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Board Highlights - November 26, 2021
Topics include medication incident reporting update, proposed bylaw amendments to adopt NAPRA Standards for Sterile Compounding, amendments to pharmacist drug administration age limit and more.
How to Watch
Along with organizations across Canada, College staff and Board members have been doing our part to reduce the spread of COVID-19 by working remotely. As such, this month’s Board meeting was conducted virtually, via video conference.
A recording of the November Board Meeting is available here:
LAND ACKNOWLEDGEMENT
On behalf of the College of Pharmacists of BC, Board Chair Claire Ishoy, acknowledged and thanked the Sylix Okanagan people on whose unceded traditional territories she chaired the November 26, 2021 meeting. With Board members meeting virtually in different locations across BC, Chair Ishoy also acknowledged that Indigenous Peoples are the traditional stewards of the lands and waters from which each member attended the meeting from.
To the Indigenous peoples of this place we now call British Columbia: We turn our minds to you and to your ancestors. You have kept your unceded homelands strong. We are grateful to live and work here.
Board Chair and Vice-Chair Election Results
The College Board elections for Chair and Vice-Chair took place at the November meeting.
Chair: Steven Hopp, District 4, was elected Board Chair
Vice-Chair: Andrea Silver, District 3, was elected Board Vice-Chair
Medication Incident Reporting Update
Ashifa Keshavji, Director of Practice Reviews and Quality Assurance, provided the Board with an update on the College’s work towards implementation of mandatory anonymous medication incident reporting in BC.
Medication related issues are among the most common complaints received at the College. Due to its potential impact on patient safety, implementation of mandatory incident reporting has been a priority for pharmacy regulatory authorities across Canada. This has prompted the College to examine its existing quality management requirements and explore options for implementation in BC.
At the September 2019 Board meeting, the Board directed the Registrar to require mandatory anonymous medication incident reporting in all pharmacies using any medication incident reporting platform of the pharmacy’s choosing that meets the College’s criteria. Medication incident reporting is also a key initiative in the College’s 2021/22 - 2025/26 Strategic Plan.
Since 2019, the College has participated in the National Association of Pharmacy Regulatory Authority’s (NAPRA’s) Model Standards of Practice for Continuous Quality Improvement and Medication Incident Reporting Working Group to develop national standards of practice for reporting, analyzing, preventing, and learning from medication-related incidents.
The NAPRA Model Standards of Practice for Continuous Quality Improvement and Medication Incident Reporting by Pharmacy Professionals, approved by the NAPRA Board and published in July 2021, are based on the principles of a culture of patient safety and a just culture within the pharmacy practice environment, wherein learning is promoted through reporting without fear of punitive action. This provides pharmacy professionals with information and learning opportunities based on meaningful analysis of both pharmacy-level and national/provincial-level data, with the goal of reducing the number of medication incidents, mitigating risks to patients, and improving the quality and safety of patient care.
COVID-19 has impacted the implementation timelines of the Medication Incident Reporting Program by approximately one year due to the delayed launch of the College’s 2021/22 - 2025/26 Strategic Plan and the NAPRA Medication Incident Reporting Working Group’s temporary pause of work in 2020.
Moving forward, the College will continue to engage in opportunities for discussion with other pharmacy regulatory authorities across Canada for the establishment of a national repository of medication incident and near miss reporting data.
Proposed Bylaw Amendments to Adopt the NAPRA Standards for Sterile Compounding
The Board approved for public posting, amendments to the Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws to adopt the National Association of Pharmacy Regulatory Authorities (NAPRA) model standards for sterile compounding.
In 2015 and 2016, NAPRA released its Model Standards for Pharmacy Compounding of Non-hazardous Sterile Preparations and Model Standards for Pharmacy Compounding of Hazardous Sterile Preparations. These Model Standards represent the minimum requirements to be applied in compounding sterile preparations nationally and are expected to be adopted by pharmacy regulatory authorities across Canada.
The aim of the Model Standards is to provide pharmacy professionals who compound sterile preparations with the standards necessary to evaluate their practice, develop service-related procedures and implement appropriate quality controls for both patients and compounding personnel, with a view to guaranteeing the overall quality and safety of sterile preparations.
Patient safety was the driving force behind the development of the Model Standards. The Model Standards were developed in response to devastating consequences resulting from chemotherapy preparation issues in Canada (Marchese Hospital Solutions) and substandard facilities operating in the United States (The New England Compounding Centre).
In 2017, the College Board approved the Model Standards for a phased implementation. This phased approach was informed by a multi-step engagement process and set the deadline for the official adoption of the Model Standards to May 2021. However, in September 2020, the Board approved a one-time extension due to the onset of the COVID-19 pandemic. As a result, the deadline was extended from May 2021 to July 2022.
In order for the Model Standards to be officially adopted in the College’s bylaws, amendments to the PODSA Bylaws, HPA Standards of Practice and a number of the College’s Professional Practice Policies are needed.
These proposed amendments are laid out in full detail in the public posting page on the College’s website.
The Bylaw amendments also limit compounding of sterile products to registrants only. In BC, as per the Pharmacists Regulation, compounding is listed as a restricted activity that can only be conducted by a registered pharmacy professional while practicing pharmacy.
Permitting only registrants to compound sterile products enhances public safety. It will increase accountability and allow for more consistency in education and training requirements, and it aligns with the College’s mandate of protecting public health by ensuring that every pharmacist and pharmacy technician in BC is fully qualified and able to provide the public with safe and ethical pharmacy care.
These amendments have been posted for public comment on the College’s website for a period of 90 days, after which they will be brought back to the Board for approval. Share your comments by February 24, 2022.
Legislation Review Committee: Temporary and Limited Training Requirement Suspension in Professional Practice Policy 66
The Board approved amendments to Professional Practice Policy – 66 Opioid Agonist Treatment (PPP-66) to temporarily suspend the OAT-Compliance and Management Program for Pharmacy (OAT-CAMPP) training requirement for pharmacists who are only providing the COVID-19 and/or flu immunizations, including boosters, during the COVID-19 public health emergency.
One of the requirements within PPP-66 is for certain College registrants to complete OAT-CAMPP. More specifically, for pharmacists, PPP-66 requires that all pharmacy managers, staff pharmacists, and relief pharmacists employed in a community pharmacy that provides pharmacy services related to OAT, to complete OAT-CAMPP.
The College was recently asked by officials responsible for the Province’s COVID-19 vaccine roll-out and immunization efforts to review its training requirements stated in PPP-66 to determine if they may pose a potential barrier for patients wanting to access the COVID booster via community pharmacies. And, if a potential barrier was identified, to consider removing it.
In keeping with the College’s public safety mandate, the Board decided to amend PPP-66 to temporarily suspend the OAT-CAMPP requirement to help effectively address the COVID-19 public health emergency.
This suspension is limited to those pharmacists who are only providing COVID-19 immunizations, including boosters, and/or flu immunizations, and will be lifted once the COVID-19 public health emergency ends.
Hospital at Home - How Curiosity and Collaboration are Transforming Acute Care in BC
Winnie Lam and Dr. Sean Spina presented to the Board on the Hospital at Home Program.
Drug Administration Committee: Amendments to Pharmacist Drug Administration Age Limit
The Board tabled a motion to amend the Health Professions Act Bylaws to lower the patient age limit for drug administration by pharmacists by injection to 4 years of age. The proposed amendments will be brought back to the Board at the February Board meeting together with additional information requested by the Board.
Concerns have been raised that some children in BC have not been able to receive routine vaccines as easily during the COVID-19 public health emergency, as many public health resources have been prioritized for COVID-19 vaccination clinics. In particular, some children may not have received the two vaccines that are recommended for children aged 4-6 prior to entering school.
Some pharmacies in BC provide school-entry vaccines to children; however, the College’s Health Professions Act Bylaws only allow pharmacists to administer vaccines by injection to children aged 5 and older, and so pharmacists cannot provide school-entry vaccines to children who are 4 years of age.
The current age limit for drug administration by injection in the Health Professions Act Bylaws aligns with most other Canadian provinces and territories; however, in the past few years, a few provinces have permitted pharmacists and pharmacy technicians to administer injections to patients as young as 2 years of age.
Pharmacists in BC have been involved in administering publicly funded vaccines to patients 5 years and older for many years. Reducing the age limit to capture 4-year-old children could have a beneficial impact for children accessing school-entry vaccines through pharmacies.
There have been no significant safety concerns demonstrated in the literature or reported by other Canadian jurisdictions regarding pharmacist administration of injections to young children.
Other minor updates to strengthen requirements and improve clarity were also part of the amendments, which include (but are not limited to) the following:
- New clear standards requiring pharmacists to act in best interest of the patient, to take all appropriate steps to ensure the drug is administered safely, and to only administer a drug within the scope of their education, training and competence.
- Clarified requirements for the pharmacist following drug administration, including a requirement to ensure the patient is appropriately monitored, and to ensure the safe and appropriate disposal of devices, supplies and remaining drug, following administration.
- Added documentation requirements, including documenting the expiry date of the drug, the identification of pharmacist who administered the drug, and the patient response to drug administration.
- Amendments to the emergency measures requirements to make them more principle-based, with an updated requirement for the pharmacist to ensure there is access to the drugs and supplies needed to manage adverse reactions (and removal of specific examples of emergency measures), and an updated requirement to respond appropriately to complications and emergencies if they arise.
The proposed amendments will be brought back to the Board at the February Board meeting together with additional information requested by the Board.
Appointment of Board Members to Board Committees
The Board approved a number of new appointments to certain College committees.
College committees are a vital resource to the Board that provide essential advice, expertise, and recommendations that ultimately help inform Board decisions.
The Governance Committee met on November 1, 2021. It reviewed the current roster of committee members and is proposing certain changes to committee membership. The proposed changes are due in part to the Board Chair and Vice Chair election which takes place at every November Board meeting.
Audit and Finance Committee
- Reappoint Steven Hopp as Committee Chair
- Reappoint Alex Dar Santos as Committee Vice-Chair
- Reappoint Steven Hopp, newly elected Board Chair as a Member
- Appoint Andrea Silver, newly elected Board Vice-Chair as a Member
- Reappoint Alex Dar Santos as a Member
- Reappoint Anca Cvaci as a Member
- Reappoint Tracey Hagkull as a Member
Governance Committee
- Appoint Claire Ishoy as a Member, for a 3-year term
- Appoint Alex Dar Santos as a Member, for a 3-year term
- Appoint Anca Cvaci as a Committee Vice-Chair
Legislation Review Committee
- Appoint Eric Sletmoen as a Member, for a 3-year term
Past Chairs Advisory Committee
- Appoint Claire Ishoy as a Member, for a 3-year term
Registrar Evaluation & Succession Planning Committee
- Appoint Steven Hopp as Committee Chair
- Reappoint Steven Hopp, newly elected Board Chair as a Member
- Apppoint Andrea Silver, newly elected Board Vice-Chair as a Member
- Reappoint Terri Gibson as Member
- Reappoint Justin Thind as a Member
- Reappoint Claire Ishoy as Member
Board Meeting Guidelines: Robert's Rules to BCCNM Meeting Guidelines
The Board directed the Registrar to develop and bring forward meeting guidelines, based on those from the British Columbia College of Nurses and Midwives, and associated bylaw amendments, for the February 2022 Board meeting. Once developed, these new meeting guidelines would replace Robert’s Rules of Order as the document that governs the procedures of College Board meetings.
The Governance Committee has been discussing whether Robert’s Rules of Order is still the most applicable guideline for governing College Board meetings. The most recent edition of the manual is about 700 pages, containing formal parliamentary rules and procedures, which is considered appropriate for larger group settings. Since the College Board is generally a small group (e.g., consisting of 12 members, with possible fluctuations in size) it may be unnecessary and cumbersome for the Board to continue to use Robert’s Rule of Order to guide its meeting procedures and management.
The BCCNM Meeting Guidelines has a particular focus on consensus decision-making. In fact, it states that, “The Board has agreed that its decisions will be achieved through consensus whenever possible.” It highlights that reaching consensus can be challenging, and at times, not appropriate. However, it is a type of decision-making that works best where there is openness and trust, and the group has a common goal, a clear process, and a strong commitment to finding a balanced solution.
The Governance Committee has stated an interest in adopting BCCNM’s Board Meeting Guidelines as they may be better suited for the intended purposes of Board meetings.
As such, the Board approved the amendments and directed the Registrar to develop a modified version of BCCNM’s Board Meeting Guidelines to govern the procedures of Board meetings, with an aim to no longer use Robert’s Rules of Order. The modified meeting guideline document along with associated HPA Bylaw amendments will be brought forward for consideration at the February 2022 Board meeting.
Registrar Bob Nakagawa's Farewell Speech
The College's Registrar, Bob Nakagawa, reflects on his tenure at the College as he prepares for retirement.