Appendix.

Canadian Pharmacy Policies and Guidelines: Summary by Jurisdiction

British Columbia	Framework of Professional Practice: Non prescription pharmaceutical products are defined as non-prescription medications, nutrition supplements, health care devices, home care products, complementary and alternative medicines.
Alberta	Standards of Practice
	Note: Health care products, aids and devices are defined in Alberta’s Pharmacy and Drug
	Regulation to include natural health products as they are defined in the NHPR s.1(1)(f).
	2. A pharmacist must consider appropriate information for each patient.
	2.1 Each time a pharmacist
	(d) conducts a review of a patient’s drug utilization, or
	(e) provides advice to a patient about a drug, a blood product or drug therapy, the pharmacist must consider appropriate information.
	2.2 Appropriate information means the following information in relation to a patient:
	(h) other health care products, aids and devices or other products being used that may affect the pharmacist’s decision;
	8. A pharmacist must take reasonable steps to offer assistance and information to a patient who wishes to purchase a schedule 3 drug or a health care product, aid or device.
	8.1 A pharmacist must be available and accessible to a person who wishes to purchase a schedule 3 drug or a health care product, aid or device.
	8.2 A pharmacist must take reasonable steps to enter into a dialogue with or provide information to a person who:
	(a) requests a schedule 3 drug or a health care product, aid or device;
	(b) requests assistance in making a choice about a schedule 3 drug or a health care product, aid or device;
	(c) appears to be having difficulty in making a choice about a schedule 3 drug or a health care product, aid or device;
	(d) is observed to be making purchases of a schedule 3 drug or a health care product, aid or device in a quantity or at a frequency that are therapeutically inappropriate; or
	(e) the pharmacist recognizes as someone who may face a risk from the selection or use of a schedule 3 drug or a health care product, aid or device.
	17. An authorized pharmacist who administers an injection to a patient must have proper regard for the interests of the patient and take all steps necessary to ensure that the injection is administered safely.
	17.1 A pharmacist who administers an injection to a patient must:
	(c) ensure that:
	(i) there is ready access to drugs and health care products, aids and devices used to treat reactions to injectable drugs, and
	(ii) the pharmacist is trained to administer the drugs and health care products, aids and devices used to treat reactions to injectable drugs;
	Miscellaneous
	The Manitoba Pharmaceutical Association:
	Pharmacy Standards (Minimum Pharmacy Site Requirements):
	4) The Minimum Library Requirements are:
	c) Interaction references for drugs, herbs, nutraceuticals and food;
	d) Information references for drugs, herbs, and nutraceuticals
Saskatchewan	Standards of Practice
	Non-prescription Medication Counselling: The pharmacist shall be accessible for consultation. The pharmacist should advise the patient on how, when and whether to take nonprescription medication, and when appropriate, advise the patient to consult a physician or other health care professional.
	NB. Natural health products are not explicitly identified as being non-prescription medications
	Supplemental Standards of Practice for Schedule II and III Drugs (NAPRA) See end of Table.
Manitoba	Standards of Practice (Community): 1.4. For any prescription medication, or regulated non-prescription medication to be provided to the patient by delivery, the pharmacist must: 1.4.4. include printed drug information plus contact pharmacy information, in addition to patient counselling. 1.34. Patient Information: Pharmacists shall maintain patient profiles for all patients. A reasonable effort shall be made to obtain and record the following information: f. Non-prescription, herbal, and homeopathic drug use 2.3 Patient counselling shall provide information to the patient on the following aspects of medication use: 2.3.5 instruction required to achieve the intended therapeutic response, which shall include, but not be limited to: 2.3.5.1 information regarding significant drug interactions with other drugs non-prescription medication, natural health products, neutraceuticals and food;
Ontario	Standards of Practice Standard 1 The pharmacist, using unique knowledge and skills to meet a patient’s drug-related needs, practices patient-focused care in partnership with patients and other health care providers, to achieve positive health outcomes and/or to maintain or improve quality of life for the patient. Operational Component 1.2 The pharmacist ensures that appropriate patient information is gathered and recorded to establish a profile for the provision of patient-focused care and that the information is maintained in a manner which ensures ease of use for patient care activities and confidentiality for the patient. The profile shall include demographic information about the patient as articulated under the Drug and Pharmacies Regulation Act and Regulations or the CSHP Standards of Practice and may also include, where appropriate, other information that is considered important for continuity of care and achievement of an optimal therapeutic outcome. This could include known patient risk factors for adverse drug reactions, drug allergies or sensitivities; known contraindications to prescription drugs, nonprescription drugs, natural health products, and complementary or alternative medicines, and other medications or treatments the patient is currently taking that may contribute to their condition or interact with suggested therapy. Operational Component 1.6 The pharmacist is clearly identifiable and is available, accessible and approachable to consult with the patient who is seeking to self-medicate with a nonprescription drug, a natural health product, or a complementary or alternative medicine. Standard 5 The pharmacist, in collaboration with the designated manager or hospital pharmacy manager, manages drug distribution by performing, supervising, or reviewing the functions of selection, preparation, distribution, storage and disposal of drugs to ensure safety, accuracy and quality of supplied products. Operational Component 5.2 - (Applies to community practice) The pharmacist locates drugs in the area of the pharmacy consistent with the appropriate drug schedule classification, regulations and safety consideration which reflect the level of risk of the drug for the patient. 5.2.3 The pharmacist ensures that all personnel know: - That only a pharmacist, intern, or registered pharmacy student under the direct supervision of the pharmacist may provide information or advice respecting the use of nonprescription products, natural health products and complementary or alternative medicines - Where Schedule II, III and other nonprescription products are located in the pharmacy - Why these products are located where they are - When the pharmacist is required or expected to intervene/consult - When to refer patients to the pharmacist 5.2.4 Schedule III drugs and all other nonprescription products should be located in an area of the pharmacy adjacent to the prescription services department (dispensary) which should allow self selection of Schedule III drugs by a patient, and provide opportunities for patient/pharmacist consultation. 5.2.5 The pharmacist should endeavour to enhance patient awareness of the benefits, limitations, appropriate use and risks associated with nonprescription products through one or more of the following: - Signage which encourages patients to consult with the pharmacist regarding the selection of nonprescription products
Quebec	Standards of Practice None located relevant to natural health products.
Newfoundland and Labrador	Standards of Practice See Model Standards of Practice for Canadian Pharmacists (NAPRA, 2003)
Nova Scotia	Standards of Practice See Model Standards of Practice for Canadian Pharmacists (NAPRA, 2003) Supplemental Standards of Practice for Schedule II and III Drugs (NAPRA) See end of Table. Policies, Positions & Guidelines: Sale of Natural Health Products in Pharmacies •The pharmacist shall have a general knowledge of natural health products. •The pharmacist shall have a current, reliable reference. •The pharmacist shall be satisfied that the products have been approved for sale by Health Canada and have been assigned an NPN or DIN-HM designation. •When counselling, the pharmacist shall be satisfied that the product(s) will not interfere/interact with the patient’s possible disease state and/or other traditional medications. •When counselling, the pharmacist shall be satisfied that the patient understands that the product is not to be used as an alternative to his/her traditional therapy, unless so directed by his/her physician. •When counselling, the pharmacist shall encourage the patient to inform his/her physician of the decision to try new therapy. The pharmacist shall recognize the need for intervention and/or referral to a physician.
New Brunswick	Standards of Practice None located.
Prince Edward Island	Policy Statement Pharmacist’s Responsibility in Providing Advice About or Selling Alternative Health Products: Prince Edward Islanders are increasingly using complementary therapies, including botanical and homeopathic medicines, as an adjunct or alternative to allopathic treatment. Pharmacists commonly offer such medicines for sale and are frequently consulted about the appropriate use of both botanical (plant based remedies) and homeopathic products (extremely small doses of substances aimed at stimulating healing). The following general guidelines are commended to pharmacists providing advice or selling alternative health products: 1. All botanical and homeopathic products distributed to patients should be safe to use in keeping with the pharmacist’s obligation to act in the patient’s best interest. Safety includes reasonable assurance of freedom from product toxicity as well as not causing harm with respect to ongoing disease states. 2. The pharmacist must have an understanding of the indications for use, possible side effects and expected outcomes of these products, and maintain appropriate references. 3. The pharmacist recognizes the need for intervention and/or when to advise referral to the purchaser’s physician for treatment or ongoing management of a disease state, in keeping with the pharmacist’s role in identifying, preventing or solving therapeutic problems. Guidelines for the Sale of Herbal Products and Homeopathic Remedies in Pharmacies •The pharmacist shall have a general knowledge of herbal products. •*The pharmacist shall have a current, reliable reference. •*The pharmacist shall be satisfied that the products are safe. •*When counseling, the pharmacist shall be satisfied that the product(s) will not interfere/interact with the patient’s possible disease state and/or other traditional medications. •*When counseling, the pharmacist shall be satisfied that the patient understands that the product is not to be used as an alternative to his/her traditional therapy, unless so directed by his/her physician. •*When counseling, the pharmacist shall encourage the patient to inform his/her physician of the decision to try new therapy. *The pharmacist shall recognize the need for intervention and/or referral to a physician.
Yukon	None located.
Northwest Territories	None located.
Nunavut	None located.
Model Standards of Practice for Canadian Pharmacists (NAPRA)	1.1 A pharmacist must develop a professional relationship with the patient. Example: …offers professional assistance in selecting non-prescription drug therapy and natural health products. 1.2 A pharmacist must gather patient information and assess its relevance to patient care. Required performance indicator: Routinely collect the information necessary to address the patient’s drug related needs or questions, such as: • the seriousness of symptoms, particularly when addressing problems associated with self care / non-prescription drugs • the history of current condition, particularly when addressing problems associated with self care / non-prescription drugs • other medications or treatments that the patient has tried for this condition and effects, particularly when addressing problems associated with self care / non-prescription drugs 1.5 A pharmacist must develop therapeutic plans, recommending therapeutic options, doses, scheduling / administration, required drug devices and compliance aids. Required performance indicator: When requested by a patient, provide accurate information concerning efficacy, toxicity, side effects or interactions of natural health products. 1.6 A pharmacist must refer patients to other health care providers when required. Optional Performance Indicators reflecting advanced or exemplary practice: Routinely refer patients to appropriate health organizations and health care professionals within the community, including complementary and alternative health care providers. 1.7 A pharmacist must develop, implement and fulfil plans to monitor the patient’s progress towards desired therapeutic outcomes Required performance indicator: … appropriately educate patients on the following when dispensing prescription and non-prescription drugs, when patient counselling on discharge medications or when providing recommendations about management of specific drug related problems: • name and class of the drug (e.g. antibiotic, pain reliever) • directions for use including education about drug devices • special storage requirements • common or important drug-drug or drug-food interactions 2.2 A pharmacist must retrieve information from relevant sources. Optional Performance Indicators reflecting advanced or exemplary practice: Routinely and efficiently retrieve the information necessary to provide recommendations about all drugs, including herbal and complementary medicines. 2.4 A pharmacist must organize and disseminate information. Optional Performance Indicators reflecting advanced or exemplary practice: Provide recommendations about all legal drugs, including herbal and complementary medicines. 4.1 A pharmacist must perform, supervise and/ or review drug preparation and distribution activities. Required performance indicator: Appropriately identify and perform professional functions associated with drug distribution, including: - providing assistance with the selection of unscheduled* non-prescription drugs when requested * according to NAPRA’s National Model Drug Schedules