COVID-19 Guidance for Pharmacists and Pharmacy Technicians

Temporary guidance for Opioid Agonist Therapy (OAT)

None of the guidance herein requires a pharmacist to provide Opioid Agonist Therapy (OAT) in a manner that they believe is unsafe for the patient, the pharmacy staff or the public.

Particular consideration should be given to patients who are, because of COVID-19, receiving more carried doses than they normally would. 

Pharmacist prescribing of OAT

Under Health Canada’s Section 56 exemption, pharmacists are permitted to prescribe controlled substances in specific circumstances, including for continuity of OAT. Refer to the ACP Controlled drugs and substances exemption guidelines and the OAT guidelines for specific details to guide your prescribing.

Carried doses

For patients using OAT medications and are isolating due to COVID-19:

• Pharmacists may accept prescriptions for methadone and buprenorphine-naloxone that include a number of carried doses greater than the standard 14 days.
• Buprenorphine-naloxone patients may receive up to a 30-day supply of carried doses, in collaboration with the prescriber.
• The threshold for when to provide carried doses may need to be lowered, and the maximum number of carried doses permitted may need to be altered based on the circumstances of the patient, the prescriber, and the pharmacy. Pharmacists should collaborate with prescribers to consider prescribing carried doses for patients whenever possible, unless the risk of opioid poisoning, to the patient or others around them such as children or roommates, outweighs the risks of presenting in person to the pharmacy.

Guidance for prescription delivery

Pharmacy professionals should exercise professional judgment to determine the most appropriate process to deliver prescriptions based on the circumstances at hand.

• A patient who is in self-isolation due to COVID-19 should be advised to get someone from outside of their household to pick up their medications. Alternatively, the pharmacy should arrange for the delivery of medications if this service is available.  The medication should be delivered to the patient without direct contact. Operationally, there may be more than one way to accomplish this, which is left to the professional judgment of the pharmacist (e.g., place in mailbox, have delivery person call the recipient once the medication is left, wait or follow up by phone to confirm they have successfully received it, etc.)
• Pharmacies that require a signature to confirm delivery should consider alternative methods of documentation that would achieve the same purpose.  This may include having the delivery person call the recipient once the medication is dropped off or having the delivery person knock and then waiting at a distance to visual confirm the medication was received or following up by phone to confirm they have successfully received it. Successful delivery should then be documented.
• When delivering controlled substances, the individual making the delivery must identify the patient or their agent and observe the receipt of the medications prior to leaving the delivery site.
• Process any payments in advance, if applicable, by secure means when delivery is arranged with the patient, to limit interaction between patients and delivery personnel.
• On the outside of the packaging, indicate transport conditions (related to temperature, fragility, and safety) and only the information required for delivery to the patient or other recipient (name, address, etc.).
• Maintain social distancing requirements during the delivery.
• Ensure any reusable totes used for delivery are sanitized inside and out before they come into the pharmacy and between each use.

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

ACP is supporting testing procedures in pharmacies by temporarily enabling regulated members to collect throat swab specimens, when conducted as part of a specimen collection program in accordance with Standard 29 of the Standards of Practice for Laboratory and Point of Care Testing (POCT). Specifically, under Standard 29(b), regulated members may “only collect specimens of capillary blood, saliva, or urine.” This temporary authorization will additionally allow the collection of throat swab specimens.

 When collecting throat swab specimens, all other requirements of Standard 29 apply.

In addition to the standards related to specimen collection, the entire laboratory and point of care testing standards and guidance must be adhered to, including standards related to patient assessment, ordering and interpreting laboratory tests, documentation, and follow up.

COVID-19 assessment and referral

In accordance with current Alberta Health guidance, pharmacists should recommend that patients with symptoms consistent with COVID-19 or that test positive for COVID-19 self-isolate and access the AHS COVID-19 Assessment and Testing Online Tool or call 811. Patients with severe symptoms should be advised to call 911.

General advice to pharmacy licensees and registrants

This guidance applies to pharmacy staff working in a dispensary or those who have direct contact with pharmacy patients.

This information is not intended to exempt employers from existing occupational health and safety (OHS) requirements. OHS questions and concerns can be directed to the OHS Contact Centre by telephone at 1-866-415-8690 (in Alberta) or 780-415-8690 (in Edmonton) or online.

There are many things pharmacy licensees must do to best protect themselves, their staff, and patients from exposure to COVID-19. Nonetheless, all regulated members share responsibility for ensuring compliance with the guidance provided by Alberta Health and ACP.

All pharmacists, pharmacy technicians, and pharmacy staff must

• remain up-to-date with all Alberta Health developments, public health orders, recommendations, and policies related to COVID-19 as well as any municipal bylaws, and
• ensure all federal and provincial travel requirements are complied with.

Review Health Canada’s Infection prevention and control for COVID-19: Second interim guidance for acute healthcare settings and the AHS Routine Practices in Community-based Services. Licensees must review the pharmacy’s occupational health and safety procedures with all pharmacy staff.

Pharmacists and pharmacy technicians have a shared responsibility for informing and educating the public about COVID-19, including promoting infection prevention and control. Multilingual resources are available from Alberta Health Services.

Personal protective equipment (PPE) for direct patient care

Continuous masking

• Mandatory masking may still be required by provincial order in certain settings, local bylaw, or by AHS, and in these circumstances, pharmacy team members must continuously wear masks.
• Where masking is no longer legally required, ACP recommends that pharmacy teams apply professional judgement to determine the risk of transmission of COVID-19 to the pharmacy team and to the public, and wear masks when appropriate. 
• Infection prevention and control measures (IPAC) can slow the spread of COVID-19 and other infections. Viral transmission in healthcare settings remains a concern, and ACP recommends regulated members continue to adhere to IPAC.
• Alberta Health recommends that individuals self-isolate when sick, and no healthcare worker with symptoms of illness should come to work.

Additional resources

• Health Canada Infection Prevention and Control for COVID-19: Second Interim Guidance for Acute Healthcare Settings
• Health Canada Risk-informed decision-making guidelines for workplaces and businesses during the COVID-19 pandemic
• Health Canada Hard surface disinfectants and hand sanitizers (COVID-19)
• Alberta Health Services Interim IPC Recommendations COVID-19
• Alberta Health Services Point of Care Risk Assessment (PCRA)
• Alberta Health Services 4 Moments of Hand Hygiene (poster)
• Alberta Health Services Cover Your Cough (poster)
• Alberta Health Services Aerosol-Generating Medical Procedure Guidance Tool novel coronavirus (COVID-19)
• Alberta Health Services Guidelines for Continuous Masking in Healthcare settings
• Alberta Health Services Routine Practices in Community-Based Services