Building a hospital outpatient pharmacy in at Sault Area Hospital in Sault Ste. Marie
In a time when accessible healthcare is more critical than ever— especially in Northern communities where medical resources are scarce— University of Waterloo School of Pharmacy alumni are tackling this challenge with innovative ideas.
When Sarah Zorzit (Rx2014) was first hired to further guide the development of and operationalize an outpatient retail oncology pharmacy at Sault Area Hospital in Sault Ste. Marie, Ontario (about 700 kilometers north of Toronto), her team started serving patients from a 200 square foot ancillary space adjacent to the inpatient pharmacy in the hospital.
The iCcare Pharmacy was developed in response to a clearly identified gap in care for oncology patients at Sault Area Hospital — the need for a dedicated outpatient pharmacy. A business case was put forward by Sault Area Hospital pharmacists, including University of Waterloo School of Pharmacy alumni Andrew Haddy (Rx2012) and Alison Hemy (Rx2012), outlining the clinical and operational benefits of establishing such a service. With support from the Hospital, and a team that included Waterloo Pharmacy alumni Jillian Grocholsky (Rx2012) and Aaron Cuthbertson (Rx2015), Zorzit opened the pharmacy in 2017.
“At the time we were only dispensing oral chemotherapy therapeutics, but we always had a vision to practice to our full scope – to support patients who are experiencing the most difficult time of their lives,” says Zorzit.
The vision became reality in 2022, when the pharmacy moved from its modest beginnings to their current location across from the Algoma District Cancer Clinic. Now the designated manager, Zorzit leads a small but impactful team serving patients from Sault Ste. Marie and the surrounding area, from Blind River to Wawa.
“It’s incredibly rewarding to work in a pharmacy that is hospital owned,” Zorzit says. “Our outpatients reap the benefits while all the revenue comes back to the hospital operations to support the healthcare system as a whole in our community.”
Sarah Zorzit and Logan Coccimiglio at iCcare Pharmacy, Sault Area Hospital. Photos credit: Sault Area Hospital.
The pharmacy has several services they offer to their patients, including a pharmacist-led immunization clinic where they optimize patient vaccinations before they start immunosuppressive therapy, ensuring patients’ immunizations are up to date and that they have the necessary antibodies before they’re immunosuppressed.
“We were inspired by a publication from the American Association of Clinical Oncology journal last fall that highlighted all vaccines patients should have before starting cancer treatment,” says Zorzit. Our pharmacists, alongside Waterloo Pharmacy co-op and fourth year patient care rotations students, now administer those vaccines two to four weeks before patients start chemotherapy to avoid preventable deaths and hospital admissions.”
The pharmacists monitor every oral chemotherapy patient’s bloodwork and medications, looking for any abnormal lab values and providing oral chemotherapy education. Patients receive tailored care and direct intervention by a pharmacist each month.
The pharmacy contains a counselling room and an over-the-counter dispensing area where the pharmacy team prepares individualized pre-medications for every outpatient, providing them with medication guidance. Each patient receives a calendar to follow, relieving them from the responsibility of managing their treatment schedule. Oral chemotherapy patients are contacted for a follow-up call one week after initiating treatment, undergo a physical assessment by the nursing team at the two-week mark, and participate in monthly consultations with both a pharmacist and their oncologist, with additional access to cancer supportive care and mental health services.
“Our retail pharmacy is deeply integrated with the cancer clinic, both physically and through close interdisciplinary collaboration. Patients appreciate that we’re present during their visits and that we coordinate their pharmacy care to align seamlessly with their treatment schedules allowing them to receive comprehensive support in one visit,” says Zorzit.
Sarah Zorzit
The oncologists and pharmacists communicate and collaborate to deliver the best patient care. “Our pharmacists practice to the full extent of their scope, supported by technicians who are essential to our operations. The patients see our camaraderie and appreciate our teamwork across the department,” adds Zorzit.
Despite the success, challenges remain particularly in recruiting pharmacists and technicians to Northern Ontario. Zorzit sees student placements as a vital pipeline for future talent.
“Welcoming Waterloo Pharmacy co-op and clinical rotation students is fundamental to our operations. I always tell them if they want a truly interprofessional environment, our small community is the place to grow with a focus on life-work balance,” she says. “Our physicians genuinely value the expertise pharmacists bring to the table, and collaboration is at the heart of everything we do, together with nurses and other healthcare professionals.”
Looking ahead, Zorzit is hopeful that with the government’s focus on the North, the hospital will receive more help for pharmacist-expanded scope to better serve patients in these smaller communities. “Investing in pharmacists will help alleviate some of the stress on our healthcare system in Canada, especially in the North.”