Board Highlights - February 14, 2020

Board Highlights - February 14, 2020

Topics include amendments to PPP-71 Delivery of Methadone for Maintenance, amendments to PPP-68 Cold Chain Management of Biologicals, amendments to the Controlled Prescription Program Forms, Budget 2020/2021 and more. 

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

Pharmaceutical Care Management Strategy Update

Mitch Moneo, Assistant Deputy Minister of the Pharmaceutical Services Division of the Ministry of Health, presented to the Board key highlights and achievements of the Pharmaceutical Services Division, as well as possible mandate changes coming soon.

Amendments to PPP-71 Delivery of Methadone for Maintenance

The Board approved the following amendments to Professional Practice Policy 71 – Delivery of Methadone for Maintenance (PPP-71):

• Broadening the policy to encompass delivery of Opioid Agonist Treatment (OAT) by including buprenorphine/naloxone and slow release oral morphine in addition to methadone. The policy name will be updated to “Delivery of Opioid Agonist Treatment” to reflect this change.
• Permitting delivery to a location that is safe for both the patient and the pharmacist, is private, maintains confidentiality of the patient, and has a verifiable address (no longer restricted to a patient’s home address).
• Removing the restriction for delivery to be provided based on immobility or extraordinary circumstances so that a pharmacist may provide delivery if it is safe, appropriate and in the best interest of the patient to do so.
• Removing the requirement for physician authorization for delivery to allow a pharmacist to use their professional judgement to decide to deliver OAT to a patient (together with appropriate communication to the prescriber).
• Adding new safety provisions including:
  • Allowing a pharmacist to refuse to deliver OAT if there is concern for the safety of the patient, the pharmacist, or the public;
  • Requiring that pharmacy managers have written policies and procedures in place to ensure the safety of the patient and pharmacist, and the security of the drug during delivery.
• Clarifying that only a pharmacist may deliver OAT directly to a patient, as a pharmacist is required to assess a patient prior to releasing an OAT drug.
• Strengthening the recommendation for pharmacists to refer a patient to another pharmacy if they are unable to provide delivery services.

As part of the development of these amendments, consultations were held with a variety of stakeholders, including prescribers and patient representatives. Overall, these amendments are intended to improve access to OAT therapy for patients whose care may benefit from delivery while ensuring the safety of both the patient and the pharmacists involved. This policy’s amendments also align with Health Canada’s position on the ​ Transportation of Controlled Substances in Canada (2018), which allows pharmacists to transport controlled substances to a patient with an appropriate prescription. 

These amendments will come into effect on April 1, 2020.

Amendments to the Controlled Prescription Program Forms

The Board approved amendments to the Controlled Prescription Program forms to create a harmonized form.

The Controlled Prescription Program (CPP) is a duplicate prescription program created to prevent forgeries and reduce inappropriate prescribing of drugs listed in Schedule 1A. Prescriptions for drugs specified in the CPP must be written on a duplicate form specifically developed for this purpose.

Prior to these amendments, there were two CPP forms in use, a generic CPP form used for the majority of controlled prescriptions, and a methadone CPP form which is used to prescribe methadone for maintenance treatment.

Since the release of the new Provincial Guidelines for the Clinical Management of Opioid Use Disorder by the BC Centre on Substance Use, prescribers have been using the generic CPP form to prescribe buprenorphine/naloxone and slow release oral morphine for OAT.

This creates inconsistencies amongst prescriptions for OAT drugs as prescriptions written on the generic CPP form are “void after 5 days,” where as prescriptions for methadone for OAT are not as they include a “start day” and “last day.”

In November 2019, the CPP Advisory Committee (CPPAC) developed a harmonized CPP form for the prescribing of all 1A drugs.

The benefits of having a harmonized CPP form include:

• A consistent approach to writing prescriptions for all 1A drugs;
• Increased patient access to OAT therapy, as all physicians will have the form (currently only OAT prescribers have the methadone CPP form); and,
• Reduce the administrative burden associated with ordering/printing of two pads for 1A drugs.

The harmonized CPP form also reflects the amendments to PPP-71 Delivery of Methadone for Maintenance which will come into effect April 1, 2020. Most notably, the form no longer requires physician authorization for delivery which reflects that pharmacists may use their professional judgement to determine whether or not to deliver OAT to a patient. Instead, the new form will allow prescribers to specify that delivery is not permitted.

To provide time for prescribers and pharmacists to update their practices, as well as phase out the current CPP forms, the new form will not be implemented until a later date which will be communicated once the new forms have been printed by the Ministry of Health.

Amendments to PPP-68 Cold Chain Management of Biologicals

The Board approved amendments to Professional Practice Policy- 68 – Cold Chain Management of Biologicals (PPP-68), broadening the application of the policy to all drugs that require cold chain management and renaming it to“Professional Practice Policy-68 – Cold Chain Management.”  These changes come into effect immediately.

PPP-68 was originally approved in 2011 and adopted the BC Centre for Disease Control (BCCDC) guidelines on the Management of Biologicals (BCCDC Vaccine Guideline) to address the concerns with larger volumes of vaccines being stored at pharmacies as a result of pharmacists’ injection authority, but lack of storage standards for vaccines and other biologicals that require refrigeration.

Recognizing that there are drugs other than biologicals and vaccines that require refrigeration, it was recommended that PPP-68 be broadened to include any drug requiring cold chain management, and revised to better align with current pharmacy practices.

The amendments specify that all drugs requiring refrigeration be maintained in accordance with applicable requirements (e.g., manufacturer’s requirement, BCCDC Vaccine Guideline, and NAPRA compounding standards).

Key requirements of the amended policy include:

Refrigerators, Freezers and other storage equipment:

• The equipment must be purposed for drug storage only (e.g. storage of food in the same equipment is not permitted);
• The equipment must maintain only one temperature range enclosed by a door with an air-tight seal (e.g. a bar fridge that contains both refrigerator and freezer compartments with only one exterior door is not acceptable as it does not maintain even temperatures).
• The equipment must maintain a temperature range suitable for the drugs stored in the equipment.
• Cold storage equipment must be equipped with a digital thermometer or digital temperature monitoring system.

Temperature Recording and Monitoring

• In recognition of modern technology, the amended policy permits temperatures to be recorded either manually or automatically.
• If the temperature is recorded and monitored manually, it must be done at least twice each working day, documenting the current temperature, and minimum and maximum temperatures reached since the last recording.
• If the temperature is recorded automatically, the system must record temperature at a frequency that can determine the same or more temperature information provided by manual recording (current temperature and minimum, maximum temperature reached twice a day), and an alarm must be in place to alert staff of temperature excursions.

Record Retention

• Temperature records, equipment maintenance records, and documentation on actions taken for drugs experiencing a temperature excursion must be easily retrievable and retained for 3 years.

Pharmacy Specific Policies and Procedures and Staff Training

• To provide more flexibility, the pharmacy manager is required to establish policies and procedures specific to the pharmacy’s practices.
• The pharmacy manager must ensure staff are trained on these policies and procedures in accordance with PODSA Bylaws.

The amendments to PPP-68 Cold Chain Management  are now in effect.

Budget 2020/2021

The Board approved the 2020/2021 budget in order to support significant College work and initiatives over the coming fiscal year and into the future. 

Regulation, along with patient needs and the healthcare environment have grown increasingly complex, and the College is facing increasing cost pressures in its work to ensure pharmacy practice is safe. 

The budget for 2020-2021 was developed to ensure support for both core functions and activities under its next strategic plan. Cost pressures, including continual increases in legal costs associated with investigations, and ongoing updates to College systems to ensure information and privacy are appropriately protected, have also added additional stress on the current resources available. 

Integral to the 2020/2021 budget is the College’s upcoming Strategic Plan, which is needed to ensure the College is poised to continue to regulate in the public’s best interest now and into the future. Major components of the strategic plan include: 

• Updating standards of practice under the Health Professions Act to ensure the public is given evidence-informed, patient-centred, team-based care. 
• The implementation of mandatory medication error reporting. 
• The development of a new innovation strategy to enable practice innovation through regulation that enhances health and wellness of the public and ensures patient safety. 
• The development of a Patient Bill of Rights to help the public know what to expect from pharmacy professionals and see them as a valuable resource on their healthcare team. 

In addition to supporting these vital strategic objectives, the 2020/2021 budget also addresses the need for ongoing investment into supporting and improving the College’s systems with regards to privacy, security, records management and registration. Central to this is ensuring that appropriate measures are taken to protect public and registrant data. 

This budget also includes ongoing work toward meeting Excellence Canada’s Gold Certification, which is designed to ensure that the College is operating efficiently and effectively through our foundational business processes, technological supports, staffing and governance. 

As such, in order to earn sufficient revenue, registrant fees will increase:

Even with this increase, the College’s fees for pharmacy professionals remain among the lowest in Canada, with annual pharmacist fees reaching up to $1,000 in other provinces. Pharmacy technician fees remain similar to those in Alberta and Ontario, both of which currently sit at $500. 

The College is funded almost entirely through registrant and pharmacy licence fees. Previously, the College has been able to keep increases to a lower level by drawing on its larger reserves to reduce the fee increases required to fund the budget. However, starting this year, the College needs to limit drawing from its reserves to ensure it maintains an acceptable reserve balance.

The College is working hard to reduce costs elsewhere and increase efficiencies to avoid increasing fees any more than is absolutely necessary this year and into the future.

Recap of the Board Meeting on Social Media