Reflections on Professional Identity and Pharmacist Role in the Canadian Health System

The role of the Pharmacist in the Canadian health care system is evolving, with accelerated changes taking place in the past decade. In an era where health care costs are continuously rising, where access to care is insufficient to meet the demands of an aging population, coupled with the rapid development of complex medications, pharmacists are taking on additional responsibilities to play an active role in alleviating health system constraints. Clearly establishing our professional identity will enable us to practice to our expanded scope in the Canadian health care system while strengthening our professional relationships with other health care providers and our patients.

The bowl of Hygieia is a symbol used to represent the pharmacy profession

The introduction of the concept of “pharmaceutical care” in the 1990’s shifted the pharmacist role from dispensing medications to patient-centred clinical decision making with a goal of safe and effective medication use. In 2014, the World Health Organization developed the concept of the “Seven-star pharmacist”, which describes the pharmacist as a: caregiver, decision-maker, communicator, manager, life-long learner, teacher, and leader. This succinctly encapsulates the professional identities of the modern pharmacist and aligns with the expanded scope of practice as authorized by federal legislation.

With the aging population and increasing demands for health services, resources are limited to respond to rapidly changing patient needs. As a hospital pharmacist, I work in an environment where the pharmacist is closely integrated into the care team. We participate in clinical rounds and regularly intervene by recommending changes in patients’ medication regimens. Colleagues working in the community setting tend to have a less collaborative experience. A study in Alberta, the first province to allow pharmacists to prescribe, shows that the emerging role of the pharmacist as primary care provider with expanded scope of practice has led to blurred professional boundaries. A recent report commissioned by the Canadian Pharmacists Association found that pharmacists delivering services such as smoking cessation clinics, advanced medication review for chronic conditions, and various vaccinations can yield significant health system cost savings over the next 20 years. Integrating pharmacists into primary care teams and optimizing expanded scope of practice where pharmacists can prescribe and adapt prescriptions, and administer drugs by injection will contribute to accessibility and sustainability of the health care system. Pharmacists need to clearly articulate our increased autonomy within care teams to promote collaborative relationships with prescribers and patients.

As a manager of a pharmacy department in a hospital, I have a role in advocating and promoting expanded scope of practice for pharmacists and pharmacy technicians. In the hospital setting, Canadian acute care studies have shown that 40% of patients at discharge transitions of care experience unintentional medication discrepancies or potential errors. It is imperative to advocate for pharmacy resources focusing on continuity across transitions of care, with the goal of ensuring safe and effective use of medications, appropriate prescribing and de-prescribing, and preventing harm from medication-related adverse events. With the new oversight provided by the Ontario College of Pharmacists (OCP) to hospital pharmacies, I am now accountable not only for my own practice as a pharmacist, but also the operating pharmacies for which I am responsible. My role includes the development of quality assurance programs, and ensuring that pharmacy practice complies with national practice standards, thereby reducing critical medication-related adverse events that can have significant burden on the health care system. My involvement in medication management systems and patient safety also allows me to contribute to valuable discussions evaluating mechanisms by which institutions can proactively address narcotic diversion. This, in turn, can reduce unexplained losses of opioids from hospitals that continue to feed the opioid crisis.

Professional values reflect the behaviours that shape how I work with my patients, my colleagues and staff, and with external stakeholders. As a professional and a leader, actions I take and decisions I make should align with my values of safety, compassion, teamwork, integrity and stewardship. It is important to recognize that these professional values should be reflected not only in the workplace, but in our increasingly prevalent presence in social media. OCP advises the following key considerations in maintaining professionalism in social media use:

1. Confidentiality and privacy

2. Maintaining professional boundaries

3. Upholding professional reputation

4. Awareness of conflict of interest

Our professional identity evolves over time as we adopt and adapt to new roles. To effectively respond to the changing needs of the health care system, we must continue to critically reflect on our professional identities and roles to determine changes needed to advance practice with a focus on the best interest of the patient.

References

Canadian Pharmacists Association (2017, April 25). Expanding role of community pharmacists could save Canada’s health care system up to $25.7 billion. Retrieved from https://www.pharmacists.ca/news-events/news/expanding-role-of-community-pharmacists-could-save-canada-s-health-care-system-up-to-25-7-billion/

Howorun, C. (2017, November 24). “Unexplained losses” of opioids on the rise in Canadian hospitals. CityNews. Retrieved from https://toronto.citynews.ca/2017/11/24/opioids-canadian-hospitals/

Institute of Safe Medication Practice Canada. (2010). Optimizing communication about medications at transitions of care in Ontario [PDF document]. Retrieved from https://www.ismp-canada.org/download/MedRec/Optimizing_Communication_about_Medications_at_Transitions_of_Care_in_Ontario_Report.pdf

Ontario College of Pharmacists. (2016). College oversight of hospital pharmacies. Retrieved from http://www.ocpinfo.com/about/key-initiatives/hospital-oversight/

Ontario College of Pharmacists. (2018). Social media – eLearning module. Retrieved from http://www.ocpinfo.com/practice-education/continuing-education/listings/resource/social-media-elearning-module/

Schidnel, T.J., Yuksel, N., Breault, R., Daniels, J., Varnhagen, S., Hughes, C.A. (2017). Perceptions of pharmacists’ roles in the era of expanding scopes of practice. Research in Social & Administrative Pharmacy, 13(1), 148-161.

Thamby, S.A., Subramani, P. (2014). Seven-star pharmacist concept by World Health Organization. Journal of Young Pharmacists, 6(2), 1-3.