Pharmacists - What They Do

Community pharmacists and hospital pharmacists compound and dispense prescribed pharmaceuticals and provide consultative services to both clients and health care providers. They are employed in retail and health centre pharmacies, or they may be self-employed. Industrial pharmacists participate in the research, development, promotion and manufacture of pharmaceutical products. They are employed in pharmaceutical companies and government departments and agencies.

Job duties

This group performs some or all of the following duties:

Community pharmacists and hospital pharmacists
Check prescriptions for proper dosage
Compound prescribed pharmaceutical products by calculating, measuring and mixing the quantities of drugs and other ingredients required and filling appropriate containers with correct quantity
Dispense prescribed pharmaceuticals to customers or to other health care professionals and advise them on indications, contra-indications, adverse effects, drug interactions and dosage
Maintain medication profiles of customers including registry of poisons and narcotic and controlled drugs
Ensure proper preparation, packaging, distribution and storage of vaccines, serums, biologicals and other drugs and pharmaceuticals
Order and maintain stock of pharmaceutical supplies
Advise customers on selection and use of non-prescription medication
Renew existing prescriptions in limited circumstances
May adapt the formulation, regimen, duration or route of administration of medication
May supervise and co-ordinate the activities of other pharmacists, pharmacy assistants, pharmacy technicians and other staff.
Industrial pharmacists
Participate in research for the development of new drugs
Formulate new drug products developed by medical researchers
Test new drug products for stability and to determine absorption and elimination patterns
Co-ordinate clinical investigations of new drugs
Control the quality of drug products during production to ensure that they meet standards of potency, purity, uniformity, stability and safety
Develop information materials concerning the uses, properties and risks of particular drugs
Evaluate labelling, packaging and advertising of drug products
Promote pharmaceutical products to health professionals.

Job titles

clinical pharmacist
community pharmacist
pharmacist
hospital pharmacist
industrial pharmacist
retail pharmacist

Employment Requirements

This is what you typically need for the job:

A bachelor of science degree in pharmacy is required.
Pharmacists also require practical training under the supervision of a pharmacist.
Licensure is required in all provinces and territories for community and hospital pharmacists.

Essential Skills

Reading

Read the directions for use on prescription labels to ensure that the text is correct. (1)
Read short text on forms such as consent forms for release of medication records and drug reimbursement forms. (1)
Read short letters from their provincial and national professional associations confirming the dates, location and subjects for their next convention. (1)
Read daily log books or communication workbooks to locate information about concerns and issues that need to be addressed or problems that have to be resolved, such as illegible writing on prescriptions, lost prescription pads, cases of 'double doctoring' or incomplete patient records. (2)
Read bulletins from Health Canada and pharmaceutical companies outlining recently discovered undesirable effects of particular prescription drugs or changes in regulations and procedures with respect to drugs and natural health products. They refer to these bulletins to gain information which may affect their own practice. (3)
Refer to reference manuals to determine if a particular prescription drug or non-prescription medication can be taken during pregnancy and lactation. They interpret information from the manuals to counsel pregnant and lactating women on the potential risks of the medication and provide alternatives if the particular drug or medication is unsuitable. (4)
In hospital settings may read a patient's medical history form and care records to establish a patient care plan prior to administering a medication such as an antiretroviral combination regimen. They synthesize information paying close attention to aspects such as reactions to previous drugs and abnormalities evidenced in laboratory reports. This allows them to establish an overall picture of the patient and develop a protocol for monitoring treatment. (4)
Read trade publications such as Pharmacy Practice, Drug Topics, Chemist & Druggist Québec Pharmacie, Pharmactuel and L'Actualité pharmaceutique to stay abreast of emerging issues and trends in pharmacy. For example, they may read about the development of new prescription and non-prescription drugs or about research conducted on the effectiveness and risks associated with certain regimens or commercial products. They are required to understand the scientific subject matter in these journals so that they can pass on current information and answer questions from patients and health professionals. (4)
Read, and interpret provincial and federal legislation relating to the pharmaceutical field and assess its application to their practice. (4)
Read drug monographs which support prescribing and dispensing decisions. For example, they refer to the Compendium of Pharmaceuticals and Specialties (CPS) and to the United States Pharmacopoeia Dispensing Information (USPDI) to identify optimal drug dosages, indications, potential interactions, physiochemical characteristics, mechanism of action, absorption, biotransformation, side or adverse effects and counselling guidelines. Drug monographs contain complex medical terminology intended for health professionals. (4)
May read scientific articles on drug treatments to assess their quality and accuracy. For example, they may review articles before publication in professional literature such as the Canadian Pharmaceutical Journal. They may also read articles to further their understanding of care for specific groups within their patient population. Such articles are dense and complex. They contain specialized terminology and biostatistics intended for a scientific audience. They may require high-level inferences in light of pharmaceutical theory, regulations and practice. (5)

Document use

Locate and retrieve data on forms. For example, they refer to physician prescription forms to identify the type of drug and dosage prescribed to individual patients. (1)
Interpret a variety of icons to locate and navigate through pharmaceutical company, professional association, governmental and medical information websites. (2)
Locate and retrieve data in tables. For example, they review tables displaying test and measurement results which appear in laboratory reports to monitor how patients are reacting to drugs or regimens and to make dosage recommendations to doctors. They refer to tables in home health care catalogues to obtain product specifications and information about the benefits and limitations of particular products such as canes and walkers. They review tables of research data in scientific articles to gain information about the research results. (2)
Monitor prescription labels to ensure they contain all necessary data. They check for the inclusion of information such as the patient's name, doctor's name, drug name, dosage, renewals and directions for use. (2)
Read the ingredient listings on non-prescription drug labels to determine which products to recommend to patients based on patient-specific factors such as allergies, food intolerances and medical conditions such as diabetes, hypertension and glaucoma. (2)
Complete forms. For example, hospital pharmacists may write prescriptions for medications and their associated monitoring in specific settings such as laboratories and radiology. (2)
Enter patient, prescription, drug inventory, financial and workload measurement information into electronic data entry forms. They may have to combine data from several sources to accurately capture information to enter onto electronic documents. (3)
May interpret scale drawings including floor plans and architectural drawings for construction and renovations to pharmacies to ensure compliance with the legislation. (3)
Interpret graphs contained in pharmaceutical and medical journals, manuals, bulletins, monographs and websites to gain knowledge about drugs and regimens They combine information from a number of graphs and accompanying texts to fully understand each drug's intended and adverse effects. (4)

Writing

Write short notes to physicians to request information or clarification regarding drug orders. (1)
Write comments in patients' files to maintain records of patient care provided and document actual or potential medication related problems. (2)
May write short memos to their regulatory bodies alerting them of individuals suspected of receiving multiple prescriptions for drugs with abuse potential through 'double doctoring' or 'double pharmacy.' (2)
Write letters to Health Canada officials notifying them of adverse effects of specific drugs experienced by patients. By reporting such effects, pharmacists contribute to early signal detection and play an important role in protecting the well-being of the population. (2)
Write letters to doctors to offer opinions and suggestions about specific pharmaceuticals and drug regimens. For example, they may recommend a change in drug dosage, the addition of an Aspirin for a diabetic patient or an Aero chamber to facilitate the use of an inhaler. They make suggestions to resolve drug-related problems. They present their recommendations, clear and logical explanations for the changes recommended and appropriate references. (2)
Write extensive procedures to be used by pharmacy staff when dispensing drugs. These procedures establish the rules, parameters and steps support staff must follow when accomplishing their tasks. These procedures must be explicit and precise to ensure consistent interpretations. (3)
May write drug information articles to inform the public about pharmacy topics such as health promotion, disease screening and new drug therapies. They gather and select information from various sources and summarize it in a language and format suitable for a lay audience. (4)
May write brochures to inform other health professionals about such pharmaceutical topics as new drug treatments, therapeutic policies and procedures, health planning, HIV prevention or smoking cessation. The writing involves gathering and selecting information from various sources and summarizing it for an audience of health care providers. (4)
May participate in the writing of research articles on the clinical investigation of pharmaceutical regimens for peer-reviewed journals. For example, they may write a dense and technical article about a trial comparing a docetaxel-based regimen with a standard anthracycline-based regimen in the treatment of metastatic breast cancer. The writing involves explaining the background to the research and the research protocol, describing the difficulties encountered in conducting the investigation, analyzing data collected, discussing the results obtained, commenting on their statistical significance and drawing conclusions about the research outcomes. (5)

Numeracy

Money Math

Handle cash, credit card and debit card transactions and provide change to patients. (1)

Scheduling, Budgeting & Accounting Math

Monitor drug inventories and determine the number of units of each product to order so as to ensure there are enough supplies on hand to fill out prescriptions. (2)
Plan work schedules for pharmacy support staff and other pharmacists, taking into account workload indicators and the need to distribute job tasks equitably. Pharmacists sometimes adjust work schedules because of vacation or sick leave. (3)

Measurement and Calculation Math

Count out pills when dispensing prescribed pharmaceuticals to patients. (1)
Convert a patient's weight from pounds to kilograms prior to determining the amount of drug which should be given. (2)
Calculate the volume of liquid medication to give when the dosage identified in a prescription is expressed as a weight. (2)
Calculate a patient's creatinine clearance as a measure of renal impairment by inserting his serum creatinine level, weight, sex and age into a mathematical equation and solving the equation. (3)
Use a glucose meter to teach diabetic patients how to take precise measurements of their blood sugar levels and monitor their illness. (3)
Calculate amounts of pharmaceuticals needed to create solutions and compounds. For example, they may calculate the amount of hydrocortisone powder to add to an ounce of ointment to obtain a 2% strength or may measure the amount of liquid to add to an amount of antibiotic powder to create a syrup of the proper concentration expressed as milligrams per litre. (3)

Data Analysis Math

Compare the average use of one drug to that of another equivalent drug to determine adjustments required in inventory management and ordering. (1)
Compare quantitative data on the ingredients and price of non-prescription products such as headache medication and vitamins in order to make purchasing recommendations to patients. (3)
Monitor the pharmacokinetics of drugs such as gentamycine, vancomycine and lithium to ensure their effectiveness and lack of toxicity. This involves analysing the patient's blood data over a period of time and increasing or decreasing the drug dosage as required until a stable reading in the desired or therapeutic range is obtained. (4)
May analyze and interpret clinical trials on new pharmaceutical products to provide information to patients and correct misinformation. In industrial settings, they have to calculate appropriate and relative statistics, such as risk reduction, relative risk reduction, absolute risk reduction and the number needed to treat. (4)

Numerical Estimation

Estimate the weight of patients by eyeballing, when exactitude is not required to determine drug dosage. (1)
Estimate the time required to fill a prescription, based on experience. (1)

Oral communication

Talk to doctors to take prescriptions over the phone (1)
Speak to pharmacy support staff and other pharmacists to give and receive routine instructions about work schedules and drug orders, preparation, dosage, delivery, storage, insurance, labelling, packaging, distribution or advertising. (1)
Interact with pharmaceutical company representatives and patient care providers such as doctors, nurses, other pharmacists, hospital discharge managers and anaesthesiologists to share information and solve problems relating to the properties, benefits, dosage, side effects and interactions of specific drugs. (2)
Counsel patients about prescribed medications and non-prescription drugs such as cough syrups, decongestants and herbal remedies. Pharmacists must be able to clearly explain the purpose of each medication, how to take the medication, the importance of using it as directed and how long it takes before one can expect to see benefits. They identify other drugs which should be avoided and potential side effects. They have to stress the importance of seeing a doctor about serious adverse effects such as redness, itching and swelling in the facial area or breathing difficulty. They may also explain the results of scientific studies about controversial drugs to patients in plain language. (3)
Exchange information and opinions in work team, committee and association meetings and give presentations to health care professionals on such matters as patient concerns, education or counselling; economic and business aspects of pharmacy; standards of practice; pharmacist education and continuing professional development programs; or assistance to new practitioners. (3)
May deal with verbally abusive, angry and threatening patients when they refuse to fill prescriptions without dispensing instructions from doctors. When faced with such patients, pharmacists must communicate with them in firm and assertive tones to calm them down. As a last resort, they may have to contact the police should situations escalate to the point of potential physical violence. (3)

Thinking

Problem Solving

Are sometimes unable to decipher a doctor's writing on a prescription form. They may consult their co-workers or call the doctor directly to get clarification. (1)
Have a patient coming in to renew a prescription for which there is no renewal left. In such cases, pharmacists may call the patient's doctor to obtain a prescription. (1)
Suspect that people are fraudulently using doctors' names to call-in prescriptions. They ask questions to ascertain their identity and legitimacy before providing the prescription. For example, they may verify their provincial billing numbers and place of work. (1)
Who work in hospitals are sometimes unable to find drugs they do not have in stock for emergency cases. The situation is further complicated if it is happening on a late Friday night when wholesalers are closed. In such cases, they contact several hospitals until they locate the drug and arrange for the fastest possible delivery to the patient. Alternatively, they may choose substitute medication. (2)
Have patients bringing back blood pressure or glucose machines that are not functioning properly. They refer to the user manuals and go through the problem solving chart to identify the problem and corresponding solution. If they can't solve the problem using the chart, they may send the product back to the manufacturer and provide a new one to the patient. (2)
Suspect that a prescription has a dosage error. For example, for the last two years a patient's dosage was 50 mg and, in the new prescription, it is 25 mg. In such instances, they contact the doctor to clarify the situation and, if he has made a mistake, they seek permission to dispense the correct dosage. (2)
Discover errors made by their staff relating to drug dosage. They identify contributing factors and implement medication error management programs to prevent further errors. For example, they may develop strategies such as dosage charts which their staff can refer to when dispensing drug orders. (3)

Decision Making

Make recommendations to doctors. For example, pharmacists may suggest that doctors increase their patients' antibiotic dosages above the normal range, based upon analysis of laboratory test results or other factors relating to the patients' illnesses. (1)
Decide which tasks to assign to the various staff. They make their decisions taking into consideration the position and strengths of each staff member. (2)
Choose the best response to patients' medication-related problems accurately and within an appropriate timeframe, considering patient preference, medical significance and urgency. For example, they may refer patients to emergency rooms, to medical clinics or to other appropriate health professionals. (3)
Decide on the amount of drugs to order. Although the computerized database keeps a perpetual inventory and provides them with quantities, they may override its calculations and order more or less. Their decision is critical because they must ensure there will be enough supplies on hand to fill all prescriptions, while optimizing profitability. (3)
Decide whether to fill or reject a prescription that they suspect is forged. To help them decide, they examine the prescription and may take it upon themselves to call the doctor to verify. They may have to deal with an angry patient if they refuse to fill a prescription. (3)
Decide which over-the-counter remedy to suggest to patients enquiring about non-prescription drugs. Their decisions are based on an analysis of answers obtained from the patients as to their symptoms; any other medications they are taking; allergies they may have; and on a comparison of the effectiveness, benefits and side effects of alternative remedies. A bad decision may result in a lack of effectiveness or an adverse outcome for the patient. (3)

Critical Thinking

Evaluate the completeness and clarity of written dispensing procedures developed for pharmacy technicians. They ensure that no crucial information has been left out nor implied to avoid misinterpretation and dispensing errors. (3)
Evaluate the ethics of their decisions such as releasing patient information to third parties including the police and insurance companies. They consider the applicable legislation and relevant principles of professional practice. (3)
Assess the validity of written narcotic prescriptions. They may look up patients' files to review their previous prescriptions, check for alerts on stolen prescription pads on the computer system, consider the behaviour and appearance of patients or ask for identification cards. Failure to do so may result in drug diversion. (3)
Assess the therapeutic value of a wide variety of non-prescription products such as headache remedies, cough syrups and vitamins to make appropriate recommendations to patients. Their assessment is based on an analysis of the active ingredients listed on products, information found in pharmaceutical industry and government bulletins, their assessment of the patient and patient feedback received. (3)
Assess the effectiveness of alternative pharmaceutical treatments. They research and analyse information from a variety of sources, including drug monographs. They compare information on each drug on aspects such as efficacy, potential interactions with other drugs, pharmacokinetics and potential side or adverse effects and cost-effectiveness. They must be able to justify their assessments with sound evidence from the literature and provide recommendations which will have the most beneficial effects on patients' health. (4)
May critically review draft articles for publication in pharmaceutical journals. They evaluate the articles with respect to the soundness of the methodological approach, the validity of research outcomes, the consistency of explanations and results obtained, the clarity of text and the appropriateness of conclusions made in the light of pharmacy theory, regulations and practice. (4)
Critically assess therapies for selected diseases and conditions to determine the most effective. They review the current literature, analyzing the research findings, including methodology and biostatistics, to arrive at recommendations for specific patients or groups of patients. (4)

Job Task Planning and Organizing

Own Job Planning and Organizing

Community pharmacists and hospital pharmacists experience competing demands on their time from patients needing prescriptions filled or enquiring about products; from doctors calling or faxing in prescriptions; and from co-workers and colleagues asking for clarifications or advice. They sequence multiple tasks for efficiency, effectiveness and safety. Their work is often team-oriented so their own tasks and work schedules are integrated with a team of pharmacy support staff, pharmacists and other health professionals to ensure safe and effective patient care. Industrial pharmacists prioritize their tasks independently based on changing circumstances. However, they must regularly revise their work plans to deal with unexpected events and issues as they arise. The ability to do this is critical to their job, as the failure to react immediately may have significant impacts on their organization, such as a declining reputation. They often coordinate their work with counterparts from international locations for the development, clinical investigation and promotion of new pharmaceutical products, as well as for the organization of training and professional development events for their peers and for medical personnel. (3)

Planning and Organizing for Others

Community pharmacists and hospital pharmacists are responsible for training and assigning work to pharmacy support staff assisting them with providing pharmacy services. (3)

Significant Use of Memory

Memorize the standard dosage of common drugs to monitor dosage accuracy when dispensing medications.
Recall doctors' names, their specialty and where they work to facilitate communication.
Remember the side effects of common drugs to facilitate counselling.
Remember the medical histories of some patients and details of their personal lives to build practitioner-patient relationships.
Remember drug formulae and ratios to mix drugs and create suspension of commonly used drugs.
In hospital settings remember multi-step instructions for specific processes and procedures such as preparing medication for patients undergoing organ transplants. Such processes may require critical evaluation and electronic processing as well as sterile preparation and dispensing of medication.

Finding Information

Find lists of medications taken by patients by referring to computerized databases. (1)
Find out if a particular prescription or non-prescription drug can be taken while pregnant or lactating by referring to the reference text Drugs in Pregnancy and Lactation. (2)
Refer to medical aid catalogues to help patients find the most appropriate product for their needs, such as a wheel chair, cane, lumbar support or blood pressure gauge. They may refer to a variety of catalogues to review several options. (3)
Find detailed information about a drug such as its optimal dosage, indications, potential interactions, physiochemical characteristics, mechanism of action, absorption, biotransformation and side or adverse effects by searching appropriate references such as the Compendium of Pharmaceuticals and Specialties (CPS) and the United States Pharmacopoeia Dispensing Information (USPDI). They need to analyse and synthesize this information so that they can counsel patients, doctors and other health care professionals. (3)
Search new therapies for management or treatment of specific disease or condition. They may consult web-based databases and articles, professional journals, primary and secondary clinical literature as well as basic science literature. (3)

Digital technology

Use word processing. For example, they use basic page and character formatting features when writing letters to pharmaceutical representatives to inform them of the unanticipated side effects of a particular drug. (2)
Use databases. For example, they use custom databases to store information or retrieve patient files and maintain drug inventory records. They also search databases on the CD ROM versions of the Compendium of Pharmaceuticals and Specialties (CPS), MICROMEDEX and Trissel's Stability of Compounded Formulations. (2)
Use spreadsheets. For example, they use existing spreadsheets to record drug usage, financial or workload statistics and to generate monthly reports. (2)
May use communications software. For example, they may send e-mail messages with attached documents to physicians and other pharmacists outlining patient drug requirements. (2)
May use the Internet. For example, they may access professional association websites, search for information about particular drugs and find medical summaries in the Cochrane Reviews and the Medline on-line libraries. They may search for information using electronic databases including those maintained by provincial health ministries for health records. (2)
May use graphics software. For example, they may prepare presentations on new drug treatments for patient care providers, importing word processing files, tables and graphs created with other software to effectively present information. (3)

Other Essential Skills:

Working with Others

Pharmacists perform some tasks independently but more generally work with a team of pharmacists, pharmacy support staff and other health professionals. They work independently when reviewing medication profiles or counselling patients, but their other tasks are carried out with team members. Within the pharmacy, they direct, lead and supervise pharmacy support staff to ensure the safe and timely provision of pharmacy services. They also coordinate their own work with that of doctors, nurses and other health care professionals to share information and updates on drugs and patient conditions and recommendations for patient care. They may also consult and collaborate with a variety of stakeholders such as other pharmaceutical companies, national and provincial professional associations, regulatory and licensing bodies, medical advisory committees and government departments to monitor the manufacturing, prescribing and use of drugs and protect the well-being of the population. (3)

Continuous Learning

Continuous learning is an integral part of the work of pharmacists. They are expected to know where to get reliable medical and pharmaceutical information, to keep up-to-date on drug developments, and to further their knowledge of medications, diseases and medical conditions. They are expected to implement their new learning into their practice for the benefit of their patients. On a day-to-day basis, pharmacists acquire new learning by reading information found in pharmaceutical and medical journals, textbooks, CD-ROMs and websites, research reports, pharmaceutical industry and government bulletins. They also listen to audiotape updates, view videotape updates, consult help lines and discuss issues with co-workers, pharmaceutical company representatives, physicians and other healthcare professionals. Pharmacists are governed by the regulatory body of the province in which they practise. They may be required to set up their own learning plans and to achieve or exceed a certain number of Continuous Education Units to maintain their license. They generally obtain such units through self-directed learning or by attending lectures, courses, conferences, symposia, workshops or seminars on topics such as the analysis of scientific publications, documentary research in pharmacy, pharmaceutical treatments in all fields including psychiatry, geriatrics, oncology, palliative care and endocrinology. They may also obtain their units by conducting research, writing papers or giving presentations. (4)