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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 August 31, 2020, at 11:57 a.m. MT.

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

Read the s56(1) exemption issued by Health Canada on March 19, 2020, and see the FAQs for further information.

Read the joint message from ACP and the College of Physicians and Surgeons of Alberta (CPSA).

Read the guidance on the exemption prepared by ACP.

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 have been

  • assessed for risk,
  • 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.
  • Prescriptions for slow release oral morphine (SROM) should only be provided for a maximum of two days’ supply and only upon careful evaluation of the risks, to the patient or others, associated with the unique risks of this medication. The pharmacist must make every effort to contact and collaborate with the 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 or an appropriate clinical reference, or contact ACP at 780-990-0321.

Carried doses

  • Pharmacists may accept prescriptions for methadone and buprenorphine-naloxone that include a number of carries 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.

Witnessed dosing

  • 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.
  • At the discretion of the prescriber, pharmacists may waive the need for a witnessed dose of buprenorphine-naloxone, slow-release oral morphine, or methadone. 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.)
  • 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. 

Mailing

  • 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.

Recordkeeping requirements

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.

Temporary changes to care provided to nursing home residents

Ministerial Order 6/2020  temporarily modifies the Nursing Homes Operation Regulation and the Nursing Homes General Regulation (referred to as the “nursing home regulations”) during COVID-19 to enable any qualified, regulated healthcare professionals to prescribe medication or order treatments for a nursing home resident according to their scope of practice. The order also enables nurse practitioners to act as primary care providers, admitting and assessing facility residents as well as offering follow-up care.

These temporary changes

  • allow pharmacists, nurse practitioners, and other types of qualified regulated healthcare professionals to prescribe drugs for facility residents in accordance with their unique regulations and standards of practice;
  • increase access to quality care for facility residents and allow operators to better adapt to COVID-19 related problems as they arise; and
  • allow additional types qualified regulated health care professionals to order therapeutic diets for facility residents.

These changes will remain in effect until August 14, 2020, unless the Ministerial Order is terminated earlier, or the public health emergency is reduced or extended. 

Licensees and pharmacists are reminded that all records of care created for their patients that reside in these facilities must be maintained at the licensed pharmacy associated with the pharmacy service in accordance with Standards 7, 11, 12, 18, and Appendix A of the Standards of Practice for Pharmacists and Pharmacy Technicians (SPPPT) and the Pharmacy and Drug Regulation.

Background and History

The historical nursing home regulations restricted prescribing to physicians in any facility that is subject to these regulations. This meant that pharmacists working in these regulated facilities were not able to prescribe, adapt, or extend any medication for residents in these facilities except in an emergency situation. As a result of this Ministerial Order, pharmacists providing services for their patients residing in these facilities may temporarily prescribe, adapt, or extend any medication for residents in these facilities according to the SPPPT.

Prescribing and dispensing of drugs to treat COVID-19

Read the joint message from ACP and the College of Physicians and Surgeons of Alberta (CPSA).

Increased urgency to affirm appropriateness of use

Assessing patients and critically evaluating their prescriptions are foundational responsibilities of pharmacists in supporting appropriate drug therapy. Standard 3 of the Standards of Practice for Pharmacists and Pharmacy Technicians states that pharmacists must consider appropriate information for each patient. Appropriate information is indicated in Standard 3.4 to include the need to consider the health condition to be treated and history of the condition.

This week, pharmacists have identified to ACP an increased demand for some drugs (e.g., Kaletra®, hydroxychloroquine) due to reports of them being prescribed as treatments for COVID-19. The prescribing and dispensing of drugs used to treat COVID-19 for the purpose of stockpiling for personal use is not appropriate.

Information we have received demonstrates the diligence of many pharmacists in assessing the appropriateness of drug therapy, and we commend them for this. We have heard stories of pharmacists receiving prescriptions for these drugs for groups of family members, for personal family members, and in other instances from specialties where these drugs are not normally used. Thank you to all of you who have been diligent in your assessments and have intervened by not dispensing these prescriptions.

ACP recognizes and appreciates the extraordinary efforts of pharmacists and pharmacy technicians during these unprecedented and challenging times. Your diligence will support appropriate use, improved health, and the continued availability of these drugs for those who need them most.

Administering injections to patients during the COVID-19 pandemic

During the COVID-19 pandemic, pharmacists may continue to receive requests from patients to administer their routine injections. Due to the close physical proximity this activity requires between pharmacists and patients, pharmacists must assess the patient’s need for the drug and determine if they are able to perform the injection in a manner that protects the health and safety of both the patient and the pharmacist. If the pharmacist makes a determination not to administer the injection, the pharmacist has a responsibility under the ACP Code of Ethics, principle 5(3) to assist the patient in obtaining the required service elsewhere, in this case an injection.

When assessing if administering a drug by injection is appropriate, pharmacists should:

  • Practice physical distancing principles while screening the patient for symptoms or exposure criteria consistent with COVID-19.
  • Direct any patient that presents with symptoms or exposure criteria consistent with COVID-19 to immediately self-isolate, call Healthlink at 811, and await further instructions.
  • Confirm what condition the injectable medication is treating and use a risk assessment approach to determine whether it is appropriate to administer the injection to patients who do not exhibit symptoms or have exposure criteria consistent with COVID-19. Using this approach, pharmacists should
    • consider postponing the administration of injections that are part of a series which have a possible range of time (“2-6 months”, “6-12 months”) to later in the range; and
    • prioritize injections that are part of a regular schedule and are required for continuity of care or where the patient’s health may be negatively impacted if they do not receive the injection (such as antipsychotics, medroxyprogesterone, or vitamin B12 for chemotherapy protocols).
  • Ensure they have the required personal protective equipment (PPE) to protect themselves and the patient if they administer the drug by injection.

The National Advisory Committee on Immunization (NACI) has issued the following Interim guidance on continuity of immunization programs during the COVID-19 pandemic to assist providers in supporting patients who may require immunizations.

When a decision is made to administer an injection

  • Pharmacists must adhere to all the requirements of the Standards of Practice for Pharmacists and Pharmacy Technicians, standards 16 and 17. In addition to the standard precautions, pharmacists should take extra care to
    • practise good hand hygiene,
    • use appropriate personal protective equipment (PPE), and
    • ensure the area where the injection was administered is cleaned and disinfected afterwards.

Additional guidance and resources, including COVID-19-related hand hygiene and cleaning procedures and guidance and resources for appropriate use of PPE during the COVID-19 pandemic, are available below.

When a decision is made NOT to administer an injection, and the patient does not have symptoms or exposure consistent with COVID-19, pharmacists should

  • provide the patient a suitable date or date range to return to the pharmacy for the injection, if the injection can be safely postponed; or
  • assist the patient to obtain injection services from another pharmacist or health professional who can safely administer the injection within an appropriate timeframe.

References

Newfoundland & Labrador Pharmacy Board: Guidance to Pharmacists: Administration of Injections During the COVID-19 Pandemic

Providing virtual care to patients

Read the guidance prepared by ACP.

Pharmacists and pharmacy technicians working remotely

This temporary guidance is applicable for the duration of the COVID-19 pandemic and must not be used to normalize the practice of pharmacists or pharmacy technicians working remotely. Rather, it should only be used in exceptional circumstances during the COVID-19 pandemic. For registrants who choose to work from home or another remote location, this document is intended as a companion to the guidance provided in the COVID-19 Guidance – Providing virtual care to patients document.

Due to self-isolation, ACP recognizes that some pharmacists or pharmacy technicians may need to continue limited practices remotely from home. 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 the COVID-19 Guidance – Providing virtual care to patients. In addition, registrants working remotely must ensure the following:

  • They notify OIPC if remote work includes accessing, using, or disclosing patient health information and uses technology or practices that have not been part of the pharmacy’s privacy impact assessment. This notification can be sent by email to OIPC and should include details of the practices including security risks and safeguards for health information. More details can be found here.
  • No scheduled drugs are procured, stored, compounded, dispensed, or sold from a remote location.
  • The pharmacy software system is only accessed remotely over a secure connection such as a virtual private network (VPN) or a secure website using secure sockets layer (SSL).

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 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

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 waive Standard 11.9 when adapting prescriptions

Due to the COVID-19 pandemic and the increased workloads pharmacists and other healthcare professionals are experiencing, ACP is temporarily waiving the requirement for pharmacists to notify other regulated health professionals whose care of the patient may be affected by their prescribing decision, when adapting prescriptions for the purpose of renewing a prescription to ensure continuity of care.

Notification about dose changes, therapeutic substitutions, prescribing in an emergency, and initial access prescribing or prescribing to manage ongoing care must still be provided as required by standard 11.9, as should any renewal that a pharmacist determines collaboration is required with the respective healthcare professional.

Temporary authorization to collect a throat swab specimen for testing asymptomatic Albertans for COVID-19

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). Specifically, under Standard 29(b), regulated members may “only collect specimens of capillary blood, saliva, or urine.” This temporary authorization will now include the collection of throat swab specimens when collected as part of Alberta Health’s Testing Asymptomatic Albertans program.

As part of the requirements of Standard 29, there must be

  • a comprehensive written standard operating procedure for each type of specimen collected,
  • an appropriate environment and facilities, and
  • regulated members must possess
    • the necessary competencies to collect the specimen,
    • have knowledge of the condition for which the specimen is collected, and
    • understand their responsibilities within the collection protocol and the communication of the test results.

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. 

Further information on the Pharmacy-based Asymptomatic COVID-19 Testing Program, including FAQs, request forms, and patient checklists, may be found on the Alberta Blue Cross website.

Repackaging non-prescription medications

Drug shortages for non-prescription medications, such as acetaminophen liquid, have increased. Repackaging of non-prescription medication is a temporary measure that can minimize the disruption of the drug supply and assist your patients. Once available, the commercially available product should be sourced again and any temporary measure to repackage the non-prescription medication should cease. Self-selection is NOT permitted for repackaged medications.

Ensure when repackaging medication for resale that the pharmacist or pharmacy technician considers the appropriate standards from the Standards for Pharmacists and Pharmacy Technicians to ensure patient safety and maintain records. Regulated members are expected to uphold Principle 1 of the Code of Ethics and hold the well-being of each patient to be their primary consideration. Regulated members should not allow their professional judgment to be impaired by personal or commercial benefits such as monetary or financial gain. When advising individuals about repackaged non-prescription medications, pharmacists must focus on an individuals’ best interests. Any advice or action that is based on providing financial advantage to the pharmacist, a pharmacy, or proprietor, without providing a material benefit to the health of the individual, may be considered unprofessional conduct.

As per Standard 7.3(b), items must be repackaged into child-resistant packaging unless

  1. the prescriber or patient directs otherwise,
  2. the pharmacist or the pharmacy technician is satisfied that child resistant packaging is not appropriate,
  3. child-resistant packaging is not suitable because of the form of the drug or blood product, or
  4. the pharmacist or the pharmacy technician is unable to obtain a child-resistant package for the drug or blood product because a supply of those packages is not reasonably available.  

The manufacturer’s suggested dose must be included in the labelling of a repackaged product. A copy of the manufacturer’s insert or the consumer information found in the product monograph must also be included with the repackaged product.

Relevant standards

Standards of Practice for Pharmacists and Pharmacy Technicians

Standard 21:

A pharmacist or a pharmacy technician who repackages drugs must take appropriate steps to protect patient safety.

Duty regarding audit trail

21.1     A pharmacist or a pharmacy technician who repackages a drug or blood product must ensure that, in respect of that drug or blood product, there is sufficient documentation to provide a clear audit trail of the repackaging process.

21.2     The documentation required under Standard 21.1 must identify:

  1. drug information from the original container including:
    1. DIN, NPN or HN;
    2. lot number;
    3. expiry date; and
  2. all individuals involved in the repackaging and verification process and the role of each individual.

Duty regarding labeling

21.3     A pharmacist or a pharmacy technician who dispenses or sells a repackaged drug or blood product must ensure that each repackaged drug or blood product has a label affixed to the package that meets the requirements of a prescription label required under Standard 7 or that explicitly identifies the following:

  1. a description of the drug, in English, by:
    1. generic name, strength and the identity of the manufacturer for a single-entity drug or blood product; or
    2. generic name, strength and the identity of the manufacturer for a combination drug or blood product, where possible, or the brand name and strength;
  2. the size of the package or quantity;
  3. a lot number that links to the audit trail described in Standard 21.1; and
  4. an expiry date for the drug or blood product.

Duty regarding directions

21.4     A pharmacist or a pharmacy technician who engages in repackaging drugs or blood products for sale to patients must ensure that the label includes a direction statement which has on it the words: “Take or use [insert the manufacturer’s suggested doses or use] or as directed by the prescriber”.

Duty regarding final check

21.5     A pharmacist or a pharmacy technician must perform a final check of all repackaged drugs, blood products or health care products to be satisfied that each step in the repackaging process has been completed accurately by verifying that:

  1. The drug or health care product, dosage form, strength, manufacturer and quantity package are correct.
  2. The information on the label is accurate according to the original container, including the drug, dosage form, strength and manufacturer. A pharmacist or a pharmacy technician who repackages drugs must take appropriate steps to protect patient safety.
  3. The label includes the information required in these standards.
  4. The package and packaging material are appropriate to protect the drug or health care product from light and moisture as necessary and to minimize the potential for interaction between a drug or health care product and the container.

21.6     Whenever possible, a final check of repackaged products must be performed by a pharmacist or pharmacy technician who did not create the label or select the drug from stock.

Special labeling requirements for individually packaged drugs

21.7     A pharmacist or a pharmacy technician must ensure that, when dispensed to a patient, individually packaged medications which include a drug (such as a lollipop) are: a) individually labeled with the name of the drug or compound, lot number and expiry date; and b) put in a larger container that bears a prescription label.

Temporary compounding of alcohol-based hand sanitizer by pharmacists and pharmacy technicians

Due to the COVID-19 pandemic and the recent shortages of commercially-manufactured alcohol-based hand sanitizer (ABHS), ACP has observed that some licensed pharmacies are compounding ABHS for the use of their pharmacy staff members and for distribution to the public. This temporary guidance is being provided to assist pharmacy staff members in carrying out necessary hand hygiene procedures and reducing the spread of the COVID-19 virus in the general public. Please remember that preparing and using a compounded preparation is inherently riskier in comparison to a manufactured product made under stringent conditions and quality controls.

This temporary guidance is consistent with Principle 8, Guidelines 1 and 2 of ACP’s Code of Ethics,which state that in serving as an essential health resource, pharmacists and pharmacy technicians must

  • maintain access to pharmacist services and care, and
  • be accessible and make resources available to care for patients and to mitigate further risk during public emergencies.

When compounding and distributing ABHS, pharmacies must:

  • Follow all current ACP standards, including the Standards of Practice for Pharmacy Compounding of Non-sterile Preparations.
  • Refer to a compounding formula that is evidence-based. Three evidence based formulas are available from USP at Compounding Alcohol-Based Hand Sanitizer During COVID-19 Pandemic. Other evidenced based formulas are available from the W.H.O.
  • Choose a commercial product over a compounded ABHS, when available.
  • Record the name and contact information of members of the public that receive compounded ABHS from the pharmacy. This will assist in the event of a product recall.
  • Ensure any ABHS repackaged and provided over the counter (OTC) meets all the requirements outlined in the ACP guidance for repackaging non-prescription medications, including requirements and restrictions involving packaging, labelling, quality assurance, self-selection, and promotion.
  • Understand that compounding ABHS in pharmacies is a temporary alternative during the COVID-19 pandemic, and that the temporary alternative is only provided during the pandemic and while commercially-manufactured ABHS is not available.

Pharmacies may also wish to refer to the U.S. Food and Drug Administration guidance document on this topic as its guidance document about ABHS refers directly to COVID-19.

Finally, it is important that pharmacies do not exploit this temporary alternative for financial gain.  Regulated members are expected to uphold Principle 1 of the Code of Ethics and hold the well-being of each patient to be their primary consideration. Regulated members must not allow their professional judgment to be impaired by personal or commercial benefits such as monetary or financial gain in this time of crisis where demand for ABHS can be heightened.

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 Self-Assessment tool to determine if they should contact Health Link at 811.  Patients with severe symptoms should be advised to call 911

Health Link at 811 may experience significant delays as the situation develops. Patients who suspect they may have been exposed should be advised to self-isolate until they are able to obtain service.

There are currently no additional processes for Alberta community pharmacists to refer or report COVID-19. However, the situation is fluid, and any updates or additional information will be communicated to pharmacists on the ACP webpage as soon as they become available.

Patient medication supply

As of June 15, 2020, pharmacists should return to usual and customary policies and practices in determining the appropriate amount of a drug to be dispensed. Where systemic shortages (i.e., critical supply situation) of a specific drug exists, consideration should be given to dispensing a smaller quantity, subject to considering the circumstances and unique needs of each patient (e.g., limited access to pharmacy services in remote locations).

Health Canada still remains concerned regarding the drug supply and on June 1, 2020 issued an advisory that stated, “The COVID-19 pandemic has resulted in significant shifts in the supply and demand of certain drugs. While supply levels may be stabilizing, supply pressures continue for certain drugs.”

At the direction of Alberta Health, Alberta Blue Cross will maintain a list of products in a critical supply situation. The list consists of drugs identified by Health Canada as Tier 3 drug shortages, plus additional drugs verified by Alberta Blue Cross as being in short supply.

Supporting self-isolation recommendations

If a self-isolated patient requires medications, ideally the patient should have someone who is not ill and has not been exposed to COVID-19 act as their agent to pick up the medications from the pharmacy. If this is not possible, medications may be delivered to the patient, but processes should be developed to ensure compliance with physical distancing requirements while maintaining security of the drugs and patient confidentiality. Please review ACP’s guidance for prescription delivery for more information.

Supporting patients impacted by pharmacy closures

When encountering patients whose pharmacies are closed and have limited access to their patient records, pharmacists are advised to review Netcare and consider other evidence of ongoing therapy as a part of their assessment to renew the prescriptions. Refer to ACP's prescribing algorithms for adaptation and renewal to aid in decision making.

Protecting the vulnerable

Current evidence suggests that those most at risk of serious complications from COVID-19 include the elderly, those with compromised immune systems, and those with underlying conditions. Pharmacists and pharmacy technicians who work in settings with these individuals must take extra care and exercise extreme vigilance to ensure the safety and security of these populations. Provide direction to these patients on when and how to reach out for assistance. Whenever practical, to avoid infection, advise these populations to access pharmacy services by telephone, use of a patient agent, home delivery, or other means that minimize direct contact. Focus on providing elderly patients and those with more complex medical conditions or chronic illnesses additional support to ensure their well-being and to maintain an adequate level of pharmacy patient care.

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.

CMOH Order 07-2020 prohibits gatherings of more than 15 people, however this does not prohibit healthcare settings including pharmacies from having more than 15 staff in a workplace.

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;
  • ensure travel restrictions and requirements are complied with:
    • Cancel all non-essential travel outside Canada, as per the Government of Canada’s travel advisory.
    • If a pharmacy staff member has travelled outside of Canada, CMOH Order 05-2020 requires that, upon their return from travel outside of Canada, they isolate for a minimum of 14 days.
    • If a pharmacy team member becomes sick during the 14-day isolation period, they must remain in isolation for an additional ten days from the start of symptoms, or until the symptoms resolve, whichever is longer.
  • 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 remain an appropriate distance (at least two metres) from others. Patients that are from the same household are permitted to be within two meters of one another;
    • 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, extreme tiredness, or other symptoms consistent with COVID-19;
      • are a person 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.

Similar messaging should be communicated on voicemail messages, websites, and social media.

Limit the number of individuals inside your pharmacy at one time, ensuring that physical distancing of 2 meters can be maintained between staff and patients at all times.  Patients may be required to wait outside the pharmacy until it is safe to enter.

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 Health Canada Risk-informed decision-making guidelines for workplaces and businesses during the COVID-19 pandemic 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 their 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
    • 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 including waiting rooms 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 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.

Hand hygiene

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: continuingcare@albertahealthservices.ca

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 and the Centers for Disease Control and Prevention’s document Cleaning and disinfection for community facilities

Workflow adjustment

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.

More information on workflow strategies is available through the Canadian Pharmacists Association (CPhA).

Personal protective equipment (PPE) for direct patient care

The Government of Alberta has enabled pharmacies to access pandemic PPE supplies. To learn more about distribution and order PPE for your pharmacy team, please visit the RxA website.

Shortages of PPE are a global issue requiring prioritization and coordination. Here are some key points to remember:

  • There is a limited amount of PPE available. Stringent controls and standardized provincial-level processes must be used to ensure equity and appropriateness.
  • Pharmacies who receive PPE from provincial supplies must restrict their use of PPE to direct patient care activities only.
  • Pharmacists providing care to any patient with symptoms suggestive of COVID-19 must do a point of care risk assessment and utilize the appropriate PPE for protection.
  • PPE received from provincial supplies must not be redistributed, sold, or given away to anyone.
  • Although the province is confident in its PPE supply, there is a limited amount and they must ensure highest risk areas are supplied.
  • Every effort should be made to conserve these limited supplies, and pharmacies providing direct patient care must only order what they require.
  • The plan to supply PPE is subject to change at any time based on system needs and supply availability.
  • PPE must be secured and closely monitored and must not be left out in public spaces.
  • N95 masks and full PPE is not routinely required for Community Health Care settings unless performing Aerosol Generating Medical Procedures (AGMP). 

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. 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.

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.

Continuous masking

As evolving evidence identifies the risk of asymptomatic transmission of COVID-19, continuous masking through the use of a surgical/procedural mask is now recommended for pharmacy personnel when involved in direct patient care activities. Pharmacists, pharmacy technicians, and pharmacy team members should review the AHS Guidelines for Continuous Masking.

Pharmacy personnel should wear a surgical/procedural mask continuously if they provide direct patient care or cannot maintain adequate physical distancing (either through use of a physical barrier or by maintaining a distance of two meters) between themselves and patients or other pharmacy personnel.

By implementing a continuous masking strategy, pharmacy personnel can minimize exposure to COVID-19 for both patients and coworkers, while also conserving the supply of standard PPE. This does not change requirements to self-isolate when sick, and no healthcare worker with symptoms of illness should come to work.

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:

  •  are experiencing symptoms including fever, cough, shortness of breath, runny nose, sore throat, extreme tiredness, or other symptoms consistent with COVID-19;
  • have returned 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.

Pharmacy staff members that are asymptomatic but meet the above criteria must be directed to quarantine for a minimum 14 day period per CMOH Order 05-2020.

When a pharmacy staff member experiences symptoms of COVID-19

Ensure pharmacy staff are aware of CMOH Order 05-2020 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 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

AHS will contact the pharmacy to provide the necessary public health guidance.

If the licensee becomes aware that a pharmacy staff member has tested positive but has not yet been contacted by AHS, the licensee should, as soon as possible

  • Implement immediate cleaning and disinfecting procedures consistent with AHS and CDC recommendations.
  • Contact AHS or designate a pharmacy team member to contact AHS to inform them that the individual who tested positive works at a pharmacy, and to obtain additional guidance on how to proceed. When contacting AHS, the licensee or designate should
    • Be prepared to inform AHS about the anticipated 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. AHS will not be familiar with all aspects of each pharmacy’s services, so the licensee or designate has a responsibility to volunteer information and ask appropriate questions to determine the best direction forward.
    • 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.
    • Implement additional cleaning and disinfecting procedures at the direction of AHS.

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.

All contact tracing will be conducted with oversight by AHS. The role of the licensee is to provide information as required and follow the direction of the AHS public health officer. Pharmacy staff must not perform any contact tracing without express direction from AHS.

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 active daily screening of patients for symptoms of COVID-19.

  • 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 screening protocol must include questions to identify:

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 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.

  • Patients may be offered services via approved virtual care platforms.
  • Patients may be offered curbside pickup or delivery of medications.

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. 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

As of March 25, 2020, 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:

  1. 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.
  1. 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.
  1. 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.

Pharmacy operations

Personal Protective Equipment (PPE) for compounding

Read the guidance prepared by ACP.

Post-consumer returns

Pharmacists are required by ACP’s Standards for Operation of Licensed Pharmacies, Standard 5.14, to accept unused drugs, expired drugs, and needles or other sharps used in the administration of drugs from patients for proper disposal unless if accepting the drug or item would pose a health risk or hazard to pharmacy staff. 

When considering the risks of COVID-19, pharmacy licensees whose pharmacies continue to accept post-consumer returns should develop and implement additional policies and procedures for safe handling, secure storage, and proper disposal of these items.

Pharmacy licensees who make the choice not to accept unused drugs, expired drugs, and needles or sharps because they feel doing so creates an unacceptable risk to pharmacy staff should ensure patients are provided with alternatives and/or advice about secure storage of these items in their home until they can be safely accepted at the pharmacy for disposal. 

The Health Canada Office of Controlled Substances (OCS) has issued a bulletin providing pharmacists with information on temporary exceptional measures for post-consumer returns containing controlled substances in light of the COVID-19 pandemic.

The bulletin includes general recommendations on accepting, and refusing to accept, post-consumer returns, as well as specific temporary measures pertaining to post-consumer returns of controlled substances including items such as opioid patches and methadone carry bottles.

The measures in the bulletin are effective as of April 16, 2020. As the duration of this pandemic is unknown, these measures are set to expire on the earliest of the following dates:

  • September 30, 2020,
  • the date that they are replaced by new or additional measures, or
  • the date upon which these measures are revoked.

If you have questions about post-consumer returns, please contact ACP at acpinfo@abpharmacy.ca or Health Canada’s Office of Controlled Substances at hc.compliance-conformite.sc@canada.ca.

 

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.