Table 3.

Examples using the conceptual framework model

	Context	Role	Communication
Example 1: Narcotic legislation changes	• Health Canada issued a temporary exemption to the Controlled Drugs and Substances Act to address the overdose crisis that was occurring simultaneously with the COVID-19 pandemic.5,34 This exemption allowed pharmacists flexibility in managing prescriptions for narcotics. 40	Changes allowed pharmacists to5,34,35 • extend or renew prescriptions for patients that were unable to get to their original prescribing provider. • take a verbal order from prescribers for prescriptions while many appointments were virtual or telehealth. • deliver controlled substances to patients that were unable to attend the pharmacy (e.g., people in quarantine or with increased health risk).	“Because of the COVID-19 pandemic, temporary exemptions have been made under CDSA, creating an opportunity to provide continuity of care to some of the most vulnerable Canadians and helping us ensure their care is not interrupted, especially in times where they may be experiencing more stress, anxiety and isolation. . . . These exemptions permit pharmacists to care for their patients by extending prescriptions, transferring prescriptions to other pharmacists, receiving verbal orders and allowing pharmacy employees to deliver prescriptions of controlled substances to patients’ homes or other locations where they may be.” (CPhA) 36
Example 2: Influenza vaccination season	• Providing an in-person vaccination service during an ongoing pandemic required additional considerations to keep personnel and the community safe (e.g., infection control, safety measures, etc.).	• Pharmacists were responsible for the mass vaccination campaign during the influenza season amid the pandemic. • This included using infection prevention and cleaning measures, scheduling appointments and avoiding walk-ins, fielding questions, patient screening for COVID infection, wearing appropriate PPE, administering vaccinations and completing documentation/postimmunization requirements. 37	“CPhA continues to promote importance of flu preparedness to avoid ‘twindemic’. Canadians are about to face yet another challenge in the COVID-19 pandemic: the arrival of flu season. . . . ‘About 35% of flu vaccinations in Canada are given by pharmacists each year,” says Shelita Dattani, director of practice development with the Canadian Pharmacists Association. She’s expecting that ‘as some family practice clinics have cut down on in-person appointments during COVID-19, pharmacists may be giving many more flu shots this year — and they’ve been preparing for months.’ ” (CPhA, inference required to understand the specific preparedness actions being undertaken by pharmacists) 38
Example 3: Massage referral	• Massage therapy services closed to limit COVID-19 transmission. • An exemption was passed that allowed Albertans to access massage therapy with a written prescription from a medical doctor, or a written referral from a regulated health professional (e.g., physiotherapists and chiropractors). Albertans were requesting prescriptions to access the massage therapy service exemption.	Pharmacists providing prescription and referral services as regulated health professionals with a responsibility to perform necessary physical assessments within their scope of practice.	“Regulated members who are considering making a referral must evaluate their own competencies and consider whether this request might be better channeled through the patient’s chiropractor, physiotherapist, or physician. As this is a public health measure designed to minimize the spread of COVID-19, regulated members considering a patient’s request for referral to access massage therapy services should consider the relative risk of massage therapy services against the need to reduce the spread of COVID-19. Regulated members who choose to issue a referral must only do so once they have established a professional relationship with the patient, assessed the patient and determined that a referral is in the best interest of the patient. Regulated members are reminded that they are required to avoid any conflicts of interest and declare any personal or professional interest with any massage therapist to any patient who may be affected.” (ACP) 39

ACP, Alberta College of Pharmacy; CDSA, Controlled Drugs and Substances Act; CPhA, Canadian Pharmacists Association; PPE, personal protective equipment.