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Pharmacy Policies & Forms

Policy #TitleRationaleDateSummaryLink
CLI.6010.SG.004.FORM.03Heparin Infusion FlowsheetMar 17, 2025
CLI.6010.PL.011Medication Order Writing and ProcessingMar 3, 2025
CLI.6010.SG.002Adult Gentamicin Tobramycin Monitoring and DosingFeb 17, 2025
CLI.6010.PL.048.FORM.01Total Parenteral Nutrition Standard OrdersUpdated standard orders to reflect the following changes: updated form number for Subcutaneous Insulin Correction Standard Order form number; updated section on CVADFeb 4, 2025
CLI.6010.PL.048Adult Total Parenteral Nutrition through a Central Venous Access Device: Administration and MaintenanceFeb 4, 2025
CLI.6010.PL.016.SD.01Medication Automatic Substitution List Acute Care AdultAdded LMWH - dalteparin AND methotrexate sections (includes dose banding)Dec 30, 2024
CLI.6010.PL.042Acute Care Formulary ReviewDec 5, 2024
CLI.6010.PL.042.FORM.003Drug Review for Formulary RequestDec 5, 2024
CLI.6010.PL.042.FORM.001Non Formulary Drug Approval Request FormDec 5, 2024
CLI.6010.PL.042.FORM.002Formulary Addition Deletion Request FormDec 5, 2024
CLI.6010.PL.042.SD.001Non Formulary Medication Orders AlgorithmDec 5, 2024
CLI.6010.FORM.003Adult Intravenous Iron AdministrationDec 5, 2024
CLI.6010.FORM.014Acetaminophen Overdose Treatment Standard OrdersChanged units on page 2 10 mcg/mL to 10 mg/L, removed bicarbonate in the investigations and initial presentation test list as well as the repeat test.Dec 1, 2024
CLI.6010.FORM.005Acute Adult PRN Medications Admission Standard OrdersChanges to diet under general ordersDec 1, 2024
CLI.6010.PL.009.FORM.05Obstetrical Best Possible Medication History BPMH and Reconciliation Admission and Dischargeremoved n/a for faxing to pharmacyNov 7, 2024
CLI.6010.PL.016.SD.02PCH Automatic Substitution ListOct 24, 2024
CLI.6010.PL.008Patients Own MedicationsAdded section/process for PCH and changed the nameOct 24, 2024
CLI.6010.FORM.020LTC Paxlovid Standard OrderOct 1, 2024
PCH Tracking Sheet for Narcotic ReturnsAug 8, 2024
CLI.6010.FORM.004Pharmacy Order Form Public Health Anaphylaxis KitsAug 1, 2024
Drug Review for Formulary RequestFeb 21, 2024
CLI.6010.PL.005Automatic Reassessment of Medication OrdersJan 25, 2024
CLI.6010.PL.003Regional Parenteral Drug Monograph Manual and Use of Infusion SMART PumpsRevised name to reflect with Use of Infusion SMART PumpsJan 25, 2024
CLI.6010.PR.002Use of Single and Multi Dose Vials in Patient Care AreasSlight revisions to existing practice requiring Independent Double Check.Jan 25, 2024
CLI.6010.PL.005.SD.01MAR Example LTC Warfarin MonitoringSlight revisions to existing practice requiring independent double check.Jan 25, 2024
CLI.6010.PL.015.SD.02MAR Example LTC Patch Application and RemovalImpact to clinical practices. slight revisions to existing requiring independent double check.Jan 25, 2024
CLI.6010.PL.015Narcotics and Controlled DrugsImpact to clinical practice - slight revisions to existing practice requiring independent double checkJan 25, 2024
Provincial High Alert Medications ListJan 19, 2024
Provincial Clinical Standard, Safety Controls for High Alert MedicationsJan 19, 2024
CLI.6010.PL.020Opioid Agonist TherapyChange titles from Antagonist to Agonist on all documents.Sep 25, 2023
CLI.6010.PL.020.SD.01Opioid Agonist Therapy Policy HighlightsChange titles from Antagonist to Agonist on all documents.Sep 25, 2023
CLI.6010.SG.004.FORM.01Heparin Infusion Standard Orders VTE PECurrent standard guideline limits heparin infusions to regional sites with 24/7 lab access on site Community sites may want to start a heparin infusion prior to sending the patient out to higher level of care in order to prevent delays in treatmentSep 11, 2023
CLI.6010.SG.011.FORM.01Ectopic Pregnancy Methotrexate Standard OrdersSep 5, 2023
CLI.6010.SG.011Ectopic Pregnancy Medical and Expectant Management GuidelineSep 5, 2023
CLI.6010.SG.011.SD.01Discharge Information After Methotrexate for Ectopic PregnancySep 5, 2023
CLI.6010.SG.011.SD.02Methotrexate Treatment for Ectopic Pregnancy Patient InformationSep 5, 2023
CLI.6010.FORM.001PCH Medication Standing OrdersSep 4, 2023
CLI.6010.PL.009.FORM.04Home Care Best Possible Medication History and Physician ConfirmationChanged the SD to a FORM - new policy guidelinesAug 31, 2023
CLI.6010.FORM.006Adult Bowel Movement Standard Orders for Acute CareAddition of MAR examplesAug 31, 2023
CLI.6010.PL.009.FORM.01Best Possible Medication History BPMH and Admission Reconciliation and Order FormAug 31, 2023
CLI.6010.PL.009Medication ReconciliationAug 31, 2023
CLI.6010.PL.009.SD.01Medication Reconciliation Quick Reference GuideAug 31, 2023
CLI.6010.FORM.013Medication Room Audit Personal Care Home1. Fridge temperature is maintained between 2-8C. 2. Medication fridge temperature is recorded at least once daily. 3. added "pareneral items" route for questions #37 & #38Aug 25, 2023
CLI.6010.FORM.012Medication Room Audit Acute CareAug 25, 2023
CLI.6010.PL.009.FORM.06Addendum Therapeutic Substitution Order from PharmacyAug 21, 2023
CLI.6010.PL.046.FORM.02Postpartum Medication Self Medication RecordThe current policy does not have specific instructions for obstetrics. Need to add post partum specific pain medications to the policy list. Added post partum medication self-administration record. Updated corresponding standard orders and MARs.Aug 17, 2023
CLI.6010.PL.046Medication Self AdministrationCurrent policy does not have specific instructions for obstetrics. Need to add post partum self-administration pain medications to the policy list. Also need a post partum medication self-administration record. To provide guidance to staff regarding self-administration of medications by patients.Aug 17, 2023
CLI.6010.PL.046.FORM.01Medication Self Administration RecordTo provide guidance to staff regarding self-administration of medications by patients. Changed from an SD to a FormAug 17, 2023
CLI.6010.PL.010Telephone or Verbal OrdersUpdated policy to include community programs i.e. home care, palliative care, mental health & My Health Team. Also, reinforce thal ALL medication orders MUST be signed by prescriber.Aug 16, 2023
CLI.6010.PL.073.FORM.01Investigated Information for Transport Medications Involved in a Temperature ExcursionCurrently communication when transporting medications from pharmacy or for monitoring temperature of refrigerated medications is fragmented. A Regional process will minimize errors and temperature excursions.Aug 10, 2023
CLI.6010.PL.004.FORM.01Antimicrobial Stewardship Feedback FormTo be used as a communication tool for pharmacists/prescribersAug 10, 2023
CLI.6010.PL.004Antibiotic Stewardship ProgramAug 10, 2023
CLI.6010.PL.073.SD.01Cold Temperature 8 Degrees Temperature Reading GuidelineAug 10, 2023
CLI.6010.PL.073.SD.02Pharmacy Process for Transport Temperature ExcursionCurrently communication when transporting medications from pharmacy or for monitoring temperature of refrigerated medications is fragmented. A Regional process will minimize errors and temperature excursions.Aug 10, 2023
CLI.6010.PL.073.SD.03Transport of Hazardous Medication by Deliver Services Driver Safety PamphletCurrently communication when transporting medications from pharmacy or for monitoring temperature of refrigerated medications is fragmented. A Regional process will minimize errors and temperature excursions.Aug 10, 2023
CLI.6010.FORM.016Patient Controlled Analgesic PCA and Assessment Flow SheetCurrently the PCA pump process is different at each site, the process has been regionalized to include preparation of medication, administration, prescribing, assessment flowsheet, updated parenteral monographs for HYDROmorphone PCA & morphine PCA.Aug 10, 2023
CLI.6010.PL.073Packaging and Transport of Pharamceuticals Facility to FacilityCurrently communication when transporting medications from pharmacy or for monitoring temperature of refrigerated medications is fragmented. A Regional process will minimize errors and temperature excursions.Aug 10, 2023
CLI.6010.PL.074Receipt Storage and Internal Transport of PharmaceuticalsComplements the Packaging and Transport of Pharmaceuticals Facility to Facility policyAug 9, 2023
CLI.6010.PL.074.FORM.01Medication Transportation Cover LetterAug 9, 2023
CLI.6010.PR.002.SD.01Handling of Multi Dose Vial ExceptionsRemoved acetylcysteine from the exception list. The product monograph states that opened vials for IV use are single use only.Jul 26, 2023
CLI.6010.FORM.015Adult Diabetic Ketoacidosis DKA Hyperosmolar Hyperglycemia State HHS Standard OrdersTo regionalize the DKA/HHS process and orders for ALL sitesJul 26, 2023
CLI.6010.SG.008Dissolve and DoseAdding a supporting document to the Dissolve and Dose guideline including instructions for Misoprostol utilized in labour inductionJul 26, 2023
CLI.6010.FORM.017Smoking Cessation Standard OrdersReplacement therapy for tobacco smokers.Jul 26, 2023
CLI.6010.PL.019Take Home Naloxone ProgramAdded Answer Key to Post Training Questionnaire.Jul 26, 2023
CLI.6010.FORM.002Subcutaneous Insulin Correction Standard OrdersUpdating confusing wording regarding on how to assess patient.Jul 26, 2023
CLI.6010.PL.019.SD.04THN Program Post Training Questionnaire Answer KeyAdded Answer Key to Post Training Questionnaire.Jul 26, 2023
CLI.6010.SG.008.SD.04Misoprostol Dissolve and Dose InstructionsAdding a supporting document to the Dissolve and Dose guideline including instructions for Misoprostol utilized in labour induction.Jul 26, 2023
CLI.6010.SG.004Anticoagulation for Venous ThromboembolismJul 25, 2023
CLI.6010.SG.004.FORM.02Dalteparin Standard Orders VTECurrent standard guideline limits heparin infusions to regional sites with 24/7 lab access on site. Community sites may want to start a heparin infusion prior to sending the patient out to higher level of care in order to prevent delays in treatment.Jul 25, 2023
CLI.6010.FORM.011Pertussis Whooping Cough Treatment Standard OrdersMay 4, 2023
CLI.6010.PL.019.FORM.05THN Kit Distribution LogApr 1, 2023
CLI.6010.PL.019.FORM.06Overdose Response FormApr 1, 2023
CLI.6010.PL.019.FORM.07THN Program Intake FormApr 1, 2023
CLI.6010.PL.019.FORM.08THN Program Post Training QuestionnaireApr 1, 2023
CLI.6010.PL.019.SD.01Training Manual Overdose Prevention Recognition and ResponseApr 1, 2023
CLI.6010.PL.019.SD.02Patient Handout What is naloxone and why do you need itApr 1, 2023
CLI.6010.PL.019.SD.03Patient Handout Naloxone Injection Training ChecklistApr 1, 2023
CLI.6010.PL.019.FORM.01THN Distribution Site Agreement FormApr 1, 2023
CLI.6010.PL.019.FORM.02THN Kit Order FormApr 1, 2023
CLI.6010.PL.019.FORM.03New Provider Application FormApr 1, 2023
CLI.6010.PL.019.FORM.04THN Kit Tracking FormApr 1, 2023
CLI.6010.PL.019.FORM.09THN Program Overdose Recognition and Response Training RecordApr 1, 2023
CLI.6010.PL.047Medication Allergy Identification and Reaction RecordingAug 11, 2022
CLI.6010.PL.047.SD.01Clinical Circumstances SheetAug 1, 2022
CLI.6010.PL.015.FORM.01Medication Transportation FormJun 1, 2022
CLI.6010.PL.009.SD.03Medication Reconciliation and Discharge Order Form BDM – ExampleMar 9, 2022
CLI.6010.PL.009.SD.02Medication Reconciliation Transfer Profile BDM Form – ExampleMar 9, 2022
CLI.6010.SG.009Vancomycin Monitoring in the Home Care Treatment ClinicMar 8, 2022
CLI.6010.PL.023Cannabis for Medical PurposesJan 20, 2022
CLI.6010.PL.018Emergency Department Starter PacksSep 23, 2021
CLI.6010.PL.018.SD.01Starter Pack Dispensing ListSep 1, 2021
CLI.6010.SG.008.SD.02Finasteride Dissolve and Dose InstructionsMay 27, 2021
CLI.6010.SG.008.SD.03Cotrimoxazole Dissolve and Dose InstructionsMay 27, 2021
CLI.6010.SG.008.SD.01Dissolve and Dose Instructions TemplateMay 1, 2021
CLI.6010.SG.007.SD.01Adult Treatment for Hypoglycemia Standard OrdersApr 14, 2021
CLI.6010.SG.007Emergency Management of Hypoglycemia Adult PediatricApr 14, 2021
CLI.6010.SG.001.FORM.01Vancomycin Prescriber Standard OrdersApr 14, 2021
CLI.6010.SG.007.SD.03Patient Handout Hypoglycemia Low Blood Sugar AdultApr 14, 2021
CLI.6010.SG.007.SD.02Pediatric Treatment for Hypoglycemia Standard OrdersApr 14, 2021
CLI.6010.PL.024.SD.02Handling of Suspected Illicit Substance FAQsJan 28, 2021
CLI.6010.SG.001.FORM.02Vancomycin Pharmacist Standard OrdersJan 14, 2021
CLI.6010.PR.001Operating Room Management of Narcotic Controlled MedicationsSep 18, 2019
CLI.6010.PR.001.FORM.02OR Nursing DCMRSep 18, 2019
CLI.6010.PR.001.FORM.01OR Anesthetist DCMRSep 18, 2019
CLI.6010.PL.015.SD.01MAR Example Acute Patch Application and RemovalSep 17, 2019
CLI.6010.PL.023.SD.01Algorithm For Continued Use of Medical CannabisApr 2, 2019
CLI.6010.PL.023.SD.02Algorithm for Medical Cannabis New Starts and Authorization RenewalsApr 2, 2019
CLI.6010.PL.023.FORM.01, CLI.6010.PL.023.FORM.01.FCannabis for Medical Purposes Agreement for Use and Release of Responsibility – BilingualApr 2, 2019
CLI.6010.PL.023.SD.03Cannabis Equivalency Chart and Active Ingredient ConcentrationApr 2, 2019
CLI.6010.PL.023.SD.04Cannabis Product MonographApr 2, 2019
CLI.6010.PL.023.SD.05Consumer Information Cannabis – BilingualApr 2, 2019
CLI.6010.PL.024Handling of Suspected Illicit SubstanceMar 28, 2019
CLI.6010.PL.024.FORM.01Suspected Illicit Substance TransferMar 28, 2019
CLI.6010.PL.024.SD.01Suspected Illicit Substance AlgorithmMar 28, 2019
CLI.6010.PL.002Look alike Sound alikeMar 28, 2019
CLI.6010.PL.002.SD.01Look alike Sound alike Names with TALLman LetteringMar 28, 2019
CLI.6010.PL.006.SD.01IV to PO Step Down Criteria and ChartMar 13, 2019
CLI.6010.SG.001Adult Vancomycin Monitoring and DosingMar 13, 2019
CLI.6010.PL.004.SD.01Adult ORAL and PARENTERAL Antibiotics Renal Dosing Chart 1Mar 13, 2019
CLI.6010.PL.006Antimicrobial Intravenous to Oral Therapeutic ConversionMar 13, 2019
CLI.6010.PL.021.SD.03Cytotoxic Spill Management AlgorithmJan 24, 2019
CLI.6010.PL.021.SD.01Cytotoxic and Non Cytotoxic Hazardous Medication ListJan 24, 2019
CLI.6010.PL.011.SD.01Do Not Use Dangerous Abbreviations Symbols Dose DesignationsJan 24, 2019
CLI.6010.PL.009.FORM.02Discharge Medication PlanJan 24, 2019
CLI.6010.PL.021.SD.02Safe Handling of Hazardous Medications ChartJan 24, 2019
CLI.6010.PL.021Safe Handling of Hazardous Medications Cytotoxic and Non CytotoxicJan 24, 2019
CLI.6010.PL.009.FORM.03Transfer Reconciliation and OrderJan 24, 2019
CLI.6010.PL.022PatientResident Leave of Absence MedicationsJan 24, 2019
CLI.6010.PL.022.FORM.01Patient Resident Leave of Absence Medication RequestJan 24, 2019
CLI.6010.PL.016Automatic Therapeutic InterchangeAug 8, 2018
CLI.6010.SG.005Intranasal Medication Administration by Mucosal Atomization DeviceSep 28, 2017
CLI.6010.SG.006Pain Relief in Infants Requiring Procedures – Oral SucroseSep 28, 2017
CLI.6010.PL.007Acetylcholinesterase InhibitorsMar 23, 2017
CLI.6010.PL.007.SD.01Acetylcholinesterase Patient BrochureMar 23, 2017
CLI.6010.PL.014Interchange of Generic DrugsMar 24, 2016
CLI.6010.PL.012Expiry of Multi dose Injectable ProductsMar 24, 2016
CLI.6010.PL.013Expiry of Opened Ophthalmic ProductsMar 24, 2016
Patients Own Medication Verification LabelMar 16, 2016
CLI.6010.SG.003Extravasation Management of Non Chemotherapeutic MedicationsJan 28, 2016
CLI.6010.SG.003.SD.02Extravasation Management Flow ChartJan 28, 2016
CLI.6010.SG.003.SD.04Extravasation Management Patient InformationJan 28, 2016
CLI.6010.SG.003.SD.03Extravasation Management DocumentationJan 28, 2016
CLI.6010.SG.003.SD.01Extravasation List of Irritant DrugsJan 28, 2016
IV to PO Conversion STICKERS print on 05159 Avery labelsJul 13, 2015
Drug Review for NONFormulary RequestNov 13, 2013

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