Answers: Behavioral, Social and Administrative Pharmacy Sciences

Pharmacy Management (including Financial, Personnel, Marketing, Quality Improvement, Risk

Management and Workplace Safety)

1. What is the appropriate action to take if you as a pharmacist realize that a patient has
received their prescription once from another pharmacy?
Difficulty Level: Intermediate
 A. Tell the patient about your concerns and that you need to contact the physician
 B. Call the police and report what has happened
 C. Do not dispense the drug and register the reason on file
 D. Discuss with the patient in a private area and tell them you know what they did
The correct answer is A.

In management questions, always pick the most correct and complete answer. In this case, the
patient should be aware of the plan and decision that is made.

References:
Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

2. Which of the below organizations regulates pharmacy practice in Canada?

Difficulty Level: Easy
 A. Territorial pharmacy regulatory authorities
 B. National Association of Pharmacy Regulatory Authorities
 C. Canadian Pharmacists association
 D. Health Canada

The correct answer is B.

National Association of Pharmacy Regulatory Authorities

The National Association of Pharmacy Regulatory Authorities (NAPRA) is an alliance of the
provincial and territorial pharmacy regulatory authorities as well as the Canadian Forces Pharmacy
Services. Our members regulate the practice of pharmacy in their respective jurisdictions in
Canada and their primary mandate is protecting and serving the public interest.
The association provides a platform for its members to discuss issues and to take a national
approach in addressing common issues in the practice of pharmacy in Canada.

References:
[1] https://napra.ca/
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

3. You are a manager in a pharmacy and you realize activities are not performed effectively due
to lack of team work. What is the appropriate measure?
Difficulty Level: Intermediate
 A. Training is the most efficient measure in improving team work
 B. The pay of the staff who cannot get along with team work should be lowered
 C. New staff with high team work abilities should be recruited to set an example
 D. Staff should report their daily routines to each other

The correct answer is A.

Effective Use of Power

Whatever the source of their power, leaders must wield that power effectively to achieve desired
outcomes. According to Fuqua and colleagues, effective leaders do not rely on their title (formal
authority) to get results instead they adhere to ethical standards (and refrain from abuses of power),
mobilize resources, inspire creativity and confidence in subordinates, and empower others.
Leaders also effectively use their power in the following ways:
• Demonstrating their qualifications to be a leader (i.e., their expertise and credentials) so
that subordinates understand leaders earned their position of authority
• Prioritizing relationships and communication networks to better understand the needs of
others, build social capital, and stay current on events and information
• Encouraging participation and soliciting input, as subordinates may have knowledge and
suggestions critical to achieving goals
• Sharing information and decision making with appropriate individuals (e.g., those who
play a critical role in a particular task)
• Rewarding accomplishments and enforcing negative consequences for failures
• Teaching others how to effectively use their power

Characteristics of True Leaders

What do true leaders do and how do they behave? As discussed earlier, true leaders have a unique
ability to move others to action. This ability arises because they tend to possess several common
characteristics:

• The ability to articulate a compelling vision for the future: A compelling vision can attract
and inspire others, increase commitment to organizational goals, provide purpose and
meaning to work activities, link current work activities to future accomplishments, and
promote change. The ability to create a compelling vision and garner widespread support
to realize it is a critical leadership competency. For example, a meticulous pharmacist who
strives to provide the safest and most efficacious care possible develops a vision in which
medication errors would be reduced to nearly 0% over the next three years. To this end,
she proposes the implementation of a new automation system to promote medication
safety. The articulation of her vision regarding the use of automated technology and its
positive effect on patient care inspires support for her proposal among her colleagues,
which is instrumental in convincing the pharmacy’s administration not only to purchase
the equipment but also to implement its use, thereby promoting goal attainment.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

• Passion: True leaders are absolutely committed to their vision and enjoy working toward
it. This passion gives them the energy to persist even during setbacks. The pharmacist’s
passion for promoting medication safety, described in the previous example, contributed
greatly to her persistence in recruiting colleagues in efforts to compel the administration to
act on her automation proposal.

• Integrity: Leaders know their strengths, are honest about their limitations, establish high
standards (such as those set by our medication safety-promoting staff pharmacist), and are
consistent in their approach. They also honor their commitments, treat others with respect,
and serve as role models.

• Encouragement of others: The tombstone of Andrew Carnegie, one of the twentieth

century’s notable leaders, reads: “Here lies a man who knew how to enlist the service of
better men than himself.” Carnegie believed that great things required the support of others
and that effective leaders harnessed the power and ideas of others.29 Indeed, it has been
said that leadership is about “creating a way for people to contribute to making something
extraordinary happen. Leaders understand the importance of engaging the collective talents
of many people, and facilitating teamwork and collaboration by creating an atmosphere of
mutual trust and respect. They make it possible for people to be successful and recognize
them for their accomplishments and contributions. As a pharmacist leader, your success
depends, to some degree, on your own technical and pharmaceutical knowledge but, more
significantly, on your ability to mobilize others. Returning to our example, the pharmacist
understood that without the support of her colleagues, her proposal would not have the
power or momentum to gain the attention of decision makers within the organization. This
reliance on the mobilization of others may represent a whole new way of thinking for those
who moved to leadership roles after establishing themselves as take-charge pharmacists
who solve challenges independently.

• Curiosity, daring, and taking calculated risks: Leaders are not afraid to challenge the status
quo and are willing to take risks to effect important change. They are not afraid to make
mistakes in pursuing their goals and use adversity to prepare for future opportunities.
Because of the expense involved in purchasing automation, the training required, and the
widespread belief that such technology would result in job cuts, the pharmacist faced an
uphill battle among colleagues and administrators. Yet, she continued to challenge the
embedded belief systems about automation to facilitate a better understanding of its cost,
benefits, and impact.

References:
[1] Marie A. Chisholm-Burns, Pharmacy Management, Leadership, Marketing, and Finance
2nnd edition
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

4. If your pharmacy runs out of narcotics what would be the policy if there is an emergency?
Difficulty Level: Intermediate
 A. You should tell the patient that they should wait until you have their medication in stock
 B. Borrowing and returning with registered documents between pharmacies is allowed
according to regulations
 C. You should transfer the prescription to another local pharmacy that has the medication
inn stock
 D. You should sign and date an order for buying the emergency amount from another
pharmacy

The correct answer is D.

Return or Emergency Sale
Marginal note: Written order
A pharmacist may, on receiving a written order for a narcotic
(a) return the narcotic to the licensed dealer who sold or provided it to the pharmacist, if the order
is signed and dated by the licensed dealer; or
(b) sell or provide to another pharmacist the quantity of the narcotic that is specified in the order
as being required for emergency purposes, if the order is signed and dated by the other pharmacist.
Borrowing is not a part of the present regulations.

Narcotics and narcotic preparation cannot be transferred according to the regulations (there is a
temporary exemption regarding this subject due to Covid-19 circumstances):

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

References:
[1]https://laws-lois.justice.gc.ca/eng/regulations/C.R.C.,_c._1041/FullText.html
[2] https://www.ocpinfo.com/wp-content/uploads/2019/05/Prescription-Regulation-Summary-
Chart-Summary-of-Laws.pdf
[3]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

5. How frequent should reconciling of narcotics be?

Difficulty Level: Intermediate
 A. At least every 2 years
 B. Yearly
 C. At least every 6 months
 D. Reconciling of narcotics is required only when a theft is suspected

The correct answer is C.

College Policy requires the Designated Manager (DM) to direct that a physical count and
reconciliation of all narcotics, controlled drugs and targeted substances is conducted regularly, at
least once every six months, and that the results of the inventory count are retained in the
pharmacy’s records for a two-year period in a readily retrievable format.
It is important that a physical count AND reconciliation occurs. Simply counting the controlled
substances provides a record of the amount of the inventory that is present on-hand at a moment
in time. Accurate on-hand amounts are important for managing inventory levels, however, for the
count to be useful as a security measure, it must be used as a starting point to conduct a
reconciliation. Note that “on-hand” amounts from a perpetual inventory management system
cannot be used in place of an actual physical count for the purposes of reconciliation, as the
potential for human and/or data entry errors still exists.
Routine reconciliations should be used in conjunction with random audits on drugs have a high
risk of diversion, and as described in the Health Canada Guidance and CSHP Guidelines.
Sales/dispensing records or similar reports should be reviewed frequently and regularly, cross-
referencing against the actual prescription orders to determine, for example:
all prescriptions/orders are accounted for, i.e., no prescriptions or prescription numbers are missing
the prescriptions are valid and meet the requirements of the relevant legislation
any unusual names, drugs, quantities or patterns are identified and investigated
The frequency of review should be appropriate for the pharmacy environment. For instance, recent
or frequent staff turnover; temporary, relief or casual staff; high volume of controlled substances
dispensed; history of past discrepancies identified; etc.

References:
[1] https://www.ocpinfo.com/practice-education/practice-tools/fact-sheets/controlled-substances-
security-and-reconciliation/
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

6. You have a huge stock of Metoprolol in your pharmacy expiring in 2 months. Which is the
most appropriate action?
Difficulty Level: Easy
 A. Convincing the prescribers to prescribe Metoprolol instead of Atenolol as this would be
a waste
 B. Present the medication to the patients who are on the same class of medication and ask
them to talk about it with their physician
 C. Destroy all of the stock as this may harm the patients accidentally
 D. Separate the medication in the storage, inform all the staff and only dispense a part of
the amount on the prescriptions that would not be expired in the duration of therapy of the
patients. When expired must be removed from current inventory.

The correct answer is D.

Dispensary This area should be accessible only to authorized personnel and contain no products
inappropriate to the practice of pharmacy. The pharmacist should ensure that:

• Drugs and non-prescription medications for external use are stored separately from internal
and injectable drugs and non-prescription medications;
• Appropriate storage areas are designated for the storage of flammable and hazardous products;
• Expired and unusable drugs and non-prescription medications are removed from current
inventory and stored in designated areas awaiting proper disposal;
• Pharmacy transport of drugs and non-prescription medications has appropriate conditions of
sanitation, light, humidity, ventilation, temperature, security.

References:
[1]https://napra.ca/sites/default/files/2018-01/Resources_for_Pharmacy_Operators.pdf
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

7. Which of the following is not a physical barrier to pharmaceutical care?

Difficulty Level: Easy
 A. Location of cash register
 B. Height of shelves
 C. Large space
 D. Aisle width

The correct answer is C.

14 identified physical barriers to pharmaceutical care:

• Elevated dispensary: prevents a relationship of trust to develop because it places the patient and
pharmacist on unequal footing;
• Location of cash register: patients remain concerned about cost and don’t hear what’s being
said until after they’ve paid - separate payment from counseling area;
• Lack of space;
• Location of dispensary within the store: travelling to the back of a large store for patients in a
hurry is a barrier;
• Lack of privacy: patients prefer privacy -- can use counseling booth, an alcove in the counter or
simply a desk in a location where there is a reasonable amount of privacy - Ideally the
pharmacist has access to the patient’s profile while speaking with the patient;
• Height of shelves: decreased accessibility of pharmacist who can’t be seen. Also the
pharmacist should be able to see easily throughout the store - lower shelves create a more open
and inviting atmosphere;
• Height of the counter in front of the dispensary: if the patient and pharmacist can’t make eye
contact, the patient won’t ask questions. The pharmacist should be able to see patients and offer
assistance;
• Location of the computer: need access to patient profile at prescription drop-off, pick-up and
counseling area;
• Aisle width: must not prevent people from reaching dispensary (e.g., wheelchairs, baby
carriages, walkers);
• Need for comfortable waiting area: provision of patient-focused care may increase time it takes
and thus may increase waiting time;
• Pharmacists’ appearance: white jacket vs. more casual - no consensus; determine according to
clientele;
• Parking availability: need access to the pharmacy and time to wait to receive pharmaceutical
care;
• Atmosphere: warm and inviting to allow for patients to open up and develop relationship of
trust;
• Wheelchair accessibility: correct door width, minimal floor obstacles and accessible
washrooms.
References:
[1]https://napra.ca/sites/default/files/2018-01/Resources_for_Pharmacy_Operators.pdf
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

8. Which of the following is considered a structural stigma?

Difficulty Level: Difficult
 A. When someone hides their use or use drugs alone
 B. When pharmacy staff have negative behaviors towards people who use drugs
 C. When there are negative labels and images in everyday conversation and in the media
 D. when healthcare providers or first responders do not take people affected by drug use
seriously

The correct answer is D.

The three types of stigma:

Self stigma
• happens when someone internalizes negative messages about people who use drugs and
apply them to themselves
• can lead to low self-esteem and feelings of shame
• can cause someone to not access support because they fear being judged or discriminated
against
• can cause someone to hide their drug use or use drugs alone

Social stigma
• negative attitudes or behaviors towards people who use drugs or towards their friends and
family members
• negative labels and images in everyday conversation and in the media
• talking about addiction like it's a choice
• judgement and discrimination from other people can lead to self-stigma, and cause harm
such as not reaching out for help or using drugs alone
•
Structural stigma
• policies in health and social services that increase stigma, such as not providing services
until drug use is better managed
• when healthcare providers or first responders do not take people affected by drug use
seriously
• workplace policies that cause harm and unintentionally encourage people to hide their
drug use or prevent them from seeking help (example: unnecessary drug tests)
• not connecting people with health or social services because of their drug use and lower
quality of care when services are accessed

References:
[1] https://www.canada.ca/en/health-canada/services/opioids/stigma.html
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

9. Which of the following questions does not affect your decision on compounding a
preparation?
Difficulty Level: Intermediate
 A. Are your pharmacy personnel competent to perform compounding of the preparation?
 B. Do you have a dedicated space for compounding that is clean and uncluttered?
 C. Do you have trained staff to supervise the compounding?
 D. Do you have a referenced formulation?

The correct answer is C.

General guidance on whether to compound a preparation

• Are the active ingredients already available in a manufactured product?

• Do you have a referenced formulation?
• Do you have the beyond-use date (BUD) and relevant stability data?
• Do you have a dedicated space for compounding that is clean and uncluttered?
• Do you have the appropriate equipment and ingredients to make the compounded
preparation? Are your pharmacy personnel competent to perform compounding of the
preparation?
• Can your pharmacy personnel compound the preparation without interruption?
• Should you refer this compounded preparation to another pharmacy with appropriate
facilities, equipment and expertise?

Although compounded non-sterile preparations are sometimes prepared by other healthcare

professionals, including nurses, physicians and veterinarians, the majority of non-sterile
compounding is performed by pharmacy personnel under the supervision or direction of
pharmacists.

References:
[1]https://napra.ca/sites/default/files/documents/Mdl_Stnds_Pharmacy_Compounding_Nonsteril
e_Preparations_Guidance_June2018_FINAL.pdf
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

10. Which of the following has the highest effectiveness among the error prevention strategies?
Difficulty Level: Difficult
 A. Education, training and communication
 B. Reminders, checklists and double-checks
 C. Technology and automation
 D. Forcing functions and constraints

The correct answer is D.

As pharmacists or pharmacy technicians must perform a final check on each and every
prescription, pharmacy culture has supported the focus on individual care and vigilance to prevent
errors. As a result, approaches to error prevention have commonly relied on education, training,
and policy development. While these are important supports, human factors principles tell us that
when used alone, they are unlikely to be effective over the long term.
The following hierarchy of effectiveness illustrates the types of strategies that are likely to be
more effective:

The first two items on the list involve physical process changes, which help, and in some cases
force, practitioners to work in a particular way. For example, if the pharmacy computer system
will not process a prescription unless the user also enters allergy information, this is a forcing
function. If correctly designed, process changes based on these higher leverage strategies are more
likely to result in sustained positive system impact than those that rely on individual care and
vigilance. Reminders, checklists, and doublechecks as well as standardization and simplification
reduce reliance on memory and individual vigilance to prevent errors. The last two items on this
hierarchy are policy development and education. While necessary, they are low leverage strategies
because they rely on individual practitioners to remember and follow them consistently to be
effective. In terms of FMEA, this hierarchy can be very useful in identifying why vulnerabilities
are present and in planning for system changes identified through the analysis.

References:
[1] https://abpharmacy.ca/sites/default/files/QAFramework_web.pdf
[2]Pharma Board Handbook.

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 Answers: Behavioral, Social and Administrative Pharmacy Sciences

11. Which of the following pharmacy processes could be targeted for FMEA review?
Difficulty Level: Intermediate
 A. Implementing a new computer system
 B. Communicating patients’ allergy information
 C. Renovating or designing a pharmacy dispensary
 D. All of the above

The correct answer is D.

Depending on the complexity of these factors, a process FMEA can be complicated and time-
consuming. Nonetheless, FMEA is well-suited for analyzing many healthcare processes.
Some examples of pharmacy processes that could be targeted for FMEA review include:
• Implementing a new computer system
• Communicating patients’ allergy information
• Developing unit-dose packaging processes
• Using patient-controlled analgesia pumps
• Renovating or designing a pharmacy dispensary
• Developing processes for compounding extemporaneous or sterile products
• Identifying drug therapy problems
• Documenting patient care activities
The ultimate goal of FMEA is to prevent harm from reaching a patient. Reducing the frequency of
errors, making errors more obvious, and reducing the severity of the impact of an error can make
systems safer.

References:
[1] https://abpharmacy.ca/sites/default/files/QAFramework_web.pdf
[2]Pharma Board Handbook.

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