the patient
the patient, their situation and treatment goals is situation are essential. During this time of changing
key to informing clinical decisions. This is facilitated guidance, the significance of effective communication
by effective communication between pharmacists and collaboration cannot be overstated. Patient safety
and prescribers. Good clinical documentation also and their retention in treatment depend on it.
assists pharmacists within practice settings. The
PAGE 24 ~ SUMMER 2021 ~ PHARMACY CONNECTIONYou can also read
