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BCPhA Member Survey results • The fight against fentanyl • Colchicine toxicity
tablet
published by the British Columbia Pharmacy Association | bcpharmacy.ca | Volume 26. No. 2 MAR/APR 2017
The next generation
of pharmacists
A voice for community pharmacy 40810576
bcpharmacy.ca Mar/Apr 2017 THE TABLET 1
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RxOwnership_TheTablet_MarApr_2017_Final.indd 1 2017-01-31 12:42 PM
THE TABLET MAR/APR 2017 | VOLUME 26. NO. 2
Editor in Chief
contents
Angie Gaddy
604.269.2863, angie.gaddy@bcpharmacy.ca
Senior Editor
Elise Steeves
604.269.2866, elise.steeves@bcpharmacy.ca
The Tablet is published by the BCPhA. Views expressed herein
do not necessarily reflect those of the Association. Contributed
material is not guaranteed space and may be edited for brevity,
clarity and content.
BCPhA offices:
#1530-1200 West 73rd Avenue 8 Patient representatives
Vancouver, BC V6P 6G5
telephone: 604.261.2092
or toll-free in BC: 1.800.663.2840
fax: 604.261.2097
toll-free fax: 1.877.672.2211
e-mail: info@bcpharmacy.ca
web: bcpharmacy.ca
Publication agreement #40810576
On the cover: Pharmacist Liisa Stover (left) helps mentor
pharmacy student Tim Liang on his fourth-year rotations at a 16 Pharmacy students 20 Fentanyl crisis
Burnaby Shoppers Drug Mart.
Features Columns Regulars
8 Patient representatives 5 President’s message 4 Small talk
New prescriptions or new patients Member feedback and engagement In the news
drive our organization
14 BCPhA Member Survey 12DPIC
Key results from the 2016 survey 6 CEO’s message Colchicine toxicity: What
Success has a thousand mothers and pharmacists need to know
16 On the cover:
failure is an orphan
The next generation 22 Member profile: Samira Guennoun
7 Pharmacy practice support Translating the patient experience
of pharmacists The quest for the ideal pharmacy job
A day in the life of a fourth-year 24 Career listings
pharmacy student Find a job in pharmacy
20 The fight against fentanyl
Pharmacists on the front lines
A voice for community pharmacy
Got a suggestion for an article in The Tablet?
Email info@bcpharmacy.ca with your story ideas.
bcpharmacy.ca Mar/Apr 2017 THE TABLET 3
SMALL TALK
In the news
London Drugs partners with The BCPhA also recently announced
I Boost Immunity to donate the promotion of Vince Lee as the new
life-saving vaccines director of member services. Lee has been
with the Association since 2012, and has
Patients who received their 2016/17 flu
diverse experience in membership and
vaccine at London Drugs helped play
loyalty programs, strategic marketing,
a role in vaccinating the world’s most
data analysis and eTraining. He previously
vulnerable children from tetanus, polio
held roles with Doctors of BC, WorkSafeBC
and measles.
and GeekRave Productions Inc.
Through a new partnership with I Boost
Immunity, a Canadian-based online Position statement on
immunization advocacy network, for every medical marijuana
flu shot administered at London Drugs, The BCPhA Board of Directors recently
a life-saving vaccine will be donated to approved a new position statement on
UNICEF Canada to immunize children in a Ann Johnston Vince Lee medical marijuana. Highlights from the
developing country. statement include:
According to UNICEF, 19.4 million children Pharmacist Ann Johnston joins
“The BCPhA believes the best way to
missed out on basic vaccines needed to BCPhA; Vince Lee new director,
ensure patient safety and education
stay healthy last year. Almost one-third member services
on medical marijuana is by ensuring
of deaths among children under five are Following Bryce Wong’s secondment availability through pharmacies.
preventable by vaccines. to a new project for the BCPhA, the Pharmacists support promoting non-
“Partnering with London Drugs is one Association is pleased to welcome smokeable forms of medical marijuana.
of the many ways we hope to increase pharmacist Ann Johnston as the new Pharmacists currently manage the supply
awareness about the importance of manager of pharmacy practice support. of medications for patients through
getting vaccinated and to improve Johnston holds a master's degree their established supply chains, which
immunization rates both here in Canada in pharmacy from the University of ensure the safe and secure distribution of
and across the globe,” says Michael Portsmouth. She has community prescription drugs in Canada. This should
Barnes, executive director of the Public pharmacy experience in both the U.K. and be expanded to include medical marijuana.
Health Association of BC. Canada, in addition to working in industry “The Association strongly urges the
I Boost Immunity aims to promote practice for five years. You can reach government to support more research
immunization as the best protection her at ann.johnston@bcpharmacy.ca or in the form of appropriately structured
against vaccine-preventable diseases 604.269.2865. clinical trials to determine the safety and
and is managed by the Public Health Don’t forget: BCPhA members can always effectiveness of cannabis as a drug for
Association of BC and partnered with call or email the pharmacy practice various medical conditions.
ImmunizeBC – a collaboration of the support team, whether you need support “Furthermore, the BCPhA advocates for
BC Centre for Disease Control, BC interpreting a new PharmaCare policy or a clear distinction between marijuana
Pharmacy Association (BCPhA) and a College of Pharmacists of BC regulation, for medical use and marijuana for
regional health authorities. or have questions about clinical services. recreational use.”
Read the full position statement at
bcpharmacy.ca/board-position-pha.
4 THE TABLET Mar/Apr 2017 bcpharmacy.ca
RANDY KONRAD | PRESIDENT
Member feedback
and engagement drive
our organization
The BC Pharmacy Association (BCPhA) wouldn’t exist without also taken on the detailed work of reviewing changes to the Health
our members. This simple fact is fundamental to every Professions Act and Pharmacy Operations and Drug Scheduling
strategic decision we make. And that’s why every two years, we Act bylaws and submitting feedback to address member concerns.
commission Canada’s leading research firm, Ipsos, to lead our Sometimes these wins seem small, but they give members a crucial
detailed member survey that helps us better understand your top voice with government and the College.
priorities and level of satisfaction with the Association.
The survey also asked how personally involved you want to be
The results are now in – and highlighted on page 14 of this issue with your professional association. Only 24 per cent of you said
– and I’m pleased to see that most members (83 per cent) hold you feel involved, but more than half want to get more active in
favourable impressions of the BCPhA. The top reasons include our the future. That’s great news.
performance in advocating and representing the profession and
One way you can make sure you’re involved is by voting in our
providing timely and effective communications.
upcoming Board elections. There are two positions open on the
However, favourable impressions have declined slightly since 2014 Board for a three-year term from Sept. 1, 2017 to Aug. 31, 2020.
(86 per cent) and 2012 (88 per cent). Though it is only a small All members have now been mailed a letter and ballot papers, and
number of members who hold an unfavourable impression (12 per you can also see a biography of each nominee at bcpharmacy.ca/
cent), some concerns include the organization’s lack of influence board-elections.
with government, putting corporate members first or lack of
Each year, the Board hosts one of our directors’ meetings at
support for members. As we move forward, we must take a hard
the University of British Columbia’s faculty of pharmaceutical
look at how we tackle these issues and impressions.
sciences, and we did so this past January. The faculty continues
Among your top priorities are securing fair reimbursement for to do the critical work of preparing students to become the future
new pharmacy services, expanding the scope of pharmacists, face of pharmacy in B.C.
having a voice in government health-care policy, advocating on
When we’re on campus, we’re always thinking about the ways we
issues of concern with the College of Pharmacists of BC and
can interact with students. This year, we decided to do something
expanding skills training. That means we’re on the right track as
different and hosted a lunch ‘n learn event on the opportunities
we continue to respond to these important areas.
that exist in rural pharmacy. Two of our members, Colleen Hogg
For example, we worked hard this past year to successfully receive from Quadra Island and Michael Ortynsky from Fort St. John,
fair reimbursement for pharmacists for medical assistance in dying made the trek to Vancouver to share their experiences, for which
(MAID) fees. We’re launching two new programs with Green Shield I’m very grateful.
Canada that will reimburse pharmacists for diabetes and asthma
You can read more about the rewards of rural practice – and what
health coaching. And, we’ve submitted a proposal to government
pharmacy students in general are thinking about rotations, school
and continue to push for pharmacist prescribing for minor ailments
and the future – in this issue’s feature story on page 16.
in rural areas. Over the past number of years, the Association has
bcpharmacy.ca Mar/Apr 2017 THE TABLET 5
GERALDINE VANCE | CEO
Success has a
thousand mothers and
failure is an orphan
I think people all too often stop short of taking a chance or The BCPhA announced its commercial business venture on
pursuing a good idea because they are worried about what Feb. 9, 2017, and is now working with our partner to launch the
will happen if things go wrong. The path of least resistance service in pharmacies. We believe providing this service will
is to do what is safe, what has been done before that no one demonstrate the expertise that every pharmacist has, which is
will challenge. often overlooked by their patients. In the day-to-day hustle of
dispensing medications, many Canadians don’t get to experience
I would argue that community pharmacy doesn’t have the luxury
the partnership they can form with their pharmacist. Helping
of playing it safe anymore. The changes to the economic model
patients interpret the impact of their individual DNA on how
in pharmacy over the last five years have been profound – and
medications work for them is a tangible demonstration that
they are not over yet. There is only so much to be made up
pharmacists are indeed medication experts.
by operational efficiencies and better deployment of existing
resources. At some point, it is time to be “disruptive,” to take a From my perspective, PGx testing on a broad scale basis is
chance and not wait to be granted permission. a game changer: it will change the relationship pharmacists
have with their patients and physicians, it will improve the
To me, the joint venture agreement signed between the BC
health of Canadians and it has the potential to help manage
Pharmacy Association (BCPhA) and myDNA Life Australia,
drug budgets for all payers. Pharmacists have long looked for
to offer pharmacogenomics (PGx) testing in any community
ways in which to contribute to improving health-care delivery,
pharmacy in Canada that wants to take this on, is an example of
to make a difference in their patients’ lives and to be relevant
the type of new opportunity that will help chart the future for
to policy-makers and payers. Is PGx testing the only way to
pharmacists and pharmacies.
do that? Certainly not. But does it have the potential to be
transformational? I believe it does.
Since our announcement, we have had a lot of inquiries and, not
surprisingly, no shortage of naysayers - those anxious to ask
unanswerable questions and throw rocks from the sidelines. It is
true there are things to work out as the service rolls out across
the country. And it is a fair bet we will make some mistakes along
On Feb. 9, 2017, the BCPhA announced that it had entered the way. But I would argue that sitting still and taking no chances
into a joint venture agreement with myDNA Life Australia is a far greater mistake.
to offer pharmacogenomics testing in community
I believe pharmacists and their patients will embrace access
pharmacies across Canada.
to this new information. And that policy-makers and payers will
myDNA has been at the forefront of research into see the benefits of the new service. I truly applaud the BCPhA
pharmacogenomics in Australia, offering PGx testing at Board of Directors for its vision and willingness to take bold
more than 300 pharmacies there. steps. We will be only too happy to share the success with as
This experience reinforces the view held by the BCPhA many as want to come aboard to chart a new opportunity for
that community pharmacists are best positioned to help the profession of pharmacy.
patients and their doctors understand the implications
their genetics have on the medications they take.
6 THE TABLET Mar/Apr 2017 bcpharmacy.ca
DEREK DESROSIERS | DIRECTOR, PHARMACY PRACTICE SUPPORT
The quest for the
ideal pharmacy job
I was recently involved in a meeting with the BC Pharmacy pharmacy. Providing clinical services including medication reviews
Association (BCPhA) Student Ambassadors where we discussed a and health coaching (e.g., cardiovascular, diabetes, asthma and
wide variety of issues including job hunting and the ideal pharmacy smoking cessation) will generate increased revenue that could, in
position. Of course, everyone has a different perspective on what turn, lead to the opportunity to hire more staff, allowing for more
that ideal position looks like, but there are some consistencies patient contact time and services.
in the responses we get from students. Furthermore, those
Now, for the flip side of the coin. In addition to the above, it is also
consistencies often align with what we hear from staff pharmacists
not uncommon for the BCPhA to hear concerns from pharmacy
who are not in ownership or management positions.
owners and managers who say they can’t get their staff to provide
It seems that many pharmacists and pharmacy students see the clinical services that generate additional revenue for the pharmacy.
ideal pharmacy job as fully clinical, in which they could spend The savvy owners recognize clinical services provide a dual
unlimited one-on-one time with individual patients resolving drug- positive effect on revenue – first, from the actual fee for the service
related problems. They wouldn’t have to dispense drugs and might provided and second, from the increased customer loyalty that
not even work in a community pharmacy but rather in a physician’s such services can create. However, what these owners are missing
office, multidisciplinary clinic or hospital. Maybe they would only is the fact that there is no incentive for their staff pharmacists to
see eight to 10 patients a day and spend 45 minutes to an hour provide such services.
with each one of them.
I have often suggested that a financial incentive for the staff
The challenge with this point of view is that some community pharmacist could be a game changer and a win-win. Sharing
pharmacists don’t want to perform any of the clinical services new revenue doesn’t cost the owner anything. By sharing the
available to them within their current scope of practice. It’s not revenue generated from added services, owners can reward
uncommon to hear a staff pharmacist say they don’t have the staff pharmacists for their extra work while still generating new
time or financial incentive to provide services like medication revenue for the pharmacy. This new revenue can, in turn, be
reviews, health coaching and injections, when profits from these used to expand service offerings through increasing staff levels
services will only benefit pharmacy owners. Other pharmacists cite or lengthening hours of operation. Furthermore, having staff
inadequate staffing levels as a barrier to providing clinical services. pharmacists who are truly engaged in the business may even
translate into better patient interactions and patient outcomes.
What these pharmacists don’t recognize, however, is that the
progroup_ad_v3.ai 13/11/2008 4:23:24 PM Again, a win for everyone.
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The bottom line is that as a profession we must
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bcpharmacy.ca Mar/Apr 2017 THE TABLET 7
PATIENT REPRESENTATIVES
Patient
representatives:
Dealing with a new
prescription
or new patient
Part 2 of 2
By Sara A. Levine, Q.C.
In community pharmacy, there are many different scenarios you may encounter when faced with
a person acting on behalf of a patient. In September 2016, changes to the Health Professions Act
(HPA) bylaws were made to define a patient’s representative as “a person who is authorized to act
on a patient’s behalf” for pharmacy services. We’ve had a lot of questions from members about how
to deal with patient representatives, so we developed a guidance note on the subject, available at
bcpharmacy.ca/patient-representative.
Remember the fundamentals Remember that your duty is always to the
patient. So whenever reasonably possible, Remember, no single factor can
Pharmacists are required to confirm the
confirm directly with the patient who they determine whether the individual
identity of the patient and the patient’s
authorize to act on their behalf, as well is authorized. Circumstances
representative before providing any
as the scope and any time limits on the change. Having authority in the
pharmacy service. When dealing with a
representative’s authority. past doesn’t automatically mean
patient’s representative, remember the
definition – you must confirm not only the person has authority in the
who they are, but also whether they are There are three steps every current circumstances or for every
“authorized to act on the patient’s pharmacist should take when professional service. You must
behalf." Check your patient’s record the person presenting at your exercise professional judgment,
to review information provided on pharmacy is not the patient: taking into account all of the
authorization status. If that isn’t sufficient relevant circumstances.
to confirm authority, you must assess the 1. Confirm their identity. Remember that a pharmacist/patient
circumstances, consider the relevant facts 2. Determine whether this person consultation must respect the
and exercise your professional judgment. is authorized to act on behalf patient’s right to privacy and there
Each situation will be different, but for of the patient. is a general duty to limit information
more about what facts could be relevant, sharing to only what is necessary.
3. Confirm the extent of
see Part 1. If in doubt, call the patient.
their authority.
8 THE TABLET Mar/Apr 2017 bcpharmacy.ca
Factors to consider: Because this is a and treatment on behalf of the patient,
Situation 1 new medication, the first consideration is and therefore is a “patient representative”
A person identifies themselves the patient’s consent to treatment. You under the HPA bylaw. However, when
as the adult daughter of an must make a reasonable effort to get the following the TSDM process, you must also
patient’s consent to treatment before comply with the HPA bylaw and confirm
elderly patient.
you consider whether the daughter has the daughter’s identity.
You have never met this person before. authority to act on the patient’s behalf.
Overall, even if your patient lacks the
She tells you that her mom has just been For more information on how to do this,
capacity to consent to treatment, she
released from the hospital and presents read the article on informed consent from
may still have the capacity to identify
a new prescription with medications the the Dec/Jan 2014 issue of The Tablet
and authorize a representative. Where
patient has not taken before. She has her (bcpharmacy.ca/informedconsent).
possible, give her this opportunity
mom’s personal health number (PHN) but
If while you are trying to get the patient’s before following the process to appoint
doesn’t have her BC Services Card. She
consent to the new treatment, you form a TSDM. Factors to consider include
also doesn’t have any legal document that
the opinion that she is not capable of any specific knowledge of the patient
shows she has authority to act on her
giving consent to treatment on her own you may have; knowledge of the person
mother’s behalf, such as a Representation
behalf, you may consider taking steps to asserting authority; the nature of the
Agreement or court order. The last time
appoint a Temporary Substitute Decision service requested; and the content of the
you saw the patient she was capable
Maker (TSDM). A TSDM has the legal PharmaNet and patient records.
of giving consent to health care and
authority to give consent to health care
treatment on her own behalf.
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bcpharmacy.ca Mar/Apr 2017 THE TABLET 9
PATIENT REPRESENTATIVES
Services you can reasonably provide: While getting the patient’s consent to capability, but it will not be determinative.
The scope of the daughter’s authority will treatment, you may confirm the scope You still have to undertake the same
depend on what the patient said to you of the daughter’s authority. Remember, steps: Confirm the patient’s consent to
when you contacted her to seek consent. If you are also required to confirm the treatment, confirm the identity of the
you appointed the daughter as the TSDM daughter’s identity. If in the course of person and the source of their authority
you may obtain consent to treatment seeking the patient’s consent to treatment (a court order, Representation Agreement,
from her on her mother’s behalf, and you conclude that he is not capable of other documentation or, if the patient is
dispense the prescription and deliver the giving consent to treatment, you may not capable, whether the person is the
consultation to her. Remember that the appoint a TSDM, as discussed in Situation patient’s TSDM) and determine the scope
authority of a TSDM lasts only during the 1. Be sure to document every action you of their authority.
period that the patient is incapable. take and the factors you considered,
Assisted living facilities require the
whether you provide services or not.
residents to be able to make independent
Services you can reasonably provide: decisions. Therefore, you should serve
Situation 2 The scope of the daughter’s authority will patients who live in an assisted living
depend on what the prescriber has told facility in the same way you would if they
A person identifies themselves as you, what the patient has said to you and were living at home in the community.
the adult daughter of an elderly any other relevant facts. Never assume a staff person at an
assisted living facility has authority to act
man who has never previously
on the patient’s behalf as this is unlikely
been your patient. to be the case.
She advises you that her dad has just
Issues in assisted living and
residential care For patients in residential care, you
been released from the hospital, and
must ensure you have obtained consent
presents a prescription. The daughter can Assisted living facilities and residential
to treatment from the patient or their
provide the patient’s PHN but not their BC care facilities and homes are unique to
authorized representative before
Services Card. You haven’t met either of one another; they provide very different
dispensing a prescription. In the course
them before. services and are subject to different legal
of getting consent, it is recommended
requirements. HPA Bylaw Schedule F Part
Factors to consider: This situation creates that you identify your patient’s
1 Community Pharmacy applies to patients
unique patient safety and professional authorized representative and the scope
living in assisted living facilities, while HPA
risks. Exercise caution. Obviously, you of their authority.
Bylaw Schedule F Part 3 Residential Care
haven’t obtained your patient’s consent
Facilities and Homes applies to patients in
to health care and treatment. Therefore,
residential care. This article is an excerpt from the Patient
prior to taking steps to determine if
the daughter can qualify as the patient But don’t be misled into thinking that Representative Guidance Note created for
representative, you must first take patients living in these places have BCPhA members. The complete note and
reasonable steps to seek consent to health different rights than those who live at references are available at
care and treatment from the patient or home. The pharmacist’s fundamental bcpharmacy.ca/patient-representative.
his substitute decision-maker. Follow the duties to know the patient, the patient’s Sara A. Levine, Q.C. is a trusted advisor
procedures on informed consent. representative and the extent of the and strategic counsel to health sector
representative’s authority, aren’t changed entities, professional associations and
Be certain about the identity of the
by where the patient lives. It is crucial regulatory bodies. Her clients rely on
patient, the person presenting the
to remember that you always have a her for legal advice on governance,
prescription, the legitimacy of the
duty to get consent to health care and risk management, health law and
prescription, and any prior drug therapy
treatment, either from the patient or, if policy, freedom of information and
problems or risks. Take care when
they aren’t capable of consenting, from privacy matters.
reviewing the PharmaNet record and
their authorized representative.
note anything unusual. Consider phoning
the prescriber, and phoning or visiting Accordingly, the patient’s address may
the patient. be a factor to consider if it is relevant to
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bcpharmacy.ca Mar/Apr 2017 THE TABLET 11DRUG AND POISON INFORMATION CENTRE
Colchicine toxicity:
What pharmacists
need to know
By Dorothy Li, B.Sc. (Pharm.), R.Ph., CSPI, Drug and Poison
Information Pharmacist, BC Drug and Poison Information Centre
Reviewed by Christopher DeWitt, MD, FACMT
Colchicine is approved in Canada for gout (acute and prophylaxis) Pharmacokinetics and drug interactions
and familial Mediterranean fever (FMF). The prevalence of gout
Colchicine is metabolized by CYP3A4 and transported out of cells
in British Columbia is 3.8 per cent, with nine per cent of patients
by P-glycoprotein (P-gp). Variable expression of CYP3A4 and P-gp
prescribed colchicine. Colchicine has a narrow therapeutic index
leads to variation in efficacy and susceptibility to toxicity. Patients
and life-threatening toxicity can occur with overdose, pediatric
with gout may have comorbid conditions requiring medications
exposures, therapeutic errors, drug interactions or decreased
that interact with colchicine. Concomitant use of strong CYP3A4
renal/hepatic function. The B.C. Drug and Poison Information
and/or P-gp inhibitors (e.g., clarithromycin, cyclosporine,
Centre (DPIC) received 51 calls concerning colchicine from 2012
diltiazem, protease inhibitors, grapefruit juice and many others)
to 2016. Two serious cases resulted from drug interaction with
elevate colchicine concentrations, which may lead to toxicity
clarithromycin. There is no antidote or consistently effective
and death. Combining strong CYP3A4 and/or P-gp inhibitors
therapy for colchicine toxicity so prevention is the key to avoiding
with colchicine is contraindicated for patients with reduced renal
colchicine toxicity and death. This article aims to increase
function; however, for those with good renal function toxicity can
pharmacists’ knowledge of colchicine dosing, drug interactions,
be prevented with colchicine dosage adjustments.
toxicity and potential therapeutic errors.
Toxicity
Dosing
Colchicine inhibits microtubule formation and thus cellular
Dosing for acute gout has been inadequately studied. Prior to
function and division. Neutrophil chemotaxis requires microtubule
2009, colchicine was dosed three or four times daily or every
formation and is the target for colchicine therapy in gout.
two hours until pain was relieved, toxic symptoms appeared
or maximum dose was reached. Subsequently, a randomized Acute colchicine toxicity is described in three phases, usually
controlled trial found low-dose colchicine (1.2 mg po stat then beginning with GI symptoms in the first 24 hours: abdominal pain,
0.6 mg in one hour) as effective as high-dose colchicine and diarrhea, nausea and vomiting. Dehydration and leukocytosis may
with fewer gastrointestinal (GI) side effects. Low-dose is now also occur. The second phase includes bone marrow suppression,
recommended by Canadian manufacturers; however, the study myoneuropathies and multi-organ failure in the next 24 to 72
has been criticised for its short duration of 32 hours. Based hours. With limited treatment options, death may result from
on expert opinion, the American College of Rheumatology cardiac, respiratory or renal failure or life-threatening infection.
recommends the following regimen for patients with good renal For survivors, alopecia and leukocytosis occur in the third phase.
function: a loading dose of 1.2 mg po stat, then 0.6 mg in one Toxicity does not always occur in phases. GI symptoms can occur
hour followed by 0.6 mg once or twice daily (starting 12 hours at any time. Some patients develop neuromyopathy (mild to
later) until attack resolves. Dosing for gout prophylaxis and severe myalgia, muscle weakness, numbness and fatigue) with
FMF is less complicated; however, for all indications dosing chronic dosing, mostly without GI symptoms. Risk factors for
should be adjusted for decreased renal/hepatic function, neuromyopathy include impaired renal function, advanced age,
age and drug interactions. use of myotoxic drugs and pharmacokinetic drug interactions.
Bone marrow suppression or failure may also occur.
12 THE TABLET Mar/Apr 2017 bcpharmacy.caColchicine toxicity can be serious. Here’s what a pharmacist can do:
1. Use current dosing recommendations and ensure doses
are appropriate considering concurrent medications, renal/
4. Advise patients who take multiple medications to be
careful when taking their medications and to keep all medications
hepatic function and age. for family members in separate locations.
• 24 per cent of therapeutic errors reported to DPIC* involved • Medication mix-up was responsible for 24 per cent of
incorrect or obsolete dosing regimens or did not specify therapeutic errors reported to DPIC. Three patients took
maximum daily dose. All patients developed GI symptoms. One six tablets of colchicine instead of six tablets of prednisone;
developed life-threatening symptoms requiring hospitalization. one had severe diarrhea. Three patients took their spouses’
• Two cases of severe toxicity from interaction with medication by mistake.
clarithromycin and one case with tacrolimus were reported to
DPIC. Concomitant use of clarithromycin and colchicine has
resulted in death. 5. Instruct patients to keep colchicine out of reach of
children. Colchicine should not be readily available to those at risk
2. Ensure patients understand how to take colchicine
and what their maximum daily dose is. Specific directions for
of suicide. Refer all overdoses to the Poison Control Centre or
the closest emergency department.
• Two cases of accidental pediatric exposure were reported
use should be on the prescription label (not ‘use as directed’). to DPIC. One required hospital monitoring, but neither had
Ensure patients understand that colchicine is not a painkiller, symptoms. Fatal pediatric exposures have been reported in
i.e., maximum therapeutic effect in acute gout may take 24 to 36 the literature.
hours or longer. • Children can successfully open child-resistant packaging. Keep
• In 29 per cent of therapeutic errors reported to DPIC, patients all medications locked up.
took their doses incorrectly: more than recommended (3.6- • Colchicine overdose has a high fatality rate. Twenty per cent of
10.3 mg for acute gout on the first day) or additional doses attempted suicides with colchicine reported to DPIC resulted
because it wasn’t working fast enough. All developed GI in death, whereas the rate of death for all attempted suicides
symptoms; one required hospitalization. Deaths have been for any substance reported to DPIC was 0.4 per cent.
reported in the literature.
*Statistics based on five-year retrospective review of DPIC calls.
3. Instruct patients to stop colchicine and call their
prescriber or pharmacist if they develop GI side effects or
References available upon request at communications@
bcpharmacy.ca. Comments or DPIC article suggestions can be sent
to info@dpic.ca.
symptoms of myoneuropathy (muscle pain, fatigue, weakness,
numbness).
• Some patients continue taking colchicine despite side effects,
which can result in worsening of toxicity.
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bcpharmacy.ca Mar/Apr 2017 THE TABLET 13MEMBER SURVEY
BCPhA Member Survey
In November 2016, the BC Pharmacy Association commissioned More than 700 members completed the online survey. The
Canada’s leading research firm, Ipsos, to conduct a survey to following represents some of the key highlights, with full results
gauge member satisfaction, priorities and attitudes about the available online at bcpharmacy.ca/member-surveys.
Association’s overall reputation and performance.
What is the number one challenge you are currently
facing in your professional life as a pharmacist? What is your overall impression of BCPhA?
Answer Percent
Having enough time to complete/perform duties 13% Favourable 83%* Unfavourable 12%*
Low staffing levels 5%
Overworked/stressed 5%
Government/third-party intervention/regulations 4% 52%
Keeping up with current knowledge 3%
Finding time to focus on patient-care 3% 32%
Work overload 3%
10% 4%
Third-party billing plan 3% 3%
Job security/stability 3%
Administrative/paperwork burden 3%
None 6% Very Somewhat Somewhat Very Don’t know/
Don’t know/No opinion 14% favourable favourable unfavourable unfavourable No opinion
* Numbers do not add up due to rounding.
What is the main reason you have a favourable
impression of the BCPhA?
On which three of the following areas would you
Answer Percent
Good job advocating/representing the profession 19%
like BCPhA to place the greatest priority over the
Timely/effective communications 16% next few years?
They care about/look after the profession 5%
Good/valuable services for members 4% Answer Percent
Address issues faced by pharmacists 3% Securing fair reimbursement for new
Answer questions quickly 3% 40%
pharmacy services
Educational support 3%
Helpful 3% Expanding the scope of pharmacists 39%
Professional 2% Having a voice in government health-care policy 37%
Good staff 2% Advocating on issues of concern with the
Good membership benefits 2% 37%
College of Pharmacists of BC (e.g., Bylaws)
Good support for the members 2%
Don't know/No opinion 19% Expanding skills training (e.g., injections, health
34%
coaching, travel medicine, regulatory compliance)
Note: Question asked only of the 83% of members with a favourable Promoting the profession of pharmacy 20%
impression of BCPhA. Identifying and advancing additional revenue
15%
streams, including pharmacogenomics, for pharmacy
Providing regulatory compliance support for
14%
Which of the following best describes your current and private and public payer audits
desired future level of personal involvement with BCPhA? Working on private payer issues 13%
Helping pharmacists and employers with
12%
I feel personally involved with employment issues
BCPhA today BUT don't want to be 12% Feel Expanding member-focused programs like
even more involved in the future Involved 9%
Affinity Rx and other benefits
I feel personally involved with Today
Assisting with recruitment/job search 8%
BCPhA today AND would like to be 12% 24% Want to
even more involved in the future Expanding technical and other training
be More 7%
for members
I don't feel personally involved Involved
with BCPhA today BUT would like 39% 51% Working with UBC's Faculty of Pharmaceutical
to be more involved in the future Sciences to develop the next generation 5%
of pharmacists
I don't feel personally involved
with BCPhA today AND don't want 23%
to be more involved in the future
Don't know 13%
14 THE TABLET Mar/Apr 2017 bcpharmacy.caDo you think the BCPhA is doing a good job or a poor job at each of the following?
Poor Job Good Job
5% Keeping me informed about BCPhA activities 92%
6% Keeping me informed about issues affecting the practice of pharmacy 90%
12% Providing useful member benefits 83%
14% Providing services that support my practice as a pharmacist 81%
13% Providing high quality member service 80%
19% Understanding the issues that matter to B.C. pharmacists 76%
18% Reflecting the general views of the profession 75%
21% Raising the concerns of B.C. pharmacists with government and 70%
other stakeholders
17% Consulting with members 69%
5% Answering my questions quickly 68%
16% Making timely decisions and taking action 67%
23% Balancing the needs and interests of Pharmacist (General) members 61%
and Pharmacy (Corporate) members
Somewhat Very Very Somewhat
How valuable are each of the following aspects of your BCPhA membership to you?
Not Valuable Valuable
5% Professional support on scope of practice 92%
6% Keeping you informed on industry/professional developments 92%
4% Personal Professional Liability Insurance 91%
7% eTraining programs 87%
10% Advocacy on behalf of profession 87%
20% Recruitment mailings and the Job Board on website and in The Tablet 73%
22% Canadian Pharmacists Journal (CPJ) 73%
16% Economic support on pharmacy practice 71%
27% Affinity Rx member discounts 68%
23% Job hunting (Post Your Resume) 62%
24% Pharmassist Counselling Program 50%
26% Store Plan/Commercial General Liability Insurance 48%
36% Annual conference 48%
29% Extended Health Individual or Group Insurance Program 45%
41% Wealth Management and Financial Literacy Advisory programs 33%
42% Homeowners and Tenants Insurance 28%
Not very Not at all Very Somewhat
See the full survey results at bcpharmacy.ca/member-surveys.
bcpharmacy.ca Mar/Apr 2017 THE TABLET 15ON THE COVER | THE NEXT GENERATION OF PHARMACISTS
A day in the life:
B.C.’s future
pharmacists
By Elise Steeves
When Tim Liang’s father suggested he become a pharmacist because
it was a well-respected profession, he took his advice to heart. Now a
fourth-year pharmacy student on rotation at a Shoppers Drug Mart in
Burnaby, Liang says he’s already confident he made the right decision.
“It’s really about the people you interact with every day as a pharmacy visits in first year and one-month rotations in the
pharmacist,” says Liang. “I’ve been able to do adaptations, summers following second and third year.
medication reviews and injections on rotation. And I’m
“Our fourth-year rotations are really about doing everything
learning problem-solving skills that will be essential to my
a pharmacist does,” says Liang. “We’ve learned drugs,
practice in the future.”
therapeutic skills and acute and chronic conditions. Now we
Liang is one of about 220 fourth-year students from can put together that knowledge with our people skills.”
the University of British Columbia’s (UBC) faculty of
A typical day on rotation starts with triaging urgent
pharmaceutical sciences who will complete a two-month
patient needs, such as those waiting for antibiotics or pain
rotation in a community pharmacy this year, as well as a
medications. But it’s also about learning all aspects of
one-month rotation in an institutional setting such as a
the pharmacy, says Liang, including putting away drugs,
hospital. In the current Bachelor of Science in Pharmacy
counting pills or even taking out the garbage.
(B.Sc. (Pharm.)) program, students also complete one-day
Continued on page 18
16 THE TABLET Mar/Apr 2017 bcpharmacy.caPharmacist Liisa Stover (left) and fourth year pharmacy student Tim Liang outside of a Burnaby Shoppers Drug Mart.
bcpharmacy.ca Mar/Apr 2017 THE TABLET 17“Being part of the team is very important
because the other pharmacists, technicians
and assistants learn to rely on and trust you.”
UBC students now also complete injections
training during fourth year, so Liang has
administered dozens of vaccines under the
supervision of his preceptor Liisa Stover.
“Tim wanted to practice clinical services,
so we’ve been focusing on that,” says
pharmacist Stover. “For fourth years, this is
really their rotation.”
After working as a pharmacy assistant since
2000, Stover recently went back to school
herself and graduated from UBC in 2015.
And since meeting UBC’s recommended
preceptor prerequisite of six months’
Pharmacist-owners Colleen Hogg (left) and Michael Ortynsky spoke to UBC pharmacy students about the
opportunities in rural pharmacy practice.
experience in direct patient care activities,
she has already taken five students under
her wing.
Consider a rotation - or career - in rural B.C. “I’ve found it’s best to be very flexible and
really tailor the curriculum to the learner,”
With around 220 students graduating from UBC’s faculty of pharmaceutical
Stover says. “Let the students direct you.
sciences every year, not everyone can find a job in B.C.’s Lower Mainland. However,
Ask questions of them: their strengths,
rural locations across the province have numerous opportunities and benefits for
weaknesses and what they’ve learned in
new grads.
the past.”
“I’ve found that working in a small community pharmacy, I have better access to direct
Jennifer May, associate-owner at the
patient care, I get to know my patients over longer periods of time and I can work
Shoppers where Liang is training, agrees it’s
in a very collegial manner with many other health-care professionals,” says Michael
valuable to have students in the pharmacy.
Ortynsky, pharmacist-owner of Fort St. John Pharmacy and Wellness Centre, who
“Each student brings something unique to
recently spoke at a BCPhA-sponsored event on campus about rural pharmacy.
the rotation, whether it’s their particular
His company also runs pharmacies in Tumbler Ridge, Keremeos and Kelowna. areas of interest, their background or their
Ortynsky says one of his bigger challenges has been attracting other pharmacists to previous experiences. I love exchanging ideas
come work with him. and sharing opinions with them.”
Colleen Hogg agrees. As the pharmacist-owner of Peoples Drug Mart on Quadra Kevin Sin is also a fourth-year student and
Island, in addition to a telepharmacy in Gold River on Vancouver Island, she says this one of BCPhA’s Student Ambassadors. He
year is the first time in 17 years she’ll have students on rotation at her pharmacy. She says the best knowledge a preceptor can
encourages more students to do so. bestow is more practical information.
“It’s a great time to get out there and see all the different areas of practice,” she says. “Students have an idea about the current
“Rural communities have a lot to offer for students. You really get to use the skills you landscape of pharmacy, but we live in a bit
acquire at school and your full scope of practice.” of a bubble,” he says. “It’s great to learn
Hogg says her pharmacies do a lot of medication reviews, injections and adaptations about things we don’t see in school, such as
that are not just renewals. insurance and billing.”
“If you find a place you like, there is always opportunity to expand your practice in The UBC curriculum also aims to increase
rural communities. People there are more willing to accept the practices, too, because these practical skills by incorporating more
they often don’t have access to those services otherwise,” Hogg says. hands-on learning opportunities through its
new Entry-to-Practice Doctor of Pharmacy
And rural B.C. still needs more pharmacists, Ortynsky adds.
(E2P PharmD) program, which had its first
“Don’t even think twice about the city,” he says. “Come to the rural part of the student intake in September 2015 and
province – there’s many areas that will welcome you with open arms.” will replace the current bachelor’s degree
18 THE TABLET Mar/Apr 2017 bcpharmacy.caON THE COVER | THE NEXT GENERATION OF PHARMACISTS
Dr. Sandra Jarvis-Selinger is the associate dean, academic, at the faculty of Kevin Sin is a fourth-year pharmacy student and one of the BCPhA
pharmaceutical sciences. Student Ambassadors.
program by 2018. The new curriculum has right from their first year,” Jarvis-Selinger of graduate. “I feel that it’s only a function of
almost double the amount of experiential says. UBC is also working to support what year you started pharmacy school and
learning – 42 weeks instead of 24 – and these preceptors as they reflect on what stage of does not determine your skill or suitability
students begin four-week rotations in the impact they want to be a part of. for the job.”
summer after first year.
Sin admits that the new PharmD program While a graduate’s designation may not affect
Dr. Sandra Jarvis-Selinger, associate dean, has been a hot topic among his classmates employability, there is still a common concern
academic, at the faculty of pharmaceutical as well. among students about the number of jobs
sciences, says it’s part of a larger shift by available to support the recently expanded
“There was definitely a bit of fear when it was
the national accrediting body to have all class sizes.
introduced,” he says. “We didn’t know what
Canadian pharmacy schools move to a
it meant for our bachelor’s degree – does it “It means we might have to leave our
PharmD program by 2020.
diminish its value?” comfort zone of the Lower Mainland,” says
“Both the B.Sc. and PharmD have all the Sin. (See side bar on opportunities in rural
He says much of that fear has dissipated
core training for future pharmacists to B.C.). Yet overall, students are incredibly
as he’s gone through school. “The
be excellent clinicians in the health-care optimistic about the future of pharmacy,
consistent message we’ve received is
system,” she says. “But there’s a natural he says.
that with a bachelor of pharmacy, you’re
progression of programs over time.”
still a fully practicing pharmacist. Your Liang agrees that the future is exciting. Like
The new program’s structure allows for more experience counts.” other fourth years, in May he’ll write licensing
integration between subjects with larger, exams and become a registered pharmacist
Jarvis-Selinger says she reminds current
multi-year courses that can be more reactive following results in July.
B.Sc. (Pharm.) students that the new
to changes in science or practice, including
PharmDs won’t graduate before them: He believes the public is becoming more
practice labs and case-based learning.
“You still graduate first and will have the aware of specialized pharmacy services, such
Preceptors are still adjusting to the changes. job market and your own career prospects as flu shots and travel medicine, and hopes
Some have expressed fears about the ahead of you.” that pharmacists will be able to prescribe for
discrepancy between their own credentials minor ailments soon.
But she notes, hopefully the E2P PharmD
and their future PharmD mentees, and others
graduates can say they have some breadth “For our profession to move forward, we need
worry about dealing with first-year students
of experience that wasn’t possible in to be willing to adapt to changing patient
in the pharmacy.
the bachelor’s program due to the extra needs,” Liang says. “ Pharmacists are more
“For employers and preceptors, there’s experiential education. integral to the health-care system and the
such a wide range of learners you can well-being of British Columbians than ever.
At this point, associate-owner May says that
now interact with and so there are many
she has no preference for hiring either type “I can't wait to get started.”
opportunities to make an impact on students
bcpharmacy.ca Mar/Apr 2017 THE TABLET 19FENTANYL CRISIS
The fight against fentanyl
By Sue Robins
In Vancouver’s Downtown Eastside Recently, Milroy received a letter of Becotte spent more than a year working at
(DTES), pharmacists have some of the commendation about his pharmacy Pier Health, although he recently moved
most challenging and fulfilling work the manager Craig Plain from a local resident. on to new opportunities. He emphasizes
profession could offer – a job where they that dealing with overdoses is what he
can apply their skills in pharmacy and, In the letter, the writer shares a story signed up for when he graduated from
quite literally, save lives. about when he overdosed in December: pharmacy six years ago.
“Craig called the ambulance and stayed
Craig Plain and Cindy Chase are with me and made sure I was breathing “I’m involved with health issues and I
pharmacists who work at Pier Health and I was alive. He saved my life.” respond accordingly, and this includes
Resource Centre in the DTES. The overdoses,” he says.
impact of overdoses from fentanyl, and Plain vividly recalls that day. “Someone
increasingly, the even deadlier carfentanil, ran into the centre and yelled, ‘Do you He adds that opioid addiction is not
loom large. Last year there were 914 have a naloxone kit?’ so I grabbed one just a DTES problem. “This is a problem
overdose deaths in B.C., an increase of of our kits and ran outside. He was still everywhere; it’s more widespread than you
almost 80 per cent from 2015. breathing, so we called 911 and waited with might think. Medication and prescription
him until the paramedics arrived.” abuse affects all pharmacists.”
Both Plain and Chase have been called
several times to respond with naloxone “I was surprised to get the letter,” says “There was never a dull moment," says
kits to overdoses occurring in the vicinity Plain, whose parents taught him that no Becotte. "Many of the patients have taken
of their workplace – in nearby single matter who you are, you treat people with a thousand steps to start treatment and
room occupancies, or in the streets and respect. This early life lesson stuck and it they are interested in getting better, but
alleys along Main Street. Sometimes is evident in his pharmacy practice. they just might not have all the tools to
they support another resident who is do it.”
Plain says another man overdosed behind
administering naloxone to a friend,
their building in January. He and fellow That’s where the staff at Pier Health
other times they assess and monitor an
pharmacist Greg Becotte were leaving Resource Centre come in. Many people
overdose themselves, or they give a dose
work late one day and found him slumped come to Pier Health for methadone
(or more) of naloxone and wait for the
against the door in the alley. treatment, but the pharmacists don’t just
ambulance to arrive.
dispense the drug – they do head-to-toe
“We grabbed the naloxone kit from the front assessments to understand other issues.
"It has been a difficult time for people
and drew up a dose. After two injections, the Taking the time to listen and cultivating
on the Downtown Eastside,” says
guy responded. Naloxone really does bring relationships are important themes here,
Robert Milroy, Pier Health Resource
people back to life,” Plain says. as is responding to the growing number of
Centre’s executive director. “There has
been so much death related to fentanyl overdoses in the neighbourhood.
Becotte adds a happy ending: “This was
and it is heartbreaking. But as a service a former patient of ours who had slipped “This is part of life here,” says Plain of
provider in the DTES, we see many people and went back to using drugs. I told him treating overdoses in the Downtown
every day of their lives. We see the good you know you can always come back to Eastside. The distribution of overdose
days and the bad days. And they become see us, and two weeks after the overdose, kits and training has been a good thing,
a sort of family.” he did. He’s a patient at Pier Health again.”
20 THE TABLET Mar/Apr 2017 bcpharmacy.caYou can also read
