Board Highlights - November 17, 2017

BOARD HIGHLIGHTS - NOVEMBER 17, 2017

Highlights from this meeting include an exploration into the potential alternatives to the College’s existing quality management requirements that include mandatory medication error reporting to an independent third party; amendments to the Pharmacy Operations and Drug Scheduling Act Bylaws regarding pharmacy ownership; amendments to Professional Practice Policy 66: Methadone Maintenance; and a review of the Framework for Pharmacist Prescribing Engagement Report. 

The College also celebrated Change Day BC 2017, encouraging registered health professionals to make a pledge to drive positive change within BC’s health system. 

LIVESTREAM

You can re-watch all the Board meeting presentations through the College’s Periscope Channel.

AUDIT AND FINANCE COMMITTEE – APPOINTMENT OF CHAIR AND VICE-CHAIR

The Board elected Mona Kwong and Arden Barry to serve as Chair and Vice-Chair (respectively) of the College’s Audit and Finance Committee. 

LEGISLATION REVIEW COMMItTEE

Mandatory Medication Error Reporting 

The Board directed the Registrar to explore potential alternatives to the College’s existing quality management requirements, including a standardized quality management program that includes mandatory medication error reporting to an independent third party. 

The second most common complaint received at the College are those regarding medication dispensing errors made by pharmacists. In addition, recent high profile cases of medication errors in Ontario and Saskatchewan have prompted the College to examine its existing quality management requirements for registrants. 

Current State 

Sections 10 and 14(1) of the Bylaws made under the Pharmacy Operations and Drug Scheduling Act (“PODSA”) requires pharmacy managers of community and hospital pharmacies to develop, document and implement an ongoing quality management program that includes, among other things, a process for reporting, documenting and following up on known, alleged and suspected errors, incidents and discrepancies.  The specific requirements of the program are left to the discretion of the pharmacy manager.  The program may or may not include requirements for mandatory reporting of medication incidents to a third party.  The College does not assess the adequacy of the program.  

The College has some oversight over quality management through its Practice Review Program, an in-person review of pharmacy professionals’ practices and the pharmacies where they work.

Interjurisdictional Scan 

Several provinces in Canada have implemented, or are in the process of implementing, new quality management requirements that include mandatory error reporting to an independent third party. In provinces that have adopted new quality management requirements, those requirements are generally more prescriptive than the College’s current requirements.

PODSA Bylaws – Owners

The Board approved amendments to the Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws regarding pharmacy ownership and consequential amendments to the previously filed telepharmacy bylaws for filing with the Ministry of Health. 

In conjunction with these amendments, the Board also approved the new Professional Practice Policy (PPP) 76 – Criminal Record History Vendor, as well as consequential amendments to eight PPP’s as a result of PODSA-Bylaw re-numbering. 

Background 

In May 2016, the Provincial government approved amendments to considerably change pharmacy ownership legislation within the PODSA. Key changes include authorizing the College to: 

• Identify pharmacy owners, including non-registrants;
• Determine pharmacy owners’ suitability for pharmacy ownership; and 
• Hold pharmacy owners accountable for providing safe and effective care, and ensuring that their pharmacies are compliant with legislative requirements.

To operationalize the amendments to the Act, the College developed corresponding bylaws. The proposed bylaws include licensure requirements for a new pharmacy licence application, renewal of a pharmacy licence and re-instatement of a licence. 

Also included in the proposed bylaws are transitional provisions for all existing pharmacies to bring them into compliance with the new requirements.

At their June 2017 meeting, the Board approved the public posting of the proposed bylaws for a 90-day period,  which ended on September 23, 2017. During the public posting period, the College received feedback recommending minor amendments to the bylaws and forms, as well as recommendations for new proposed bylaws.  

Minor amendments were made to the bylaws, including new definitions for clarity, as well as minor language changes to the roles and responsibilities of direct owners, directors, officers and forms. 

The revisions made to the bylaws have led to the renumbering of the entire PODSA bylaws document. As a result, existing professional practice policies (PPP’s), schedules and forms have been amended to reflect the new numbering of bylaws. 

The amended PPP’s will be in effect once the amended PODSA Bylaws come into force. 
 

HPA Bylaws – Board Terms of Office

The Board approved amendments to the Health Professions Act Bylaws to change the terms of office for elected Board members from two years to three years, and the maximum number of consecutive terms served by elected board members from three to two. These amendments also change  the Board election cycle into a three-year process. Elections  for four of the eight electoral districts will be held in each of the first two years of the cycle, and no elections held in the third year. 

These amendments are to be filed with the Ministry of Health. They will be effective by mid-January 2018, and implemented for the 2018 election. 

Policies on Buprenorphine/Naloxone and Slow Release Oral Morphine (Amendments to PPP-66)

The Board approved amendments to Professional Practice Policy (PPP) 66 Methadone Maintenance Treatment, including renaming the policy to “Opioid Agonist Treatment,” to be effective on January 1, 2018. 

The Board also approved the following two new PPP 66 Policy Guides, to also be effective on January 1, 2018:

• PPP 66 Policy Guide – Slow Release Oral Morphine Maintenance Treatment (2018)
• PPP 66 Policy Guide – Buprenorphine/Naloxone Maintenance Treatment (2018) 

 
The College has requirements in place for methadone when used as an OAT drug. However, with the release of the OAT prescribing guidelines by the BC Centre on Substance Use (BCCSU), a gap in policy exists in which there are no specific requirements regarding two other OAT drugs – slow release oral morphine (SROM) and buprenorphine/naloxone (commonly known as Suboxone®). The guideline recommends buprenorphine/naloxone (Suboxone®) as the preferred first-line treatment, methadone as the second-line treatment, and slow release oral morphine (Kadian®) as the third line treatment. These OAT medications are currently being prescribed and dispensed. And, the absence of requirements for safe dispensing of these drugs can lead to patient safety concerns. Therefore, staff have been establishing minimum requirements for dispensing SROM and buprenorphine/naloxone to complement the existing methadone requirements. 

The new SROM and buprenorphine/naloxone policy guides include many of the methadone requirements with the following noted differences: 

• Duplicative requirements from existing legislation were not included (e.g. privacy and confidentiality requirements which are already requirements in the Health Professions Act Bylaws, Schedule F-Standards of Practice, Part 1- Community Pharmacy);
• The regular Controlled Prescription Form will be required, and not the Methadone Controlled Prescription Form (which is specific to methadone);
• Faxed Controlled Prescription forms are not accepted with SROM and buprenorphine/naloxone, in accordance with the Controlled Prescription Program (CPP); and,
• Alterations to the Controlled Prescription forms are not accepted with SROM and buprenorphine/naloxone, in accordance with the CPP. 

In addition to speaking with a subject matter expert, the following groups were consulted with on the new SROM and buprenorphine/naloxone requirements: 

• BCCSU 
• The College’s Community Pharmacy Advisory Committee (CPAC); and
• The BC Pharmacy Association 

Feedback from these consultations was largely positive and as a result minor changes were made to the requirements.

In future, the requirements will be transitioned from policy to bylaws. 

Framework for Pharmacist Prescribing in BC 

The Board approved the submission of a proposal for pharmacist prescribing in BC to the Minister of Health, requesting amendments to the Pharmacists Regulation under the Health Professions Act. The submission will include the final Framework for Pharmacist Prescribing in BC and the Certified Pharmacist Prescriber Engagement Report. 

Gillian Vrooman, the College’s Director of Communications and Engagement, presented to the Board, the 2017 Certified Pharmacist Prescriber Engagement Report. 

The College is in the final stages of developing a Framework for Pharmacist Prescribing in BC which aims to help protect patient safety and improve patient outcomes. 

Development of a framework and proposal for pharmacist prescribing dates back to 2010 when the Board first decided to move forward with a feasibility study. The initial Draft Framework was approved for stakeholder engagement by the College Board at the November 2015 Board meeting, and used to help facilitate an initial stakeholder engagement was conducted from February to August 2016. 

After reviewing the results of the engagement, the College Board at their November 2016 meeting made the decision to amend the initial draft framework by narrowing the scope of pharmacist prescribing to within collaborative practice. 

2017 Engagement

The second engagement on pharmacist prescribing was conducted through June to October 2017 and feedback was sought on the new Framework for Pharmacist Prescribing in BC under four key themes: 

• Confidence in Pharmacist Prescribing 
• Collaboration 
• Improving Patient Care 
• Support for Pharmacist Prescribing 

The online consultation ran from September 21 through to October 8, 2017 and sought feedback from registered pharmacy professionals, patients and other health professionals. 

The College also hosted 3 live engagement sessions with patients and pharmacy professionals. Live engagement sessions included a Pharmacist Prescribing Patient Session on September 21, 2017, as well as sessions with the College’s Advisory Committees, Canadian Society of Hospital Pharmacists BC Branch and Health Authority Pharmacy Directors.

The purpose of this engagement was to give patients, pharmacy professionals and other health professionals an opportunity to provide their input and share their thoughts on how pharmacist prescribing in collaborative practice relationships could work to help care for patients in BC. 

Who We Heard From 

The College reached out to patients, pharmacy professionals, pharmacy students and other health professionals as part of the engagement on pharmacist prescribing. Like the initial engagement in 2016, the College continued to receive significant participation during the second engagement on pharmacist prescribing. 

The College would like to thank everyone who provided feedback during the consultation period, as well as those who helped build awareness of the opportunity to provide input. 

Feedback was collected in the following ways: 

• 1,122 completed responses through an online survey 
• 3 live engagement sessions
• 10 letters 

During the course of the online consultation period there were more than 3,700 visits to the Pharmacist Prescribing Engagement Page on the College`s website. 

The College also reached an estimated 58,000 through its Facebook channel and received over 470 reactions (with more than 90% positive reactions including likes and loves). The College also reached over 5,800 on Instagram and over 2,800 on twitter. 

Over 1,120 completed the online survey providing over 10,364 comments to a range of questions on pharmacist prescribing. 

While the majority of responses came from registered pharmacists (54%), the College received many responses from both members of the public (14%) and other health professionals (11%). Pharmacy students also made significant contributions to the survey (15%).
 
What We Heard 

Overall, most stakeholder groups had confidence in pharmacist prescribing in BC. Feedback indicated strong support for implementing pharmacist prescribing to help care for patients from pharmacists, pharmacy technicians, pharmacy students and members of the public. Physicians illustrated strong resistance, while others (such as nurses and nurse practitioners) indicated support for pharmacist prescribing. This pattern was apparent across the four key themes of confidence in pharmacists prescribing, collaboration, improving patient care, and support for pharmacist prescribing.

The greatest convergence across stakeholder groups surrounded the opportunities for greater collaboration in caring for patients as well as the ability to help protect patient safety and improve patient outcomes. In particular respondents noted that pharmacist prescribing would be beneficial for chronic disease management as well as minor ailments and prescription renewals and increased monitoring and management of drug therapy. 

GOVERNANCE COMMITTEE

Committee Update 

Public Board Member and Chair of the Governance Committee, Norm Embree provided an update on the activities of the Governance Committee since the previous Board meeting.

Application Committee – Appointment of Members 

The Board approved the formation of an Application Committee. 

This committee will be needed when the new amendments to the Pharmacy Operations and Drug Scheduling Act (PODSA) come into force anticipated for March 2018. The PODSA amendments give the college the authority to identify pharmacy owners, and as part of this change, the Application Committee will be required to review pharmacy licence applications that do not meet requirements in PODSA. 

The College has requested applications and the Governance Committee has populated the following members to serve on this committee. 

Board Members as Chairs of all Committees 

The Board approved the amendment to make the requirement for board members to serve as Chairs of committees voluntary for the Inquiry, Discipline, Application, and Registration Committees. 

As these four committees do not meet as a group, but in panels of usually 3-5 members on a frequent basis, it is decided that a board member will not be required to chair these committees.  This does not preclude a board member from being designated to chair one of these committees if so desired.

PODSA Ownership Project – Privacy and Security Update 

Doreen Leong, the College’s Director of Registration and Licensure provided the Board with an update regarding the work being undertaken on the PODSA.

To date, the privacy and security activities being completed by the College in relation to the PODSA Modernization Project include:

• Implementing the key recommendations from a thorough organization wide IT security review that was completed by Opus in 2016 
• A Privacy Impact Assessment has been developed with a legal/privacy expert and will soon be reviewed with College executive for approval
• A process review is being undertaking to determine any additional privacy risk mitigation strategies
• A consultation with the Office of the Information and Privacy Commission is being planned for a proactive review and an opportunity to learn other best practices

Given the sensitive nature of some of the information that the College is legislatively required to collect and use (e.g. Criminal Record Histories), there will need to be a continued focus on privacy and security over time.  Some of the ongoing steps will include:

• Continuing to monitor and implement emergent best practices as and when appropriate
• Continuing to review and refine internal staff process and processes involving the soon to be formed Application Committee
• Continuing to review Bylaws and Forms to ensure ongoing alignment with the legislative framework within which the College is collecting, using and disclosing information
• Continuing to review retention and disposal timelines

IT Competitive Bid Update

Mary O’Callaghan, the College’s Chief Operation Officer, provided the Board with an update regarding the early termination of the existing IT Managed Services Provider contract and the status of the current competitive bid, which was issued in September 2017. 

A review team is in the process of reviewing and scoring these proposals and expects to have a short list prepared prior to Christmas. The shortlisted businesses will be interviews mid-January and a recommendation will be brought to the Board at its February 2018 meeting. 

Change Day BC 2017

Gillian Vrooman, the College’s Director of Communications and Engagement provided a presentation to the Board on Change Day BC 2017, encouraging Board Members, Staff and other health professionals in attendance to make pledges to improve patient care in British Columbia. 

Change Day BC is on November 17, 2017 and is organized by the BC Patient Safety and Quality Council. 

As an official Organizational Partner of Change Day BC, the College is helping to build awareness by encouraging BC’s registered health professionals to join the movement and make a pledge to drive positive change within BC’s health system. 

What is a Pledge? 

A pledge is a voluntary personal commitment to changing healthcare in BC for the better. Past pledges have included: 

• Talking about mental health; 
• Spending a day in a patient gown; 
• Working to increase cultural safety for Indigenous people seeking health services; and 
• Acknowledging the work of fellow healthcare professionals. 

Pledges can be submitted at ChangeDayBC.ca/PLEDGE before end-of-day November 17, 2017.  

COMMITTEE UPDATES

The following College Committees provided updates on their activities since the previous Board meeting. 

• Audit and Finance Committee 
• Discipline Committee 
• Ethics Advisory Committee 
• Governance Committee 
• Inquiry Committee 
• Jurisprudence Subcommittee 
• Legislation Review Committee 
• Practice Review Committee 
• Quality Assurance Committee 
• Registration Committee 

​RECAP OF THE BOARD MEETING ON SOCIAL MEDIA