11.4 Intra- and Interprofessional Collaborative Care
Key Takeaways
- The Canadian interprofessional competency framework covers six domains: interprofessional communication, patient-centred care, role clarification, team functioning, collaborative leadership, and interprofessional conflict resolution.
- Role clarification means understanding both one's own scope and that of every team member, and it is the foundation on which the other competencies rest.
- Regulated pharmacy technicians independently accept accountability for the technical accuracy of a dispensed product, which releases pharmacist time for clinical care.
- SBAR — situation, background, assessment, recommendation — is the standard structure for a clinical handover or a recommendation to a prescriber.
- Transitions of care are the highest-risk points for medication error, and a documented, communicated medication list is the principal safeguard.
11.4 Intra- and Interprofessional Collaborative Care
Exam Focus: Collaborative care (intra- and interprofessional) is a named subcategory of the Pharmacy Practice blueprint area, and scope of practice for the pharmacy team also appears under the Canadian Healthcare System area of BSA. Items commonly test who may legally do what, and how a pharmacist raises a concern effectively.
The Canadian Pharmacy Team
| Team member | Core accountability |
|---|---|
| Pharmacist | Therapeutic appropriateness, clinical assessment, patient care decisions, counselling, and, under provincial authority, prescribing activities |
| Regulated pharmacy technician | Independently accountable for the technical accuracy of the product: product and dose verification, transfers, and receiving verbal prescriptions where permitted |
| Pharmacy assistant | Unregulated support tasks under supervision; no independent verification authority |
| Pharmacy student or intern | Practises under the direct supervision and accountability of a licensed pharmacist |
Regulation of pharmacy technicians was a structural change in Canadian pharmacy: by transferring accountability for technical checking, it created the capacity for pharmacists to expand into clinical services. The division is functional rather than hierarchical — a technician's independent product check is a distinct professional judgement, not a delegated task.
The Wider Healthcare Team
| Provider | Relevance to medication management |
|---|---|
| Family physician, nurse practitioner | Diagnosis and prescribing; the nurse practitioner prescribes independently in every province |
| Registered nurse, registered practical or licensed practical nurse | Administration, monitoring, patient education; often first to detect an adverse effect |
| Dietitian | Nutrition support, enteral and parenteral feeding, food-drug interactions |
| Physiotherapist, occupational therapist | Function, falls risk, device and dexterity assessment |
| Social worker | Coverage, housing, and social determinants affecting adherence |
| Dentist, optometrist, midwife, podiatrist | Prescribe within defined scopes that vary by province |
Canadian care settings each shape the pharmacist's role: primary care and family health teams (chronic disease management and medication reviews), acute care (order review, antimicrobial stewardship, dosing services), long-term care (quarterly medication reviews and deprescribing), and home care (adherence support and caregiver education).
The Six Interprofessional Competency Domains
The Canadian national interprofessional competency framework defines six domains. Two are described as supporting the other four.
- Interprofessional communication — communicating in a responsive, responsible manner across professions.
- Patient-, client-, family-, community-centred care — the patient is a partner, not a subject of the team's plan.
- Role clarification — understanding one's own role and the roles of others, and using that knowledge to set goals. Most avoidable interprofessional conflict traces back to role ambiguity.
- Team functioning — the principles and processes of effective teamwork, including shared decision processes and meeting structure.
- Collaborative leadership — leadership shared according to the situation and expertise rather than fixed by profession.
- Interprofessional conflict resolution — actively engaging with disagreement rather than avoiding it.
Communicating a Recommendation: SBAR
A recommendation that is unclear, undocumented, or unactionable does not change care. SBAR gives every clinical communication a predictable shape:
- S — Situation: who the patient is and what the issue is, in one sentence.
- B — Background: the relevant history, current therapy, and pertinent results.
- A — Assessment: the pharmacist's clinical interpretation.
- R — Recommendation: a specific, actionable proposal, including monitoring.
"Dr. Nadeau, this is about Mrs. Okafor, 78, on your list. She was started on trimethoprim-sulfamethoxazole three days ago and she also takes ramipril and spironolactone. Her potassium today is 6.1 mmol/L, up from 4.6 last month. I think the antibiotic combination is driving the hyperkalemia. I'd suggest switching to nitrofurantoin given her creatinine clearance of 48 mL/min, holding the spironolactone, and repeating the potassium in 48 hours. Would you like me to arrange the repeat blood work?"
The elements that make this effective are the specific alternative, the dosing-relevant data, the concrete monitoring plan, and the offer to take on part of the work.
Documentation follows every significant recommendation: what was communicated, to whom, when, the outcome, and any recommendation that was declined together with the stated reason.
Conflict Resolution
Conflict in healthcare teams arises from role ambiguity, differing priorities, scarce resources, and communication breakdown. Constructive resolution follows a recognisable path: address it early and privately, describe the behaviour or issue rather than the person, use "I" statements, seek first to understand the other perspective, focus on the shared goal of patient care, and separate positions ("you must change this order") from interests ("we both need this patient not to be readmitted").
When the disagreement concerns patient safety, the pharmacist's professional obligation prevails over deference. Escalate through the recognised chain — prescriber, then the most responsible physician or clinical lead, then the pharmacy manager and, where applicable, the medical advisory committee — and document each step. A pharmacist who is not satisfied that a therapy is safe is entitled and obliged to decline to dispense it, having taken reasonable steps to resolve the concern and to ensure the patient is not abandoned.
Transitions of Care
Admission, transfer, and discharge are the highest-risk points in the medication use process, because two systems hold different lists and neither is authoritative. Safeguards:
- Complete a best possible medication history on admission and reconcile it against the admission orders.
- Reconcile again at every transfer between units or facilities.
- At discharge, produce a single reconciled list that states what has been started, stopped, changed, and continued, and explain it to the patient and caregiver.
- Send the list to the community pharmacy and the family physician; the community pharmacist is often the only clinician who sees both the pre-admission and post-discharge regimens.
- Follow up by telephone within a few days for high-risk patients — those on anticoagulants, insulin, opioids, or with many medication changes.
In a Canadian community pharmacy, which task falls within the independent accountability of a regulated pharmacy technician?
Which element is essential to a recommendation structured with SBAR?
Which interprofessional competency domain is most directly addressed when a team explicitly maps who is responsible for adjusting insulin doses between the nurse practitioner, the pharmacist, and the diabetes educator?
What is the most effective single safeguard against medication error at hospital discharge?