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Position Statements

Statement Regarding Cultural Competentcy Continuing Education

Adopted August 2014
The Oregon Board of Pharmacy is charged with preserving and protecting the health of our state’s citizens in the delivery of pharmacy related healthcare. Oregonians are growing increasingly diverse, and inequities in access to quality health care are apparent according to the Oregon Health Authority’s Office of Equity and Inclusion. The Office has identified that racial and ethnic populations, lesbian, gay, bisexual and transgender communities, low literacy level individuals and rural Oregonians experience health disparities. The Board believes that increasing understanding and awareness of the necessity to provide culturally competent health care is a patient safety priority.
 
The National Institutes of Health (NIH) speaks to the critical importance of healthcare practitioner’s awareness and competency in equal care given to patients across cultural lines. The NIH provides the following background to define Cultural Competence: Culture is often described as the combination of a body of knowledge, a body of belief and a body of behavior. It involves a number of elements, including personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions that are often specific to ethnic, racial, religious, geographic, or social groups. For the provider of health information or health care, these elements influence beliefs and belief systems surrounding health, healing, wellness, illness, disease, and delivery of health services. The concept of cultural competency has a positive effect on patient care delivery by enabling providers to deliver services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients.1
 
Cultural competency continuing education is a life-long process of examining values and beliefs while developing and applying an inclusive approach to health care practice in a manner that recognizes the context and complexities of provider-patient interactions and preserves the dignity of individuals, families and communities. Continuing education in cultural competency should teach attitudes, knowledge and skills to care effectively for patients from diverse cultures, groups and communities. The Office of Equity and Inclusion states that such training enables health care providers to work effectively in cross-cultural situations.
 
The Board recommends and encourages licensees to pursue ongoing continuing education opportunities for cultural competency. For purposes of maintenance of licensure, the Board considers continuing education (CE) in cultural competency to be relevant to the current practice of all licensees, and licensees may use this type of continuing education toward satisfying the required CE hours for license renewal. The Board will document licensees’ voluntary participation in cultural competency CE through the license renewal process beginning in 2015.
 
In order for Oregon to achieve the triple aim of improving health, improving care, and lowering cost, providers must be responsive to the needs of diverse populations. Cultural competency training for health care providers is one method for helping Board licensees adapt to the needs of Oregon’s socially and culturally diverse communities.
 
 
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Optimizing Patient Safety & Reducing Medication Errors in Oregon

Adopted October 2008
Beginning in 2000, in response to the number of medication errors and medication distribution issues, state boards of pharmacy across the country began to convene committees and work groups to research and report back to the boards about ways to reduce medication errors. In response to the Oregon Board of Pharmacy’s interest in promoting an awareness of and ultimately a decrease in medication errors, the Board convened its Medication Error Reduction – Patient Safety Research Council. 
 
The charge of Oregon’s 12-member multi-disciplinary Research Council was to investigate procedures designed to reduce medication errors and evaluate the role the Board currently plays in supporting medication error reduction efforts. The Research Council was also asked to recommend measures the Board could take to improve patient safety through medication error reduction programs in the state. The Research Council has developed a document that reflects optimum standards for providing patient care in today’s pharmacies. While the document is not intended to be a comprehensive list of goals that are completely achievable on a continual basis, it does suggest a number of specific procedures that can be implemented in pharmacy practice settings in an effort to enhance existing quality improvement programs.  This list is not exclusive of other improvements and may be supplemented by the Board from time to time.
 
Optimizing Patient Safety and Reducing Medication Errors, the 23-point document developed by the Research Council, was based on a review of current literature and work done in other states. The recommendations have been modified and edited specifically for use in Oregon pharmacies. The Board would like to acknowledge the work done by the National Association of Boards of Pharmacy’s 2007-08 Task Force on Continuous Quality Improvement, Peer Review, and Inspecting for Patient Safety, the Massachusetts Board of Registration in Pharmacy, and The Institute for Safe Medication Practices. 
 
It is the Board’s position that all pharmacies and pharmacists should review these recommendations as a high priority and should consider implementation of those measures that are appropriate to the particular pharmacy setting. The Board believes that adoption and institution of these practices will lead to optimal patient safety through enhanced pharmacy medication delivery systems, improved performance generally and, ultimately, a significant reduction in medication errors.
 

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Treatment and Management of Pain

Adopted June 2006
Healthcare leaders and patient advocates have come together in a legislatively mandated pain commission to work toward providing well managed and adequate pain control to the citizens of Oregon.  Involvement with The Oregon Pain Commission has prompted the Board of Pharmacy to take a leadership role in promoting the effective management of pain for the state’s citizens. The mission of the Oregon Board of Pharmacy is to promote, preserve and protect the public health, safety and welfare by regulating the practice of pharmacy and the distribution of drugs within and into the state. As a part of that endeavor, the Board strives to ensure that all Oregonians have access to appropriate pain relief. Appropriate and effective pain therapies, including the use of controlled substance medications, can greatly improve a patient’s quality of life and reduce unnecessary morbidity and cost associated with inadequate treatment of pain. 
 
Inadequate pain control, in some cases, may result from a lack of knowledge or understanding of proper pain management by health care professionals and patients. Under-treatment of pain can also be the result of fear or misunderstanding of the position of regulatory boards or law enforcement agencies regarding the use of controlled substances in the treatment and management of pain. This statement is intended to clarify the Board of Pharmacy’s position regarding pain management in the practice of pharmacy.
 
The Oregon Board of Pharmacy recognizes that the use of controlled substances, including opioid analgesics, is often essential for the treatment and management of both acute and chronic pain of any origin. A pharmacist involved in the care of a patient undergoing treatment for pain should not fear disciplinary action from the board for dispensing controlled substances, including opioid analgesics, for a legitimate medical purpose as defined in the state of Oregon. Pharmacists' involvement with pain management in the usual course of their professional practice should be based upon accepted scientific knowledge and sound clinical judgment.     
 
The Board of Pharmacy also recognizes that controlled substances, by their nature, carry with them a risk of abuse or misuse. All health care professionals must remain alert to the fact that these drugs are subject to abuse and that some people will seek them for inappropriate uses. Care must be taken to balance this risk with the desired outcome of effective pain control for all who are in need.
 
Dispensing of controlled substances for the treatment of pain must be based upon a valid prescription issued within currently accepted standards. All pharmacists are encouraged to increase their knowledge of current medical standards for the treatment of pain and develop effective strategies for delivering pharmaceutical care to patients suffering with pain. Pharmacists should actively participate on the health care team by providing expertise to the patient, physician, nurse and hospice provider or other care giver. As a member of the health care team, pharmacists can contribute to positive therapeutic outcomes for patients suffering from pain and can reduce the potential for drug abuse. Detailed documentation of the patient’s medical condition and clinical response to treatment provides the strongest foundation for providing optimal patient care.
 
The Board acknowledges the review of position statements from the Iowa, Michigan, Wisconsin, and Texas Boards of Pharmacy as well as the Oregon Board of Nursing and the Oregon Board of Medical Examiners and the Oregon Pain Commission in developing this Position Statement on the Treatment and Management of Pain.   

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Considering Moral and Ethical Objections

Revised February 2007
 
No provision exists within Oregon pharmacy laws or regulations that require a pharmacist to dispense every lawful prescription presented in a pharmacy. Indeed, pharmacy laws and regulations require a pharmacist to delay the dispensing of a prescription when faced with questions of potential harm to a patient or concerns of clinical appropriateness of a drug, a dose, or a dosage form for a particular patient. Pharmacists are required to seek clarification prior to dispensing and to collaborate with prescribing practitioners in the patient's best interest.
 
Just as other health care professionals and practitioners in Oregon have a choice, so do pharmacists have a choice whether or not to participate in activities they find morally or ethically objectionable. Oregon pharmacists cannot however, interfere with a patient's lawfully and appropriately prescribed drug therapy or request for drugs and devices approved by the U.S. Food and Drug Administration (FDA) for restricted distribution by pharmacies. Pharmacists enter into relationships with patients in the daily course of normal pharmacy practice. Within these relationships pharmacists have a duty to provide professional pharmaceutical care in the patient's interest.
 
The Board of Pharmacy expects each Oregon Pharmacist-in-Charge (PIC) to adopt written policies and procedures that address the issues of pharmacists' moral, ethical and professional responsibilities. It is the Board's belief that pharmacy policies and procedures could allow a pharmacist to exercise his or her choice to not participate, and at the same time not interfere with the patient's right to receive appropriate and lawfully prescribed drug therapy or drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies. These may include dispensing of the prescription or drug or device by another pharmacist on site or arranging for the prescription to be dispensed by a pharmacist at another site. The Board also expects Oregon pharmacists to discuss issues of moral, ethical and professional responsibilities with their Pharmacist-In-Charge and to understand and comply with the pharmacy’s policies and procedures.
 
The Board expects that pharmacy policies and procedures will ensure patients in Oregon always receive appropriate and lawfully prescribed medications and information or drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies in a timely and professional manner and that patients are not burdened by the pharmacist's individual beliefs. Interference with a patient’s right to receive timely, professional prescription services and information or drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies may be considered unprofessional conduct and could result in disciplinary action by the Board. (See attached “Clarification”)
 
 
Position Statement History
Originally Adopted September 2005
Revised February 2007
 

Clarification
 
For Example, the Board would consider it unprofessional conduct for a pharmacist to lecture a patient about the pharmacist’s moral or religious beliefs, to violate the patient’s privacy or to destroy, confiscate or otherwise tamper with the patient’s prescription.
 
The written policy should require an objecting pharmacist to inform the PIC in advance so that the PIC can reasonably accommodate that objection before a patient presents a prescription or makes a request for drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies. The accommodation may not include permission to lecture the patient. The policy should also ensure that the patient's prescription or drug and device needs are met either by ordering the drug, if it is not in stock, pursuant to the usual pharmacy policies, by transferring or returning the prescription to the patient if the patient requests, or by referring the patient to another pharmacy nearby where the patient can get the prescription filled or receive drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies. In the event of a referral, the pharmacist is responsible for identifying another pharmacy that has the medication in stock and will dispense the prescription or dispense drugs or devices approved by the U.S. FDA for restricted distribution by pharmacies.
 
Pharmacists licensed in Oregon may seek clarification of questions or concerns about moral or ethical objections from the Board of Pharmacy. Patients who believe they have been inappropriately refused medication may file a complaint with the Board of Pharmacy. Information about the complaint process can be found on the Board’s website at: /Pharmacy/pages/complaint.aspx 
 

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