Vial of Life Project • Ipsos Reid Poll Results • Frontline Pharmacy
tablet
published by the British Columbia Pharmacy Association | www.bcpharmacy.ca | Volume 21. No. 4
AUG/SEP 2012
Injections Update Pharmacists embracing authority
S GI RE O D T
2012
AY
TE R
COMPOUNDING TRAINING THE SCIENCE OF PHARMACEUTICAL COMPOUNDING® : NON-STERILE TRAINING COMPREHENSIVE – RELEVANT – EMPOWERING
activity Offerings : A University of Florida College of Pharmacy accredited Practice-based Activity
ACTIVITy DESCRIPTION : The Practice-based Activity will provide compounding pharmacists and technicians with the competency to prepare current and viable pharmacotherapeutic non-sterile dosage forms. Unique concepts will be taught facilitating a decision-making process the pharmacist and technician can apply in their day-to-day practice. Consideration will be given to meeting the physician’s prescription and patient-specific need, compliance-related solutions, medical necessity, and legal and regulatory guidelines. Practical techniques and technology-related applications are developed through hands-on experience in a compounding laboratory environment where pharmacists or technicians will be trained in all aspects of non-sterile preparatory procedures. Pharmacists and technicians have the opportunity to develop important aspects of a business development and marketing plan. Additionally, included in the Activity are current practice tips for numerous specialty niche markets.
vancOuver, bc september 14 – 16, 2012 gainesviLLe, fL november 2 – 4, 2012
ESSENTIAL ELEMENTS OF COMPOUNDED STERILE PREPARATIONS COMPREHENSIVE – RELEVANT – EMPOWERING
activity Offerings : A University of Florida College of Pharmacy accredited Practice-based Activity
ACTIVITy DESCRIPTION : The Practice-based Activity will provide the pharmacist and technician with the knowledge, skill and measurable competencies necessary to meet the high standard of practice required to compound sterile preparations and the autonomy to make informed decisions as it relates to various performance measures. Comprised of an interactive self-study workbook and a highly dynamic live activity staged in a state-of-the-art regulatory compliant sterile compounding facility, the activity is unique in its design and is complemented by a broad range of training utilities. Pharmacists and technicians will realize how to minimize regulatory, preparatory and clinical-related risk while making up a sterile, appropriately potent and stable compounded preparation thereby reducing the likelihood of untoward or deleterious side effects for patients. The development of competencies in the preparation of low, medium and high risk compounding while working within regulatory compliance guidelines is a central focus to the live event. The participant will conduct all necessary maintenance, control, monitoring and testing procedures to sustain a sterile compounding facility within regulatory compliance guidelines while validating and documenting that process.
®
vancOuver, bc september 28 – 30, 2012 gainesviLLe, fL october 19 – 21, 2012
the University of Florida College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Program materials used during these activities are Copyright © MEDISCA NEtwork Inc.
For complete activity descriptions and to register for these activities : Call 866.333.7811 or visit http://www.medisca.net/cen/cont_curriculum.aspx
THE TABLET
AUG/SEP
2012 | VOLUME 21. NO.4
contents Editor-in-Chief Kathie Taylor 604.269.2863, kathie.taylor@bcpharmacy.ca
16 on the cover
Senior Editor Elise Riedlinger 604.269.2866, elise.riedlinger@bcpharmacy.ca
22 vial of life
Advertising Sales Shannon Ward, OnTrack Media 604.639.7760, tablet@ontrackco.com 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 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: www.bcpharmacy.ca
24 DPIC
Pharmassist: 1.800.667.2190 For confidential counselling referral for employment or addiction related assistance Publication agreement #40810576
Features 16 19 22
Columns
Regulars
6
President’s Message A year in reflection
12
Frontline Pharmacy Shingles vaccine
Pharmacists embrace authority
7
15
Ipsos Reid Poll Results A larger role for pharmacists
CEO’s Message Finding a balance
Product in Focus Health Canada approves Pradax
8
24
Vial of Life Richmond project
Professional Services Keeping up the good work
9
Member Services Supporting new members
DPIC Methemoglobinemia and EMLA® cream
26
Internet Rx Non-drug measures for insomnia
Up Close with Doreen Brunner
28
Career Opportunities Find a job in pharmacy
Cover Article: Injections Update
10 14 Got a suggestion for an article in The Tablet? Email info@bcpharmacy.ca with your story ideas.
Financial Matters Succession planning
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
3
SMALL TALK
In the news Community pharmacy residents BCPhA recently hosted two community pharmacy residents, Harpreet Khtaria and Fatima Ladha, for two weeks in June. The community pharmacy residency program offers a one-year structured, postgraduate education and training experience that provides for the development of advanced knowledge and skills in the delivery of pharmaceutical services that emanate from a community pharmacy. Community pharmacy residents Harpreet Khtaria (l) and Fatima Ladha (r) join Parkash Ragsdale, BCPhA deputy CEO and director of professional services.
In memoriam BCPhA Honorary Life Member David Clifford Allen passed away on May 15, 2012 in Kamloops, BC. He was born July 16, 1929 in Regina, Saskatchewan and became a well-known pharmacist in Kamloops through the many years he owned Mallory Drugs and Kipp Mallory Pharmacy. Allen is survived by his wife of 58 years, Thelma, and his three sons Richard (Sue), Scott (Elizabeth) and Stuart (Pam), as well as 13 grandchildren and four great grandchildren.
Nanoose Bay pharmacists receive CPhA Award Congratulations to Tracie Der and Darcy O’Toole, who were recently honoured with the 2012 Canadian Pharmacists Association Patient Care Achievement Award for Health Promotion. They were recognized for demonstrated excellence in the ongoing education of patients on wellness, the encouragement of a healthier lifestyle and disease prevention and management. Der and O’Toole are both BCPhA members based in Nanoose Bay.
4
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
MEET THE BOARD
Meet…Julie Ford She now resides in Kamloops, working part time at Glover’s Medicine Centre and contributing to business development at her family’s business, Highlands Irrigation. Ford will join the BCPhA Board of Directors for her first term in September. What motivated you to run for a position on the BCPhA Board of Directors?
Julie Ford was raised in Williams Lake, BC. She graduated from high school in Victoria at St. Michael’s University School and graduated as a pharmacist from UBC in 1994. Ford began her career as a pharmacist at an independent pharmacy in Williams Lake and then went on to work for Shoppers Drug Mart in Vancouver. After a few years practicing pharmacy, Ford completed her MBA at the Ivey School of Business, graduating in 2000. For the next several years she held positions outside of pharmacy practice, most notably as the business affairs leader, pathology and lab medicine, at the BC Cancer Agency.
I have a strong interest in improving and sustaining health care in BC and this seemed like a perfect opportunity/ challenge to apply my business acumen and health care experience. What are you most looking forward to in the year ahead? I am looking forward to learning more about the challenges facing the BCPhA and being able to contribute to addressing these challenges in a positive way. What area would you like to see pharmacists more involved in?
If you weren’t a pharmacist, what would you be? That’s a tough one but definitely something involving business and people. What advice would you give to pharmacists just starting their careers? My advice would be to think outside the box. Think about what you can do within your scope of practice as a vital member of the health care team that will make a positive impact on a patient’s experience in the pharmacy and have a positive economic influence on the overall delivery of health care in our province. If you were stranded on a desert island what three things would you want with you? I would bring my two daughters (they are a package deal!), fresh water, and sunscreen. And I’d hope food would be supplied!
It would good to see more pharmacists take advantage of our expanded scope of practice. For example prescription adaptation and emergency fills, creating positive patient outcomes and reducing the burden on other health care providers, especially primary care physicians. Many times pharmacist interventions prevent unnecessary trips to the ER or walk-in clinics.
What’s next for Julie Ford?
Shakeel Bhatti, Langley (604) 534-6605, shakeelbhatti@shaw.ca
Julie Ford, Kamloops (250) 318-1371, julieford@shaw.ca
Allison Nourse, Vancouver (604) 276-5280, allisonn@unipharm.com
Bill Bright, Calgary (403) 663-8793, b.bright@telus.net
Caren Heughan, Victoria (250) 388-5181, carenheughan@gmail.com
David Pavan, Vancouver (604) 301-2620, david.pavan@gmail.com
Don Cocar, Kelowna (250) 808-1308, don@dycksdrugs.com
Victor Ikari, Ashcroft (250) 453-2553, pdm72@pdmstores.com
Greg Shepherd, Vancouver (604) 317-9608, gshepherd@pharmasavebc.ca
Derek Desrosiers, Richmond (604) 276-5236, derekd@unipharm.com
Ralph Lai, Langley (604) 881-3882, ralph_lai@owfg.com
Nadeem Zia, Surrey (604) 585-5666, nadeem.family.pharmacist@gmail.com
After having a family, Ford left that position to work on various contracts for the Provincial Health Services Authority.
So far this next year is ramping up to be a busy one with exciting challenges including my new position on the Board at the BCPhA and continuing to pursue my work in Kamloops.
Board of Directors
Ken Foreman and John Tse have completed their terms as of August 31, 2012.
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
5
GREG SHEPHERD | PRESIDENT
A year in reflection Pharmacists as medication experts
This is my last column as president of
the BCPhA Board and, as I reflect on my term, I am actually a little overwhelmed at all the activity in the world of pharmacy since my term began last September. What a busy year it has been, to say the least – and there are no signs of slowing down anytime soon. Not a day goes by it seems without an announcement somewhere in the country regarding the practice of pharmacy. Across Canada, our profession continues to defend itself against the constantly growing pressures from governments and other stakeholders focused on balancing budgets and reducing spending. At the same time, pharmacists have never before been involved in so many aspects of our patients’ health. Enhancing pharmacy services while spending less is an interesting problem. What it means, really, is that the practice of pharmacy as we know it is changing.
and administer injections across the province. The increase in access to care for the people of BC would not be possible without pharmacists stepping up and owning drug delivery, and proving that we are the medication experts in our communities. Two themes that appeared throughout my Tablet columns this past year were “constant change” and “value and trust.” As a profession, we all must never let go of being valued and trusted. As we saw in the Ipsos Reid poll results published in January of this year, it’s easy for professions to move up or down from year to year. Although our “approval rating” slipped from 91 per cent in 2003 to 78 per cent in 2011, pharmacists remain the most trusted of all professionals – in and out of the health care sector. We can celebrate that achievement but we must continue
“there are no signs of slowing down anytime soon”
Here in BC, it has been a busy time for the Board and staff of the BCPhA. We continue to work extremely hard to protect the interests of all our members, while remaining active leaders in ensuring our profession a solid place in primary health care in our province. Although the BC government chose to terminate the Pharmacy Services Agreement prematurely, we have continued to work with government, looking to a fair and realistic outcome. The process has been long, political, and at times frustrating, but as you will read in the CEO’s column, we remain optimistic that pharmacy’s voice will be heard. Although we find ourselves somewhat in limbo with respect to government regulation, what does remain certain is the role of pharmacists in delivering non-dispensing clinical services in BC. Pharmacists continue to perform medication reviews, adaptations
6
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
to work to stay there. By embracing our role in primary care, we will continue to make progress in how we are “valued” by our patients, and by other health care providers. Being trusted does not imply being valued, and there is still work to be done. This year we also welcomed a new leader at the BCPhA. Geraldine Vance took over as CEO in January and had to hit the ground running. She has proven herself a very valued addition to the Association and I want to thank her, the Board, and all the staff at the BCPhA for making my term as president such a great experience, both professionally and personally. As Ralph Lai takes over as Board president in September, I am pleased to remain on the Board for another term and I look forward to working hard for all of you as we continue to move our profession forward.
GERALDINE VANCE | CEO
The pharmacy eco-system Finding a balance among many factors
As I was driving to work
on a sunny day in July I listened to a news story on the 50th anniversary of the battle to bring universal health care to Saskatchewan. I grew up in the land of Tommy Douglas and there is a general sense of pride most Saskatchewanians have about the role the province played in making health care accessible to every citizen. As I listened to the news feature on the hot summer of 1962, which included doctors withdrawing services and neighbours embroiled in philosophical debates that left deep scars, I couldn’t help but think about all the expectations that Canadians now have of their health care system. Regardless of political preferences or philosophical differences, Canadians share a huge sense of entitlement when it comes to health care. We all want the newest treatments, no wait times for surgeries and the best medicines available, and we want it all for “free.” In this regard I have some genuine sympathy for our elected officials. They are faced with an insatiable demand for health care services with the simultaneous pressure to manage costs and avoid raising taxes. Not any easy job.
of good discussions with government officials about our recommendations. What seems clear is that there is a consensus amongst provincial governments that there are major savings to be had in the area of generic drugs pricing. We support government’s overall objective to manage drug costs. But, the problem comes when this issue is looked at in isolation. We have done our best to ensure our government understands that the commodity drug costs are one piece of a sometimes complex puzzle of the pharmacy sector. For pharmacists to deliver the patient
“For pharmacists to deliver the patient services that are needed, many factors must be in balance.”
In a small way we are seeing this challenge play out as our provincial government tackles the issue of prescription drug pricing. As you will know, the government passed Bill 35 – Pharmaceutical Services Act, in May and is now developing regulations related to pricing and incentives. The BCPhA in partnership with the CACDS submitted its recommendations on these two key issues to government (posted on the members’ side of www.bcpharmacy.ca) and had two days
services that are needed, many factors must be in balance. Making substantial changes to only one or two elements of what I recently heard referred to as the “pharmacy eco-system” could have far reaching and long lasting negative impacts on the health care system as a whole. We know we provide some of the answers to meeting the neverending demands patients place on our politicians. We have shown that we are part of the solution to delivering patient care while managing fiscal imperatives. As I have said previously, we have a big job to tell pharmacy’s story and that remains one of our most pressing priorities.
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
7
PARKASH RAGSDALE | DIRECTOR, PROFESSIONAL SERVICES
Keeping up the good work
For the second consecutive year,
BC pharmacists increased utilization of clinical pharmacy services, thus improving access to primary health care for patients while contributing to the sustainability of our health care system. The dramatic increases in uptake of clinical pharmacy services are positive signs that patients are recognizing what their pharmacist can do for them. As we have seen, utilizing your full scope of practice to improve the health of British Columbians leads to further opportunities for pharmacists to apply their knowledge and skills to care for patients. Adaptations*
Injections**
Medication Review Services***
2009/10
91,036
31,803
N/A
2010/11
101,353
49,967
N/A
2011/12
169,228
116,602
150,110
* Includes all prescription adaptation fees paid by PharmaCare in the fiscal year ** Includes all publicly funded vaccine administration of injection fees paid by PharmaCare in the fiscal year *** Includes all Medication Review Services fees paid by PharmaCare in the fiscal year
Fee increases for prescription adaptations took effect April 1, 2011 and, as can be seen in the accompanying chart, there were significantly more adaptations provided by community pharmacists in the last fiscal year compared with the previous two years. The rise in use of this scope of practice is a step forward in assisting patients to receive affordable, safe, effective medications in a timely way. Considering the millions of prescriptions filled annually, there is still room to expand the provision of these services.
During the 2011/12 influenza season pharmacists authorized to inject doubled the number of influenza vaccines they administered. This showed how effective pharmacists can be as community vaccine providers, and provided evidence for the Fraser and Vancouver Coastal Health Authorities to partner with pharmacists to mount a timely response and administer whooping cough vaccinations to stem outbreaks in those areas. These partnerships, coupled with the growing number of pharmacists authorized to administer injections, then supported pharmacist involvement in the province’s one-time HPV vaccine program. With the influenza season almost upon us, it’s time to get prepared, get authorized and keep your community healthy. BC pharmacists also did well in implementing Medication Review Services for the first time in 2011. Excellent uptake has demonstrated the need and demand for these services, which has resulted in the government’s continued funding and reduced eligibility requirements (reduction from patient having seven to five qualifying medications) for the services to allow even more British Columbians to benefit. Pharmacists across Canada are expanding their roles as integral members in primary health care. In order for BC pharmacy to continue gaining more opportunities to meet the current and future needs of BC residents, community
“utilizing your full scope of practice to improve the health of British Columbians leads to further opportunities”
8
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
pharmacists need to carry on practicing to their fullest scope to care for patients and demonstrate our growing and untapped value to the primary care system.
CYRIL LOPEZ | CHIEF OPERATING OFFICER
Supporting our new members’ practice
Congratulations, on behalf of the
entire BCPhA membership, to all our newly minted members, whether you are a UBC graduate, an international graduate or a graduate from another province. Every summer we welcome 100+ newly registered members as they embark on their pharmacy careers. It is an honour for all our members that BCPhA receives such a strong level of support from new graduates. BCPhA provides grads with tools to help you navigate your new world of community pharmacy practice. In fact, the connection starts much earlier at UBC through our collaboration with the Pharmacy Undergraduate Society, the Speaker Series and the newly-launched BCPhA Student Ambassador program, as well as presentations to the international student programs. Every fall, BCPhA provides pharmacy students preparing for the PEBC with administration of injections training to ready them for their community practice. Now, to clinch that job. There are numerous jobs in the Career Opportunities section in every issue of The Tablet, and the job board on our website. On average, the board has a dozen new advertisements each month from every region in BC and practice category. The job board is the most preferred channel of advertising pharmacy career opportunities in BC, with more openings than other major boards like monster or workopolis. That is because of the breadth and depth of BCPhA’s membership: we provide the most efficient and direct connection between the pharmacy owner – whether chain, banner or independent – and the pharmacist.
There’s a wealth of information available for pharmacists on the professional resources section of the BCPhA website.
Now that you are a member, make sure you maximize your benefits by accessing the professional resources section of our website. Produced and kept up-to-date by our professional services department, this page includes a wealth of information for new (and well-established) pharmacists, including injections, drug shortage updates and third party information. Don’t neglect reading the weekly Practice Update email, keeping you informed on important developments as they happen.
And finally, mark your calendars for the annual conference in Kelowna from May 30 to June 1, 2013, at the Grand Okanagan Resort and Conference Centre. Come to learn, network and fulfill your PDAP progroup_ad_v3.ai 13/11/2008 4:23:24 PM learning requirement. And yes, guaranteed fun as well.
(BCPhA also offers owners a targeted recruitment mailing to pharmacists charged at cost plus a nominal handling fee. Owners can manage their cost by selecting the specific region in which they want to market the vacancy. Low cost and higher success rate - that is the value of BCPhA membership! And NEW CAR PURCHASE PLANS that is not all: General Members can take control of All Makes & Models their job search by posting their resume on the Hire a Pharmacist section of the job board. Managers Te l: 6 0 4 - 2 7 0 - 4 4 6 6 To l l F r e e : 1 - 8 8 8 - 3 8 5 - 4 4 6 6 of pharmacy members can access these postings, 390 H owa r d Av e. B ur na by, B C , V5B 3P 8 which are especially useful when looking for a relief or locum staff on short notice.) C
M
Y
CM
MY
CY
CMY
K
www.bcpharmacy.ca
member benefit partner since 1985 visit us online:
P R O GROU P B C . C A
Aug/Sep 2012
THE TABLET
9
NEW MEMBERS
JASON MIN AND LARRY LEUNG | INTERNET RX
Welcome to BCPhA! More than 100 new members have recently joined our Association, including many of the newly graduated class of 2012. We look forward to representing your interests as pharmacists and advancing your role as primary health care providers. NEW MEMBERS General Mohamed Hemdan Abu-Khater, Janak Adhuria, Grace Ayodele Afolaranmi, Alykhan Alladina, Eunjin An, Varinder Aujla, Kristen B. Azcarraga, Navid Bayat, Birpaul Bhander, Jas Brar, Andrew Braun, Emma Brizan, Walter Cantwell, Sheri Dawn Cater, Billy Chai, Fiona Chan, Raymond Chan, Man Ying Chu, Lydia K. Chui, Soyoung Chun, William Chung, Maryam Daftarian, Kyle Denley, Ramandeep Kaur Dhillon, Sundeep Singh Dhillon, Thao Do, Cody Drzewiecki, Abdulrahman Elnagdi, Tania Faessler, Karim Fazaa, Benyamin Ghali, Jeffrey Giles, Manpreet Gill, Rajinder Gill, Mohamed Hessein Hassona, Stephanie Houston, Helen Hua, Ajit Johal, Ahmed Khalil, Shafqutullah Khan, Nay Myo Khine, Jung Mi Kim, Miseung Kim, Lindsay Kufta, Nelson Philipp Kuhlen, Davie Lam, Karmen Larsen, Kar Lun Lau, Karen Wing Hei Lau, Bobby Kam Tao Lee, Junkyung Lee, Sarah Lee, Amanda Wai Yuin Li, Cheuk Wai Li, Sarah Hui Wen Li, ShihWei Lin, Yu-Chen Lin, Mario Linaksita, Mei Chun Shelley Liu, Vinson Liu, Savio-Marie Loh, Andrew Low, Yuen Wa Luk, Sharn Mashiana, Ali Reza Meghji, Christen Moffatt, Shaheen Moosa, Craig R.Morton, Sarah Murray, Nancy Nashed, Maryam Nassaji Zavareh, Andrew-Tam Nguyen, Meghan O’Rourke, Tammy C.Olsson, Okechukwu Oranu, Rex Pai, Dhara Parikh, Terry Park, Megha Patel, Pauravi Patel, Amarpal Powar, Valaykumar Rajgor, Gurpreet Kaur Ranauta, Jenneth D.Reyes, Juliane Romanuik, Omar Saad, Kris Scott, Rina Serjeant, Mit Shah, Shrenik P. Shah, Muffadal Shamshuddin, Shamah Sharma, Kimberly Shew, Jared Siemens, Esther Suzanne Simmons-Foot, Emil Slewa, Suzanne Soneff, Kendra Southwood, Holly IreneSumner, Mehrnoush Towfighidaryani, Beverly Ann Webb, Alice Wong, Hugo Wong, Steven Alexander Wowchuk, I-Chang Wu, Qiong Wu, Judy Xie, Rui Michael Xu, Fuyun Yang, Mandy Yang, Yachin (Joyce) Yu, Cindy Yuen Corporate Medicine Shoppe Pharmacy #332
10
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
Non-drug measures for insomnia Insomnia is the most prevalent sleep
disorder and is a common issue either independently (primary insomnia) or comorbidly with another medical disorder (secondary insomnia). Regardless of where you work as a pharmacist, whether in the community, hospital, or clinic setting, chances are you have encountered a patient that is dissatisfied with their sleep. In fact, insomnia is estimated to affect 25 per cent of all adults.1 It’s important to note that only six to 10 per cent of adults experience primary insomnia1, indicating that the majority of patients likely have secondary insomnia with an underlying cause, such as a mood disorder, chronic pain, and sleep apnea that may or may not be treated for. Although there are new medications that we can expect to become available for use in insomnia, they may not offer significant benefits over existing medications. Therefore, to best manage a patient’s sleep disorder, we should treat the underlying cause, but also implement important non-drug measures that any pharmacist can provide. Here are three simple internet resources on nondrug measures we have used in practice that may help you with your patients. Anyone who experiences any type of insomnia requires education on the importance of sleep hygiene and careful monitoring. One of the easiest tools that we can give to patients is the sleep hygiene guide and sleep diary located on the last page of the BC guidelines on insomnia: www.bcguidelines.ca/pdf/sleepcomp.pdf. Although the rules of
sleep hygiene are generally self-explanatory and many patients are familiar with them, you will be surprised at how many don’t actually follow them. In addition, encouraging your patients to complete the seven day sleep diary and return for follow-up with the results will allow you to make the necessary adjustments in their sleeping habits and patterns and monitor for efficacy of sleep medications and non-drug measures. This is a good opportunity to remind your patients that not everybody should necessarily aim for eight hours of sleep every night and that our sleep needs generally decrease as we age. Some patients may find that white noise is an effective way of managing insomnia. One of our favourite free apps for the iPhone and iPad is called Relax Melodies, which has an array of 46 different sounds that you can mix and match to your preferences. There is also a useful alarm and timer feature that you can set to match your schedule.
The Canadian Sleep Society, an association dedicated to the advancement of sleep and its disorders, offers a useful resource called Ask a Sleep Specialist: www.canadiansleepsociety.com/specialists.html. This is a list of specialists in areas such as sleep apnea, sleep respiration and infant sleep problems who have volunteered to be contacted via email for general information and inquiries. These three easy resources can be implemented in your everyday practice to improve patient care during your medication reviews, counselling, and education sessions. Stay connected with us on Facebook at Clinicare Pharmacists for all of our sleep resources and regular posts on other great pharmacy tools.
References 1. Morin CM, Benca R. Chronic Insomnia. Lancet 2012; 379: 1129–41
Finally, there may be questions you receive from patients that require expertise from other health professionals to answer.
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
11
FRONTLINE PHARMACY
Shingles vaccine: What you should know Written by Gina Chang. Reviewed by Lori Bonertz.
“Have you heard about shingles?”
When I ask patients this question at the pharmacy counter, I am surprised by the high response rate of “yes” from young and elderly patients alike. I often receive a bonus story of an unlucky neighbour or relative who had a terrible case just last year. Discussing shingles and the vaccine is a great way for pharmacists to engage patients.
Shingles Shingles (herpes zoster, or HZ) is a reactivation of the latent varicella zoster virus (VZV), often decades after the primary chicken pox infection. HZ causes a unilateral, painful vesicular eruption lasting seven to 10 days and usually takes two to four weeks to completely heal. It may result in serious complications such as potentially blinding eye infections (zoster ophthalmicus) and central nervous system infections. The most common complication is post-herpetic neuralgia (PHN): a prolonged and often debilitating neuropathic pain that persists from the acute infection (10 to 30 per cent of HZ cases)1. Antiviral treatment should be initiated within 72 hours to minimize the severity, duration, and complications of HZ. Patients should be reassured that shingles is not contagious, although exposure to shingles can cause chicken pox in an individual who has not had chicken pox or been immunized against it. Inform patients that it isn’t only elderly people who can experience shingles, although incidence increases with age. The average lifetime risk for HZ is estimated to be 10 per cent to as high as 32 per cent.2-4 Each year, there are 130,000 cases of HZ and 17,000 cases of PHN in Canada, costing approximately $68 million annually.5
12
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
Vaccine efficacy A live, attenuated varicella virus vaccine was introduced in Canada in 2008. It has a virus concentration of ≥14 times compared to that in the chicken pox vaccine, and was initially approved only for adults aged 60 or over. The vaccine greatly reduces the risk for HZ (RRR=51%, NNT=59) and PHN (RRR=67%, NNT=363), according to the largest randomized controlled trial (RCT), the Shingles Prevention Study (SPS).6 To date, a booster is not recommended until further data is presented, though follow-ups have proven the vaccine’s efficacy for up to four to seven years.6,7 In 2011, Health Canada expanded the target age to include 50 to 59-year-olds based on a RCT that demonstrated the vaccine’s safety, immunogenicity, and efficacy (RRR=70%, NNT=163 for HZ) in this group.10
History of chicken pox, shingles, or chicken pox vaccination The Canadian National Advisory Committee on Immunization (NACI) states that the vaccine may be used in people with unknown history of chicken pox, as nearly all Canadian adults in the indicated age group will have had prior varicella exposure.8 Because the SPS excluded those with a history of shingles, currently neither the NACI nor the American Advisory Committee on Immunization Practices (ACIP) has sufficient evidence to recommend the vaccine for this group.2 That said, recurrent HZ is possible1, and there are no safety concerns with administering the vaccine to adults with a history of HZ.9 The shingles vaccine is unnecessary for those immunized with the chicken pox vaccine, as they are not at risk of severe HZ.2
Contraindications and precautions A history of anaphylactic reaction to gelatin or neomycin is considered a contraindication to the vaccine, as are pregnancy and immunodeficiency.12 Patients taking prednisone (<20mg/d) for less than two weeks, methotrexate (≤0.4mg/kg/week), azathioprine (≤3.0mg/kg/d), or mercaptopurine (≤1.5mg/kg/d) can still receive the vaccine.2 Those on biologics, especially tissue necrosis factor inhibitors (i.e. “mabs”/ etanercept), should wait at least one month after discontinuation of therapy to receive the vaccine.2,13 Anyone on antivirals should discontinue the medication 24 hours prior to immunization and may only resume it at least 14 days after.2
Adverse events The most common adverse effects are local injection site reactions (erythema, pain, swelling). Varicella-like and zoster-like rash occurred at similar rates in the vaccine and placebo groups in the SPS; it is prudent for a person who develops a rash from the vaccine to take precaution around close contacts who are VZV-seronegative.12
Administration Because one study revealed lowered varicella virus immunogenicity with co-administration of the pneumococcal vaccine14, NACI recommends administering the two vaccines four weeks apart.8 In contrast, ACIP recommends simultaneous immunization based on a new observational study that found no increased risk of HZ after coadministration.2,15 Lyophilized HZ vaccine must be stored in a freezer (below -15°C) and should be administered subcutaneously in the deltoid region immediately after reconstitution as the vaccine loses potency after 30 minutes.12 The vaccine currently costs CDN$175 to 195.16
Communication opportunity Shingles prevention has an important role in the well-being of the aging
generation, especially those with pre-existing chronic pain, severe depression, or other comorbidities.11 Because of the strict cold-chain requirements, the need for a prescription, and the fact that it isn’t currently a publicly-funded vaccine, the shingles vaccine is a great fit for pharmacists with injection authority. Talking about shingles does not need to be limited to elderly patients - it can also be an opportunity to discuss with parents the importance of the chicken pox vaccine and other children’s public health immunizations. Educating patients on the risks of shingles and the benefits of vaccination can open a broader dialogue of preventive medicine and ensure your patients continue to bring their health care concerns to you. References available upon request; contact the BCPhA communications team.
“Amazing programs and great services when you join the Peoples group ” Chris Dreyer Lytton Peoples Pharmacy
If being a successful owner operator in retail pharmacy is part of your life plan, Peoples Drug Mart is the proven program that will help you achieve your goals. For as little as $100 per month, the Peoples program offers opportunities that are unique to independent pharmacies and provides financial benefits that are unparalleled. If you own an independent pharmacy or have plans to, call us today.
Helping People Live Better Lives To learn more about the Peoples Drug Mart and Peoples Pharmacy programs, contact:
Frank Fidyk 778-678-6717 or Ian Maxwell 604-431-3595 ext 23 email: fgfidyk@telus.net email: ianm@pdmstores.com www.peoplesdrugmart.com
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
13
GLENN SCHOENROTH | FINANCIAL MATTERS
Key planning strategies for business owners
Financial planning is important
for your retirement, and is particularly critical for those of you fortunate enough to own your business. Many pharmacists have accumulated their wealth from their business, or will realize substantial wealth when they decide to sell it. Approximately 40 per cent of all Canadian entrepreneurs plan to exit their business within five years and 70 per cent within 10 years, according to the Canadian Federation of Independent Business (CFIB). The same study, however, indicates that only one-third of business owners have a succession plan for the transition of their business to the next generation or for the outright sale of the business. Of those that have a succession plan, 82 per cent indicate that it helped them plan for their family’s future. Following are some planning tips that can help to ease the transition: • Plan your succession early. Include your professional wealth manager, your tax advisor and/or lawyer. • Keep it in the family. If you have a family business, or plan to transfer the business to a family member, include your family in these discussions. It can help avoid family disharmony and misunderstandings. • Groom your successor well in advance. Develop a mutual understanding of their responsibilities for the business and the roles you will both play during this time. For example, it should be clear if you plan to gradually transfer duties, what these duties are, and how this will be communicated to other employees. • Early tax planning can help to avoid surprises. For many people who own their business, taxes at the time of a sale will be the largest expense they will ever have – and will reduce their retirement capital. Planning early for this next stage can help to reduce this tax burden.
14
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
• Plan ahead to minimize tax. Have a professional advisor prepare a financial plan to determine if the expected aftertax proceeds on the sale of your business will be enough to meet your family’s retirement income and estate planning needs. Some potential structures for maximizing your estate and retirement income and minimizing tax include insured annuities, family trusts and tax-exempt life insurance. The right solution will be based on your individual circumstances, so professional advice is essential. • Anticipate your capital gains. If you do plan to sell your business, and if the capital gains on the sale are expected to be substantial, speak to your tax advisor prior to the sale to discuss additional, advanced tax planning strategies. • Have a financial plan prepared. Like many business owners, you may not have a defined retirement savings strategy since you are relying on the equity in your business to fund your retirement. A comprehensive, professionally prepared financial plan can help integrate your business and personal needs into a plan to ensure you are able to meet your goals. It can also help you determine tax-savings strategies for your family, including income splitting and the use of family trusts. These are only a few of the many strategies to consider as part of a larger succession plan. However you envision your life after leaving the business, planning early and working with your professional advisors can help create a retirement you’ve truly earned. This article is supplied by Glenn Schoenroth, an Investment Advisor with RBC Dominion Securities Inc., member CIPF. This article is for information purposes only. Please consult with a professional advisor before taking any action based on information in this article. Glenn Schoenroth can be reached at 604-257-7196.
PRODUCT IN FOCUS
Health Canada ® approves Pradax
Health Canada recently approved Pradax® (dabigatran etexilate) for eligible patients living with atrial fibrillation (AF) for the prevention of stroke and systemic embolism. Atrial fibrillation, which causes the heart to beat irregularly, affects approximately 48,000 British Columbians. People with AF are three to five times more at risk of having a stroke and are twice as likely to die from one.1 Pradax® is a novel, reversible, oral direct thrombin inhibitor. It provides its anticoagulant effect by selectively blocking the activity of thrombin, the central enzyme in clot (thrombus) formation.2,3
Pradax® profile • Following oral administration, dabigatran etexilate is rapidly absorbed and converted to its active form, dabigatran.2 • It has a rapid onset of action with peak plasma concentration achieved within two hours of administration in healthy subjects.2 • It has a predictable and consistent pharmacokinetic profile that has no known interactions with food, and a low potential for interaction with other drugs.2 • Its half-life is 12 to 14 hours in healthy volunteers.2 • It is eliminated mainly via the kidneys.2 • It is not metabolized by cytochrome P450 and does not affect the metabolism of other drugs that use this system, leading to a low potential for drug-drug interactions.2 • Pradax® has a favourable risk / benefit profile and comes in a convenient twice-daily oral dose with no requirement for anticoagulation monitoring.2 • It is available in two dose options – 150mg BID for the majority of patients and 110mg BID for patients above 80 years of age who are at a higher risk of bleeding may be considered.2
RE-LY® Study In the landmark RE-LY® Trial published in 2009 in the New England Journal of Medicine, dabigatran etexilate 150mg was shown to be
superior to warfarin in reducing the risk of stroke and vascular death in patients with AF.4 Specifically, dabigatran etexilate 150mg twice daily significantly reduced the risk of stroke and systemic embolism by 35 per cent (p=0.0001) without increasing the risk of major bleeding, and reducing the risk of intracranial bleeding by 59 per cent (p<0.0001).2 The adverse event reported in the RE-LY® trial that was significantly more common with dabigatran etexilate than with warfarin were gastrointestinal (GI) disorders, such as abdominal pain, diarrhea, dyspepsia and nausea. There was a comparable rate of major GI bleeding with dabigatran etexilate 110 mg bid and warfarin, though the rate of major GI bleeds was significantly higher with dabigatran etexilate 150mg than warfarin (110 mg bid (1.1%/yr; p=0.6); warfarin (1.1%/yr) and dabigatran etexilate 150 mg bid (1.6%/yr; p= 0.001).2
Other Indications Pradax® is approved in Canada for the prevention of stroke and systemic embolism in adults with atrial fibrillation in whom anticoagulation is appropriate.2 For complete prescribing information, refer to the product monograph. Based on the results of RE-NOVATE®, RE MODEL™ and RE-MOBILIZE, Pradax® is also approved in Canada for the prevention of blood clots (venous thromboembolic events) in adults who have undergone elective total hip or elective total knee replacement surgery.2
References 1. http://www.heartandstroke.on.ca/site/pp.aspx?c=pvI3IeNWJwE&b=5052981&printmo de=1 Accessed March 27, 2012 2. PRADAX Product Monograph, October 2010. 3. Di Nisio M, Middeldorp S, Büller HR, et al. Direct thrombin inhibitors. N Engl J Med 2005;353:1028–40. 4. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Eng J Med 2009; 361: 1139-1151.
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
15
ON THE COVER | INJECTIONS UPDATE
BC pharmacists continue to embrace injection
Giving it 16
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
How do we compare? BC Pharmacists can offer immunizations.
authority
Alberta
Runny noses, fever, body aches – it’s time to start thinking about flu season again and BC pharmacists are more ready than ever. This fall, community pharmacists will make an even bigger impact on the annual flu campaign, with more than 1, 800 now authorized to inject in the province. Considering it’s only been three years since pharmacists were first granted injection authority, that’s a significant accomplishment. Back in July 2009, the BC Ministry of Health proposed regulatory changes under the Health Professions Act that would allow qualified pharmacists to administer injections. As the most accessible of all health care workers, pharmacists were ideally positioned to respond to the H1N1 pandemic situation that was expected that fall. In October, BC pharmacists began providing patients with both the flu and H1N1 flu vaccines. More than 150 pharmacists had already completed the newly-created BCPhA Accredited Administration of Injections Program. “It was a perfect opportunity for pharmacists to step up to the plate at a time of need,” said Parkash Ragsdale, deputy CEO and director of professional services at BCPhA. “As primary health care providers, we have the trust of our patients, and are an accessible and convenient option for providing flu shots.” BCPhA also ensured remuneration for this expanded scope of practice was in place. Pharmacists providing eligible patients with publicly-funded vaccinations received a $10 payment through PharmaNet. Tenneille Metz was one of the first pharmacists to take injections training in 2009. “I took the training to serve a need in our community,” said Metz. “It’s also great for our pharmacy because people see we can do more than just hand them their prescription and tell them how to take it.” As the pharmacy manager at Clinic Drug Store in Dawson Creek, Metz has incorporated injections into her daily practice, booking appointments for vaccinations and also doing flu shots on a drop-in basis.
Pharmacists can offer flu vaccinations, and as of July 1, 2012, are able to receive payment for administration of medications by injection.
Manitoba Pending. Bill 41, which includes allowing pharmacists to administer injections, passed the legislature but the bill has not yet been proclaimed.
Ontario Pending. The Ontario College of Pharmacists submitted regulations that would allow pharmacists administer injections.
Quebec Pending. Legislation passed in 2011 that will allow pharmacists to administer injections. No standards of practice or regulations have been filed.
New Brunswick Pharmacists can provide season influenza vaccination only.
Nova Scotia Pending. Legislation passed in 2010 that allows pharmacist to do vaccinations but the standards of practice have not been completed.
our best shot by Elise Riedlinger
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
17
Feeling inspired to get authorized? Injections workshop dates include: Aug 12, 2012 Aug 25, 2012 Sep 8, 2012 Sep 22, 2012 Oct 14, 2012 Oct 21, 2012 Nov 4, 2012
Prince George Richmond Castlegar Burnaby Richmond Burnaby Burnaby
To register or learn more, visit
www.bcpharmacy.ca
Tenneille Metz, pharmacy manager at Clinic Drug Store in Dawson Creek, has been providing injections since 2009.
Even though the threat of H1N1 subsided, the momentum for pharmacists to give injections continued. Pharmacists not only have access to influenza and pneumococcal Authorized to administer vaccine from the publicly-funded vaccine supply, but can also injections: 1,812 offer privately-funded vaccines at discretionary pricing. This includes travel vaccines, which Metz gives on aBCPhA weekly basis. trained, not authorized: 250 authorized: 2,135 2012 Number of authorized community pharmacists inNotBC as of July
Authorized to administer injections: 1,812 BCPhA trained, not authorized: 250 Not authorized: 2,135
“We had a lot of patients coming to me for travel advice, so I took it upon myself to learn about it since we didn’t have a travel clinic in town,” said Metz. “Patients had to get a prescription from their doctor for a vaccine, pick it up from us, and wait to get back in to see the doctor to have it administered. “Now that we can give the vaccines ourselves, it saves patients a lot of time.” Patients have also responded positively to pharmacists administering publicly-funded pertussis vaccines during the whooping cough outbreak in the Fraser Health and Vancouver Coastal Health regions and pharmacists continue to play an important role in the province’s one-time HPV program. In total, more than 1,500 pharmacists have taken injections training through the BCPhA program. More than 140 UBC fourth year pharmacy and CP3 students also received injections training in the last academic year, and are fully authorized as they now join the workforce. “Our goal is to have at least one pharmacist who can provide injections in each pharmacy in the province,” said Ragsdale. “As well, we’re hoping to reach 2,000 pharmacists authorized by the end of 2012.”
BC community pharmacists’ authorization by year 4500
Not authorized community pharmacists
On top of providing immunizations in the pharmacy, she goes to patients’ homes if they have reduced mobility and can’t get to a clinic, particularly during the winter months when it’s difficult to travel in the snow. Metz has also holds flu clinics at seniors’ complexes a few times a year.
Authorized community pharmacists
“If I can do it, as a pharmacist by myself filling 150 to 200 prescriptions a day, than any pharmacist can,” she said.
4000 3500 3000 2500 2000 1500 1000 4500 500 4000
35000 3000
2009
2010
2011
2000
1000
*Jan – Jul 2012
Not authorized community pharmacists
2500
18 1500 THE TABLET
2012*
Authorized community Aug/Sep 2012
As for Metz, who is the only regular full-time pharmacist on staff in her pharmacy, the upcoming flu season will be busy but well worth it.
pharmacists www.bcpharmacy.ca
IN THE POLLS
Canadians welcome larger role for pharmacists in health care Ipsos Reid recently published the results of a poll assessing public support for private pharmacies offering a range of health services. After surveying 1,030 adults across the country, the poll revealed that Canadians are welcoming the possibility of pharmacists expanding their scope of practice.
Ipsos Healthcare survey of BC pharmacists
Support was strongest for having trained pharmacists administer doctor-prescribed vaccines and other drugs on site, at 88 per cent. Support remained strong across the board for other proposals, such as having pharmacies provide in-home nursing or medical care, offer outpatient clinics for physiotherapy or sports medicine, offer hospitals for specific treatments, and provide nursing homes.
research study as part of a collaborative project between
More than 80 per cent of respondents said they believed that the products and services owned and offered by pharmacies would be higher than or as good as those currently available.
the issues you might be facing with regards to these
The results of this poll are very promising, and build on another recent Ipsos Reid survey that indicated that pharmacists are the most trusted profession in Canada for the second year running. Moreover, health care services offered by pharmacists are already expanding in BC to include injections, medication review services and adaptations. This poll suggests that public support exists for continued development of clinical pharmacy services.
the current barriers to immunization at the pharmacy
The Ipsos Reid poll was conducted from April 26 to 30, 2012. Weighting was employed to balance demographics. A survey with an unweighted probability sample of the same size and a 100 per cent response rate would have an estimated margin of error of plus or minus 3.1 percentage points, 19 times out of 20, of what the results would have been if the entire population of Canada had been polled.
Members are encouraged to take part in an important BCPhA and the University of British Columbia. The study investigates the challenges that BC pharmacists face with immunization. It looks at current immunization-related services offered at your pharmacy, services and the administration and stocking of vaccines. The results will be used to develop strategies to overcome level and to better support pharmacists. The study is being conducted online by Ipsos Healthcare. Invitations to participate were sent by email in July, including a link to access the survey on a secure website. BCPhA strongly supports this research initiative. If you havenâ&#x20AC;&#x2122;t yet completed to survey, please take the time to do so.
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
19
IN THE POLLS
The question asked by Ipsos Reid was: “All things considered, do you support pharmacies owned or operated by entities as Safeway, Shoppers Drug Mart/Pharmaprix, Rexall, PharmaPlus, Overwaitea, Gaurdia, Sobey’s, Jean Coutu or Familiprix - or other more locally based independent pharmacy outlets, offering any of the following products or services?” The following graphs show Canadians’ responses to a variety of services: Do you support pharmacies: Having trained pharmacists administer doctor-prescribed vaccines and other drugs on site? Strongly Support
Support Somewhat
National Total
45%
BC
49%
43% 41%
54%
AB
33%
Total ‘Support’
Strongly Support
88%
National Total
89%
BC
88%
AB
SK/MB
39%
47%
85%
SK/MB
Ontario
39%
45%
84%
Ontario
Quebec
49%
Atlantic
46%
44% 42%
93% 88%
Strongly Support National Total BC AB SK/MB Ontario Quebec Atlantic
THE TABLET
Support Somewhat 34% 39% 31% 25% 37% 27% 46%
53% 50% 56% 57%
56% 43%
Aug/Sep 2012
Support Somewhat 29% 35% 29% 25% 31% 24% 31%
Total ‘Support’
52%
81%
50% 50%
85% 75%
57%
82%
48%
79%
57%
81%
56%
87%
Do you support pharmacies offering: In-home nursing or medical care for seniors or others requiring attention?
Total ‘Support’
Strongly Support
87%
National Total
43%
41%
84%
BC
43%
40%
84%
AB
42%
40%
82%
89% 87% 82%
53%
Quebec Atlantic
Do you support pharmacies offering: Outlets in malls or storefronts for medical services such as wheelchairs and other devices?
20
Do you support pharmacies offering: Outpatient clinics for physiotherapy or sports medicine?
SK/MB
90%
Ontario
83% 89%
www.bcpharmacy.ca
Support Somewhat
30% 41%
Total ‘Support’
50%
80%
39%
81%
Quebec
48%
43%
91%
Atlantic
47%
43%
90%
BCPhA Members Survey BCPhA would like to hear from all members about how we are doing as an organization. As part of the transition to new leadership, we’re evaluating the direction and priorities of the Association, and working to enhance the value of your membership. The past year has also brought about many changes with the passage of Bill 35, and we’re looking to what we can do to best support you in the next fiscal year. The BC Pharmacy Association has commissioned Ipsos Reid to conduct this members’ survey, which will be sent out via email. All responses will remain confidential with Ipsos Reid. Please keep an eye out on your inbox for further details in September.
Do you support pharmacies offering: A hospice for those in need of palliative care? Strongly Support
Do you support pharmacies offering: Nursing homes?
Support Somewhat
Total ‘Support’
National Total
34%
74%
National Total
30%
BC
37%
75%
BC
31%
40% 38%
Strongly Support
Support Somewhat 40% 43%
70% 74%
AB
30%
44%
74%
AB
32%
SK/MB
29%
46%
75%
SK/MB
30%
40%
69%
Ontario
32%
38%
70%
Ontario
34%
37%
Quebec
33%
42%
Atlantic
43%
71% 75%
42%
85%
Do you support pharmacies offering: Ambulance or medical transport services? Strongly Support National Total BC AB SK/MB Ontario
Support Somewhat 33% 38% 32% 25% 35%
Quebec
30%
Atlantic
35%
38% 33% 34% 45% 33% 47% 42%
Total ‘Support’
Quebec Atlantic
25% 32%
31%
Total ‘Support’
44% 43%
63%
69% 75%
Do you support pharmacies offering: Hospitals for specific treatments, such as geriatric care? Strongly Support
Support Somewhat
71%
National Total
32%
71%
BC
34%
44% 45%
Total ‘Support’ 75% 79%
AB
29%
47%
76%
70%
SK/MB
30%
46%
76%
68%
Ontario
31%
77%
Quebec
30%
76%
Atlantic
66%
www.bcpharmacy.ca
41%
39% 50% 36%
71% 80% 77%
Aug/Sep 2012
THE TABLET
21
VIAL OF LIFE by Elise Riedlinger
A life-saving ‘script
Rahim Janmohamed, pharmacy manager at Shoppers Drug Mart, explains the Vial of Life program to patient Janice Adams.
When his mother-in-law experienced a severe allergic reaction last year, Rahim Janmohamed knew time was of the essence as he called the ambulance. “When something like that happens, you’re always in a state of shock or panic,” he said. But luckily, his mother-in-law had her full medication history printed and easily accessible, saving precious time for the paramedics once they arrived on site.
22
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
“It really helped alleviate that stress,” said Janmohamed. “The paramedics could see right away what medications she was on, her emergency contact information and whether she had any chronic conditions.” Janmohamed, pharmacy manager at the Richmond Centre Shoppers Drug Mart, has been helping others be prepared as a volunteer with the Vial of Life program for the past two years.
Vial of Life is a trademarked program of the Victorian Order of Nurses (VON) that assists emergency personnel in obtaining important medical facts and prescription information during a crisis in the home. The program in Richmond is targeted at seniors, and is a partnership with the VON, BC Ambulance Service, Richmond FireRescue, Vancouver Coastal Health, and other community groups. “The Vial of Life is a program that encourages seniors to take charge and ownership of their health information,” said Cherryl Pacheco, a pharmacist with the Jim Pattison Outpatient Care and Surgery Centre, and a Vial of Life committee volunteer. “Older adults in particular will benefit from the program as they are more likely to take multiple medications, have multiple medical conditions and are at greater risk of a debilitating health event. They often live alone and may not have someone to help communicate important health information to emergency personnel.”
Paramedics and firefighters in Richmond know to look for the Vial of Life symbol. Because the patient’s full medication history is included, they can often start treatment on site, versus having to wait to pull the information off PharmaNet. This also saves time for emergency room and hospital personnel. “If a patient is hypertensive or diabetic, the paramedics know right away,” said Janmohamed.“It works so well because the system is easily recognizable. It’s not high tech – just a pen, paper and your fridge. It’s simple but effective.” Janmohamed has been involved with the program since 2010, and his entire pharmacy team also knows how to help patients sign up for Vial of Life.
She adds that promoting medication review services is a perfect way that pharmacists can be involved. That’s because patients need their medical history to place inside the “vial” – a clear, labeled prescription bottle that they store inside their refrigerator. “We often tie the program in with medication reviews so that patients receive their best possible medication history,” said Karen Ong, pharmacy manager at the Blundell Centre Shoppers Drug Mart. “Or, even if the patient is only taking a few meds, we can fill out the medical history form that’s included in the vial.” She first heard about the program through some enquiring patients.
Linda Lane-Devlin, Victorian Order of Nurses; Ron Gracan, pharmacy manager at Regency Medicine Centre; and Roger Mah, BC Ambulance Service
“It’s routine now, just part of our work flow,” he said. “When patients come in we’ll ask if they’ve heard about the program. Often we’ll end up filling out forms for a couple, or an entire family.” “Particularly with our aging population, this program is so beneficial.” “It’s a great program to be involved in,” agreed Ong. “We’ve already heard feedback from the ambulance paramedics who say it’s helpful because they know right away what medications they can give or not give the patient.” Similar programs are available through a handful of fire and police departments and professional associations in Canada, the United States and other countries around the world, but Janmohamed believes it’s something that should be in every city. Roger Mah, BC Ambulance Service, Karen Ong, pharmacy manager at Shoppers Drug Mart, Blundell Centre; and Linda Lane-Devlin, Victorian Order of Nurses
“Hopefully more people will hear about it and the program can be expanded to the entire region, or even nationally,” he said.
“We have a large seniors community and they were interested because they’d seen a presentation on the program,” said Ong. “I contacted Vial of Life to get involved.”
For now, he’s committed to being involved and supporting the program in his own pharmacy – and with his own family.
Now, Ong’s store promotes the program through a small display in the pharmacy, and gives out at least one or two vials a day.
Participating pharmacies in Richmond include three Shoppers Drug Mart locations, Aberdeen Centre Pharmasave, Regency Medicine Centre, Steveston Pharmacy and McCue Drugs.
Along with the vial containing medical and emergency information forms, participants receive a bright orange Vial of Life sticker for their front door and a magnet for their refrigerator.
“It has to start somewhere.”
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
23
DPIC
By Rob Gair, B.Sc. Pharm., CSPI
Methemoglobinemia following topical application ® of EMLA cream Case Report
Discussion
A 19-year-old male presented to the emergency department with shortness of breath, light-headedness, and cyanosis of his lips and nail beds. The patient stated that he applied “10 tubes of EMLA® cream” to his groin area prior to a hair removal procedure. He developed symptoms soon after and washed the cream from his skin before coming to the hospital. His initial pulse oximeter oxygen saturations were 84 per cent; administration of 100 per cent oxygen produced only a slight improvement. The emergency physician consulted with the BC Drug & Poison Information Centre and the opinion was the patient was suffering from local anesthetic-induced methemoglobinemia. Approximately 90 minutes after coming to hospital, co-oximetry measurement of hemoglobin oxygen saturations revealed a methemoglobin fraction of 24.5 per cent (normal is less than one per cent). The patient was treated with one mg/kg intravenous methylene blue and his symptoms immediately improved. Three hours later the patient’s methemoglobin fraction had decreased to 3.6 per cent.
EMLA® cream is a eutectic mixture of local anesthetics consisting of 2.5 per cent lidocaine and 2.5 per cent prilocaine. It is available without a prescription (behind the counter) at pharmacies. EMLA® cream is commonly employed as a topical anesthetic prior to painful dermal procedures. Local anesthetics are well known for their central nervous system and cardiovascular toxicities following supratherapeutic intravenous doses. Perhaps less well known is the ability of some of these agents to alter hemoglobin oxygen saturation by inducing methemoglobinemia.
24
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
Oxidizing potential of local anesthetics: The oxidizing properties of local anesthetics can be attributed to their chemical structure. Benzocaine is metabolized to strong oxidizers like aniline, phenylhydroxylamine, and nitrobenzene. In one study, the use of benzocaine 20 per cent spray in hospitals was associated with mean peak methemoglobin levels of 43.8 per cent in five patients. Prilocaine is derived from aniline and metabolized in the liver to ortho-toluidine,
another potent oxidizer. Several published case reports have associated methemoglobinemia with topical application of EMLA® cream in both adults and children. Cases of methemoglobinemia are primarily associated with overuse of the product by applying it to large surface areas or leaving it on for too long. Applying EMLA® to broken skin or mucous membranes, or the use of occlusive dressings also increases the risk of toxicity. Methemoglobinemia is also documented following subcutaneous administration of prilocaine during circumcision in male neonates. The potential for other local anesthetics to induce methemoglobinemia is not well demonstrated. Methemoglobinemia: Methemoglobin is an altered state of hemoglobin where the ferrous (Fe2+) irons of heme are oxidized to the ferric (Fe3+) state. The ferric irons are unable to bind oxygen resulting in impaired oxygen delivery to tissues. The observed cyanotic skin colour is imparted by the oxidized hemoglobin and not from impaired oxygen delivery to tissues. The presence of methemoglobin is measured by examining hemoglobin oxygenation fractions using a co-oximeter. Normally, the methemoglobin fraction is less than one per cent, while the oxyhemoglobin fraction approaches 100 per cent. The half-life of methemoglobin following acute exposures to oxidants is one to three hours. With continuous exposure the half-life is prolonged. Signs and symptoms: Cyanosis and low oxygen saturation that does not respond to supplemental oxygen are the first observed signs. These typically occur when methemoglobin fractions exceed 10 to 15 per cent. Headache, dizziness, fatigue, dyspnea, exercise intolerance, and weakness occur at levels above 20 per cent. More serious symptoms such as tachypnea, chest pain, dysrhythmias, seizures, and CNS depression occur at fractions above 50 per cent and death is associated with methemoglobin levels exceeding 70 per cent. Patients with pre-existing anemia may become symptomatic at lower methemoglobin fractions due to an already reduced oxyhemoglobin concentration. Acute hemolysis may occur one to three days after an episode of methemoglobinemia. Management: Methemoglobinemia is typically managed with intravenous administration of methylene blue, a basic thyazine dye. In the presence of cellular NADPH, methylene blue is reduced to leukomethylene blue, which, in turn, reduces methemoglobin to hemoglobin. Treatment is not usually required unless methemoglobin fractions exceed 10 per cent. Symptomatic patients with methemoglobin fractions between 10 and 25 per cent should receive one to two mg/kg methylene blue. All patients with documented methemoglobin fractions exceeding 25 per cent should receive treatment regardless of symptoms. Methylene blue is infused intravenously over five minutes followed immediately by a saline flush of 15 to 30 mL to reduce injection site pain. Symptoms generally improve within 15 to 30 minutes. Repeat doses are usually not required.
EMLA® cream and laser hair removal Although EMLA® cream is frequently used to avoid pain during laser hair removal, some authors suggest that many patients can be treated without anesthetics. EMLA® cream has not been adequately
studied for this indication, and its use in laser hair removal should be considered off-label. As stated in the product monograph, EMLA® should only be used for the approved indications because maximum safe doses for other uses are not known. Serious adverse events including methemoglobinemia, CNS toxicity, and cardiovascular collapse have occurred when EMLA® cream was used for laser hair removal. In one case, EMLA® was applied to an area of intact skin measuring only five cm by five cm for 30 minutes. The application of heat from the laser may have increased the absorption of EMLA®. Thermal injury due to excessive laser application under EMLA® anesthesia has also been reported.
Recommendations Methemoglobinemia is a serious blood disorder associated with overuse of EMLA® cream. Patients requesting EMLA® for laser hair removal or requesting large quantities should be cautioned about the possibility of methemoglobinemia. Procedures involving large quantities over a large skin area must be conducted at facilities where staff are trained and equipped to deal with toxicities. Patients should always be instructed to apply the cream to the smallest possible skin surface area and not to leave the cream on for longer than necessary. Patients reporting symptoms of methemoglobinemia should be immediately referred to a hospital emergency department.
References 1. Guay J. Methemoglobinemia related to local anesthetics: A summary of 242 episodes. Anesth Analg. 2009;108:837-45. 2. Hahn I, et al. EMLA®-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med. 2004;26:85-88. 3. Howland MA. Methylene blue. In: Nelson LS, et al. editors. Goldfrank’s Toxicologic Emergencies. New York: McGraw-Hill; 2011. p. 1708-10. 4. jakobson B, et al. Methemoglobinemia associated with a prilocaine-lidocaine cream and trimethoprim-sulphamethoxazole. A case report. Acta Anaesthesiol Scand. 1985;29:453-55. 5. Kizilyildiz BS, et al. Toxic methemoglobinemia due to prilocaine use. J Emerg Med. 2010;38:663-5. 6. Parker JF, et al. EMLA toxicity after application for allergy skin testing. Pediatrics. 2004;113:410-1. 7. Peker E, et al. Methemoglobinemia due to local anesthetia with prilocaine for circumcision. J Paediatrics Child Health. 2010;46:361-6. 8. Price DP. Methemoglobin inducers. In: Nelson LS, et al. editors. Goldfrank’s Toxicologic Emergencies. New York: McGraw-Hill; 2011. p. 1698-1707. 9. Raso SM, et al. Methemoglobinemia and CNS toxicity after topical application of EMLA to a 4-year-old girl with molluscum contagiosum. Paediatric Dermatol. 2006;23:592-3. 10. Schwartz DR, et al. Local anesthetics. In: Nelson LS, et al. editors. Goldfrank’s Toxicologic Emergencies. New York: McGraw-Hill; 2011. p. 965-75. 11. Cil Y. Second-degree skin burn after intense pulsed light therapy with EMLA cream for hair removal. Int J Dermatol. 2009;48:206-7. 12. Hahn I-H et al. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med. 2004; 26: 85-8. 13. Elsaie ML. Cardiovascular collapse developing after topical anesthesia. Dermatology. 2007; 214: 194. See also:
Morena Higueras M, et al. Methemoglobinemia induced by local anesthetic administration previous to laser depilation. Med Clin (Barc). 2008; 131: 198-9.
Garcia-Saura PL, et al. Rev Esp Anestesiol Reanim. 2012. [Epub ahead of print]
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
25
UP CLOSE
Doreen Brunner at the Canadian Museum of Flight in Langley, BC
The wandering pharmacist by Elise Riedlinger Doreen Brunner’s 50 years in pharmacy have taken her from Nova Scotia to British Columbia, and more than a dozen locations along the way.
Ontario for four months, spent the following summer in Nova Scotia, and completed my last rotation at White’s Pharmacy in Saskatoon.”
She’s worked in both community and hospital pharmacies, small towns and large cities, and has experienced a significant change in pharmacists’ role. Yet from the beginning, she’s always been dedicated to making a difference in people’s lives.
After graduation, jobs were not plentiful, so Brunner moved to Williams Lake where her sister was nursing. She completed the forensic exam and became licensed to practice pharmacy in BC, subsequently moving to Prince George to work at Reid’s Prescriptions for four years.
Growing up in Moose Jaw, Saskatchewan, Brunner excelled in math and sciences, and discovered her passion for health care by babysitting for a number of doctors’ families. In 1958, she enrolled in the University of Saskatchewan with the intent of becoming a physician, but decided the switch to the four-year pharmacy program was more financially viable in a family of four girls.
The pharmacy was in a new medical building and the work was varied – from mixing gallons of mosquito repellent for horses to making suppositories.
It was after this transfer that Brunner joined the University Reserve Training Program with the Royal Canadian Air Force and served two summers in Eastern Canada.
“It was a great time for pharmacists because everyone helped one another,” she said. “You could call up another pharmacy down the road, and they’d open up their store and give you a medication you needed. Even if it was after hours, they’d deliver it to you. A pharmacist helped another pharmacist out, regardless.”
“At the time, we all had to put in 12 months of apprenticeship,” said Brunner. “I apprenticed in pharmacy at Camp Borden in
In 1967, Brunner moved to Vancouver to work as a pharmacist, but she soon needed a new challenge. So she enrolled in
26
THE TABLET
Aug/Sep 2012
www.bcpharmacy.ca
the University of Toronto in the College of Education. After completing her degree she taught high school in Prince George, and continued to work at Reid’s pharmacy relieving the owners over the summer. She was then offered the opportunity of opening a drugstore in Fort St. John, and became a senior shareholder there for the next nine years. During that time, Brunner worked as relief pharmacist for the local hospital when the pharmacist was out of town. Both the hospital and small town setting helped Brunner see a shift in pharmacists’ role quite early on.
“The doctors were gods, and we never questioned anything,” she said. “Nowadays they look to the pharmacist for answers. We have a lot more autonomy.” Brunner’s ability to connect with her customers is one thing that hasn’t changed over the decades, and her coworkers at Kroll’s describe her as well-known and loved in the community.
“In the Fort St. John’s hospital, we were very involved. We got into the facts about what was on the formulary and which medications we could use for specific conditions. There weren’t the specialists, so we had to know more.” Brunner continued to develop her skills as she moved around the province over the next few years, back to Prince George, then to Duncan and Langley. “I’ve lived in pretty much every small town in BC,” she joked. “But my favourite is Alert Bay.” The town of around 600 permanent residents is on a small island across from Port McNeil, and has what Brunner described as “an eclectic bunch of people.” She’s looking forward to returning there for a reunion this August, when her husband Terry accompanies a historic aircraft to the island. Terry is the general manager at the Canadian Museum of Flight in Langley, and Brunner often supports him with fundraising, members’ day and other museum events. She also enjoys gardening in her spare time, and coworkers note that during the summer there’s a never-ending supply of fresh cut flowers in the pharmacy. Yet despite these other passions, Brunner is far from retirement. She’s been a part-time pharmacist at Kroll’s Pharmacy in Surrey since 1983, and continues to work there four days a week. “I once told Lorna [Kroll] that I was going to work until 50, but it’s too much fun to leave. Pharmacy is just so much more interesting now.” Brunner said that’s because pharmacists have more independence, knowledge and expertise.
Brunner enjoys gardening in her spare time, and is known for always bringing fresh flowers into Kroll’s Pharmacy in Langley, BC
“As a pharmacist, I’ve always really enjoyed the fact you can be such a big part of a patient’s life,” she said. “You just need to spend the time to talk to them and find out how they feel, and answer every question they have.” Brunner is a firm believer in helping her patients to understand their medication and takes pride in being able to counsel her clients. “When we graduated [in 1962], the dean told us at the time: ‘You can’t remember everything, that’s why we trained you how to look it up.’” And it still holds true, she said. “Even now sometimes, if I get a question I don’t know about herbal medicine, I’ll get out the book and look. You can always say: ‘I don’t know, but I’ll find out.’”
“When I first started working, you just filled a prescription. We did some compounding, but not nearly as intricate as today. We didn’t have the background on chronic conditions that we do now.”
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
27
CAREER OPPORTUNITIES
pharmacist with an entrepreneurial spirit that is detail oriented and committed to clinical pharmacy practice. This position may lead to a pharmacy manager position in the future as well as the potential for a partnership opportunity. Interested applicants are requested to send their cover letter and resume to spremji@forewest.ca. Short listed candidates will be contacted for interviews.
ARE YOU MAXIMIZING THE VALUE OF YOUR MEMBER BENEFITS? Corporate Members can place free Career Opportunities listing in these columns and on the web. General Members looking for new career opportunities get free access to PostYour-Resume. To learn more, log in and visit the Career Opportunities. The BCPhA Career Opportunities connects our members like no other job board, bringing member employers and potential employees together, and it is free!
CHEMANIUS Rexall #7114 has immediate opening for full-time pharmacist, Monday to Friday, 9am to 5pm. This clinic pharmacy specializes in home health care and is attached to a medical clinic. We offer a very competitive compensation package. Please contact Ellie Rahmani, Rexall #7114, 9892 Esplanade, Chemainus BC. V0R 1K1. elhumr@gmail.com
ABBOTSFORD Pharmasave in Abbotsford is looking for parttime pharmacist. No evenings and occasional weekends. Pharmacy is located inside the new Abbotsford Regional Hospital. Remuneration paid according to experience. Contact Shaf or Shabita at 604.870.5600 or email: info@pharmasaveabby.com, Fax: 604.870.2955
CUMBERLAND Vancouver Island Health Authority is recruiting temporary and causal pharmacists for the Cumberland Health Centre Retail Pharmacy on Vancouver Island. Join a top employer with great benefits and a competitive salary. Email: hraccesshumanresources@viha.ca
ARMSTRONG We want you to be excited about your pharmacy career! At Armstrong Pharmacy you have the opportunity to be the pharmacist you’ve imagined. We are a team of clinically oriented pharmacists committed to making a difference in our community. We have great relationships with our patients and local physicians, and want a pharmacist who is willing to continue to foster and build these relationships. Experience what it’s like to work with a manager and team that will fully support you in developing new and creative ways to improve the health of our community while making full use of our growing scope of practice. We are currently working on several innovative programs including collaboration with local schools and public health nurses. Come find the work-life balance you are after and find out what living in Armstrong is all about. Buy local organic food, go fishing or boating, ski at Silver Star or take a short trip to Vernon or Kelowna; there are things to do all year round. This is your chance to explore the Okanagan and be near all of the urban amenities. If you are interested we would love to hear from you. Please contact Dwight Johnson; email: gaarscott@gmail.com; phone: 250.546.3195. BURNS LAKE Forewest Holdings is currently recruiting for a pharmacist for our Pharmasave location in Burns Lake. Located in northern BC, Burns Lake is an ideal location for a pharmacist interested in clinical pharmacy practice in a rural setting. Burns Lake also provides easy access to numerous outdoor recreation activities. We are looking for a
28
THE TABLET
Aug/Sep 2012
DAWSON CREEK Clinic pharmacy - just renovated. Looking for a smiling, passionate and seasoned regulated pharmacy technician with experience in BC to join our pharmacy. Goal is to free up pharmacists’ time so that more clinical services can be provided to patients. You must be able to work with minimal supervision, prioritize tasks, and provide excellent service to patients. Pharmacy is open Monday to Friday 9am to 5:30 pm, Saturday 9am to 1pm (except summer closed), no stats. Pay is based on experience and performance, $20-28 per hour. Contact: Tenneille Metz, email: clinicph@telus.net, phone: 250.782.3100, fax: 250.782.8120 FORT ST. JOHN We here at Shoppers Fort St. John are looking for a full time pharmacist who thrives in a busy environment. The ideal candidate would be patient oriented, able to multitask in a high script volume environment, make medication reviews a daily focus. Starting wage is $54/hr and negotiable depending on experience. If you believe you are a suitable candidate, please email me your resume or call Irvin to discuss further details. Email asdm274@shoppersdrugmart.ca, phone 250-793-8413. HOPE Forewest Holdings is currently recruiting for a pharmacist for our Pharmasave location in Hope, BC. Hope is located in the Fraser Valley, 40 minutes away from Chilliwack. This is an ideal
www.bcpharmacy.ca
location for anyone interested in living in a small town with direct access to numerous outdoor recreation activities. We are looking for a parttime pharmacist with a commitment to clinical pharmacy practice. Pharmacists with injection training and experience performing medication reviews are desirable. Interested applicants are requested to send their cover letter and resume to spremji@forewest.ca. Short listed candidates will be contacted for interviews. LANGLEY An independent community pharmacy in Langley is looking for an energetic, independent and highly motivated pharmacist for full-time work. We are looking for someone interested in clinical work, developing strong therapeutic relationships with patients and communicating with physicians. Attention to detail and time management skills are essential. Our pharmacy is on the leading edge of community practice and we are continuously looking for new ways to increase our level of patient care. We provide an excellent opportunity for a pharmacist who is interested in developing new programs and expanding community pharmacy practice. Compensation is competitive. Excellent hours - no evenings, rarely weekends. Contact contact@gloverfamilypharmacy.ca or fax: 604.534.8383 OKANAGAN Canada Safeway Limited currently has a career opportunity for an Okanagan float pharmacist. If you are a pharmacist who is licensed to practice in BC and looking to provide patient-focused care within a strong team environment, then this opportunity may be for you. We offer a full compensation and benefits package with industryleading components. We are a company committed to both pharmaceutical care and customer care. If you would like to pursue this opportunity further, please send a cover letter and résumé by e-mail or fax to the address below: Christine Lee, BSc. Pharm. Pharmacy Recruiter Canada Safeway Ltd. Phone: 604.301.2632, Fax: 604.322.2508, Email: Christine.lee@safeway.com PENTICTON Busy 1200 sqft store needs competent technician to free up pharmacists’ time for med reviews and injections. WinRx on 4 terminals. Your help would be most appreciated! Contact email: aarage@shawbiz.ca, phone: 250.493.7200, fax: 250.493.7201 Full-time staff pharmacist/pharmacy manager - If you are a pharmacist who is looking for a great opportunity that provides growth, development and a great work environment then we have the opportunity for you! Excellent compensation and
CAREER OPPORTUNITIES
benefits plan, relocation allowance, on-going career development and training programs, opportunity to work with seasoned professionals, participate in our customer clinic day events, annual bonus plan, company stock purchase plan, employee discount program, comprehensive health and dental benefits, employee share ownership plan, flexible hours with no 24-hour pharmacies in all our locations. We support continuing education and offer various in-house training programs. Please contact: Kay Sajid at kay.sajid@loblaw.ca, Tel: 1.905.216.6010 Fax: 1.866.628.5329, www.drugstorepharmacy.ca. PORT ALBERNI Vancouver Island Health Authority is seeking a pharmacy coordinator and casual pharmacists for the West Coast General Hospital in Port Alberni on Vancouver Island. Three years running, VIHA has been a Top Employer in Canada and BC. Comprehensive benefits accompany the competitive salary. To learn more and apply: https://viha.hua.hrsmart.com/ats/job_search.php Pharmacy Coordinator: https://viha.hua.hrsmart. com/ats/js_job_details.php?reqid=4244 Pharmacist: https://viha.hua.hrsmart.com/ats/ js_job_details.php?reqid=5663 PORT COQUITLAM Pharmasave in Port Coquitlam is looking for a parttime or full-time pharmacist to join our team. The ideal candidate will be self motivated and possess excellent communication skills. Prior knowledge of Kroll, compounding experience, injection training certification and compression stocking fitting would be an asset. We are a community based pharmacy focused on customer care. If you would like to be part of our pharmacy team please email your resume in confidence to Darin Fenton at ps190job@telus.net SALMON ARM Canada Safeway Limited currently has a career opportunity for a full-time pharmacist in Salmon Arm. If you are a pharmacist who is licensed to practice in BC and looking to provide patientfocused care within a strong team environment, then this opportunity may be for you. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. If you would like to pursue this opportunity further, please send a cover letter and résumé by e-mail or fax to the address below: Christine Lee, BSc. Pharm. Pharmacy Recruiter Canada Safeway Ltd. Phone: (604) 301-2632, Fax: (604) 322-2508, Email: Christine.lee@safeway.com
SURREY NAZ’s Pharmacy is seeking a full-time pharmacist for our Surrey location. NAZ’s Pharmacy is a group of independent, community-based pharmacies that provide patient-centered practices. We offer the autonomy of an independent pharmacy, with the stability, competitive wage and benefits package of the large chain stores, without the micromanaging and corporate layers. We pride ourselves on our dedication to our employees and interest in long-term relationships. New graduates and any experience level are welcome to apply. Contact us to learn more about our opportunities and what NAZ’s Pharmacy can offer you! Please send your resume to Nafisa Merali, Tel: 604.603.7923, Fax: 604.608.3230, Email: hr@nazpharmacy.com. Pharmacy manager and part-time pharmacist needed for independent community pharmacy. Friendly environment, flexible shifts and no evenings. We offer a competitive wage. Must be able to work some weekends. New Grads Welcome! Please fax your resume. Tel. 604.543.6677, Fax 604.543.4433 VANCOUVER A full time pharmacist position available immediately for weekdays and some weekends. We are offering competitive wage and full benefit package. Contact mehdi@thechemist.ca, phone: 604.928.3837, fax: 604.630.2351 Part-time pharmacist position available ‘immediately’. Shoppers Drug Mart Pharmacy is located at 3303 Main St Vancouver BC, V5V 3M8. Please contact Henry Tel: 778.328.9580 or email “Associate SDM2252” asdm2252@shoppersdrugmart.ca. NAZ’s Pharmacy is seeking a full-time pharmacist for our Vancouver location. NAZ’s Pharmacy is a group of independent, community-based pharmacies that provide patient-centered practices. We offer the autonomy of an independent pharmacy, with the stability, competitive wage and benefits package of the large chain stores, without the micromanaging and corporate layers. We pride ourselves on our dedication to our employees and interest in long-term relationships. New graduates and any experience level are welcome to apply. Contact us to learn more about our opportunities and what NAZ’s Pharmacy can offer you! Please send your resume to Nafisa Merali, Tel: 604.603.7923, Fax: 604.608.3230, Email: hr@nazpharmacy.com Part-time pharmacists who are able to work two of the three shifts from Friday to Sunday (no evenings or holidays) - Available to cover vacation coverage in Jan 2013. Experienced in retail pharmacy and have exceptional communication and
www.bcpharmacy.ca
organizational skills- Able to work productively as a member of a dynamic team- If required, willing to work at two different pharmacy locations, both in the Lower Mainland- Also, having second language is an asset. Please apply via email: ymm@yyoung.com or by fax: 604.324.1727 A busy pharmacy is looking for a self-motivated, well-organized, efficient registered pharmacy technician to join our team in our Vancouver store full-time. You must work well under minimal supervision, handle pressure effortlessly, and be able to work as a team player. Excellent hours, no evenings or weekends. You must be able to take initiative and prioritize your work load. In addition, you must have strong and efficient technical skills as this position is very fast paced. We offer a very good competitive wage starting at $25.00 - $28.00 per hour based on experience. Medical and dental package provided after three months. We also cover your liability insurance through the BCPhA and the College of Pharmacists annual fee. Interested candidates that fit this criteria should fax your resume to 778.737.2889 or email to khtong@shaw.ca VICTORIA Pharmasave (Millstream Village) - Full-time and part-time pharmacists required to fill permanent positions. Each opportunity requires an experienced, organized, self-motivated pharmacist who is dedicated to providing exceptional service to our community. Compounding, injection certification and/or experience with Kroll is an asset. We offer competitive compensation plus benefits. Please email applications to: chriskiiskila@hotmail.com Permanent part-time home and community care pharmacist. Reports to the manager, clinical pharmacy services and works collaboratively with the home and community care team. Responsible for practicing client centered care by identifying and resolving potential drug therapy problems in the community setting. Provides medication counseling and drug information to clients and health care workers. Conducts home visits for community-dwelling clients and provides academic detailing sessions to optimize prescribing practices. For more information see Vancouver Island Health Authority posting at: https://viha.hua.hrsmart. com/ats/js_job_details.php?reqid=7284 or contact: Leslie Barker access leader, home and community care, phone: 250.388.2285, cell: 250.213.2207 Pharmacist required to work at the UVic Campus Pharmacy, Shelbourne Plaza Pharmacy and Cadboro Bay Compounding Pharmacy, owned and operated by Naz Rayani. We are looking for an engaged, clinically oriented outgoing, full-time pharmacist to work at our unique community pharmacies. Our focus is on patient-centered
Aug/Sep 2012
THE TABLET
29
CAREER OPPORTUNITIES practice with a desirable and friendly population. All applications are confidential. Compensation is commensurate with experience. Please submit applications to jobs@victoriapharmacy.com Full-time pharmacy technician required to work at the UVic Campus Pharmacy, Shelbourne Plaza Pharmacy and Cadboro Bay Compounding Pharmacy, owned and operated by Naz Rayani. Our focus is on patient-centered practice with a desirable and friendly population. All applications are confidential. Compensation is commensurate with experience. Please submit applications to jobs@victoriapharmacy.com Vancouver Island Health Authority has an exciting pharmacy leadership position available! We are looking for a new director of pharmacy to be based in Victoria, BC. Join a top employer with great benefits and a competitive salary. For more information: email: hraccesshumanresources@viha.ca Forbes Pharmacies are a local success story, located in beautiful Victoria, BC. To support our growth and expansion we are accepting resumes for part-time and full-time Pharmacists to join and add to our success. When you join The Forbes Pharmacy Group you become one of the family. We work hard and well as a team...sometimes it doesn’t even feel like work. Your strengths and passions are recognized. We have an amazing team and great customers. We offer a competitive salary and benefits package, and full pharmacy technician coverage. If you are interested in working for Forbes Pharmacies please submit your CV along with cover letter to Forbes’ President, Mike Forbes, at mforbes@forbespharmacy.ca. WEST VANCOUVER A Pharmasave in West Vancouver is seeking a friendly, outgoing, reliable pharmacy technician to provide superior customer service. Duties will include greeting customers, receiving prescriptions and obtaining relevant information, compounding, compliance packaging, processing cash and other duties as required. Previous pharmacy technician experience or recent graduation from a pharmacy technician program is mandatory. Good interpersonal and computer skills are essential. Excellent written and spoken English are compulsory. Experience with Kroll is beneficial but not required. We offer flexibility, an enjoyable working environment and competitive wages. Please send resume to Roberto at pharmacist@prvpharmasave.com OPPORTUNITIES ACROSS BC FOREWEST HOLDINGS - Pharmacists are needed for various Forewest Holdings locations across BC. We are currently looking for pharmacists to join our rapidly expanding company. Forewest Holdings operates 30 locations in BC and Alberta
30
THE TABLET
Aug/Sep 2012
LONDON DRUGS is accepting applications for pharmacist positions throughout BC. Pharmacists will have the opportunity to be involved with various patient care initiatives offered at London Drugs such as INR monitoring, long term care, certified diabetes education, immunization and various clinics such as osteoporosis screening, heart health, diabetes, sun and smoking cessation. We offer competitive salary and benefit package, moving allowances, professional working environment, scheduled meal breaks, semi-private counseling booths, automated robotic dispensing machines and employee discounts. Please apply in confidence to: Shawn Sangha, B.Sc. (Pharm), London Drugs Ltd. Pharmacy Operations Manager, BC. Tel: 604.272.7469, Fax: 604.448.1075, E-mail: ssangha@londondrugs.com OVERWAITEA FOOD GROUP - consisting of Overwaitea Foods, Save-On-Foods, PriceSmart Foods, Urban Fare and Coopers Foods are hiring. Staff Pharmacist positions are available in 100 Mile House, Campbell River, Chilliwack, Cranbrook, Creston, Fort Nelson, Grand Forks, Kelowna, Kitimat, Parksville, Prince George, Quesnel, Squamish, Terrace, Williams Lake and Fort McMurray, Red Deer and Lethbridge in Alberta. Relief pharmacist floater positions and pharmacy technician positions in BC and Alberta are also available. We provide an excellent pharmacy practice environment with personal growth and career development potential. Very competitive wages and benefits including a pharmacist incentive plan. We thank all applicants however only shortlisted candidates will be contacted. Contact: Chi Quon, Regional Pharmacy Manager, 604.881.3574, fax: 604.882.7896, chi_quon@owfg.com, www.saveonfoods.com PEOPLES DRUG MART and Peoples Pharmacy have several locations throughout beautiful British Columbia offering a desired combination of employment opportunity and unbeatable lifestyle. Contact: Smita Natha, Professional Services Manager, Peoples Drug Mart, 520-4400 Dominion Street, Burnaby, BC. V5G 4G3 Tel: 604.431.3595 ext. 26, Fax: 604.431.3596, Email: smitan@pdmstores.com
www.bcpharmacy.ca
GIG3135
and we will be expanding in the near future. To facilitate our expansion plans, we are interested in hiring pharmacists that are committed to clinical pharmacy practice in the community setting and possess an entrepreneurial spirit. Pharmacists interested in developing their skills to grow a pharmacy business in an independent environment are encouraged to apply. Pharmacists should be team players. We are looking for pharmacists who are committed to building relationships with customers and physicians and who will work hard to make their store a destination for health and wellness information. If you are interested in joining our dynamic company, please send your resume to spremji@forewest.ca
Anyone can make an error. Protect yourself. Preventing dispensing errors and the potential injuries to clients is the focus of this educational series. To help you understand and deal with these issues, Grain Insurance and Guarantee Company has commissioned a series of articles from Ms. Marie Berry, B.A., B.Sc. (Pharm), LL.B. Ms. Berry is a pharmacist and lawyer specializing in health care law. You can find her article at http://graininsurance.com/ pharmacy/page_bcpa.html For more information about the specialized insurance products that can protect all you’ve worked for, contact Stephen or Stuart Adams at 604-251-3571 or 1-877-251-4079, or email pharmacy@theadamsgroup.ca
CAREER OPPORTUNITIES ASSOCIATION CONTACTS
REXALL- Since 1904, Rexall has been a trusted name in retail pharmacy. Rexall is also the flagship pharmacy for Katz Group Canada, a leading drug store company and the largest integrated retail pharmacy network in Canada, with more than 1,800 corporate, independent and franchise pharmacies across the country. As the umbrella brand for a family of pharmacies including the Rexall, Rexall Pharma Plus, The Medicine Shoppe, Guardian and I.D.A. banners, Rexall is dedicated to the health and well-being of our customers and patients and strives to provide the best possible pharmacy care in a pharmacy first environment. Our long term care pharmacists and pharmacy technicians provide highly specialized clinical and medication management services for residents of nursing homes, retirement residences, assisted living facilities and group homes through dedicated pharmacies. If you are interested in applying or would like to learn more about the opportunities we have, please visit our website at www.rexallcareers.ca or contact a member of our team: Neerav Joshi, Pharmacy Recruitment Manager njoshi@rexall.ca SHOPPERS DRUG MART is one of the most recognized and trusted names in Canadian retailing. The Company is the licensor of full-service retail drug stores operating under the name Shoppers Drug Mart (Pharmaprix in Québec). With over 1,000 Shoppers Drug Mart and Pharmaprix stores operating in prime locations in each province and three territories, the Company is one of the most convenient retailers in Canada. At Shoppers Drug Mart, we have always remained true to our belief that the root of our success lies with our people. We pride ourselves on the quality and commitment of our employees who thrive on exciting challenges.
BUSINESS OPPORTUNITIES At PHARMASAVE we understand that you want to be in business for yourself, not by yourself. You can have the best of both worlds! Maintain your freedom and independence while having access to the most comprehensive retail and professional programs in the industry. Pharmasave’s proven products, programs and strong national Brand are always at your service. Pharmasave is unlike any other independent pharmacy venture in Canada. We are a true cooperative that is 100% member owned and governed. With Pharmasave, not only do you benefit from owning your own business, but you also share in the economic advantages of a 400+ strong group of stores. Plus, you will be an owner in an organization that delivers all of its profits directly back to you, the shareholder. Allow us to demonstrate the advantages of Pharmasave. If you are a store owner or a pharmacist interested in purchasing a pharmacy, or if you are planning on selling your business, please give us a call. Pharmasave’s only priority is you and your success! Contact: Dave Reston, CEO, Pharmasave Pacific, Tel: 604.575.5730 or 1.800.665.3344, dreston@pharmasavebc.ca Port Alberni - A super community pharmacy for sale. Viable Rx department. Price will include 2700 sqft. Strata lot. Easier financing if required. Alberni Valley economy is on rebound. Tel: 250.723.9323, Fax: 250.723.8221 Are you thinking of selling your pharmacy? OVERWAITEA FOOD GROUP may be interested. If you would like more information contact us at pharmacybuyer2012@gmail.com Listings have been edited for brevity – for complete job postings please visit www.bcpharmacy.ca
Geraldine Vance Chief Executive Officer 604.269.2860, Geraldine.Vance@bcpharmacy.ca Parkash Ragsdale Deputy CEO, Director, Professional Services 604.269.2862, parkash.ragsdale@bcpharmacy.ca Cyril Lopez Chief Operating Officer 604.269.2869, cyril.lopez@bcpharmacy.ca Kathie Taylor Director, Communications 604.269.2863, kathie.taylor@bcpharmacy.ca Elise Riedlinger Manager, Communications 604.269.2866, elise.riedlinger@bcpharmacy.ca Vince Lee Manager, Member Services 604.269.2867, vince.lee@bcpharmacy.ca Bryce Wong Manager, Professional Services 604.269.2865, bryce.wong@bcpharmacy.ca Riva Pickering Coordinator, Professional Services 604.261.2092, riva.pickering@bcpharmacy.ca Linda Tinnion Assistant, Member Services 604.269.2864, linda.tinnion@bcpharmacy.ca Ray Chow Database Administrator Member & Corporate Services 604.269.2868, ray.chow@bcpharmacy.ca Emilija Stanic Executive Assistant 604.269.2861, emilija.stanic@bcpharmacy.ca Starr Rempel Receptionist and Administrative Assistant 604.261.2092, starr.rempel@bcpharmacy.ca 604.261.2092, Toll-free: 1.800.663.2840 info@bcpharmacy
THRIFTY FOODS - Bring your professionalism and your dreams to Thrifty Foods new frontier and become an important part of our company as we grow together. Pharmacy manager and staff positions available. Thrifty Foods Pharmacy is committed to offering a comprehensive pharmacy service to these communities. Competitive wages and benefits. Interested candidates are invited to submit their resumes to Nafeesa Shaikh, Pharmacy Recruitment and Retention Specialist, Sobeys Pharmacy Group. Toll Free #: 1-800-790-0733 x. 7704, Phone #: (902) 468-1000 x. 7704 Fax #: (877) 662-1955
www.bcpharmacy.ca
Aug/Sep 2012
THE TABLET
31
Affinity BCPhA prescribed member discounts
BC Lions Canucks Car rental Cineplex Hotels around the world PNE and Playland Show tickets and much more!
About Affinity Rx Affinity Rx is a new BCPhA member benefit, offering exclusive and limited discounts as well as value-added services. Members may also share these offers with colleagues, friends and family.
Vancouver Whitecaps Save big on all ticket types!
PNE and Playland events
Save from $5 to $39 depending on the ticket type you choose!
Best prices in town for the Fair at PNE and Playland Adult passes!
Hotels around the world 10 - 15% cheaper than any other booking website
Lower bowl tickets! 10 - 15% off regular season 55% off pre-season
Las Vegas New York Orlando
Events, shows and restaurants Savings in Las Vegas, New York, and Orlando!
More upcoming offers! Wireless phone plans â&#x20AC;&#x201D; exclusive rates on premium packages Optical discounts â&#x20AC;&#x201D; 10% off the lowest price ...and many more!
HOW TO ACCESS THE DEALS Login to www.bcpharmacy.ca and go to the Member Support - Affinity Rx section or email vince.lee@bcpharmacy.ca