Getting the most out of your scpp practice review l. postnikoff

1. Getting the most out of your
SCPP Practice Review
Lori Postnikoff, BSP
Complaints Director / Field Officer
Saskatchewan College of Pharmacy
Professionals
www.saskpharm.ca

2. Practice Review goals
• Assess compliance of pharmacists with
NAPRA Model of Standards of Practice for
Canadian Pharmacists;
• Provide information regarding Safe
Medication Practices;
• Communicate with members the SCPP
priorities and policies;

3. Practice Review goals
• Provide support and help pharmacists
solve practice related challenges; and
• Assess pharmacy compliance with The
Pharmacy and Pharmacy Disciplines Act,
Bylaws, Standards, and Guidelines of
SCPP.

4. Self Assessment
• Review in preparation for the visit
• Now online
• Reviews SCPP Bylaws and guideline:
– All patients are provided the opportunity to
speak to the pharmacist
– A pharmacist is on duty when the pharmacy is
open to the public

5. Self Assessment
– The dispensary is well lit, clean and neat
– Refrigerator requirements
– Professional services area (appropriate
signage, products)
– Narcotic/controlled drug reconciliation
– Pharmacy Reference Manual (SHIRP)

6. Ratings for indicator stmts
(1) Indicator has no
activity/compliance – improvement
required (WRITTEN ACTION PLAN within
60 days)
(2) Indicator has some
activity/compliance – improvement
required (WRITTEN ACTION PLAN within
120 days)

7. Ratings for indicator stmts
(3) Indicator has most/complete
activity/compliance
(4) Indicator was not
observed/discussed
•(a return visit will be dependent upon
observations and recommendations)

8. Indicator question ratings
• A – no activity/evidence
• B – discussed for possible
implementation
• C – partial implementation or activity
• D – implemented for some patients
• E – implemented for all patients
• (based upon COMPASS*)

9. Tips for surviving the Visit
• Breathe
• Be available and able to answer questions
regarding your pharmacy practice
• Read the NAPRA Model Standards of
Practice at
http://scp.in1touch.org/uploaded/web/refmanu

10. Indicator Statement #1
• Pharmacists are obtaining and
documenting all relevant patient
information in order to be able to
provide the most appropriate and best
possible medication therapy for the
patient.

11. Indicator questions
Questions: A B C D E
1. Patient’s demographic information (name,
address, date of birth, home telephone
number).
2. Patient’s current/relevant medical
conditions.
3. Patient’s relevant social and lifestyle factors
(e.g. smoker, social drinker, exercise, etc.).
4. Current medication therapy including
prescription drugs, vitamins,
herbal/homeopathic and other non-prescription
drugs/therapies.
5. Drug allergies and intolerances.
6. Information obtained is periodically (yearly)
reviewed and updated with the patient.

12. Stats
• Documentation (indicator - 3)
• 2015 2014 2013 2012
22% 35% 20% 28%

13. Indicator Statement #2
• Based on gathered and documented
patient information, the pharmacists
are assessing the medication therapy,
identifying and resolving drug related
problems, documenting care provided
and providing the best possible
medication therapy for the patient.

14. Indicator questions
Questions: A B C D E
7. The pharmacist determines the
indication for use for all patients’
medications.
8. The pharmacist assesses the
appropriateness of all new therapy
through discussions with the patient and
review of patient profile.
9. Patient factors/expectations are
considered when assessing
appropriateness of therapy (e.g. cost of
drug, frequency of administration,
swallowing issues, other conditions).

15. Indicator Questions
10. When the pharmacist identifies any
problems regarding incorrect dosage, possible
allergies, drug interactions, drug duplications,
inappropriate frequency and drug
contraindications, the pharmacist documents
who was consulted, any recommendations that
were made and if they were accepted, any
monitoring required, etc. and how the issue
was resolved.
11. Upon identifying concerns regarding
inappropriate drug use (over/under-use) the
pharmacist documents all discussions and/or
consultation with the patient or patient’s
practitioner(s).

16. Indicator Questions
Indicator #2 Questions continued: A B C D E
12. The pharmacist accesses the patient's profile and
PIP/e-Health viewer prior to filling of prescriptions to
ensure appropriateness of therapy and to determine
any other drug related problems.
13. The pharmacist monitors the patient’s progress
towards desired therapeutic outcomes and
discussing those outcomes with the patient,
including reviewing any relevant lab values (e.g. asks
about BP, BS, pain).
14. Medication adherence reviewed at each refill.
15. Reviews and discusses issues of adherence with
the patient and find mutually agreeable solutions.
The reasons for proper adherence are clearly
explained to the patient.

17. Indicator Questions
16. The pharmacist has access to and refers to
best practice guidelines and other clinical
practice resources when required.
17. The pharmacist, pharmacy technician(s)
and assistant(s) work collaboratively to ensure
any computer generated warnings including
drug allergy warning, drug duplication
warning, drug interaction warning, and drug
contraindication warning are resolved.
18. The pharmacist documents all relevant
patient care information needed for continuity
of care (e.g. monitoring results, patient's
progress towards therapeutic goals, follow-up
required).

18. Indicator Question #3
• The pharmacists are providing best
possible medication therapy for the
patient by providing appropriate patient
education.

19. Indicator Questions
Questions: A B C D E
19. Discusses medication therapy to
ensure patient understands the clinical
purpose and goals of therapy.
20. Ensures adequate time is given to
provide patient education, including an
opportunity for patients to ask questions.
21. Provides sufficient medication
information to the patient including drug
name, drug strength, indication, directions
for use, common side effects, drug-drug
and drug-food interactions, how to know if
therapeutic response is not occurring and
what to do.

20. Indicator Questions
22. Provides all patient medication and
medical condition information in a manner
that is appropriate to the patient.
Computer-generated drug information is
understandable to the patient and
provided with each new prescription.
23. Goals of medication therapy
(monitoring, follow-up, etc.) are reviewed
when medication is refilled.
24. Provides all patient education in an
area that allows for confidentiality and
minimizes distractions.

21. Indicator Question #4
• Pharmacists are prescribing when in
the best interest of the patient to do so.

22. Indicator Questions
25. Patient profile and PIP are accessed prior to
prescribing.
26. Patient medication history is assessed prior
to prescribing to ensure appropriateness of
therapy.
27. Pharmacist Assessment Record contains all
required information.
28. When prescribing for a minor ailment the
pharmacist ensures that the drug therapy is
appropriate for the treatment of the patient's
self-assessed condition.
29. Pharmacist's minor ailment prescribing
decisions based on treatment algorithms.
30. All prescribing decisions, the rationale for
prescribing, and any follow-up required is
documented on Pharmacist Assessment

23. Indicator Question #5
• Pharmacists, when utilizing an
advanced scope of practice
(injection/lab value interpretation),
apply medication use, expertise and
knowledge.

24. Indicator Questions
Questions: A B C D E
31. When administering injections, ensure
patient safety is maintained (suitable/safe
environment).
32. When administering injections, ensure
appropriate procedures are in place to ensure
maintenance of the cold chain for medications
(vaccines and others as required).
33. When administering injections, ensure there
are policies and procedures for handling
emergencies and adverse events which are
accessible to all appropriate staff.
34. Ensure patient privacy and confidentiality is
maintained during the injection process.

25. Indicator Questions
34. Ensure patient privacy and
confidentiality is maintained during the
injection process.
35. Ensure pharmacists have and maintain
adequate education, knowledge, training
and certification for injections.
36. Ensure pharmacists maintain and
provide to applicable sources, all adequate
documentation for injections.
37. Pharmacists appropriately inject all
medications (follow product monograph,
etc.).

26. Indicator Questions
38. Refrigerator temperatures are checked twice
daily when storing vaccines and adequately
monitored to identify a cold chain break.
39. Pharmacists access lab tests only under
applicable laws/regs/policies/guidelines.
40. Pharmacists interpret lab results to identify
required changes to patients’ medication
therapy and manage any required changes
(with appropriate documentation).
41. Pharmacists are aware of, and are in
compliance with, all applicable legislative
requirements, documentation and standards
regarding advanced scope of practice.

27. Indicator Question #6
• Pharmacy personnel are being
employed effectively by the pharmacy
manager and support safe medication
practices within the optimal workflow.

28. Indicator questions
Questions: A B C D E
42. The pharmacy manager has ensured
that staffing allows pharmacists on duty
for all shifts to be able to perform all
required tasks, including medication
management, prescribing, and additional
services such as providing injections ,
reviewing and interpreting lab tests as
well as compliance packaging, long term
care services, etc.
43. Pharmacists interact with each patient
at prescription drop-off or pick-up or via
phone to provide medication management
and optimize patient care.

29. Indicator questions
44. Workflow provides the pharmacist with
opportunities to engage in patient
medication management and interaction
with each patient.
45. Pharmacy is neat, orderly and free
from clutter to allow for safe dispensing
practices.
46. Activities which require concentration
are segregated to areas which minimize
distractions within the physical layout
(e.g. patient assessment, compliance
packaging).

30. Indicator Question #7
• There is a formal system in place in the
pharmacy that identifies and resolves
all issues involving medication errors,
near misses and unsafe practices. All
pharmacy staff are aware of the
applicable policies and procedures.
Quality improvement processes are in
place.

31. Indicator questions
• Key Element #1 – Managing Medication
Errors: Manages known, alleged and
suspected medication errors that reach
the patient consistent with the best
practices. Review pharmacy policy and
procedure manual to ensure procedure
for dealing with medication errors is
outlined.

32. Indicator questions
Questions: A B C D E
47. All medication errors are promptly
disclosed to the patient and/or the
patient’s agent.
48. An apology and explanation is
provided to the patient or patient's agent.
49. Patients are provided with adequate
information to manage any medical effects
of the medication errors and any follow up
required.

33. Indicator questions
50. Practitioners are notified of any
adverse events/effects of medication
errors.
51. All medication errors and near misses
are discussed and all pharmacy staff are
consulted to determine the contributing
factors (causal factors).
52. Potential causal factors are
determined and communicated to the
patient or patient's agent.
53. Actions are taken to reduce the
likelihood of the error occurring again.

34. stats
Medication error reporting
2015 2014 2013 2012
75% 80% 62% 96%

35. Indicator Question #8
• Pharmacists, when providing patient
care as part of medication therapy
management, obtain the necessary
patient consent, document their
concerns adequately and perform the
necessary follow up to ensure optimal
patient care.

36. Indicator questions
Questions: A B C D E
67. Perform medication reviews with
patients who are at risk of experiencing
problems with their medication to identify
drug-related problems (interactions,
contra-indications, adverse events).
68. Educate the patient as to appropriate
medication management during the
review.
69. Prepare and provide the best
medication history as well as
recommendations to improve medication
management to the patient’s health care
providers.

37. Indicator questions
70. Determine and discuss with the patient
and appropriate care givers and
practitioners any medications which are
no longer required/appropriate therapy.
71. Perform necessary follow up with the
patient and their health care providers to
ensure optimal medication management.

38. Indicator Question #9
• Failed Transactions: Ensures all
information provided to electronic
databases (e.g. PIP viewer) is accurate
and complete.

39. Indicator questions
Questions: A B C D E
72. Pharmacists ensure all prescriptions
are captured for viewing on PIP (other
than non-SK residents).
73. Failed Transactions are being
reviewed and resolved daily.
74. Prescriptions transfers into or out of
the pharmacy are documented as such in
PIP.

40. Indicator Question #10
• Drug distribution processes ensure the
safe dispensing of medications.

41. Indicator questions
75. All drugs are stored appropriately both for
temperature and location to maintain stability
and integrity (including compounded
products).
76. Expiry dates are checked regularly on all
inventory including prescription, and non-
prescription drugs and where applicable
devices. Outdated inventory is removed and
stored in a segregated area so as not to be re-
entered into active inventory.
77. Ensure the final check of prescription
products prepared for dispensing
(distribution) has been completed by the
appropriate pharmacy professional and
adequate documentation will verify the final
check.

42. Indicator questions
78. There are regular inventory counts of
narcotic and controlled drugs and
reconciliation of any identified shortages and
review of computer adjustments.
79. Prescriptions for Schedule I, II and III
medications reviewed are complete and
contain all required information.
80. All prescriptions reviewed contain
necessary information regarding which
pharmacists and support personnel were
involved in filling the prescription.
81. All sales/purchases reports for
narcotic/controlled drugs are up to date and
filed in a manner that allows for audits.

43. Special services/considerations
• Privacy
• Compliance packaging (NOSHI)
• Provision of Methadone
• Compounding
• Depot Services (‘telepharmacy’)
• Central Fill

44. New developments
• Administration of drugs by injection and
other routes
• Ordering and interpreting lab values
• Regulating Pharmacy Technicians
• 3rd
phase of the COMPASS project
• Sinks in the consultation room
• Refrigerator requirements
• New Compounding Standards – NAPRA

45. • Questions?
• lori.postnikoff@saskpharm.ca
• (306)-584-2292