Pharmacy Regulation’s Hottest Topics: 2020
The Year in Review
2020 was a year like none other we’ve experienced in the recent past. Much like organizations across Canada and the world, much of the College’s focus this past year has been on supporting our Province’s response to the COVID-19 pandemic. Additionally, the College continued working to combat the opioid crisis, as well as to stand up against anti-Black and Indigenous-specific racism in BC’s health system.
Take a look at some of the topics that shaped pharmacy practice in BC in 2020:
On March 11, 2020, the World Health Organization declared the novel coronavirus, COVID-19, a pandemic, citing concern over alarming levels of spread and severity across the globe.
The pandemic brought with it many challenges to respond to, challenges which will continue to evolve as we move into 2021.
During the COVID-19 public health emergency, BC’s pharmacy professionals have been vital to our province’s efforts in ensuring patients continue to receive drugs, supplies and knowledge that they need to manage, prevent and treat a multitude of diseases and symptoms.
Throughout 2020, in order to support the response to this new illness as part of BC’s health system, the College worked closely with the Ministry of Health and other partners to introduce practice changes for pharmacy professionals and share vital information intended to reduce unnecessary practice strain and provide broader flexibility to continue to ensure adequate continuity of care for BC patients.
- CPBC – Novel Coronavirus (COVID-19)
- Registrar's Message: We're in this together
- Maintaining Your Drug Administration Certification During the COVID-19 Pandemic
- Temporary Registration Now Available to Support BC's COVID-19 Response
- Joint Statement on the Unproven Therapies for COVID-19
- Guest Post: Acetaminophen vs. NSAIDs (Ibuprofen) during COVID-19 Pandemic
- BC’s COVID-19 Response - Self-Isolation Advice for Pharmacy Professionals and the Role of Pharmacy Managers
- BC’s COVID-19 Response - Pharmacists to Provide Prescription Refills and Emergency Supplies of Medication as Needed
- COVID-19 Public Information - Prescription Refills Can Be Provided by a Pharmacist
Cultural Safety and Humility
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, where individuals feel safe and respected.
In 2020, the College continued its commitment to working towards meeting our pledge to improve cultural safety and humility for First Nations and Aboriginal People in BC.
Take a look at some of the Cultural Humility focused articles we published in 2020:
- ReadLinks – FNHA Gathering Wisdom Forum: What We Heard
- ReadLinks – Orange Shirt Day is September 30
- ReadLinks – National Indigenous Peoples Day
Addressing Racism and Discrimination in BC’s Health System
Black Lives Matter
The College of Pharmacists of British Columbia stands against racism in solidarity with the Black Community.
Our hearts were heavy this year as we watched Black Communities and allies, across the US and Canada, endure the pain caused by the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, Tony McDade and countless others, at the hands of police brutality and a culture of systemic racism and violence.
In response, College Registrar Bob Nakagawa pledged the College’s commitment to developing a plan to guide our organization in raising awareness of, and combatting, the racism faced by Black People in BC.
Learn More: Registrar’s Message – Black Lives Matter
Investigation into Indigenous-Specific Racism
On June 19, 2020, BC Health Minister Adrian Dix announced an investigation into disturbing allegations of racism in BC’s health system. Staff in one or more BC emergency rooms were said to have been playing a “game” involving guessing the blood alcohol content of patients coming into the ER for help, in particular Indigenous patients.
The College, along with BC’s Health Regulators were in full support of the investigation, led by Mary Ellen Turpel-Lafond, and the culminating report “In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C Health Care.”
We recognize that, while we are making progress, there is still more to be done to ensure that Indigenous people consistently receive qualified, safe, and ethical care from health professionals who integrate cultural safety and humility into their practice.
We encourage all regulated health professional to review the report.
Opioid Overdose Crisis
While BC continues to respond to the COVID-19 pandemic, it is important that our province’s health professionals recognize that this is not our only health crisis.
The opioid overdose crisis continues to have a major impact on the province. Since the COVID-19 pandemic was declared a public health emergency in March 2020, the BC Coroners Service has detected a sustained increase of illicit drug toxicity deaths, recording seven consecutive months with over 100 overdose deaths, three of which saw more than 170 deaths.
Acknowledging the marked increase in overdose deaths since the onset of COVID-19, the College has been hard at work supporting continuity of care for patients in the midst of dual health emergencies.
Learn more about how we continue to address BC’s Opioid Crisis during the COVID-19 Pandemic:
- ReadLinks – Dual Health Emergencies: BC’s Opioid Crisis and the COVID-19 Pandemic (September 30, 2020)
- NEWS – Opioid Agonist Treatment Alert - Potential Slow Release Oral Morphine (Kadian) Shortage (March 10, 2020)
- NEWS – Changes to the Delivery Requirements for OAT Now In Effect (March 17, 2020)
- NEWS - BC’s COVID-19 Response: Temporary Authorizations for the Delivery of Opioid Agonist Treatment by Non-Pharmacists (April 7, 2020)
- NEWS – Provincial Health Officer Issues Order Authorizing RNs and RPNs to Prescribe OAT (September 16, 2020)
- ReadLinks - Providing Care for OAT and iOAT Patients Over The Winter Holidays (November 27, 2020)
New Confidentiality Undertaking Form
A new, single Confidentiality Undertaking form is now available for all pharmacy staff, including registrants, who have access to personal health information.
As of December 1, 2020, any new pharmacy staff who have access to personal health information will need to complete the form before they start working at a pharmacy.
Previously, pharmacy staff, including registrants, were required to complete one of five confidentiality undertaking forms, depending on their role at the pharmacy.
The new, single Confidentiality Undertaking Form replaces those forms and has been broadened to include the collection, usage and disclosure of any personal health information, not just information contained within PharmaNet.
Current pharmacy staff who have access to personal health information will need to complete the new form by March 1, 2021.
Learn More: NEWS – New Confidentiality Undertaking Form
Proposed Changes to Health Professional Regulation in BC
On November 27, 2019, the Honourable Adrian Dix, Minister of Health, announced proposed changes to the regulation of BC’s health professions, with a focus on increasing transparency and patient safety.
The proposed changes, developed by the Steering Committee on Modernization of Health Professional Regulation, were presented in a consultation paper entitled “Modernizing the provincial health professional regulatory framework: A paper for consultation.”
Key recommendations made by the steering committee include:
- That regulatory boards have equal numbers of registrant and public members, and that they move to a more consistent and smaller size.
- A reduction in the number of regulatory colleges in BC from 20 to five.
- The creation of a new independent body to oversee BC’s health regulatory colleges.
- Simplification of the complaints and discipline process in order to provide clear focus on patient safety, public notification and strengthen public trust in regulation.
Much like the recommendations made by Harry Cayton in his report, many of the proposals in the consultation paper resonated with us as a high performing college, as they reinforced current practices already underway at CPBC.
See the College’s full submission to the Steering Committee:
- Feedback on “Modernizing the Provincial Health Profession Regulatory Framework Consultation Paper” (January 10, 2020)
On August 27, 2020, Minister Dix announced the release of a report outline final recommendations for changes to the province’s health profession regulatory system.
The report, “Recommendations to modernize the provincial health profession regulatory framework,” has implications for all health profession regulatory colleges in BC.
- ReadLinks – Proposed Changes to Health Professional Regulation in BC (February 28, 2020)
- ReadLinks – Provincial Government Releases Final Recommendations for Health Profession Regulation (August 31, 2020)
Addition of Antiretroviral Therapies in PharmaNet
Effective May 4, 2020, the dispensing pharmacies for the BC Centre for Excellence in HIV/AIDs Drug Treatment Program (BC-CfE) will begin entering antiretroviral (ARV) prescriptions in PharmaNet.
HIV/AIDS patients are living longer and, as such, may face increasing co-morbidities and associated drug therapies, putting them at risk of significant drug interactions, which may diminish the therapeutic effectiveness of ARVs or lead to adverse drug events.
The Ministry of Health made this decision with the utmost consideration to patient privacy, and with consideration of views from health care providers and advocacy groups that inclusion of ARVs in PharmaNet would provide greater safety to patients than harm. The PharmaNet system has strict access controls, and the Ministry expects all health care professionals that access the system to honour their professional obligation to patient confidentiality.
Implementing of the National Association of Pharmacy Regulatory Authorities’ Model Standards for Pharmacy Compounding
Due to the unforeseen onset of the COVID-19 public health emergency, the Board approved extending the implementation plan timeline for adoption of the Model Standards for Pharmacy Compounding of both Non-Hazardous and Hazardous Sterile Preparations from May 2021 to July 2022.
In June 2020, College staff surveyed pharmacies to assess the status of their compliance with NAPRA’s Sterile Model Standards. Results from the survey indicated that hospital sites and community pharmacies are progressing towards compliance with the Sterile Model Standards. However, the majority (84%) of sites will not achieve full compliance by May 2021.
This one-time only extension provides hospital and community pharmacies additional time to implement the Sterile Model Standards.
New Requirements for Verbal Prescription Orders
On June 19, 2020, new requirements for the written records of verbal prescriptions to be filled at community pharmacies came into effect.
The new requirements address a barrier whereby hospital discharge prescriptions written by pharmacists via verbal authorization from a practitioner are often not accepted by community pharmacies and residential care facilities
The new requirements provide an additional subsection acknowledging verbal prescriptions as valid if the written record includes:
- The name and regulatory college identification number of the practitioner
- The name, college identification number and signature or initial of the registrant who received the verbal prescription
This means that all written records of verbal orders to be filled at a community pharmacy must now meet these requirements. This includes written records of verbal orders taken by registrants in the community.
BC Wildfires – Accessing Medications and Providing Continuity of Care
During the summer of 2020, BC saw a surge of more than 150 wildfires across the province.
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 precautions necessary to help prevent the spread of COVID-19 when visiting a pharmacy; as well as the provisions laid out in Professional Practice Policy 31 – Emergency Supply for Continuity of Care; and to provide them with appropriate additional resources.
Temporary Registration Now Available to Support BC’s COID-19 Response
Given the anticipated increased demand for pharmacists and pharmacy technicians to help with BC’s response to the pandemic, in April 2020, the College developed amendments to the Health Professions Act Bylaws to enable eligible individuals to apply for temporary registration with the College to provide pharmacy services during the COVID-19 pandemic.
Individuals who may be eligible for temporary registration with the College during the COVID-19 pandemic, include:
- Former Registrants
- Non-Practising Pharmacists
- Pharmacy Graduates (including UBC) who are not yet full Pharmacists
- Pharmacy Students from Outside of BC
If you are interested in applying for temporary registration to contribute to BC’s response to the COVID-19 response, use the following chart to determine your options for temporary registration with the College.
Temporary Exemption for Dispensing Drugs for the Purposes of Medical Assistance in Dying (MAiD)
In May 2020, the Board approved a temporary exemption allowing injectable drugs, previously dispensed for the purpose of providing Medical Assistance in Dying (MAiD), to be returned to inventory during the COVID-19 public health emergency.
This means that during the COVID-19 public health emergency, if there is a shortage for any injectable drug dispensed for the purposes of MAiD, all unused injectable MAiD drugs dispensed and returned within the same, original sealed tamper-proof kit may be returned to inventory.
This temporary exemptions comes in response to reported shortages of a number of drugs used in the MAiD intravenous drug protocol that are also used in the treatment of patients with COVID-19, who require critical care.
Amendments to PPP-58: Medication Management
In May 2020, the Board approved amendments to the adaptation of transferred prescriptions and the limitation on drug categories for therapeutic substitution as part of Professional Practice Policy-58: Medication Management (Adapting a Prescription) to support patient care during the COVID-19 public health emergency.
In light of the COVID-19 pandemic, the College review PPP-58 for opportunities to support patient care during the ongoing public health emergency. Based on the review, temporary amendments were made to:
- Permit the adaptation of transferred prescriptions; and
- Remove the limitation on drug categories for therapeutic substitution where there is a drug shortage.
These amendments will remain effective for the duration of the COVID-19 public health emergency in British Columbia.
Amendments to Professional Practice Policy – 68: Cold Chain Management
Amendments to Professional Practice Policy 68 – Cold Chain Management of Biologicals (PPP-68), including broadening its scope and renaming it PPP-68 – Cold Chain Management, were approved by the College Board at its February 2020 meeting, and are now in effect.
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.
Community Based Point of Care Testing Policy
On May 1, 2020, the Ministry of Health approved the Community-Based Point-of-Care Testing Policy, which is now in effect.
The policy is intended to help enable quality and safe access to point-of-care testing provided in community-based settings. The policy also provides a foundation for Colleges seeking to establish POCT standards of practice to enhance the quality of care provided by their registrants.
The Ministry of Health’s policy defines Point-of-care testing (POCT) as a form of patient-centric health care and refers to diagnostic tests performed at, or near, the site of a patient, with the result leading to a possible change in care for the patient.
The College of Pharmacists of BC is currently in the process of developing specific Point-of-Care Standards. More information on these specific standards will be published at a future date.
As of December 1, 2020, the Ministry of Health began requiring all new PharmaNet users to enrol in PRIME.
PRIME is an online application for eligible healthcare practitioners who need PharmaNet to provide health services.
PharmaNet is a critical part of BC’s health care system, necessary for ensuring prescription safety and protecting British Columbians from adverse medication reactions as well as prescription fraud. With the demand for PharmaNet constantly increasing, PRIME is intended to address multiple issues related to PharmaNet user management.
Learn More: ReadLinks – PRIME – New PharmaNet Users Must Enrol on Dec 1, 2020 (November 27, 2020)
In December 2020, due to an ongoing global shortage of the active ingredient, the availability of NARDIL (phenelzine sulfate) in Canada has decreased with no known resupply date.
In response to the shortage, the College reached out to the public and registrants via email, social media and the College website urging immediate contact between patients and healthcare professionals to discuss how to safely discontinue NARDIL to minimize discontinuation symptoms.
NARDIL is a monoamine oxidase inhibitor (MAOI) used to treat atypical depression in adults when other medicines have not been effective. Abrupt withdrawal of NARDIL can be associated with uncommon withdrawal syndrome, thus requiring a gradual ‘wash out’ period of at least 10 days after discontinuation.