The Year in Review
As we prepare to hit the ground running in 2019, we’d like to reflect on many of the different ways we worked on improving public safety the over the past year. From introducing new pharmacy ownership requirements and new electronic record keeping requirements, to our continued efforts on the opioid crisis, and our work towards improving cultural safety and humility for First Nations and Aboriginal People’s, 2018 was a busy year for the College and brought in significant changes for pharmacy practice in BC.
Take a look at some of the topics that shaped pharmacy practice in 2018:
Pharmacy Ownership Requirements
On April 1, 2018, the College’s amendments to the Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws, which incorporate the new pharmacy ownership requirements approved by the Provincial Government in 2016, came into effect.
The new requirements permit the College to know the identity of all pharmacy owners, determine their suitability for pharmacy ownership and hold them accountable for providing safe and effective care by ensuring their pharmacies are compliant with the legislative requirements for pharmacies in BC.
Key changes in the amendments include shifting the responsibility of applying for a new pharmacy licence, renewing a pharmacy licence, and submitting changes of pharmacy licensure information from the pharmacy manager to the direct owner.
Cultural Safety and Humility
On March 1, 2017, the College’s Registrar, Bob Nakagawa, pledged the College’s commitment to improving BC pharmacy professionals’ work with First Nations and Aboriginal Peoples by signing the “Declaration of Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal Peoples in BC”
The College believes that cultural safety and humility are vital for the provision of fair and equal health services, as well as the creation of a healthcare environment free of racism and discrimination.
The declaration commits the College to report on its progress within our annual report and outline strategic activities that demonstrate how we are meeting our commitment to cultural safety.
Medication Error Reporting
In November 2018, the College decided to begin exploring the implementation of mandatory medication error reporting to an independent third party.
This comes after Melissa Sheldrick – a patient safety advocate whose son passed away due to a drug dispensing error in Ontario – requested that the College consider the implementation of mandatory medication error reporting.
Mandatory anonymous error reporting provides data that can be analyzed to help identify trends in errors that are occurring and provide opportunities to learn from mistakes, improve practice and better protect the public.
Cannabis Legalization in Canada
On October 17, 2018, the Government of Canada’s Cannabis Act came into force, establishing a new framework for controlling the production, distribution, sale and possession of non-medical cannabis in Canada.
While those using cannabis for medical purposes are expected to comply with BC’s cannabis laws, the province has included some exemptions for the use of Health Canada authorized medical cannabis in otherwise prohibited areas, as long as specific requirements are met.
Cannabis (for medical or non-medical purposes) is not available through pharmacies in BC.
Private retail stores licenced through the Province will also be prohibited from using a business name that includes the words (in traditional or non-traditional spelling) “pharmacy,” “apothecary,” or “dispensary.” Graphics associated with a pharmacy, including for example a green cross, are also prohibited.
Read More: ReadLinks – Cannabis Legalization in Canada
Public Health Crises
2018 brought with it a number of issues that had a powerful impact on public health and safety. Including the opioid crisis, wildfires and drug shortages/recalls.
As a health regulator and trusted source of public health information, the College needs to help communicate what to expect from pharmacy professionals in caring for the patients that are affected by crises and emergency situations.
EpiPen® auto-injectors have been in short supply since January 2018 with PharmaCare placing a limit for EpiPen® products in PharmaNet to two per dispense for PharmaCare-paid claims starting in April 2018.
EpiPen® and EpiPen Jr® auto-injectors are used to deliver an emergency treatment of adrenaline (epinephrine) to patients who are at risk or have a history of life threatening allergic reactions (anaphylaxis).
In response, the College created and distributed a comprehensive resource with advice for affected patients; guidance for pharmacists to provide access to alternate forms of epinephrine; as well as a patient information sheet developed in collaboration with the BC Pharmacy Association.
In July of 2018, Health Canada issued a recall for several drugs containing valsartan due to contamination with a potential carcinogen.
Drugs containing valsartan are used to treat patients with high blood pressure to prevent heart attacks and stroke as well as patients who have had heart failure or a recent heart attack.
In response, the College distributed multiple announcements and resources outlining the Drug Information Numbers and Lot Numbers of affected products, as well as guidance for pharmacy professionals to provide safe therapeutic alternatives and substitutions.
BC Wildfires - State of Emergency
In response to the emergency, the College reached out to registrants via email, social media and through our website to provide them with information on how to use our Find a Pharmacy tool to locate a pharmacy in an affected community; the provisions laid out in Professional Practice Policy 25 – Pharmacy Disaster Preparedness; and to provide them with the appropriate College contact for questions related to continuity of care during an emergency.
Opioid Overdose Crisis
The opioid crisis continues to be a top concern for us and other public health organizations across the province. BC’s opioid overdose crisis has continued its unprecedented escalation over the past three years, the rate of overdose deaths in BC 2018 remaining consistent with that of 2017.
Here is a brief recap of some of the policies and materials we developed this year to help address BC’s opioid crisis:
Understanding How Stigma can Impact Patient Care
Our former Board Chair, Mona Kwong, spoke about her experiences with stigma in health practice, and how health professionals can work to reduce it using respectful language.
Stigma involves negative attitudes (prejudice) and negative behaviours (discrimination) toward people with substance use and mental health problems. Within the context of healthcare, stigma often has negative impacts on patient health, creating barriers to access, and contributing to shame, isolation, risk taking and overdoses.
Learn more about stigma and how it relates to the opioid crisis in this special message from our Board Chair: A Message from Our Board Chair: Understanding How Stigma can Impact Patient Care
Nasal Naloxone Available at No Cost to First Nations in BC
As part of the ongoing strategy to reduce harm from opioid drug use and save lives, the First Nations Health Authority has added Naloxone nasal spray as a benefit, effective April 4, 2018.
Nasal Naloxone provides people with a fear of needles, or those living in communities where needles are stigmatized, with an easier option for responding to opioid overdoses.
First Nations in BC may now request Nasal Naloxone directly from their pharmacy.
New Opioid Agonist Treatment Policy
On January 1, 2018, amendments to Professional Practice Policy – 66, including changing its name from “Methadone Maintenance Treatment” to “Opioid Agonist Treatment,” came into effect. These amendments also include the introduction of new policy guides for buprenorphine/naloxone, and slow-release oral morphine.
PPP-66 now supports the BCCSU’s new Provincial Guidelines for the Clinical Management of Opioid Use Disorder that recommend buprenorphine/naloxone as the preferred first-line opioid agonist treatment for opioid use disorder.
New Policy on Injectable Opioid Agonist Treatment
On September 1, 2018, the new Professional Practice Policy-67 for Injectable Opioid Agonist Treatment (iOAT), as well as an accompanying Policy Guide for Injectable Hydromorphone Maintenance Treatment will come into effect. These documents set out the requirements for the safe dispensing of injectable hydromorphone for the treatment of opioid use disorder, addressing the previous absence of such requirements.
Under this model, patients will self-administer injectable hydromorphone within their community pharmacy up to 3 times per day.
New Opioid Agonist Treatment Training Requirements
A new opioid agonist treatment training program for community pharmacy has been developed aimed at reducing stigma and expanding pharmacists’ knowledge about methadone, buprenorphine/naloxone and slow-release oral morphine in order to address the opioid crisis.
Developed by the BC Pharmacy Association, the new Opioid Agonist Treatment Compliance And Management Program (OAT-CAMPP) includes training on buprenorphine/naloxone, methadone and slow release oral morphine maintenance treatments, as well as on opioid use disorder itself.
The training program aligns with PPP-66 and will replace the College’s current MMT training program.
The new training requirements will be effective starting on January 1, 2019 with a transition period taking place up until March 31, 2021 at which point the College’s MMT Training Program will no longer be available.
Electronic Record Keeping
The College introduced new Electronic Record Keeping requirements came into effect on November 13, 2018.
Under the new records management framework, pharmacies are permitted to continue keeping only hard copy records, only electronic records, or a combination of both.
Well-kept records support the provision of safe services, continuity of care, and evidence-based care, as well as good professional practice and medication management.
While the College had already enforced general record keeping requirements in s. 23(1) of the Pharmacy Operations and Drug Scheduling Act Bylaws prior to this, a number of requests had been submitted by registrants to formally allow electronic record keeping.
Medical Assistance in Dying
On November 1, 2018, new reporting requirements for Medical Assistance in Dying (MAiD) came into effect.
In BC, pharmacists who dispense drugs for the purposes of MAiD are now required to submit both federally and provincially required information to the Ministry of Health within 6 business days after the scheduled date of MAiD Protocol.
College Wins Regulatory Excellence Award for Pharmacy Security
On September 28, 2018, the Council on Licensure, Enforcement & Regulation (CLEAR), presented the College with the 2018 Regulatory Excellence Award for our work on pharmacy security measures.
The CLEAR Regulatory Excellence Award recognizes an individual, team, program or agency demonstrating an outstanding contribution to the enhancement of occupational or professional regulation, regulatory processes, or consumer and public protection.
This comes after an evaluation found that the College’s pharmacy security measures had their intended effect across the province, most notably in Vancouver where the rate of pharmacy robberies dropped 94% after the requirements took effect.