The Tablet - Oct/Nov 2014 Issue by BC Pharmacy Association

Pharmacist Patient Communication • Osteoporosis Awareness Month • Prescription Renewals in Residential Care

tablet

published by the British Columbia Pharmacy Association | www.bcpharmacy.ca | Volume 23. No. 5

Four generations of pharmacy

OCT/NOV 2014

Regulatory Compliance Support The BCPhA has developed policy and procedure

We have also developed a new Regulatory

manuals to support pharmacies in documenting policy

Compliance Bootcamp that addresses regulatory

and procedures that ensure operational activities are compliant with the regulatory framework governing

compliance issues and is designed to help mitigate the risks of penalties associated with audit assessments. It

pharmacy practice.

will also address privacy practices, as well as College of Pharmacists of BC regulations.

Manuals now available for download by Pharmacy (Corporate) members are:

√ √ √ √ √

Dispensary Activities Operation of a Community Pharmacy (UPDATED: August 2014)

Administration of Injections Methadone Maintenance NEW! Incident Management & Reporting

This workshop is essential for pharmacists, pharmacy managers and owners. It is a hands-on event using real life situations and the errors we have seen in many different audits. There is no other playbook on this topic. The first two sessions are scheduled for October 19 and November 9, 2014. More sessions coming soon.

Learn more at www.bcpharmacy.ca/regulatory-compliance-support

BCPhA eTraining

NEW! CPhA CPD Programs

Another member benefit.

Discounts for BCPhA members.

• Videos • PowerPoint with voiceovers • Interactive elements • Quiz questions

Complimentary programs now online

Special discounted rates on

New Expanded Access to Publicly Funded Vaccines

ADAPT Patient Care Skills Development

Frequency of Dispensing

QUIT (Smoking Cessation Program)

Joint Action on Joints

Lab Tests

A Health Care Consent or Privacy Consent?

Canadian Pharmacists Journal

NEW! Resume Guide for Pharmacists

www.bcpharmacy.ca/etraining

www.bcpharmacy.ca/cpha-benefits

THE TABLET

OCT/NOV 2014 | VOLUME 23. NO. 5

contents Senior Editor Elise Steeves 604.269.2866, elise.steeves@bcpharmacy.ca Advertising Sales Shannon Ward, OnTrack Media 604.639.7763, 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.

5 Mary Ackenhusen

BCPhA offices: #1530-1200 West 73rd Avenue Vancouver, BC V6P 6G5 telephone: 604.261.2092

14 osteoporosis awareness

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 Pharmassist: 1.800.667.2190 For confidential counselling referral for employment or addiction

16 four generations

related assistance Publication agreement #40810576

On the cover: Don, Tom, and Sam Nolan, of Nolan’s Pharmasave in Vernon, BC. Photo credit: Brandon Lal, UBC Faculty of Pharmaceutical Sciences.

Features

Columns

Regulars

Timely Prescription Renewals Residential care facilities and homes

President’s Message Demonstrating our value

Meet Mary Ackenhusen Vancouver Coastal Health

Osteoporosis Awareness Month

CEO’s Message Sorting out the lines of professional obligation

Clinicare Pharmacists Andropause and testosterone supplementation

Pharmacy Practice Support Flu season countdown

Career Listings Find a job in pharmacy

Government Relations Expect a lively fall session at the legislature

Member Services Managing your practice risk

The pharmacist’s role

On the Cover:

Member Profile: Nolan’s Pharmasave Four generations of pharmacy

Communication in Health Care Effective communication with patients

A voice for community pharmacy

Got a suggestion for an article in The Tablet? Email info@bcpharmacy.ca with your story ideas.

www.bcpharmacy.ca

Oct/Nov 2014

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SMALL TALK

In the news Save the date: 2014 Annual General Meeting

Start the conversation now – more than 360,000 publicly-funded vaccines were administered by pharmacists in the 2013/14 flu season and there are now more than 3,000 community pharmacists authorized to inject in BC.

The BCPhA’s Annual General Meeting is coming up on Saturday, November 22, at the Vancouver Marriott Pinnacle Downtown Hotel. This year’s AGM is being held on the same day and at the same venue as those of the College of Pharmacists of BC and the Canadian Society of Hospital Pharmacists - BC Branch. Registration for the BCPhA AGM will once again be handled by the College. More information will be available closer to the date.

BCPhA Member Survey In September, the BCPhA commissioned Canada’s leading research firm, Ipsos Reid, to conduct the 2014 BCPhA Member Survey.

If you’re doing a great job in your pharmacy promoting and offering flu shots, please email elise.steeves@bcpharmacy.ca – we’d love to share your story.

Shakeel Bhatti selected as CPhA representative On September 1, the BCPhA officially became a member of the Canadian Pharmacists Association (CPhA) as part of its new governance and membership model. Membership in the CPhA is now comprised of provincial pharmacist associations (PPAs) and select national pharmacist associations.

The survey aimed to gauge member satisfaction, priorities, and attitudes about the Association’s overall reputation and performance. Results are now being compiled and will be shared with members in the next issue of The Tablet and online at www.bcpharmacy.ca. Thank you to everyone who took the time to complete this year’s survey.

Flu season promotional materials This flu season, BCPhA Pharmacy (Corporate) members with at least one pharmacist authorized to inject will be receiving a number of promotional materials created by ImmunizeBC. Shelf talkers, bag stuffers and flu clinic date and time posters will be mailed directly to pharmacies in October to increase awareness among the public that community pharmacists can offer a quick and convenient option for this year’s flu shot.

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Oct/Nov 2014

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Each association selects a representative to sit on the Board of Directors, which will also include up to six skill-based individuals. The BCPhA Board of Directors has selected Shakeel Bhatti to represent our Association. Shakeel was on the BCPhA Board from September 2008 until August 2014, and was president from 2010 to 2011. He recently sold his group of independent pharmacies in Langley, and is now concentrating on independent pharmacy consulting, entrepreneurship and teaching. The criteria for selecting the BCPhA’s representative included someone who has recent Board experience, an understanding of our Association’s goals and interests, the ability to speak to the current climate in BC, is well-versed in governance, and can work to protect the interest of BCPhA members.

MEET MARY ACKENHUSEN, VANCOUVER COASTAL HEALTH

Meet...Mary Ackenhusen President and Chief Executive Officer, Vancouver Coastal Health quality and efficiency. Mary’s passion is to transform the current public health care system that we cherish as Canadians in a manner that will ensure its future financial sustainability in the face of growing demand and finite government funding. An engineer by training, she intends to do this by supporting staff, physicians and partners in the introduction of new service models that will provide better care, at lower cost, while also exploring the use of technology, analytics and electronic health records to improve productivity. Prior to joining VCH, Mary served on the Fraser Health Authority’s leadership team for almost a decade. She led Fraser Health’s facility planning and real estate, systems analysis and performance improvement, and new business development. In 1990, she became director of quality and operations at INSEAD, an international business school based in Fontainebleau, France. Mary is a graduate of the Harvard Business School’s Master of Business Administration program and the West Virginia University’s Industrial Engineering masters and undergraduate programs. In 2013, she was named one of Canada’s Most Powerful Women by the Women’s Executive Network. As president and chief executive officer of Vancouver Coastal Health (VCH), Mary Ackenhusen leads the largest academic and tertiary health authority in British Columbia, serving a population of one million with a budget of $3 billion. As a member of the VCH Senior Executive Team since 2007, Mary has distinguished her collaborative leadership style by fostering a patientcentred approach to care, innovation and the redesign of services to enhance

What do you consider your greatest achievement? The leadership teams that I have built. We all want to work on a high performing team, and I think I have been able to create this caliber of team in most of my leadership positions in health. What do you most value in your colleagues?

and optimism to keep trying, even when it is not easy. What is your most marked characteristic? Hiring great people. Which talent would you most like to have? A photographic memory that would allow me to remember faces and names. How would you spend your perfect day? A summer day on Salt Spring Island: trail riding my horse in the morning, kayaking in the afternoon, and having a wonderful family dinner on the deck at night cooked by my son who is an extraordinary chef. I already miss summer! What would you like to accomplish in the next five years? I would like to see VCH firmly on a path to modernize its delivery of health care through technology, a single patient record, and new models of care. I’d also like to see the VCH culture continue to evolve to truly become a place where we can each do our best work every day. What role do you see for pharmacists in the development of new models of care? Like all the professions, pharmacists need to aggressively adapt technology into their practice so that we can ensure that we are minimizing errors, complying with best practice and becoming more cost effective, all at the same time. This, I believe, is the key to the sustainability of our health care system.

Their strong values that drive them to do the right thing, and their persistence

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Oct/Nov 2014

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DAVID PAVAN | PRESIDENT

Demonstrating our value

The 2014/15 fiscal year has officially begun at the BC Pharmacy Association, and I am excited to be stepping into the role of president for this term. I am confident it will be a year filled with positive change and it has already started as we officially became a member of the new Canadian Pharmacists Association on September 1. As part of CPhA’s new governance model, we are joining provincial pharmacy associations across the country to give pharmacy a stronger pan-Canadian advocacy voice. Most importantly, as decisions made by the Council of the Federation are affecting all provinces, this will give British Columbia's pharmacists a voice at the national level. The new structure of the CPhA will give us the ability to influence changes affecting our profession and the health care system both provincially and nationally. In addition, for BCPhA Pharmacist members, this means increased access to a number of benefits. These include significant discounts on continuing professional development programs, national conference registration rates, opportunities to earn free CEUs with CPhA’s e-Therapeutics Highlights CE, and access to national and international research and reports. When the Board and senior staff at the Association met for the strategic planning session for this fiscal year, a lot of discussion centered on the BCPhA’s value to our members. We want to ensure our strategic direction will continue to allow us to thrive as an association and most importantly as a profession. In the year ahead, developing new training opportunities, focusing on ways to secure new revenue streams for members, and the advocacy work being done with government will all continue to be priorities for the organization. As well, one of our key objectives is assessing risk and developing strategies to deal with adjudication issues both with PharmaCare

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Oct/Nov 2014

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and third-party payers. The BCPhA Audit Task Force will continue its work to ensure a fair process while the Association provides members with advice and support on audits. We remain committed to this but, as you’ll read in the CEO's column, as practicing pharmacists, we also have the responsibility of meeting our own legal and contractual requirements when it comes to dispensing and documentation. Personally, an important focus in the year ahead will be working collaboratively with the College of Pharmacists and the ministry of health on issues affecting retail pharmacy. As pharmacists, this is a very exciting time for the profession. We are shaping the future of pharmacy as we move to a patient-centric practice from a product-centric one. Unfortunately, we find ourselves where we were three years ago with respect to our scope of practice and this needs to change. Pharmacists are being challenged to prove our value in delivering cost-effective services and improving patient outcomes while decreasing the financial impact on the health care system. As a profession, this has been clearly demonstrated with the incredible success of pharmacists immunizing. Much work lies ahead with the government and CPBC bylaws in making changes that will expand the practice of pharmacy and ultimately improve the health and quality of life for British Columbians. Finally, I want to express my gratitude to the 2013/14 Board, and to our past-president Don Cocar, for all the hard work over the past year. I would also like to welcome our two new Board members, Glen Schoepp and Mark Dickson. I look forward to meeting many of our members in the busy year ahead.

GERALDINE VANCE | CEO

Sorting out the lines of professional obligation

In my now nearly three years with the Association, one thing I have come to know is that pharmacists are health care professionals who take their commitment to their patients seriously. This was something I didn’t truly appreciate until I took on my current position. I had always enjoyed a good relationship with my community pharmacist and they had always given me good advice. But somehow I didn’t think of them in the same way as other health care professionals in terms of them seeing me as their “patient.” The notion of continuity of care from my pharmacist wasn’t something I really thought much about.

For many months our priority has been sorting through the various problems that have emerged with PharmaCare audits. We have looked closely at the College of Pharmacists’ bylaws and professional practice standards, PharmaCare policy and the audit team's adjudication of the various policies. And we’ve found some problems. Our Audit Task Force submission (www.bcpharmacy.ca/ submissions-to-government-public) identifies the major issues we believe need to be addressed to make the audit process fair and transparent.

“Meeting one’s professional and ethical requirements has to start first and foremost with meeting all legal requirements.”

But, I have since come to understand that pharmacists seek to build the same longitudinal relationships with their patients as do physicians. Just like the best family doctors, the best community pharmacists aim to understand their patients and the issues that affect their health, and establish trusting relationships that stand the test of time.

I also now know that this commitment to patient care and desire not to disrupt continuity of care sometimes has pharmacists challenged to meet what they see as their professional obligations with the need for administrative compliance with payers and compliance with legal requirements. All self-regulated professionals face the dilemma of balancing what they perceive to be their obligation to uphold professional standards and ethical obligations with external legislation and other requirements such as contractual obligations from payers of their services. Lawyers, doctors, dentists, architects, accountants and pharmacists all must wisely use the right of professional judgment they have been granted. And they all face the same balancing act of meeting all the standards of professional good conduct, not just some.

And, we are pleased to have worked with the College to seek an important change to the bylaw related to the requirements of a prescription record (www.bcpharmacists.org/about_us/ key_initiatives/index/articles/32.php). This will eliminate some of the audit penalties that have been imposed. Also, the College of Physicians and Surgeon of BC has worked with us on the issue of getting appropriate physicians’ signatures and has provided clear direction to their registrants on the need for each prescription to have a unique “wet” signature. What we have also found is that there is a widespread view among pharmacists that their “ethical” obligations and commitment to their patients can be used as a rationale to explain noncompliance with the administrative and contractual requirements of PharmaCare, other payers and provincial legislation.

continued on page 8

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Oct/Nov 2014

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CEO'S MESSAGE/NEW MEMBERS

While I understand where this line of thinking comes from, there really shouldn’t be a choice between ethics and administrative/legal compliance. Furthermore, one should remember that ethical behavior isn’t just about doing whatever it takes to meet the patient’s needs but rather means practicing within the confines of the law. Meeting one’s professional and ethical requirements has to start first and foremost with meeting all legal requirements. For example, in the case of pharmacy, the law says a prescription issued by a physician to a patient in the general community is only valid for one year. And pharmacists are obligated to only dispense legal prescriptions. So, no matter how sad a story a patient has, how long you have known them or how bad their health situation is, no pharmacist should dispense any medication to a patient when a valid prescription is not available. To do so puts the pharmacist at enormous risk – the audit penalty is the least of the problems in this situation. Perhaps the greatest risk of all relates to malpractice insurance coverage. Like all insurance, malpractice insurance will not apply to claims arising from practice outside of legal limits.

Welcome to the newest members of the BCPhA! Pharmacist (General) members: Alaa Amara, Kenneth Berg, Leizl Camacho, Ken Choi, Phillip Curran, Marisol De Leon, Nazneen Dhaliwal, Prabhjeet Dosanjh, Sameh Elbably, Khaled Ezzeldin, Lisa Forster,Rushita Gandhi,Danielle Ghag, Paul Gibbons, Jaya Prakash Gunda, Marla Hamann, Mariam Henein, Charnjit Herr, Jillian Hewitt, Lianne Ho, Maryam Houshmand, Shirley Imperial, Sali Iskander, Gunveen Kaur, Narmin Khimji, Manish Khullar, Dong Hyun Kim, Jung Yeon Kim, Seon Ah Kim, Ana Latis, Koon Yan Lee, Hardikkumar Matalia, Joshua McPherson, Jonathan Meyers, Rory Miller, Alana Minty, Stephanie Mo, Vijay Murthi, Kenji Nakajima, Asghar Nandan, Samuel Nolan, Nazar Osman, Sneh Parikh, Ankur Patel, Dhruti Patel, Dilenkumar Patel, Megha Patel, Natasha Patel, Nikulkumar Patel, Priyank Patel, Tushar Patel, Cindy Preston, Wade Rains, Mohammad Sarkar, Karen Schmelzle, Colleen Schultz, Krupen Shah, Nimesh Shiyaniya Aka Patel, Sukhjinder Sidhu, Vishal Sukhadiya, Jesse Tottle, Mohamed Toubar, Nicole Tsao, Lily Van, Charyl Villar, Valerie Weber, Paul Woodward and Rania Zoarob.

Pharmacy (Corporate) members: Corning Drugs Ltd., Peoples Pharmacy #288, Shoppers Drug Mart #2287, Surlang Medicine Centre Pharmacy, Target Pharmacy #T-3508, Target Pharmacy #T-3534, Target Pharmacy #T-3548, Target Pharmacy #T-3557, Target Pharmacy #T-3575, Target Pharmacy #T-3586, Target Pharmacy #T-3616, Target Pharmacy #T-3617, Target Pharmacy #T-3690, Target Pharmacy #T-3698, Target Pharmacy #T-3719, Target Pharmacy #T-3739, Target Pharmacy #T-3744 and Target Pharmacy #T-3760.

I know this position seems harsh and may be at odds with common wisdom in the pharmacy community. No one wants to tell a patient they can’t help them. But the hard truth is that sometimes this is the only option. If a patient urgently needs their medication and they can’t see their regular doctor, sending them to a walk-in clinic or the emergency department may be the only option. But one thing’s for sure: acting outside of legislated and contractual requirements will have its price.

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DEREK DESROSIERS | DIRECTOR, PHARMACY PRACTICE SUPPORT

Flu season countdown

Last year, a number of pharmacies in Vancouver Island Health Authority took part in a pilot project exploring a new distribution model for publicly funded flu vaccine. Pharmacies ordered this vaccine directly from a qualified pharmaceutical wholesaler rather than picking it up from their local health unit. This proved to be a very successful project, with both pharmacies and health units saying it reduced the administrative resources required to manage and procure inventory.

Eligibility criteria for publicly funded flu vaccine remain the same as last year. For further details visit www.bccdc.ca/dis-cond/commmanual/CDManualChap2.htm or www.bcpharmacy.ca/flu-resources.

We hoped this process would be implemented across BC, but government funding could not be secured for the 2014/15 flu season. So, for now pharmacies will pick up publicly funded flu vaccine at health units as in the past. We are continuing to pursue this with provincial immunization stakeholders, and by next year it is our intent to have a government-funded wholesale distribution model in place.

It’s been five years since the first few hundred pharmacists were trained to administer injections and since then thousands more have come onboard with this scope of practice. To assist pharmacists in maintaining best practices around patient assessment, intramuscular and subcutaneous injection technique, management of adverse events, and clinic management – in addition to supporting those who may not have given many injections in recent years – we have developed a live Vaccine Administration Refresher Program. This program will be a half-day in-person workshop where you’ll receive up-to-date information about vaccines and administration processes, and have an opportunity to practice your vaccination technique in front of our experienced team of pharmacist and nurse trainers.

Once again, pharmacies are invited to participate in ImmunizeBC’s flu clinic locator. It’s an important tool that informs the public where they can access flu vaccine. ImmunizeBC is updating the locator, so the process for entering your pharmacy data may change – further details will follow soon. This year’s publicly funded flu vaccine products will be Fluviral, FluAd and Agriflu. The Province has also ordered a limited supply of FluMist; however, FluMist will not be made available to pharmacists as it remains outside our scope of practice to administer it. We continue to work with the ministry of health on the required legislative changes to allow pharmacists to administer intranasal vaccine. A reminder that BC does not have a universal flu vaccine program and only patients who qualify for publicly funded vaccine are eligible to receive it. Pharmacies should attempt to target eligible patients at greatest risk of harm from the flu with the publicly funded supply. Be clear in how you promote vaccine services to the public, as there have been several reports of miscommunications around publicly funded vaccines being offered without regard to eligibility. Remember, you may only bill PharmaCare using the PINs for Publicly Funded Vaccine Administration when administering publicly funded vaccine to an eligible patient.

The capacity of pharmacists to administer flu vaccines in BC has yet to plateau. If the trend of previous years continues, it’s likely we’ll administer more than 400,000 vaccines over the 2014/15 flu season! Vaccine Administration Refresher Program

eTraining Two new influenza courses have been developed by the BC Immunization Committee (BCIC) Professional Education Working Group (PEWG), of which the BCPhA is a member. Foundations of Influenza: Disease & Vaccines: for those new to flu immunizations, as well as those who want in-depth information on the disease and/or vaccines. Seasonal Influenza Update – 2014/15: for those who have taken the Foundations course and/or experienced clinicians wanting an update for this flu season. Watch for more information on these courses and Vaccine Administration Refresher workshop dates in Practice Update and at www.bcpharmacy.ca.

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Oct/Nov 2014

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REGULATORY COMPLIANCE SUPPORT

Timely prescription renewals in residential care facilities and homes In August, the Canadian Medical Association released a study that confirmed there are too few health care workers to serve the growing number of residents in long-term care facilities – and the problem is only going to get worse. Pharmacists in British Columbia who serve patients in these facilities and homes (as defined in the Health Professions Act – Bylaws, Schedule F, Part 3 – Residential Care Facilities and Homes Standards of Practice) know just how real the problem is, notably when it comes to getting prescribers to renew prescriptions in a timely fashion. Physicians are often faced with having to look after the needs of too many patients and sometimes the paperwork lags. For many years pharmacists have taken the risk of not being compliant with their PharmaCare contractual obligations and College of Pharmacists of BC ethical and legal obligations in the name of good patient care. They have dispensed medications to patients in these facilities, who are on established regimens, when their prescriptions have expired based on their experience that the physician would ultimately complete the renewal documentation. In some cases pharmacists would use the emergency prescription refill provisions to bridge the gap between prescription expiry and renewal. This is the only action that is appropriate. Continuing to dispense any medications, under any other circumstances after a prescription has expired, is illegal. Over the past couple of years pharmacies have received heavy audit penalties for not receiving the appropriate, timely renewal of prescriptions from prescribers and/or for not doing the appropriate documentation to support emergency refills. The financial penalties are significant – PharmaCare has issued penalties of hundreds of thousands of dollars to individual pharmacies.

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Over the summer, the BCPhA engaged in discussions with the Ministry of Health Audit Team and the Medical Beneficiary and Pharmaceutical Services Division (MBPSD) to address this issue. Their initial position was that pharmacists should bear the burden of tracking down physicians to get the renewals – make as many calls and send as many faxes as needed to get the renewal. They indicated that emergency refills should be used only in the rarest of circumstances. In our view the position they took essentially alleviated the physician’s responsibility to make timely renewals of medications for their patients in residential care facilities and homes a priority. It placed pharmacists in an untenable position. So, we made it clear to the ministry that we rejected this approach. Our discussions led to an agreement with the ministry that a standard renewal notification process for physicians needed to be in place. The suggested protocol we agreed to is as follows: • Pharmacists should not continue to dispense medications beyond the expiry date of a prescription to any patient. This is not appropriate or legal. Regardless of the motivation a pharmacist has for doing this, it is not acceptable. • Pharmacists will provide prescribers with patients in residential care facilities and homes with 30 days notice that a patient’s prescription is set to expire. • In the event renewal authorization is not received by the date a prescription expires, the pharmacist may use the emergency prescription refill provisions and must complete all needed documentation to support this action. A 14-day supply of the medications may be dispensed.

• If a renewal is not received at the end of the 14-day emergency prescription refill period, dispensing to the patient can stop. There is no legal basis to continue to dispense medications if a current prescription has expired. And, PharmaCare will not reimburse for any medications or dispensing fees beyond this point until a valid prescription is in place. Input into this protocol and template forms was sought from physician organizations and the College of Pharmacists of BC. The protocol has also been shared with most long-term care facilities across the province, the BC Care Providers Association and the Ministry of Health. As of October 1, 2014, we recommend employing this standardized approach. More information and templates are available on the members’ side of www.bcpharmacy.ca under Pharmacy Practice Support – Regulatory Compliance Support – Residential Care Facilities & Homes.

All members of the health care team must do their part to provide patients in long-term care and group homes with the highest quality of care possible, despite the challenges this presents. For pharmacists, that means taking the appropriate level of responsibility within their scope of practice and meeting documentation and legal requirements. This protocol and the templates on the BCPhA website have been created to support members’ efforts to obtain timely prescription renewals for residents of long-term care facilities. Members who experience difficulties with obtaining these renewals are encouraged to contact the BCPhA for support. Note: Portions of this article have been modified from the August 20th CEO Update and September 30th E-blast.

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GOVERNMENT RELATIONS

Expect a lively fall session at the legislature by Letlotlo “Coco” Lefoka The provincial legislature resumes sitting on October 6, 2014. MLAs spent the summer in their ridings while cabinet ministers were busy meeting with stakeholders and moving policy files forward. The BCPhA was able to meet with the minister of health on August 6, and that discussion led to incremental progress on the issue of prescription renewals in long-term care facilities.

On the health front the Province announced plans to move forward on the construction of a new patient care tower at Penticton Regional Hospital and a new Teck Acute Care Centre at BC Children’s Hospital. Also noteworthy was the Province’s review of opioid substitution treatment. A report

tax and a "lack of appropriate incentives." Achieving the government’s dream of a $100 billion prosperity fund created with LNG revenues now faces challenges. The government also faced the teachers’ strike during the summer. The strike began

“For the government the summer saw political victories, setbacks and labour discontent.”

Though things were quiet in the legislative chamber, BC’s political scene was not. New NDP leader John Horgan began rebuilding his party after it was surprisingly trounced in the 2013 election. Horgan overhauled his party’s critics, leaving the impression that his NDP wants to connect with the hard hat voter it lost last year. Judy Darcy has retained her health portfolio.

published by Provincial Health Officer Dr. Perry Kendall on August 7 concluded that “methadone saves lives and lowers health care costs.” Though the government secured wins in these policy areas during the summer it also faced a number of roadblocks. A breach at a mine in the Cariboo (Mount Polley) affected waterways, dealing a blow to public confidence in mine safety. Mining is a key pillar in the government’s economic agenda.

For the government the summer saw political victories, setbacks and labour discontent. Premier Christy Clark returned from the premiers’ conference in Charlottetown with an agreement signed with Alberta and Saskatchewan that committed the three provinces to reviewing improvements to “liberalize trade, particularly in the area of occupational health and safety by March 31, 2015.” The government had good news for British Columbians on the fiscal front, announcing the budget remained balanced despite financial challenges from natural disaster costs (fires and floods). The finance minister projected a year-end surplus of $266 million for 2014/15 in his fiscal update on September 9.

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The liquefied natural gas industry (LNG) that the government won its election on now faces challenges. Across the Pacific, Russia and China signed a $400 billion gas deal giving BC stiff competition in the Asia-Pacific LNG market. Additionally, an LNG project planned for Kitimat now faces an uncertain future after one of its US partners backed out, while a Malaysian company has warned it was prepared to withdraw from its $10 billion LNG project because of a delayed regulatory approval process, plans by the provincial government to impose an LNG

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on June 17, dragging on until a deal was reached on September 13. Many wondered why government would not go to arbitration and endure a lengthy fight with teachers given that school strikes frustrate parents – a very powerful voting bloc found in every riding. One reason is that government has been burned by arbitrated wage settlements before, most significantly a decade ago with doctors. That dispute saw doctors awarded a settlement that prompted a tax hike. That painful lesson and concerns that the 160,000 public employees without contracts for the current bargaining cycle would demand comparable deals explains why government was unyielding. In the end the deal reached with teachers met the government’s fiscal objectives. These factors – a determined government, LNG challenges, a budgetary surplus, labour negotiations and an opposition looking to regain its footing – should all contribute to a lively and boisterous session when MLAs return to Victoria this October.

CYRIL LOPEZ, CHIEF OPERATING OFFICER

Managing your practice risk You can and must take steps to mitigate the risk: we can help honest errors is high, so you need robust risk mitigating processes to avoid an assessment of $200,000. To my knowledge, none of those audited kept aside $200,000 for audit clawback. We believe that these errors are preventable if error prevention steps are adopted.

In the previous issue, I touched upon the risk exposure in professional practice and noted the strategies to manage that risk. I hope it triggered some reflection on your practice’s processes. The pharmacy environment has changed, particularly in the last three years. Payers are determined to bend their cost curve. This is why you need to become more aware and comply with the “technical” (legislation and regulations) issues around your practice. Members are opening assessment notices of $200,000 to $900,000 or being closed down. Non-compliance is expensive, whether you operate an independent or chain practice. And, it is not just “bad pharmacists.”

So what is the BCPhA doing about supporting members to improve error prevention? We have developed multiple resources available on the members’ side of www.bcpharmacy.ca under Regulatory Compliance Support.

The other day a Common Not signed/ No renewal Dispense not errors and dated by prescription handwritten Missing member said to or DD prescription physician at 180 days costs me that patient information and 10% 0% 0% 4% Pharmacy1 payer audit issues 5% 7% 0% 1% Pharmacy2 are really the owner’s problem. 5% 0% 88% 0% Pharmacy3 I beg to differ. 0% 37% 0% 0% Pharmacy4 Pharmacy is a practice and Dollar value $42,670.61 $272,314.02 $29,053.72 $27,226.11 hence it is the practitioner or registrant who is held accountable. You can see that in the Code of Ethics under Standard 1. d) Registrants are knowledgeable of, and adhere to, national and provincial legislation, standards of practice and policies relevant to the practice of pharmacy and in the Health Professions Act bylaws, Section 74. Storage of Personal Information: A registrant must ensure that all records pertaining to his or her practice, and containing personal information about patients are safely and securely stored (a) at the pharmacy, or (b) off site.

Different prescriber in Expired PNET prescription

Missing RPh/Patient signature

Alteration to prescription Qty qty mismatch

Refill auth missing

FOD/Plan C

21%

11%

28%

20%

19%

51%

13%

$49,591.39 $170,445.77 $65,713.37 $50,460.92 $5,622.69

$2,024.41 $55,420.76

To support members in enhancing their error prevention processes, we’re launching a Regulatory Compliance Bootcamp series on October 19, and will hold more sessions depending on demand. This is for every pharmacist registrant, not just managers or owners. It is a hands-on workshop, using real life situations and the errors we have seen in audits. There is no other playbook on this topic; we need to fix it ourselves.

Compliance is heavy-lifting and mundane but is a major investment in your practice as well as the bottom line as an owner. Can you afford to be progroup_ad_v3.ai 13/11/2008 4:23:24 PM Above is an extract of some recent audit assessments. There are 11 common responsible for a $200,000 audit assessment? error types in these four examples and the assessments totaled $770,000. That means the pharmacy service was nullified even though the service was rendered and the patient consumed the drug. So if the practice does not change, the result will be the same at the next audit visit: NEW CAR PURCHASE PLANS another $200,000 assessment. C

The question to ask is: are these errors avoidable? Whose responsibility is it to reduce the incidence of such errors? Given the busy nature of your practice and the complexity of the various rules, the probability of

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NOVEMBER IS OSTEOPOROSIS MONTH

Osteoporosis and the pharmacist’s role by Elise Steeves More than two million Canadians are affected by osteoporosis. According to Osteoporosis Canada, each year hundreds of thousands needlessly experience debilitating fractures because osteoporosis is undetected and untreated. These cost the Canadian health care system an estimated $2.3 billion annually. At least one in three women and one in five men will suffer a broken bone from osteoporosis during their lifetime. In fact, more than 80 per cent of all fractures in people over the age of 50 are osteoporosis-related. However, these fractures can be prevented and the disease can be well managed – and pharmacists have an important role to play. What is osteoporosis? Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fracture, particularly of the hip, spine, wrist and shoulder. It is often known as “the silent thief” because bone loss usually progresses without symptoms until a fracture occurs. In some cases, bones can become so fragile that fractures occur spontaneously or as the result of minor

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Oct/Nov 2014

bumps, falls, or normal stresses such as bending, lifting and even coughing. Although osteoporosis was once viewed primarily as a disease of old age, it is now recognized as a disease that can stem from less-than-optimal bone growth during childhood and adolescence, as well as from bone loss later in life. Normal growth and development of bone As we age, our bones increase in size and strength until we reach peak bone mass around ages 16 to 20 for women, and ages 20 to 25 for men. By our mid 30s, both genders naturally begin losing bone mass at a rate of one-half to one per cent per year. Women lose bone at an accelerated rate during the first 10 years after menopause. In contrast, men lose bone more slowly as they age, with a higher rate of loss after age 65. Bone is a living tissue that is constantly renewed through a process where old bone is removed and replaced by new bone. Cells called osteoclasts erode the bone, creating small cavities; boneforming cells called osteoblasts then fill in the cavities with new bone. Bone loss occurs with age because new bone is not laid down at the same rate as older bone is lost.

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Drug treatments Common osteoporosis medications: Bisphosphonates are the most common family of drugs used to treat osteoporosis and are part of the group of medications called antiresorptives. Four bisphosphonates are currently used for osteoporosis in Canada: alendronate (Fosamax®, Fosavance® and generics), risedronate (Actonel®, Actonel DR™ and generics), zoledronic acid (Aclasta® and generics) and etidronate (Didrocal® and generics). Bisphosphonates bind to the surfaces of the bones and slow down the bone resorbing action of the osteoclasts. This alters the balance between the osteoclasts and the osteoblasts such that bone loss is usually stopped and bone strength is improved. Denosumab (Prolia®) belongs to a new class of osteoporosis treatment called a RANK ligand inhibitor. It inhibits the development and activation of osteoclasts. Although it works in a unique way compared to other osteoporosis agents, it is part of the antiresorptive group of medications. Hormone therapy (HT) is commonly used to relieve the symptoms of menopause and is also an effective treatment to help reduce the risk of osteoporotic fractures.

Treatment can consist of estrogen alone or estrogen and progesterone in combination. Parathyroid hormone (PTH) and its related drugs are part of a class called bone formation agents. Teriparatide (Forteo®) is the only drug from this class currently available in Canada. It works by activating the osteoblasts, creating new bone faster than old bone can be resorbed. Raloxifene (Evista®) is from a family of drugs called SERMs (Selective Estrogen Receptor Modulators). Although SERMs are non-hormonal, they act like estrogen in some parts of the body, including the bones where they can be used to treat osteoporosis. The pharmacist – the first line of defence is maintaining good bone health For many Canadians, community pharmacists are their first source for daily health and wellness information, including bone health. Pharmacists can inform patients on managing their bone health and how to decrease risks; the importance and recommended intake of calcium and vitamin D; drug management when taking supplementation; and common food sources with calcium.

“Pharmacists play a key role in the education, treatment and support of osteoporosis – from instructing patients on how to accurately take their medications, to providing information to the public on the benefits of calcium and vitamin D and supporting families on making bone health a priority,” said Dr. Famida Jiwa, president and CEO of Osteoporosis Canada. “They are a wealth of knowledge and readily accessible when members of the community are in need of medical and health information.” It’s also important for pharmacists to get involved with screening and prevention because of their accessibility, said Pindy Janda, a London Drugs pharmacy manager in North Delta. London Drugs has been providing Osteoporosis Screening Clinics for the past 12 years, and has continuously updated their technology and sophistication. “In these screening clinics, we perform a non-invasive test to check bone strength. And, along with patient history screening, we provide detailed counselling about minimizing risk,” said Pindy. “Osteoporosis has modifiable risk factors that can be identified by the pharmacist.

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I ask patients about their level of physical activity, in particular loadbearing exercise, as well as the amount of calcium-containing foods they have in their daily nutritional intake.” Patient feedback on the clinics has been very positive, said Pindy. “Patients greatly appreciate having personalized care plans prepared for them during their screening tests. There’s an opportunity for discussion and any patient concerns can be addressed in a personal setting.” Beyond the formal screening clinics, pharmacists often encounter questions about osteoporosis from patients, and Pindy said they can provide counselling on calcium supplements and the importance of vitamin D. “Ask patients about how much dairy they consume in a day – it’s a good starting point for the conversation,” she recommended. “For example, an eight ounce glass of milk contains 300mg of calcium. Most patients should be aiming for more than 1,000mg/day of calcium.” As part of November’s Osteoporosis Month, why not reach out to your patients, too?

Oct/Nov 2014

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MEMBER PROFILE: NOLAN’S PHARMASAVE

All in the family: Four generations of pharmacy by Elise Steeves

When Sam Nolan graduated from the University of British Columbia’s Faculty of Pharmaceutical Sciences in May of this year, he had some pretty big shoes to fill. Not only was he joining the ranks of his father, Tom, and grandfather, Don, who had become community pharmacists before him, but he was set to work at his family business in Vernon, BC – Nolan’s Pharmasave – that was established in 1927 by his greatgrandfather, Hazel, and his brother, Chester. “We have a lot of seniors in our community who seemed to recognize me right away, before actually knowing my name,” said Sam of his first experiences at the pharmacy. “They always say I must be a Nolan; I have my grandfather’s look!” While his old kindergarten journals reveal that at five years old he already wanted to be a pharmacist, at times Sam said he

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went back and forth with the decision. In 2004, he began working as a staff member on the front tills, and progressed his way from stocking shelves into the dispensary as a pharmacy assistant. “It’s always given me a sense of home and made me feel connected to my grandparents,” he said.

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The original Nolans: Hazel (above) and brother Chester (below), completed their pharmacy training at Stanley Park Pharmacy Ltd. on Robson Street in Vancouver in the 1920s.

Three generations of pharmacists: grandfather Don, father and pharmacy manager Tom and recent pharmacy graduate Sam Nolan.

After completing two years of medical biochemistry at UBC’s Okanagan Campus in Kelowna, Sam knew his passion for pharmacy wasn’t going away, and made the trek to Vancouver and UBC to complete the four-year program. “A Nolan had graduated from UBC exactly every 30 years since 1927,” said his father, Tom. “In 1927, 1957, 1987 and now 2014. Sam kind of upset the rhythm by graduating early!” As pharmacy manager at Nolan’s Pharmasave, Tom said he too knew from an early age that he would follow in the family business. “I grew up in the pharmacy and was exposed to it my whole life. Part of it is I was well-aware of the lifestyle the profession provided. As a pharmacist you have to be a people-person and as pharmacy manager or owner, you have to be someone who loves the retail world to stick with it this long, because it certainly does have its challenges.” It’s the recent shift towards a more clinical approach for pharmacists that has been

the biggest change on a professional level, said Tom. On a business level, his concerns lie with the challenges and time-consuming process of dealing with PharmaCare and third-party payers. Yet Nolan’s Pharmasave continues to strive to expand its clinical services. A compounding pharmacy, the location does a lot of hormone replacement therapy and veterinary prescriptions, and includes a clean room for injectables and ophthalmics. It services the local hospice house and has a palliative care specialist pharmacist available 24 hours a day. With a population of approximately 40,000, Vernon is far from being considered rural, yet still has the benefits of a close-knit community of health providers. “We’re certainly familiar with all of the local physicians’ signatures, names and voices, which makes authenticating prescriptions a lot easier,” said Tom. He noted the industry has grown quite drastically in recent years, with 18

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community pharmacies now located in the small city. To adapt to the situation, Nolan’s recently expanded beyond its full-service pharmacy footprint to open two smaller clinical locations: one inside a medical office, and a second within Vernon Jubilee Hospital. Also under the Pharmasave banner, the hospital location is still a full-fledged community pharmacy, serving not only emergency room and discharged patients, but also providing a convenient location for hospital staff and neighbourhood residents. After only a few months of operation, the location has also allowed them to expand into new areas of clinical services. “It’s been quite an interesting experience as various hospital departments begin trusting us and relying on our pharmacists for more services,” said Tom. “Programs that departments may be stressed over and not had enough time for are being slowly moved to our pharmacy, such as the anticoagulation program.”

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MEMBER PROFILE: NOLAN’S PHARMASAVE

Traditionally when patients are discharged with deep vein thrombosis or coagulation issues, they go through a brief teaching program provided by the hospital, followed by seven days of injectable therapy with daily INR monitoring before bridging over to oral warfarin or other anticoagulation medications. Since the new pharmacy has opened, Vernon Jubilee Hospital has rolled that process over to Nolan’s community pharmacists. “Patients are still required to do five to seven days of daily lab visits, but now our pharmacists monitor patients’ daily lab values and adjust their warfarin dosage, instead of having the strain put on the emergency department,” said Tom. Like many community pharmacies, they also run diabetes programs that focus on meter training, insulin training and devices. It’s a process that continues to evolve and look for ways to enable

pharmacists to perform some of the more clinical parts, while the in-hospital diabetes educators continue to focus on a dietary and nutritional approach. “Most importantly, the pharmacy can capture patients before or immediately after they’re discharged,” Tom said. “It’s a very good step for most diabetics, and it’s been great seeing our staff become increasingly comfortable with counselling procedures.” Sam is also looking forward to implementing some of the transitional outpatient care programs now that the hospital location is in full-swing. “In the future I see pharmacists playing a much bigger role, including daily follow-up and contact in outpatient care immediately following discharge from hospital,” he said, “Especially for new diagnoses such as heart attack or stroke,

A simpler time: Just dial 2-9 to reach Nolan’s Druggists and Stationers.

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Oct/Nov 2014

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or chronic disease in more severe stages such as heart failure or COPD.” Sam feels it’s an area where there is a disconnect in BC’s health care system, resulting in re-admissions and wasted health care money. “There are lots of opportunities for pharmacists to enhance continuity of care.” Nolan’s Pharmasave certainly puts a new spin on continuity of care as it nears its ninth decade in business, and there’s a large population of patients that trust the Nolan name and rely on its quality of service. “After being here for 87 years there’s a significant loyalty factor to our customer base,” said Tom. “We often see multigenerational customers – grandchildren of the original customers – and they share stories about things that they find in their attics relating to old memorabilia.”

Pharmacists Jim Carrie, Don Nolan, Monte Morden and Larry Fischer (left to right) bought the pharmacy from Hazel Nolan and joined the Pharmasave program in the 1980s.

He pointed to a particularly poignant example – old prescription labels and advertising with the pharmacy’s original phone number. “Back when you only needed two digits to call somebody – you just dialed 2-9 to reach the pharmacy!” Nolan’s Pharmasave remains in the original building from the early 1900s,

one that also sits proudly on the City of Vernon’s heritage registrar. “It’s a turn-of-the-century building and we love to embrace the history,” said Tom. But with pharmacy continuing to move forward, there are some aspects of history Tom – and Sam – are happy to leave behind.

“A customer came in recently, an older gentleman who’d be coming to the pharmacy since the 1940s, and he recalled seeing my grandfather and his brother smoking cigars in the dispensary,” said Tom, laughing. “He thought my grandfather was quite a character, but I have to say, I certainly couldn’t imagine that happening now!”

CLARITY & COVERAGE As an industry evolves, so must its insurance. Which is why Wynward has enhanced its Pharmacists Professional Malpractice policy with revised language that brings greater clarity to the scope of coverage and a doubling of our legal defense costs limit. We have also introduced a new, distinct endorsement designed to provide coverage for individual pharmacists and legal entities.

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Oct/Nov 2014

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COMMUNICATION IN HEALTH CARE

What you say and how you say it – The art of communication in health care Part 2 – Strategies for effective communication with patients By Barbara Gobis B.Sc.(Pharm.), ACPR, M.Sc.Phm.; Larry Leung B.Sc.(Pharm.), R.Ph.; Jason Min B.Sc.(Pharm.), R.Ph.; and Andrea Paterson B.Sc.(Pharm.), R.Ph. Strong positive correlations exist between a health care professional’s communication skills and a patient’s ability to follow through with health recommendations, self-manage a chronic medical condition, and adopt preventive health behaviours. A clinician’s ability to explain, listen, and empathize has a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care.1 A pharmacist will interact with hundreds of thousands of patients over the course of a typical career. In fact, the patient interview is the most common health care procedure used by all health care professionals, including pharmacists. Given the frequency and importance of effective communication with patients, pharmacists need to continually strive to develop their communication skills. In the last issue of The Tablet, Part 1 of this article provided practical communication

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Oct/Nov 2014

and collaboration strategies for effective communication with other health care professionals. Part 2 provides practical strategies for pharmacists to optimize their interactions with patients. Stating the obvious Communication between a patient and a pharmacist is first and foremost an interaction between two human beings. Patients need to feel respected and valued, have a voice in health care decisions, and be treated with courtesy. Although these points are obvious and intuitive, they need to remembered, especially during hectic and stressful times. Understanding between experts An interaction between a pharmacist and a patient is a meeting of experts. Pharmacists have expertise and knowledge about medications. Patients are experts on themselves - their own beliefs, attitudes, living conditions, daily routines,

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past experiences with medications, and personal circumstances. The purpose of the interaction between these experts is to optimize the patient’s drug therapy outcomes so the patient’s needs are at the centre of all discussions. Patients need to be engaged in all aspects of their care. This patient-centred philosophy is integrated throughout the standardized approach to patient care that has been established at the Pharmacists Clinic at the UBC Faculty of Pharmaceutical Sciences. The Assessment step includes informationgathering from the patient. The Care Plan step involves negotiation with the patient to identify and prioritize drug therapy problems. The Evaluation step includes shared responsibility between the patient and other health care team members. A diagram of the Comprehensive Medication Management (CMM) service model at the Pharmacists Clinic is provided as Figure 1.

Figure 1: Comprehensive Medication Management (CMM) Patient Care Process

Figure adapted from Practice Development, Practice Skills Bootcamp with permission from: Patient Care Process Working Group, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta AND Regional Pharmacy Services, Alberta Health Services.

Clarifying questions Regardless of the patient scenario, a critical first communication step is always for the pharmacist to ask the patient a few

clarifying questions. This gives the pharmacist key information about the patient, their situation, and their needs. Examples of clarifying questions that can be used to gather information about the

patientâ&#x20AC;&#x2122;s situation are provided in Table 1. Without this first step, a pharmacist has no way of connecting with a patient and is at risk of making incorrect assumptions.

Table 1 â&#x20AC;&#x201C; The power of clarifying questions

Scenario

Assumptions

Clarifying questions (and examples of answers)

A woman asks for her medications to be reviewed.

She is not doing well. Her treatment is expensive. She does not want to take drugs.

Do you have any specific concerns? She would like to take medications fewer times per day. Has anything recently changed for you? She is going on an extended vacation. What do you want to get from this Medication Review? Wants to know about traveling with Rx in a foreign country.

A man asks which decongestant is best.

He is asking for himself. He has a cold. He has not tried anything yet. He is otherwise healthy.

Who will be using this product? His wife. What are her symptoms? She has seasonal allergies. What has she already tried? She has tried saline spray. Any other health conditions? She is three months pregnant.

A woman has a prescription for an antidepressant.

She is depressed. She has not taken this before. She is emotional.

What did the doctor tell her? She has PTSD and this will help. Have you taken this before? She took samples for two weeks. Do you have questions for me? When will it start to help?

A man asks if he can order Zostavax at the pharmacy.

He wants to get vaccinated. He knows about Zostavax. He is a candidate for Zostavax.

Who will be using the product? He is asking for his 45-year old brother. The caller just recovered from shingles himself. What do you know about it? The caller erroneously thinks that shingles is hereditary.

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COMMUNICATION IN HEALTH CARE

Initial clarifying questions need only take a few seconds but the information provided by the patient is extremely valuable to the pharmacist, who can then decide on what to say and do next.

Active role

Take part in

Avoid

Stay away from, do not use/eat

Choosing words wisely

Collaborate

Work together

Many people, including those with high literacy, can have trouble understanding the words and jargon used in health care. Some words may be totally unfamiliar and others may be familiar, but a patient may not understand them in a health care context.

Reassess

Review and possibly change

Intake

What goes into your body

Option

Choice

Referral

Second opinion

Wellness

Good health

Monitor

Keep track of

Adverse (reaction)

Bad, unwanted

Cognitive

Learning, thinking

Hazardous

Not safe, dangerous

Noncancerous

Not cancer

Non-benefit

Cost not covered by a drug plan

Supportive

Helpful

Adequate

Enough

Adjust

Fine-tune, change

Cautiously

With care, slowly

Excessive

Too much

Many words pharmacists (and other health care professionals) use routinely can be confusing to patients. Examples are provided in Table 2.2 Pharmacists need to choose their words carefully to minimize confusion and maximize patient understanding.

Concepts

Descriptors

Table 2 â&#x20AC;&#x201C; Words to watch and alternatives

Types of words

Example

Alternatives

Medical terminology

Benign

Will not cause harm, not cancer

Condition

How you feel, health problem

Chronic

On-going

Inhibitor

Drug that stops something that is bad for you

Intermittent

Off and on

Lesion

Wound, sore, infected area of skin

Oral

By mouth

Increase gradually

Add to

Sublingual

Under the tongue

Moderately

Not too much

Hypertension

High blood pressure

Progressive

Get worse (or better)

Anticoagulant

Reduces the formation of blood clots

Routinely

Often

Analgesic

Pain reliever

Significantly

Enough to make a difference

Arrhythmia

Irregular heartbeat

Temporary

For a limited time

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Aug/Sep 2014

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Value judgements

Asking clarifying questions and listening to the patient’s answers are also useful ways for the pharmacist to get a sense of a patient’s level of health literacy. The pharmacist can then choose similar words when providing information to the patient. Asking the patient to summarize their understanding of what they heard is another way for the pharmacist to check that key information has been successfully received by the patient.

Pulling it together

Using supplemental written information

• Be sincerely interested in what your patient is talking about.

Patients already have access to information about medications and health from a variety of sources including the internet. Pharmacists have a responsibility to help patients make sense of the information they have, get answers to their specific questions, and put information into context that is meaningful for their own situation. Supplemental written information is a useful tool when used in one of two ways: • As a source of health information the patient reads before having a discussion with the pharmacist, or • As a written summary of information the patient takes away and reviews after a discussion with the pharmacist. In either situation, written information is never a replacement for pharmacist-patient conversation. Patients also need to know they can follow up with the pharmacist if they don’t understand or have questions about supplemental written information they receive.

The best chosen words can fall flat if the speaker delivers them without appropriate empathy and active listening. Active listening: • Look at your patient and suspend other things you are doing. They deserve your undivided attention. • Listen to the feelings behind your patient’s words.

• Restate what your patient said. • Ask clarifying questions as needed. • Be aware of your own feelings and any strong opinions that may be forming. • Reserve your opinions until after you have listened to your patient.

Skilled, artful communication is a cornerstone of a good pharmacist-patient relationship. As this relationship develops, so too does trust and patient satisfaction.3 When patients understand the goals of their treatment and have answers to their questions, the end result is more informed and engaged patients achieving better health outcomes.

References 1. Impact of Communication in Healthcare. Institute for Healthcare Communication. http://healthcarecomm. org/about-us/impact-of-communication-in-healthcare/ 2. Adapted from: Words to Watch Fact Sheet. National Patient Safety Foundation. www.npsf.org 3. Worley MM, Hermansen-Kobulnicky CJ. Outcome and self-efficacy expectations for medication management of patients with diabetes: influence of the pharmacist-patient relationship. J Am Pharm Assoc. 2008;48(5):621–631.

Empathy key points: • Empathy is the process of becoming aware and in tune with another person’s feelings or motives. Empathy is not sympathy and empathy does not mean taking on a patient’s problems with or for them. • Empathy requires the listener to stop listening to their own inner voice and focus attention on the other person. • Pharmacists need to listen and sense the emotions of the patient to realize true empathy. • True empathy helps patients feel safe and understood, and opens up the discussion of more issues.

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CLINICARE PHARMACISTS

Andropause and testosterone supplementation

By Larry Leung B.Sc. (Pharm.), R.Ph., and Jason Min, B.Sc. (Pharm.), R.Ph. Recently we have seen a growing interest among our male patients in “andropause,” also known as late-onset hypogonadism. We had one interesting case in particular that required a thorough literature search to help with our recommendations: • 52-year-old male with documented low serum testosterone • Experiencing low muscle mass and strength, low energy levels, and depressed mood • Medications: Esomeprazole 40mg once daily for GERD Andropause is associated with an age-related decline in testosterone and is often considered the “male version of menopause.” Andropause has been associated with symptoms such as reduced sexual function, lower bone mineral density, reduced muscle mass and strength, and lower mood.1 Symptoms vary widely, which can make diagnosis and assessment difficult. Supplementing with testosterone does not always improve symptoms and may worsen age-related risk factors such as an enlarged prostate or prostate cancer. Health Canada recently completed a safety review of testosterone products and found a growing body of evidence for serious cardiac side effects such as stroke, heart attack, and even death. Our patient was just diagnosed with andropause and low serum testosterone by his physician. He was referred to us following a cardiac workup and confirmation that he was a candidate for testosterone supplementation. The patient was keen to try testosterone and had read online that applying testosterone topically on the testes and groin area would lead to better absorption and subsequently better effects. He asked if this was a safe and effective way to increase his testosterone levels more rapidly. We took a different approach to this case than we normally would, by starting with a Google search. We wanted to know what our patient had read online and we found different forums discussing the benefits

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of applying testosterone on the scrotum. Many forum posts referred to the use of Testoderm, a testosterone-containing transdermal patch applied to the scrotum, which was previously available in the USA but not in Canada. Other posts mentioned studies demonstrating transscrotal testosterone as being safe and effective. However, when we reviewed our sources on the effects of trans-scrotal testosterone we found indication of a significant increase of serum dihydrotestosterone over testosterone, which can promote prostate volume and exacerbate benign prostatic hyperplasia.2 The skin of the scrotum has a higher anticipated rate of absorption over other areas of the body due to high vascularization and thinner skin. Some studies showed as little as a five per cent greater absorption, while others showed a 40 times greater absorption efficiency.3,5 Our primary concern was for the patient’s safety, given that higher levels of testosterone can increase the risk of developing side effects such as hepatotoxicity and gynecomastia. Our recommendation was to start Androgel 1% gel, 5gms applied once daily. The patient agreed that it was not worth the potential risks in applying the gel to the scrotum and planned to apply it on his shoulders. We know there are many controversies surrounding andropause and testosterone supplementation, especially in regards to the monitoring of serum testosterone levels and weighing the risk versus benefits of treatment. Would you have made a different recommendation? Larry Leung and Jason Min are directors of Clinicare Pharmacists Inc. and lecturers at UBC. They have a passion for interdisciplinary care and the development and implementation of innovative clinical pharmacy services in the community. References available upon request; please contact the BCPhA Communications team.

CAREER LISTINGS

ARE YOU MAXIMIZING THE VALUE OF YOUR MEMBER BENEFITS? Pharmacy members can place free Career Opportunities listings in this section and on the BCPhA website. Job postings for pharmacy technicians and assistants are also distributed by the Pharmacy Technician Society of British Columbia (PTSBC). A new enhancement to the best pharmacy job board in BC! Pharmacist members looking for new career opportunities can post their resumes for free on the Hire-aPharmacist page. To learn more, visit the Recruitment section of bcpharmacy.ca ARMSTRONG Pharmacist – full-time We are independently owned group of pharmacies in the North Okanagan region seeking a clinically orientated pharmacist. Our vision is to have pharmacists completely separate from dispensing functions in order to focus on clinical interventions and follow up with patients. We have great relationships with our patients, local physicians, and other members of the community health care team. We are seeking a pharmacist who is willing to continue to foster and build these relationships. Experience what it's like to work with a 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 offer great hours and a competitive wage and benefit package. Please send resumes to gaarscott@gmail.com. Pharmacy technician – full-time Independent pharmacy in the North Okanagan seeking pharmacy technician. Candidates must be fully registered with the College of Pharmacists of BC (CPBC). Excellent communication skills and experience with being part of a team is required. We are currently changing our workflow to have a patientfocused pharmacy experience, and we intend to fully implement the scope of practice of a pharmacy technician. To apply, please send resume to armstrongpharmacy@telus.net. BURNABY Pharmacist – part-time We have a very competitive compensation package. Duties include: Demonstrate strong sales ability, leadership, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care; consult with patients to maximize Rx and OTC sales; provide professional advice and applicable dialogue with patients on prescription and OTC products to provide

excellent customer service; be aware of and support any in-store events; supervise pharmacy technicians; ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed; implement proper pricing and receiving procedures to minimize shrinkage and maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resumes to 7150rx@rexall.ca CHILLIWACK Pharmacy manager – full-time The pharmacy manager is responsible for managing store pharmacy operations and maintaining a professional and cohesive working relationship with the front store manager and staff. They are a catalyst in the execution of a superior patient care experience that translates into an environment that ensures people make the healthiest choices quickly, easily and confidently helping them feel better every day. Please send resumes to 7194rx@rexall.ca. Pharmacy assistant – full-time We currently have an opening for a pharmacy assistant at SDM 2251 in Chilliwack. We run assistant shifts until 10pm on weekdays and we work on a revolving schedule for weekends. Please send resumes to owner Don Martens at asdm2251@shoppersdrugmart.ca, fax 604.824.1037 or please call 604.824.1036. Pharmacy assistant – full-time We are currently looking for a full-time compounding pharmacy assistant to start immediately at our pharmacy with a dedicated compounding lab. A range of experience will be an asset but can be trained. Please send resumes to owner Don Martens at asdm2251@ shoppersdrugmart.ca, fax 604.824.1037 or please call 604.824.1036. COQUITLAM Pharmacist – full-time Specialized, high quality patient care pharmacy looking for an energized full-time pharmacist (maternity leave 15-18 month contract). Very unique and rewarding environment with a focus on high-level patient support with exceptional customer service. Successful applicant must be able to work well in fast paced environment. Organization, attention to detail, and excellent communication skills are a must. Excellent computer skills required. Preferred minimum of three years’ experience in retail and/or hospital pharmacy. A perfect opportunity to be challenged with continual learning opportunities and advancement. Competitive salary and benefits. Please fax resume to 1.866.246.7796. Pharmacy technician – full-time Specialized, high quality patient care

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pharmacy looking for an energized fulltime technician. Very unique and rewarding environment with a focus on high-level patient support with exceptional customer service. Successful applicant must be able to work well in fast-paced environment and have exceptional computer skills. Maturity, organization, attention to detail, and excellent communication skills are a must. Preferred minimum of four years' experience in retail (Kroll an asset) with extensive understanding in PharmaCare coverage/insurance billing. A perfect opportunity to be challenged with continual learning opportunities and advancement. Competitive salary and benefits. Please fax resume to 1.866.246.7796. Pharmacy assistant – full-time Specialized, high quality patient care pharmacy looking for an energized full-time assistant. Very unique and rewarding environment with a focus on high-level patient support with exceptional customer service. Successful applicant must be able to work well in fastpaced environment and have exceptions computer skills. Organization, attention to detail, and excellent communication skills are a must. Preferred minimum of two years’ experience in retail (Kroll an asset) with extensive understanding of PharmaCare coverage/insurance billing. A perfect opportunity to be challenged with continual learning opportunities and advancement. Competitive salary and benefits. Please fax resume to 1.866.246.7796. DELTA Pharmacist – full-time We are looking for full-time pharmacists for our Lower Mainland pharmacy. Experience with WinRX/Kroll and Microsoft Office (Word, Excel, etc.) are necessary. The successful applicant is required to have at least one to two years of experience working in a community pharmacy and to be injection certified. Pharmacists must also have a good working knowledge of PharmaCare and third party billing policies, knowledge of Medication Reviews, and experience with blister packing. Pharmacists must be strong communicators, clinically oriented, and willing to further their pharmacy practice and patient-centered care. Wages start at $37/hour and increases steadily with experience. Full medical and dental benefits are provided after a trial period of three months. Please send resumes to shafik@wescanapharmacy.com. Pharmacy technician or assistant – full-time We are looking for full-time pharmacy assistants or registered pharmacy technicians for our Lower Mainland pharmacy. Experience with WinRX and Microsoft Office (Word, Excel, etc.) are assets. Start date is immediate upon hiring. Compensation is between $12-18 depending on the applicant’s experience.

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Medical and dental benefits are provided after a trial period of three months. If interested, kindly send a resume and cover letter to shafik@wescanapharmacy.com. FORT NELSON Pharmacist – full-time Position available immediately, offering a very comprehensive compensation package and a flexible 40 hour work week (no evenings, Sundays or statutory holidays). The successful applicant will be highly customer-oriented, possess exceptional communication skills and exhibit a keen willingness to work collaboratively with our local physicians and to develop and implement clinical services. Compensation includes highly competitive wages, full benefits including MSP, extended medical and dental, both College and Association memberships, continuing education allowance, staff discount, RSP matching, relocation allowance and signing bonus as well as Northern residents allowance. Full description of job available at www.bcpharmacy. ca/jobs. Please send resumes to Duane Knott at fortnelsonida@hotmail.com, fax 250.774.2326 or please call 250.774.2323.

with no 24-hour pharmacies in all our locations. We support continuing education and offer various in-house training programs. Please email Aashi Nanda, recruiter, health & wellness, at Aashyita.Nanda@loblaw.ca or call direct, 905.459.2500 ext. 617615.

learner; and exceptional communication and organizational skills. Please send resumes to 7180rx@rexall.ca.

KAMLOOPS

We are looking for a full-time permanent pharmacist at our clinic pharmacy. Our hours of operation are 9:30am to 5:30pm, closed Sundays and holidays. Applicants should be outgoing and like to work in a social environment. Please apply to the following contact information: Medicine Centre, 107-5501 204 Street, Langley, BC. Phone 604.532.1996, fax 604.532.1937, email langley@ medicinecentre.com. Manager: Pinder Mann.

Pharmacist – part-time Manshadi Pharmacy (477 Paul Street, Kamloops) is looking to hire a motivated pharmacist to work in a well-established independent retail pharmacy. Position is for Saturday and Sunday, 10am to 2pm. We specialize in diabetic care, compounding and home health care products. Great team that supports our pharmacist. We prefer a longterm commitment. Kamloops is a great place to be. We are close to two ski hills, Sun Peaks and Harper Mountain, and dozens of nearby lakes. Good community to raise a family with all needed amenities. Please send resumes to Missagh Manshadi, pharmacist/owner at missagh@manshadipharmacy.com. Fax 1.250.434.2527, phone 1.250.574.0111, www.manshadipharmacy.com. LADYSMITH

FORT ST. JAMES

Pharmacist – full-time

We have a very competitive compensation package. Duties include: demonstrate strong sales ability, leadership, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care; consult with patients to maximize Rx and OTC sales; provide professional advice and applicable dialogue with patients on prescription and OTC products to provide excellent customer service; be aware of and support any in-store events; supervise pharmacy technicians; ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed; implement proper pricing and receiving procedures to minimize shrinkage; and maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resumes to choloiday@rexall.ca.

A full-time pharmacist is needed to start the spring of 2015 in the scenic town of Fort St. James. Lucrative compensation package including: basic salary, annual bonus, retention bonus, moving allowance, extended medical benefits and six weeks of vacation time. Please send resumes to s_hawari75@yahoo.com, fax 250.996.7366 or please call 250.996.7202. GRAND FORKS Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com. Pharmacist – part-time Currently seeking a part-time staff pharmacist. 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, on-going career development and training programs, opportunity to work with seasoned professionals, participate in our customer clinic day events, and flexible hours

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Oct/Nov 2014

Pharmacy technician – part-time Rexall Ladysmith has immediate opening for a pharmacy technician. We offer a very competitive compensation package. Skills required: pharmacy technician diploma or bridging program from accredited College (mandatory); advance computer knowledge; customer service skills; excellent written and verbal communication skills; strong attention to detail and excellent organizational skills; ability to work in a fast paced environment; discretion in handling confidential matters; and inventory control experience preferred. Please send resumes to 7180rx@rexall.ca. Pharmacy assistant – part-time Rexall in Ladysmith has immediate opening for a pharmacy assistant. We offer a very competitive compensation package. Required skills: experience with Nexxsys an asset; professional attitude; friendly and customerservice oriented; attentive to detail and ability to multi-task; reliable, hard-working and a quick

www.bcpharmacy.ca

LANGLEY Pharmacist – full-time

Pharmacist – full-time or part-time Shoppers Drug Mart Valley Center, located at 107-20151 Fraser Highway, Langley, is looking to hire a staff pharmacist. Duties to perform include: prescription checking for accuracy and clinical appropriateness; outstanding counselling on OTCs; injection certified; outstanding customer service skills and communication skills; experience is a big asset but new grads are welcome to apply. Please send resumes to Mina Fahim, associate/owner at asdm2115@shoppersdrugmart.ca, visit www.ShoppersDrugMart.ca, fax 604.534.3874 or please call 604.534.3870. Pharmacy technician – full-time We are now hiring dedicated and dynamic registered pharmacy technician to join our team in Langley. At Remedy’s Rx Specialty Pharmacy, we service long-term care, retirement homes and group homes through our dedicated pharmacy. Specialty pharmacy provides opportunities for registered technicians to practice the full scope of their practice, thus providing an opportunity to thrive. This fulltime position requires minimal evenings and weekends, and we offer a competitive wage and benefit package. If you would like to become a member of a national pharmacy company with exceptional growth potential please forward your resume via email to Enna Aujla, regional director of operations, at enna@remedys.ca. LANGLEY/WHITE ROCK Pharmacist – full-time Looking for full-time pharmacist who can work collaboratively with physicians and specialists in a pharmacy located inside a medical building. Applicants should be able to do clinical services (Medication Reviews, injections) and have great communication skills. New pharmacy graduates are welcome to apply for this position. Only selected candidates will be contacted for interview. Please send resume via email to pcyrealcorp@gmail.com. MAPLE RIDGE Pharmacist – part-time Target Pharmacy located at Haney Place Mall, 11850-224th Street, Maple Ridge, is looking to hire a self- motivated pharmacist committed to customer care. Must be certified for injection administration. Please send resumes to Narmin Khimji, owner, at narminkhimji@gmail.com, fax 604.467.4234 or please call 778.316.9070.

Pharmacy technician or assistant – full-time or part-time Unique long-term opportunity exists for a pharmacy technician or assistant, full-time or part-time within our fast-growing, full service pharmacy within a medical clinic in Maple Ridge. You will use your strong communication ability to build long-term relationships with customers, while providing superior levels of services and care. You are familiar with POS and KROLL processing systems and are seeking a long-term, mutually rewarding opportunity. Prior compounding experience is appreciated but not mandatory. We offer an excellent compensation package, consisting of very attractive salary, opportunities for growth and work/life balanced environment. Apply online at www.medlandia.com. MILL BAY Pharmacist – full-time Join the team at our established community pharmacy, working closely with professional colleagues, patients, and their families. You'll play an integral role in creating high quality patient outcomes by providing traditional and alternative therapies; Med Reviews; injections; community education seminars; blister packaging; compounding; patient counseling; and prevention outreach. We are a PCCA certified compounding center, and have a large natural health section and on-site natural health specialist. Our support staff is excellent! We provide competitive wages, benefits, continuing education and a desirable Island lifestyle just 30 minutes north of Victoria. Wages, benefits, incentives and learning opportunities are negotiable, based on experience and performance. Please send resumes to Erika Pfahl, pharmacy manager at Pharmasave Mill Bay, by email to rxmanagerps221@gmail.com. NANAIMO Pharmacist – part-time London Drugs has a part-time opportunity in Nanaimo. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075. NEW WESTMINSTER Pharmacy manager – full-time Medicine Shoppe Pharmacy #142 is looking for a pharmacy manager to lead our dynamic team. The pharmacy is designated renal pharmacy for New Westminster and works very closely with the renal department at Royal Columbian Hospital to meet pharmaceutical needs of dialysis patients. The pharmacy is located directly across from Royal Columbian Hospital and is surrounded by medical buildings. Please see attachment at www.bcpharmacy.ca/job for complete details on the pharmacy manager

position. Please send resumes to Nimisha Virani, owner, at nimishavirani@gmail.com, fax 604.521.9614 or phone 604.521.9313. Pharmacist – full-time Key responsibilities include: checking prescriptions for accuracy, counseling on prescription medications, OTC counseling, health management consulting, and collaboration with pharmacy assistant to accurately dispense prescription medications. Qualifications: Bachelor of Pharmacy, license to practice in the province seeking employment, superior interpersonal skills; strong verbal and written communication skills, commitment to providing exceptional customer service, and computer proficiency. Work hours: flex schedule, some weekends and evenings. Please send resumes to sabeeh@globalhealthmanagement.ca Pharmacist – full-time We have a very competitive compensation package. Duties include: Demonstrate strong sales ability, leadership, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care; consult with patients to maximize Rx and OTC sales; provide professional advice and applicable dialogue with patients on prescription and OTC products to provide excellent customer service; be aware of and support any in-store events; supervise pharmacy technicians; ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed; implement proper pricing and receiving procedures to minimize shrinkage and maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resumes to 7162rx@rexall.ca PEACHLAND Pharmacy technician – full-time Independent pharmacy in the Central Okanagan seeking a registered pharmacy technician. Candidates must be registered with the College of Pharmacists of BC (CPBC). Excellent communication and organizational skills are required. Candidates must demonstrate a commitment to exceeding customer expectations of service and pharmacy care. We offer great hours 9am to 6pm Monday to Friday, Saturday 9am to 5pm, closed Sundays and statutory holidays. Join with us as we fully integrate your scope of practice into our dynamic and collaborative team. For inquiries please email pharmtechokanagan@shaw.ca. PENTICTON Pharmacy assistant – part-time Rexall in Penticton has immediate opening for a pharmacy assistant. We offer a very competitive compensation package. Required skills: experience with Nexxsys an asset; professional attitude; friendly and customerservice oriented; attentive to detail and ability to multi-task; reliable, hard-working and a quick learner; and exceptional communication and organizational skills. Please send resumes to 7179rx@rexall.ca.

www.bcpharmacy.ca

POWELL RIVER Pharmacist – full-time Looking for a motivated and dynamic pharmacist with experience in the holistic integrative field of pharmacy and health care. Training in advance compounding, homeopathy and naturopathy an advantage. If this is you, please consider Powell River as the place for you. Please send resumes to Dirk de Villiers, director, by emailing ms0309@store. medicineshoppe.ca, fax 604.485.5536, or please call 604.485.5530. PRINCE GEORGE Pharmacist – full-time London Drugs has a full-time opportunity in Prince George. Join a clinical and patient focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075. RICHMOND Pharmacy technician – full-time A well-established specialty community pharmacy in Richmond is seeking a mature pharmacy technician. Numerous opportunities for continuing education available. Ability to speak Mandarin/Cantonese an asset. Responsibilities: data entry with Applied Robotics (Rx software system); third party adjudication; dispensing of medications; inventory management; blister packaging; home health care and front store sales (bath safety equipment, compression stockings, mobility aids, etc.). Required qualifications: minimum two years’ experience as a pharmacy technician or certification from an accredited pharmacy technician program; home health care experience a definite asset; excellent organization skills; demonstrated customer service experience; and proficient computer skills. Please send resumes to Azim Datoo or Anisha Datoo at mccuedrugs@gmail.com or please call 604.278.9601. Pharmacy assistant – part-time, relief Newly opened clinic pharmacy looking for experienced candidate. Excellent wages, hours, and environment offered. Compounding experience and mandarin speaking are assets. Please send resumes to Art Thorrougood, owner, at Art93@me.com or fax 604.285.6132 or please call 604.644.3158. SALMON ARM Pharmacist – part-time Pharmasave in Salmon Arm is seeking a motivated, energetic and experienced pharmacist to join our team of friendly professionals. We are offering a predictable two day per week rotating schedule to the right candidate to start immediately. The desire to provide exceptional customer service and medication management counseling

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is mandatory. Our Pharmasave store is actively involved with private consultations, immunizations, compliance packaging, community seminars and prescription compounding. Please submit your resume in confidence to Troy Cook, pharmacy manager, at rx244@forewest.ca or apply online at www.pharmasavesalmonarm.com. SALT SPRING ISLAND Pharmacist – full-time Pharmasave on Salt Spring Island has an opening for a full-time pharmacist. If you dream about living in one of the most vibrant and beautiful Gulf Island communities in British Columbia while still maintaining an interesting and rewarding career, then you should consider joining our team of experienced and dedicated professionals. We offer a competitive compensation and benefits package and the opportunity for a truly great lifestyle. Our standards are high and we aim to offer our customers the best service and pharmacy counseling available. Come and find out why The New York Times calls Salt Spring Island one of the "gems" of the Pacific Northwest. Please send resumes to gary@saltspringpharmasave. com or please call 250.537.5534.

TOFINO

Pharmacy technician – full-time

Pharmacist – full-time

Immediate opening for a pharmacy technician. Previous experience an asset and applicant must possess excellent communication skills. Please send resumes to Nafisa, pharmacist/ manager at nafisam@telus.net or fax 604.325.3276.

Pharmasave Tofino is a new health centre that provides a unique community pharmacy experience. We are currently recruiting for a full-time pharmacist to join our team on the west coast of British Columbia. This position is geared toward a hard-working, lifestyle orientated individual. The successful candidate must be injection trained and committed to providing exceptional pharmacy services. Essential qualities: professional, confident, reliable, positive, organized, detail orientated, and outstanding communication skills. Please send resumes to Laura, owner, at info@epicpharmacy.ca, www.epicpharmacy.ca, fax 250.725.1249 or please call 250.725-4949. VANCOUVER Pharmacist – full-time

Pharmacist required for one to two days per week at a small clinical pharmacy. No evenings, Sundays or holidays. Must have excellent communication skills; injection training preferred. Please send resumes to llbryan@ shaw.ca, fax 604.538.6389 or please call 604.538.6334.

We are a well-established, fast-paced independent community pharmacy currently looking for a motivated, focused and diligent full-time pharmacist to join our expanding team. We are a dynamic, clinical-based dispensary who works with multidisciplinary health care professionals to provide excellent customer service and quality patient focused care. Successful candidates must be registered and in good standing with CPBC, possess strong and effective communication and organizational skills, and the ability to work effectively in a team environment as well as independently. Experience with adaptations, administering injections and Medication Reviews an asset. No evenings. Position to start immediately. If interested, please send a cover letter and resume to vancouverpharma@gmail. com. New grads are welcome to apply.

SURREY

Pharmacist – full-time

Key responsibilities: check prescriptions for accuracy, counsel on prescription medications and OTCs, health management consulting, participate in SDM programs including cognitive/ enhanced services, collaborate with pharmacy assistant to accurately dispense medications. Qualifications: Bachelor of Pharmacy; license to practice in BC; superior interpersonal skills; strong communication skills; commitment to providing exceptional customer service; computer proficiency; ability to manage a fast-paced, high-volume pharmacy; expertise in Medication Reviews, adaptations, injections and other professional services; and experience in a multidisciplinary health care team. Certified Diabetes Educator or Certified Geriatric Pharmacist designations highly desirable. Evenings only, four-days a week. Please send resumes to Jennifer Kim, owner at asdm201@shoppersdrugmart.ca, fax 604.681.3280 or please call 604.681.3411.

SOUTH SURREY Pharmacist – part-time

We have a very competitive compensation package. Duties include: Demonstrate strong sales ability, leadership, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care; consult with patients to maximize Rx and OTC sales; provide professional advice and applicable dialogue with patients on prescription and OTC products to provide excellent customer service; be aware of and support any in-store events; supervise pharmacy technicians; ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed; implement proper pricing and receiving procedures to minimize shrinkage and maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resumes to 7152rx@rexall.ca Pharmacy technician – full-time Immediate opening for a pharmacy technician. Previous experience an asset and applicant must possess excellent communication skills. Please send resumes to Nafisa, pharmacist/ manager at nafisam@telus.net or fax 604.325.3276.

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Oct/Nov 2014

Pharmacist – part-time Part-time pharmacist position available, experienced in retail pharmacy, exceptional communication and organization skills, familiar with Telus RxA or RxT program, and 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. Please, no phone calls about this job. Please send resumes to ymm@yyoung.com or fax 604.630.1001.

www.bcpharmacy.ca

Pharmacy technician – full-time The successful applicant must be a registered, regulated pharmacy technician with at least one year compounding experience working in a pharmacy dispensary and/or compounding lab. Must be fluent in English. Knowledge and use of Microsoft Office and excellent computer skills are a necessity. You will be dealing with all aspects of a specialized compounding lab. You must be a highly motivated team player who works well independently and with others. Very competitive compensation rate. Full benefits available after successfully completing the three month probation period. Please send resumes to michelle@macdonaldsrx.com, www.macdonaldsrx.com, phone 604.872.4200. Pharmacy technician – full-time We are now hiring dedicated and dynamic registered pharmacy technician to join our team in Vancouver. At Remedy’sRx Specialty Pharmacy, we service long-term care, retirement homes and group homes through our dedicated pharmacy. Specialty pharmacy provides opportunities for registered technicians to practice the full scope of their practice, thus providing an opportunity to thrive. This full-time position requires minimal evenings and weekends, and we offer a competitive wage and benefit package. If you would like to become a member of a national pharmacy company with exceptional growth potential, please apply via email to Enna Aujla, regional director of operations, at enna@remedys.ca. Pharmacy assistant – full-time Full-time pharmacy assistant position available at our renal pharmacy. The successful applicant must have at least two years’ experience working in a pharmacy dispensary and must be fluent in English. Knowledge and use of Microsoft Office and excellent computer skills are a necessity. You will be dealing with all aspects of dispensary operations and will be providing excellent and quick customer service, answering phone calls, dispensing and entering and processing prescriptions on our computer system. You must be a highly motivated team player. Competitive compensation based on experience. Full benefits available after successfully completing the three month probation period. Please send resumes to michelle@macdonaldsrx.com, www.macdonaldsrx.com, phone 604.872.4200. VICTORIA Pharmacist – full-time This position is full-time working at different locations. We have a very competitive compensation package. Duties include: demonstrate strong sales ability, leadership, passion and communication skills as we strive to be recognized as the Canadian leader in pharmacy health care; consult with patients to maximize Rx and OTC sales; provide

professional advice and applicable dialogue with patients on prescription and OTC products to provide excellent customer service; be aware of and support any in-store events; supervise pharmacy technicians; ensure company standard operating procedures, policies, professional standards and applicable laws and regulations are followed; implement proper pricing and receiving procedures to minimize shrinkage; and maintain the dispensary inventory level within the prescribed guidelines through accurate perpetual inventory records. Please send resumes to choloiday@rexall.ca. Pharmacist – full-time Are you looking for an opportunity with an established independent pharmacy chain that is looking to grow and expand its focus on patient care, and clinical specialization. We take patient follow up to a whole new level. We are looking for energetic pharmacists who want to practice their full scope of clinical skills and help us bring top-notch health care to our customers. Heart Pharmacy IDA owned by Naz Rayani is looking for an engaged, clinically oriented and outgoing full-time pharmacist to work at our unique community pharmacies. Please send resumes to jobs@victoriapharmacy.com. Pharmacist – full-time St. Anthony's Clinic Pharmacy has an opening for a staff pharmacist to start in November 2014. We offer a wide variety of opportunities for professional growth, including clinical services to community-based patients and over 400 residents of long-term care facilities. We offer a competitive remuneration package and benefits. Experience with long-term care an asset, as well as experience with Kroll. Applicant must be available to work on Saturdays and eventually share on-call responsibilities. Our pharmacy is closed on Sundays, evenings and statutory holidays. Please send resumes to manager Greg at staclinicpharmacy@shawcable.com or phone 250.478.8338. Pharmacist – full-time or part-time Forbes Pharmacy is currently hiring for full or part-time pharmacist. The successful candidate will reside in the Victoria area and will work a rotation of shifts at our community pharmacy in Cold Lake, AB. This is an excellent opportunity to practice pharmacy in BC and Alberta, while also enjoying the amenities and lifestyle that both locations offer, such as outdoor lake-life in the summer and skiing in the winter. We support career growth, continual education and career advancement with our pharmacy chain. We cover travel costs, accommodation and transportation in Cold Lake, in addition to a signing bonus on-top of competitive wages. The successful applicant will enjoy working with our experienced pharmacy support team, and will thrive in our fun, family-like environment. Please send resumes to Tracy Pheiffer, human resources manager, at hr@forbespharmacy. ca, apply online at www.forbespharmacy.ca or please call 250.882.7530.

counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager, at ssangha@londondrugs.com or fax 604.448.1075. Pharmacy technician – full-time Pharmacy technician required to work at Heart Pharmacy IDA owned and operated by Naz Rayani. Our focus is on patientcentered practice with a desirable and friendly population. All applications are confidential. Compensation is commensurate with experience. Please send resumes to jobs@victoriapharmacy.com. Pharmacy technician – part-time Rexall Oak Bay has immediate opening for a pharmacy technician. We offer a very competitive compensation package. Skills required: pharmacy technician diploma or bridging program from accredited College (mandatory); advance computer knowledge; customer service skills; excellent written and verbal communication skills; strong attention to detail and excellent organizational skills; ability to work in a fast paced environment; discretion in handling confidential matters and inventory control experience preferred. Please send resumes to 7128rx@rexall.ca.

OPPORTUNITIES ACROSS BC Float pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 110 pharmacies across BC and Alberta. We’re a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

Pharmacy assistant – full-time or part-time Rexall Tuscany Village Store in Victoria has immediate opening for a pharmacy assistant. We offer a very competitive compensation package. Required skills: experience with Nexxsys an asset; professional attitude; friendly and customer-service oriented; attentive to detail and ability to multi-task; reliable, hard-working and a quick learner; exceptional communication and organizational skills. Please send resumes to 7126rx@rexall.ca. Pharmacy assistant – full-time, part-time Rexall in Victoria has immediate opening for a pharmacy assistant. We offer a very competitive compensation package. Required skills: experience with Nexxsys an asset; professional attitude; friendly and customerservice oriented; attentive to detail and ability to multi-task; reliable, hard-working and a quick learner; exceptional communication and organizational skills. Please send resumes to 7127rx@rexall.ca.

Pharmacist – part-time London Drugs has a part-time opportunity in Victoria. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and

www.bcpharmacy.ca

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OPPORTUNITIES OUTSIDE BC FORT MCMURRAY, AB Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com. LETHBRIDGE, AB Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com. RED DEER, AB Pharmacist – full-time The Overwaitea Food Group (OFG) proudly provides professional, patient-centered care through more than 80 pharmacies across BC and Alberta. We’re a leading-edge food and consumer goods retailer known for our belief that well-being is about prevention, not just intervention. And thanks to the breadth and depth of our well-established health related offerings, our pharmacists are in a unique position to counsel clients about nutrition and wellness. At OFG, we're committed to fostering a work environment that encourages personal growth, training and career opportunities and provides continuous learning. We offer an attractive compensation package and our extensive benefits package for full-time pharmacists is one of the industries finest. Learn more about what we have to offer. Please send resumes to pharmacyemployment@owfg.com.

THE TABLET

Oct/Nov 2014

BUSINESS OPPORTUNITIES What is important to you is important to us. PHARMASAVE is the best choice for independent business in BC. Maintain your freedom while having access to the most comprehensive retail and professional programs in the industry and our strong national brand. We are a true cooperative, 100% memberowned and governed. Benefit from owning your own business and also share in the economic advantages of a strong group of over 500 stores. Be an owner in an organization that delivers all of its profits directly back to you, the shareholder. If you are a store owner and would like to consider opportunities with Pharmasave, or a pharmacist interested in purchasing a pharmacy, or are planning on selling your business, please give us a call. Our only priority is you and your success! Contact Dave Reston, CEO, Pharmasave Pacific, phone 604.575.5730 or 1.800.665.3344, email dreston@pharmasavebc.ca. Are you thinking of selling your pharmacy? OVERWAITEA FOOD GROUP may be interested. If you would like more information please contact us via email at pharmacybuyer1@gmail.com. PEOPLES DRUG MART is an established and proven pharmacy banner that will make your pharmacy business more successful and profitable. We provide outstanding marketing support and services for a low monthly fee. Unlike other banners, Peoples Drug Mart does not charge a percentage of sales. Our belief is that the profits from your hard work should stay in your business. With Peoples, you get the best of both worlds, outstanding support and services, and the ability to maintain your profits. If you are interested in purchasing, selling or opening a new pharmacy, please contact Frank Fidyk at fgfidyk@telus.net or please call 778.678.6717. Partnership – Vancouver Currently operating a busy pharmacy with large blister pack clientele. Would like to collaborate with other business owners and expand. We have a strong IT and construction team looking for opportunities. Please send resumes to hr@cloudpharmacy.ca or please call 1.877.331.4411.

ASSOCIATION CONTACTS Geraldine Vance Chief Executive Officer 604.269.2860 geraldine.vance@bcpharmacy.ca Cyril Lopez Chief Operating Officer 604.269.2869 cyril.lopez@bcpharmacy.ca Derek Desrosiers Director, Pharmacy Practice Support 604.269.2862 derek.desrosiers@bcpharmacy.ca Letlotlo “Coco” Lefoka Manager, Public Affairs 604.269.2868 coco.lefoka@bcpharmacy.ca Vince Lee Manager, Marketing 604.269.2867 vince.lee@bcpharmacy.ca Bryce Wong Manager, Pharmacy Practice Support 604.269.2865 bryce.wong@bcpharmacy.ca Elise Steeves Manager, Communications 604.269.2866 elise.steeves@bcpharmacy.ca Nelson Chen Coordinator, Pharmacy Practice Support 604.269.2880 nelson.chen@bcpharmacy.ca Ray Chow Database Administrator, Member & Corporate Services 604.269.2882 ray.chow@bcpharmacy.ca Maria dela Cruz Executive Assistant & Project Coordinator 604.269.2861 maria.delacruz@bcpharmacy.ca Linda Tinnion Assistant, Member Services 604.269.2864 linda.tinnion@bcpharmacy.ca Starr Rempel Administrative Assistant Member & Corporate Services 604.261.2092 starr.rempel@bcpharmacy.ca 604.261.2092, Toll-free: 1.800.663.2840 info@bcpharmacy

www.bcpharmacy.ca

You spend your life helping others. It’s now your turn to receive the right advice.

We Have the Perfect Prescription for Your Home. For 35 years Reliance has been protecting the home and automobiles of BC residents. Reliance is now a partner with the BC Pharmacy Association and has teamed up with them and Adams Insurance to offer HomeProtect Rx—a home insurance policy exclusively for members of the BCPhA. Home Protect Rx is a Comprehensive Home Insurance Policy providing Guaranteed Replacement cost coverage against loss or damage to your home and replacement cost coverage to your personal property. In addition to our exceptional policy features, as BCPhA members you will receive benefits not available to the general public: ■

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Premium Claims Service 24 hour emergency claim service; Claims advocate who works for you to ensure a quick and fair settlement Discounts up to a maximum of 70% in savings Policy Extensions, Optional Coverage, Convenient Payment Options

Fill Your Prescription Today! Contact Richard Seto or Doug Chan for your no obligation quote. TEL: 604 255 4616 TOLL FREE: 1 800 255 6789

BC Lions Canucks Car rental Cineplex Hotels around the world PNE and Playland Show tickets and much more!

Affinity BCPhA prescribed member discounts

Save from

10 - 45%

Lower bowl tickets starting at as low as $89 A variety of tickets still available Image from: http://canucks.nhl.com/club/page.htm?id=40177

Receive up to $325 back!* $250 in bill credits plus a $75 Visa cash card*

Save big on a

voice & data plan priced much lower than the market offerings.

Pharmacist (General) members share with your immediate family Pharmacy (Corporate) members share with your pharmacy staff

*Bonus credits and Visa cash card offers are limited time offers. The â&#x20AC;&#x153;Up to $325 backâ&#x20AC;? offer is only available for orders between Oct 1 to October 31, 2014, with a new activation on a 2-year contract. Promotional offers for upgrade/renewal of a 2-year contract for existing Telus customers may vary. For all promotional offers, you must be subscribed on our plan for at least 6 months or an additional cancellation fee equivalent to the applicable bonus credit and cash will be applied. The bill credits will applied to your account over a 5-month period if eligible. Please visit our website for the latest promotional offers and eligibility details: www.bcpharmacy.ca/telus.

Hotels around the world

Fright Nights @PNE

10 - 15% cheaper than any other booking website on average

Best prices in town for Playland! Great savings on all other PNE events

HOW TO ACCESS THE DEALS Log into www.bcpharmacy.ca and go to the Member Benefits - Affinity Rx section or email vince.lee@bcpharmacy.ca