COVID-19 Guidance for Pharmacists and Pharmacy Technicians
The situation with COVID-19 is evolving rapidly. The guidance provided in this document is intended to provide pharmacists and pharmacy technicians with foundational information and advice, but be advised that anything that appears in this document is subject to change.
Page last updated on July 7, 2021, at 11:45 a.m. MT.
|Administering influenze immunizations to patients during the COVID-19 pandemic||Removed guidance: Outdated.||July 7, 2021|
|Prescribing and dispensing drugs to treat COVID-19||Removed guidance: Outdated.||July 7, 2021|
|Administering injections to patients during the COVID-19 pandemic||Removed guidance: Outdated.||July 7, 2021|
|Providing virtual care to patients||Removed guidance: Replaced by Providing virtual care to patients.||July 7, 2021|
|Pharmacists and pharmacy technicians working remotely||Updated guidance: Updated references to virtual care to reflect Providing virtual care to patients.||July 7, 2021|
|Temporary authorization to waive requirements to see patients personally||Updated guidance: End date of July 31, 2021 added.||July 7, 2021|
|Repackaging non-prescription medications||Removed guidance: Outdated.||July 7, 2021|
|Patient medication supply||Removed guidance: Outdated.||July 7, 2021|
|Protecting the vulnerable||Removed guidance: Outdated.||July 7, 2021|
|General advice to pharmacy licensees and registrants||Updated guidance: Removed references to outdated CMOH orders and travel advisories.||July 7, 2021|
|Personal protective equipment (PPE) for direct patient care||Update guidance: Updated requirement for continuous masking to recommendation/best practice.||July 7, 2021|
|Personal protective equipment (PPE) for compounding||Removed guidance: Outdated.||July 7, 2021|
|Post-consumer returns||Removed guidance: Outdated.||July 7, 2021|
|Administering injections to patients during the COVID-19 pandemic||Updated guidance: This document has been updated with guidance and recommendations from the National Advisory Committee on Immunization (NACI) that address the continuity of immunization programs during the COVID-19 pandemic and provide specific recommendations on the use of COVID-19 vaccines.||March 12, 2021|
|Administering influenza immunizations to patients during the COVID-19 pandemic||Updated guidance: This document has been updated with guidance and recommendations from the National Advisory Committee on Immunization (NACI) that address the continuity of immunization programs during the COVID-19 pandemic and provide specific recommendations on the use of COVID-19 vaccines.||March 12, 2021|
|Personal protective equipment (PPE) for direct patient care||Updated guidance: This guidance has been altered to reflect Alberta Health's new recommendation that pharmacy teams in community practice should evaluate the benefits of adding protective eyewear to their PPE requirements.||February 12, 2021|
|Temporary authorization to collect a throat swab specimen for testing for COVID-19||New guidance: This temporary guidance has been altered in recognition of the pharmacies that are working with government to provide COVID-19 testing. Additionally, this will support COVID-19 testing within Alberta Health Services.||November 4, 2020|
|Temporary changes to care provided to nursing home residents||Deleted document: This legislative change is now permanent.||October 23, 2020|
|Temporary compounding of alcohol-based hand sanitizer by pharmacists and pharmacy technicians||Deleted document: There is sufficient commercially prepared hand sanitizer to meet the demand.||October 23, 2020|
|Temporary authorization to waive Standard 11.9 when adapting prescriptions||Deleted document: Pharmacists should currently be able to fulfill this requirement in their practices.||October 23, 2020|
|Repackaging non-prescription medications||Updated guidance: Minor language changes have been made to this guidance.||October 23, 2020|
|Administering influenza immunizations to patients during the COVID-19 pandemic guidance||Updated guidance: The post immunization requirements have been updated to ensure that pharmacy team members are advising patients to isolate for 48 hours if they develop symptoms that are consistent with COVID-19.||October 23, 2020|
|COVID-19 assessment and referral||Updated guidance: Links within this document have been updated, and a reference to referring Albertans to 811 has been removed.||October 23, 2020|
|Post-consumer returns||Updated guidance: Additional guidance for accepting returns has been included, and the reference to the Health Canada Office of Controlled Substances bulletin has been updated.||October 23, 2020|
|Personal protective equipment (PPE) for compounding||Updated guidance: The introduction for this guidance has been rewritten as has the section on Considerations when anticipating PPE shortages. References have also been updated.||October 23, 2020|
|Management of staff illness||Updated guidance: Updates to the screening protocol for pharmacy staff members for COVID-19, and what to do when a pharmacy staff member has tested positive for COVID-19 has been included.||October 23, 2020|
|Personal protective equipment (PPE) for direct patient care||Updated guidance: Information related to PPE shortages has been deleted from this guidance, and additional information on masking has been included.||October 23, 2020|
|Management of patient illness||Updated guidance: Additional guidance for screening of patients when arriving to the pharmacy, and guidance in providing care has been included.||October 23, 2020|
|Planning and preparation for pharmacy staff shortages resulting from COVID-19||Updated guidance: Additional resources from CPhA, and suggestions for mask use in the pharmacy have been included in this guidance.||October 23, 2020|
|General advice to pharmacy licensees and registrants||Updated guidance: Chief Medical Officer of Health (CMOH) orders have been updated, along with a reference to adhering to municipal bylaws with respect to masking.||October 23, 2020|
|Pharmacists and pharmacy technicians working remotely||Updated guidance: Clarity on the provision of services across provincial jurisdictions has been included.||October 23, 2020|
|Administering injections to patients during the COVID-19 pandemic||Updated guidance: Additional guidance has been provided for assessing if administering a drug by injection is appropriate, and references have been updated.||October 23, 2020|
|Guidance for prescription delivery||Updated guidance: Additional guidance has been provided for documenting delivery of medications.||October 23, 2020|
|Temporary guidance for Opioid Agonist Therapy (OAT)||Updated guidance: Additional guidance for witnessed dosing has been included.||October 23, 2020|
|Protecting the vulnerable||Updated guidance: Additional guidance for protecting vulnerable individuals including resources has been included.||October 23, 2020|
|Health Canada s56(1) exemption for controlled substances||Updated guidance: The introduction to this guidance has been rewritten. This exemption now extends to September 30, 2021, and additional restrictions for extending prescriptions has been included.||October 23, 2020|
|Temporary authorization for throat swab specimen collection||New guidance: Due to the COVID-19 pandemic, ACP is supporting Alberta Health’s asymptomatic COVID-19 testing in pharmacies by temporarily enabling the collection of throat swab specimens when conducted as part of a specimen collection program in accordance with Standard 29 of the Standards of Practice for Laboratory and Point of Care Testing (POCT). This document will detail the standards related to specimen collection. In addition, the entire laboratory and point of care testing standards and guidance must be adhered to, including standards related to patient assessment, ordering and interpreting laboratory tests, documentation, and follow up.||July 3, 2020|
|Patient medication supply||Updated guidance: Patient medication supply was previously limited to a 30-day supply limit to help ensure that individuals requiring drug therapy had access to their prescribed drug needs. Alberta Health is relaxing its policy that limited prescriptions to a 30-day supply, effective June 15, 2020. This means that pharmacists in Alberta can dispense larger quantities again—up to a 100-day supply. Despite this, pharmacists should use their professional judgement to limit the dispensed quantities of specific drugs that continue to be in short supply, or at risk of a shortage. Alberta Blue Cross, at the direction of Alberta Health, will maintain a list of products in a critical supply situation that pharmacists are able to access.||July 3, 2020|
|Providing virtual care to patients||Updated guidance: To support pharmacies that wish to integrate virtual care technology into their practice in response to COVID-19, ACP has updated the Evaluate virtual care technologies and Notify the Office of the Information and Privacy Commissioner (OIPC) sections of the Providing virtual care to patients guidance document. Questions for consideration have been added to assist pharmacy teams in assessing the privacy impact of their proposed changes. Additional information on the requirement to notify OIPC have been provided.||June 5, 2020|
|Additional resources||New guidance: A section was added to provide links to documents and websites recommended by the CMOH.||May 29, 2020|
|Management of patient illness||Updated guidance: The Screening of patients and Interacting with patients subsections were updated with additional details added to the screening protocol, and what steps to take if a patient screens positive. The Treating symptomatic patients or asymptomatic patients who are required to quarantine in exceptional circumstances subsection was updated with additional guidance along with a link to support pharmacists when they need to treat symptomatic patients or asymptomatic patients who are self-isolating.||May 29, 2020|
|Management of staff illness||Updated guidance: The Screening pharmacy staff for COVID-19 subsection was updated.||May 29, 2020|
|Preventative COVID-19 exposure measures in pharmacies||Updated guidance: The Alberta Health Services 4 Moments for Hand Hygiene document was added as a link to the hand hygiene sub-section, and additional guidance in the cleaning and disinfecting subsection was added.||May 29, 2020|
|Planning and preparation for pharmacy staff shortages resulting from COVID-19||Updated guidance: A link was added for the Health Canada Risk-informed decision-making guidelines for workplaces and businesses during the COVID-19 pandemic document.||May 29, 2020|
|General advice to pharmacy licensees and registrants||Updated guidance: New information on signage, as well as links for signs and infection prevention was added.||May 29, 2020|
|Interim guidance on continuity of immunization programs during the COVID-19 pandemic||Updated guidance: To assist providers in supporting patients who may require immunizations during COVID-19, ACP has updated its guidance on administering injections to include a link to Interim guidance on continuity of immunization programs during the COVID-19 pandemic from the National Advisory Committee on Immunization. This guidance document addresses immunizing individuals during the COVID-19 pandemic and the impact of immunization deferral.||May 22, 2020|
|Temporary changes to care provided to nursing home residents||New guidance: ACP has added the guidance document “Temporary changes to the care provided to nursing home residents.” This guidance document provides information about Ministerial Order 6/2020 and its temporary modification to the manner in which health services, including prescription services, can be provided to nursing home residents. These temporary changes will give nursing home residents greater access in fulfilling their medication needs and help ensure their medication therapy is not disrupted.||May 15, 2020|
|Management of patient illness||New guidance: This section has been added and provides pharmacy team members with guidance on screening patients for COVID-19 and how to conduct appropriate interactions with patients during the pandemic. Additionally, guidance is provided on how to treat symptomatic patients when required for exceptional circumstances.||May 15, 2020|
|Management of staff illness||Updated guidance: Screening information, direction on how to manage symptomatic team members, direction on working with Alberta Health Services, and direction on how and when ill team members should return to work has been updated.||May 15, 2020|
|Preventative COVID-19 exposure measures in pharmacies||Updated guidance: Significant additional information has been added on hand hygiene, cleaning, and disinfecting the pharmacy, and on workflow adjustments required due to COVID-19.||May 15, 2020|
|Planning and preparation for pharmacy staff shortages resulting from COVID-19||Updated guidance: Additional information has been provided on ensuring compliance with the requirements and recommendations of the CMOH public health order 16-2020 and the Alberta government.||May 15, 2020|
|General advice to pharmacy licensees and registrants||Updated guidance: Guidance and links have been added outlining how to achieve compliance with the mandatory CMOH public health order 16-2020. Additional information on signage has also been added.||May 15, 2020|
|Temporary guidance for Opioid Agonist Therapy (OAT)||Updated guidance: When a patient requires an extension or renewal of their OAT prescription and the pharmacist is unable to contact the original prescriber, pharmacists now have the option to assess the patient and prescribe these medications. The updated guidance provides a clinical resource, available to all prescribers, that enables consultation with an OAT specialist physician when additional support with assessment or patient management is required.||April 24, 2020|
|Guidance for pharmacy staff occupational illness||Updated guidance: ACP has updated the advice to pharmacy licensees, pharmacists, and pharmacy technicians about preparing for staff illness due to COVID-19, and steps to be taken when a staff member has tested positive. Included are links to resources on cleaning and disinfecting, as well as the AHS protocol for when it is appropriate to return to work.||April 24, 2020|
|Patient medication supply guidance||Updated guidance: Given the worldwide disruptions to drug manufacturing, distribution channels, as well as increasing shortages of certain medications, ACP, along with Alberta Health and the Alberta Pharmacists’ Association, have established the expectation that prescriptions are to be provided in quantities that do not exceed a 30-day supply. Questions have been received from the public about this direction and ACP has updated its advice for the public and guidance for patient medication supply for pharmacy professionals.||April 24, 2020|
|Guidance for pharmacists and pharmacy technicians working remotely||New guidance: ACP recognizes that some pharmacists or pharmacy technicians may need to work remotely during the COVID-19 pandemic due to self-isolation or pharmacy closure. This guidance provides a framework for pharmacists and pharmacy technicians working remotely, and includes direction on the various requirements, limitations, and on how to mitigate security concerns.||April 24, 2020|
|Post-consumer returns||New guidance: Due to COVID-19, there is an increased level of risk associated with accepting post-consumer returns from patients, including unused drugs, expired drugs, and sharps. The ACP post-consumer returns guidance provides pharmacists direction on accepting or refusing to accept these items for disposal. It also provides a link to the bulletin published by the Health Canada, Office of Controlled Substances, on temporary measures for accepting post-consumer returns of controlled substances.||April 24, 2020|
|Personal protective equipment (PPE) for direct patient care||Updated guidance: As information about asymptomatic and pre-symptomatic transmission of COVID-19 evolves, additional guidance has been provided by Alberta Health Services (AHS) regarding the need for continuous masking for pharmacy professionals and team members when providing direct patient care services and where physical distancing is difficult. For more information, please review the updated guidance on PPE for direct patient care.||April 17, 2020|
|Administering injections during the COVID-19 pandemic||New guidance: ACP has received concerns about pharmacists refusing to provide patients with essential drugs by injection, such as vitamin B12 for cancer patients. This guidance has been developed to support pharmacists in their decision making when a patient requires an injection and to inform pharmacists of their options and obligations when it is determined not safe to perform this activity.||April 17, 2020|
|Temporary guidance for Opioid Agonist Therapy (OAT)||Updated guidance: Due to the requirements for self-isolation and social distancing, many Opioid Agonist Therapy (OAT) patients might be receiving carried doses more frequently than normal. The OAT section update provides guidance on the importance of an assessment and providing an adequate supply of naloxone to avoid opioid poisoning in these vulnerable patients.||April 9, 2020|
|Health Canada s56(1) exemption for controlled substances||Updated guidance: There may be times where a pharmacy is temporarily closed due to COVID-19 and patients cannot access their prescriptions for controlled substances. The s56 exemption section update describes circumstances when it would be appropriate for a pharmacist to prescribe an extension for controlled substances when they do not have a copy of the original prescription at their pharmacy.||April 9, 2020|
|Preventative COVID-19 exposure measures for pharmacists and pharmacy technicians||Updated guidance: As knowledge of COVID-19 transmission develops, we are providing updates on crucial measures for minimizing exposure risks in pharmacies. The update in this document is the reminder that hand hygiene activities should be completed after doffing each PPE element as well as after disposal of these items.||April 9, 2020|
|Personal protective equipment (PPE) for direct patient care||Updated guidance: The Alberta Pharmacists’ Association (RxA), with the support of ACP, have worked together to supply personal protective equipment (PPE) for all community-based pharmacies. Pharmacy professionals are reminded that there is a limited supply of PPE across the health system. Judicious use of PPE is imperative. PPE is for direct patient care activities only and must not be sold to the public. More information on allocation, distribution, and best practice when using PPE can be found in this guidance.||April 9, 2020|
|Health Canada s56(1) exemption for controlled substances||Updated guidance: Health Canada’s Office of Controlled Substances has provided ACP clarification that targeted drugs may be transferred interprovincially and may be transferred more than one time. The guidance has been updated to reflect this new information.||April 6, 2020|
|Temporary guidance for Opioid Agonist Therapy (OAT)||Updated guidance: Information to support pharmacists was reorganized, updated, and moved from the Health Canada s56(1) exemption page of the guidance to its own section.||April 6, 2020|
|Guidance for prescription delivery||Updated guidance: When delivering prescriptions to patients, pharmacy professionals are reminded of their responsibility to ensure the safety and integrity of drugs as well as the security of confidential health information. The guidance for prescription delivery section has been updated to highlight these responsibilities.||April 6, 2020|
|General advice to pharmacists and pharmacy technicians||Updated guidance: ACP has updated the general advice to pharmacists and pharmacy technicians section to reflect the current direction from public health. Pharmacy professionals are encouraged to review this to ensure that their information is up to date when triaging patients.||April 6, 2020|
|Preventative COVID-19 exposure measures for pharmacists and pharmacy technicians||Updated guidance: The key updates in this article include more details about routine cleaning activities within the pharmacy and workflow strategies that support effective physical distancing. This guidance document also provides links to additional practice resources on hand hygiene, cleaning, and physical distancing efforts.||April 6, 2020|
|Providing virtual care to patients||New guidance: ACP has provided temporary guidelines for pharmacy professionals on delivering pharmacy services to patients remotely using virtual care technologies in a manner that meets the standards of practice.||April 6, 2020|
|Pharmacist and pharmacy technician occupational illness||Use the online healthcare worker self-assessment tool to help determine whether you need to be tested and to get additional advice on COVID-19, such as the need to self-isolate. This self-assessment tool is for all healthcare workers who think they may have COVID-19 or may have been exposed to COVID-19.||March 27, 2020|
|Temporary compounding of alcohol-based hand sanitizer||This temporary guidance is provided to assist pharmacy staff members in carrying out the compounding of ABHS appropriately to reduce the spread of the COVID-19 virus.||March 27, 2020|
|Delivery of drugs to assisted living facilities||This document provides guidance in situations when it is not possible to deliver drugs directly to a resident in an ALF. The temporary guidance outlines steps to ensure the integrity of the drug and the confidentiality of patients’ health information during delivery. It also outlines steps to maintain a secure drug supply and minimize risks to others who might come in contact with drugs during transport.||March 27, 2020|
|Non-compliance with mandatory requirements to self-isolate||If a pharmacist or pharmacy technician suspects a patient, pharmacy professional, or other healthcare provider is not complying with mandatory Alberta Health measures, guidance has been developed to assist a pharmacist or pharmacy technician in addressing the non-compliance.||March 27, 2020|
|Repackaging non-prescription medications||Guidance has been provided to assist in completing repackaging appropriately and safely according to our Standards of Practice for Pharmacists and Pharmacy Technicians and Code of Ethics.||March 27, 2020|
|Guidance for prescription delivery||New guidance: information to assist pharmacy professionals with ensuring the safety of patients and delivery persons, security and stability of drugs, and the security of patient health information.||March 24, 2020|
|Patient medication supply||Updated guidance: ACP, along with Alberta Health and RxA, have established the expectation that, effective immediately, prescriptions are to be provided in quantities that do no exceed a thirty (30) day supply.||March 24, 2020|
|Personal Protective Equipment (PPE) for compounding||Updated guidance: Guidance on conservation measures for garb and PPE have been updated to address shortages as ACP actively works to address needs.||March 24, 2020|
|Health Canada s56(1) exemption for pharmacists||Updated guidance: Health Canada has published an FAQ to accompany their s56(1) exemption guidance.||March 24, 2020|
|Prescribing and dispensing of drugs to treat COVID-19||New guidance: ACP has received reports of increased demand for some drugs (e.g., Kaletra®, hydroxychloroquine) due to reports of them being prescribed as treatments for COVID-19. There is an increased urgency to affirm appropriateness of use as per Standard 3 of the Standards of Practice for Pharmacists and Pharmacy Technicians.||March 21, 2020|
|ACP Guidance - Temporary authorizations for controlled substances||New guidance: ACP Guidance - Temporary authorizations for controlled substances includes information on how to use the exemption in context with the Standard of Practice for Pharmacists and Pharmacy Technicians.||March 19, 2020|
|Joint message about s56(1) exemption from ACP and CPSA||New guidance: Joint message about s56(1) exemption from ACP and CPSA to communicate to their respective members on how to interpret these temporary exemptions and put them into practice.||March 19, 2020|
|Health Canada s56(1) exemption for pharmacists||New guidance: Health Canada s56(1) exemption for pharmacists includes information about Health Canada's exemptions for prescriptions of controlled substances under the Controlled Drugs and Substances Act (CDSA) and its regulations.||March 19, 2020|
|COVID-19 Guidance for Pharmacists and Pharmacy Technicians||
New guidance: The COVID-19 Guidance for Pharmacists and Pharmacy Technicians includes updated advice in the following areas as they relate to the pandemic:
|March 17, 2020|
|COVID-19 Guidance for Pharmacists and Pharmacy Technicians||
New guidance: The COVID-19 Guidance for Pharmacists and Pharmacy Technicians includes advice in the following areas as they relate to the pandemic:
|March 13, 2020|
Pharmacy professionals should also review ACP's COVID-19 resources page on an ongoing and frequent basis for the latest updates.
Caring for patients
Health Canada s56(1) exemption for controlled substances
On March 19, 2020, Health Canada issued s56(1) exemptions to support Canadians in accessing controlled substances when needed for medical treatments during the COVID-19 pandemic. This exemption has been extended to September 30, 2021.
- Read the s56(1) exemption issued by Health Canada.
- Read the Health Canada FAQs for further information and clarification on the exemptions.
- Read the policy document entitled Prescription management by pharmacists with controlled substances under the Controlled Drugs and Substances Act and its regulations.
To support pharmacists and pharmacy technicians integrating these exemptions into their practice, ACP has developed the document COVID-19 Guidance - Temporary authorizations for controlled substances.
Read the joint message from ACP and the College of Physicians and Surgeons of Alberta (CPSA).
Temporary guidance for Opioid Agonist Therapy (OAT)
None of the guidance herein requires a pharmacist to provide Opioid Agonist Therapy (OAT) in a manner that they believe is unsafe for the patient, the pharmacy staff or the public.
Ensure continuity of care
For patients who are stable on OAT, interruptions to treatment can have severe consequences such as withdrawal symptoms and increased risk of relapse.
- If pharmacists are not able to meet the needs of the patient due to reduced hours, pharmacy closure or other reasons, the pharmacy must transfer the care of the patient to another pharmacy.
Importance of Naloxone
Pharmacy staff at pharmacies that dispense OAT should be familiar with the ACP Providing naloxone as an unscheduled drug: Guidelines for pharmacy teams document.
Pharmacists should ensure that all patients receiving OAT are
- routinely assessed for risk,
- routinely offered injectable or nasal naloxone, and
- trained on appropriate use of the naloxone kit or device.
Particular consideration should be given to patients who are, because of COVID-19, receiving more carried doses than they normally would.
The Alberta Health Services Community-Based Naloxone Program has advised ACP that they have temporarily relaxed their requirements; and pharmacy staff, at their discretion, may release more than one AHS naloxone kit to a patient at a time.
For guidance on responding to an opioid poisoning event during the COVID-19 pandemic, please refer to the AHS resource Opioid Poisoning Response and COVID-19.
Pharmacist prescribing of OAT
Under Health Canada’s temporary Section 56 exemptions, pharmacists are permitted to prescribe controlled substances in specific circumstances, including for continuity of OAT. Refer to the ACP guidance for specific details to guide your prescribing.
- Collaboration with the original prescriber is always the preferred option and pharmacists should only prescribe an extension when it is in the best interests of the patient to do so and they have completed a thorough assessment.
- Pharmacists may adapt a prescription for OAT only for the purpose of renewing an existing and current prescription to ensure continuity of care.
- If a pharmacist does not have the original prescription or written order at their pharmacy, before prescribing an extension, the pharmacist must
- contact the original pharmacy to transfer the prescription if there is quantity remaining on file, or
- contact the original prescriber and collaborate to obtain a new prescription.
- Pharmacists must not make any changes to the dosage of existing therapy except in collaboration with the prescriber.
- Patients taking slow release oral morphine (SROM) should only be provided a maximum of two days’ supply and only upon careful evaluation of the unique risks associated with this medication. The pharmacist must make every effort to contact and collaborate with the original prescriber as soon as possible after prescribing.
Pharmacists who are unable to collaborate with the original prescriber and are required to prescribe OAT due to immediate patient need, may contact the AHS Opioid Use Disorder - Telephone Consultation Service if they require additional clinical guidance and support. This service is intended for OAT prescribers and gives them access to consult with an opioid use disorder physician specialist.
This service has limited capacity and is not intended for dispensing or regulatory questions. Pharmacists with these type of questions should consult the ACP ODT Guidelines, an appropriate clinical reference, or contact ACP at 780-990-0321.
- Pharmacists may accept prescriptions for methadone and buprenorphine-naloxone that include a number of carried doses greater than the standard 14 days.
- Buprenorphine-naloxone patients may receive up to a 30-day supply of carried doses, in collaboration with the prescriber.
- The threshold for when to provide carried doses may need to be lowered, and the maximum number of carried doses permitted may need to be altered based on the circumstances of the patient, the prescriber, and the pharmacy. Pharmacists should collaborate with prescribers to consider prescribing carried doses for patients whenever possible, unless the risk of opioid poisoning, to the patient or others around them such as children or roommates, outweighs the risks of presenting in person to the pharmacy.
- Pharmacists should ensure that carried doses are provided only when they are satisfied that the carried doses can be transported and stored safely by the patient in a manner that minimizes risk to the public.
- Pharmacists should advise patients that the return of used carry bottles is not recommended at this time. Pharmacists must provide direction to these patients to ensure the used carry bottles are rinsed and properly disposed of.
- For patients who are self-isolating, alternative measures to support witnessed dosing should be considered, including approved virtual communication methods or home delivery if the requirements of social distancing are maintained.
- Regardless of the method used, the dose must be witnessed by a pharmacist or other authorized health care professional working in collaboration with the pharmacist. It is not appropriate for a dose to be witnessed by a pharmacy technician, pharmacy assistant, or unregulated delivery staff.
- At the discretion of the prescriber, the need for a witnessed dose of buprenorphine-naloxone, slow-release oral morphine, or methadone may be waived. Despite this requirement being waived, pharmacists must make every effort to conduct a commensurate assessment, in person or remotely.
Dispensing to authorized individuals
- For patients in self-isolation, a pharmacist may release OAT to another authorized individual. Pharmacists must take steps to confirm the individual is authorized by the patient, to confirm the identity of the individual before releasing the medication, and to confirm the receipt of the medication by the patient.
Guidance for prescription delivery
Pharmacy professionals should exercise professional judgment to determine the most appropriate process to deliver prescriptions based on the circumstances at hand.
- A patient who screens positive or is in self-isolation should be advised to get someone from outside of their household to pick up their medications. Alternatively, the pharmacy should arrange for the delivery of medications if this service is available. The medication should be delivered to the patient without direct contact. Operationally, there may be more than one way to accomplish this, which is left to the professional judgment of the pharmacist (e.g., place in mailbox, have delivery person call the recipient once the medication is left, wait or follow up by phone to confirm they have successfully received it, etc.)
- Pharmacies that require a signature to confirm delivery should consider alternative methods of documentation that would achieve the same purpose. This may include having the delivery person call the recipient once the medication is dropped off or having the delivery person knock and then waiting at a distance to visual confirm the medication was received or following up by phone to confirm they have successfully received it. Successful delivery should then be documented.
- When delivering controlled substances, the individual making the delivery must identify the patient or their agent and observe the receipt of the medications prior to leaving the delivery site. For more information, please refer to the guidance on delivering controlled substances to patients’ homes.
- Process any payments in advance, if applicable, by secure means when delivery is arranged with the patient, to limit interaction between patients and delivery personnel.
- On the outside of the packaging, indicate transport conditions (related to temperature, fragility, and safety) and only the information required for delivery to the patient or other recipient (name, address, etc.).
- Maintain social distancing requirements during the delivery.
- Ensure any reusable totes used for delivery are sanitized inside and out before they come into the pharmacy and between each use.
- Pharmacists cannot mail controlled substances (including narcotics, controlled drugs, and targeted substances) to patients located outside of Canada, as per the Controlled Drugs and Substances Act, Section 6(1). This requirement is still in force and is not affected by the recent Health Canada section 56(1) exemptions for controlled substances.
- Mailing non-controlled prescription medications to your out-of-country patients is still permitted. However, medications arriving in other countries from Canada are subject to the laws of that country.
- Not all prescription medications available to Canadian patients have been approved for use in other countries. Verify if the drug is approved, and if not, confirm the documentation requirements for any exceptions. Refusal of entry or seizure of the medication is at the discretion of the destination country.
- Contact the delivery service to find out what documentation is required to ship prescription medications to a particular country. If the delivery service is unsure, the country’s embassy or consulate here in Canada may be contacted for information.
- Ensure all packages are traceable and auditable.
- Advise patients that there may be delays.
As per the Standards for the Operation of Licensed Pharmacies (SOLP) 8.1(e) and 8.2, the licensee must ensure that there is an effective system for creating, maintaining, securing storage of, and retrieving all required records. This includes
- keeping records of the mode of delivery for all medications delivered to patients, and
- storing records securely in the dispensary or completing an off-site storage application if the records will be stored outside the dispensary.
Delivery of drugs to assisted living facilities
Read the guidance prepared by ACP.
Pharmacists and pharmacy technicians working remotely
Due to self-isolation, ACP recognizes that some pharmacists or pharmacy technicians may need to continue limited practices remotely from their home or another location. Registrants working in licensed pharmacies must be aware that Section 11.1 of the Pharmacy and Drug Act requires that a pharmacist must always be present and supervising the practice of pharmacy when the public has access to the pharmacy.
Registrants who work remotely must review and implement ACP's guidelines document Providing virtual care to patients. In addition, registrants working remotely must ensure that no scheduled drugs are procured, stored, compounded, dispensed, or sold from a remote location.
To prevent unauthorized access and protect patient confidentiality and privacy, registrants must
- Ensure unauthorized persons are not allowed access to
- any health information, including patient or pharmacy records, stored on any computers, tablets, phones, or other electronic devices used to facilitate pharmacy practice; and
- pharmacy software, or any other applications or resources that may contain health information.
- Ensure all computers, tablets, phones, or other devices used to facilitate pharmacy practice are password protected and locked when not in use. Passwords must not be shared with unauthorized individuals.
- Set devices to automatically lock when left unattended.
- Enable encryption settings or use software to encrypt data on devices when possible to minimize risk of data loss in the event the device is stolen.
- Ensure data on all portable storage devices is encrypted and password protected.
- Use some form of security software (e.g., Windows Defender, Norton, McAfee) to protect the devices from malware or viruses.
- Encrypt all emails or email attachments containing patient identifying health information.
- Perform all work in a physical location where unauthorized persons cannot overhear or view health information.
- Avoid or minimize the use of paper files. Ensure any paper files created are secured when not in use so that others cannot access them and are returned to and stored at the pharmacy as soon as reasonably possible.
Nothing in this guidance document relieves pharmacy registrants from meeting the other requirements under the Standards of Practice for Pharmacists and Pharmacy Technicians including Standards 2.2, 2.3, and 2.6.
Temporary authorization to waive requirements to see patients personally
NOTE: This temporary authorization will expire on July 31, 2021.
As a result of the ongoing COVID-19 pandemic, ACP recognizes that seeing a patient personally may not be possible or advisable given requirements for social distancing and self-isolation. The Standards of Practice for Pharmacists and Pharmacy Technicians (SPPPT) have requirements that certain activities must occur in person with the patient present. In order to meet the needs of patients during this extraordinary situation, pharmacists have been given temporary authority to prescribe without meeting the requirements noted in SPPPT 2.6, 12.2(a), 13.2(a), and 14.2. Despite this authorization, pharmacists are advised that they must use their professional judgement as to whether it is appropriate and in the best interest of the patient to prescribe remotely.
When prescribing remotely, pharmacists must meet their obligations to the SPPPT and provide a level of care commensurate with the care they would provide if they saw the patient personally. Above all else the pharmacist must
- consider the well-being of the patient, and
- take all reasonable steps to prevent harm to patients.
Pharmacists must establish and maintain a professional relationship with each individual for whom they prescribe medications remotely.
Establishing a professional relationship means the pharmacist must speak directly with the patient, their agent, or their caregiver to
- identify the health priorities of the individual,
- determine what the patient understands about their medication and their condition, and
- gather information about their health history and current medication use.
Refer to ACP’s Chat Check and Chart – Vital to Patient Care tool to learn more.
Considerations when prescribing remotely
When prescribing without seeing the patient personally, pharmacists must:
- Consider the limitations of the technology or method of communication used and evaluate the clinical activity being conducted to ensure the pharmacist can reasonably
- access any information required to make a clinical assessment,
- complete a thorough clinical assessment of the patient,
- identify and take appropriate action for any drug therapy problems, and
- ensure the privacy and confidentiality of the patient are maintained.
- Reflect on whether you have the knowledge and information necessary to treat the patient’s condition. If not, determine whether you should contact other members of their health team or refer them to another prescriber.
If it is determined that it is appropriate to prescribe, the pharmacist must then perform a thorough patient assessment, including reviewing patient health information on Netcare, and proceed in accordance with the Standards of Practice for Pharmacists and Pharmacy Technicians and ACP’s Code of Ethics.
This authorization should not be used to normalize the practice of not seeing a patient personally, but instead should be used permissively in exceptional circumstances given the COVID-19 pandemic. Please note that nothing in this authorization relieves a pharmacist from their obligation to meet all other applicable standards of practice.
Temporary authorization to collect a throat swab specimen for testing for COVID-19
ACP is supporting testing procedures in pharmacies by temporarily enabling regulated members to collect throat swab specimens, when conducted as part of a specimen collection program in accordance with Standard 29 of the Standards of Practice for Laboratory and Point of Care Testing (POCT). Specifically, under Standard 29(b), regulated members may “only collect specimens of capillary blood, saliva, or urine.” This temporary authorization will additionally allow the collection of throat swab specimens.
When collecting throat swab specimens, all other requirements of Standard 29 apply.
In addition to the standards related to specimen collection, the entire laboratory and point of care testing standards and guidance must be adhered to, including standards related to patient assessment, ordering and interpreting laboratory tests, documentation, and follow up.
The specimen collection program must
- ensure that the laboratory to which collected specimens are sent to, is accredited in Canada;
- ensure that the pharmacist or pharmacy technicians only collect specimens of capillary blood, saliva, or urine;
- identify each type of specimen collection that will occur, and the pharmacists and pharmacy technicians, if any, who can collect the specimen;
- include a clear and comprehensive written standard operating procedure for each type of specimen collected, written in accordance with the policies and procedures of the laboratory for which they are collecting the specimen, that describes how the pharmacist or pharmacy technician is to collect, store, and transport specimens;
- ensure that there is an appropriate practice environment and facilities for collecting the specimen;
- ensure that pharmacists and pharmacy technicians who collect the specimen are trained, competent, and follow standard operating procedures;
- ensure that pharmacists understand the etiology and treatment protocols for the disease state or chronic condition for which the specimen is being collected; and
- outline the nature of the collaborative relationship among the pharmacist, the laboratory and other involved health professionals with respect to
- responsibilities and protocols for acting on the test results, and
- communicating the test results and subsequent actions taken
COVID-19 assessment and referral
Pharmacists should advise patients with symptoms consistent with the AHS Emergency Coordination Centre COVID-19 Screening Criteria to self-isolate and access the AHS COVID-19 Testing/Online Booking Tool. Patients with severe symptoms should be advised to call 911
Asymptomatic patients who do not require testing should be directed to monitor their status and use the AHS COVID-19 Testing/Online Booking Tool to reassess if they need to be tested.
Protecting pharmacy staff and patients from COVID-19 transmission in the pharmacy
General advice to pharmacy licensees and registrants
This guidance applies to pharmacy staff working in a dispensary or those who have direct contact with pharmacy patients. The Alberta College of Pharmacy (ACP) recognizes that many pharmacies are located within a larger business entity such as a grocery store or a retail store. For further information and guidance for these businesses, please refer to the Government of Alberta COVID-19 Workplace guidance for business owners.
This information is not intended to exempt employers from existing occupational health and safety (OHS) requirements. OHS questions and concerns can be directed to the OHS Contact Centre by telephone at 1-866-415-8690 (in Alberta) or 780-415-8690 (in Edmonton) or online.
There are many things pharmacy licensees must do to best protect themselves, their staff, and patients from exposure to COVID-19. Nonetheless, all regulated members share responsibility for ensuring compliance with public health orders, and with the guidance provided by Alberta Health and ACP.
All pharmacists, pharmacy technicians, and pharmacy staff must:
- Remain up-to-date with all Alberta Health developments, public health orders, recommendations, and policies related to COVID-19 as well as any municipal bylaws.
- Ensure travel restrictions and federal and provincial requirements are complied with.
- Ensure signage is posted on all entrances to the pharmacy area. Signage should be placed where it is likely to be seen by staff and patients and, at a minimum, should be placed at all entrances, in all public/shared washrooms, and all counseling areas/treatment areas. Appropriate signage will:
- direct patients to wear a mask or face covering if required;
- direct patients to cover their cough and clean their hands after coughing or sneezing.
- provide guidance on hand hygiene (hand washing and hand sanitizer use); and
- require individuals to self-identify and not enter the premises if they
- are experiencing symptoms including fever, cough, shortness of breath, runny nose, sore throat, or other symptoms consistent with COVID-19;
- are a person returning to Alberta after having travelled outside of Canada in the last 14 days; or
- are a close contact of a person who is confirmed as having COVID-19.
Similar messaging should be communicated on voicemail messages, websites, and social media.
Review Health Canada’s Infection prevention and control for COVID-19: Second interim guidance for acute healthcare settings, Routine Practices for Infection Prevention and Control, and the AHS Routine Practices in Community-based Services. Licensees must review the pharmacy’s occupational health and safety procedures with all pharmacy staff.
Patients should have access to alcohol-based hand sanitizer as they enter the site and be encouraged to use it. Alcohol-based hand sanitizer must be greater than 60% alcohol content. Tissues and a lined waste container should also be available to patients and staff in the pharmacy.
Pharmacists and pharmacy technicians have a shared responsibility for informing and educating the public about COVID-19, including promoting infection prevention and control. Multilingual resources are available from Alberta Health.
Planning and preparation for pharmacy staff shortages resulting from COVID-19
Staffing limitations in the pharmacy should be anticipated. Proprietors and licensees should prepare for the possibility of increased absenteeism due to staff illness, mandatory self-isolation, or increased family commitments due to COVID-19, and take steps to minimize the impact of illness on the continuity of patient care and pharmacy operations. Proprietors and licensees can use the Canadian Pharmacists Association – Staffing and Business Considerations if a Pharmacy Team Member Becomes Ill document to help guide them.
To prepare the pharmacy for staff shortages resulting from COVID-19, the pharmacy licensee must
- maintain an up-to-date contact list for all staff, including names, addresses and phone numbers;
- ensure the pharmacy policies and procedures align with the COVID-19 related recommendations and public health orders approved by the Government of Alberta and listed on the Alberta Health website;
- Pharmacy sick-leave policies should not disincentivize staff from staying home due to illness or self-isolation.
- Changes to the Employment Standards Code mean that full-time and part-time employees are allowed to take 14 days of job-protected leave if they are required to self-isolate or if they are caring for a child or dependent adult who is required to self-isolate. Medical notes are not required for such leave.
- implement measures to limit the spread of COVID-19 between pharmacy staff members, such as
- recommending wearing a mask continuously, at all times, and in all areas of their workplace if they are involved in direct patient contact or cannot maintain adequate physical distance from patients and co-workers;
- dividing pharmacy staff into teams with no overlap;
- judiciously using appropriate Personal Protective Equipment (PPE);
- increasing separation between desks and workstations;
- limiting the number of people in shared spaces (such as lunchrooms) or staggering break periods;
- removing unnecessary chairs from shared staff areas or, if chairs are necessary for accessibility reasons, spacing them by at least 2 metres;
- eliminating non-essential gatherings (such as staff meetings) or conducting them using virtual methods; and
- maintaining physical distancing of 2 metres between staff members when possible.
- Ensure pharmacy staff are aware of all steps being taken by the pharmacy licensee to prevent the risk of transmission of infection, and their responsibilities in upholding these measures.
- Provide pharmacy staff information about available social and mental health supports during this stressful time, and encourage them to use these resources.
Pharmacy licensees must also make contingency plans that include the following:
- understanding their responsibilities, should the pharmacy be closed temporarily at the direction of Alberta Health Services (AHS) or due to staffing constraints. For more information, review the ACP guidance for temporary closures;
- being prepared to assist AHS with COVID-19 contact tracing by providing:
- roles and positions of persons working in the pharmacy;
- who was working in the pharmacy at any given time;
- names of patients in the pharmacy by date and time; and
- names of staff members who worked on any given shift.
- reviewing all services provided by the pharmacy and develop plans to ensure continuity of patient care. Special consideration should be given to unique, customized, or difficult-to-obtain services (e.g., provision of opioid agonist therapy, scheduled injections, sterile compounding, services for long-term care facilities, etc.) and options must be provided for patients that receive these services.
Preventative COVID-19 exposure measures in pharmacies
A successful mitigation strategy for preventing exposure and transmission of COVID-19 requires the cooperation and compliance of all pharmacy staff. The pharmacy team’s strategy should include three main elements: hand hygiene, cleaning and disinfecting, and workflow adjustment.
Currently, the best defense against the spread of COVID-19 is the proper application of hand hygiene and proper cleaning procedures. Please review the ACP Guidelines for Hand Hygiene, the AHS 4 Moments for Hand Hygiene, and the AHS How to Hand Wash poster for proper hand hygiene technique. These documents should be posted in a location visible to all pharmacy staff.
All pharmacy staff must
- wash hands often with soap and water for at least 20 seconds, especially after using the washroom, before preparing food, or if hands are visibly dirty;
- use alcohol-based hand sanitizer (greater than 60% alcohol content) if soap and water are not available;
- cough or sneeze into a tissue or the bend of the arm, not the hand;
- dispose of any used tissues as soon as possible in a lined waste basket and wash hands afterwards;
- avoid touching eyes, nose, or mouth, especially with unwashed hands;
- avoid any unnecessary high-risk procedures that require contact or can generate droplets (e.g., rapid strep throat testing), and if these procedures are required, refer to the AHS Contact and Droplet Precautions guidance and utilize the required personal protective equipment before proceeding;
- perform hand hygiene activities before donning PPE, and after doffing and disposing of each PPE item; and
- remember that glove use alone is not a substitute for hand hygiene. Hands should be cleaned before and after using gloves.
Cleaning and disinfecting - general
Pharmacy licensees must also implement regular cleaning and disinfecting procedures to mitigate the risk of COVID-19 infection. The pharmacy licensee must ensure pharmacy staff understand the need for enhanced environmental cleaning and disinfection. All regulated members share responsibility to ensure proper cleaning and disinfecting occurs.
Cleaning refers to the removal of visible soil. Cleaning does not kill germs but is highly effective at removing them from a surface. Disinfecting refers to using a chemical to kill germs on a surface. Disinfecting is only effective after surfaces have been cleaned. Important factors to consider when developing this cleaning and disinfecting policy include:
- The types of cleaning and disinfecting agents used.
- Use disinfectants with viricidal activity that have a Drug Identification Number (DIN) issued by Health Canada and do so in accordance with label instructions.
- Whenever possible, equipment and products used for cleaning and disinfecting should be disposable.
- Surfaces and areas to focus on for cleaning and disinfecting activities.
- Increase the frequency of cleaning and disinfecting of high traffic/touch areas, shared, reusable patient equipment, and electronic devices used within the patient environment (e.g. doorknobs, light switches, computers, phones, debit machines, etc.), common areas, public washrooms, kitchen, and staff rooms.
- Where feasible, communal items that cannot be easily cleaned (e.g., newspapers, magazines, brochures) should be removed from the pharmacy.
- Documentation of cleaning and disinfecting activities.
- Maintenance of an adequate supply of soap, paper towel, toilet paper, hand sanitizer and other supplies.
Cleaning and disinfecting - pharmacy equipment
Staff should ensure that hand hygiene has been performed before touching any equipment. Staff should clean and disinfect:
- any health care equipment (e.g., wheelchairs, walkers, lifts), in accordance with the manufacturer's instructions;
- any shared patient care equipment (e.g., blood pressure cuffs, thermometers) prior to use by a different patient; and
- all staff equipment (e.g., computers, computer screens, tables, counters, telephones, chair arms, etc.) at least daily and when visibly soiled.
For difficult to clean items, follow the manufacturer’s recommendations or consult with Alberta Health Services (AHS) Infection Prevention and Control (IPC). All IPC concerns, for all settings, are being addressed through the central intake email: email@example.com
For more information and specific recommendations on cleaning and disinfecting, review the Alberta Health Services’ COVID-19 Public Health Recommendations for Environmental Cleaning of Public Facilities.
Workflow adjustments should be designed to minimize close contact between individuals in the pharmacy, including both staff and patients, when possible. Adjustments that should be considered as part of a pharmacy’s preventative measures include
- placing hand hygiene stations at the pharmacy entrance and encourage their use;
- screening and triaging patients before entering the pharmacy premises. This could include the use of signage or telephone assessments. If staffing levels and pharmacy layout allow, dedicated screening personnel may be used at the entrance;
- limiting the number of individuals inside the pharmacy;
- encouraging physical distancing (including the use of signage) to maintain a two-meter distance from customers whenever possible;
- where feasible, transparent barriers (e.g. plexiglass) should be installed to protect pharmacy staff and patients. These barriers should be placed at the drop-off area, pick-up area, cash register, and any other areas where face to face interaction occurs;
- minimizing the number of chairs in your waiting area, and ensuring that any chairs present are spaced at least 2 metres from each other; and
- encouraging patients to call the pharmacy in advance whenever possible in order to minimize waiting time; and
- asking each patient to remain outside the pharmacy until the pharmacist or pharmacy technician is ready for them.
Personal protective equipment (PPE) for direct patient care
Infection prevention and control measures (IPAC) have significantly slowed the spread of COVID-19. Viral transmission in healthcare settings remains a concern, and ACP recommends regulated members continue to adhere to IPAC, including continuous masking wherever possible.
The AHS document Personal Protective Equipment (PPE) - Guidance to Help Make Continuous Masking Work for You provides practical suggestions and tips on managing the challenges that pharmacy personnel may experience while wearing a mask continuously.
By implementing a continuous masking strategy, pharmacy personnel minimize exposure to COVID-19 for both patients and coworkers. Nothing in this guidance changes the requirements to self-isolate when sick, and no healthcare worker with symptoms of illness should come to work.
Additional PPE requirements
Pharmacists and pharmacy team members are encouraged to review CPhA’s Personal Protective Equipment (PPE)- Suggested Best Practices for Pharmacies During the COVID-19 Pandemic and Alberta Public Health Disease Management Guidelines. This guidance will assist you in better understanding risk analysis, risk mitigation measures, and what to do with PPE, in order to best protect your pharmacy team and the individuals that you serve.
Pharmacists providing care to any patient with symptoms suggestive of COVID-19 must do a point of care risk assessment and use the appropriate PPE for protection. N95 masks and full PPE are not routinely required for Community Health Care settings unless performing Aerosol Generating Medical Procedures (AGMP). However, if the pharmacy is providing care to symptomatic patients under exceptional circumstances, contact and droplet precautions are required in addition to any routine precautions taken.
It is important that garbing in PPE occurs in alignment with best practices. The AHS website provides information on proper technique for putting on (donning) and taking off (doffing) PPE. Information on infection control and droplet precautions can be found on the Alberta Health Services and CPhA websites, respectively.
Management of staff illness
Screening pharmacy staff for COVID-19
Pharmacy licensees should implement active daily screening of pharmacy staff. Screening protocol should include screening to determine if pharmacy staff:
- have tested positive for COVID-19
- are experiencing symptoms including fever, cough, shortness of breath, runny nose, sore throat, , or other symptoms consistent with COVID-19;
- have returned to Alberta from travel outside of Canada in the last 14 days;
- or have been in close contact with a person who is confirmed as having COVID-19.
When a pharmacy staff member experiences symptoms of COVID-19
Ensure pharmacy staff are aware of CMOH Order 05-2020 and its clarification, which states that any person who is a confirmed case of COVID-19 or has COVID-like symptoms (cough, fever, shortness of breath, runny nose, or sore throat) must self-isolate.
If any pharmacy staff member contacts the pharmacy because they are experiencing symptoms of COVID-19, they should stay home and not enter the pharmacy.
If any pharmacy staff member presents with COVID-19 symptoms upon arrival to the pharmacy, or becomes symptomatic while at the pharmacy, the licensee or pharmacist in charge must
- send the symptomatic staff member home immediately, and ensure they
- are masked;
- maintain at least two metres distance from other employees and patients while exiting the premises; and
- follow hand hygiene and respiratory etiquette, as appropriate, as they exit the premises; and
- in addition to routine COVID-19 cleaning processes, immediately clean and disinfect all surfaces and areas that the symptomatic dispensary staff member may have come in contact with.
In all cases, the licensee must advise the symptomatic staff member to
- use Alberta Health Services’ online healthcare worker self-assessment tool in order to determine next steps, including whether they need to be tested for COVID-19, and to obtain additional advice, such as the need to self-isolate;
- not visit a hospital, physician’s office, lab, or healthcare facility without first consulting Health Link (811), except in cases of emergency; and
- call 911 if they are seriously ill and require immediate medical attention and inform them that they are experiencing symptoms common to COVID-19.
At this point it is not necessary to isolate other staff members unless directed to do so by AHS.
When a pharmacy staff member has tested positive for COVID-19
If the licensee becomes aware that a pharmacy staff member has tested positive, the licensee should, as soon as possible:
- Implement immediate cleaning and disinfecting procedures consistent with AHS recommendations.
- Anticipate impacts on patients, taking into consideration the unique aspects of the pharmacy, such as whether it is a rural or remote location, and all unique, customized, or difficult-to-obtain services the pharmacy provides. Once the impact to patients have been identified, take steps to ensure continuity of care for these patients.
- Be prepared to provide records/contact lists to support contact tracing, which may be sought for up to two days prior to the individual becoming symptomatic.
The licensee should be prepared to close the pharmacy temporarily, either at the direction of AHS or as result of having too few staff to safely deliver essential services.
If the pharmacy uses a third-party cleaning service, the licensee must ensure that a pharmacist is present to supervise and ensure the security of health records and scheduled drugs when cleaning is underway.
Return to work
Pharmacy staff must follow the mandatory isolation orders instituted by the Government of Alberta. They must also follow any specific direction from AHS public health officers with respect to their illness. Pharmacy staff may only return to work once
- they are asymptomatic and have complied with all mandatory isolation orders, or
- they have been cleared by AHS to return to work.
For more information review the AHS Return to Work Guide to help determine when it is appropriate for pharmacy staff to return to work if they have been self-isolating or have had symptoms.
Management of patient illness
Screening of patients
Pharmacies should implement screening of patients for symptoms of COVID-19.
- At minimum, signage should be posted at the entrance to the pharmacy, instructing those individuals who may have been exposed to COVID-19 or who are symptomatic not to enter.
- Pharmacies may want to consider active screening of patients for possible exposure or symptoms, especially before conducting higher risk activities (i.e., injections, point of care testing, and specimen collection) where it is difficult or impossible to maintain a two-metre distance.
- Patients should be screened over the phone for symptoms of COVID-19 whenever possible, prior to coming to the pharmacy.
- In the case where patients present in-person without prior phone screening, staff should screen patients upon arrival to assess for symptoms.
CMOH Order 05-2020 directs when individuals are required to be isolated. The pharmacy’s signage and screening protocol must include questions to identify:
- symptomatic patients experiencing symptoms including fever, cough, shortness of breath, runny nose, sore throat, extreme tiredness, or other symptoms consistent with COVID-19;
- asymptomatic patients who
- are returning to Alberta after having travelled internationally in the last 14 days; or
- are a close contact of a person who is confirmed as having COVID-19.
Patients experiencing symptoms consistent with COVID-19 should be directed to use the AHS online assessment tool. Advise patients that CMOH Order 05-2020 legally requires individuals who have a cough, fever, shortness of breath, runny nose, or sore throat (that is not related to a pre-existing illness or health condition) to isolate for 10 days from the start of symptoms, or until symptoms resolve, whichever takes longer.
Patients who are asymptomatic but indicate they have returned to Alberta after having travelled internationally in the last 14 days or who are a close contact of a person who is confirmed as having COVID-19 should be informed of the self-isolation requirements outlined in CMOH Order 05-2020 regarding self-isolation.
Interacting with patients
When interacting with all patients, physical distancing of two metres should be maintained at all times, and appropriate PPE should be used when necessary.
If a patient, while in the pharmacy, exhibits any symptoms consistent with COVID-19 or is asymptomatic but has been identified as a close contact of a COVID-19 positive case or has returned to Alberta after having travelled internationally in the last 14 days:
- They should be given a mask, if they are not already wearing one, and sent home immediately in a private vehicle and avoid public transportation if possible.
- Clients/patients should complete the online self-assessment tool once they have returned home and be tested for COVID-19.
- For patients who are too ill to return home, or require immediate medical care, consider using a designated quarantine area in the pharmacy in order to support physical distancing while awaiting direction from AHS or medical attention.
- Once a symptomatic individual has left the pharmacy, clean and disinfect all surfaces and areas with which they may have come into contact.
- The licensee, or their designate, should immediately assess and record the names of all close contacts of the symptomatic patient. This information will be necessary if the symptomatic patient later tests positive for COVID-19.
For patients who are self-isolating for any reason, pharmacy staff should make every effort to meet their pharmacy needs while maintaining compliance with relevant public health orders, physical distancing requirements, and hygiene.
Treating symptomatic patients or asymptomatic patients who are required to quarantine in exceptional circumstances
Where a symptomatic patient or an asymptomatic patient who is required to quarantine requires in-person care that cannot be delayed such as a necessary injection, the following should apply:
- When possible, provide care virtually even if an in-person visit is needed, in order to minimize the in-person time required (e.g. assessment could occur virtually with a brief in person visit for the actual injection).
- Set a dedicated time of day specifically for symptomatic individuals to minimize risk to other patients.
- Have a dedicated consultation room for symptomatic patients where possible.
- Perform a Point of care risk assessment before each patient interaction.
- Use the Aerosol-Generating Medical Procedure Guidance Tool to determine which procedures are considered to be aerosol generating.
- Have the patient stay outside the pharmacy until the consultation room is ready and then call them in.
- Provide the patient with a surgical/procedural mask for them to wear upon entry and throughout entire time in pharmacy.
- Pharmacy staff must adhere to the AHS Interim IPC Recommendations for COVID-19 and the PPE requirements in the Personal protective equipment (PPE) for direct patient care section of this document.
- Additional IPC precautions (contact and droplet precautions) and PPE (eye protection, gloves, and gowns) may be required depending on assessment and care that is needed.
- Symptomatic patients - implement Contact and Droplet precautions and Routine Practices. For aerosol generating medical procedures, pharmacy staff are required to wear an N95 mask and place patient in a private room with hard walls and a closed door.
- Asymptomatic patients who are isolating or required to quarantine. For aerosol generating medical procedures, pharmacy staff are required to wear an N95 and place patient in private room with hard walls and a closed door.
- Complete a thorough cleaning between each patient.
Noncompliance with mandatory requirements to self-isolate
What to do when a patient or healthcare professional is not complying with the mandatory requirements to self-isolate
The government of Alberta has put legally binding rules in place through a ministerial order to protect the health and safety of Albertans. These are not suggestions or guidelines – they are now the law and must be followed.
If a pharmacist or pharmacy technician suspects a patient, pharmacy professional, or other healthcare provider is not complying with the Alberta Health mandatory measures to stop the spread of COVID-19, they should approach the situation in steps:
- Speak to the individual to determine their awareness of their responsibilities and what steps they have taken.
- In many cases, especially with regulated health professionals, the individual may have already been assessed and cleared by Alberta Health Services.
- Educate the individual.
- Requirements and information vary from jurisdiction to jurisdiction and, even within Alberta, guidance has changed several times in the last few weeks and likely will continue to do so. Provide the individual contact information for the appropriate resource.
- If all else fails, report the individual to the appropriate authority.
- If an individual continues to refuse to comply with the mandatory requirements of the public health orders, the pharmacist or pharmacy technician should assess the situation and determine if they need to report the individual to the medical officer of health, as required under section1.1(1) of the Health Professions Act.
Required reporting to the medical officer of health applies to either members of the public or healthcare professionals who are in violation of public health orders.
When to report
A pharmacist or pharmacy technician should not report an individual simply for having COVID-19. They must however make a report if they are aware that an individual with a diagnosis (or symptoms) is acting in a manner that is likely to cause transmission or if an individual is not complying with the Alberta Health mandatory measures to stop the spread of COVID-19.
How to report
Reporting patients or members of the public
If a pharmacist or pharmacy technician has reason to believe that the patient, despite being notified of the need to take such precautions, is acting in a manner that may be injurious to public health, or where there the patient’s actions may have already caused an increased risk of transmission, they are obligated to report the individual to the medical officer of health. Complaints should be made online.
Reporting a pharmacist, pharmacy technician, or other healthcare professional
If a regulated member has confirmed that another regulated member is continuing to provide professional services despite having been diagnosed with COVID-19, or after returning from international travel without first self-isolating as required by mandatory public health orders, they must
- report the regulated member to the medical officer of heath online, and
- report the individual to the complaints department of their respective regulatory college.
Currently, it is critical that pharmacists and pharmacy technicians keep themselves aware of the situation as it develops by checking abpharmacy.ca/covid-19 on a frequent and ongoing basis for updates and changes. If after reviewing the available resources you have additional questions, please call ACP at 780-990-0321 or toll free at 1-877-227-3838 and leave a voicemail. Messages will be returned during normal business hours.