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Advocacy in Action: December 5

December 5, 2023
 
  

What's happened

November 22, Choosing Wisely Canada Consultation 

CSHP provided feedback on Choosing Wisely Canada’s clinical biochemistry recommendations which will ultimately be released in early 2024 by the Canadian Society of Clinical Chemists.   

November 27, Drug Shortages Expert Review Panel

CPO Rita Dhami officially joined a panel of experts representing various pharmacy sectors that will be contributing to a CIHR-funded project. This collaborative initiative is led by the University of Toronto, Health Canada, and CADTH, with the goal of creating a systematic, adaptable, transparent, and regularly updated national list of at-risk medicines. 

November 30, Natural Health Products Consultation 

CSHP is providing ongoing feedback on the first round of new and updated natural health product monographs as part of the implementation of the new Natural Health Product (NHP) labelling initiative. This Natural and Non-Prescription Health Product Directoriate (NNHPD) led project is currently in its first round of consultations where CSHP is focused on accessing the accuracy, conciseness, and consistency of statements in their monographs. 

Ongoing, Health Canada Drug Shortages Meetings

CSHP is continuing to monitor these ongoing drug shortages:

  • Nov 16: Tier Assignment Committee –  Lidocaine/Bupivicaine (with and without Epinephrine)
  • Nov 22: Multi-Stakeholder Call – Shortages of Amoxicillin
  • Dec. 1: Multi-Stakeholder Call –  Lidocaine/Bupivicaine (with and without Epinephrine)

What's happening

December 5, Multilateral Meeting with Health Canada / Marketed Health Products Directorate

The CSHP Executive team, alongside our partners at A.P.E.S. and several other key stakeholders, will be participating in a multilateral meeting with Health Canada. This meeting will provide us with updates from the various divisions of Health Canada including the Marketed Health Products Branch, Pharmaceutical Drugs Directorate, and Biologic and Radiopharmaceutical Drugs Directorate.

December 15, Consultation Canadian Council of Accreditation for Pharmacy Programs – Pharmacy technicians    

CSHP was invited to consult and provide feedback on the Canadian Council of Accreditation for Pharmacy Programs’ first draft on their updated standards for pharmacy technicians programs.  

What's worth repeating

October, Health Canada consultation on the Handbook for healthcare professionals on biosimilar biologic drugs

Professional Practice Specialist Kiet-Nghi Cao joined a working group of subject matter consultants from across the country to help with the development of a Health Canada handbook focused on informing and educating healthcare professionals on biosimilars. The guidelines will provide background on the immunogenicity of biosimilars, details on authorization, accessibility, and monitoring of them, and includes example case studies. This handbook is now available and can be found here

To catch up on CSHP advocacy news, click here.

Have a question about Advocacy in Action or CSHP's advocacy and consultation work?
Reach out to our professional practice team!   

December 05, 2023
Advocacy in Action: December 5

Latest News

Call for expressions of interest – Sustainability Implementation Task Force

December 5, 2023 
 

CSHP is committed to supporting and advocating on behalf of the profession to make pharmacy’s voice heard and stimulate action in areas that require multi-agency or systemic change as it pertains to Climate Change and Sustainability in pharmacy practice.

In February 2023, CSHP struck a Sustainability Task Force to research and identify specific goals and deliverables for CSHP to work on to address climate change.  This task force delivered a comprehensive list of recommendations for CSHP and the Board struck another Task Force to implement these recommendations.

If you are, or know someone, who has knowledge and expertise in one or more of the following areas, please email Professional Practice at practice@cshp.ca your Curriculum Vitae (CV), and a letter of intent (max. 500 words) describing your experience, by close of business on Tuesday, December 19, 2023

  • Qualifications, existing role, or knowledge in relevant sustainability fields or providing specialist sustainability services to healthcare organizations.
  • Good understanding on how hospitals, pharmacies and healthcare systems operate and are compliant with relevant legislation, regulations, codes of practice, technical guidance for environmental sustainability matters.
  • Experience engaging in initiatives from conception through to implementation
  • Experience working with networks of key or influential stakeholders relevant to sustainability and social value.
  • Knowledge of pharmacy technician practice.

We are looking for pharmacy professionals from all practice settings and with various levels of experience!

CSHP is committed to ensuring that our task forces and committees represent the full diversity of our members. Please feel free to indicate if you belong to an equity-deserving group, as this will be taken into consideration with all expressions of interest.
 
View the Terms of Reference for the Sustainability Implementation Task Force here

December 05, 2023
Call for expressions of interest – Sustainability Implementation Task Force

Latest News

Call for nominations: President Elect and Treasurer

Dec 1, 2023

The CSHP Nominating Committee, chaired by Dr. Sean Spina, is seeking nominations for
 
President Elect
(Term:  1 year - 3 years total as Presidential Officer)

Treasurer (Finance Liaison Portfolio)
(Term: *3 years as Executive Officer)
 

For information on the criteria and competencies for the position and to obtain a nomination form, please click here.

If you would like additional information about either position, please contact Sean Spina at sean.spina@islandhealth.ca.

Please send nomination forms to Hira Tauqeer at htauqeer@cshp.ca

Deadline for submission of nominations:
Friday, January 19, 2024
December 01, 2023
Call for nominations: President Elect and Treasurer

Latest News

Call for poster abstract reviewers: Professional Practice Conference 2024

November 28, 2023
 

Volunteering as a poster reviewer is an opportunity to help the Society and your fellow members by providing valuable feedback and supporting high quality research. Abstracts will be assigned to reviewers in mid-January, with about 3 weeks allotted for review. 

Abstract reviewers must be current CSHP members. To volunteer as a reviewer, please contact practice@cshp.caThank you for contributing your time and expertise to the CSHP community!  

Call for poster abstracts for PPC 2024

Do you have a research project that you'd like to present as a poster at PPC? Poster abstract submissions are now open. Click here for more details.

November 28, 2023
Call for poster abstract reviewers: PPC 2024

Latest News

Call for poster abstracts: Professional Practice Conference 2024

November 27, 2023
 

CSHP's Professional Practice Conference will be held April 19-21st, 2024 in Niagara Falls, Ontario.  As we gear up for this hybrid gathering, we're calling for poster abstract submissions from the CSHP community. Poster presentations are an integral part of the conference experience, and an opportunity to share your work with attendees across Canada. Last year, the Together Conference in Banff featured 50+ posters with a wide range of the latest topics in hospital pharmacy research. The deadline for abstract submissions is December 22, 2023 at 16:00 ET 

Submit your proposal

Please carefully review the instructions below; only abstracts that meet these requirements for formatting and submission will be considered. 


Poster abstract guidelines for PPC 2024


Category

Authors must specify the category that best suits their abstract. Abstracts will be judged according to the category specified by authors upon submission.

  1. Original Research (includes Pharmaceutical/Basic Science, Clinical Research, Drug Use Evaluations, Systematic Reviews with or without Meta-Analysis, Pharmacoeconomics Analysis, etc.)
  2. Pharmacy Practice (includes Administration Projects, Health Professional Education, Medication Safety Initiatives, etc.)
  3. Case Reports


Abstract style rules

Abstracts that do not adhere to the following rules will be rejected. 

Title

  • Should be brief and clearly indicate the nature of the presentation
  • Use title-style capitalization (i.e., capitalize only the first letter of each word of the title except for minor words, unless it is the first word of the title; do not capitalize prepositions)
  • Do not use abbreviations
  • Do not place a period at the end
  • Do not write out numerals 

Authors

  • List the authors as “last name + initials” (e.g., “Lee K, Patel L, Smith J”) under the title, with superscript numbers linked to affiliation notes
  • Institutional affiliation, city, and province should be listed under the list of authors with corresponding footnotes identifying author affiliation(s)
  • When there is more than one superscript number for an author with multiple affiliations, the superscript numbers should be separated by commas only (no spaces)
  • Put department/faculty first, then institution name
  • Present affiliations with city and two-letter provincial abbreviations
  • For affiliations outside of Canada, include name of country
  • Omit degrees, titles, and appointments
  • Please underline the name of the author who will present the poster if accepted

Body and headings

Organize the body of the abstract using the exact headings outlined below for the selected category. Use bold for paragraph headings, add a colon after paragraph headings, and capitalize the second word in a two-word heading, such as “Literature Review”. Please note that studies with multiple outcomes must be presented in the same poster. Do not report individual outcomes from the same study data in separate posters.

  • Original Research:
    • Background: Briefly describe the rationale for the study
    • Objective(s): Include the main study objective(s)
    • Methods: Include study design, methods, intervention, and statistical analysis
    • Results: Provide main results
    • Conclusion(s): Include the main conclusion and interpretation of the results which are supported by the data provided
  • Case Reports:
    • Background: Briefly describe the rationale for the case report
    • Case Description: Provide details of the case. Enough details should be provided to clearly outline the case and support the assessment of causality
    • Assessment of Causality: Case reports of suspected adverse drug reactions should report on causality using a causality assessment tool such as the Naranjo scale. If the case report does not involve an adverse drug reaction, the authors should still articulate the association between the therapy and the observed outcome
    • Literature Review: Briefly examine current literature relating to or surrounding the case report
    • Importance to Practitioners: Briefly describe implications/importance of the case report to pharmacy practitioners
  • Pharmacy Practice:
    • Background: Briefly describe the background and rationale for service, program, problem, need, etc.
    • Description: Describe the concept, service, role, or situation
    • Action: Describe the steps taken to identify and resolve a problem(s), implement change, or develop and implement the new program
    • Evaluation: Describe the evaluation process of the project and results of evaluation
    • Implications: Describe the concept’s importance and usefulness to current and/or future practice

Abstract text

  • Abstract body (not including title and authors) is limited to 300 words. This includes the required section headings as outlined above. Any abstract that exceeds the word count will be rejected.
  • Each table is equivalent to 30 words.
  • Each graphic is equivalent to 60 words.
  • Results or evaluation must be included in the abstract. It is not acceptable to state that results will be discussed. Abstracts doing so will be rejected.
  • Do not indent the start of a paragraph.
  • Place abbreviations in parentheses after the full word or phrase upon first mention. Please keep abbreviated terms to a minimum.
  • Use numerals to indicate numbers, except at the beginning of sentences.
  • Use only generic names of drugs, material, devices, and equipment.
  • Do not include citations, reference numbers, or reference lists.

Submission instructions

  • Authors must submit TWO copies of their abstract – one original copy (for inclusion in the conference program) and one blinded copy (for review purposes)
  • Please ensure that the following steps are taken for the blinded copy:
    • Author names, location, and affiliations are removed
    • The abstract (including the title and body) should not contain any identifying information, such as the geographic location, authors, programs, or institutions of origin
  • Abstracts MUST be submitted electronically as a file in MS Word format
  • The two MS Word files must be named according to the following convention:
    • Blinded copy: First three words of the title_Submitter's last name_Blinded 
    • Unblinded copy: First three words of the title_Submitter's last name_Unblinded


Only abstracts that meet these requirements for formatting and submission will be considered.


November 24, 2023
Call for poster abstracts: Professional Practice Conference 2024

Latest News

In Memoriam: Tribute to Kevin Hall

November 23, 2023

A tribute to Kevin Hall 



Kevin Hall

BScPhm, PharmD, FCSHP
October 18, 1954 – November 14, 2023

The Canadian Society of Hospital Pharmacists (CSHP) and the pharmacy world have lost a great leader, visionary, and influential force with the passing of Kevin Hall BScPhm, PharmD, FCSHP on November 14, 2023.  Kevin was notably active at the branch and national levels of CSHP from his early beginnings as a Clinical Pharmacist at the Winnipeg Health Sciences Centre to when he later became Regional Director of Pharmacy in the Winnipeg Regional Health Authority.

The pharmacy services at the Winnipeg Health Sciences Centre, and Winnipeg Health Region were recognized as benefiting from great leadership in providing an optimal pharmacy service and, consequently, by invitation, Kevin performed numerous operational reviews of pharmacy services in large hospitals across the country. 

After serving as the President of the Manitoba Branch of CSHP, Kevin actively engaged as the Manitoba Branch Delegate to CSHP Council and followed as its National President in 1986-87.  Kevin remained extremely active in the affairs of CSHP in his Past President’s role and later assumed the position of Chair of the CSHP Research and Education Foundation.  The Foundation was rejuvenated under Kevin’s leadership, increasing its visibility and fundraising capability. The title of Managing Editor, Hospital Pharmacy Survey (Lilly Survey), was held by Kevin, in 2005, after serving nearly 10 years as a member of its Editorial Board.  As a CSHP member at large, Kevin was a popular speaker at numerous CSHP conferences sharing influential strategies for growth of the profession.

Kevin did not limit his expertise and knowledge to the hospital sector of pharmacy alone. He served as President of the Canadian Pharmacists Association (CPhA) in 1994-95 and CPhA Delegate to the Council of the International Pharmaceutical Federation (FIP).  Kevin was recognized by his peers as the recipient of numerous awards. CPhA bestowed upon Kevin the CPhA Meritorious Service Award and the Centennial Pharmacist Award. Through CSHP, he was honoured with the Distinguished Service Award and Fellow status. 

Kevin was a valuable resource for positively influencing the newcomers to the pharmacy profession.  In addition to training and mentoring pharmacy residents at his institution, Kevin was an active lecturer, sessional instructor and assistant professor to undergraduate pharmacy students at the University of Winnipeg and University of Manitoba.  Kevin, the educator, last taught as Clinical Associate Professor at the University of Alberta in Edmonton.  

There is no doubt that Kevin’s passion for pharmacy and his influence left a huge footprint on the profession.

But there was more to Kevin than the pharmacist persona he portrayed so well.  Kevin was an avid golfer and a socially engaging friend to so many.  Good food and fine wine were enjoyed by Kevin and his wife Anita, and together, they travelled the world. Simply put, Kevin Hall was just a great guy and he will be missed.

Submitted by Linda Poloway, CSHP President - 2000 to 2001

CSHP remembers Kevin Hall

"I appreciated his visionary leadership in healthcare practice & our volunteer HPC Board work, significant contributions to the profession, & his down-to-earth style of communication which set people at ease and helped us find a way out of challenging situations. Gone too soon. Condolences to his wife, family & friends."  - Doug Doucette


"Kevin’s passing is a great loss to the profession and especially to members of the board, past and present, who have had the great chance to work with Kevin. I will always remember the wonderful welcome I received from him when I first started with the board. As a new head of pharmacy and new board member, I was quite intimidated by Kevin’s accomplishments and reputation. This all dissipated quickly when he came to sit with me at our first board meeting supper at the famed Milcroft. His very genuine, human approach (or even "fatherly" approach) calmed my fears and made my integration smooth. I can’t remember exactly what he said, but will always remember how he made me feel
." -  André Bonnici

"I had the privilege of knowing Kevin in 1996 when I joined the editorial board of the Canadian Hospital Pharmacy Report. Visionary, altruistic, open, involved, rigorous, interested in others, he opened the doors to the rest of the country for me... when you are a French-speaking Quebecer! May the history of pharmacy remember the contribution of this exceptional pharmacist. An exhibition on the history of pharmacy at the Faculty of Pharmacy of the University of Montreal will highlight his contribution in the fall of 2024. I lost a colleague, but above all, a friend. Have a good trip." -  Jean-Francois Bussières

"I met Kevin at the Harrison Conference, where he presented on the ‘Lily Survey.’  He showed great kindness, and I appreciated hearing his stories during the Harrison dinners. He was a remarkably knowledgeable and delightful person. My heartfelt condolences go out to his family." - Bal Dhillon

"This is truly sad news. I remember him for his kindness and his smile" -  Debbie Merrill


Offer condolences and memories here

November 23, 2023
In Memoriam: Kevin Hall

Latest News

Apply Now for the 2024 Pharmacy Leadership Academy Scholarship

November 15, 2023

FoundationLogo-Colour.png

CSHP FOUNDATION IS NOW ACCEPTING APPLICATIONS FOR THE
2024 Pharmacy Leadership Academy Scholarship

The CSHP Foundation is committed to offering educational opportunities that develop Canada’s hospital pharmacy leaders using innovative, evidence-based methods. The Pharmacy Leadership Academy® (PLA) is a 12-month on-line integrated program offered by the ASHP Foundation that will appeal to Canadian hospital pharmacy leaders or those aspiring to leadership positions who want additional training. 

This scholarship is for the July 14, 2024, program start date and is valued at $5,000 CDN towards the PLA tuition fee. Application information for the CSHP Foundation scholarship is available at CSHP Foundation.
Further information on the ASHP PLA program is available at https://www.ashpfoundation.org/leadership-development/pharmacy-leadership-academy.

The ASHP Pharmacy Leadership Academy has the following program objectives: 

  1. Provide a curriculum that enhances leadership competency and tackles contemporary issues in healthcare.
  2. Provide leadership education in a graduate credit-worthy platform applicable to practitioners in small to large hospitals and health systems. 
  3. Provide integrated, real-world pharmacy case studies to highlight and amplify critical thinking, integration of ideas and perspectives.
  4. Incorporate mentorship into the fabric of the program. 
  5. Maximize distance education of qualified persons through an advanced Learning Management System and technologies.

HOW TO APPLY:  

  1. Submit an ASHP Foundation Pharmacy Leadership Academy application by February 1, 2024.
    • ASHP will accept applications until March 31, 2024. However, to be considered for the CSHP Foundation Scholarship you must apply to the ASHP Foundation by February 1, 2024, to ensure notification of acceptance to the PLA 
      program prior to submitting your CSHP Scholarship application.
  2. Submit a CSHP Foundation scholarship application with required documents by March 13, 2024.

The successful CSHP Foundation PLA Scholarship applicant will be notified by April 30, 2024.

 

November 20, 2023
Apply Now for the 2024 Pharmacy Leadership Academy Scholarship

Latest News

2023 AGM Weekend Recap – Meet the new CSHP President, Board members and task forces! 

November 7, 2023
 
 
From October 20 to 22, CSHP held Board meetings and its Annual General Meeting in Montréal.
 
Throughout the weekend Board members, Executive members, Branch presidents, and CSHP staff had plenty of discussions on priority topics for CSHP and hospital pharmacy. Keep reading to learn what happened! 

 

Board of Directors changes

 

The Board saw a few changes over AGM weekend. Very notable was the departure of CSHP National Board of Directors stalwart, Zack Dumont; he took his final bows after more than a decade of demanding work on the Board of Directors- and Saskatchewan Branch leadership before that. Throughout his tenure, Zack has touched everything from a pharmacy technician task force to being an expert and speaker for CSHP’s Hospital Pharmacy 101 to being a co-chair of the Vision for the Hospital Pharmacy Profession Task Force, and much more. His dedication and knowledge on top of his unprecedented two-year presidency where he led CSHP through a time of uncertainty. CSHP is incredibly grateful to Zack who remains committed to CSHP with his presence on committees, serving as Saskatchewan Branch’s secretary and, as of AGM weekend, as a proud CSHP Fellow! 

Other moves on the Board include Sean Spina taking up the Past President mantle after leading CSHP through the end of the 2020-2023 strategic plan. Ashley Walus was promoted to the President position where she will be focused on incorporating CSHP’s vision for hospital pharmacy into the next strategic plan. Katie Hollis officially stepped into her role as President-Elect. As for representation from the Branches, CSHP bid adieu to the now-former New Brunswick Delegate Chantal Michaud along with former Student Delegate Abby Krupski and then welcomed New Brunswick’s new delegate Timothy MacLaggan and Student Delegate Jacqueline Tian-Tran from the University of Saskatchewan.

 

Task forces

Vision for the Hospital Pharmacy Profession Task Force
The Vision for the Hospital Pharmacy Profession Task Force crafted 12 outstanding vision statements unanimously approved by the Board. They are as follows:

  1. Pharmacy professionals engage in shared decision-making to provide evidence-informed care that incorporates patients' values, needs, and preferences.
  2. Pharmacy professionals provide equitable, culturally appropriate care tailored to the populations they serve. 
  3. Pharmacy professionals collaborate to address patients' medication needs across the continuum of care.  
  4. Pharmacy professionals engage patients and their caregivers in managing the patient's health and wellness. 
  5. Pharmacy professionals optimize patient care by practicing with their full and expanding scope of responsibilities. 
  6. Pharmacy professionals develop and maintain leadership skills to benefit their patients, themselves, and the profession. 
  7. Pharmacy professionals meet complex practice needs in healthcare systems by engaging in formal training opportunities, including specialization and credentialling. 
  8. Pharmacy professionals are engaged in the education and mentorship of peers, future hospital pharmacy professionals, and other health care providers. 
  9. Pharmacy professionals pursue innovative solutions to improve access and provide care to patients in the most appropriate location, which may include their homes or local communities. 
  10. Pharmacy professionals lead quality improvement and research initiatives with a focus on medication use, pharmacy practice, and resource allocation. 
  11. Pharmacy professionals lead and implement rational medication use practices that are fiscally and environmentally sustainable. 
  12. Pharmacy professionals promote diversity, equity, inclusion, accessibility, and belonging, both within the pharmacy profession and the broader healthcare system. 

In a task force led by Co-Chairs Zack Dumont and Mary Gunther, these statements were narrowed down over a three-round process through a Delphi panel. On this panel, there were representatives from patient advocacy, IPPC, APES, CAPSI, Technicians, AFPC, 2SLGBTQA+ advocacy, and, for the first time, patients.  

With these statements agreed upon by the Board, this task force has been dissolved and will be replaced with a Vision Implementation Task Force. This new task force will concentrate on a plan to put the proposed work into practice in line with the approved vision statements.

Sustainability Task force
The Sustainability Task Force produced a set of short-term and long-term recommendations covering various aspects of CSHP work. This work will include: 

  • Advocacy & partnership 
  • Education 
  • Policy and procedure development 
  • Research and quality improvement 
  • Branding.

These recommendations advocate to Accreditation Canada, NAPRA, plus federal and provincial governments for the inclusion of environmental sustainability criteria, standards, and practices.  

They also plan for the creation of a planetary health education series, guideline development for sustainable conferences, and establishing a dedicated sustainability section on the CSHP website.  

This task force was also dissolved and is being replaced by a Sustainability Implementation Task Force. With several fresh faces on board, the new task force will be putting these approved recommendations into action.

The cornerstone of progress

On top of these changes, Board members and Branch presidents were able to take in highly anticipated updates from CSHP’s Year in Review. Topping out the list was continuous membership growth and brand-new non-dues revenue sources. The Hospital Pharmacy in Canada Survey Report is now more accessible than ever through multiple webinars, conference sessions, etc. Hospital Pharmacy 101 program sales continue to climb. These and other promising developments will be presented in CSHP’s upcoming 2022-23 Annual Report – so stay tuned to see how the past year has set the stage for great things from CSHP! 

November 07, 2023
2023 AGM Weekend Recap – Meet the new CSHP President, Board members and task forces!

Latest News

Advocacy in Action: November 7

November 7, 2023
 
  

What's happened

October 16, CSHP-CASCADES Exploring Collaboration Opportunities on Sustainability in Hospital Pharmacy 

After the successful launch of the Playbook on Climate Resilient, Low Carbon Sustainable Pharmacy with CSHP as a proud collaborator, Professional Practice team met with CASCADES to explore further potential collaborations focusing on sustainability practices in hospital pharmacy.

October 24, Mohawk-Medbuy Presentation on Sustainability in Hospital Pharmacy

CPO Rita Dhami attended the annual Pharmacy Committee Meeting at Mohawk-Medbuy where she shared recommendations from the CSHP Sustainability Task Force. Rita also highlighted the opportunities hospital pharmacy's clinical and operations teams can take to integrate sustainable considerations into procurement and practices. 

October, Health Canada consultation on the Handbook for healthcare professionals on biosimilar biologic drugs 

Professional Practice Specialist Kiet-Nghi Cao joined a working group of subject matter consultants from across the country to help with the development of a Health Canada handbook focused on informing and educating healthcare professionals on biosimilars. The guidelines will provide background on the immunogenicity of biosimilars, details on authorization, accessibility, and monitoring of them, and includes example case studies. This handbook is due to be released next month. 

Ongoing, Health Canada Drug Shortages Meetings

CSHP is continuing to monitor these ongoing drug shortages:

 

  • Oct 16: Multi-Stakeholder Call – Supply disruptions of Ozempic 
  • Oct 18: Multi-Stakeholder Call – Shortages of Amoxicillin oral 
  • Oct 27: Multi-Stakeholder Call – Supply disruptions of Ozempic
  • Nov 1: Clinical Stakeholders Call – Supply disruptions of Ozempic 
  • Nov 2: Tier Assignment Committee – Review of de-escalation of Erwinase 

What's worth repeating

October 5, Roundtable on Meeting of the Health Product Supply Chain Advisory Committee 

The Drug Shortages Task Force, including Rita and Assistant Deputy Minister Stefania Trombetti, met for a roundtable discussion. Deputy Minister Trombetti provided stakeholders with an overview of the consultation results on public drug shortages and informed committee members that Health Canada would develop a summary 'What we heard' document that would be shared with them soon.  

October 6, Collaboration on a National ‘At-Risk Medicines’ List   

As part of a CIHR-funded project with Health Canada and CADTH, Rita will join an expert panel to develop a national at-risk medicine list. 


To catch up on CSHP advocacy news, click here.

Have a question about Advocacy in Action or CSHP's advocacy and consultation work?
Reach out to our professional practice team!   

November 07, 2023
Advocacy in Action: November 7

Latest News

Resource Spotlight: Immune-related adverse events due to immune checkpoint inhibitors

October 24, 2023
 

Written by Huy Pham

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

Background 

Immune checkpoint inhibitors are a class of immunotherapy that are used in the treatment of various cancers including lung cancer, melanoma, and colon cancer. There are currently eight immune checkpoint inhibitors marketed in Canada. The side effects of immune checkpoint inhibitors are collectively called immune-related adverse events and can affect any organ or organ system. The appropriate management will depend on the severity of the immune-related adverse event and the organ/organ systems affected. This “Resource Spotlight” contains links to tools and resources that pharmacy professionals can use to learn more about immune-related adverse events and how to manage them. To learn more about immune-related adverse events, check out CSHP's recent Clinical Pearls on immune-related adverse events due to immune checkpoint inhibitors. 

Canadian Guidelines and Healthcare Resources 

Cancer Care Ontario is a provincial agency responsible for providing healthcare professionals, organizations, and policy-makers with up-to-date knowledge and tools to support them with the prevention of cancer and the delivery of high-quality care in Ontario. They developed monographs for seven immune checkpoint inhibitors  that are marketed in Canada (ipilimumab, nivolumab, cemiplimab, avelumab, durvalumab, pembrolizumab, atezolizumab). In addition, Cancer Care Ontario has an Immune Checkpoint Inhibitor Side Effect Toolkit with toxicity algorithms to guide clinicians in determining the best course of treatment depending on the affected organ systems. The toolkit also contains a template for wallet cards and letters to notify healthcare providers that the patient is on immunotherapy, as well as a medication information sheet that can be given to patients to inform them about immunotherapies.

Cancer Care Alberta has created a guideline on the recommended strategies for prevention, anticipation, detection, and management of immune-related adverse events due to immune checkpoint inhibitors. The guideline is sectioned by organ systems and provides tables to help assess the severity of immune-related adverse events.

The Immune-Mediated Pathophysiology & Clinical Triage (i-MPACT) podcast is a ten-episode series created from the collaboration of Alberta Health Services, the Alberta Cancer Foundation, and Bristol Myers and Squibb. This series focuses on patient care with regards to immunotherapy such as immune checkpoint inhibitors with an emphasis on proactive and longitudinal care, the pathophysiology of immune-related adverse events, and toxicity management strategies.

BC Cancer has a comprehensive cancer control program that encompasses the entire spectrum of cancer care, from the prevention and screening of cancer to supportive and palliative care. BC Cancer provides protocols for healthcare professionals to use to guide the management of immune-related adverse events as well as a patient handout outlining the common and serious side effects of immune checkpoint inhibitors. Monographs may be found on the BC Cancer’s webpage. In addition, they have print-out wallet cards that patients in B.C. can carry to alert other clinicians that they received immune checkpoint inhibitor therapy.

The Canadian Association of Pharmacists in Oncology (CAPhO) is the membership-based national advocacy organization for the field of oncology pharmacy, acting as a resource centre to support pharmacists with providing optimal care for cancer patients. One of these resources is their CAPhO Connection Podcast, a recent episode of which covers the role of the pharmacist in immune checkpoint inhibitor management. Topics discussed includes the wide spectrum of adverse events associated with immune checkpoint inhibitors, the five pillars of management as described by an article in the Annals of Oncology by Champiet et al(“Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper”), and clinically relevant pharmacodynamic drug interactions associated with immune checkpoint inhibitors.

International Guidelines and Healthcare Resources 

The Immuno-Oncology (IO) Essentials Initiative is an organization dedicated to improving the health outcomes of patients receiving immunotherapies by providing healthcare professionals with the information needed to approach immune-related adverse events in an optimal manner. They also aim to empower patients by educating them to actively participate in their therapy in the context of immune-related adverse event recognition and management. The Immuno-Oncology Essentials Initiative curates content by country including a page for Canada. Their website has a library of videos detailing immune-related adverse events as a whole and in the context of specific cancers. They also have toolkits on the individual immune checkpoint inhibitors (as well as one on an oncolytic viral immunotherapy) and single-page Care Step Pathways documents to aid with the assessment of the presence and severity of immune-related adverse events and management strategies.

The American Society of Clinical Oncology released an update2 to their 2018 guideline on the management of immune-related adverse events due to immune checkpoint inhibitor therapy. The guideline contains tables that outline the work-up and evaluation of a patient presenting with an immune-related adverse event, the criteria for grading and management strategies, as well as a table of possible therapeutic alternatives for steroid-refractory immune-related adverse events. There is a complementary article3 that focuses on the ten most common immune-related adverse events secondary to immune checkpoint inhibitors and how they are managed. The guideline is also accompanied by an interactive tool to help with creating a comprehensive care plan for the immune-related adverse event.

The Society for Immunotherapy of Cancer is an organization that seeks to advance the science, development, and application of immunotherapies to improve the health outcomes of cancer patients. They have a guideline4 to aid with clinical decision-making for patients’ immune-related adverse events and a library of webinars and modules on their management, and patient resources to help patients understand immunotherapies and their use as cancer treatment.

The European Society for Medical Oncology is a professional organization for medical oncology with over 28,000 members from over 160 countries. They have released a clinical practice guideline5 that outlines their recommendations for the assessment, diagnosis and treatment of toxicities secondary to immunotherapy. The guideline contains treatment algorithms to guide one’s approach depending on the severity of the toxicity.

References

  1. Champiat S, Lambotte O, Barreau E, Belkhir R, Berdelou A, Carbonnel F, et al. Management of immune checkpoint blockade dysimmune toxicities: A collaborative position paper. Ann Oncol. 2016 Apr;27(4):559–74.
  2. Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol. 2021 Dec 20;39(36):4073–126.
  3. Schneider BJ, Lacchetti C, Bollin K. Management of the Top 10 Most Common Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy. JCO Oncol Pract. 2022 Jun;18(6):431–44.
  4. Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021 Jun;9(6):e002435.
  5. Haanen J, Obeid M, Spain L, Carbonnel F, Wang Y, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Dec;33(12):1217–38.
     

October 24, 2023
Resource Spotlight: Immune-related adverse events due to immune checkpoint inhibitors

Education Spotlight - Souzi Badr

October 24, 2023 

Souzi Badr, BScPhm, PharmD, ACPR
CSHP Foundation Education Grant Recipient

“The ENHANCE-AC program aims to provide pharmacists and pharmacy learners with the knowledge, skills, and judgement to safely manage patients’ anticoagulation while in hospital.”

Souzi was a 2017 CSHP Foundation Education Grant Recipient in the amount of $5,500

Co-applicants: Laura Murphy, Amita Woods, Larissa Boychuk, Emily Ching, Jacqui Herbert, Lynda Mao and Laura Marcus
Current ENHANCE-AC leadership team: Souzi Badr, Larissa Boychuk, and Kori Leblanc


Project Summary
ENgaging pHarmacists to AdvaNce Competency through Education in AntiCoagulation (ENHANCE-AC) is an e-learning program developed at the University Health Network (UHN) that focuses on the management of anticoagulation in the hospital setting and is comprised of four main courses: i) Warfarin Management, ii) Atrial Fibrillation, iii) Venous Thromboembolism, and iv) Management of Bleeding. 

Each course aims to build on pharmacists’ foundational knowledge and skills, with the AF and VTE courses delving further into complex cases such as the anticoagulant management of patients with renal insufficiency, obesity, acute coronary syndrome, or stroke. 

ENHANCE-AC uses e-learning modules for self-directed learning, virtual interactive cases (VIC cases), and print resources. Elements such as multiple-choice and true-false questions allow for self-assessment of comprehension. The VIC cases are simulated, depicting real-world scenarios and require learners to think critically, problem-solve, and develop their decision-making skills. 

What gap did you see in your practice that led to this project? 
When patients are admitted to hospital, changes in clinical status, renal function, medications, and other comorbidities can influence the selection or dosing of an anticoagulant. In addition, the anticoagulation landscape is ever-evolving.  Establishing and maintaining pharmacist knowledge and confidence is central to improving the safety of anticoagulation use and improving patient outcomes. 

Prior to ENHANCE-AC, training resources were paper-based and time consuming, requiring several one-on-one meetings with an experienced pharmacist to review examples and real-life cases. 

We recognized an opportunity to build a model that would result in active learning for more individuals. Additionally, with the increasing use of direct oral anticoagulants and the indication for heparin or low molecular weight heparins in many patient-case scenarios, it was important for our education program to consider all anticoagulation options.   

How will this project impact pharmacy practice and/or care of patients?
This educational program will provide individuals with the necessary knowledge, skills, and confidence to manage anticoagulation in the hospital setting. This foundation will allow pharmacists and pharmacy learners to take a more proactive approach to managing anticoagulation in hospital inpatients, ultimately improving patient safety and care. 

What did you learn that you weren’t expecting? 
What did you learn that you weren’t expecting? We gained an appreciation for the level of upkeep that a multi-faceted educational program requires. With rapidly evolving evidence, having a process to continually review and update content is important for ensuring the program remains relevant, sustainable, and updatable as technology advances. 

Where should people go to learn more about this topic if they are interested? 
Individuals interested in learning more are welcome to contact me at souzi.badr@uhn.ca. This training program could not have been achieved without the support of content contributors from within UHN and across Canada. We also thank the CSHP Foundation and UHN for their financial support. 

The role of the hospital pharmacist is changing; research and education will support the change.

CSHP Foundation grant and scholarship recipients are changing the face of pharmacy practice. 
Find out more at https://cshp-scph.ca/cshp-foundation.

Latest News

October 24, 2023
Education Spotlight - Souzi Badr

Latest News

CSHP is searching for our new Professional Practice Coordinator

October 18, 2023
 
 

Professional Practice Coordinator (Full-Time Position)

 Apply now
 

Position Summary

The incumbent will coordinate the pharmacy practice programs, tools, and resources for CSHP.  The Professional Practice Coordinator is responsible for the operations of the Professional Practice Team and corresponding committees and task forces; the workflow and operations of the Hospital Pharmacy 101 Program, Pharmacy Specialty Networks, educational events such as Professional Practice Conference and support for members on these programs. This role reports to the Chief Pharmacy Officer and requires close collaboration with other staff, committees, task force chairs and members.

Key Responsibilities

  • Administer and support the operations of the CSHP Professional Practice Team, committees, and task forces. 
  • Coordinate pharmacy practice programs such as the Hospital Pharmacy 101 Program, Pharmacy Specialty Networks, etc.
  • Coordinate educational events such as professional practice conference, cardiovascular symposium and webinars.
  • Assist with tracking of metrics and data analysis for key projects related to professional practice programs.
  • Respond to inquiries from CSHP current and potential members on professional practice programs.

Partial list of duties

CSHP Professional Practice Team operation

  • Manage team meeting logistics, including but not limited to developing work plans and calendars, preparation and distribution of agendas, notifications, and advance reading material. 
  • Prepare briefing notes, policies, research summaries and other documents and deliverables that are required to advance the work of the team.
  • Attend team meetings and oversee the preparation of minutes. 
  • Communicate and follow-up on action items to the appropriate staff, member, or stakeholders. 
  • Revise existing and develop new materials for CSHP’s Resource Manual.

Program Management

  • Hospital Pharmacy 101
    • Administer the current program including registrations, validating assessments, issuing of certificates upon completion.
    • Support the process of program maintenance including updates of content and accreditation renewal as needed. 
    • Monitor and compile key metrics on the program.
  •  Pharmacy Specialty Networks (PSNs)
    • Administer the current program including registration of members, updating network lists quarterly, 
    • Organize PSN chair meeting including but not limited to scheduling, preparation and distribution of agendas, notifications, and advance reading material. 
    • Support PSN activities including but not limited to polls, surveys, sharing tools with the network, organizing educational events.
    • Prepare and distribute PSN metrics to PSN chairs.

Educational Events

    • Creates and compile a summary of the educational needs assessment from the annual membership survey, post-sessions evaluations, and member engagement sessions.
    • Corresponds with registrants regarding enrolment and course completion requirements.
    • Supports the Professional Practice Specialist, course authors, reviewers and developers regarding education creation, annual updates, and accreditation processes.
    • Tracks and produces regular registration and financial reports.
    • Assists with planning and executing educational events.
    • Acts as a primary contact for the practice email inbox and triages inquiries as appropriate.

    Communications and Information Systems 

    • Manage SharePoint site for Professional Practice team and corresponding committees and task forces, including membership rosters, documents, permissions, etc. 
    • Maintain allocated sections of the CSHP website 
    • Liaise with appropriate CSHP staff on material for Interactions, Avenues for Education, Annual Reports, event scheduling, publicity, and promotions. 

    Education

    • Post-secondary education is required.  
    • Experience in an administrative role is an asset.  
    • Certification as a Registered Pharmacy Technician is highly desirable. 

    Skills and Experience

    • Experience with a not-for-profit organization. 
    • 5 years of senior administrative roles including project management experience and specialized knowledge of board governance procedures 
    • Extensive computer and software skills, especially in Excel, PowerPoint, SharePoint and database programs 
    • Accurate, detail-oriented, and high-quality outputs 
    • Multi-tasking skills and ability to be flexible when priorities shift 
    • Excellent oral and written communication skills 
    • Proactive problem-solving skills  
    • Ability to work with confidential and sensitive matters 
    • Fluency in both official languages an asset 

    Location and travel

    • The CSHP National Office is located in Ottawa. 
    • This role would be fully remote, work from home, with occasional travel within Canada required. 

    Salary Range

    • Starting at $60,000 per year with an excellent benefit package. 

    Starting date

    • December 4th, 2023 or earlier.

    How to apply

    • We hire top talent, recognizing that our accomplishments are achieved through the commitment of dedicated individuals. If you think your personality, skills, education, and experience make you the person for this position, we’d love to hear from you.  
    • The CSHP office is in Ottawa, Ontario, but the position can be held by someone working remotely. Please apply here by November 3, 2023 by noon EST.

    About CSHP

    The Canadian Society of Hospital Pharmacists (CSHP) represents pharmacy professionals working in hospitals and other collaborative health care settings who seek excellence in patient care through the advancement of safe and effective medication use. A non-profit organization, CSHP offers its over 3,000 pharmacist and pharmacy technician members a national voice through advocacy, education, information sharing, promotion of best practices, conferences, facilitation of research, and recognition of excellence. The Society publishes the Canadian Journal of Hospital Pharmacy, conducts the Hospital Pharmacy in Canada Survey and accredits pharmacy residency programs across Canada.  

    Please note: We thank all applicants for their interest in this position. However, only those selected for an interview will be contacted.   

     

    October 18, 2023
    CSHP is searching for our new Professional Practice Coordinator

    More than just a tech: Supporting pharmacy technicians year-round

    October 17, 2023


    A sample of the CSHP resources available to you:  

    Type Resource  Description  Availability  
     CSHP Foundation News  CSHP Foundation welcomes inaugural Pharmacy Technician Trustee Bal Dhillon  To represent the perspectives of the growing number of CSHP pharmacy technician members, the CSHP Foundation announced the appointment of the Foundation’s inaugural Pharmacy Technician Trustee, Bal Dhillon.
     
    Publication date: June 1, 2023
     Open access
     Webinar The ins and outs of a stability study for compounded non-sterile preparations

    Presenter: Daphne Coache, Benjamin Tanguay
     Are you a pharmacist or pharmacy technician involved or interested in compounding non-sterile products for patients? Curious about shelf-life stability? This webinar will provide industry insight into these and many other compounded non-sterile preparation questions.

    Date: February 28, 2023
     Members only
     Clinical Pearls Hospital Pharmacy Practice in Rural Canada

    By: Layne Liberty 
     Learn how the joint-effort clinical pharmacy services model could begin to close the accessibility gap for rural Canadian populations

    Publication date: February 13, 2023
     Open access
    Webinar 

    The emerging role of Pharmacy Technicians in Leadership

    Presenter: Annik MacLeod  

    A virtual webinar describing how pharmacy technicians can develop leadership skills and seek opportunities to participate in operations management.

    Date: October 20, 2022.

    Open access 
     Webinar
    The Pharmacy Technician’s Role in Medication Reconciliation 


    Presenter: Christa Ng 

    This webinar recording discusses the tools and strategies technicians can use to complete accurate BPMHs in a hospital setting.

    Date: March 29, 2022 
     Members only
     Webinar
    Unit-Based Pharmacy Technician Practice Model: A Pilot Project at Mount Sinai Hospital

    Presenter:
    Clarence Lam 

    This webinar highlights a pilot project completed at Mount Sinai Hospital aimed at exploring the impacts of leveraging the expanded scope of pharmacy technicians in hospital practice.

    Date: August 01, 2021 
     Members only
    Webinar 
    COVID-19: Coping and Resilience for Pharmacy Professionals  

    Presenter: Dr. Karen Cohen
    In this webinar, Dr. Karen Cohen, CEO of the Canadian Psychological Association, provides evidence-based tips for caring for our own mental health as frontline workers. 

    Date: June 29, 2021  
     Members only
     CJHP Article

     

    Best Possible Medication Histories by Registered Pharmacy Technicians in Ambulatory Care

    By:  Ida-Maisie Famiyeh, Neil Jobanputra, and
    Lisa M McCarthy

    This article describes the implementation process of a RPhT-conducted BPMH program at Women’s College Hospital in Toronto. It highlights how the role of pharmacy technicians can be leveraged to improve medication reconciliation programs in the context of ambulatory care. 

    Publication date: April 19, 2021 

     Open access
     HP 101 
    Learning Module

     Hospital Pharmacy 101 – Module 7: The basics of aseptic compounding 

    This module provides participants with an understanding of what aseptic compounding is, provides information on standards of aseptic compounding, and explains the role of pharmacy technicians in aseptic compounding practices. 
     Paid resource
    PSN   Compounding
    The Compounding PSN invites discussions on sterile, non-sterile, hazardous and non-hazardous compounding. These include topics such as compounding formulations, beyond-use dating, drug-drug and drug-material stability and compatibility, sterility testing, primary and secondary engineering controls, air and surface microbial sampling and speciation, compounding technique, garbing technique, cleaning technique, volumetric and gravimetric compounding, material disinfection and handling, gloved fingertip sampling, media fill testing, quality assurance, IV workflow management systems, compounding-related drug information resources, and any other issues that arise with interpreting and implementing NAPRA compounding/USP 797/795/800 standards. As compounding is a cross-disciplinary specialty, we invite discussions and resource-sharing from all pharmacy professionals including pharmacists and pharmacy technicians.
     
     Members only
    PSN  Medication Safety 
    The Medication Safety PSN assists pharmacists by confirming the changes that are needed to ensure safe practice and therefore safe patient care. Through online dialogue, safety focused pharmacists share their experiences in addressing the change management of impacted staff. They share the broader viewpoint of ALL impacted parties eg physicians, patients and nurses in addition to the impact on the pharmacy environment. As the accreditation standards shift their focus towards patient centered safe care, the Medication Safety PSN supports Canadian pharmacists as they review their current practices, compare their practices to the accreditation standards and identify any gaps that may need to be addressed. The members of the Medication Safety PSN freely share their knowledge, skills and experiences to advance patient
    safety across Canada. 

    Members only  
    PSN Medication Distribution 
    The Medication Distribution PSN discusses best practices related to medication distribution functions. Pharmacy technicians and pharmacists share practice resources related to medication distribution, and connect with each other to share ideas on how the scope of a pharmacy technician is influencing medication distribution being utilized to its fullest potential. Practice areas such as final medication checking, repackaging practices and handling drugs that are on the NIOSH list as hazards are all areas of interest and discussion for this PSN. 

    Members only 
    PSN Parenteral Services 

     

    The Parenteral PSN is a forum to network, discuss and share information on a wide variety of issues related to aseptic services and parenteral drug administration. The scope of topics can be broken down into five (5) broad categories:

    • Drug specific questions
    • Policy/Standard Operating Procedures/Standards of Practice/Equipment to Support
    • Sterile Compounding / Formulas
    • Smart pumps
    • Parenteral nutrition 

    Members only 
    PSN  Small Hospital
    The purpose of the small hospitals PSN is to link together pharmacists working in small hospitals, in order to share learnings and discuss issues that are common to these practice sites. Since there are often only 1 or 2 pharmacists working in a small hospital, the opportunities for networking are limited within the practice sites. The PSN provides a forum by which pharmacists can gain additional knowledge or information to help them meet best practice recommendations at their sites. 

    Members only 
    Compounding Resource

    Compounding Briefing Series 
     
     
    This six part series provides members with an overall view of the key tools needed for ensuring safe, high-quality compounding.
    Members only 
     Compounding Resource Assessment Tool for Aseptic Compounding
    This aseptic compounding assessment tool was created in collaboration with ISMP to help strengthen the medication-use system at practice sites. It consists of 11 key elements that have been deemed to influence aseptic compounding practices and provides organizations with summary results of their assessment that can help identify areas for improvement. 
     
     Paid resource
     Resource Spotlight
    Clinical resources and creating safe spaces for 2SLGBTQ+ patients 

    By: Jessica Sheard
    Learn more about the 2SLGBTQ+ community, how to integrate inclusive strategies into their practice to create safe and welcoming spaces for 2SLGBTQ+ patients, and access clinical guidelines important for transgender patient care.               

    Publication Date: July 27, 2022
    Open access
     Clinical Pearls
    Clinical considerations and creating safe spaces for 2SLGBTQ+ patients

    By: Jessica Sheard

    This Clinical Pearl covers the clinical considerations the pharmacy team can make to help 2SLGBTQ+ patients feel comfortable and safe during their interactions in hospitals. 
                 
    Publication Date: June 15, 2022
    Open access 

    Want to take advantage of these resources, on top of other membership perks? Register to be a Pharmacy Technician member.

    Join or Renew today!
     



    Latest News

    October 17, 2023
    More than just a tech: Supporting pharmacy technicians year-round

    Latest News

    Advocacy in Action: October 10

    October 10, 2023
     
      

    What's happened

    September 26, Alliance for Safe Online Pharmacies member meeting

    The Alliance for Safe Online Pharmacies (ASOP Canada), known for its research, education, advocacy, and policy efforts, strives to address the growing threat of illegal online drug sellers to public health. CSHP CPO Rita Dhami attended one of their member meetings at the end of September to learn more about ASOP’s government engagement plans and results from their recent survey in addition to being told about their plans for a toolkit. 

    October 5, Roundtable on Meeting of the Health Product Supply Chain Advisory Committee

    The Drug Shortages Task Force, including Rita and Assistant Deputy Minister Stefania Trombetti, met again for a roundtable discussion. Deputy Minister Trombetti provided stakeholders with an overview of the consultation results on public drug shortages and informed committee members that Health Canada would develop a summary 'What we heard' document that would be shared with them soon. 

    October 6, Collaboration on a National ‘At-Risk Medicines’ List 

    As part of a CIHR-funded project with Health Canada and CADTH, Rita will join an expert panel to develop a national at-risk medicine list.   

    Ongoing, Health Canada Drug Shortages meetings

    CSHP is continuing to monitor these ongoing drug shortages:

    • Sept. 28: Multi-Stakeholder Call #15 – Shortages of Paediatric Analgesics 
    • Sept. 29: Multi-Stakeholder Call #3 – Supply disruptions of Ozempic  

    What's worth repeating

    September 12, Appropriate Use Advisory Committee Interim Report Roundtable

    A unified appropriate-use program is being developed by the Canadian Drug Agency (CDA) to improve the pharmaceutical landscape. During this interim report roundtable, Rita spoke about the importance of promoting evidence-based approaches and interventions to improve the pharmaceutical industry. In addition to identifying drivers of inappropriate use, hospital pharmacy teams also employ multi-pronged behaviour change strategies in order to improve prescribing.

    September 14, European Association of Hospital Pharmacists

    President Sean Spina, CEO Jody Ciufo, and CPO Rita Dhami met with Ambassadors from the European Association of Hospital Pharmacists (EAHP) where EAHP introduced their organization and its strategic priorities. Over the course of this meeting, both organizations found several areas of overlap in their work including a shared focus on vision for practice, drug shortages, sustainability, and human resource challenges. It is expected that this meeting will be the first of many collaborations between CSHP and EAHP. 


    To catch up on CSHP advocacy news, click here.

    Have a question about Advocacy in Action or CSHP's advocacy and consultation work?
    Reach out to our professional practice team!   

    October 10, 2023
    Advocacy in Action: October 10

    Clinical Pearls: Immune-Related Adverse Events from Immune Checkpoint Inhibitors

    October 10, 2023
    By Huy Pham
     
    This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.
     

    Background

    Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target and bind to immune checkpoint molecules, either blocking co-inhibitory receptors or stimulating co-stimulatory receptors to enhance antitumour immunity. There are eight ICIs currently available in Canada. These ICIs either target cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death program-1 (PD-1), or programmed death-ligand 1 (PD-L1) and are primarily used in several cancers   including but not limited to non-small-cell lung cancer, renal cell carcinoma, Hodgkin lymphoma, and melanoma. They have differing mechanisms of action compared to conventional chemotherapies and thus, have different spectrums of adverse effects with varying clinical presentations, onsets, durations and severities. These are collectively called “immune-related adverse effects” (irAEs) and are autoimmune toxicities arising from the augmentation of the immune system and reduced immune tolerance. IrAEs can affect any organ or system in the body but are predominantly gastrointestinal, dermatologic, hepatic, endocrine, and pulmonary toxicities.1 The severity of irAEs is graded using the National Cancer Institute’s Common Terminology Criteria for Adverse Events2 and ranges from 1–5, with Grade 3 adverse events being those that are severe or medically significant and where hospitalization or prolongation of hospitalization is needed and Grade 4 adverse events being those with life-threatening consequence and where urgent interventions are needed. 

    IrAEs typically occur within weeks to 3 months of treatment though there may be a possible delayed onset of up to 1 year.3-6 They may persist for months beyond their initial onset. The incidence of irAES is generally higher with anti-CTLA-4 antibodies (occurring in up to 90% of patients) compared to anti-PD-1/PD-L1 antibodies (occurring in up to 70% of patients), with combination therapies having irAEs of greater incidence and severity. Between the two types, gastrointestinal irAES such as colitis and endocrine irAEs such as hypophysitis are more common in anti-CTLA-4 antibodies while thyroid dysfunction, myocarditis and pneumonitis are more common in anti-PD-1/PD-L1 antibodies.5,7-9 Anti-PD-1/PD-L1 antibodies have a grade ≥3 irAE incidence of 6%, anti-CTLA-4 antibodies a grade ≥3 irAE of 24%, and combination therapy  a grade ≥3 irAE of 55%.10 There may be a possible correlation between immune-related adverse events from ICIs and positive clinical outcomes such as greater ICI efficacy and increased overall survival.11-15

    Given the growing prevalence of ICIs in the treatment of cancers such as non-small cell lung cancers, the high incidences of irAEs associated with ICIs, and the variable nature of irAEs, it is imperative for pharmacists to comprehend how to manage irAEs.

    General Principles of Treatment

    Regardless of the specific organs affected by the irAEs, there are general principles of treatment depending on the degree of severity. In cases of Grade 1 irAEs of mild severity, ICI therapy can be continued with close monitoring except for some cardiac, hematologic, and neurologic toxicities such as aseptic meningitis. For most Grade 2 toxicities, clinicians should consider holding ICIs and resuming therapy when the symptoms and/or laboratory values have reverted to Grade ≤1. The patient may also be given prednisone at an initial dose of 0.5–1 mg/kg/day or equivalent. For Grade 3 toxicities, ICIs should be held and high doses of corticosteroids such as prednisone at 1–2 mg/kg/day should be started then tapered over 4–6 weeks once symptoms resolve to Grade 1 or lower. Infliximab 5 mg/kg IV every 2 weeks until symptom resolution may be administered for grade ≥3   toxicities if symptoms do not improve after 48–72 hours of corticosteroid therapy. Patients may be rechallenged with ICIs (either the same ICI or a different ICI) once symptoms and/or laboratory values revert to grade ≤1 and the benefits of therapy outweigh the risks. PD-1/PD-L1 monotherapy may be started in patients who experienced an irAE from PD-1/PD-1 and CTLA-4 combination therapy once symptoms resolve to grade ≤1. For grade 4 toxicities, ICIs should be permanently discontinued except for endocrine toxicities that can be managed with hormone replacement.1,16

    Patients on high-dose corticosteroids or other immunosuppressants are at risk of opportunistic infections and may benefit from antimicrobial prophylaxis. Pneumocystis jirovecii pneumonia (PJP) prophylaxis should be started in patients taking prednisone 20 mg or more (or equivalent) for 4 weeks or more. The recommended therapy for PJP prophylaxis is sulfamethoxazole/trimethoprim. If the patient has a sulfa allergy, dapsone 100 mg once daily or atovaquone  750 mg BID may be used.17,18 Patients on prolonged steroid therapy   (≥4 weeks) post-discharge should also be educated on the signs and symptoms of adrenal insufficiency such as fatigue and abdominal pain, the increased risk of osteoporosis and osteonecrosis, monitoring for hyperglycemia if the patient has pre-diabetes or existing diabetes, potential volume overload resulting in edema and weight gain, and the increased risk of peptic ulcers and gastrointestinal bleeding. Steroid-induced osteoporosis may be limited with adequate calcium and vitamin D intake of calcium 1000 mg daily if age 19–50 or 1200 mg daily if age <50 and vitamin D 400 units daily if age <50 or 800–2000 units daily if age >5019,20 with the option of bone-modifying agents such as alendronate 10 mg once daily or alendronate 70 mg once weekly if on steroid therapy for over 3 months.1 To reduce the risk of peptic ulcers and gastrointestinal bleeds, NSAIDs should be avoided and patients may be started on proton-pump inhibitor prophylaxis such as pantoprazole 40 mg once daily for 4–8 weeks as prophylaxis if they have risk factors for peptic ulcers such as a history of GI bleeds.1 If the patient is continued on steroid therapy beyond 4–8 weeks, deprescribing may be considered before or at the end of steroid therapy.

    Patients with pre-existing autoimmune diseases were excluded from the clinical trials of ICIs due to concerns about a higher risk of serious autoimmune toxicities in that population.10,21-23 Patients with autoimmune disorders who take ICIs do experience symptom flares and/or irAEs though these adverse events can be easily managed and usually do not lead to permanent discontinuation.22-25 One proposal for the use of ICIs in patients with autoimmune disorders is to first discontinue all non-selective immunosuppressants, initiate the appropriate selective immunosuppressants, and assess the patient prior to beginning ICI treatment  . Afterwards, the patient is started on concomitant ICI therapy.26

    Common irAEs and their management

    This section provides a general overview of the management strategies for irAEs by the organ system affected and is derived from the guidelines by the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO), and Cancer Care Ontario (CCO).1,3,16 The CCO and the ASCO guidelines provide recommendations on supportive therapies for patients experiencing an irAE. ASCO and ESMO guidelines cover a broader range of irAEs than the CCO guideline, discussing irAEs such as severe cutaneous adverse reactions, encephalitis, and pancreatitis.

    Dermatologic toxicties
    The most common types of irAE are dermatologic toxicities that usually present as maculopapular rashes, pruritus (with or without eruptions), and vitiligo and have been reported in up to 71.5% of patients on ICIs.1 Dermatologic toxicities are usually the earliest observed irAEs, occurring within 3–6 weeks of treatment.10 The primary treatment strategy is the use of corticosteroids (topical or systemic) along with emollients, cool compresses for itches, and antipruritic drugs if necessary as supportive therapy. Systemic corticosteroids such as methylprednisolone dosed at 1 mg/kg IV once daily  are to be initiated if lesions are severe and/or persistent and tapered down over 4–6 weeks once symptoms resolve to Grade 1 or less or return to baseline. The patient should be assessed for signs and symptoms such as fever, skin pain, and skin sloughing as these may indicate the presence of immune therapy-induced severe cutaneous adverse reactions. ICI discontinuation is warranted in these cases.1,3,16 Discontinuation should also occur if dermatologic symptoms do not improve after 12 weeks of supportive management.27 Patients may be rechallenged with the same ICI (or a different ICI as according to the cancer type) in a case-by-case basis. The decision to rechallenge a patient with ICI therapy depends on a multitude of factors. One factor to consider is the prior tumour response, where an objective response to the initial therapy renders resumption of therapy a less favourable choice as the antitumor response due to ICI therapy is likely sustained. Another factor is the type and severity of the presenting dermatologic irAE as more life-threatening irAEs makes rechallenging a less favourable option. Other factors include overall duration of cancer treatment, the efficacy, safety and availability of ICI alternatives, and the efficacy, safety and availability non-ICI alternatives such as traditional chemotherapy for the cancer type.1

    Diarrhea and colitis
    GI toxicities are also common complications of ICIs. Diarrhea and colitis are common GI toxicities, occurring at any grade in approximately 30% of patients on anti-CTLA-4 antibodies. Grade ≥3 diarrhea has an incidence of less than 10%.28,29 Although the onset can range from 1-107.5 weeks, the median time to onset is 6–8 weeks for anti-CTLA-4 antibodies and 2–3 months for anti-PD-1/PD-L1 antibodies.29 Infectious causes of diarrhea and or colitis such as C. difficile infections should be ruled out.16,27,30 The treatment of diarrhea and colitis are similar and will depend on the frequency of daily bowel movements, with mild cases involving antidiarrheal drugs (such as loperamide 4 mg then 2 mg every 4 hours or after every loose bowel movement until diarrhea-free for 12 hours with a maximum daily dose of 16 mg) as primary management. Oral rehydration and electrolyte supplementation using oral rehydration solutions such as Gatrolyte ® and dietary modifications towards a low-fiber diet may serve as supportive care. Corticosteroids such as prednisone taken as a daily oral 1 mg/kg  dose followed by a minimum 4-week taper upon resolution are used in moderate to life-threatening cases and ICI therapy is withheld or permanently discontinued. Other immunosuppressants such as infliximab, which is taken as an intravenous 5 mg/kg dose every 2 weeks, or mycophenolate mofetil, which is taken in twice-daily 5000 mg doses until resolution, may be administered if symptoms are refractory to corticosteroids.1,16 Rechallenge with the same or different ICI may be a possible option with consideration for alternative antineoplastic therapies and the association between the severity of the initial diarrhea/colitis and the likelihood of recurrence

    Hepatic toxicities
    Hepatitis is another common irAE that typically presents as an asymptomatic elevation of aspartate transaminase, alanine transaminase, and occasionally bilirubin. The incidence in monotherapy is 1–10% and usually appears 8–12 weeks into therapy. Severe hepatitis may occur in 1–2% of cases with symptoms of fatigue, fever, nausea, and abdominal pain.1,16,28 Ideally, liver function tests (LFTs) are done at baseline and before each dose of ICIs. Other causes of hepatotoxicity and LFT elevation like viral or drug-induced hepatitis should be investigated before starting irAE management. The mainstay therapy for immune-mediated hepatitis is corticosteroids (for instance, oral prednisone 1 mg once daily for Grade 2 hepatitis) with the option of additional immunosuppression such as mycophenolate mofetil dosed at 500–1000 mg BID or tacrolimus dosed at 0.10–0.15 mg/kg/day if the LFTs remain elevated despite corticosteroid therapy in patients with Grade ≥3 hepatitis. Infliximab should be avoided as hepatotoxicity has been reported.31 Rechallenge with the same or a different ICI may be considered for patients, especially if there are no suitable antineoplastic alternatives. LFT monitoring once or twice weekly may be needed (especially if ICI therapy is continued) since rebound elevation may occur and resolution typically occurs in 4–9 weeks, with higher grade hepatitis having a greater time to resolution.1,16,32,33

    Endocrine toxicities
    Endocrine irAEs are fairly common, occurring in 5–20% of patients at any grade. Symptoms usually occur within 12–24 weeks of therapy but can arise months into the therapy.16 The more common endocrine irAEs are thyroiditis, hypophysitis (inflammation of the pituitary gland), diabetes and adrenal insufficiency. Lifelong hormone replacement therapy is likely needed due to endocrine deficiencies resulting from the adverse event.26 Hypothyroidism and hyperthyroidism can occur in patients using ICIs though hypothyroidism is more common. Immune-related hypothyroidism is managed with levothyroxine at an initial dose of 0.5-1.5 mcg/kg daily with   methylprednisolone 1–2 mg/kg IV once daily or equivalent and supportive care for cardio-respiratory symptoms for severe cases. Symptoms of immune-related hyperthyroidism may be managed with beta-blockers such as propranolol dosed at 10–40 mg PO QID, or if urgent and Grave’s Disease is present, methimazole or propylthiouracil. The initial dose of methimazole will depend on the severity of hyperthyroidism, ranging from 15 mg for mild cases and 60 mg for severe cases, divided into 2–3 doses daily, with a gradual reduction over 4–6 weeks to a maintenance dose of 5–15 mg daily. Propylthiouracil may be started at 50–100 mg PO TID and titrated until euthyroidism is achieved, after which the dose should be gradually reduced by 33% every 4–6 weeks to a lowest effective maintenance dose. Patients may be continued on therapy for 12–18 months with possible discontinuation if thyroid function is normal.34 If hyperthyroidism is due to autoimmune thyroiditis, hypothyroidism may follow after hyperthyroidism has been treated and would require thyroid hormone replacement.1,3,16 Hypophysitis has an incidence of ~10% and may present with non-specific symptoms of headache, nausea, fatigue, weakness, visual impairments, insomnia, temperature intolerance, sexual dysfunction, and memory loss. Low levels of TSH, LH, FSH, GH, ACTH, and cortisol may be indicative of hypophysitis.29 Unlike hypothyroidism, hypophysitis presents with low free T4. High-dose corticosteroids such as methylprednisione dosed at 1 mg/kg IV daily are used to reverse the inflammatory process and prevent long-term hormone deficiencies.16 Immune-mediated adrenal insufficiency is an urgent condition characterized by electrolyte imbalance, severe hypotension, and dehydration. Sepsis should be ruled out prior to starting treatment with IV high-dose steroids such as hydrocortisone 100 mg IV QID.16,27,28 Fludrocortisone 50–100 mcg PO daily may be used for postural hypotension until symptom resolution or as indefinite hormone replacement in primary adrenal insufficiency.35,36 For patients with endocrine irAEs, they may be restarted on the same or different ICI upon recovering to Grade ≤1 symptoms.

    Pneumonitis
    Pneumonitis is an infrequent and potentially life-threatening irAE that occurs more frequently with anti-PD-1/PD-L1 therapy (1–5%) than with anti-CTLA-4 therapy (<1%).10 The time to onset has a broad range with a median onset of approximately 3–6 months.16 Patients with pneumonitis present with symptoms of new or worsening shortness of breath, chest pain, cough, and hypoxia. Corticosteroid therapies are the main therapeutic options with infliximab 5 mg/kg IV every 2 weeks, mycophenolate mofetil 500–1000 mg PO BID, cyclophosphamide 1–2 mg/kg once daily, or IV immunoglobulins 2 g/kg over a period of 2–5 days in divided doses of 400–500 mg/kg as possible choices if symptoms do not improve or worsen. Empiric antibiotics may be considered if concurrent community-acquired pneumonia is suspected (for instance, ceftriaxone 1 g IV Q24H for 5 days) and prophylactic antibiotics for patients on immunosuppression for >4 weeks, specifically sulfamethoxazole/trimethoprim 800mg/160mg PO daily for PJP prophylaxis during the period when the daily corticosteroid dose exceeds prednisone 20 mg (or equivalent).1,3,16 Rechallenging with the same or different ICI may be considered if the patient has had a grade ≤2 pneumonitits or grade 3 pneumonitits if the benefits of continuing the ICI for cancer treatment outweigh the risks of a recurrent pneumonitis or other irAEs. Rechallenging should not be offered to patients with grade 4 pneumonitis.

    Neurological toxicities
    Neurotoxicity associated with ICIs have incidences of <5% and encompasses a heterogeneous spectrum of irAEs including paresthesias, encephalitis, aseptic meningitis, and Guillain-Barré–like syndrome.1,26 They may occur within 1–6 weeks of treatment.10,37 Patients with grade 1 irAEs (asymptomatic or mild symptoms) are to be continued on ICI and monitored. Patients with grade ≥2 irAEs should have their ICI therapy withheld with discontinuation for patients with severe symptoms. Corticosteroids (such as prednisone 1 mg/kg PO daily or equivalent for moderate cases) are used to manage these irAEs with the introduction of other immunosuppressants like infliximab 5 mg/kg IV every 2 weeks if symptoms worsen.16 Immunosuppressive therapy is to continue until symptom resolution to Grade 1 or less.

    Pharmacist’s Role

    Hospital pharmacists play numerous roles in the management of irAEs and, by extension, ICI therapy.38 Pharmacists can provide patient education on ICIs, particularly on how the adverse event profiles of ICIs are different from that of conventional chemotherapies and how these irAEs generally resolve if managed in a prompt and appropriate manner. 

    Pharmacists also have a role in the continuous monitoring of patients for irAEs, whether it is during the initiation of ICI treatment, during therapy, or during the post-therapy follow-up period. Pharmacists could provide an immunotherapy consult service for the early identification and management of irAEs in patients taking ICIs.39 One cancer centre implemented a proof-of-concept pharmacist-driven immune checkpoint inhibitor management program with an enrolment of 47 patients.40 In addition, an evaluation of intensive pharmacist follow-ups and interventions in outpatients receiving ICIs over three years observed 1664 recommendations made by pharmacists, which included recommendations on supportive care, educational sessions, and medication initiation and adjustments. Pharmacist interventions were associated with reduced odds of therapy discontinuation secondary to irAEs.41

    Finally, pharmacists can be involved with the management of irAEs, where they can evaluate the benefit-risk balance and individualize therapy for the management of irAEs. A retrospective chart review of the implementation of an irAE pharmacy protocol involving 17 patients observed that the pharmacists started 21 new therapies for the management of irAEs including hypothyroidism, hepatotoxicity, rashes, and colitis. The pharmacist-led protocol also reduced the time physicians spent on irAE management and increased their confidence in the pharmacist management of irAEs.42 Pharmacists may also formulate a steroid taper schedule for hospitalized patients who are on corticosteroid therapy.

    References

    1. Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol. 2021 Dec 20;39(36):4073–126.
    2. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 [Internet]. National Institutes of Health. 2017 [cited 2023 May 19]. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf
    3. Haanen JBAG, Carbonnel F, Robert C, Kerr KM, Peters S, Larkin J, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul;28(Supplement 4):iv119–42.
    4. Parakh S, Cebon J, Klein O. Delayed Autoimmune Toxicity Occurring Several Months After Cessation of Anti-PD-1 Therapy. Oncologist. 2018 Apr 17;23(7):849–51.
    5. Raschi E, Gatti M, Gelsomino F, Ardizzoni A, Poluzzi E, De Ponti F. Lessons to be Learnt from Real-World Studies on Immune-Related Adverse Events with Checkpoint Inhibitors: A Clinical Perspective from Pharmacovigilance. Target Oncol. 2020 Jul 28;15(4):449–66.
    6. Tang SQ, Tang LL, Mao YP, Li WF, Chen L, Zhang Y, et al. The Pattern of Time to Onset and Resolution of Immune-Related Adverse Events Caused by Immune Checkpoint Inhibitors in Cancer: A Pooled Analysis of 23 Clinical Trials and 8,436 Patients. Cancer Res Treat. 2021 Apr 15;53(2):339–54.
    7. Boutros C, Tarhini A, Routier E, Lambotte O, Ladurie FL, Carbonnel F, et al. Safety profiles of anti-CTLA-4 and anti-PD-1 antibodies alone and in combination. Nat Rev Clin Oncol. 2016 May 4;13(8):473–86.
    8. El Osta B, Hu F, Sadek R, Chintalapally R, Tang SC. Not all immune-checkpoint inhibitors are created equal: Meta-analysis and systematic review of immune-related adverse events in cancer trials. Crit Rev Oncol Hematol. 2017 Nov;119:1–12.
    9. Khoja L, Day D, Wei-Wu Chen T, Siu LL, Hansen AR. Tumour- and class-specific patterns of immune-related adverse events of immune checkpoint inhibitors: a systematic review. Ann Oncol. 2017 Oct;28(10):2377–85.
    10. Martins F, Sofiya L, Sykiotis GP, Lamine F, Maillard M, Fraga M, et al. Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol. 2019 May 15;16(9):563–80.
    11. Amoroso V, Gallo F, Alberti A, Paloschi D, Ferrari Bravo W, Esposito A, et al. Immune-related adverse events as potential surrogates of immune checkpoint inhibitors’ efficacy: a systematic review and meta-analysis of randomized studies. ESMO Open. 2023 Apr;8(2):100787.
    12. Das S, Johnson DB. Immune-related adverse events and anti-tumor efficacy of immune checkpoint inhibitors. J Immunother Cancer. 2019 Nov 15;7(1).
    13. Fan Y, Xie W, Huang H, Wang Y, Li G, Geng Y, et al. Association of Immune Related Adverse Events With Efficacy of Immune Checkpoint Inhibitors and Overall Survival in Cancers: A Systematic Review and Meta-analysis. Front Oncol. 2021 Apr 12;11.
    14. Wang D, Chen C, Gu Y, Lu W, Zhan P, Liu H, et al. Immune-Related Adverse Events Predict the Efficacy of Immune Checkpoint Inhibitors in Lung Cancer Patients: A Meta-Analysis. Front Oncol. 2021 Mar 1;11.
    15. Zhou X, Yao Z, Yang H, Liang N, Zhang X, Zhang F. Are immune-related adverse events associated with the efficacy of immune checkpoint inhibitors in patients with cancer? A systematic review and meta-analysis. BMC Med. 2020 Apr 20;18(1).
    16. Cancer Care Ontario. Immune Checkpoint Inhibitor Toxicity Management - Clinical Practice Guideline [Internet]. Cancer Care Ontario. 2018 [cited 2023 May 19]. Available from: https://www.cancercareontario.ca/sites/ccocancercare/files/guidelines/full/ImmuneCheckpointInhibitor.pdf
    17. Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, et al. An Official American Thoracic Society Statement: Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients. Am J Respir Crit Care Med. 2011 Jan 1;183(1):96–128.
    18. Stern A, Green H, Paul M, Vidal L, Leibovici L. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev. 2014 Oct 1; CD005590.
    19. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010 Oct 12;182(17):1864–73.
    20. Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DEC, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ. 2010 Jul 12;182(12):E610–8.
    21. Menzies AM, Johnson DB, Ramanujam S, Atkinson VG, Wong ANM, Park JJ, et al. Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab. Ann Oncol. 2017 Feb;28(2):368–76.
    22. Leonardi GC, Gainor JF, Altan M, Kravets S, Dahlberg SE, Gedmintas L, et al. Safety of Programmed Death–1 Pathway Inhibitors Among Patients With Non–Small-Cell Lung Cancer and Preexisting Autoimmune Disorders. J Clin Oncol. 2018 Jul 1;36(19):1905–12.
    23. Efuni E, Cytryn S, Boland P, Niewold TB, Pavlick A, Weber J, et al. Risk of Toxicity After Initiating Immune Checkpoint Inhibitor Treatment in Patients With Rheumatoid Arthritis. J Clin Rheumatol. 2020 Jan 23;27(7):267–71.
    24. Johnson DB, Sullivan RJ, Ott PA, Carlino MS, Khushalani NI, Ye F, et al. Ipilimumab Therapy in Patients With Advanced Melanoma and Preexisting Autoimmune Disorders. JAMA Oncol. 2016 Feb 1;2(2):234.
    25. Tison A, Quéré G, Misery L, Funck‐Brentano E, Danlos F, Routier E, et al. Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study. Arthritis Rheumatol. 2019 Oct 21;71(12):2100–11.
    26. Haanen J, Ernstoff MS, Wang Y, Menzies AM, Puzanov I, Grivas P, et al. Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: review of the literature and personalized risk-based prevention strategy. Ann Oncol. 2020 Jun;31(6):724–44.
    27. Villadolid J, Amin A. Immune checkpoint inhibitors in clinical practice: update on management of immune-related toxicities. Transl Lung Cancer Res. 2015 Oct;4(5).
    28. Friedman CF, Proverbs-Singh TA, Postow MA. Treatment of the Immune-Related Adverse Effects of Immune Checkpoint Inhibitors. JAMA Oncol. 2016 Oct 1;2(10):1346.
    29. Postow MA. Managing Immune Checkpoint-Blocking Antibody Side Effects. 
    Am Soc Clin Oncol Educ Book. 2015 May;(35):76–83.
    30. Michot JM, Bigenwald C, Champiat S, Collins M, Carbonnel F, Postel-Vinay S, et al. Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer. 2016 Feb;54:139–48.
    31. French JB, Bonacini M, Ghabril M, Foureau D, Bonkovsky HL. Hepatotoxicity Associated with the Use of Anti-TNF-α Agents. Drug Saf. 2015 Dec 21;39(3):199–208.
    32. Gauci ML, Baroudjian B, Zeboulon C, Pages C, Poté N, Roux O, et al. Immune-related hepatitis with immunotherapy: Are corticosteroids always needed? J Hepatol. 2018 Aug;69(2):548–50.
    33. Weber JS, Dummer R, de Pril V, Lebbé C, Hodi FS. Patterns of onset and resolution of immune-related adverse events of special interest with ipilimumab. Cancer. 2013 Feb 7;119(9):1675–82.
    34. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343–421.     
    35. Hobbs K, Yackzan S. Adrenal Insufficiency: Immune Checkpoint Inhibitors and Immune-Related Adverse Event Management. Clin J Oncol Nurs. 2020 Jun 1;24(3):240–3.
    36. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 Feb;101(2):364–89.     
    37. Cuzzubbo S, Javeri F, Tissier M, Roumi A, Barlog C, Doridam J, et al. Neurological adverse events associated with immune checkpoint inhibitors: Review of the literature. Eur J Cancer. 2017 Mar;73:1–8.
    38. Medina P, Jeffers KD, Trinh VA, Harvey RD. The Role of Pharmacists in Managing Adverse Events Related to Immune Checkpoint Inhibitor Therapy. J Pharm Pract. 2019 Nov 6;33(3):338–49.
    39. Kamta J, Magruder B, Hymel L. Implementation of a pharmacy consult service for evaluation of immune checkpoint inhibitor related adverse events at a large community hospital. J Oncol Pharm Pract. 2020 Nov 11;27(8):1821–8.
    40. Renna CE, Dow EN, Bergsbaken JJ, Leal TA. Expansion of pharmacist clinical services to optimize the management of immune checkpoint inhibitor toxicities. J Oncol Pharm Pract. 2019 Apr 12;25(4):954–60.
    41. Myers G, Stevens J, Flewelling A, Richard J, London M. Evaluation and clinical impact of a pharmacist-led, interdisciplinary service focusing on education, monitoring and toxicity management of immune checkpoint inhibitors. J Oncol Pharm Pract. 2021 Nov 30;29(1):145–54.
    42. Le S, Chang B, Pham A, Chan A. Impact of pharmacist-managed immune checkpoint inhibitor toxicities. J Oncol Pharm Pract. 2020 Jun 6;27(3):596–600.

    Latest News

    October 10, 2023
    Clinical Pearls: Immune-Related Adverse Events from Immune Checkpoint Inhibitors

    Latest News

    Advocacy in Action: September 26

    September 26, 2023
     
      

    What's happened

    September 1, Roundtable on Improving Canada’s Medical Countermeasure Readiness for Health Emergencies 

    CPO Rita Dhami participated in a roundtable with Deputy Minister Stephen Lucas and spoke on how to improve Canada's medical countermeasure preparedness for future health emergencies. Rita covered hospital pandemic preparedness plans including interdepartmental key accountabilities and critical paths. Additionally, she stressed the importance of coordination among all healthcare providers across Canada, as well as the importance of public communication and education. 

    September 12, Appropriate Use Advisory Committee Interim Report Roundtable 

    A unified appropriate-use program is being developed by the Canadian Drug Agency (CDA) to improve the pharmaceutical landscape. During this interim report roundtable, Rita spoke about the importance of promoting evidence-based approaches and interventions to improve the pharmaceutical industry. In addition to identifying drivers of inappropriate use, hospital pharmacy teams also employ multi-pronged behaviour change strategies in order to improve prescribing. 

    September 14, European Association of Hospital Pharmacists meeting 

    Canadian Society of Hospital Pharmacists (CSHP) President Sean Spina, CEO Jody Ciufo, and CPO Rita Dhami met with Ambassadors from the European Association of Hospital Pharmacists (EAHP) where EAHP introduced their organization and its strategic priorities. Over the course of this meeting, both organizations found several areas of overlap in their work including a shared focus on vision for practice, drug shortages, sustainability, and human resource challenges. It is expected that this meeting will be the first of many collaborations between CSHP and EAHP.

    Ongoing, Health Canada Drug Shortages meetings

    CSHP is providing weekly feedback and amplifying the voice of hospital pharmacy on drug shortages.

    • Sept. 15: Multi-Stakeholder Call #2 – Supply disruptions of Ozempic 
    • Sept. 20: Multi-Stakeholder Call #12 – Shortages of Amoxicillin Oral Suspension/Capsules/Tablets

    What's happening 

    September 25, Canadian Nosocomial Infection Surveillance Program

    CSHP will be attending a meeting regarding the Canadian Nosocomial Infection Surveillance program, a collaboration between the Public Health Agency of Canada (PHAC) and the National Microbiology Laboratory (NML), which will be addressing the program’s Antimicrobial Medication Use data in hospitals. The meeting will also highlight protocols and current advocacy to bring new antimicrobials to Canada. As advocates for antimicrobial stewardship, CSHP looks forward to being updated on these topics and their impact on hospital pharmacy.  

    What's worth repeating

    August 30, Drug Shortages Consultation has been submitted

    CSHP’s submission provided four fundamental pillars that serve as a blueprint for collaborative action between Health Canada and fellow stakeholders. View the submission here.

    To catch up on CSHP advocacy news, click here.

    Have a question about Advocacy in Action or CSHP's advocacy and consultation work?
    Reach out to our professional practice team!   

    September 26, 2023
    Advocacy in Action: September 26

    Latest News

    Resource Spotlight: Environmental Sustainability in Pharmacy Curriculum 

    September 26, 2023
     

    Written by Holly Wingate

    This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

    Background

    Climate change is an active concern for all citizens globally, with the harmful effects of air pollution manifesting in many different health problems, and fatalities from said conditions.1 Researchers estimated that healthcare emissions between 2009-2015 resulted in 23,000 years of life lost due to disability or early death, signifying the important role of healthcare professionals in the sustainability movement.2  In Canada specifically, hospitals and pharmaceutical companies are two of the biggest drivers of emissions.2,3 In knowing this, environmental sustainability advocacy should naturally fall onto healthcare professionals, with pharmacists alongside pharmacy technicians in an ideal position to do this. However, in training our pharmacy professionals in Canada, there are no mandated environmental sustainability curricula. In order to advocate, one must be educated in climate change and environmental sustainability measures and kept abreast of new sustainability practices. Once educated, one can take this knowledge and teach students they are precepting, lecturing, working alongside, etc. This “Resource Spotlight” contains environmental sustainability tools for educating oneself, and therefore advocating on behalf of the profession. To learn more, see the Canadian Society of Hospital Pharmacists (CSHP) recent Clinical Pearl: Environmental Sustainability in Pharmacy Curriculum: A PharmD Student’s Perspective

    Webinars 

    International Federation of Pharmaceuticals (FIP) 
    In a recorded webinar, Setting Goals for the Decade Ahead, the FIP discusses direction and context their 21st goal, “Sustainability in Pharmacy”. This goal is not only about ensuring sustainable services in practice, but also covers the impact of pharmacy and pharmaceuticals on the environment. Thus, this online event, which is free for one to watch, is a great starting point for pharmacy professionals, and students, to begin their learning. FIP explores sustainability in pharmacy from the perspectives of workforce and education, as well as practice, showcasing strategies, tools, and resources of FIP on this goal. One can view the event, here. There are many other resources, events, and webinars available on their website to support one’s learning, as well. 

    Choosing Wisely
    Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in healthcare in Canada, with specific information around hospital pharmacy. Choosing Wisely works with national clinical societies, including CSHP, to identify these test and treatments which are frequently overused and not supported by scientific evidence. They provide six recommendations for hospital pharmacy, which have been created by CSHP. On their website, there are also patient resources on various conditions depending on the topic of interest, available for clinicians to download in PDF form. They offer many webinars that clinicians and students can attend, such as one hosted in September of 2022, where the Environmental Co-Benefits of Reducing Low-Value Care and carbon footprint was discussed. One can sign-up with their email to stay up to date on upcoming events, here

    Training Courses

    Chalmers University of Technology: Sustainability in Everyday Life 
    This online course, which runs for roughly 6-weeks, is a great opportunity for those who want to bring sustainability into their personal lives, including students. This self-paced instructor-led course teaches skills and information required to make more sustainably informed choices in everyday life, and is organized into five key themes: chemicals, globalization, climate change, food, and energy. These five themes were chosen as they represent challenges that people face day-to-day managing choices relating to sustainability. In the free track of the course, one has access to the course materials and support, however graded assignments, exams, and a shareable certificate of completion are only available in the purchasable track. One can access the course information and registration, here

    United Nations (UN) System Staff College (UNSSC): Sustainable Development Goals Primer 
    This online primer aims to establish a base of understanding and approach for the UN system in supporting the 2030 Agenda for Sustainable Development. At a duration of 3.5 hours, participants will gain understanding and articulation around the meaning and value of sustainable development, how the Sustainable Development Goals (SDGs) interrelate across various sectors and what it will take to achieve them, at all levels: national, regional, local governments, private sectors, civil society, academia, and in people at large. In this way, this primer course is applicable for all individuals interested in learning more about how they can work to improve sustainability. One can register for the course, here

    UNSSC: Sustainable Lifestyles 
    This course discusses lifestyle choices and their impact on the world in the context of the UN 2030 agenda, in order to find tailored solutions for everyone to live better and lighter. Through six different objectives, supplemented with case studies and interactive exercises, participants will learn why we are living in unsustainable ways, what sustainable lifestyles are, how we can drive lasting sustainable change, and what sustainable lifestyles can look like in action. Students may find this course to be personally useful as it provides a self-paced approach where learners complete activities on their own time when it best fits their schedule. One can view details and register for the course, here

    CASCADES: Fundamentals of Sustainable Health Systems 
    CASCADES is led by the University of Toronto Centre for Sustainable Health Systems, in partnership with the Healthy Populations Institute at Dalhousie University, the Planetary Healthcare Lab at the University of British Columbia, and the Canadian Coalition for Green Health Care, with the mission to support Canada’s healthcare community to transition towards an environmentally sustainable, net zero carbon emission, and resilient health system. CASCADES offers many courses, including the Fundamentals of Sustainable Health Systems, which is free to join and offers interactive, transformative, and experiential learning online and in two zoom sessions on the afternoons of November 7 and 9th 2023. This course is aimed for frontline staff, administrators, and leaders within care delivery, professional, and support organizations with an interest in harnessing opportunities to achieve high quality, low carbon care. There are many other training courses available on their website, including over 20 video recordings from events CASCADES has hosted, partnered on or presented at. For example, within these recordings is a one-hour Introduction on Climate, Health, and Healthcare to start one’s educational journey. 

     

    Reading

    CSHP Student Clinical Pearl: The environmental impact of inhalers 
    In this clinical pearl by Layne Liberty, a former CSHP student, the environmental impact of inhalers, as well as a brief background into COPD and asthma is explained in detail. Layne describes the role of the pharmacist specifically in this environmental movement of inhalers, and why it is essential they incorporate these sustainable concepts into pharmacy practice. For example, she goes over life cycle assessment of inhalers, ensuring proper disposal of inhalers, recommending alternate inhaler therapies, and ensuring proper diagnosis and promoting deprescribing where clinically possible. Layne summarizes this information with useful figures, including an infographic with carbon friendly switches along with the impacts of switching, and a carbon footprint comparison table. One can access this clinical pearl here, and the subsequent resource spotlight here, where Layne highlights useful resources to help pharmacists begin implementing environmentally sustainable practices.  

    CSHP Endorsed: Climate Resilient, Low Carbon Sustainable Pharmacy 
    In this playbook from Creating a Sustainable Canadian Health System in a Climate Crisis, or CASCADES, background information, resources, and considerations for climate resilience and environmentally sustainable pharmacy practice is described in digestible amounts for readers. This playbook was created in association with the Government of Canada and in reviewal by members of the CSHP Sustainability Task Force. Included in this playbook is the impact of climate change on patient health, environmental impact of medications, the specific role of pharmacy professionals in medication optimization and sustainable operations, and an education and policy development for pharmacy professionals and trainees. These sustainable operations are described in 14 individual and implementable actions. This book is intended for any pharmacy professional within Canada, including pharmacists, technicians, assistants, educators and trainees, or students. One can access this book on the CSHP website, or here.  

    Resources within the Climate Resilient, Low Carbon Sustainable Pharmacy Playbook 
    Within the playbook’s 14 Action items, there are specific suggestions for resources that pharmacy professionals can use themselves, or provide for their patients, to implement these Actions within their practice and personal life. Below is a sample of those key suggestions. One can look through all Action items chronologically, here.

    • Action 1 considers medication optimization and the environmental risks of different medications when prescribing, during shared decision-making with patients, and when dispensing. Highlighted in this action is the resource FASS, a Swedish drug database that has been developed to classify the environmental risk of medications. This website can be used to search for specific medications and determine their individual environmental risk. One can access the website, here.  
    • Action 3 describes discontinuing unnecessary medications, with specific suggestions for more community focused practices. For example, suggestions when dispensing PRN medications, insulin pens, and more. 
    • Action 6 explains proper disposal of medications and offers Health Canada resources for safe disposal of prescription drugs, and infographics for patients to take to foster understanding on disposal.
    • Action 8 teaches about climate-related health threats and how pharmacists can encourage continuity of care by providing province specific emergency resources for Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan. 
    • Action 9 provides exemplary tables for pharmacy professionals to use in order to evaluate current practice activities' impacts on the environment and develop a strategic environmental plan.  
    • Action 13 offers resources for specific policies and curricula which include sustainability for current pharmacy professionals and trainees, whether PharmD or Pharmacy Technician students, to advocate for such change in the Canadian education system. Staying up-to-date on the current accreditation standards for Canadian Pharmacy Professional Programs is an important way to be able to effectively advocate as a pharmacy professional for the upcoming generation.  

     References

    1. FIP Call To Action: Mobilising Pharmacists Across Our Communities to Mitigate the Impact of Air Pollution on Health. International Pharmaceutical Federation; 7 Sep 2021. Available from: https://www.fip.org/file/5024  
    2. Mercer C. How health care contributes to climate change. Canadian Medical Association Journal (CMAJ). 2019;191(14):E403-E404. doi:10.1503/cmaj.109-5722 
    3. Mathers A, Fan S, Austin Z. Climate change at a crossroads: Embedding environmental sustainability into the core of pharmacy education. Canadian Pharmacists Journal/ Revue des Pharmaciens du Canada. 2023;156(2):55-59. doi:10.1177/17151635231152882  
     

     

    September 26, 2023
    Resource Spotlight: Environmental Sustainability in Pharmacy Curriculum

    Latest News

    APOthecary Heroes Contest

    Sept. 25, 2023
    Apotex has launched its APOthecary Heroes Program and is now accepting nominations! This program reinforces the critical role Canada’s Pharmacy Professionals play in improving patient health. Increasingly the impact of these front-line healthcare providers is being recognized, most recently with expanded prescriptive powers and administering abilities in many provinces. The APOthecary Heroes Program is Apotex’s way of honouring them for their continued efforts to strengthen the Canadian healthcare system.

    The program is open to anyone in Canada, including Pharmacists, Pharmacy Technicians, Pharmacy Assistants, Students, and Interns, who have demonstrated excellence in their role and made a significant impact on their community.

    Nominate a colleague or yourself to be an APOthecary Hero today! Click here to nominate—it’s quick and easy! Program closes October 25th.

     

    September 25, 2023
    APOthecary Heroes Contest 2023

    Latest News

    Student Member Stories: Raymonda Zheng

    September 10, 2023
     
     

    About Raymonda

    Pronouns: She/Her/They/Them
    School, Program & Year: University of Saskatchwan, PharmD, fourth year
    Social media: Raymonda Zheng on Linkedin

    What is enticing to you about hospital pharmacy?

    I enjoy working in a fast-paced environment where I challenge myself to be a more well-rounded healthcare professional. Hospital pharmacy gives me the adrenaline I need to achieve my potential to provide optimal patient care while also providing me with meaningful connections with patients and families. The interdisciplinary collaboration in hospital pharmacy allows me to work alongside and be inspired by excellent clinicians with diverse backgrounds, knowledge, skills, and perspectives. This collaborative approach aids me in improving my own practice continuously and engaging in patient-centred and informed decision-making where all aspects of a healthcare team are considered. 

    What drew you to join CSHP as a student?

    At every orientation for the new school year, our CSHP student reps present what CSHP is to the student body of the college. They were great at advertising, and I was sold! As an international student who was not familiar with the Canadian healthcare system, I joined CSHP to become part of a community that values professional development and innovation and commits to excellence in patient care. CSHP aligns with my beliefs and provides me with resources to support my professional growth.

    How do you see yourself reflected by CSHP?

    I see myself reflected in CSHP through the commitment to patient care excellence and the platform of collaboration. I feel grateful to be mentored by many CSHP members who inspired me on my journey as a pharmacy student. I’ve worked with resident, pharmacist, and technician members who all strived for shared value. I wish to give back to the community as a practicing pharmacist to guide students in the future, just like those who guided me. 

    Have you ever attended or presented at a CSHP event?

    I have remotely attended webinars hosted by the national and provincial branches to deepen my understanding of knowledge learnt in school and to keep up with the ever-updating health guidelines. The sessions were very informative hosted by pharmacists across Canada, so I also got to educate myself on the scopes of pharmacists in different provinces and in different hospital settings. As I relocate to BC this fall for an APPE rotation, I will be attending the BC clinical symposium.

    What is one CSHP resource or benefit that you couldn’t live without?

    As I start thinking about my career path upon graduation next May, the residency roadmap course helps me to navigate through the residency application process. I would recommend all graduating pharmacy students to watch the free first module to consider if hospital pharmacy would be an option for them.

    What is one piece of advice you give soon-to-be pharmacy students?

    Don’t hold yourself back. Seek mentorship and explore a diversity of opportunities. The field of pharmacy is constantly evolving. Find your passion, take chances, and discover what unfolds!

    Anything else you'd like to say to the CSHP members reading this?

    I appreciate the community that CSHP and our members have built. I hope we all continue to inspire one another and endeavour to deliver exceptional patient-centred care.

     

    Want to share your student story?
    Tell us about yourself here for a chance to be featured.

    September 10, 2023
    Student Member Stories: Raymonda Zheng

    Clinical Pearls: Environmental sustainability in pharmacy curriculum - A PharmD student’s perspective  

    September 8, 2023
    By Holly Wingate 
     
    This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think. If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.
     

    Climate change: Background

    While not a new concern, climate change is becoming more recognizable across the world, with extreme storms, forest fires, and more. For example, air pollution is the greatest environmental risk to health as nine out of ten people breathe polluted air every day, which kills 7 million people/year.1 The harmful effects of air pollution manifest in lung cancer, stroke, allergy, chronic obstructive pulmonary disease (COPD), asthma, and heart disease, among other health problems.1 These emissions are responsible for more than 25% of deaths from heart attack, stroke, lung cancer, and chronic respiratory disease globally.2  As we step back and look at these statistics from a health care professional lens and see the clear link between the environment and patient health, one can see the immense amount of work ahead to decrease pharmaceutical impacts on the climate and in turn, on our patients. For example, researchers estimated that health care emissions between 2009-2015 resulted in 23,000 years of life lost due to disability or early death.3 

    As we shift viewpoints towards healthcare, we see that hospitals and pharmaceutical companies are two of the biggest drivers of emissions.3 Medicines are the most common intervention in healthcare, accounting for roughly 25% of carbon emissions within the NHS.4 In Canada, our healthcare systems are responsible for 5% of all greenhouse gas emissions within the country, and pharmaceuticals comprise 25% of these.4  If we consider the entire life cycle of a medicine, from design and development, marketing authorization to production, post-authorization, health technology assessment, prescription, consumption and finally waste disposal, pharmacy can have an impact at every stage.5  For example, certain inhalers account for around 3% of these emissions.5 Perhaps, if more pharmacy professionals were aware of the environmental impacts and actively encouraged environmentally friendlier alternatives, we may be able to mitigate some of these effects. 

    Training the upcoming generation of pharmacy professionals

    In Canada, the PharmD and Pharmacy Technician program curricula’ are mandated by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP). For PharmD programs, curriculums must include foundational content in areas such as biomedical, pharmaceutical, behavioral, social, and administrative pharmacy sciences, as well as teaching clinical sciences including clinical practice skills, and intra- and inter-professional collaborative practice skills.6  Also required is a total of a minimum of 40 weeks of practice experience, of which 32 weeks must occur near the end of the program.6 In pharmacy technician programs across Canada, foundational content requirements are similar; however, there is more focus on product distribution, calculations, and communication practices, among other skills. Alongside this, is a required minimum of nine weeks' practium.7 Additionally, curricula are based off the Canadian Pharmacy Technician Educators Association’s (CPTEA) nine educational outcomes, which include Professional, Provider of Care, Contributor to a Safe, Effective, and Efficient Practice Setting, Knowledgeable Professional, Communicator and Educator, Contributor to Quality and Safety, and Roles in Product Distribution, Health Promotion, and Intra- and Inter-Professional Collaboration.8 For PharmD programs specifically, the curriculum is free to be modified as long as CCAPP requirements are met, and curricular content demonstrates competency in the 7 educational outcomes created by the Association of Faculties of Pharmacy of Canada (AFPC).The AFPC provided these updated educational outcomes for PharmD programs in 2010, stating “The revised educational outcomes are formatted with the overall goal of graduating Medication Therapy Experts.” Emphasis is placed on the multiple roles of graduates through explicit statements within the appropriate outcome.9 These outcomes include Care Provider, Communicator, Collaborator, Manager, Advocate, Scholar, and Professional.9 

    In my fourth year of my PharmD program, I frequently reflect on all I have learned in my short few years within Pharmacy. I feel my professionalism and clinical knowledge has increased substantially; however, as I look at the environment around me in which I am supposed to live and work, and see the impact from pharmaceuticals, I feel a large knowledge gap in how to improve my impact here. At present, there is no consensus or mandatory requirements among pharmacy schools in Canada, or elsewhere in the world, detailing the specific environmental sustainability competencies and skills a pharmacist should possess.3 Neither the AFPC nor CCAPP mandate any sustainability measures in PharmD or Pharmacy Technician students. As I head to graduation, I worry that this lack of knowledge may impact the upcoming generation of pharmacy professionals more than expected, as the effects of climate change on our patients becomes abundantly clear. 

    My thoughts on why it is important for students to be taught environmental sustainability   

    Pharmacists have a duty to their patients to be educated and up to date on therapies and healthcare treatments; however, when it comes to issues surrounding the environment there is an overall lack of training, despite a clear link between patient health and the environment. When we look at who climate change impacts the most, our most vulnerable patients are at the greatest risk of feeling its effects, and in turn, its effects on their health. Knowing the large carbon footprint of pharmaceuticals and how pharmacists are experts on how medications affect patients, they are uniquely positioned and skilled as trusted health care professionals and clinical leaders to take a leadership role in the environmental movement.10 However, overall, there is a lack of awareness among pharmacists in respect to pharmaceutical impacts on climate change, signifying an increased need for environmental training within the profession.11 This includes students, as they want to learn, and engage in prioritizing sustainable practices for their future careers.3 Training our students, who will advance to many different careers within pharmacy, will ensure that effective mitigation strategies reach all ends of the profession.12   

    On a personal level, though my experiences with the world are limited, I have already felt an impact from climate change, even if I didn’t call it that at the time. Across Canada, we’re seeing and feeling extreme weather, including forest fires reaching all ends of the country with their smoke. The effects of climate change are ones that all students, regardless of background or place in the country, will experience in some sort of way, and will be the catalyst for change. This is based on the fact that education is an effective method to changing behaviour, as long as there is a deep connection or personal relevance to the issue being taught.13 Now that I have completed the classroom learning component of my pharmacy education, and as I think of my future career, I feel education in environmental sustainability would have changed how I consider medications for patients and would have been a valuable addition to the PharmD education I received. Aside from professional reasons, I think learning about how pharmacy impacts the environment, and how the environment impacts our health, would have been incredibly enlightening for me as a person. Afterall, I am going to be living on this planet for quite a few more years if I’m lucky; I’d like it to last that long for me. 

    Though Canada is lacking in sustainability teachings, especially for pharmacy students, many places around the world have begun this training for students. Although not a pharmacy specific example, it shows the impact of this type of education on students in the long run. At San José State University in California, students from different colleges, including humanities, business, and sciences, were taught core themes of climate science, climate mitigation and environmental communication, in a one-year course.13 The effects on students’ behaviour after this course were then assessed through a survey, a minimum of 5 years afterwards. Findings showed that graduates reduced their individual carbon emissions by 2.86 tons of CO2 on average each year, and described a strong connection to climate change solutions, both personally and professionally.13 A majority of participants also agreed that global warming would affect their lives, that they’ve already experienced the effects of global warming, and that it will have a large impact on future generations.13 This type of educational opportunity allowed each of these students to take what they learned into their personal and professional lives, and the education translated into behavioural changes, likely due in part to the personal connection everyone shares with climate change. The effect of the course may be extrapolated to pharmacy students as the students in the study were from different backgrounds and colleges but showed similar changes in behaviour. 

    There are some specific pharmacy programs which have begun incorporating sustainability into student training. For example, the University of Huddersfield in Queensgate, United Kingdom, began consciously teaching environmental sustainability in the MPharm curriculum in 2021, with the key role of delivering future pharmacists who will be best placed and ready to play their part in fighting climate change.14 After the National Health Service (NHS) made public their efforts towards becoming NetZero, pharmacy faculty at the University of Huddersfield decided that refocusing their MPharm curriculum through an environmental sustainability lens was needed, to ensure students were as prepared as possible at graduation, especially considering the huge contribution medicines have on the environment.14 This being said, no new curricular content was introduced, as what students needed to learn was already present within the existing curriculum.14 The University of Huddersfield is a great example of how pharmacy curricula across the globe can incorporate sustainability into pharmacy teachings and is a great starting place for Canadian PharmD and Pharmacy Technician programs to begin such change as well. 

    How to advocate for this as a profession

    Although education on pharmaceuticals, climate change and environmental sustainability are likely to be absent in pharmacy curricula for a few more years, as a profession we have an opportunity to advocate, encourage and support our students in this learning. We need to become knowledgeable and/or maintain our knowledge on the effects of climate change, how pharmacy plays a part, and know which resources are available to you and those around you. This starts with a personal reflection on climate change; knowing how it has personally impacted you in your life forms the personal connection which will encourage behavioural changes that can translate into professional practice. Professionally, you can participate in continuing education opportunities such as webinars and online courses, which focus on sustainability education. You can also reflect on how your practice could improve its’ impact on the environment. For example, knowing how a patient’s medications impact the environment is a great place to start learning. For more information about the environmental impact of inhalers specifically, please see CSHP’s recent Clinical Pearl: Environmental Impacts of Inhalers. As pharmacy professionals, we need to use our voice to advocate for more sustainable practices and paperless formats in our workplaces to minimize operational waste.15

    Starting with yourself is the best actionable measure to ensure this movement continues. However, taking the opportunity while precepting, lecturing, or talking to students, to initiate conversations on environmental sustainability and encourage life-long learning early on, can make the difference in the spread of sustainability practices in pharmacy. Ensure you have resources on-hand to share with students so they can start their personal sustainability journey. Stay tuned for our Resource Spotlight for more information on these specific resources.  

    References

    1. FIP Call To Action: Mobilising Pharmacists Across Our Communities to Mitigate the Impact of Air Pollution on Health. International Pharmaceutical Federation; 7 Sep 2021. Available from: https://www.fip.org/file/5024  
    2. Urgent health challenges for the next decade. World Health Organization; 2020. Available from: https://www.who.int/news-room/photo-story/photo-story-detail/urgent- health-challenges-for-the-next-decade  
    3. Mercer C. How health care contributes to climate change. Canadian Medical Association Journal (CMAJ). 2019;191(14):E403-E404. doi:10.1503/cmaj.109-5722 
    4. Mathers A, Fan S, Austin Z. Climate change at a crossroads: Embedding environmental sustainability into the core of pharmacy education. Canadian Pharmacists Journal/ Revue des Pharmaciens du Canada. 2023;156(2):55-59. doi:10.1177/17151635231152882  
    5. Pharmacy’s Role in Climate Action and Sustainable Healthcare. Royal Pharmaceutical Society of Great Britain; 2023. Available from: https://www.rpharms.com/recognition/all-our-campaigns/policy-a-z/pharmacys-role-in-climate-action-and-sustainable-healthcare  
    6. ACCREDITATION STANDARDS for CANADIAN FIRST PROFESSIONAL DEGREE IN PHARMACY PROGRAMS. The Canadian Council for Accreditation of Pharmacy Programs; 2018 (Revised 2020). Available from: https://ccapp.ca/wp-content/uploads/2020/10/July7-CCAPP-Professional-Standards-ENG.pdf  
    7. ACCREDITATION STANDARDS FOR CANADIAN PHARMACY TECHNICIAN PROGRAMS. The Canadian Council for Accreditation of Pharmacy Programs; 2019 (Revised 2020). Available from: https://ccapp.ca/wp-content/uploads/2020/10/2020-PT-CCAPP-PharmTech-Standards_ENG.pdf  
    8. Educational Outcomes for Pharmacy Technician Programs in Canada. Canadian Pharmacy Technician Educators Association (CPTEA); 2017. Available from: https://cptea.ca/media/files/files/081ad2cf/cptea-2016-final-revised-document-february-10-2017.pdf 
    9. Educational Outcomes for First Professional Degree Programs in Pharmacy (Entry-to-Practice Pharmacy Programs) in Canada. Association of Faculties of Pharmacy of Canada (AFPC); 2010. Available from: https://www.afpc.info/sites/default/files/AFPC%20Educational%20Outcomes.pdf  
    10. Roy C. The pharmacist's role in climate change: A call to action. Can Pharm J (Ott). 2021;154(2):74-75. Published 2021 Feb 10. doi:10.1177/1715163521990408 
    11. Tai BW, Hata M, Wu S, Frausto S, Law AV. Prediction of pharmacist intention to provide medication disposal education using the theory of planned behaviour. J Eval Clin Pract. 2016;22(5):653-661. doi:10.1111/jep.12511 
    12. Self E. Universities must teach future pharmacists about protecting the environment. The Pharmaceutical Journal; 15 Sep 2021. Available from: https://pharmaceutical-journal.com/article/opinion/universities-must-teach-future-pharmacists-about-protecting-the-environment 
    13. Cordero EC, Centeno D, Todd AM. The role of climate change education on individual lifetime carbon emissions. PLoS ONE 2020;15:e0206266. doi:10.1371/journal.pone.0206266  
    14. ‘Greening’ the MPharm: embedding environmental sustainability in the curriculum. The University of Huddersfield; Oct 2021. Available from: https://www.hud.ac.uk/news/2021/october/embedding-environmental-sustainability-in-pharmacy/  
    15. Miller J. Pharmacy sustainability: What is our role? American Pharmacists Association (APhA); 11 Nov 2021. Available from: https://www.pharmacist.com/Publications/Transitions/pharmacy-sustainability-what-is-our-role

     

    Latest News

    September 08, 2023
    Clinical Pearls: Environmental Sustainability in Pharmacy Curriculum: A PharmD Student’s Perspective

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