The Apothecary Newfoundland and Labrador Pharmacy Board Spring 2009
The Apothecary is the Continuing Professional Development Standards of newsletter of the Pharmacy Practice Now Approved for Circulation Newfoundland & Labrador Pharmacy As communicated in a recent Memo to This opens up new opportunities as well Board. It contains Pharmacists, the final draft of the revised as enhancing the pharmacist’s learning important regulatory Standards of Pharmacy Practice— experience. information that all Continuing Professional Development has As a result of feedback from pharmacists in the now been approved by the Board for pharmacists, both of the primary province of circulation. (See www.nlpb.ca/spg.html Continuing Professional Development Newfoundland & for the complete revised document.) forms have been updated: Labrador are expected to be aware of. Changes pharmacists should be aware of The Learning Portfolio Record Pharmacists are include: Sheet was updated to remove the responsible for The Standard no longer permits the word “source” and to streamline the ALL INFORMATION carry-over of CEUs from one year to form. contained within the next. However, pharmacists are The Professional Development Log including documents permitted to claim CEUs for programs has been revised to eliminate the which are made completed in December of one year in available on the NLPB need for pharmacists to transfer the the following calendar year, as long as website via links key learning ideas from the they were not used to fulfill the throughout the Learning Portfolio Record Sheets newsletter. minimum professional development over to the Professional The Apothecary is now requirement in that previous year. Development Log. Pharmacists who claim such programs circulated electronically Pharmacists are strongly encouraged to will be expected to submit both year’s and is available in hard make every effort to use these new forms. copy format only upon Professional Development Logs. Both forms are available at specific request. Due to the confusion surrounding the www.nlpb.ca/cpd.html in two versions— word “source”, the committee has one (pdf) for printing and completing by Linked in this issue... removed the requirement to complete hand and one (MSWord) for saving and programs from more than one source. Standards of Pharmacy completing electronically before printing. Pharmacists are still encouraged to use Practice—Continuing These Standards of Pharmacy Practice Professional Development multiple delivery formats and take effect immediately. Any questions or Continuing Professional providers to fulfill their professional clarification should be directed to the Development forms development requirements each year. Registration as a Pharmacy Board office. Student Change of Employment Form Are your pharmacy students registered? Report of Loss or Theft of Pharmacy students who intend to work in ANY capacity in a pharmacy in Newfoundland Narcotics Form NLPB Strategic Plan 2009- and Labrador must first be registered with the NLPB and shall not identify themselves as 2011 anything other than a “Pharmacy Student”. For more information, see the NLPB Policy— NAPRA Notes—February Registration as a Pharmacy Student, available at www.nlpb.ca/reg_&_lic.html 2009 Page 2 The Apothecary Complaints and Discipline Resolution Case #1 physician for injection. She that “Take/Use as directed” is The Complaints Authorization indicated that “Even though the Rx NOT generally acceptable with Committee considered an was refilled early, it was unknown Rx’s for injections to be allegation from a specialist to the pharmacist that the patient administered by the physician in physician regarding a prescription was going to his Dr. each month for his clinic when specific directions written for Lupron 22.5mg, to be his injection.” She indicated that have been indicated on the injected IM every 3 months for one both she and another pharmacist at prescription, and particularly year. It was alleged that the the pharmacy had refilled the when the physician administering prescription had been improperly prescription at various times. the injection is not the physician labelled at the pharmacy with The response also indicated that who ordered the prescription. The instructions “Use as directed”; that the original dispensing pharmacist original dispensing pharmacist the patient had been receiving had indicated to the prescribing should not have permitted the monthly injections of the drug; and specialist, when discussing this instructions “Use as directed” to that the prescription had been incident after the error had been have been used in recording the refilled monthly without the error discovered, that “we were refilling prescription; being questioned by the the Rx as requested by the patient that the pharmacists who pharmacist. The error was and we have no control over what authorized the refills should have apparently detected when a the patient does with that Rx once questioned the requests for request for renewal of the it leaves the store” and that the monthly refills of the prescription prescription and clarification of family physician indicated…”he on three different occasions, dosage was sent to the specialist was under the impression from the particularly since the pharmacy’s from the pharmacy since the refills patient that he was supposed to computer system indicated that were depleted and the patient get the injection each month” and the amount being dispensed said he was supposed to get this that the prescribing specialist “had represented 90 days supply and injection every month. not in the following three months that the requested refill was The response from the pharmacist- sent any follow up letters to between 55 - 63 days early in in-charge indicated that the indicate otherwise.” each case; original prescription had been Decision of the panel: that there was no evidence labelled by the pharmacy assistant The panel decided that there were provided that any of the as “Use as directed”, “which is reasonable grounds to believe that pharmacists had counseled the generally acceptable with Rx’s for each of the three pharmacists patient about the prescribed injectables to be administered by involved at some point with this dosage of the drug prescribed; the physician in his clinic”, and also prescription had engaged in had ensured that administering indicated that the pharmacist who conduct deserving of sanction. physician was aware of the had checked the original The panel directed that the dosage prescribed by the prescription for accuracy was allegation be considered as prescriber; or had questioned the satisfied “especially since a 90 constituting a complaint and that early refills or checked the day interval was indicated on the letters of caution be sent to each of original prescription to confirm hard copy of the Rx”. the pharmacists involved. the prescribed dosage; The pharmacist-in-charge indicated The panel directed that points that that the statement attributed to that the patient returned for refills should be specifically noted in the the dispensing pharmacist that each month for three months and letters of caution are: took the drug to his local family (Continued on page 3) Spring 2009 Page 3
(Continued from page 2) on the prescription label; that as a delivery logs, which are now result of this error she went into kept for a minimum of 2 years, “we were refilling the Rx as opioid withdrawal and required have been revised to show requested by the patient and admission to hospital; that she had whether the prescription was we have no control over what also been given heart medication delivered or picked up, and the patient does with the Rx prescribed for another person; and Continued on page 4) whether the once it leaves the store” is an that untrained technicians were delivery was a prescription or inappropriate and involved with the filling of her OTC; unacceptable standard of prescriptions. that all pharmacy staff have pharmacy practice. There is an The response from the pharmacist- been trained in these expectation that pharmacists in-charge indicated that one of the procedures and that a formal will question early refills of contributing factors to the error policy and procedure manual is prescriptions to determine the was that the prescribing physician being written. reason for such requests, ensure had ordered a 5mg dosage. Since Decision of the panel: that the patient understands the the product only comes in 3mg and The panel decided that there were prescribed dosage of the 6mg strengths, both the 3mg and reasonable grounds to believe that medication, and determine if 6mg tablets had been kept on the the respondent had engaged in there are any reasons why the dispensary counter awaiting conduct deserving of sanction. medication is not being used as clarification of the dosage from the The panel directed that the prescribed and take prescribing physician. allegation be considered as appropriate steps where The pharmacist-in-charge’s constituting a complaint and that a possible to address such issues. response also spoke to the training letter of caution be sent to the obtained by assistants employed in The panel directed that a report of Pharmacist-in-Charge. the pharmacy, the checking this complaint, on a no names basis, The panel directed that points that procedures used at the pharmacy, be included in the next edition of should be specifically noted in the and the changes that have been the Apothecary, so that ALL letter of caution are: made since this incident occurred, pharmacists are reminded by this that counselling and checking including: incident of their responsibilities with procedures at the pharmacy a triple check is performed on respect to labelling of (including documentation of such every prescription; prescriptions, properly counselling counselling and checking) needs pharmacy assistants and the patients on the proper use of the to be improved; pharmacist sign-off on their medication prescribed and that counselling must take place involvement at each step of the monitoring compliance with the use on every new prescription and process, of prescriptions. should take place on refills. a way of identifying new Checking the prescription bottle prescriptions has been Case #2 or package at the time of implemented so that pharmacists The Complaints Authorizations counselling is a very important on duty will counsel the patient Committee considered an step that every pharmacist about these prescriptions; allegation made by a patient should be doing to help prevent when new prescriptions are concerning a prescription for medication errors; delivered, the required patient Hydromorph Contin. It was alleged that a written policy and counselling is done by that Hydromorph Contin 3mg had procedure for checking been dispensed instead of the 6mg telephone; (Continued on page 4) strength prescribed and indicated Page 4 The Apothecary
(Continued from page 3) considered two similar letters of 2) subsection 17(1) of the prescriptions that every allegation against Labrador Pharmacy Regulations, which pharmacist at the pharmacy has PharmaChoice which were reads: signed and implemented must forwarded to it by the Complaints 17. (1) A pharmacist shall not advertise, be sent to the NLPB office for Authorization Committee. or permit a person to advertise on review within 3 months of this The complaints alleged that Mr. behalf of a pharmacy which that pharmacist operates, using information notice; Brendan Mullins, the pharmacist-in- that that NLPB will provide the charge of Labrador PharmaChoice (a) is false, misleading, fraudulent, pharmacist-in-charge with in Happy Valley-Goose Bay had deceptive, ambiguous or confusing, information programs that are violated the Board’s Guidelines on or likely to mislead or deceive the available, including: Advertising in an “advertorial” that public due to partial disclosure of NAPRA’s Ensuring Dispensing appeared in The Labradorian on relevant facts; Accuracy and Minimizing November 26, 2007 announcing (b) is not relevant to the public’s Medication Errors the opening of Labrador ability to make an informed choice; NB Pharmaceutical Society’s PharmaChoice. It was alleged that (c) is not verifiable by facts Medication Errors Prevention the ad included information that independent of personal feelings, beliefs, opinions or interpretations; and Reduction Guidelines was false and deceptive, defamatory and misleading. It (d) makes comparisons either Ontario College of directly or indirectly with another was also alleged that statements in Pharmacists’ Preventing pharmacy or pharmacist or would be the ad were of personal opinion Dispensing Errors and A reasonably regarded as suggestive Pharmacist’s Accountability in not verifiable by fact, deprecated of uniqueness or superiority over Response to a Dispensing another pharmacy and were likely another pharmacy or pharmacist; or Error, and to demean the integrity or dignity (e) as a result of its content, method a copy of the Summer 2006 of the profession or bring the or frequency of dissemination is such Apothecary article (Institute profession into disrepute. as to be reasonably regarded by pharmacists as likely to demean the for Safe Medication A hearing of an adjudication tribunal of the disciplinary panel integrity or dignity of the profession Practices) or bring the profession into was held to determine whether the disrepute. The panel directed that a report on conduct of Mr. Mullins in this matter this complaint, on a no names basis, constituted a violation of: 3) subsection 37(1)(c) of the be included in the next edition of 1) subsection 12(1)(b)(ii) of the Pharmacy Regulations, which the Apothecary so that ALL Pharmacy Regulations, which reads: pharmacists are reminded by this reads: 37. (1) The term unprofessional conduct incident of their responsibilities to 12. (1) All pharmacists who are or professional misconduct for the review checking procedures, to designated and named on a business purpose of consideration of a complaint counsel patients on original and licence as the pharmacist-in-charge of and the institution of disciplinary repeat fillings of prescriptions, and that pharmacy proceedings includes but is not limited to to generally review policies and (b) shall be responsible for (c) breach of the Code of procedures in their pharmacy to (ii) prohibiting an owner or Advertising as outlined in section 17 ensure error prevention as much as other person who is not a pharmacist of these regulations; possible. from directing, influencing, controlling Decision of the disciplinary panel: or participating in the management or The tribunal found Mr. Mullins Case #3 operation of a pharmacy for which the failed to establish the defense of pharmacist-in-charge is responsible A hearing of an adjudication under the Act and these regulations, (Continued on page 5) tribunal of the Disciplinary Panel Spring 2009 Page 5
(Continued from page 4) indicated that this had occurred follows: without her knowledge or request. A formal reprimand is to be due diligence and was guilty of the Mr. Lloyd Bennett, the pharmacist- entered on the files of Mr. complaints and consequently guilty in-charge of East End Pharmasave Bennett and Mr. Whalen. of conduct worthy of sanction. At a was notified of this allegation and Any prescriptions which had subsequent hearing to determine asked to respond. been improperly charged to the sanctions the tribunal was patient’s account or billed to her presented with a joint submission of The CAC decided that there were insurer and which have not been proposed sanctions which had been reasonable grounds to believe the repaid are to be reimbursed to agreed to by Mr. Mullins and the respondent had engaged in the appropriate party, by the Secretary-Registrar. The tribunal conduct deserving of sanction and accepted the proposed sanctions that the allegation be considered a respondents or East End and ordered as follows: complaint. The panel instructed the Pharmasave, immediately. A formal reprimand is to be Secretary-Registrar to file the Both Mr. Bennett and Mr. entered on Mr. Mullins’ file. complaint against the respondent Whalen must successfully Mr. Mullins must attend at the and refer it to a hearing of the complete the Board’s Office of the Pharmacy Board disciplinary panel. registration examination within within 6 months of the Order of On further investigation it 3 months of the Order of the the Adjudication Tribunal, at a appeared that some of the Adjudication Tribunal. time to be set by the Secretary- prescriptions in question were filled There will be publication of a Registrar; to review with the by Mr. Gerald Whalen and summary of the Decision and Secretary-Registrar the therefore a Notice of Allegation Order of the Adjudication responsibilities of a Pharmacist- was forwarded to Mr. Whalen as Tribunal, on a named basis, in in-Charge, pursuant to the well. Subsequent to a second CAC The Apothecary. Pharmacy Act and Regulations. meeting, this complaint was also The costs of the investigation There will be publication of a referred to the Discipline Panel. and hearing of the complaints summary of the Decision and will be paid on a 60/40% basis Further investigation also Order of the Adjudication by Mr. Bennett and Mr. Whalen determined that a prescription Tribunal, on a named basis, in respectively (Mr. Bennett being appeared to be refilled and The Apothecary. the Pharmacist-in-Charge of dispensed without a valid That Mr. Mullins pay the costs of East End Pharmasave), such costs prescription for these refills. the investigation and hearing of to be paid within 60 days of A hearing of an adjudication the complaint, set at $12,500 the Order of the Adjudication tribunal of the disciplinary panel within 60 days of the Order of Tribunal, or such further time as the Adjudication Tribunal. was held to consider sanctions may be agreed by the against Mr. Bennett and Mr. Pharmacy Board. Case #4 Whelan. At the hearing the tribunal was presented with a joint The Complaints Authorization submission of proposed sanctions Committee met to consider an which had been agreed to by Mr. allegation from a patient Bennett, Mr. Whelan and the regarding two instances where she Secretary-Registrar. had received notice that claims had been processed through her health Decision of the disciplinary panel: insurance for prescriptions filled at The tribunal accepted the East End Pharmasave. The patient proposed sanctions and ordered as Page 6 The Apothecary Newfoundland and Labrador Pharmacy Network Benefits Evaluations
In preparation for the launch of the Newfoundland recruit seniors over 65 years of age to participate in and Labrador Pharmacy Network, the Centre for this study. The Centre for Health Information would like Health Information has engaged in four benefits to take this opportunity to thank-you for your evaluations to determine the impact of the Pharmacy cooperation in helping us meet our goal. We have now Network on various aspects of medication use. These successfully finished recruitment for this study. studies all have a pre/post study design and we are Over the next two to three months, the Centre will be happy to say that the first phase of this study is completing the data collection portion of this study, nearly complete. which involves an in-home interview with the senior by a Two studies focused on the rates of adverse drug registered pharmacist. The information is kept events in the community by completing emergency confidential and the senior is assigned a study code. room chart reviews in both the adult and pediatric During the interview, the pharmacists will ask some population. The third study evaluated expected basic demographic questions and then take a complete impact of the Pharmacy Network on prescription drug medication history. If the senior poses questions abuse. These three studies are complete. The study regarding their medications during the interview, the team is now preparing manuscripts for peer review pharmacists will provide any necessary counselling. publications and preliminary findings will be shared If you, or any of your customers, have any questions at the upcoming PANL conference. about the studies, please feel free to contact either The fourth study examines the impact of the Pharmacy Jennifer Donnan ([email protected]; 752- Network on appropriate use of medication among 6025) or Kayla Collins([email protected]; 752- seniors. For those of you practicing in the St. John’s 6045) at the Centre for Health Information. area, your assistance was requested in helping us
Retirement of Hugh O’Neil Conroy Each year a number of pharmacists retire from practice and particularly notable is the retirement at the end of 2008 of Hugh O’Neil Conroy. Hugh Conroy was the longest practising pharmacist in the province, having been initially licensed in 1944, and has retired after a distinguished career of 64 years as a practising pharmacist. After serving a four year apprenticeship at McMurdo’s Drug Store in St. John’s he attended the Maritime School of Pharmacy at Dalhousie University, graduating in 1946. After returning to the province from Halifax, besides being a practising community pharmacist, he also took on the role of a pharmacy instructor in the apprenticeship program conducted at that time by the Newfoundland Pharmacy Board. He served the profession in this capac- ity from 1946 to 1966. (From 1957 to 1964, while he operated a pharmacy in Placentia, he commuted weekly to St. John’s to hold pharmacy classes and participate as a member of the Council of the Nfld. Pharmaceutical Association.) Mr. Conroy was Registrar of the Newfoundland Pharmacy Board from 1952 to 1954 and was associated with the preparation of the 1954 Pharmaceutical Association Act, which saw the merging of the Newfoundland Phar- maceutical Society and the Newfoundland Pharmacy Board into the Newfoundland Pharmaceutical Association, and with the 1970 revision of that Act. He was made an Honorary Life Member of the NPhA in 1992 “Life long learner” is an apt description of Hugh Conroy. He was notably always among the first to sign up when continuing education programs were offered to the NPhA membership and he was a regular participant at CE functions. After a long and distinguished career of service to the public and our profession we wish him a well deserved retirement. He continues registration with our Board as an Honorary Non-practising Pharmacist. Spring 2009 Page 7 Frequently-Asked Questions Recently we had a question from a pharmacist 21. (2) An application for registration under subsection (1) regarding whether or not a person registered as non- shall be approved where the applicant… practicing is required to be a member of PANL and/or (b.1) provides proof that he or she has obtained professional obtain the required amount of liability insurance. liability insurance coverage in a form and amount satisfactory to the board;... The requirement for pharmacists to be a member of “the association” (i.e. PANL) is found in section 18(3) We would caution any pharmacist who registers as of the Pharmacy Act: non-practicing of the following prohibitions in section 23(1) of the Pharmacy Act: 18. (3) It is a condition of the issuing of a certificate of registration under this section that the person to whom the 23. (1) A person other than a pharmacist with a certificate certificate is issued be a member of the association or within shall not one month of the date of issuing the certificate become a (a) represent or hold himself or herself out as or as being member of the association, and the failure of that person to entitled to use the title or designation of pharmacist; comply with this condition makes the certificate void from (b) carry on the practice of pharmacy in the province; that date. (c) conduct a business or operation for selling drugs except The “certificate of registration” referred to is the as expressly permitted under this Act; or annual certificate that certifies that a pharmacist is (d) hold himself or herself out, conduct himself or herself in a eligible to practice pharmacy in our province. manner or wear or use clothing or a sign, emblem, title or Pharmacists who register with the Board as “non- advertisement which may reasonably lead the public to infer practicing” are not issued this certificate; that he or she is registered as a pharmacist and qualified to consequently they are not required to become practice pharmacy under this Act. members of PANL. Therefore non-practicing pharmacists should not Since “non-practicing” pharmacists are not issued this engage in any activity, or offer any pharmacy certificate, they are not required to meet the advice, counselling or opinion that might be construed provisions in section 21 of the Act, including the as “practicing pharmacy” or leave the public open to requirement for professional liability insurance: improper pharmacy care, and themselves open to potential liability.
New NLPB Employee—Professional Affairs Coordinator
Melanie Healey has recently joined the staff at the Melanie received her Bachelor of Science (Pharmacy) NLPB as Professional Affairs Coordinator. This is a degree from MUN in 1996 and has worked in a professional 2-year 4/5 time contractual position, variety of practice settings including community and reporting to the Secretary-Registrar. academia as well as with the former Newfoundland The primary role of Melanie’s position will be to Pharmaceutical Association as Professional Relations provide coordination and support to the activities of Assistant and Interim Executive Director (Advocacy the Board relating to professional practice, policy Board). Recently, she has been providing consultancy and legislative issues including support of the services to both the NLPB and the NLCHI Pharmacy Professional Practice and Legislative committees. Network project. Melanie also continues to practice in the community as a relief pharmacist. She will also be responsible for scanning the professional practice environment on a local, national Please feel free to contact Melanie to offer your and international level to identify issues of importance comments or suggestions in these areas at (709) 753- relating to professional practice and assisting the 5877 or [email protected]. Board in establishing priorities for action. Page 8 The Apothecary NLPB Strategic Plan 2009—2011 Following the December 2008 Newfoundland and Labrador Pharmacy Board ALL changes in a Meeting, Board members and other invited stakeholders participated in a Strategic pharmacist’s Planning session, facilitated by Lynn Morrissey, with the goal of setting the priorities employment MUST be for the Board for the next 3 years. A wide variety of issues were identified including reported to the NLPB those relating to the Pharmacy Network, the regulation of Technicians and the pursuit Office AT LEAST 7 days of Medication Management Authority for pharmacists. The complete document is before the change is to available to all pharmacists on our website at www.nlpb.ca/about_us.html (under take place, using the Board Documents). A summary by timeline is given below. appropriate form IMMEDIATE THREE YEARS (available at www.nlpb.ca/ 1.4 Develop Standards of Practice for 1.3 Raise Awareness of Pharmacists & forms.html) and Pharmacy Network the Public on Patient Safety Issues including the 1.5 Identify Mandate (Structure and 3.3 Develop and Implement an appropriate fee. Responsibilities) of Professional Evaluation Process for the Board Practice Committee 5.4 Evaluate the Outcomes of the As NLPB mailings are 2.1 Communicate and Consult with Continuing Professional now being done almost Pharmacists Regarding Changes Development Process entirely electronically, Impacting the Profession pharmacists are 3.1 Develop and Implement an ONGOING responsible for ensuring Evaluation Process for the Office 2.2 Promote Pharmacists' Involvement that the NLPB Office has 5.2 Develop and Implement a Process in Board and NLPB Committees their CORRECT E-MAIL to Make the Public(s) Aware of the 4.1 Liaise and Interact with ADDRESS on file at all Impact of Regulatory Changes Government and Regional Health times. 5.3 Review the Revised Standard of Authorities to Ensure the Practice Involvement of the Board in all Pharmacists-in-charge Relevant Health Issues are reminded that any ONE YEAR 4.2 Collaborate with Other Provincial loss or theft of narcotics, 1.1 Define the Role of Pharmacy Regulatory Authorities, Advocacy controlled drugs, Technicians Groups, Education Institutions and targeted substances 3.2 Develop and Implement an Student Organizations and/or precursors MUST Evaluation Process for the Board 4.3 Ensure a Process of Adequate and be reported within 10 Committees Timely Communication Regarding days using the Public Health Issues appropriate Health 4.5 Liaise with Key Stakeholders in Canada form (available Pharmacy Profession to Facilitate 4.4 Endorse and Promote Research at www.nlpb.ca/ Dialogue on Common Language Activities to Enhance Practice and forms.html). One copy Policy of this form should be ONE - THREE YEARS 5.1 Revise Governing Documents as kept at the pharmacy, 1.2 Define and Pursue Medication Required to Reflect Changes in one sent to the NLPB Management Authority Pharmacy Practice (e.g. Act & Regulations, Standards of Practice, Office and one sent to Health Canada. By-Laws) Spring 2009 Page 9 Service Desk: Ready to Assist You During deployment of the Newfoundland The Service Desk can be contacted for and Labrador Pharmacy Network to assistance to: community pharmacies in the coming Obtain general support for the Phar- months, pharmacists will have support macy Network and the Electronic through the Centre for Health Informa- Health Record tion’s Service Desk. The Service Desk is Report any Pharmacy Network con- already up and running, providing tech- nectivity issues nical and service support to individuals Add providers that are not in the Pro- using the Client Registry, Health Informa- vider Registry or update existing re- “The Service Desk tion Network (HIN), and to answer ques- cords. For example, adding an out of is already up and tions regarding Pharmacy Network con- province provider to the system or re- running, providing formance and the deployment processes activating a provincial provider to technical and to pharmacists. process a patient’s prescription service support to The Service Desk provides a single point Set up a username and password to individuals using of contact for users who need technical access the Pharmacy Network after the Client and service support. It ensures that there verification by the Centre for Health Registry, Health is follow through with all requests for Information. Once pharmacies have Information the ability to connect, pharmacists are assistance, allows users to get status up- Network, and to dates on their requests for help, and en- required to contact the Service Desk answer questions sures issues have been resolved. Users of to get a username and password the Pharmacy Network, such as com- which will give them access to the regarding munity pharmacies, should only con- Pharmacy Network Pharmacy tact the Service Desk after consulting Reset a password, in the event a Network their software vendor to diagnose the pharmacist has forgotten his/her conformance and problem. password to access the system the deployment Users can contact the Service Desk via phone or email. Emergency issues should be processes to communicated by phone and non-imperative issues can be communicated via email. pharmacists.” To contact the Service Desk, please call 1-877-752-6006 or 709-752-6006 or email [email protected].
Updates to the NLPB Website New! Updated! Canadian Adverse Reaction Newsletter January Continuing Professional Development page 2009 Continuing Professional Development forms MedEffect advisories NLPB Pharmacy Binder (March) NAPRA Notes February 2009 NLPB Standards of Pharmacy Practice—Continuing NLPB Board Meeting Minutes for 2008 Professional Development NLPB Strategic Plan 2009-2011 Pharmacies and Pharmacists Registers (March) Requirements for Registration as a Pharmacist—for out-of-province applicants
BOARD STAFF Newfoundland and Don Rowe, Ph.C., Secretary Registrar...... [email protected] Labrador Pharmacy Board Arlene Crane, Ph.C., Deputy Registrar ...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator ...... [email protected] Apothecary Hall Veronica Harvey, Executive Assistant to the Registrar...... [email protected] General Information ...... [email protected] 488 Water Street St. John's, N A1E 1B3 BOARD MEMBERS Elected Members Tel: 709-753-5877 Zone 1 ...... Margot Priddle Toll Free: 1-877-453-5877 Zone 2 ...... David Jenkins Fax: 555-753-8615 Zone 3 ...... John Rideout Zone 4 ...... Joanne Howlett E-mail: [email protected] At Large ...... Keith Bailey, Brian Healy, Linda Hensman Appointed Members ...... Don Mifflin ...... Eugene Toope Observer MUPS Representative ...... Megan Dawe
EXECUTIVE COMMITTEE Chair ...... John Rideout Vice-Chair ...... Joanne Howlett Executive Member ...... David Jenkins Past Chair ...... Don Mifflin
Quick Notes
We’re on the Web!! On March 25, 2009, The Apothecary would like to take this opportunity to www.nlpb.ca Hall Trust was a recipient of the Historic thank them for giving their time so Sites Association Manning Award for generously to serve their profession over Excellence in the Public Presentation of the past number of years: Historic Places. This award is presented Board—Jerry Young in recognition of the fine heritage work Finance Committee—Margot Priddle accomplished across the province by Joint Committee on Structured Practice community-minded groups and Experience—Darlene Mansfield organizations and honours the late Bill Registration and Licensing Manning, former Parks Canada Committee—Don Hillier (chair); Superintendent of Historic Sites for Melanie Healey and Mike LeBlanc Newfoundland and Labrador. Manning realized that the preservation and presentation of our heritage requires the involvement of the people in these communities. Members of the Apothecary Hall Trust were on hand at Tip! the Sheraton Hotel Newfoundland to Visit the Frequently- receive the award. Asked Questions page on our website for Over the past year, several pharmacists quick answers to many have moved on from the Board as well
as from a number of committees. We common questions!! The Apothecary
Newfoundland and Summer 2009 Labrador Pharmacy Board 2009 Board Election Now Complete As communicated to pharmacists on June 9, 2009, this year’s election of NLPB board members is now completed. This year, the election, which saw pharmacists nominating and electing members for Zone 1 and Zone 4, began on March 3, 2009 with a Call for The Apothecary is the Nominations. Nominations were subsequently received for Deborah Kelly and Heather newsletter of the Seeley in Zone 1 and for Joanne Howlett, Christina Tulk and Bert Warr, Jr. in Zone 4. Newfoundland & Ballots were mailed to registered pharmacists in these zones and were counted on June Labrador Pharmacy 2, 2009 with Debbie Kelly elected in Zone 1 and Christina Tulk elected in Zone 4 . Board. It contains information The elected members began their 3 year terms of office at the 2009 Annual General on a wide variety of Meeting, which took place on June 7, 2009. Also at the AGM, John Rideout completed topics intended to his term of office as Board Chair assuming the position of Past-Chair. Following the enhance the practice AGM, at a Special Meeting of the Board, a new Executive was elected with Keith Bailey of all pharmacists in elected Board Chair, Christina Tulk elected Vice Chair and Debbie Kelly elected the province of Executive Member For a complete list of the current Board as well as the Executive Newfoundland & Committee members, please see the back page of this Apothecary. Labrador. Pharmacists are Message from the Chair of the Board responsible for reviewing any and It is indeed my pleasure to take this opportunity to address pharmacists of the province as ALL INFORMATION the new Chair of the NL Pharmacy Board. The progress we have made over the past year contained within has been tremendous and I congratulate John Rideout on his leadership and the office including documents team for their diligent efforts. The upcoming year promises to very exciting and, while the which are made Board is responsible for the day to day practice of pharmacy, I believe that, using our available on the NLPB strategic plan, we can chart a course for the future that will result in growth for both our website via links professional practice and the quality of service to the public. throughout the Certainly the Pharmacy Network, Medication Management and plans for technician newsletter. regulation will be very prominent on the agenda this year and all these elements will be The Apothecary is now pillars to growing the profession. I encourage all pharmacists to get involved. We need circulated collaboration and communication between the various stakeholders in pharmacy and electronically and is individual pharmacists to move forward effectively. Continued Board communication and available in hard copy engagement will be high on this year’s agenda. format only upon specific request. To that end, I am more than available for feedback from pharmacists and will visit as many stores and hospital sites as I can over the year to talk to you. My cell number is (709) 689-0086 and my email [email protected] . Contact me anytime! Respectfully, Keith Bailey Page 2 The Apothecary Complaints and Discipline Resolution Case #1 developed for the pharmacy other pharmacy staff with respect The Complaints Authorization as a result of this prescription to third party insurance coverage Committee (CAC) considered an error be implemented by all and income tax receipts. allegation received from a patient pharmacists and staff in the Decision of the panel: that alleged he had been pharmacy. The panel ruled that there were not dispensed the incorrect dosage of that counselling must take reasonable grounds to believe that prednisone and that this error had place on every new the respondent had engaged in not been discovered for four prescription and should take conduct deserving of sanction with consecutive months. The panel place on refills. Checking the respect to the practice of found that on the initial filling of prescription bottle or package pharmacy and therefore the panel the prescription, the pharmacist at the time of counselling is a dismissed the allegation. had dispensed the correct dosage very important step that every of prednisone (5mg), but that the pharmacist should be doing to Case #3 prescription had been mislabeled help prevent medication errors. An adjudication tribunal heard a (as 50mg). Subsequent to this, the that a report on this complaint, complaint lodged by the patient returned to the pharmacy on a no names basis, be Secretary-Registrar against for a refill, at which time, the placed in the next edition of pharmacist David McIsaac, prescription was refilled by The Apothecary, so that ALL practicing at the Pharmacy another pharmacist in accordance pharmacists will be reminded Department of the G.B. Cross with the record in the pharmacy by this incident of their Memorial Hospital in Clarenville. computer. Because of the responsibilities to review The tribunal also considered a previously undetected error checking procedures, to counsel complaint lodged against Mr. prednisone 50mg was dispensed patients on original and repeat McIsaac by Mr. Gary Peckham, the instead of prednisone 5mg, fillings of prescriptions, and to Director of Pharmacy of Eastern resulting in the patient taking a generally review polices and Health. dosage of the medication that was procedures in their pharmacy As a result of the complaint by Mr. 10-fold higher than prescribed. to ensure error prevention as Peckham and upon the Decision of the panel: much as possible. recommendation of the CAC, the The panel decided that there were that a copy of the policy and Board suspended Mr. McIsaac’s reasonable grounds to believe that procedure developed by the licence to practice pending a both pharmacists involved at some pharmacy be distributed as a hearing into the complaints. guide to help other pharmacies point with this prescription had Decision of the panel: develop policy and procedure engaged in conduct deserving of The adjudication tribunal agreed to for reducing medication errors sanction. The panel directed that accept a jointly submitted (see attached) the allegation be considered as Agreement on Disposition from the constituting a complaint and that Case #2 Secretary-Registrar and Mr. letters of caution be sent to each of McIsaac that included a plea of the pharmacists involved. The CAC considered an allegation from a patient regarding an guilty by Mr. McIsaac with respect The panel directed specific points to all the allegations under should be noted in the letters of incident that had taken place at the pharmacy where it was alleged consideration. The tribunal ruled caution including: that Mr. McIsaac had committed a that the counselling and that the patient was treated checking procedures discourteously by a pharmacist and (Continued on page 3) Summer 2009 Page 3
(Continued from page 2) that he advise the Secretary- purchases. The Secretary-Registrar Registrar, verbally or in writing, determined that the pharmacist number of violations of the of every pharmacy where he had not acted inappropriately and Pharmacy Regulations, including: practices, for any period of that this letter did not constitute an failing to abide by the terms, time. allegation. He did, however, conditions or limitations of a that he notify the pharmacist-in- respond to the patient in writing. licence; charge of any pharmacy in Excerpts from his letter include the acting as a pharmacist while the which he practices of this order. following: ability to perform an action as a that he cannot be designated as “All pharmacists...are required to pharmacist is impaired by alcohol the pharmacist-in-charge of a adhere to the Act, Regulations, By- or by a drug; pharmacy or be responsible for laws, Standards of Practice adopted by the Board and to normally follow failing to maintain the standards the general management and Guidelines adopted by the Board. of practice of the profession, supervision of a pharmacy These are minimum expectations and including written standards; and without the written consent of most pharmacists in this province conduct or an act relevant to the the Board. practice to an even higher standard practice of pharmacy that, having that violation of this order by than the minimum set by this board.” regard to all the circumstances, him will result in an allegation “In the Guidelines for the Sale of would reasonably be regarded by being referred to the CAC. Dimenhydrinate in Community members as disgraceful that the terms, conditions and Pharmacies, pharmacists are advised dishonorable or unprofessional” restrictions on practice and all to limit and monitor the sale of The order of the panel included the reporting requirements imposed dimenhydrinate-containing products following conditions: by this order shall remain in effect until removed by notice in in their pharmacies. In particular, that he be reprimanded by the writing by the Board. one item refers to documentation in Board. a patient’s profile. While this that he agrees to pay to the that he participate fully in a statement refers primarily to the sale Board the costs of the rehabilitation program for of quantities larger than 30 units, investigation and hearing alcohol and/or drug many pharmacists choose to related to this complaint and dependency acceptable to the document all sales in the patient’s any costs to the Board Board and continue to drug profile, particularly if the drug associated with his participation participate in such programs is being taken on a regular basis, in the rehabilitation program until notified otherwise by the even when there is no evidence of and the blood and/or urine Board. abuse. The Pharmacy Board screening. that he provide blood and/or considers this to be an appropriate that there shall be publication urine samples on a random practice. of the Order of the basis for screening to determine Adjudication Tribunal in There is growing recognition that that he is alcohol and drug free. accordance with section 44 of non-prescription...drugs can interact that, prior to reinstatement of the Pharmacy Act. with prescription drugs that ...and his licence and his re-entry to that by adding non-prescription practice, he provide the Board For Your Information... drugs that a patient may be taking with written medical clearance A letter was received from a regularly to the patient’s drug from his attending physician that patient questioning the profile such interactions may be he is suitable to return to work, appropriateness of his pharmacist detected more readily, leading to with no restrictions. recording and labeling his Gravol improved patient care and safety.” Page 4 The Apothecary Delegation to Pharmacy Assistants and the Future of Technician Regulation Background appropriate regulatory body. Further to this, some Currently in this province, there is no definition in also intend to establish defined, protected pharmacy legislation for the title of “Pharmacy responsibilities for “Pharmacy Technicians” as well as Technician”. Despite this, there are many persons potentially requiring “Pharmacy Technicians” to retain employed as such in almost every pharmacy in the liability insurance coverage and show proof of province. This has been accepted up to now, as it was professional development considered a job title with no legal ramifications In NL, the intent is to develop Standards of Pharmacy above and beyond the employer’s job description for Practice that will first recognize and build structure the position. around the current practice of employing “pharmacy Over the past several years many provinces have assistants” and will eventually enable either those made significant strides to regulate “Pharmacy assistants currently in the workforce or those entering Technicians”. This work has included, for some, the profession from an accredited program to become establishing “Pharmacy Technician” as a recognized, a registered “pharmacy technician”. The diagram protected title, setting qualifications for use of this title below outlines this process. and introducing a requirement for registration with the
Stream A Stream B (Existing) (New) Reflects and legitimizes current practice of Reflects the national movements underway and delegation to pharmacy assistants by pharmacists. the ability for NLPB to register pharmacy Standards of practice in development to more fully technicians. Currently, NLPB is taking a “watchful explain delegation and the role of the pharmacy waiting” approach as the national foundation for assistant and other delegates. regulation unfolds.
Persons currently working in a “Pharmacy Assistant” role in the province would fall into Stream A and could, if desired, progress to Stream B by completing an approved “Bridging Program” and the PEBC Evaluating Exam. Eventually, graduates from CCAPP‐Accredited Pharmacy Technician programs would enter Stream B directly. Summer 2009 Page 5 Frequently-Asked Questions on Pharmacy Technician Regulation Why do things need to change? “Pharmacy Technician” a protected title meaning unless The need for pharmacists to transition toward someone meets all the criteria (currently no one does) medication management and a patient-centered and is registered with the Board as such, then they practice has been clearly identified. Pharmacists, now cannot use the title “Pharmacy Technician”. Employers facing greater demands on their time, will need to shift and staff should start using the term “Pharmacy their focus from the mechanics of dispensing and Assistant” on signage, nametags and in conversation administrative tasks to a more cognitive-based now. practice. Delegation of technical tasks to pharmacy Will there be fewer jobs for pharmacists? assistants and the further enabling of qualified With the growth in professional responsibility, scope of Registered Pharmacy Technicians will help allow this. practice and number of pharmacies it is likely demand Will current pharmacy assistants have to retrain? Is for pharmacists will remain very high. stream B mandatory? Will pharmacists still be responsible for the actions of No. Pharmacies that wish to continue to operate “as is” pharmacy assistants? may continue to do so and assistants currently working Yes. Very little will change under the Stream A may go to work tomorrow doing the activities delegation process. It really legitimizes current described in the standards of practice. The Board is practice. very cognizant of the need to balance the future with Will pharmacists be responsible for the actions of present practice and the varied needs of each practice Registered Pharmacy Technicians? site. Yes and no. The pharmacist in charge will remain the What about those “technicians” already trained and gatekeeper for activity in a pharmacy as is presently in the workplace? Will they be “grandfathered”? the case and individual pharmacists will remain No, there will be no grandfathering. The training and responsible for many professional activities. However, experience of individuals who currently work in Registered Pharmacy Technicians will be solely pharmacies is quite varied. This poses a challenge since responsible for any tasks that fall under their the Board needs to ensure individuals applying for established Scope of Practice and as such will need to licensure have the defined competency to practice maintain competency and have malpractice insurance. safely and effectively within the scope of their Could a pharmacy have both pharmacy assistants profession. Those already in the workplace who wish and Registered Pharmacy Technicians working side to become a Registered Pharmacy Technician will be by side? subjected to the same evaluation and assessment Possibly. In the future, this will depend on the location, measures required for registration as those who are workload and type of practice. Some locations could new to the profession. With that in mind, it is have just pharmacy assistants, others all Registered anticipated a bridging education program will be Pharmacy Technicians and others a mix. Some available for a limited time that will prepare all pharmacies may have no supplementary staff at all. current assistants who wish to become regulated for the Delegation of tasks, in accordance with the Regulations, new expanded role. The process will be challenging. will be a decision of each pharmacist. Building on the knowledge these individuals have gained through formal education or on-the-job training, How much will it cost for a person to become the bridging program will prepare them to attempt to registered as a Pharmacy Technician? meet the educational requirements for registration. There is no question there will be costs associated with becoming registered but, at this point, we are not able Can I still call myself a technician? to give a credible estimate as there are many At some point very soon, the Board will deem the term (Continued on page 6) Page 6 The Apothecary
(Continued from page 5) competent to perform. They do NOT authorize pharmacy technicians to immediately assume their variables to consider: training, certification, licensing expanded role nor do they authorize pharmacists to fees to name a few. immediately delegate these activities. Are the terms regulated and registered the same? The Canadian Council for Accreditation of Pharmacy Programs (CCAPP: www.cccap-accredit.ca), the Different provinces and people seem to use them organization that accredits pharmacy programs in interchangeably. Canada, has agreed to undertake accreditation of These terms mean basically the same thing but the pharmacy technician training programs. More than a nomenclature does vary a little. To be regulated, one dozen programs have already been accredited but no must be registered with the NLPB. The term “Pharmacy schools in NL presently meet the criteria. Technician” will be a protected title. The Pharmacy Examining Board of Canada (PEBC: Will the salary of a Registered Pharmacy Technician www.pebc.ca), the national entry to practice certification be higher than that of a non-regulated pharmacy board for the pharmacy profession, is developing and assistant? administering the exam for pharmacy technicians which Unfortunately, any answer to this question would only will is based on the NAPRA Professional Competencies be an assumption on our part. It is not the Board’s for Pharmacy Technicians at Entry to Practice. The exam mandate to comment on salary-related issues. has a written and a practical component just like the one for pharmacists and is called the PEBC Pharmacy Will Registered Pharmacy Technicians be required to Technician Qualifying Exam. This exam will be critical show evidence of continuing competency like for licensure and the technician will have to pass both pharmacists? parts of the exam to be licensed. A Pharmacy Yes. Registered Pharmacy Technicians will be Technician Evaluating Exam will also be available for responsible for maintaining and improving their core current assistants who are considering regulation. competencies through continuous professional Will this all apply to hospital practice? development and be able to show evidence of such. No, not initially. Hospital pharmacies currently have The Canadian Council on Continuing Education in well defined policies and procedures and the goal is Pharmacy (CCCEP) has partnered with the Canadian not to create barriers in their practice but to see Association of Pharmacy Technicians (CAPT) to accredit community pharmacy progress. educational activities for these individuals. When will all these changes happen? Could you describe the national and assessment The Board is actively working on Stream A which initiatives underway? involves delegation of task to pharmacy assistants. This There are three national initiatives underway with will more or less reflect current practice. Stream B is respect to pharmacy technician regulation: not the current focus of the NLPB but it will be once the The National Association of Pharmacy Regulatory programs and exams have been tested and proven in Authorities (NAPRA: www.napra.org) has developed the other jurisdictions. Due to limited resources, NLPB has document “Professional Competencies for Pharmacy adopted a “watchful waiting” approach for now. Technicians at Entry to Practice”. This is a key document Stakeholder consultation, communication and education because these competencies are the basis for will continue to flow in the months ahead. requirements for entry into regulated pharmacy technician practice; examinations required to enter the The Newfoundland and Labrador Pharmacy Board profession; and standards for pharmacy technician appreciates any and all feedback from pharmacists and programs accreditation. As well, these competencies may current pharmacy technicians. Please feel free to discuss assist in developing or revising legislation and this issue with any Board Member or send your comments regulatory authority’s standards, by-laws, ethics, and through [email protected] or the Feedback form on the codes of conduct. These competencies describe the roles and responsibilities that pharmacy technicians must be NLPB website. Summer 2009 Page 7 NAPRA News NAPRA Board elects new building the pharmacy services Yukon representative participated President for 2009-2010 department for the Lamont Health at this meeting for the first time Dianne Donnan will serve as the Care Centre, an Acute and Surgical since rejoining the association last new President of the National Care Hospital and large Long Term January. Association of Pharmacy Care Centre in Lamont, Alberta. “Yukon’s membership in NAPRA Regulatory Authorities (NAPRA). A strong leader in the pharmacy comes at an important juncture. Elected from among her peers on community in both her work and There is a significant amount of April 26, 2009, Ms. Donnan will volunteer settings, Ms. Donnan change in the profession of serve a one year term concluding served at the provincial level as pharmacy as a whole,” says in April 2010. President of the Canadian Society registrar Fiona Charbonneau. “We “It is my pleasure to serve as of Hospital Pharmacists Alberta look forward to being a part of President of NAPRA for the coming Branch and as the President of the NAPRA in order to approach and year,” says Donnan. “I believe my Council for the Alberta College of resolve regulatory issues together.” practice and volunteer experience Pharmacists. will serve me well to advance the NAPRA also welcomed David For more information on NAPRA and association’s key initiatives.” McLeod, representing the Prince their initiatives, visit their website at www.napra.ca or click HERE to see A graduate of the University of Edward Island Pharmacy Board, as the latest issue of their newsletter, Alberta, Ms. Donnan entered her the new Vice President for 2009- NAPRA Notes, on our website under professional career as a 2010. News & Communications. pharmacist manager in 1986. Most The recent Board meeting also recently, Ms. Donnan has enjoyed marked a significant milestone – a
Pandemic Preparedness
As communicated to pharmacists and pharmacies on these drugs and how they can be obtained, as the April 30, 2009, Charles Coady, Director of Public Department wants only to monitor actual prescriptions. Health Information & Surveillance, Department of It is not being asked that patient or pharmacy Health and Community Services has contacted the identification be disclosed, only the number of NLPB concerning monitoring taking place at the prescriptions and in which Regional Health Authority Department as part of the provincial pandemic area the prescription occurred. preparedness strategy. You are asked to report prescription activity for these The Department particularly would like to monitor any two drugs on a daily basis changes in the number of prescriptions for the anti- until notified further. viral drugs Tamiflu or Relenza in this province. Reports should be faxed Regardless of the fact that availability of these drugs directly to the Department is often limited, pharmacists-in-charge are being of Health and Community Tip! asked to provide daily reports of the number of Services at (709) 729- Visit the Frequently‐ prescriptions filled for Tamiflu or Relenza in their 4647. Asked Questions page pharmacies. This report should also include an account If you have any further on our website for of any prescriptions presented to the pharmacy that questions please contact quick answers to were unable to be filled. Do not include information Charles Coady at (709) many common regarding general requests for information about 729-5306. questions Page 8 The Apothecary Continuing Professional Development Audit Results The Continuing Professional Development (CPD) Audit Process is now completed. This year, 184 pharmacists were audited and the results of the reviews are as follows: Out‐of‐Province First Review (March 5/6/9th) Second Review (April 21st ) Prescriptions 184 reviewed 39 reviewed 145 compliant 36 compliant As discussed in the June 39 asked for additional information 3 given one final week to clarify information 5, 2009 notice to pharmacists, The Registration and Licensing Committee certificates should indicate success in Newfoundland and Labrador pharmacists would like to point out the following: the program and the number of CE’s are now permitted to The Professional Development (PD) Log acquired. dispense prescriptions and Learning Portfolio Record Sheet The form for documenting Credit for written by prescribers have been revised over the past year acting as a Preceptor to a Pharmacy licensed to practice in other provinces of to reflect changes made to the Student or Intern can be found on the Canada. For more Standards of Pharmacy Practice on NLPB website and must be submitted information on the Continuing Professional Development. as part of the Learning Portfolio when legislative change, please All pharmacists should now be using claiming credits for being a preceptor. see the FAQ Re: Filling Prescriptions from Out of the updated versions of these forms. If audited, pharmacists should Province Prescribers, When recording credits on the ensure that Learning Portfolios which can be found with Learning Portfolio Record Sheet and (Learning Portfolio Record Sheets and the Pharmacy Act on the the PD Log, credit should be supporting documentation for each Legislation page of the submitted as either accredited or self- program) are submitted in an NLPB website. assigned, not both. organized fashion – i.e. in the order ∞ the events are documented on the PD Credit should be recorded on the PD naproxen sodium Log for the year in which the credit is Log. (Aleve®) being claimed. This is usually the year If audited, pharmacists must submit in which the program was completed. Learning Portfolios by mail, courier, or Though Aleve® is now commercially available in However, programs completed in hand. Faxed portfolios will no longer Canada, pharmacists in December may be documented in the be accepted as there have been too Newfoundland and same calendar year OR in the next many issues with this mode of delivery. Labrador may not sell it calendar year. Any pharmacist, who has been non- just yet. We have written the Minister of When completing programs that compliant in the previous audit year, Health and Community contain timely information (e.g. will, in most circumstances, be audited Services to request the Pharmacist’s Letter) pharmacists should again in the next year. necessary change be ensure the programs are still relevant Once the audit process is concluded a made to our Provincial (ideally, from within the last 2 years). copy of the result is placed in the Drug Schedules but at the time of publication, Pharmacists attending multiple sessions pharmacist’s file, and documentation we have received no at one event (i.e. a conference) must submitted for audit purposes is notification of this document each session separately. shredded. change. As soon as we Certificates of Completion must do, we will update the For copies of all forms as well as the Provincial Drug Schedules always be included for online Standards of Pharmacy Practice, please visit accordingly (See Drug programs and for video presentations the Professional Development page of the Schedules) and notify all borrowed from PANL (issued from pharmacists. NLPB website. PANL upon return of the video). These Summer 2009 Page 9 Professional Practice Issues Are You Responsible? maintaining adequate and suitable stock, If you are the Pharmacist-in-Charge of a pharmacy, dispensing equipment, and a reference library remember that you are responsible for: maintaining the pharmacy, its stock, dispensing all professional activities occurring in the pharmacy equipment and library in a clean and sanitary including ensuring that the pharmacy is compliant condition suitable for the practice of pharmacy with all applicable legislation and standards of notifying the secretary-registrar: practice of the names of pharmacists employed by personally managing, controlling, or supervising the pharmacy and when a pharmacist the pharmacy, including devoting the majority of ceases employment with the pharmacy your working time and attention to the operation of any change in ownership, corporate of the pharmacy name or location of the pharmacy being present in the prescription department for a of any lock & leave enclosure being used in reasonable portion of the operating hours of the the pharmacy pharmacy if the pharmacy intends to dispense prohibiting an owner or other person who is not a methadone pharmacist from directing, influencing, controlling of the cessation of operation of the or participating in the management or operation pharmacy of the pharmacy
Updates to the NLPB Website New! Annual Report 2009 FAQ on Out-of-Province Prescriptions Letter of Standing template MedEffect advisories & Canadian Adverse Reaction Newsletters April & July 2009 NLPB Board Meeting Minutes February 2009 Registration and Practice Experience Requirements for International Pharmacy Graduates Pharmacy Assistants / Technicians section of Professional Practice Resources page Updated! Contacts and Committees pages Frequently-Asked Questions NLPB Pharmacy Binder Pharmacies and Pharmacists Registers Pharmacy Act, Board Bylaws & Schedule of Fees Registration and Practice Experience Requirements for New Grads & MRA pharmacists Program of Examinations Standards of Pharmacy Practice—Required Reference Library Q & A on Narcotic and Controlled Drug Records Why is it necessary to print and review a monthly diversion, or theft. As well, the introduction of perpetual Narcotic Sales Report? inventory management by software providers is a The Narcotic Sales Report is an important management useful tool for facilitating the reconciliation process. tool in curbing diversion and theft, when properly What must a pharmacist report to Health Canada reviewed. Owners and managers should review the regarding narcotics and controlled drugs? report in conjunction with narcotic prescription files to Both the Narcotic Control Regulations (section 42) and ensure that all reportable narcotics and controlled the Regulations to the Food and Drugs Act (s.G.03.013) drugs are properly recorded; all prescriptions are requires a pharmacist to report any loss or theft of accounted for; all narcotics and controlled drugs these drugs within 10 days of discovering the loss. requiring a written prescription are present and unusual What is considered a loss of controlled patterns of drug usage are monitored or identified. substances? Why should I do a regular narcotic inventory A loss can take many forms but is basically anything count? that results in a shortage in your inventory of controlled Narcotic inventory counts are necessary to provide a substances. Some examples are theft or robbery, starting point or baseline to perform narcotic diversion or unexplained loss, spillage or wastage, reconciliations. Counts of your narcotic and controlled damage or contamination of products, etc. drug inventory (including benzodiazepines) should be How do I report a loss? done on a regular basis, preferably monthly, in Forms can be found on the NLPB website under conjunction with random reconciliations on specific “Miscellaneous Forms.” Copies of this form should also drugs. This will help to identify any shortages, possible be sent to the NLPB and retained in the pharmacy.
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar ...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator...... [email protected] Veronica Harvey, Executive Assistant to the Registrar ...... [email protected] General Information...... [email protected] The Apothecary BOARD MEMBERS published quarterly by the Newfoundland and Labrador Elected Members Pharmacy Board Zone 1 ...... Debbie Kelly Apothecary Hall Zone 2 ...... David Jenkins 488 Water Street Zone 3 ...... John Rideout St. John's, NL A1E 1B3 Zone 4 ...... Christina Tulk At Large ...... Keith Bailey, Brian Healy, Linda Hensman
Appointed Members Tel: 709-753-5877 ...... Don Mifflin Toll Free: 1-877-453-5877 ...... Eugene Toope Fax: 555-753-8615 Observer E-mail: [email protected] MUPS Representative ...... Megan Dawe
EXECUTIVE COMMITTEE We’re on the Web!! Chair ...... Keith Bailey Vice-Chair...... Christina Tulk www.nlpb.ca Executive Member...... Debbie Kelly Past Chair ...... John Rideout
The Apothecary
Newfoundland and Fall 2009 Labrador Pharmacy Board In Memoriam We express our sincere condolences to the families of two pharmacists who made significant contributions to the profession of pharmacy in this province. Neil P. Curtis The Apothecary is the November 21,1932—September 11, 2009 newsletter of the Neil was born in St. John’s and graduated from St. Bonaventure’s College in 1950. He began Newfoundland & his pharmacy career with Tommy Ricketts while still in high school. He apprenticed at Theatre Labrador Pharmacy Pharmacy and the General Hospital in St. John’s and was first registered as a pharmacist in Board. 1954. It contains information During his career, Neil served as Chief Pharmacist and Assistant Administrator at the General on a wide variety of Hospital. Subsequently, he was the Pharmacy Consultant at the Department of Health until topics intended to 1979. After early retirement, he returned to community pharmacy and, in 1992, was a enhance the practice founding member of the Alpha Group, serving as its Executive Director since its formation. At of all pharmacists in the same time he continued a level of relief practice in independent pharmacy. the province of Neil’s involvement with the former NPhA includes having served three terms as a member of Newfoundland & the Council from 1964-1973 as well as Secretary-Registrar from 1964-1971. He was Labrador. instrumental in establishing a local presence of CSHP, serving as its first local president as well Pharmacists are as the first President of the national Conference of Pharmacy Registrars of Canada. Neil also responsible for served on the NPhA Negotiating Committee and acted as a resource person for the ad-hoc reviewing any and Reciprocity Committee. Neil was the first recipient of the NPhA E.C. MacDonald Memorial ALL INFORMATION Medal for exceptional contribution to the work of the profession in NL and was made an contained within Honorary Member of NPhA in 2002. including documents Thomas John (Johnny) Stowe which are made June 1, 1927—October 14, 2009 available on the NLPB John was born in St. John’s and graduated from Holy Cross School in 1942. He apprenticed website via links at Burfitt’s Drug Store in St. John’s and was first registered as a pharmacist in 1946. throughout the John was a community pharmacist for 26 years and, along with his pharmacist brother Nelson, newsletter. he operated Stowe’s Pharmacy in St. John’s from 1958-1973. In 1973 he moved to hospital The Apothecary is now pharmacy, first at the Janeway Child Health Centre and then as Director of Pharmacy at St. circulated Clare’s Mercy Hospital from 1974 until his retirement in 1986. electronically and is He served on the Council of the former NPhA for 12 years and was President from 1973- available in hard copy 1975. He also served on numerous Association Committees including the CTT Pharmacy format only upon Advisory Committee, the Third Party Payment Committee, the Community Practice Committee, specific request. the Hospital and Governmental Committee and the Education Committee. He was the Newfoundland member of the Council of CPhA from 1968-1972. He represented NPhA on the Atlantic Provinces Pharmacy Council, was a member of CSHP and served on the Canadian Foundation for Pharmacy for over 20 years. John was appointed as the NPhA representative to the Board of PEBC in January 1979, served on the Executive Committee of PEBC and was President of PEBC in 1983. His contribution to the profession was recognized when he was made an Honorary Member of NPhA in 1989. Page 2 The Apothecary H1N1 Influenza Prevention Strategies—“Clean, Cover & Contain” CLEAN your hands regularly with soap and water or hand sanitizer Pharmacy staff members should wash their hands often with soap and water or use an alcohol-based hand cleaner, especially after coughing or sneezing. Employers can place posters in the pharmacy that encourage hand hygiene. Employers can provide soap and water and alcohol-based hand sanitizers in the workplace and ensure that adequate supplies are maintained. If feasible, place hand sanitizers in multiple locations to encourage hand hygiene.
COVER coughs and sneezes Pharmacy staff members should be encouraged to cover coughs and sneezes with a tissue or, in the absence of a tissue, one’s sleeve. Employers can place posters in the pharmacy that encourages cough and sneeze etiquette. Employers can provide tissues and no-touch disposal receptacles for use by employees. See: Department of Health and Community Services CONTAIN your illness by staying home and resting Information page on H1N1 Influenza Virus Pharmacy staff members should watch for any signs of fever or other H1N1 Frequently-Asked Questions signs of influenza-like illness. Those with influenza-like illness should “Clean, Cover & Contain” Hygiene Campaign stay home from work and remain there until at least 24 hours after they are free of fever or signs of a fever, without the use of fever- How to Wash Hands reducing medications. How to Sanitize Hands
Information for Pharmacists on the Release of the National Antiviral Stockpile (NAS) We have received many calls in the past few days regarding The tracking tool that was enclosed in the packages with the Provincial Government’s decision on October 16, 2009 to the stockpile must be completed for all dispenses from release the National Antiviral Stockpile (NAS). There are a the NAS. If you did not receive a tracking tool with your few important points we would like to remind pharmacists of: shipment, call (709) 729-6507 or e-mail either Patricia Clark ([email protected]) or Dennis Davis The Department of Health and Community Services has ([email protected]). made a supply of Tamiflu (Oseltamivir) and Relenza (Zanamivir) available to retail pharmacies in the The Public Health Agency of Canada (PHAC) notes that province. A supply has also been delivered to the reports of adverse reactions to antiviral medications are Regional Health Authorities for distribution to internal an important source of information that will help guide pharmacies associated with hospitals, clinics and long their safest and most effective use. Serious adverse term care facilities. reactions can by reported by calling 1-866-234-2345 or by completing the online Canada Vigilance Reporting Prescriptions for ALL residents of the province or visitors Form. to the province may be dispensed from the NAS as long as the prescription has been labeled PANDEMIC USE by Since TAMIFLU Suspension is not currently commercially the prescriber and the treatment regimen is as available, many pharmacists have been inquiring about approved: the availability of a compounding formula to prepare TAMIFLU (OSELTAMIVIR) - Max 10 doses per their own suspension. It has also come to our attention patient of either the 30mg, 45mg or 75mg that these instructions are available in the TAMIFLU capsules or 75 mL per patient of the 12mg/ml Product Monograph on the Roche website as well as in a Suspension (suspension is not available at this time) more concise handout from Roche that has been RELENZA (ZANAMIVIR) rotadisk - Max 1 box (20 circulated to pharmacies as well as on the website for doses) per patient the British Columbia Centre for Disease Control. Pharmacists are cautioned that these instructions result in For a verbal prescription, pharmacists must confirm a 15mg/ml suspension that differs from the PANDEMIC USE with the physician and document this commercially available 12mg/ml suspension and that accordingly. dosage adjustments will be necessary as a result. Fall 2009 Page 3 Antivirals Vaccines Due to increased influenza-like-illness activity and Seasonal Influenza Vaccination laboratory confirmed H1N1 cases in the province, NL’s For this year, the Department of Health and Community share of the National Antiviral Stockpile (NAS) was released Services recommends the seasonal influenza vaccine for: on October 16th, as a precautionary measure. The anyone over the age of 65; experience to date with H1N1 in Canada is that it is still a residents of long-term care homes; and mild disease. adults and children with chronic heart or lung disease or Antivirals can reduce influenza symptoms, shorten the length with other diseases severe enough to require regular of illness, and reduce the serious complications of influenza medical treatment or hospital care (such as severe if taken within 48 hours of getting sick. Antivirals do not asthma, diabetes, kidney disease, cancer, etc.). T provide immunity against the virus and should not be The vaccine will be available at no cost for these individuals. confused with the H1N1 vaccine. Anyone in these recommended groups should get the Currently the use of antivirals is indicated only for those seasonal flu shot as soon as possible. All others should get patients who have severe disease, or who are at risk of the H1N1 pandemic vaccine first. Similar to previous years, complications. People at a higher risk of complications for the seasonal influenza vaccinations this year will be the H1N1 influenza virus include: available from both physician offices and public health individuals with chronic conditions such as heart or kidney clinics. disease, diabetes, asthma and chronic lung disease, suppressed immune systems, neurological disorders, liver H1N1 Pandemic Influenza Vaccination disease, blood disorders and severe obesity; The H1N1 pandemic vaccine will be available to everyone children under five years of age; and, in late October through public health clinics. There will be no women who are pregnant. cost for the vaccine. (see addendum at bottom of page) Not all patients with H1N1 influenza need to either see their doctor, or receive an antiviral medication. People with mild Reference for this page: influenza-like-illness and no chronic health conditions should “Information on H1N1 Influenza Virus.” Department of Health and Community Services. Government of Newfoundland and Labrador. stay at home to prevent spread to others and should contact n.d. Web. 20 Oct. 2009.
As pharmacists, we all know that one of the worst things to For controlled drugs, double-count the number hear about is a dispensing error. We are often told that of dosage units dispensed how we respond to an error is critical. But what we do to It is also good practice to: prevent additional errors from occurring in the future is check that the labels on the items have not been even more important. transposed when dispensing more than one item to the same patient KNOWN RISKS count the number of items on the prescription and then There are many things that contribute to dispensing errors count the corresponding number of dispensed items into such as distractions or interruptions, working long hours the bag without a break, quieter periods (research shows that fewer check that you have not included any stock containers in errors occur when the dispensary is busy), lack of focus due the bag to illness or personal problems, an over-reliance on the accuracy of other staff members involved in dispensing the DOCUMENTATION medication, self-checking, and new staff members. Each staff member involved in the dispensing of a
DEVELOP THOROUGH CHECKING PROCEDURES prescription is responsible for its accuracy and should physically document their involvement by marking and/ A thorough and consistent checking procedure is perhaps or signing/initialing the pharmacy “hard copy” that is the best defense against dispensing errors. This involves affixed to the prescription. several steps including: For example, if an assistant picked the drug from the Check the drug name and strength by comparing: shelf, counted it and labeled the vial, she should check the prescription to the label the drug name and strength (triple-check), document the the prescription to the bottle or package DIN from the stock bottle, the quantity counted and sign the label to the bottle or package or initial the hard copy prior to passing it to the Check the product dispensed after preparation: pharmacist for checking. The pharmacist should then If using multiple bottles or packages, check that all complete all other checks as indicated previously, bottles or packages are the same making some sort of physical mark next to each piece If using stock bottles, carry out a quick visual check of information on the hard copy, finishing by signing/ on the contents of the bottles and the contents of the initialing the hard copy. container to ensure they match PRESCRIPTION MEDICATION COUNSELLING TIPS If using packages, open all unsealed packages Effective patient counseling should also pick up any checking that the contents are correct, the number of unidentified errors and should include: strips present in each package is correct, and that verifying the patient's and prescriber's names there are no loose blisters or tablets discussing the patient’s understanding of why the Check the expiry date on each stock bottle or medication is being prescribed package how, when and for how long to take the medication - Check the rest of the information on the prescription: ensure spoons, oral syringes, etc. are included if Patient name necessary Prescriber how to store the medication Instructions to the patient what to do if a dose is missed Dosage form Quantity how the patient will know the medication is working Check that the correct quantity has been given whether or not the prescription can be refilled, and if (the correct number of packages or a quick so, when visual check of the container) Finally, as a last check, show the patient what the medication looks like. Fall 2009 Page 5 Professional Practice Committee Update
The Professional Practice Committee has had some needs and implement in NL (includes issues related great successes over the past few years and the to Education, Protected title, Financial implications, dedication of the people on the committee has been Competency, Discipline, etc…) the key to that success but there have been a few Sub-Committee on Safe Medication Practices challenges. To keep a group this size informed and Look at a number of patient safety issues including: actively involved has proven to be very difficult. The Narcotic Control / Security Guidelines complexity and the organization of the committee Prescription Error Prevention and/or Handling made doing any task labour-intensive for both the Dispensing Accountability committee chair, Sandra Carey, and the Deputy Quality Assurance Registrar, Arlene Crane, who helped organize the Seamless Care (Medication Reconciliation) information and prepare it for the Board. Hiring Contribute to public communications plan Melanie Healey as the Professional Affairs Coordinator was the first step in making this committee Sub-Committee on Pharmacy Communication/ more efficient and timely in its responses to the Board. Computer Standards At its most recent meeting, the Board agreed that the Review and make recommendations related to the next step should be a reorganization of the committee Standards of Pharmacy Practice for Reference structure to improve information flow and productive Materials. issue resolution. Comment and provide feedback on other computer & technology related pharmacy practice issues. Previously: Revised: Committee with Chair One overall Chair Sub-Committee on Long Term Care Standards of Sub-Committees with Sub-Committees with Practice (already appointed & in progress) Individual Chairs Co-Chairs Responsible for professional practice issues related Sub-Committees Chair and Co-Chairs to the provision of pharmaceutical care to Personal reported to Committee oversee Sub- Care Homes and Long Term Care Facilities. which reported to the Committees which Board report directly to the Make recommendations to the Board with respect Board to Standards of Pharmacy Practice for pharmacists related to Long Term Care Facilities and Personal The various sub-committees will be struck to deal with Care Homes. specific Professional Practice issues and may be dissolved after a short time if the mandate is complete or stay as “standing” sub-committees to deal with Next Steps: related issues as they arise. The first set of sub- o Bring draft changes to Terms of Reference to committees are as follows: November Board Meeting Sub-Committee on Medication Management o Contact all potential sub-committee members to Look at this as a Two-Tiered process with Tier One ensure interest / commitment being “Medication Management” with no advanced o Set dates for meetings with each sub-committee to training required. Tier Two would be for those with set / discuss change of focus / mandate advanced training and/or those in a collaborative
practice with a physician. Pharmacists who have a particular interest in one or Sub-Committee on Pharmacy Assistants/Regulated more of these areas are encouraged to contact Melanie Technicians Healey at [email protected] to indicate willingness to Look at what is happening nationally, tailor it to our serve on a sub-committee. Page 6 The Apothecary Frequently Asked Questions about Nurse Practitioners’ Prescriptions Updated October 2009
Q: What are the rules regarding a Nurse Practitioner situations where a pharmacist is not available or Prescribing? accessible and /or it is in the best interest of the client. A: According to the Nurse Practitioner Regulations, 2.7 In accordance with the federal Food and Drug Act "nurse practitioner" means a nurse practitioner as shall not distribute pharmaceutical drug samples. defined in paragraph 2(f) of the Registered Nurses Act, In effect, this means that NPs may independently 2008 and "specialty nurse practitioner" means a prescribe those drugs listed in Schedule C or any OTC registered nurse who meets the criteria for licensure as a drug which may require a prescription for insurance speciality nurse practitioner established by the coverage. However, under the federal Controlled Drugs association and is issued a practice protocol. and Substances Act NPs do not have authority to Consequently, according to paragraph 5(c) of the Nurse prescribe narcotics or controlled drugs. Schedule C is Practitioner Regulations, a nurse practitioner may organized in a table by according to the American prescribe a drug permitted by the practice standards or Hospital Formulary Services (AHFS) Pharmacologic which he or she is authorized to prescribe under a Therapeutic Classification System (therapeutic class and practice protocol. The practice standards discussed in the subclass) along with associated notes and/or conditions regulations refers to the professional standards and under which certain drugs can be prescribed. Schedule scope of practice standards established by the C can be found on the Legislation page of the NLPB Association of Registered Nurses of Newfoundland and website. Labrador document, Framework for Nurse Practitioner Practice in Newfoundland and Labrador. It states under Q: When a nurse practitioner prescribes a renewal of Scope of Practice Standard 2: a drug that was previously prescribed by a physician, The nurse practitioner shall manage and monitor the care can she prescribe all classes of drugs (Schedule F, of the client population by providing safe, effective, and Narcotics, Controlled Drugs, Targeted Substances)? It current pharmacological therapy within the NP’s scope of doesn't specifically say they can't in the Nurse practice. The NP: Practitioner Regulations. Correct me if I'm wrong, but I 2.1 Prescribes pharmacological therapy in accordance can’t see any mention of Nurse Practitioners in the with Schedule C of the NP Schedules for Ordering federal legislation, but our provincial Nurse or his/her practice protocols. Practitioner Regulations provide for prescribing by 2.2 Utilizes an authoritative source of evidence-based Nurse Practitioners. Can you please clarify this and drug and therapeutic information, to point me to the place in the regulations where I appropriately prescribe drugs in the clinical management of clients. should be looking.
2.3 Prescribes over-the-counter medication for the purpose of accessing a drug payment plan. A: Part of the confusion about the prescribing authority 2.4 Provides client education about prescription and for NPs stems from the fact that there are different non-prescription drugs including: expected action definitions of “practitioner” in the federal Food and of the drug, importance of compliance, side Drugs Act (with respect to Schedule F drugs) and the effects, potential adverse reactions, possible Controlled Drugs and Substances Act (with respect to interactions with food or other drugs, follow-up narcotics, controlled drugs and benzodiazepines). The plan and reporting adverse reactions. Food and Drugs Act defines a prescription as “an order 2.5 Documents medications (prescribed or given by a practitioner…” where a “practitioner” means discontinued) on the client’s permanent health “a person authorized by the laws of a province to treat record. patients with any drug listed or described in Schedule F to 2.6 Dispenses specific medications in small quantities in (Continued on page 7) Fall 2009 Page 7
(Continued from page 6) A: In practical terms it is very difficult, if not impossible, for the regulations” (This essentially pharmacists to have a clear Out‐of‐Province Prescriptions & allows the province to decide who knowledge of the various prescribing the TRPDP may prescribe Schedule F drugs.) On authorities for all categories of NPs. So far, there has been no change to the other hand, the Controlled Drugs While some aspects of prescribing the requirements of the and Substances Act has the same authority are quite clear, others may Department of Health and definition of a “prescription”, but not be so clear, especially in Community Services’ Tamper‐ limits the definition of a protocol-style situations. For Resistant Prescription Drug Pad “practitioner” to mean “a person who example, as only designated Program to allow pharmacists to is registered and entitled under the physicians may prescribe accept prescriptions for drugs laws of a province to practice the methadone, a prescription for covered by this program written by profession of medicine, dentistry or methadone from an NP could not be out‐of‐province prescribers. If veterinary medicine…” (This accepted – this is clear. However, a there is any change in this essentially means that under federal Specialty NP prescribing according requirement in the future, regulations only a physician, dentist to a protocol that the pharmacist pharmacists in the province will be or veterinarian may prescribe does not have access to would be an notified at that time. narcotics, controlled drugs or example of a situation in which ∞ benzodiazepines.) prescribing authority is not quite so Pharmacy Name Change
clear. Pharmacists‐in‐Charge are Q: Can the nurse practitioner reminded that before making any continue to write refills over and According to the NLPB Policy, Nurse change to the corporate or trading over again, without a new Practitioner Prescribing and name of a pharmacy, it must be prescription being written by the Pharmacists’ Responsibilities, the reported to the Board on a physician in between? Board takes the position that it is “Change of Business License” form, reasonable for a pharmacist to at least 7 days before the change is A: NPs may issue renewal expect that NPs will prescribe in to take place, in accordance with prescriptions for patients. However, accordance with the applicable NLPB Bylaw 94. a patient with a chronic condition protocols, Regulations, Standards of ∞ must be reassessed by a physician on Nursing Practice and Code of Ethics. Lock & Leave Hours an annual basis, or sooner if the It is also reasonable for pharmacists Pharmacists‐in‐Charge are patient’s condition destabilizes or to assume that prescriptions issued reminded that, in accordance with requires changes in the treatment. by NPs have been issued within the section 11 of the Standards of When a physician reassesses a given Nurse Practitioner’s scope of Pharmacy Practice—Lock & Leave patient, it will be the physician who practice and in accordance with the in Community Pharmacies, where orders the new, or revised, protocols or regulations governing changes are proposed to a Lock prescription. No prescription, NP prescribing, unless there is and Leave [enclosure], or the times regardless of who prescribes it, can specific evidence to the contrary. It is during which professional services be filled for longer than a year. NOT the responsibility of are provided, he/she shall first pharmacists to “police” the obtain the approval of the Q: I am aware that it is the adherence of NPs to their protocols, Secretary‐Registrar by applying in pharmacist's responsibility to know regulations or Standards of Practice. writing and specifying the nature of whether every prescription they fill Rather, if there is specific evidence the change. This can be done by is valid or not, but, exactly how far of failure by the Nurse Practitioner submitting a new “Application for are we liable, with regard to Nurse to do so, the pharmacist should Lock & Leave Approval” form to the Practitioners scope of practice? present such evidence to the ARNNL NLPB Office PRIOR to making the for appropriate action. change. Page 8 The Apothecary
Continuing Professional Development Focusing on the Need Not the Numbers
Yes, 15 CEUs meet the annual registration renewal Given the rapid pace of changes in health care, the requirements, but have you ever asked yourself if need for practitioners to stay abreast of new those courses really met the needs of your patients development has also never been greater. The and your personal learning needs? Were your course opportunities for practice improvement are choices the best investment of your time? unprecedented. Pharmacists’ distinctive competency is based on the As a health professional, you have an obligation to use of their knowledge base to ensure the yourself, your patients and your colleagues to ensure appropriate and safe use of drugs in patients. that you are competent. Furthermore, you need to However, like many other trades and professions, the ensure that you are competent in areas that best knowledge base of our profession is no longer the serve your practice and your patients. exclusive domain of the pharmacist. The availability Rather than repeat a frantic scramble for CEUs next fall, of travel, the increase in medical publishing, and the or attend programs just for the sake of CEUs or a fancy Internet have all provided new ways for information dinner, why not make a plan for 2010 now? to reach the public. How well we develop and maintain our expertise and apply it to our patients Remember… will determine whether we have a distinctive Pharmacists may claim up to 7.5 non‐accredited competency compared with other health professionals CEUs per year ‐ this can be for anything from and perhaps even the lay public. attendance at non‐accredited programs or service Also, with the increasing complexity and risk of as a preceptor to preparing presentations for other medication therapy today, the need for the pharmacist in the appropriate initiation, monitoring, health professionals or first aid training. These are adjustment, and discontinuation of drug therapy has all valid learning opportunities even though they are never been more evident. not "accredited".
There are more organizations and websites that offer accredited professional development activities than we would ever be able to list completely but here are Professional a few to get you started: Development American College of Clinical Pharmacy American Pharmacists Association Resources American Society of Health-System Pharmacists Canadian Pharmacists Association Canadian Society of Hospital Pharmacists Dalhousie University Continuing Pharmacy Education Medscape Pharmacists National Community Pharmacists Association Pharmacists’ Association of Newfoundland and Labrador Pharmacy Gateway Power-Pak C.E. rxBriefCase Fall 2009 Page 9 Learning Portfolio Documentation Tips Audit Do’s and Don’ts
When completing Learning Portfolio Record Sheets If you receive an audit letter, here (LPRS) and Professional Development (PD) Logs, there are some Do’s & Don’ts to follow: are a few points for pharmacists to keep in mind: Do: All pharmacists should ensure they are using the Ensure that Learning Portfolios are most current versions of all forms. These are submitted in an organized posted on the NLPB website on the Professional fashion—ideally, in the order the Development page. events are documented on the PD Log. Only claim credit for those learning activities that Ensure that ALL required information is included: you are able to substantiate with certificates or Every entry on the PD Log should align with a non-accredited learning documentation; Learning Portfolio Record Sheet (LPRS). When documenting credit for a learning activity, Every LPRS should be accompanied by either credit should be documented as either accredited a Certificate of Completion or, for non- or self-assigned, not both: accredited programs, other suitable proof of If the learning activity was accredited, the completion. accrediting body should be identified on Conversely, every certificate should be the forms and the credit documented should accompanied by a LPRS. be as assigned by the body. Fulfill all audit requirements within the timeframe If the learning activity was not accredited, identified in the letter of notification. the pharmacist may self-assign credits using Make sure you are sending documents for the the rule of thumb, correct registration year. “One Hour of Time = One CE Credit” Submit your Learning Portfolio to the NLPB by Pharmacists attending multiple sessions at one hand, mail or courier. event (e.g. PANL conference) must document each session individually on separate LPRS. Each Don’t: session should then also be entered individually on the PD Log. Fax your Learning Portfolio to the NLPB. At its June 2009 meeting, the Board “Certificates of Completion” must be included for decided that, based on experience all accredited programs including live events, of previous years, faxed portfolios online programs and video presentations (these will no longer be accepted. are usually issued upon return of the video). These Pharmacists will be reminded of this certificates should indicate success in the program on the audit letters. and the number of CE’s acquired. Send information that is not Documentation of credits for service as a required such as copies of exams, handouts, slides, preceptor must be documented as non-accredited conference brochures, receipts, etc. learning using the appropriate form (found on the NLPB website). This form must be completed and Alter Certificates in any way (e.g., strike out included in the pharmacist’s Learning Portfolio. If participant’s name and write in another name, the pharmacist was preceptor to more than one changes the # of credits assigned, etc.). student or intern during the year, a separate form Claim non-accredited learning activities that are should be completed for each person. not really “learning activities”, such as golf tournaments, committee meetings, etc. Updates to the NLPB Website Food for Thought... New! While change may generate potential threats, it Application for Registration as a Pharmacy Intern— can also open up immense opportunities. International Graduates Pharmacists’ services and involvement in patient‐ H1N1 Influenza section of Professional Practice centred care have been associated with improved Resources page health and economic outcomes, a reduction in MedEffect advisories and Canadian Adverse medicine‐related adverse events, improved Reaction Newsletter—October 2009 NLP Board Meeting Minutes June 2009 quality of life, and reduced morbidity and Presentation to Pharmacy Technician Conference mortality. September 2009 These accomplishments have been achieved Board Policy - Practice Experience Requirements for through gradual expansion of traditional roles International Graduates and, in some cases, through the emergence of You and Your Pharmacist page collaborative drug therapy management Updated! NLPB Pharmacy Binder—October 2009 programs. NL Provincial Drug Schedules and Guidance Nonetheless, the potential for pharmacists to document—October 2009 effect dramatic improvements in public health Pharmacies and Pharmacists Registers remains largely untapped. Register of Licensed Veterinarians 2009 — World Health Organization Nurse Practitioner Regulations—August 2009 Application for Registration as a Student or Intern- Developing pharmacy practice: A focus on patient care Canadian Graduates
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar ...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator...... [email protected] Veronica Harvey, Executive Assistant to the Registrar ...... [email protected] General Information...... [email protected] The Apothecary BOARD MEMBERS published quarterly by the Newfoundland and Labrador Elected Members Pharmacy Board Zone 1 ...... Debbie Kelly Apothecary Hall Zone 2 ...... David Jenkins 488 Water Street Zone 3 ...... John Rideout St. John's, NL A1E 1B3 Zone 4 ...... Christina Tulk At Large ...... Keith Bailey, Brian Healy, Linda Hensman
Appointed Members Tel: 709-753-5877 ...... Don Mifflin Toll Free: 1-877-453-5877 ...... Eugene Toope Fax: 555-753-8615 Observer E-mail: [email protected] MUPS Representative ...... Emily-Ann Munden
EXECUTIVE COMMITTEE We’re on the Web!! Chair ...... Keith Bailey Vice-Chair...... Christina Tulk www.nlpb.ca Executive Member...... Debbie Kelly Past Chair ...... John Rideout The Apothecary
Newfoundland and Winter 2009 Labrador Pharmacy Board As the Christmas Season is upon us once again, and the old year draws nearer to its The Apothecary is the end, we take this opportunity to wish you and newsletter of the those dear to you a Joyous Christmas and a Newfoundland & Prosperous New Year. Labrador Pharmacy Board. It contains information May the Christmas message of on a wide variety of Peace and Goodwill remain with us topics intended to the whole year through. enhance the practice of all pharmacists in Best Wishes from all of us at the offices the province of Newfoundland & of the Newfoundland and Labrador Labrador. Pharmacy Board. Pharmacists are responsible for Holiday Hours for NLPB Office reviewing any and With the Christmas and New Year holiday season approaching it would useful ALL INFORMATION to note the holiday hours of operation for the Board office: contained within this newsletter including Thursday, Dec 24th, Christmas Eve Office Closed (vacation day)
any documents which Friday, Dec 25th, Christmas Day Office Closed may be made Monday, Dec 28th Office Closed (for Boxing Day holiday) available via links to the NLPB website. Thursday, Dec 31st, New Year’s Eve Office Closes at 12:00 noon The Apothecary is now Friday, Jan 1st, New Year’s Day Office Closed
circulated During the holidays mail may be left in the mail slot of our fire exit door. electronically and is Messages may also be left on our telephone answering machine, by fax, or by available in hard copy e-mailing one of the Board staff members at the email addresses listed at the format only upon back of this newsletter. specific request.
Professional Development Logs for 2009 must be received at the NLPB Office NO LATER THAN December 31st Page 2 The Apothecary First Pharmacy Has Connected to Provincial Pharmacy Network The Newfoundland and Labrador Centre for Health Information (the Centre) is pleased to announce it has connected the first provincial community pharmacy to the Pharmacy Network, marking an important step in the development of the provincial Electronic Health Record. The Pharmacy Network, a component of the provincial Electronic Health Record (EHR), is designed to support improved patient safety and overall enhanced care for patients. It is a drug information system that will hold a record of all medications prescribed to patients and will, ultimately, connect pharmacists, physicians, and other authorized health professionals to comprehensive electronic medication profiles for their patients. The first community pharmacy, the Baccalieu Trail Pharmacy in South River, is serving as a reference, or pilot, site for the project. As a reference site, Baccalieu Trail Pharmacy has agreed to partner with the Centre in the early use of the Pharmacy Network to foster learning and provide an opportunity for system refinement prior to full implementation. “Engaging this first community pharmacy brings us closer to implementing the Pharmacy Network in community pharmacies province-wide and we extend our sincere appreciation to the Baccalieu Trail Pharmacy and its staff for taking that step with us,” says Mike Barron, CEO of the Centre. “The Government of Newfoundland and Labrador is pleased to see the Pharmacy Network moving forward through today’s announcement of the first community pharmacy pilot,” said the Honourable Jerome Kennedy, Minister of Health and Community Services. “The Pharmacy Network will undoubtedly establish a more comprehensive approach to medication management while also providing the medical information required to support enhanced quality care to patients.” The Pharmacy Network will eventually be rolled out to all community pharmacies in the province in phases. Once a pharmacy is connected, information about prescriptions filled at that pharmacy will be added to the Pharmacy Network by a pharmacist from that point onward. In turn, the Pharmacy Network will begin to feed prescription information into the provincial Electronic Health Record (EHR), working to create a more complete picture for health professionals when making decisions around a patient’s care. “Once established, the Pharmacy Network is anticipated to improve patient care by reducing risk of medication errors and adverse drug interactions and by enhancing information sharing between the health professionals who make decisions about patient care, all while protecting the privacy of personal health information,” concludes Barron. “Reaching the point of bringing our first community pharmacy on board is an achievement to be celebrated and we look forward to the future expansion of this project.” Sections of PHIA Relevant to Pharmacy Network Proclaimed Now that the Professional Development In the November 20, 2009 issue of the Newfoundland and year for 2009 is completed, pharmacists are Labrador Gazette, several sections of the Personal Health Information Act were proclaimed. In addition to this, reminded to download and use the updated regulations related to the Pharmacy Network were also Professional Development Log and Learning passed. For more information, see the document entitled, Portfolio Record Sheet forms available on “Proclaimed Sections of PHIA and Pharmacy Network the Professional Development page of the Regulations”, on the Legislation page of the NLPB website. NLPB website. Winter 2009 Page 3 NL Pharmacist Participates in Mission Trip to Rwanda Newfoundland and Labrador Pharmacist and NLPB Board Member, David Jenkins (Tri-Con Pharmacy, Old Perlican) recently spent time in Kigali, Rwanda on a mission trip with the non-profit organization “Shelter Them” (www.shelterthem.com). Here is Dave’s description of his time in Kigali:
“My wife and I, along with three other friends from NL, recently returned from a mission trip to Kigali, Rwanda where we worked with street children, helped with a feeding program as well as built a playground area for an orphanage that houses 45 - 50 children. We went with an organization called " Shelter Them". This is a non-profit organization founded by twin sisters, Jocelyne Alexandre & Josephine Murphy, who lived through the 1994 genocide in Rwanda where one million people were killed in 100 days, and now live in Ontario. We have been involved with this organization for the past 2 years and with the help of our local church and generous donations from the Alpha Group as well as some drug companies, we have raised over $30,000.00 to date. 100% of this money goes directly to the children in Rwanda and on our trip we were able to see what this money has accomplished. Besides running a feeding program once a week for 150 street kids - probably the only real meal they get that week - they also supply the necessary funding to an orphanage that's called home for 45-50 children. Since January 2009, they have taken 14 children, who until then lived on the streets, and have placed them in homes that have a "mom" and as well they now get an education, a health card and all the necessities of life. Homelessness in Rwanda is a big problem due to the after effects of the genocide and the AIDS crisis. We have seen first hand that the need in Rwanda is great but we have also seen hope through the success stories of Shelter Them. A little goes such a long way in Kigali. One day while we were walking the streets of Kigali, giving shoes to children with bare feet, we met 5 street kids who hadn't eaten anything in 2 days. We bought food for those children for less than $2.00 and their bellies were full. No one begs there and the children work very hard just to survive. We helped a 12 year old, Jean Claude, with a serious leg wound,. He has been living on the streets since he was nine and works three jobs to survive. We made friends with the children we worked with as well as women afflicted with AIDS. We learned lessons of humility and forgiveness from the people there but the joy we saw on the faces of those children who have absolutely nothing is something that we will never forget. God willing, this will be the first of many trips to Kigali. Hopefully, on our next trip, we will be building homes so that more homeless children will have hope and a future. If anyone is interested in helping this very worthwhile cause, they may contact us or visit the Shelter Them website for more information.” Page 4 The Apothecary Complaints and Discipline Resolution
Case #1: Facts. The Audit and Claims Integrity division of the Department Complaint #1: of Health and Community Services alleged that following Expired Prescriptions Continuing to be Filled – Violation an audit of billings to the NLPDP by a pharmacy, a of sub-sections 37(1)(w), 13(11), 12(1)(a), (b)(iii), (xi) number of issues had been identified that may be of and 12(2) of the Pharmacy Regulations and section interest to the Board, namely: C.01.042(1) of the Food and Drug Regulations 1. expired prescriptions continuing to be filled, Between November 11, 2003 and November 10, 2004 2. no supporting prescriptions on file for prescriptions the pharmacists filled a number of prescriptions over one filled, year from the original date the prescription was written. 3. unauthorized refills or excess quantities being filled or The prescriptions in question had been continued to be refilled, filled past the one year date as a result of an intentional 4. verbal prescriptions that did not document the required change to the computer software made by the pharmacist- information, and in-charge to address what was felt to be a patient safety 5. “emergency supply” of one prescription, filled without concern at a nursing home serviced by the pharmacy. The a prescription from a physician.. computer software at the pharmacy had been preset to The CAC found that there were reasonable grounds to automatically stop “expired” prescriptions (those over one believe the respondent had engaged in conduct deserving year old) from being filled. From time to time this meant of sanction in relation to issues 1, 2, 3 and 4. The CAC did that some prescriptions for patients at the home (especially not think there were reasonable grounds to forward issue those that were not being filled monthly such as prns, number 5 to a hearing, since the pharmacist used their injectables or topicals) would expire and not be pickup up professional judgment, as reflected by documentation on on the Three Month Review (TMR). At one point a this prescription. In accordance with section 39(3)(b) of the prescription for a Vitamin B12 injection had expired and Pharmacy Act, the panel instructed the Secretary-Registrar was not noted by the staff of the home and was therefore to file the first four complaints against the respondent and not reordered or administered for approximately 10 refer them to the disciplinary panel for a hearing. The months. Following this, the facility staff asked what the committee also felt that the following additional issues pharmacy could do to prevent this from happening again. should be brought to the attention of the Disciplinary Part of the solution suggested at that time, and Panel: implemented by the pharmacist-in-charge, was to change the practice of rewriting “Doctors’ Orders” forms and the automatic stop date on the computer software to two identifying them as verbal prescriptions, years rather than one year. Staff at the home were the issue of the pharmacist-in-charge changing the reminded to check each TMR and medication automatic 365 day expiry date for prescriptions in the administration record (“MAR”) for accuracy and, as there pharmacy computer, would always be a medication review sheet authorizing the acceptability of a policy that all medications the medications for 6 month periods on file at the pharmacy to authorize these prescriptions, it was felt that written at the Long Term Care Centre serviced by the solution was acceptable. While the Board is prepared to pharmacy are to be continued until discontinued by a accept that the pharmacist felt that this was the best way physician, and to address this issue, it does not feel that the measure the appropriateness of using physician’s prescription implemented was a prudent one, in keeping with pads to write up verbal orders. acceptable Pharmacy practice. The measure implemented At the hearing the tribunal was presented with an Agreed also affected prescriptions for patients not residing at the Statement of Facts and a Joint Submission acknowledging home (for whom there were no TMR’s). When the NLPDP the violations and proposing disposition on the four audit out of which the Allegation arose was completed, the complaints detailed in the Complaint Document and pharmacist-in-charge became aware that expired Agreed Statement of Facts. prescriptions were being refilled and immediately The following is summary of the Agreed Statement of (Continued on page 5) Winter 2009 Page 5
(Continued from page 4) to provide continuity of therapy or to supply sufficient medication until physician appointments. Proper changed the default date on the computer system back to documentation regarding the reason for giving the extra 365 days. The vast majority of the refilled expired refill was not carried out on these prescriptions. The prescriptions were nursing home prescriptions for which pharmacy now fully documents all reasons for providing medication reviews were on file authorizing their renewal. emergency refills. The Board is prepared to accept that There was no deliberate act to knowingly fill a prescription there may be compelling reasons on a case by case basis that was expired without authorization. While the for providing an interim short term supply of a medication Allegation arose out of the NLPDP audit referenced but makes a distinction between interim supply and above, the Board’s mandate is to ensure that appropriate extending a prescription by supplying a complete refill. standards of Pharmacy Practice are followed, and not to There were also 2 claims in which the quantity billed enforce the NLPDP audit and recovery process for claims exceeded that authorized both due to documentation paid. error. In one case the total quantity of a verbal Complaint #2: prescription narcotic was incorrectly recorded by the No Supporting Prescriptions on File for Prescriptions pharmacist as 400 rather than 408 although the physician Filled – Violation of sub-section 37(1)(u), 13(12) and 12 had intended it to be 408, a multiple of 34 (a 34 day (1)(a), (b)(iii), (xi), 12(2) of the Pharmacy Regulations, blister pack is the quantity usually supplied to the facility). and section C.01.041(2) of Food and Drug Regulations The other case involved a prescription which was initially short filled to be filled within the nursing home monthly For the 12 month period covered by the NLPDP audit there batch fill. The prescription was meant to be for 12 refills were a number of original prescriptions unable to be with a 34 day supply for each refill but the 34 day supply produced by the pharmacy on the date the auditor quantity was not specifically documented. attended. All these prescriptions had an original date of more than 2 years before the date of the audit. At the Complaint #4: time, the pharmacist-in-charge did not make further efforts Verbal Prescriptions that did not Document the Required to locate and provide these prescriptions to the auditor Information – Violation of sub-section 37(1)(u), (w) and because they were over 2 years old and the pharmacist- 12(1)(b)(xi), 12(2) of the Pharmacy Regulations, and in-charge believed there was no obligation to provide section C.01.041(4) of the Food and Drug Regulations them based on his interpretation of section 13(12) of the The NLPDP audit indicated there were a number of Pharmacy Regulations which reads: Each pharmacy shall prescriptions that did not indicate the date, one of the ensure that every original prescription is retained on file for required elements of information to be recorded on a 2 years from the date of prescription (emphasis added). verbal prescription. Staff pharmacists believed that After the NLPDP audit was received the pharmacists logging the prescription on the system was an adequate became aware that original prescriptions must be retained record of its date. The Board is concerned that all the for 2 years from the date of any refill (under Food and requirements for verbal prescriptions as set out in the Food Drug Regulations, C.01.041 (2)), in addition to retaining and Drug Regulations be adhered to at all times. them for 2 years from the original date of the prescription. Additional Issues The vast majority of the prescriptions in question were From the time this pharmacy had begun servicing the home subsequently located and the pharmacy now keeps all there had been a practice to rewriting “Doctor’s Orders” original prescriptions on file for 3 years from the written and identifying them as verbal prescriptions. All date. medications for residents at the home are ordered by a Complaint #3: physician on a form called the “Doctors Order”, which is Unauthorized Refills or Excess Quantities Being Filled or forwarded to the pharmacy once signed by the doctor. Refilled – Violation of sub-sections 37(1)(w) and 12(1) These “Doctor’s Orders” were written up by pharmacists as (a), (b)(iii), (xi), 12(2) of the Pharmacy Regulations and verbal prescriptions for a 34 day supply and 11 repeats. section C.01.042(1) of the Food and Drug Regulations A computerized TMR was supplied by the pharmacy for The NLPDP audit identified a number of unauthorized each patient but it appears that in some cases, Pharmacy refills, some of which were for maintenance medications (Continued on page 6) where an extra refill was provided by the staff pharmacist Page 6 The Apothecary
(Continued from page 5) left on the pad (they had been (Pharmacist A) regarding another returned by the physician due to a pharmacist (Pharmacist B, the staff was not reviewing the patient typographical error) in order to respondent). profile for completeness for all record verbal prescriptions. The The allegation related to difficulties medications applicable to each pharmacists at the pharmacy have Pharmacist A alleged she encountered patient for whom drugs were being been advised to discontinue this when attempting to speak to dispensed. The TMR was then practice as it is potentially confusing. Pharmacist B when transferring reviewed by a member of the facility No further action is required in prescriptions between pharmacies. staff who notified the doctor of any respect of this issue, as the Board is The panel was presented with a letter omissions, medications which have not satisfied that the practice has ceased. of response to the allegation from been used in 3 months and any other Decision of the tribunal: Pharmacist B as well as relevant issues arising. The TMR is completed Having considered the Agreed sections of Part C of the federal Food every 3 months authorizing the Statement of Facts and the Joint and Drug Regulations related to the pharmacy to continue dispensing for Submission, and other submissions transfer of prescriptions. the next 6 months. Once a year every made at the hearing, the Adjudication patient is reviewed by an Decision of the panel: Tribunal accepted the guilty pleas interdisciplinary team, including a Having considered the information entered by the pharmacist-in-charge pharmacist which allows for before it, the panel ruled that: in respect of Complaints 1, 2, 3 and 4 medications to be reviewed once The transferring of a prescription and the proposed disposition of the more. All doctor’s orders were kept at must include direct communication Complaint, and ordered: the pharmacy for reference purposes between the transferring and the but they were not kept as the Reprimands to be issued by the receiving pharmacist, in order to “prescriptions” relied upon by staff Board to the pharmacist-in-charge ensure that all relevant information for the dispensing process. They were in respect of Complaints 1, 2, 3 pertaining to the transfer is also not kept in the prescription file. and 4; obtained. The Board and the pharmacy agreed The pharmacist-in-charge will The process for transferring a that, if all required information is in immediately implement practices prescription implied by the the Doctor’s Order, and is signed by satisfactory to the Board, and will respondent in his letter of response the doctor, the pharmacy may use provide a written policy and would not have been in that particular document as the procedure document covering the compliance with the requirements prescription if it records all essential issues raised in the Complaint, of Part C of the federal Food and elements of a prescription, but the including those detailed in the Drug Regulations related to the Board does not agree that the process Agreed Statement of Facts, transfer of prescriptions. of rewriting Doctor’s Orders and satisfactory to the Board, by There were reasonable grounds to referring to them as “verbal orders” is December 31, 2009, or such later believe the respondent had appropriate, as it increases the risk of date as may be agreed by the engaged in conduct deserving of errors in prescriptions, thereby Secretary-Registrar; compromising patient safety. The sanction. Costs in the amount of $10,000.00 pharmacy will immediately implement The panel determined in accordance to be paid by the pharmacist-in- practices satisfactory to the Board in with 39(3)(a) of the Pharmacy Act a charge; and, respect of this issue and will provide a letter of caution be sent to the written policy and procedure publication of a summary of the respondent and placed in his file. document which will address this issue Order of the Adjudication The letter should caution the in a manner satisfactory to the Board. Tribunal, on a no-name basis, in respondent to ensure direct Upon investigation, it was determined this newsletter. communication with the other that the pharmacists were using pharmacist when transferring a rejected physician’s prescription pads Case #2: prescription. with the name of a physician (not The CAC considered an allegation necessarily the prescribing physician) received from a pharmacist Winter 2009 Page 7 NLPB Board Update - November 30, 2009 Meeting
Budget for 2010 Approved way, regardless of setting, the expectation of care The Board approved, with only slight modification, the associated with a particular role will be consistent. Budget for 2010 as proposed by the Finance The new Standards of Practice can be viewed on our Committee. This year’s budget involves no increase in the annual registration fee for pharmacists or the website under Standards, Policies & Guidelines. annual business licence fee for pharmacies. REVENUE Bylaw Amendments Pharmacist Registrations 332,000.00 Amendments to the Schedule of Fees referred to in the Business and Hospital Licences 192,000.00 Bylaws were approved as follows: Students Registration Fees 8,000.00 New Fees: Non Practicing Fees 2,625.00 - Reinstatement Fee for pharmacy students or intern Other Fees 9,000.00 (for existing students who fail to renew by paying the Other Revenue 17,750.00 Annual Registration fee on or before September 30th TOTAL REVENUE 561,375.00 in each calendar year) - $15.00 EXPENSES - Processing an application for accreditation of a Administration Expenses 405,407.00 professional development program - $50.00 Legal Expenses 11,000.00 Revised Fee: Building Expenses 41,300.00 Change in a business licence of a pharmacy: Operating Expenses 81,500.00 - made in accordance with Regulation 6.(6) - TOTAL EXPENSES 539,207.00 $50.00
Projected Operating Surplus (Deficit) 22,168.00 - reported to the Secretary-Registrar after the Capital Expenditures - 3,000.00 change has occurred - $100.00 Contingency Fund - 10,000.00 Projected Surplus (Deficit) 9,168.00 Request for Interest in Appointment to PEBC Board The Board has been notified that our representative Model Standards of Practice Adopted to the Board of the Pharmacy Examining Board of At the meeting the Board adopted the most recent Canada has resigned from that position and we have version of the National Association of Pharmacy been asked to appoint a replacement representative. Regulatory Authorities (NAPRA) Model Standards of Practice for Canadian Pharmacists. This update of the To be eligible for appointment, a pharmacist must Model Standards is modeled after best practices but have PEBC certification and preferably have is not competency based. The Standards are drafted association or board experience and involvement. like a framework for good pharmacy practice and do The PEBC Board usually meets twice a year, in March not contain the former competency elements or and October. Meeting are usually 2 or 3 days. performance indicators. However, the Standards are Should the appointee become a member of the PEBC referenced against the competency elements in Executive Committee, additional meetings (usually by NAPRA’s “Professional Competency for Canadian conference call) would be likely. Pharmacists at Entry to Practice”, so that members can Appointments to the PEBC Board are for a term of 3 access the appropriate elements in the competency years, and may be renewed. document to determine the skills needed to meet the Pharmacists who are interested in being appointed as standard. While not all pharmacists perform each of our representative to the PEBC Board are asked to the roles described in the Model Standards in their indicate their interest to our office at the earliest daily work, when they do, they will be expected to opportunity. do so to the level specified in the Standards. This Final Year Pharmacy Students Completing SPE IV in Community Pharmacies
SPE IV is a clinical pharmacy rotation during the Winter Semester of the final year of the pharmacy program. Students are required to complete two 6-week rotations from January to April. These are completed at two different sites, and may be in institutional or community based settings. Having students complete clinical practice experiences in community pharmacies was an initiative piloted in a few pharmacies in 2009. It will continue again in 2010 with increased numbers. It is hoped that in the future it can be expanded further to allow each student one placement in community pharmacy and the other in an institutional setting. The clinical pharmacy rotation provides an opportunity for students to take direct responsibility for individual patient’s drug-related needs. The role of the pharmacist is evolving from that of a supplier of pharmaceutical products towards that of a provider of services, information and patient care. Increasingly, the pharmacist’s role is to ensure that a patient’s drug therapy is appropriately indicated, the most effective available, the safest possible, as well as economical and convenient. Students are expected to interact with the health care team, interview and assess patients, make specific therapeutic recommendations, monitor patient responses to drug therapy and provide patient education, as well as meet the drug information needs of the health care team. While a student’s “home base” may be in a particular pharmacy, physicians may refer patients who normally fill their prescriptions at another pharmacy. In such situations, it is possible that you may be contacted by a pharmacy student inquiring about one of your patients. We would ask you to be supportive of such collaborations as they may serve to improve patient care and also help demonstrate the expanding role of the pharmacist. If you have any questions about the Structured Practice Experience Program, please contact Wanda Spurrell at [email protected] or telephone 777-6498. Any pharmacist who would like to become more involved with the community pharmacy clinical rotations by serving as a preceptor is asked to contact Wanda at the School of Pharmacy.
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar ...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator...... [email protected] Veronica Harvey, Executive Assistant to the Registrar ...... [email protected] General Information...... [email protected] The Apothecary BOARD MEMBERS published quarterly by the Newfoundland and Labrador Elected Members Pharmacy Board Zone 1 ...... Debbie Kelly Apothecary Hall Zone 2 ...... David Jenkins 488 Water Street Zone 3 ...... John Rideout St. John's, NL A1E 1B3 Zone 4 ...... Christina Tulk At Large ...... Keith Bailey, Brian Healy, Linda Hensman
Appointed Members Tel: 709-753-5877 ...... Don Mifflin Toll Free: 1-877-453-5877 ...... Eugene Toope Fax: 555-753-8615 Observer E-mail: [email protected] MUPS Representative ...... Emily-Ann Munden
EXECUTIVE COMMITTEE We’re on the Web!! Chair ...... Keith Bailey Vice-Chair...... Christina Tulk www.nlpb.ca Executive Member...... Debbie Kelly Past Chair ...... John Rideout The Apothecary
Newfoundland and Spring 2010 Labrador Pharmacy 100 Years of Pharmacy in Newfoundland and Labrador Board “What’s Old is New Again…”
This past January marked the 100th Anniversary of a meeting held on Sunday, January The Apothecary is the 2, 1910 when ten St. John’s druggists met (in the Reading Room of the Total Abstinence newsletter of the Club) to select a delegation to meet the Prime Minister to discuss a proposed Pharmacy Newfoundland & Bill. (Remember that we were an independent country at that time.) Labrador Pharmacy At the same meeting it was decided to have a further meeting the following Wednesday Board. to form an association to be known as the Pharmaceutical Society of Newfoundland. It contains information The first Pharmacy Act was passed by the Newfoundland Legislature on March 22, and on on a wide variety of March 29 a meeting of the newly formed Pharmaceutical Society was held at which 29 topics intended to founding members signed the original constitution of the Society. Then, on April 11, six enhance the practice members were elected by the Society for appointment by the government to the newly of all pharmacists in established Newfoundland Pharmacy Board. the province of It is interesting to note that in 1954 the Pharmacy Act was revised, in part to reflect the Newfoundland & practice of pharmacy in the rest of Canada, and at that time the Pharmaceutical Society Labrador. and the Pharmacy Board were merged into the Newfoundland Pharmaceutical Association Pharmacists are (NPhA). Then in 2005 the Act was revised again, this time separating the NPhA into the responsible for Pharmacists’ Association of Newfoundland and Labrador and the Newfoundland and reviewing any and Labrador Pharmacy Board. (As the old saying goes, what goes round comes round.) ALL INFORMATION It is interesting to note that the minutes of that first meeting on January 2, 1910 indicate contained within that a motion was adopted “that the Druggists & Druggists’ Assistants should form an including documents association to be known as the Pharmaceutical Society of Newfoundland”. This is an which are made interesting parallel to the concept being pursued today in more and more provinces that available on the NLPB Pharmacists and Pharmacy Technicians be seen as categories of the same profession. website via links throughout the Further “file cabinet archeology” in the archives of the Apothecary Hall Trust indicates that newsletter. in 1910 the government saw the need for at least one pharmacy in St. John’s to be open The Apothecary is now 24 hours a day (even if it meant a subsidy from government to keep it viable). circulated Also in 1910, the Royal Pharmaceutical Society in Great Britain proposed the mutual electronically and is recognition of all pharmacists registered in the British Empire who met an agreed upon available in hard copy basic training and competency criteria. format only upon (Incredibly to us today, our Society rejected the idea as “impracticable”.) Again however, specific request. this is an interesting parallel to today’s discussions around more open registration requirements from jurisdiction to jurisdiction, including international jurisdictions. Photocopies of minutes of the earliest meetings of our Pharmaceutical Society (available for viewing on the James J. O’Mara Pharmacy Museum section of our website) give a fascinating glimpse into our profession 100 years ago and serve to illustrate both how far we’ve come and also how many issues haven’t changed at all. Page 2 The Apothecary Dextromethorphan Abuse Still a Problem As evidenced by a recent article on CanadianHealthcareNetwork.ca, dextromethorphan (DM) abuse is still a problem in this country. According to the report, the intentional overdoses by four teens in Victoria, BC in a two week span has led the College of Pharmacists of B.C. to recommend to pharmacies that they move cough remedies containing DM behind the counter. While the teens survived the overdose, they had to go through a 7- 10 day detox process. Youths use such cough remedies to get high by exceeding the recommended dose, which they refer to as “Skittling”, “Tussing”, or “Robo-Tripping”. Abuse of such medicines has risen due to word-of-mouth via the Internet, and because youths think the products are safe as they’re sold over-the-counter. Furthermore, cough remedies are easier to obtain than alcohol. DM overdose can cause such symptoms as breathing difficulties, nausea, dizziness and rapid heartbeat, as well as death. In this province, all products containing DM are included in Schedule III of the Provincial Drug Schedules and the NLPB has intentionally not pursued any change to this status despite the fact that the National Drug Scheduling Advisory Committee did approve a change moving DM products containing less than 300mg DM base to Unscheduled status a number of years ago. While we do not intend to change the scheduling status of DM-containing products to Schedule II at this time, we would advise pharmacists to be aware of the potential for abuse of these products. In particular, watch for purchases of large quantities of DM-containing products as well as any increase in the theft of these products from the pharmacy. If a problem is noted, it would be advisable to move these products, particularly single- entity high dose DM products, behind the pharmacy counter to reduce the opportunity for theft and to better monitor purchases.
Appointment of New Board Personnel
In recent weeks callers to our offices will have noticed Veronica was required to go on sick leave in January. a different voice answering the phone or a different Aileen’s responsibilities include all the administrative name responding to e-mail messages. This change is processes related to the registration and licensing of due to the fact that our Executive Assistant, Veronica pharmacies, pharmacists and pharmacy students, as Harvey, has been placed on extended leave by her well as the maintenance of Registers kept by the physician. Veronica has dedicated the past 7 years of Board. She will also be responsible for maintenance her career to the Board as our Executive Assistant and and optimization of the Board’s information database. we extend her our best wishes for improved health, as Meghan Handrigan ([email protected]) has well as sincere thanks for the service she has given to been appointed Office Administrator. Meghan the Board since January 2003. began work with our Board on March 15th and once Since Veronica will be on leave for an undetermined her training and familiarization period is completed time, and to implement the office reorganization she will be responsible for the day-to-day strategy adopted by the Board, the following administrative functions of our office, including personnel appointments are announced: greeting callers and visitors needing services from our Aileen O’Keefe ([email protected]) has been office as well as facilitating our communications to appointed Registration and Licensing Administrator. pharmacists and the public. Aileen began work with our office on a part time basis We welcome these two new employees as they look last November to assist with the annual registration forward to responding to your needs, as well helping and licensure renewal process. She has been filling in our office to operate as efficiently as possible. as Executive Assistant on a temporary basis since Fall 2009 Page 3 Report from March Board Meeting At the most recent meeting of the Board on March develop Standards of Practice regarding the 6, 2010, the Board made the following decisions: provision of pharmaceutical care to residents of A new Policy on Accreditation of Professional long term care facilities. Development Programs was approved. In short, The NAPRA Position Statement—Sale of Non- this policy establishes the formal process for Approved Marketed Health Products was applying to the Board for accreditation of live endorsed and approved for circulation to professional development programs. It also pharmacists (see page 4). Pharmacists are advised clarifies the responsibilities of the provider with that this is not a new policy, but rather a reminder regard to content and documentation of attendance for pharmacists of the already existing Food and at live events and adds a fee for processing an Drug Regulations regarding the sale of drugs in accreditation request. For more information on this Canada (including natural health products and policy, see the Professional Development page of homeopathic products). We are releasing this the Board website. position statement at this time due to the confusion A Project Plan for Proceeding with Pharmacy caused by the increasing number of drug products Technician Regulation was endorsed. The Board showing up in pharmacies without the identification staff and Professional Practice Sub-Committee on numbers required by Health Canada (DIN, NPN or Pharmacy Assistants/Regulated Pharmacy DIN-HM). Subsequent to the release of this position Technicians now have the direction to proceed with statement by NAPRA, Health Canada is considering the next steps in this process. Please watch future new regulations to appropriately deal with this Board communications for more information on this situation, as well as how to best deal with the initiative. backlog of applications in the approval pipeline. It was decided to move the date of this year’s However, pharmacists in this province are reminded Annual General Meeting to coincide with the of the existing federal regulations that prohibit the Pharmacist’s Conference in St. John’s in September. sale of unapproved drugs. For the last several years the meeting had been Subsequent to the meeting, two other documents held in June with very few pharmacists attending. were approved via email poll and can be found on The hope is with this change, more pharmacists may the Standards, Policies & Guidelines page of the choose to attend this meeting. NLPB website: Two external appointments were made: A new Standard of Pharmacy Practice on Karen Mercer—appointed to the Pharmacy Delegation of Duties in Community Pharmacy Examining Board of Canada (PEBC) was approved to replace the previous Standard of Dr. Linda Hensman—appointed to the Practice - The Role of the Pharmacy Technician in Community Pharmacies. The intention of this change National Association of Pharmacy Regulatory is to lead the way for the future regulation of Authorities (NAPRA) Board of Directors Pharmacy Technicians and also to formally establish A draft revision to the Standards of Practice the delegation of tasks to pharmacy students and regarding the Provision of Pharmaceutical Care interns. to Personal Care Homes was circulated for A new Policy on Committees of the Board. The information. This document is currently under intent of this Policy is to set a basic level of review by the Professional Practice Sub-Committee expectation for all Board committees. Variations on Long Term Care. Once completed, a final draft due to the specific needs and goals of any will be sent to the Board for approval. The next particular committee would then be outlined in the initiative on the sub-committee’s agenda is to Terms of Reference for the committee. Page 4 The Apothecary
Endorsed by the Newfoundland and Labrador Pharmacy Board March 6, 2010 Fall 2009 Page 5 Professional Development Audit 2010
The Professional Development Audit Process for 2010 is nearing completion. The Registration and Licensing Committee has noted that a fairly large number of pharmacists are still struggling to meet the documentation requirements of the Professional Development Standards of Practice and would like to remind pharmacists of the following points, in particular: The Professional Development (PD) Log and Learning Portfolio Record Sheet have both been updated several times over the years. Some pharmacists are still using the original forms (marked DRAFT) or earlier versions of the forms. ALL PHARMACISTS SHOULD NOW BE USING THE MOST RECENT VERSIONS OF BOTH OF THESE FORMS. These were circulated to ALL pharmacists earlier this year and are also available on the Professional Development page of the Board website. When documenting multiple similar CE’s such as for programs like the Pharmacist’s Letter CE-in-the-Letter, pharmacists must document EACH ISSUE ON A SEPARATE LEARNING PORTFOLIO RECORD SHEET AND IN A SEPARATE LINE ENTRY ON THE PD LOG. When documenting CE’s earned while attending an event where multiple presentations were given (such as a conference), pharmacists must document EACH PROGRAM INDIVIDUALLY ON A SEPARATE LEARNING PORTFOLIO RECORD SHEET AND IN A SEPARATE LINE ENTRY ON THE PD LOG. WHEN DOCUMENTING CE’s EARNED FOR SERVICE AS A PRECEPTOR, pharmacists are reminded that these CE’s are considered “Self-Assigned”. Pharmacists DO NOT have to complete a Learning Portfolio Record Sheet in this instance. As well, pharmacists must complete and retain the NLPB Form, Documentation of Credits for Service as a Preceptor, also available on the Professional Professional Development page of the Board website. Regardless of which university program the student is attending (MUN, Dalhousie, etc.), the NLPB formulas must be applied. When indicating the accreditation status of a program, pharmacists should document the CE’s earned as EITHER “Accredited” (for programs with an accreditation file number) OR “Self-Assigned” NOT BOTH. Certificates of Completion or Participation MUST BE RETAINED FOR ALL PROGRAMS INCLUDING ONLINE PROGRAMS AND VIDEO PRESENTATIONS BORROWED FROM PANL (these are issued by PANL upon return of the video). These certificates MUST indicate success in the program and the number of CE’s acquired. When selected for audit, pharmacists are asked to be respectful of the committee member’s time (which they have volunteered without compensation) and SUBMIT THEIR LEARNING PORTFOLIO IN AN ORGANIZED MANNER – preferably in the order the events are documented on the PD Log. Learning Portfolio Record Sheets & supporting documentation for each item listed should be kept together wherever possible and extraneous material such as slides, handwritten notes, etc should not be included unless absolutely necessary. This is an ongoing problem as the committee members often have to spend considerable time organizing the portfolios before they can be reviewed. When selected for audit, pharmacists may only submit their Learning Portfolios by mail, courier, or hand. FAXED COPIES OF LEARNING PORTFOLIOS WILL NOT BE ACCEPTED IN THE FUTURE.
PHARMACISTS ARE REMINDED THAT NON-COMPLIANCE WITH THE STANDARDS RELATED TO THE PROFESSIONAL DEVELOPMENT LOG WILL LEAD TO YOUR PORTFOLIO BEING FLAGGED FOR AUDIT. IN ADDITION, ANY PHARMACIST WHO WAS NON-COMPLIANT IN THE PREVIOUS YEAR WILL LIKELY BE AUDITED AGAIN IN THE NEXT YEAR. Page 6 The Apothecary
Professional Practice Issues
Documentation of Refill Prescriptions Prescription Counselling Requirements
Following up on our previous Professional Practice A pharmacist’s consultation with their patient, or their Issues article, “Check, Check and Check Again” (The patient’s representative, is one of the most important Apothecary, Fall 2009), Pharmacists are reminded cognitive functions that a pharmacist performs. The that section C.01.042. of the Regulations to the Food Pharmacy Regulations are very clear with respect to and Drug Act states: Pharmacist’s responsibility in this regard: (1) No person shall refill a prescription for a Schedule 13.(16) On the original filling of each prescription, the F Drug unless the practitioner so directs and no person patient shall be counselled by the pharmacist and that shall refill such a prescription more times than the counselling shall include, but is not limited to number of times prescribed by the practitioner. (a) the identity of the patient; (2) The person filling or refilling a prescription for a (b) the identity of drugs being dispensed; Schedule F Drug shall enter on the original of the (c) the dosage regimen and instructions required prescription or in a suitable record of prescriptions to achieve the intended therapeutic response; kept under the name of each patient (d) storage requirements; and (a) the date of filling; (e) major adverse side effects and cautions. (b) the date of each refill, if applicable; Beyond this requirement, we would also suggest that (c) the quantity of drug dispensed at the original it would be appropriate for the pharmacist to also filling and each refill; and cover: (d) his [the pharmacist’s] name. common drug and food interactions and The Secretary-Registrar would like to reiterate his therapeutic contraindications that may be previous advice to pharmacists regarding the encountered, including their avoidance, and Board’s interpretation of a “suitable record”: the actions required if they occur, The Board’s interpretation includes the requirement prescription refill information, that the record of the original filling, and of each information regarding: refill, of a prescription be physically initialed or how to monitor the response to therapy, signed by the pharmacist at the time of filling or expected therapeutic outcomes, refilling. action to be taken in the event of a A computer-generated copy of the refill is missed dose, and acceptable but it must still be signed or initialed by when to seek medical attention, and the pharmacist at the time of filling, as any other information unique to the specific documentation of the final check of the prescription. drug or patient. This documentation should then be filed in an Though the regulation only requires this counselling organized manner and be available at the on the original filling of a prescription, we would pharmacy for potential future inspection. strongly recommend that pharmacists also provide counselling to patients when they present for refills of their prescriptions to discuss issues such as side effects, compliance issues and any other challenges the patient may be facing with the medication. Fall 2009 Page 7
Election Timeline This year’s NLPB Board elections will focus on electing Board members for Zone 2 and Zone 3. According to NLPB Bylaw 17, Zone 2 is considered to be the Conception Bay North/Trinity South peninsula, beginning at Avondale and extending west to Port Blandford, including Placentia and the Cape Shore to (but not including) Trepassey, the Burin peninsula, the Trinity North/Bonavista South Peninsula; and Zone 3 is considered to be that part of the island west of Port Blandford to the Hampden junction, and that part of the South Coast that does not include Burgeo and Ramea. Pharmacists in these areas are reminded to watch for the Board’s Call for Nominations around the middle of June. ∞ Nominations for Centennial Pharmacist Award This year, as part of the 100th Anniversary Celebrations the Board will be awarding Centennial Pharmacist Award to 100 pharmacists who have made a significant contribution to the profession of pharmacy in this province over the past 100 years. Nominations may be submitted for pharmacists regardless of whether they are still living or are deceased. Please submit your nomination to Don Rowe at [email protected] including a brief paragraph describing the nominee’s contribution to pharmacy. ∞ Scheduling Status of Adult Hepatitis Vaccines Pharmacists are reminded that Hepatitis A and B vaccines for adults (Engerix-B, Twinrix, for example) are in Schedule I of the Provincial Drug Schedules and, as such, require a Prescription for Sale. For a quick summary of the Scheduling Status of the various vaccines and immune globulins, please see Appendix D of the NLPB document, A Guide to Understanding the Newfoundland and Labrador Provincial Drug Schedules. The March 2010 edition was recently posted to the Drug Schedules page of the NLPB website.
Newfoundland and Labrador Pharmacy Board “NLPB‐CHSP Joint Professional Development Day” Joint Professional Development Day HOLD THE DATE - Saturday, June 12, 2010 - HOLD THE DATE 9:30 AM—3:00 PM (with social to follow) More Information Coming Soon! Recent Updates to the NLPB Website
About the Board page - NLP Board Meeting Minutes updated “The Apothecary” & Other Communications page - Notice of Changes to Drug Schedules added, MedEffect advisories Professional Development page - forms revised and updated, new Policy on Accreditation of Professional Development Programs added Registration and Licensing page - many forms revised and updated Legislation page - NLPB Pharmacy Binder updated to March 2010 Standards, Policies & Guidelines page - new Standards of Pharmacy Practice for Delegation of Duties in Community Pharmacies added, new Guidelines for the Destruction of Expired or Unusable Narcotics or Controlled Drugs added, new Policy on Committees of the Board added Professional Practice Resources page - Canadian Adverse Reaction Newsletter—January 2010 added Provincial Drug Schedules page - NL Provincial Drug Schedules and Guidance documents updated to March 2010 Miscellaneous Forms page - new form - Request to Destroy Drugs Covered by the Controlled Drugs and Substances Act added Find a... page - new staff members added, committee members updated, new external appointments added, pharmacist and pharmacy registers updated and list of registered optometrists added
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar ...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator...... [email protected] Aileen O’Keefe, Registration & Licensing Administrator...... [email protected] Meghan Handrigan, Office Administrator ...... [email protected] The Apothecary General Information...... [email protected]
published quarterly by the BOARD MEMBERS Newfoundland and Labrador Elected Members Pharmacy Board Apothecary Hall Zone 1 ...... Debbie Kelly Zone 2 ...... David Jenkins 488 Water Street Zone 3 ...... John Rideout St. John's, NL A1E 1B3 Zone 4 ...... Christina Tulk At Large ...... Keith Bailey, Brian Healy, Linda Hensman Tel: 709-753-5877 Appointed Members Toll Free: 1-877-453-5877 ...... Don Mifflin Fax: 555-753-8615 ...... Eugene Toope E-mail: [email protected] Observer MUPS Representative ...... Emily-Ann Munden
EXECUTIVE COMMITTEE We’re on the Web!! Chair ...... Keith Bailey www.nlpb.ca Vice-Chair...... Christina Tulk Executive Member...... Debbie Kelly Past Chair ...... John Rideout The Apothecary
Summer 2010 Newfoundland and Labrador Pharmacy Standards of Pharmacy Practice for Medication Management in Board Community Pharmacy Approved and Implemented
Recent changes to the Pharmacy Regulations approved by the Hon. Jerome Kennedy, The Apothecary is the Minister of Health and Community Services, as well as new Standards of Pharmacy newsletter of the Practice adopted by the Newfoundland and Labrador Pharmacy Board are now being Newfoundland & implemented by pharmacists across the province. As of the date of publication, Labrador Pharmacy approximately 220 pharmacists have educated themselves and submitted their Board. “Medication Management Declaration Form” to the NLPB Office. It contains information Once a pharmacist is prepared to meet the requirements set out in the new Standards, he on a wide variety of or she may then participate in Medication Management under three key areas: topics intended to Providing an Interim Supply - provision of a small quantity of medication to meet enhance the practice a patient’s short term needs (usually less than 30 days supply) of all pharmacists in Extending a Prescription (Continuation of Care) - provision of an additional the province of prescription refill to meet a patient’s needs beyond the short term (usually 30-90 Newfoundland & days supply) Labrador. Adapting a Prescription - changing the dosage form, dosage regimen or quantity Pharmacists are dispensed, completing missing information on a prescription, or making a non- responsible for formulary generic substitution reviewing any and In all instances, pharmacists must follow specific requirements and limitations set out in the ALL INFORMATION Standards including requirements related to patient consent, documentation and contained within notification. including documents For your information a selection of Frequently-Asked Questions is included in this issue of which are made The Apothecary (see page 4) and the full document is available on the Standards, available on the NLPB Policies & Guidelines page of the NLPB website. website via links As mentioned in the Notice to Pharmacists circulated with the Standards last month, we throughout the expect there will be updates to this information over the coming months as pharmacists newsletter. integrate this new authority into their practice. In fact, the Medication Management The Apothecary is now Documentation & Notification Form has already been revised slightly based on feedback circulated received from pharmacists. We will continue to send any other updates or additional electronically and is information to pharmacists through the usual methods – email, The Apothecary and the available in hard copy NLPB website, www.nlpb.ca or through our latest communications strategy - by following format only upon us on Twitter (@nlpharmacyboard). specific request. Standards of Pharmacy Practice ‐ Personal Care Homes & Community Care Homes Pharmacists are reminded that the newly updated Standards of Pharmacy Practice ‐ The Provision of Pharmaceutical Care to Personal Care Homes & Community Care Homes were recently circulated to all pharmacists via postal mail. Pharmacists at pharmacies providing this type of service should be sure to review the document and implement any necessary changes. Page 2 The Apothecary NLPB Chair Keith Bailey Featured in Smokers’ Helpline Newsletter
The Smokers’ Helpline is very pleased to feature the work of has worked as a pharmacist in various communities across Keith Bailey as this month’s Spotlight. Keith is currently the the province including Goose Bay, Clarenville, Gander and Pharmacy Operations Specialist (Atlantic Region) for currently in St. John’s. Keith states, “I am in pharmacy Shoppers Drug Mart. Keith has been involved in tobacco operations with Shoppers Drug Mart and am also the Chair control as a pharmacist for 15 years, however in the past of the NL Pharmacy Board. I work as a pharmacist in many two years he has really made tobacco cessation a priority in stores and see the need and benefits of a concerted effort his work. He says, “In the past two years I have undertaken towards smoking cessation. Helping people in this role is one to become more informed about the topic through continuing of the most important interventions a pharmacist can make, education, training courses and wellness intervention so that I hence the passion toward wellness.” can help patients directly and also pass on information and Some words of advice from Keith: “A key to helping patients support to other pharmacists in the community.” live healthier is developing a long term relationship with a Keith strives to address smoking cessation with patients and patient and always being there to listen and understand. also educates other pharmacists on the importance of Smoking cessation is hard work and takes time so being in addressing tobacco addiction. He promotes the Smokers’ tune with people and knowing when they are ready is Helpline services and CARE Program in Shoppers Drug Mart important. Never stop asking smokers (in a nice way) if they pharmacies and to other pharmacists. Keith is an outstanding would like help. As health care providers we always have to role model for other pharmacists in demonstrating effective support and plant the seed of change.” approaches to help patients take action on quitting smoking Keith encourages others to get involved in using the and ensuring that pharmacists are equipped to offer help Smokers’ Helpline CARE Program since it is such an easy and through use of Smokers’ Helpline CARE Referrals and effective tool to connect smokers with support to quit. He promotional materials (such as posters, pamphlets and tear- says, “I’d encourage all health care providers (pharmacists, offs). physicians, nurses, dentists, etc.) to become familiar with the The Smokers’ Helpline acknowledges Keith’s work on CARE Referral Program. It’s a great resource to help tobacco cessation initiatives. In addition to general patients in the community!” promotion of the Helpline services in his everyday work, he A sincere ‘Thank You’ to Keith Bailey on his outstanding work has also arranged more formal training sessions through in tobacco cessation. You are really making a difference in conference calls on the CARE Program and also the helping people of this province live healthier tobacco free. We development of a training presentation on tobacco cessation appreciate your support of the Smokers’ Helpline programs programs and treatments which has been accredited by the and we look forward to continuing to work with you in the Pharmacy Board. Since his involvement with the Smokers’ future. Helpline, the number of referrals from Shoppers Drug Mart Reprinted from the Newfoundland and Labrador pharmacists has increased! Smokers’ Helpline e-Newsletter July 2010 (Issue #35) Keith was born in Twillingate, attended Memorial University with a degree in Pharmacy (1996) and an MBA (2004). He NLP Board Elections 2010
This year, the Board seats for Zone 2 and Zone 3 were due for election. As such, a Call for Nominations was mailed to all registered pharmacists in Zones 2 and 3 on June 16, 2010. Nominations were received up until July 21, 2010, with one nomination being received for Zone 2: and one nomination being received for Zone 3. As a result of there being only one nomination for each zone, the result of the election is as follows: Raymond Gulliver, Baccalieu Trail Pharmacy (South River) Elected in Zone 2 by Acclamation Dorothy Ainsworth, Central Newfoundland Regional Health Centre (Grand Falls-Windsor) Elected in Zone 3 by Acclamation We would like to take this opportunity to welcome Ray and Dorothy to the Board. Summer 2010 Page 3 Reminder to Pharmacists Re: Methadone Carry Doses
Pharmacists dispensing methadone are reminded that physician including the number of carries to be “Take-Home” or “Carry” Doses are a privilege extended to dispensed per week, or the days of the week the patient certain patients meeting particular criteria as determined by receives carries, or the specific dates the patient is to the prescribing physician. The intention of this privilege is to receive carries. reduce disruption in and improve the quality of the patient’s The dispensing of carries MUST be recorded in a similar daily life. manner as the daily administration records. Having said that, certain requirements must still be met and Physicians generally will not authorize more than six the pharmacist’s responsibility is not lessened. For example: consecutive carry doses. If the number of carries authorized Carries MUST always be diluted to 100 ml with TANG by the prescription exceeds the guidelines established by or other suitable diluent. the College of Physicians and Surgeons, the pharmacist Carries MUST be dispensed in childproof bottles and should obtain documentation of the reason extra carries patients must be counselled to keep doses out of the were authorized from the physician before the carries are reach of children. dispensed. Carries MUST be labelled according to federal and Pharmacists are also reminded that this privilege may be provincial requirements and MUST include a warning discontinued at any time by the physician or pharmacist for that the amount of drug contained could cause serious any of several reasons as described in the Standards of harm or toxicity if taken by someone other than for Pharmacy Practice - The Newfoundland and Labrador which it was prescribed. Methadone Maintenance Program (found on the NLPB website, on the Standards, Policies & Guidelines page). Specific instructions regarding the dispensing of carries MUST be clearly indicated on the prescription by the
Faxing...the Right Way!! Faxing represents an effective and efficient means of the original prescription will be invalidated or relaying prescription information from prescribers to retained so that it cannot be re-issued. pharmacies. It can help streamline workflow and A Model Prescription Form (found with the Standards) allow medications to be prepared in advance of the can be distributed which may help the prescriber to patient’s arrival thereby reducing the amount of time a successfully meet all requirements of a faxed patient is required to wait for their prescription. prescription. Prescribers may choose to develop their However, practice standards cannot be sacrificed for own form but it MUST contain ALL the elements found the sake of convenience or avoidance of dialog with on the Model Form. the physician. The NLPB has been made aware that some pharmacies In order for a faxed prescription to be considered a are continuing to accept inappropriate faxed legal prescription, the necessary requirements as listed prescriptions. This not only contravenes the in the Standards of Pharmacy Practice - Facsimilie requirements set out by the NLPB and the federal Transmission of Prescriptions for Community Pharmacies government, but upon audit, the prescription could be must be fulfilled. Pharmacists are asked to particularly considered invalid by third party insurers. Additionally note that not only must the prescription include the this practice creates problems for those pharmacists prescriber’s name, address, telephone number, fax who are following the policy. Inconsistencies in practice number and signature, but also certification statements are perceived by prescribers which then make it by the prescriber that: difficult for pharmacists to enforce the requirements. the prescription represents the original of the Pharmacists are reminded that the responsibility to prescription drug order, ensure that the Standards are being followed lies both the addressee (i.e. pharmacy) is the only intended with the pharmacist filling the prescription and the recipient and there are no others, and pharmacist-in-charge. Page 4 The Apothecary Frequently Asked Questions Medication Management Do I have to participate in Medication Management? pharmacist must initial the appropriate box on the No. Authorization does not mean obligation. The decision to Documentation and Notification Form (Appendix C) to perform any or all of these acts is at the discretion of the indicate that informed consent was obtained. individual pharmacist. However, if a pharmacist does choose to perform any of these actions, it must be done in How should I document Medication Management? accordance with the Standards of Pharmacy Practice and The Board has developed a Documentation and Notification within the limits of the pharmacist’s own competencies. Form template (Appendix C of the Standards) to assist pharmacists with documenting instances of Medication Are there special requirements needed in order to Management. This form must be completed IN FULL and participate in Medication Management? retained in the pharmacy in case of future audit. Yes, prior to participating in Medication Management, a pharmacist MUST: How do I file these forms? What about the computer hard copies? STUDY the Standards of Pharmacy Practice for Medication Management IN DETAIL, SIGN the NLPB Our consultation has indicated that the best way to handle Declaration Form included at the end of the Standards these forms would be to file them in sequential order along (Appendix B) and SEND the form to the Board office for with your other prescriptions. For example, when providing retention in the pharmacist’s permanent file; an interim supply or prescription extension, you would attach your computer “hard copy” to the form and file it. Maintain Personal Professional Liability Insurance When adapting a prescription, you would attach the Coverage in an amount equivalent to or greater than computer “hard copy” as well as the original prescription to that stated in the Board’s Policy on Professional Liability the form before filing it. Insurance; and Be prepared to: Can our pharmacy develop our own medication obtain informed consent from each patient to management form? Can it be saved electronically versus whom these services are provided, on paper? document all instances of Medication Yes, we have intentionally called our Documentation and Management, and Notification Form a “template” to allow pharmacies to notify the original prescribers, within the develop their own version of this form, if they so desire. The indicated timeframes. only condition on this would be that all information on the template MUST be on the customized form. Having said What is informed consent? that, there is something to be said for consistency and it As discussed in the Standards, informed consent has two would certainly be beneficial, from a physician’s or nurse basic components: patients have a right to determine what practitioner’s perspective, to have some continuity between happens to their bodies; and health professionals have an the forms they will be receiving. inherent duty to provide patients with enough information to With regard to saving the form electronically, this certainly make an informed decision. The cornerstone to achieving may be possible as long as all the information required is informed consent is developing a good relationship with the captured on the form, the electronic form can be transmitted patient. In order to achieve this, talk to the patient to to the original prescriber in a suitable way and the form can discover specific needs and concerns, give the patient the be easily retrieved and associated with the correct information they need to make an appropriate choice and transaction if required for audit. allow the patient time to ask any questions they may have. When a pharmacist performs one of the activities under Does informed consent need to be documented in writing Medication Management, do they have to notify anyone with the patient’s signature? else? No, the patient’s signature is not required. However, the Yes, the Standards require that the original prescriber must Summer 2010 Page 5 be notified of the pharmacist’s decision within a particular I have just received a prescription with the following timeframe depending on the area of Medication statement “Do Not Renew &/or Adapt” (or something Management: similar) hand-written on it. Does this mean that I cannot Providing an Interim Supply - 72 hours adapt or renew this prescription? Extending a Prescription (Continuation of Care) - 1 Yes. Just as we honour notations like this from prescribers week today regarding generic substitution, pharmacists are Adapting a Prescription - 1 week expected to honour hand-written “Do Not Renew &/or Adapt” instructions on prescriptions. What information needs to be provided to other health It is important to remember in this situation that should a professionals? pharmacist still feel that an extension or adaptation is in You must provide ALL the information that is indicated on the best interest of the patient, he or she can always the Documentation and Notification Form template, contact the prescriber for permission to extend or adapt including: the prescription. In any case where the original prescriber the name of the pharmacist responsible, was contacted, this would then be considered a verbal the type of Medication Management that was provided, order and would not be subject to the requirements of a copy of the new prescription label, Medication Management (see Appendix A in the Standards). the rationale for extending or adapting the
prescription, and What happens to refills when a prescription is adapted? any follow-up plan that may apply. When a pharmacist adapts a prescription, he or she also
How should other health professionals be notified? takes responsibility for any authorized refills. The pharmacist could choose to provide an initial adaptation of Through consultation with the College of Physicians and the prescription but reduce or eliminate the authorized Surgeons of Newfoundland and Labrador (CPSNL) and the refills (for example, if the quantity of drug dispensed was Association of Registered Nurses of Newfoundland and altered due to package size availability, the number of Labrador (ARNNL), it has been determined that the refills may be reduced or increased accordingly). If they preferred method of notification is via fax transmission of did this they would need to provide the rationale for their the Documentation and Notification form. This will serve to decision in their documentation and inform the patient that assist prescribers with documentation on their end as well. they will need to return to their physician earlier than However, pharmacists may determine that another method intended (note: a pharmacist cannot add refills that were is best for you and for the prescribers you communicate not initially authorized by the prescriber). with. It may be beneficial to speak with the health professionals in your area to find out how they wish to be If the pharmacist adapts the prescription and maintains the notified. authorized refills, when the patient returns for a refill the pharmacist would process the refill as they would any other Are there limitations on Medication Management? refill prescription. The process of refilling an adapted prescription is not considered an adaptation per se, so the Yes, Medication Management is not permitted on documentation and notification requirements do not apply prescriptions: to the refills. originally written by a Dentist, Optometrist or Veterinarian; Should the patient return to the pharmacy for a refill and a different pharmacist is on duty that pharmacist would again for Narcotics, Controlled Drugs or Targeted Substances, process the refill as they would any other refill. If they have including benzodiazepines; a concern about the appropriateness of the adapted for the pharmacist themselves; prescription they should do what they normally do if they for a family member, or someone of a “close personal have a concern about refilling a prescription; refuse to fill, or emotional relationship”, unless there is no other provide an emergency fill if necessary and in this case pharmacist available in the community; or either refer the patient back to the adapting pharmacist or that bear a specific indication otherwise (e.g.: “Do Not to the original prescriber. Renew/Extend” or “Do Not Adapt”). Page 6 The Apothecary Professional Practice Issues New Canadian Guideline for the Safe and Effective Use of Opioids for Chronic Non-Cancer Pain
In Nov. 2007, the National Opioid Use Guideline Group effective opioid prescribing habits of physicians in treating (NOUGG) formed with the support and/or representation patients with CNCP through an evidence-based approach. from all provincial and territorial medical regulatory As physician prescribing practices change, pharmacists must authorities. NOUGG’s aim was to oversee the development be aware of these guidelines and utilize the learnings as and implementation of a national guideline to assist part of your assessment of the appropriateness of opioid physicians in managing patients with Chronic Non-Cancer prescriptions you dispense and medication therapy you Pain (CNCP) by prescribing opioids safely and effectively. manage. Pharmacists will have an integral role in The culmination of NOUGG’s efforts has been the recent collaborating with physicians and patients to implement publication of the Canadian Guideline for Safe and Effective these guidelines as part of ensuring optimal health Use of Opioids for Chronic Noncancer Pain (referred to as outcomes and harm reduction. the Canadian Guideline). The Canadian Guideline provides 24 evidenced-based One of the primary principles of NOUGG’s work in practice recommendations. These recommendations centre developing the Canadian Guideline was to assist on the practice areas of: practitioners, including pharmacists, in treating patients’ Deciding to Initiate Opioid Therapy pain safely. Harms associated with opioid use can be Conducting an Opioid Trial reduced when: Monitoring Long-Term Opioid Therapy (LTOT) 1. drugs are prescribed and monitored with knowledge of Treating Specific Populations with LTOT the patient’s history and risks, Managing Opioid Misuse and Addiction in CNCP 2. patients understand potential benefits and harms and participate in reducing harms, and Patients. 3. clinicians assess outcomes for both effectiveness and The Canadian Guideline includes practice tools intended to harms. assist busy clinicians in decision making. Pharmacists may also benefit from using these tools in their practice. Why was the Canadian Guideline developed? References Canadian medical regulatory authorities undertook guideline development in response to: The full Guideline is available in PDF and web format at: 1. physicians and other stakeholders seeking guidance nationalpaincentre.mcmaster.ca/opioid/ and is also linked about the safe and effective use of opioids, from the Professional Practice Resources page of the NLPB 2. a growing concern about opioid misuse creating patient website. and public safety issues, and Review article published in the Canadian Medical 3. the lack of systematically developed national guidelines Association Journal, with a related commentary: on opioid use for CNCP. Review: Opioids for chronic non-cancer pain: A new A National Advisory Panel (comprised of 49 individuals Canadian practice guideline from across Canada including pain specialists, family Commentary: What we still don’t know about treating physicians, addiction experts, pharmacists, academics, chronic non-cancer pain with opioids nurses and patient group representatives) followed a formal process to review the draft recommendations from From time to time, we receive requests for the research team. interviews or information spoken in the French In May 2010, the Canadian Guideline for Safe and Effective language. If you are a pharmacist who is Use of Opioids for Chronic Non-Cancer Pain was finalized bilingual and would be willing to assist us in and is now being implemented across the country. these situations, please contact What does the Canadian Guideline mean for your Meghan Handrigan at practice? [email protected] or by calling the Part of the intent of this guideline is to promote safe and office at (709) 753-5877. Summer 2010 Page 7
UPDATE ‐ Counselling on New Prescriptions Update on Availability of Required and As a follow up to a related article in the Spring Recommended References edition of The Apothecary (available on the The We have been notified that in August 2010, CPhA Apothecary and Other Communications page of will release the new editions of both Patient Self‐ the NLPB website) and in response to a recent Care (PSC) and the Compendium of Self‐Care verbal complaint received at the NLPB office, Products (CSCP). All of the content in both texts pharmacists are reminded that the Pharmacy have been completely revised and updated. As Regulations REQUIRE pharmacists to provide neither of these references has been published in counseling on the INITIAL FILLING OF ALL some time and the Standards of Pharmacy Practice PRESCRIPTIONS. Failure to do so could be grounds ‐ Required and Recommended References for for a finding of Professional Misconduct by the Community Pharmacy requires that pharmacies Complaints Authorization Committee or an have the current edition of each of these Adjudication Tribunal. references, pharmacists‐in‐charge are encouraged ∞ to replace the current pharmacy copies as soon as Health Canada Adverse Reaction Online they become available. Reporting Form ∞ Health Canada’s MedEffect program allows for In addition, we have recently updated the online reporting of Adverse Drug Reactions by both Standards of Pharmacy Practice ‐ Required and Consumers and Health Professionals through their Recommended References for Community Pharmacy reporting forms available at the MedEffect Adverse to reflect the availability of new references as well Reaction Reporting page. as to indicate exactly what reference categories can be satifsfied by having an iPharmacist handheld on‐ ∞ site at the pharmacy. Please see the NLPB website Preparation for 100 Year Celebrations for the updated document. With the 100 year celebrations fast approaching, ∞ preparations are underway. If anyone has any No E‐mailed Prescriptions Please! older pharmacy‐related photos that may be appropriate to use in a slideshow or booth display, Pharmacists are reminded that e‐mailed please share them with us! Contact Meghan prescriptions are not considered legal Handrigan at [email protected] prescriptions. Until such time that security in transmission can be assured pharmacists are not to ∞ accept e‐mailed prescriptions under any NAPRA Notes April 2010 Now Available circumstances. The most recent edition of NAPRA’s newsletter ∞ NAPRA Notes is now available on NAPRA’s website. Recent Break‐ins Items in this issues include: NAPRA celebrates 15th anniversary; NAPRA receives $3.7 million in funding As there have been several recent pharmacy break‐ to help international pharmacy graduates access ins in the province, we want to remind pharmacists information for licensure in Canada; Information that all narcotics and controlled drugs should be regarding the role of the pharmacist in the sale of properly inventoried and secured. For more non‐approved marketed health products; Blueprint information or assistance in impementing changes for Pharmacy moves into next phase and National to your current procedures, please contact the office grows with the addition of new staff NLPB office. members. Recent Updates to the NLPB Website About Us page- Board Meeting Dates and Minutes for 2010; Annual Report 2010 added Contacts (Find A…) page - New Registers of Optometrists, Pharmacists, Pharmacies and Veterinarians added “The Apothecary” & Other Communications page - Press Release re: Pharmacy Network; Memo to Pharmacists & Pharmacy Owners re: Regulation of Pharmacy Technicians; Notice of Regulations re: Medication Management; MedEffect advisories added Legislation page - New Regulations re: Medication Management added; NLPB Binder files updated Standards, Policies & Guidelines page - Standards of Practice for Medication Management and accompanying documentation (form, FAQ) added; Standards of Practice for the Provision of Pharmaceutical Care to Personal Care Homes and Community Care Homes updated; Standards of Practice for Required and Recommended Reference Materials for Newfoundland and Labrador Pharmacies updated Professional Practice Resources page - Link to Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain added Frequently-Asked Questions page - New Questions added! Answers updated! For the Public page - updated with a new name (previously “You & Your Pharmacist”) and with information on the NLPB Complaints Process NEW! Pharmacy Technician Regulation page - News and Updates regarding Pharmacy Technician regulation, a snapshot of the recommended Pharmacy Technician Regulation Process and a feedback form have all been added to this new page
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar ...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator...... [email protected] The Apothecary Aileen O’Keefe, Registration & Licensing Administrator...... [email protected] Meghan Handrigan, Office Administrator ...... [email protected] published quarterly by the General Information...... [email protected] Newfoundland and Labrador Pharmacy Board BOARD MEMBERS Apothecary Hall Elected Members 488 Water Street Zone 1 ...... Debbie Kelly St. John's, NL A1E 1B3 Zone 2 ...... David Jenkins Zone 3 ...... John Rideout Tel: 709-753-5877 Zone 4 ...... Christina Tulk Toll Free: 1-877-453-5877 At Large ...... Keith Bailey, Brian Healy, Linda Hensman Fax: 555-753-8615 Appointed Members E-mail: [email protected] ...... Don Mifflin ...... Eugene Toope Observer MUPS Representative ...... Emily-Ann Munden We’re on the Web!! www.nlpb.ca EXECUTIVE COMMITTEE Chair ...... Keith Bailey Vice-Chair...... Christina Tulk Executive Member...... Debbie Kelly Past Chair ...... John Rideout The Apothecary Fall 2010 Newfoundland and 100 Years...100 Pharmacists (1910-2010) Labrador Pharmacy Board This year, the Board, with the collaboration of the Apothecary Hall Trust, decided to recognize 100 pharmacists from 1910 to 2010 as a way of celebrating the 100th anniversary of organized, self- regulated pharmacy in Newfoundland and Labrador. The project began by compiling a Master Register of all pharmacists who had been registered at The Apothecary is the one time or another with the Board, something which had not been done until now. The Master newsletter of the Register was circulated to the trustees of the Apothecary Hall Trust, members of the PANL Awards Newfoundland & Committee and other pharmacists, some of whom were familiar with members from the past and others who were more familiar with pharmacists who are currently in active practice. The intent was Labrador Pharmacy that pharmacists from all eras and all areas of practice would be considered. To this end no specific Board. or restrictive criteria for selection were applied, rather the pharmacists polled were asked simply to It contains information indicate who they personally felt were “worthy of recognition”. The results from this poll were on a wide variety of tabulated along with the results from a call for nominations from all pharmacists in the province and topics intended to a final list of 100 pharmacists of the past century was determined. enhance the practice We hope this list is taken for what it is – an opinion expressed at a moment in time that corresponds to a significant milestone in the history of our profession in this province, but nevertheless the opinion of all pharmacists in of a select but knowledgeable sampling of members of the profession. the province of RICK ABBOTT (1990) BRIAN HEALY (1965) PETER O’MARA (1910) Newfoundland & AUBREY ANSTEY (1974) THOMAS HEALY (1974) JAMES J. O’MARA (1962) Labrador. W.J.K. (KELL) ASHFORD (1945) DR. DONNA HENDERSON (1967) ALBERT EDWARD PARKINS (1915) Pharmacists are KEITH BAILEY (1996) DR. LINDA HENSMAN (1985) DR. LESLIE PHILLIPS (1983) DWIGHT BALL (1977) DERRICK HIERLIHY (1975) MARGOT PRIDDLE (1984) responsible for THOMAS BINDON (1947) DONALD HILLIER (1967) JAMES C. QUICK (1948) reviewing any and J. FORBES BROWN (1958) MARY HISCOCK (1962) JOHN P. RAHAL (1934) BRENDA BURSEY (1978) DONALD HOGAN (1943) THOMAS RICKETTS (1943) ALL INFORMATION DOUGLAS BUTT (1953) WILLIAM HOGAN (1958) JOHN RIDEOUT (1976) contained within EDWARD J. CAHILL (1933) JOHN V. (JACK) HOGAN (1962) DONALD ROWE (1976) including documents SANDRA CAREY (1991) KEITH HOGAN (1985) PAMELA RUDKIN (1978) KAREN COLBOURNE (1992) GEORGE HUTCHINGS (1966) ROY SAUNDERS (1957) which are made CARSON COLLINS (1975) CLARENCE JACKMAN (1953) BARBARA SCAPLEN (1977) available on the NLPB HUGH CONROY (1944) J. FRANK JANES (1939) ROBERTA SCOTT (1967) ARLENE CRANE (1981) MARY E. JOHNS (1928) WILLIAM SIMMONS (1960) website via links NEIL P. CURTIS (1954) DR. DEBORAH KELLY (1999) G. REX SINYARD (1962) throughout the WILLIAM DAVIS (1976) LOUIS J. LAWTON (1911) BERND STAEBEN (1962) newsletter. ALFRED DAWE (1959) KEITH LAWTON (1950) AUGUSTUS STAFFORD (1910) EDWARD (TED) DAWE (1979) AUGUSTUS LILLY (1941) T. JOHN STOWE (1946) The Apothecary is now FRASER DAY (1966) THOMAS LYNCH (1976) NELSON STOWE (1953) circulated JOHN DOWNTON (1967) JOHN LYNCH (1978) DR. BARBARA THOMAS (1985) electronically and is ROBERT DOYLE (1990) ROBERT GEAR MACDONALD (1910) CHRISTINA TULK (2002) JASON DRUKEN (1999) ERNEST C. MACDONALD (1943) DR. CHRISTOPHER TURNER (1989) available in hard copy DR. GERALD R. DUNCAN (1986) VAUGHAN MACDONALD (1964) ROBIN VATCHER (1979) format only upon DR. SCOTT EDWARDS (1997) DOUGLAS MANNING (1965) KEVIN WALSH (1947) RICK ELLIOTT (1976) ROBERT MCGRATH (1956) KENNETH WALSH (1979) specific request. HARVEY W. FLIGHT (1944) DENISE MCGRATH (1985) CHARLES WARR (1961) RODNEY FORSEY (1999) THOMAS MCMURDO MCNEIL (1910) TRENT WHITE (1996) EDWARD D. FREEMAN (1911) J. WAYNE MORRIS (1967) RALPH WINSOR (1966) DAVID GALWAY (1967) THOMAS MURPHY (1958) GEORGE YOUNG (1948) SEUMAS GIBBONS (1963) MICHAEL J. O’BRIEN (1954) JERRY YOUNG (1976) THOMAS GOULDING (1975) DENISE O’BRIEN (1981) DR. STEPHANIE YOUNG (1990) RALPH J. HARRIS (1940) PHILIP O’KEEFE (1981) MELANIE HEALEY (1996) LEO A. O’MARA (1910) Page 2 The Apothecary 2010-2011 Board and Executive Now in Place
As reported on July 22, 2010, this year’s election of NLPB board members is now completed. This year, the election, which saw pharmacists nominating and electing members for Zone 2 and Zone 3, began on June 16, 2010 with a Call for Nominations. Nominations were subsequently received for Ray Gulliver in Zone 2 and for Dorothy Ainsworth in Zone 3. As both zones received only one nomination each, Ray and Dorothy were subsequently elected by acclamation. The elected members began their 3 year terms of office at the 2010 Annual General Meeting, which took place on September 18, 2010. We would like to welcome Ray and Dorothy to the Board and would also like to take this opportunity to thank Dave Jenkins and John Rideout, out- going Board members for Zones 2 and 3 respectively, for their time and dedication to the Board. Also at the AGM, Keith Bailey completed his term of office as Board Chair assuming the position of Past-Chair. Following the AGM, at a Special Meeting of the Board, a new Executive was elected with Christina Tulk assuming the role of Board Chair, Debbie Kelly elected Vice Chair and Linda Hensman elected Executive Member. For a complete list of the current Board as well as the Executive Committee members, please see the back page of this Apothecary. Message from the New Chair of the Board It is certainly an honour and a privilege for me to Practice situations as well as exploring opportunities address the pharmacists across our province as the for pharmacists to get involved in immunizations and, new Chair of the NL Pharmacy Board. I would like to potentially, other types of injections. I encourage all take this opportunity to recognize Keith Bailey for his pharmacists to get involved with our profession as we leadership, as well as John Rideout and Dave Jenkins need your support and collaboration to continue to for their dedication to their positions on our Board navigate our future. and wish them well with their future endeavours. I also Please do not hesitate to contact with me with any wish to acknowledge the entire Office team for their feedback and/or suggestions as I am more than support and guidance. It is my hope that we will available to the pharmacists of the province. My cell harness the momentum gained with the acceptance of number is (709) 632-2748 and my e-mail is our Medication Management Standards to continue to [email protected]. I look forward to move forward in our profession. speaking to as many of you as I can. In the next year, we will continue to work towards Respectfully, technician regulation, begin moving towards procuring Christina Tulk prescribing rights for our pharmacists in Advanced Suspicious Email Making the Rounds
The Board would like to make pharmacists aware of a suspicious email that is making the rounds. With a subject line of “Wholesalers & Exporters of Pharmaceuticals”, the email purports to be from a company identified as Z&S Impex, “one of the leading Wholesalers & Exporters of Pharmaceuticals from Pakistan”. It goes on to describe the “respectable name” they have earned among a number of international countries. They have attached a list of medications for purchase to the email. While we expect most pharmacists would see this email as a potential scam, we still felt it would be prudent to remind pharmacists to be extremely cautious about purchasing any pharmaceutical product online except from known reputable sources. Pharmacists should also be sure that any and all pharmaceutical products sold in pharmacies should have a DIN, NPN or DIN-HM to show that they have been authorized for sale in Canada by Health Canada. Fall 2010 Page 3 Reminder to Pharmacists Regarding r nde Exempted Codeine Products Standards of Practice Remi Since it has been several years since addressed. the publication of the Board’s Labelling Standards of Pharmacy Practice - The Sale of Exempted Finally, as described in section 2.b. of the Standards, Codeine Products in Community Pharmacies, we wanted all pharmacist-authorized exempted codeine products to remind pharmacists of a few key points. At the end MUST BE LABELLED prior to being supplied to the of the article, a couple of Q&A’s from the associated patient. At a minimum, labels must show the date; FAQ re: Exempted Codeine Products are also brand name of drug, or generic name of the drug reprinted. For the complete Standard as well as the and name of manufacturer; quantity of the drug; associated FAQ, please visit the Standards, Policy & directions to the patient; identification of the Guidelines page of the Board website. pharmacy; and the initials of the authorizing Creation of a Patient Profile pharmacist. In accordance with section 2.a. of the Standards, “the pharmacist must record the purchase of an Exempted Excerpts from FAQ: Codeine Product on the patient profile…” What this means is that if this is a returning patient to your Do I need to ID patients now? pharmacy, you would add the exempted codeine Just as there are currently no requirements for this product to their usual medication profile. In addition, when filling prescriptions, there is no requirement for if this is a new patient to your pharmacy, you are the positive identification of patients requesting OTC expected to set up the same profile as you would for codeine. However, pharmacists should be confident any other patient presenting with a prescription. As about the identity and intent of the patient and if a stated in Pharmacy Regulation 13(8), this includes but pharmacist has concerns about the correct identity is not limited to “surname and given names, address, of the patient, it would not be unreasonable to ask telephone number, sex, date of birth, chronic medical for direct identification from the patient. conditions, and notations of allergies and drug What if people refuse to give the necessary reactions”. In addition to these items, documentation information? of the patient’s MCP number will also become especially relevant as pharmacies connect to the These are required Standards of Pharmacy Practice Pharmacy Network. and sale cannot be made unless the required information is provided. Explain to the patient that Identification of “Prescriber” such information is collected to enable the pharmacist In essence, when a pharmacist authorizes the provision to provide them with proper professional service and of an exempted codeine product to a patient and care. adds it to the patient’s profile as a “pharmacist- Do I write these items up as prescriptions? authorized medication”, they are prescribing. As such, the pharmacist MUST document the transaction using Yes, you should document these provisions in the same his or her OWN NAME AND LICENSE NUMBER on way that you would document a prescription. A the patient’s medication profile and retain a hard hardcopy record of the purchase should be retained copy of the interaction in the prescription files. We on file. While you may wish to manually write up have seen many cases of a pharmacist using “MHO” documentation of the transaction, a suitable computer- or “Pharmacist” as the identification in the prescriber generated hardcopy, signed or initialed by the field of the profile. This is not appropriate practice in dispensing pharmacist will be adequate for accordance with the Standards and should be documentation purposes. Page 4 The Apothecary Professional Practice Issues Preventing and Handling Prescription Forgeries We receive many calls from pharmacists asking for Confirm the identity of the prescriber. One cannot assistance in dealing with forgeries. The Board would assume a suspect prescription is a forgery without like to thank these pharmacists and encourage all receiving confirmation from the prescriber. Often, pharmacists to continue reporting confirmed forgeries faxing the prescription to the prescriber’s office will to the Board – whether or not the prescriptions were assist the prescriber in confirming the handwriting and filled – to facilitate the sharing of information and the the patient’s name. Of course, this cannot happen promotion of preventative action. when the physician named does not exist. A Ensuring Authenticity physician’s identity can be confirmed by contacting the College of Physicians and Surgeons or by Determining the validity of a prescription can be a accessing their Doctor Search online. challenge for pharmacists, as it requires careful consideration on the spot. Many reported forgeries Be wary of telephone numbers provided. Do not were filled by the pharmacist and only later contact the prescriber at the phone number given on discovered to be false. If there is doubt as to the the prescription unless you have confirmed that it is authenticity of a prescription, and unless staff and legitimate. If a pharmacist dials a “fake” phone other members of the public are in immediate danger, number, the person answering the phone can do not fill it. impersonate a physician or a physician’s secretary or nurse to confirm the prescription. Often staff members are unsure of how to deal with forgery attempts and are caught off guard. What To Do Once A Forgery Is Confirmed Preparation is key; do not put yourself or your staff in Once a prescription is confirmed as a forgery, we danger. recommend pharmacists contact the police, regardless Questions for pharmacists to consider: of whether the prescription has been filled. • Do you know the patient and/or the prescriber? Pharmacists should document a description of the • Does the patient and/or prescriber live or work in the person passing the forgery (security camera footage area? could be helpful here) and any other details of the • Can the prescriber be contacted in a timely manner? situation that might assist the police in identifying the • Does the prescriber’s handwriting look too good (i.e., suspect. As the police are likely to require the original overly neat)? forged prescription as evidence, it is prudent to make • Do quantities and directions differ from the norm? a photocopy of it . The police will leave a “receipt” of • Is there unusual use of terminology or abbreviations? items taken from the pharmacy as evidence. • Are there spelling mistakes? Reporting • Are the directions written in full, with no abbreviations? • Is an inexpensive non-narcotic prescribed along with a Forged prescriptions should also be reported within to narcotic? the Office of Controlled Substances: Tips for Verifying a Suspect Prescription Compliance, Monitoring, and Liaison Division Office of Controlled Substances Confirm the identity of the patient. Asking for Drug Strategy and Controlled Substances Programme identification such as a valid driver’s license to confirm Health Canada, Address Locator: 3502 B the identity of the patient named on the prescription Ottawa, ON K1A 1B9 may be useful. ID alone, however, is insufficient in Tel: (613)954-1541 determining whether the prescription is forged. Fax:(613)957-0110 Email: [email protected] Expert perpetrators are using stolen driver’s licenses and drug insurance cards to accompany forged Please also forward a copy to the Board via fax at (709) 753-8615. prescriptions. The Personal Health Information Act (PHIA) What it means to you!
Many pharmacists are aware of the new Personal Health transferred and disposed of in a secure manner. Information Act (PHIA) but most do not truly understand their The PHIA Risk Management Toolkit is intended to assist responsibilities under the legislation and what it will mean to their custodians in: day-to-day practice. Many are also not aware that PHIA is • understanding their obligations as they relate to the expected to come into force in December of this year. safeguarding of personal health information; Recently, the Department of Health and Community Services held • assessing their current state of compliance with PHIA; a PHIA Implementation Information session in order to introduce • assessing the effectiveness of the physical, administrative the new privacy legislation to stakeholders and to provide an and technological controls that they have established to overview of the support materials that have been developed to protect the personal health information in their custody or provide assistance to custodians in implementing PHIA. These control; and, resources include: • identifying any gaps or areas for improvement .
An Overview of PHIA A Policy Development Manual A brief presentation that provides an introduction to PHIA as well PHIA requires that custodians have policies and procedures in as an overview of some of the implementation resources. place that describe the ways that they collect, use and disclose personal health information. The PHIA Policy Development An Online Education Program manual is intended to provide custodians with a framework for As PHIA requires that custodians ensure that their employees, developing their own policies and procedures to meet this agents, contractors and volunteers are aware of the duties obligation. imposed by the Act and regulations, this program is intended to The manual sets out the legal requirements of PHIA and arranges help custodians to understand their obligations under the Act, as those requirements into a policy framework. The manual also well as to assist them in providing the education and training provides custodians with sample policy and procedure language. required by the Act. While custodians may customize the sample language provided, they should be careful to ensure that whatever policies or A Facilitated Education Program procedures developed are compliant with the requirements of the If online education is not preferred, there are also two versions Act. (1/2 day and full day) of a Facilitated Education Program. Each version contains information on adult learning for facilitators and materials to assist with organizing and delivering information These resources, as well as an upcoming FAQ are all available sessions as well as materials to provide to persons attending for download from the Department of Health and Community information sessions, including a participant’s workbook and Service’s PHIA resource web page at www.health.gov.nl.ca/ resources for further reading. health/PHIA. A link to this page is also provided on the Professional Practice Resources page of the NLPB website and A Risk Management Toolkit on the Home page of the PANL website. PHIA requires that custodians take steps to ensure that personal Pharmacists and Pharmacy Owners should begin familiarizing health information in their custody or control is protected against themselves NOW with this information as the December theft, loss and unauthorized access, use or disclosure; protected implementation date is fast approaching. against unauthorized copying or modification; and retained,
Donald F. Rowe Mary Ann Butt Secretary-Registrar Executive Director Newfoundland and Labrador Pharmacy Board Pharmacists’ Association of Newfoundland and Labrador Page 6 The Apothecary Frequently Asked Questions Medication Management in Community Pharmacy
Despite the fact that these questions included at the end of the of the activities under Medication were included in the last edition of Standards and Send the form to Management, do they have to The Apothecary, we felt that due to the Board office for retention in the notify anyone else? the number of inquiries we have pharmacist’s permanent file; Yes, the Standards require that the received, we would re-publish this • Maintain Personal Professional original prescriber must be notified of Liability Insurance Coverage excerpt for pharmacists who may be in an the pharmacist’s decision within a amount equivalent to or greater only now integrating these Standards particular timeframe depending on the than that stated in the Board’s area of Medication Management: into their day-to-day practice. All Policy on Professional Liability Providing an Interim Supply - 72 hours Pharmacists are reminded that the Insurance; and Extending a Prescription - 1 week complete FAQ is posted on the • Be prepared to: Adapting a Prescription - 1 week Standards, Guidelines and Policies • obtain informed consent How should other health page of the NLPB website and will from each patient to whom professionals be notified? be updated as new Questions come these services are provided, Through consultation with the College along. • document all instances of of Physicians and Surgeons of Medication Management, What does Medication Newfoundland and Labrador (CPSNL) and Management really mean? and the Association of Registered • notify the original The Standards of Pharmacy Practice for Nurses of Newfoundland and prescribers, within the Medication Management describes Labrador (ARNNL), it has been indicated timeframes. three key areas: determined that the preferred method of notification is via fax transmission of • Providing an Interim Supply How should I document the Documentation and Notification • Extending a Prescription Medication Management? form. This will serve to assist • Adapting a Prescription The Board has developed a Documentation and Notification Form prescribers with documentation on their Do I have to participate in template to assist pharmacists with end as well. However, pharmacists Medication Management? documenting instances of Medication may determine that another method is No. Authorization does not mean Management. This form must be best for you and for the prescribers obligation - the decision to perform completed IN FULL and retained in the you communicate with. It may be any or all of these acts is at the pharmacy in case of future audit. beneficial to speak with the health professionals in your area to find out discretion of the individual pharmacist. How do I file these forms? What However, if a pharmacist does choose how they wish to be notified. about the computer hard copies? to perform any of these actions, it must Are the limitations on Medication Our consultation has indicated that the be done in accordance with the best way to handle these forms would Management? Standards of Pharmacy Practice and be to file them in sequential order • Yes, the limitations on Medication within the limits of the pharmacist’s own along with your other prescriptions. For Management include prescriptions: competencies. example, when providing an interim • originally written by a Dentist, Are there special requirements supply or prescription extension, you Optometrist or Veterinarian; needed in order to participate in would attach your computer “hard • for Narcotics, Controlled Drugs or Medication Management? copy” to the form and file it. When Targeted Substances, including Yes, prior to participating in adapting a prescription, you would benzodiazepines; Medication Management, a pharmacist attach the computer “hard copy” as • for the pharmacist themselves; MUST: well as the original prescription to the • for a family member, or someone • Study the Standards IN DETAIL, form before filing it. of a “close personal or emotional Sign the NLPB Declaration Form When a pharmacist performs one (Continued on page 7) Fall 2010 Page 7
Medication Management FAQ... pharmacist could choose to provide an initial adaptation of (Continued from page 6) the prescription but reduce or eliminate the authorized relationship”, unless there is no other pharmacist refills. If they did this they would need to provide the available in the community; or rationale for their decision in their documentation and • that bear a specific indication otherwise (e.g.: “Do Not inform the patient that they will need to return to their Renew/Extend” or “Do Not Adapt”). physician earlier than intended (note: a pharmacist cannot I have just received a prescription with “Do Not add refills that were not initially authorized by the Renew &/or Adapt” written on it. Does this mean prescriber). that I cannot adapt or renew this prescription? If the pharmacist adapts the prescription and maintains the Yes. Just as we honour notations like this from prescribers authorized refills, when the patient returns for a refill the today regarding generic substitution, pharmacists are pharmacist would process the refill as they would any other expected to honour hand-written “Do Not Renew &/or refill prescription. The process of refilling an adapted Adapt” instructions on prescriptions. It is important to prescription is not considered an adaptation per se, so the remember in this situation that should a pharmacist still feel documentation and notification requirements do not apply that an extension or adaptation is in the best interest of the to the refills. Should the patient return to the pharmacy for patient, he or she can always contact the prescriber for a refill and a different pharmacist is on duty that permission to extend or adapt the prescription. pharmacist would again process the refill as they would any other refill. If they have a concern about the What happens to refills when a prescription is appropriateness of the adapted prescription they should adapted? do what they normally do if they have a concern about When a pharmacist adapts a prescription, he or she also refilling a prescription. takes responsibility for any authorized refills. The
Final Year Pharmacy Students Completing SPE IV in Community Pharmacies
SPE IV is a clinical pharmacy rotation during the to interact with the health care team, interview and Winter Semester of the final year of the pharmacy assess patients, make specific therapeutic program. Students are required to complete two 6- recommendations, monitor patient responses to drug week rotations from January to April. These are therapy and provide patient education, as well as completed at two different sites, and may be in meet the drug information needs of the health care institutional or community based settings. Having team. students complete clinical practice experiences in While a student’s “home base” may be in a particular community pharmacies is a relatively new initiative pharmacy, physicians may refer patients who which, with the support of the pharmacy community, normally fill their prescriptions at another pharmacy. the School of Pharmacy is hoping to expand to allow In such situations, it is possible that you may be each student one placement in community pharmacy contacted by a pharmacy student inquiring about one and the other in an institutional setting. of your patients. We would ask you to be supportive The clinical pharmacy rotation provides an of such collaborations as they may serve to improve opportunity for students to take direct responsibility patient care and also help demonstrate the for individual patient’s drug-related needs. The role expanding role of the pharmacist. If you have any of the pharmacist is evolving from that of a supplier questions about the Structured Practice Experience of pharmaceutical products towards that of a Program, please contact Wanda Spurrell at provider of services, information and patient care. [email protected] or by telephone at 777-6498. Increasingly, the pharmacist’s role is to ensure that a Any pharmacist who would like to become more patient’s drug therapy is appropriately indicated, the involved with the community pharmacy clinical most effective available, the safest possible, as well rotations by serving as a preceptor is also asked to as economical and convenient. Students are expected contact Wanda. Recent Updates to the NLPB Website
• About Us page - June 11, 2010 Board Meeting Registration & Licensing Renewal Deadline Minutes added Pharmacists and Pharmacy Owners are reminded that the • Contacts (Find A…) page - Board Members and deadline for receipt of all forms and payments related to the Executive Committee updated; New Registers of Renewal of Pharmacist Registrations and Pharmacy Licenses Pharmacists, Pharmacies and Veterinarians is NOVEMBER 30th, in accordance with the Board’s Policy - added Registration and Licensing Renewal Deadline (available on the Standards, Guidelines & Policies page of the NLPB • “The Apothecary” & Other Communications website). Renewal Forms will be mailed to all pharmacists page - News items and MedEffect advisories and pharmacists-in-charge by the end of October. added ∞ • Legislation page - Consolidated Pharmacy Avoid Additional Fees!! Regulations updated; NLPB Binder files updated The Board’s Schedule of Fees (available on the Legislation • Standards, Guidelines & Policies page - Policy - page of the NLPB website) allows for additional fees to be Registration & Licensing Renewal Deadline added applied in certain circumstances (for example, Change of Employment notifications received less than 7 days before • Professional Practice Resources page - new the change). While these additional fees may not have been Canadian Adverse Reaction Newsletter added applied consistently in the past, these oversights have • Provincial Drug Schedules page - Official Drug become enough of an issue of concern for the Board that it Schedules and Guide to the Newfoundland and has been decided that all such fees will be applied from this Labrador Provincial Drug Schedules updated point going forward. • Pharmacy Technician Regulation page - new ∞ FAQ - The Pharmacy Technician Regulation & NAPRA Notes Registration Process The Fall 2010 edition of the NAPRA newsletter, NAPRA Notes has been posted to the News section of the NLPB website.
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator...... [email protected] The Apothecary Aileen O’Keefe, Registration & Licensing Administrator...... [email protected] Meghan Handrigan, Office Administrator...... [email protected] published quarterly by the General Information ...... [email protected] Newfoundland and Labrador Pharmacy Board BOARD MEMBERS Apothecary Hall Elected Members 488 Water Street Zone 1...... Debbie Kelly St. John's, NL A1E 1B3 Zone 2...... Ray Gulliver Zone 3...... Dorothy Ainsworth Tel: 709-753-5877 Zone 4...... Christina Tulk Toll Free: 1-877-453-5877 At Large...... Keith Bailey, Brian Healy, Linda Hensman Fax: 555-753-8615 Appointed Members E-mail: [email protected] ...... Don Mifflin www.nlpb.ca ...... Eugene Toope Observer MUPS Representative...... Andrew Sweetapple
EXECUTIVE COMMITTEE Chair...... Christina Tulk Vice-Chair ...... Debbie Kelly Executive Member...... Linda Hensman Past Chair...... Keith Bailey The Apothecary
Newfoundland and Winter 2010 Labrador Pharmacy Board As the Christmas Season is upon us once again, and the old year draws nearer to its end, we take this opportunity to wish you and those dear to you a Joyous The Apothecary is the newsletter of the Christmas and a Prosperous New Year.
Newfoundland & May the Christmas message of Labrador Pharmacy Board. Peace and Goodwill remain with us It contains information the whole year through. on a wide variety of topics intended to Best Wishes from all of us at enhance the practice the Newfoundland and Labrador of all pharmacists in Pharmacy Board. the province of Newfoundland & Labrador. Pharmacists are responsible for reviewing any and Holiday Hours for NLPB Office ALL INFORMATION With the Christmas and New Year holiday season approaching please note the contained within holiday hours of operation for the Board office: including documents Friday, Dec 24th, Christmas Eve Closed (vacation day) which are made Monday, Dec 27th Closed (for Christmas Day holiday) available on the NLPB Tuesday, Dec 28th Closed (for Boxing Day holiday) website via links throughout the Friday, Dec 31st, New Year’s Eve Closing at 12:00 noon
newsletter. Monday, Jan 3rd Closed (for New Year’s Day holiday) The Apothecary is now circulated During the holidays mail may be left in the mail slot of our fire exit door. Messages may electronically and is also be left on our telephone answering machine, by fax, or by e-mailing one of the Board staff members at the email addresses listed at the back of this newsletter. available in hard copy format only upon specific request. Professional Development Logs must be received NO LATER THAN December 31st in order to be registered on time. Due to the holiday schedule, Logs received after noon on the 31st will not be processed until January 4th Page 2 The Apothecary Professional Practice Issues NEW! Narcotic and Controlled Drug Security and Accountability Standards of Practice
At its most recent meeting on November 26, 2010, the manual Perpetual Inventory of Narcotics and Board approved a new Standard of Pharmacy Controlled Drugs. Practice - Security and Accountability Procedures for Physical Inventory Counts Narcotics and Controlled Drugs in Community Pharmacists-in-Charge must ensure a physical Pharmacies (available on the Standards, Policies & inventory count of Narcotic and Controlled Drugs is Guidelines page of the NLPB website). The forms performed and documented at least once every mentioned can also be found with the Standards or on three months. the Miscellaneous Forms page. In addition, physical inventory counts of Narcotic The main principle of this document is: and Controlled Drugs must be conducted upon any Pharmacists have the responsibility for the safe and change of Pharmacist-in-Charge. This count should secure storage of drugs from the time they are received be conducted by both the departing Pharmacist-in- at the pharmacy to the time they are provided to the Charge and the new Pharmacist-in-Charge (either patient or removed from the pharmacy’s inventory. separately or together) and the signatures of each However, pharmacists often struggle with interpreting Pharmacist-in-Charge shall be recorded on the the many legislative references with regard to count documents, which shall be retained for two narcotics and controlled drugs as well as with years. implementing strategies that will allow them to maintain security and accountability while also being Record-Keeping Procedures practical. This Standard is intended to provide Purchase Records pharmacists-in-charge as well as other practicing Pharmacies must maintain a register or log of all pharmacists with an effective means to assist them in receipts of Narcotic and Controlled Drugs in a assuring that the narcotic and controlled drugs in the readily retrievable format in accordance with pharmacy are secure from internal loss, theft and section 30. of the Narcotic Control Regulations. diversion as well as providing a strategy for maintaining accountability documentation. It Paper copies of purchase invoices, or photocopies represents the minimum requirements expected of thereof, must also be retained in an organized pharmacies in achieving this purpose. manner in the pharmacy, filed in order by date and invoice number. The document’s major points are summarized Pharmacists-in-Charge should ensure a random below: audit of purchase records is conducted monthly to ensure they have been accurately recorded in the Storage and Inventory Requirements Perpetual Inventory Record. Storage Requirements Sales Records Pharmacists-in-Charge must ensure that all narcotic All pharmacies must maintain a paper copy of a and controlled drugs are stored in a lockable register or log of all sales/transactions of Narcotic cabinet that is solely intended for the storage of and Controlled Drugs in an organized manner in specified medications. the pharmacy in accordance with sections 38. of Perpetual Inventory the Narcotic Control Regulations. Pharmacies must maintain either a computerized or Pharmacists-in-Charge should print and review a Narcotic and Controlled Drug Sales Report Winter 2010 Page 3
monthly. as of this time, pharmacists may not fill Pharmacists-in-Charge should ensure a random prescriptions written by out-of-province prescribers audit of sales records is conducted monthly to for Narcotics or Controlled Drugs on Schedule I of ensure they have been accurately recorded in the the TRPDP brochure. Perpetual Inventory Record. Pharmacists are required under the TRPDP and Filing and Storage section 5. b) of the Standards of Practice – Facsimile Transmission of Prescriptions for In accordance with section 40. of the Narcotic Community Pharmacies to “specifically confirm the Control Regulations, prescriptions for Narcotics and authenticity of a faxed prescription for a drug which Controlled Drugs must be filed in a separate file in by regulation must be written on a tamper resistant sequence by date and transaction number (in the prescription blank through contact between the absence of a transaction number, a prescription pharmacist and a person at the site of transmission number may be used). who can verify the transmission of that prescription”. This file should also include prescription records for Narcotics or Controlled Drugs may be supplied to exempted codeine products as described in the other pharmacists “For Emergency Use” in Standards for Pharmacy Practice – The Sale of accordance with section 45. of the Narcotic Control Exempted Codeine Products in Community Regulations but the provision of such an Emergency Pharmacies. Supply must be documented accordingly. Prescriptions should be bundled or otherwise In accordance with section 42. of the Narcotic sorted into manageable groups of prescriptions, Control Regulations, Losses or Thefts must be and enclosed in a jacket or cover. The outside of reported by completing a Loss or Theft Report the jacket or cover must be labelled in an form (See NLPB Miscellaneous forms page) and appropriate fashion which clearly identifies the sending or faxing it to the Office of Controlled prescription series in that particular file (i.e. Substances at Health Canada within 10 days of transaction number, prescription number and/or detection. A copy of this form should be sent to date range). the NLPB office.
Destruction of Expired Narcotic and Controlled Drugs Forgeries should be reported by completing a The Narcotic and Controlled Drug inventory should Forgery Report form and sending it to the Office be reviewed regularly for expired and/or of Controlled Substances at Health Canada. A otherwise unusable drugs. copy of this form should be sent to local law enforcement and to the NLPB office. Requests for Destruction of these drugs must be directed to the Office of Controlled Substances at Pharmacists-in-charge and pharmacists should Health Canada in accordance with the NLPB familiarize themselves with the full Standards Guidelines for Pharmacy Practice – Destruction of document which contains much more detail Expired or Unusable Narcotics and Controlled including implementation strategies and sample Drugs. forms and procedures.
Pharmacists-in-charge should make every effort to The Standards document also reminds pharmacists begin implementing policies and procedures related about a number of Narcotic and Controlled Drug- to this new Standard of Pharmacy Practice as soon related “Miscellaneous Points”: as possible as it will be a key point of discussion Pharmacists are responsible for following all during future pharmacy inspections by the requirements of the Tamper Resistant Prescription Assistant and Deputy Registrars. Drug Pad Program (TRPDP) including the fact that, Page 4 The Apothecary Limitations on Medication Management notations, be they stamped, pre-printed or hand-written, should make a notation on the patient medication profile Pharmacists are reminded that section 2 of the so that other pharmacists are aware of the original Standards of Pharmacy Practice - Medication prescriber’s wishes. Management by Community Pharmacists outlines several limitations on the use of Medication Management. One in particular is any indication from the prescriber that Medication Management Tip they do not want their prescriptions extended or Though most prescribers include their adapted. This may be a written indication - i.e. “Do fax number at the top of their Not Renew” or “No Adaptation” but may also include a prescription pads, sometimes this stamped or pre-printed notation on the prescription number is not as readily available and pad. a call to the prescriber’s office is In addition, section 3 poses several questions required. Once you track down the pharmacists should ask themselves before applying the number, add it to the prescriber’s file principles of Medication Management. One of these is on you Practice Management System “Am I comfortable that the original prescriber would not and/or add it to your Fax Machine’s object?”. Obviously, if the prescriber has made some contact list so that, next time, it is indication that adaptation or renewal is not wanted, the right where you need it! answer to this question should be “No.” Pharmacists in receipt of prescriptions with such
In Memoriam We are very saddened to report the loss of two more the 1970 revision of that Act. He was made an distinguished pharmacists. Hugh O’Neill Conroy Honorary Life Member of the NPhA in 1992. (1921-2010), passed away on December 5th. Mr. We express our sincere condolences to Mr. Conroy’s Conroy was the longest practising pharmacist in this family on the passing of a man who made a significant province, having been initially licensed in 1944 and contribution to the profession in this province. retiring after a distinguished career of 64 years at ∞ the end of 2008. It was with great sadness that the Pharmacy Class of Mr. Conroy started his pharmacy career when, after 1976 learned of the sudden passing of Kenneth serving a four year apprenticeship at McMurdo’s Gerard Fleming (1956-2010), in his beloved great Drug Store in St. John’s, he attended the Maritime outdoors on November 27th at the age of 54 years. School of Pharmacy at Dalhousie University, Ken began the CTT Pharmacy Program in September graduating in 1946. After returning to the province of 1973 immediately after graduating from St. from Halifax, Mr. Conroy practiced community Stephen’s High School in Stephenville. He was only 19 pharmacy while also taking on the role of pharmacy years old when he graduated in 1976. Since his instructor in the Newfoundland Pharmacy Board graduation Ken practised in Stephenville and other Apprenticeship Program from 1946 to 1966. areas on the west coast of the island. Mr. Conroy was Registrar of the Newfoundland Besides his many pharmacy friends, he will be sadly Pharmacy Board from 1952 to 1954 and was missed by his loving wife, Dana, daughters, Isabella associated with the preparation of the 1954 (13 years old) and Jillian (8 years old) and son, Pharmaceutical Association Act, which saw the merging Jackson (5 years old) as well as his mother, Mary of the Newfoundland Pharmaceutical Society and the Fleming of Stephenville. He was predeceased by his Newfoundland Pharmacy Board into the pharmacist father, Richard Fleming, who also died of a Newfoundland Pharmaceutical Association, and with heart condition at too early an age. Winter 2010 Page 5 NLPB Board Update - November 26, 2010 Meeting Budget for 2011 Approved Appointments to Joint Committee on Structured The Board approved the Budget for 2011 as Practice Experience proposed by the Finance Committee. This year’s Two new NLPB representatives, Evelena Verge and budget involves no increase in the annual registration Ray Gulliver were appointed to the Joint MUN-NLPB fee for pharmacists or the annual business licence fee Committee on Structured Practice Experience. The for pharmacies. Board would like to congratulate Evelena and Ray on their appointment and also thank out-going committee REVENUE members, Randy McFadyen and Justin Peddle for Pharmacist Registrations $348,300.00 their service on the committee. Business and Hospital Licenses $192,000.00 Students Registration Fees $8,000.00 Appointments to the Disciplinary Panel Non Practicing Fees $2,625.00 The Board reappointed all current Disciplinary Panel Other Fees $9,800.00 members whose term of appointment expired this Other Revenue $8,950.00 year. The Board would like to thank these TOTAL REVENUE $569,675.00 representatives, Colleen Abbott-Hibbs, Mike Batt, Barry Downey, Stephen Gillingham, Denise O’Brien EXPENSES and Connie Burt (alternate) for their continued service to this committee. These appointments are for an Administration Expenses $425,507.00 additional three year term, expiring in 2013. Legal Expenses $11,000.00
Building Expenses $37,000.00 New Policies Operating Expenses $81,610.00 The Board has approved two new policies - one on TOTAL EXPENSES $555,117.00 Pharmacy Relocation and another on Pharmacy (Dispensary) Renovation. Both policies are available $14,558.00 on the Standards, Policies & Guidelines page and Projected Operating Surplus the Registration & Licensing page of the NLPB website. Less Capital Expenditures $3,000.00
Transfer to Contingency Fund $10,000.00 Appreciation of Service Projected Surplus (Deficit) $1,558.00 The Board would like to express its appreciation to New Standards of Pharmacy Practice Margot Priddle for her service on the National Drug Scheduling Advisory Committee. This committee is As described on page 2 of this newsletter, the Board very important to our work on the Provincial Drug approved a new Standard of Pharmacy Practice - Schedules as it advises the provincial regulatory Security and Accountability Procedures for Narcotics bodies on matters related to the placement of drugs and Controlled Drugs in Community Pharmacies. This and drug products within the Schedules. Margot document is summarized on pages 2 & 3 and can be recently completed a three year term on this viewed in its entirety on our website under Standards, committee, during which she also served as the Policies & Guidelines. committee’s chair.
Page 6 The Apothecary
MedEffect e‐Notice ‐ Avandia, mention Lupus Newfoundland Strategies to Improve Patient Avandamet, Avandaryl and Labrador to them and Safety Pharmacists are reminded that if provide our contact information. We would like to refer all they have not yet read this Thank You, pharmacists to an article advisory, posted to our website Shawn Layman published in the October 2010 issue of Pharmacy Practice on November 18, 2010, they Pharmacist and Lupus NL board magazine. Entitled, Keep it Safe, should do so as soon as possible. member the article describes a number of The notice contains important strategies that can be developed information regarding new Contact Information: prescribing restrictions for these and implemented by community Shawn Layman - 745-2048 (H) drugs that pharmacists should be pharmacists with the ultimate Provincial office - 368-8130 aware of and discuss with their goal of improving the safety of patients during patient education. Website: www.envision.ca/webs/ their patients. These include: lupusnfldlab/ ∞ establishing a culture of ∞ patient safety in the Lupus NL is Requesting Your Dispensing Buprenorphine pharmacy, Assistance When the Board approved the reporting and analyzing “Lupus is an autoimmune disease Guidelines for Dispensing medication incidents, and is often referred Buprenorphine in March of 2008, optimizing the distribution as a disease of 1000 faces" there were few physicians in the system, province prescribing the Many Lupus patients within our performing medication medication, Butrans (Purdue Province are not aware that there reconciliation, and is a Provincial Chapter of Lupus Pharma) or Suboxone (Schering‐ implementing independent Canada in Newfoundland and Plough). However, in recent double checks. Labrador. months, we have become aware of more instances of this Implementing some or all of Lupus Newfoundland and medication being prescribed and these strategies in community Labrador is a non‐profit, wanted to take a moment to pharmacies can go a long way in registered, charitable remind pharmacists of these improving patient safety organization that provides Guidelines. They can be found on outcomes. support to people affected by the Standards, Policies & Lupus, promotes education and Guidelines page of the NLPB awareness of Lupus and supports website and any pharmacist advances in research and in the presented with a prescription for treatment of Lupus. The this medication should be sure to organization is in the process of familiarize themselves with the creating a database and would document. like to provide information and support to all those patients and their families ‘living with Lupus’. Our request is, if you have any patients with this condition, you
ARE YOU A PHARMACIST INTERESTED IN INTERNATIONAL PHARMACY?
The SEP provides an opportunity for international students to experience the exciting practice of pharmacy in Canada. The program not only provides students with the opportunity to learn about pharmacy outside their own country, it also enriches both their professional and personal lives with unique cultural experiences. Canadian students who find a host site strengthen their own SEP application.
Your role as a preceptor/host site will be a rewarding one. Students bring a great deal of knowledge and enthusiasm to the workplace and can add an international diversity to your establishment. Also, if you choose to accept an international student, you enable a much deserving Canadian pharmacy student to go abroad the following year.
Most exchanges are one month and usually take place from May to September. However, exchanges can be anywhere from two weeks to three months and can occur within any month during the year. It all depends on what is convenient for you, the host site.
During the exchange, the amount of time the student spends on site will be catered to your preferences. IPSF recommends that the student works for 4-8 hours/day for 4 days/week.
We require host sites in all areas of pharmacy practice (i.e. Research, Industry, Hospital, Community, etc.)
The exchange students are volunteers and therefore are unpaid. Students are also responsible for the cost of their transportation and accommodations and therefore there is no cost to you!
You will be able to determine criteria of a preferred student (ie. Spoken language, year of pharmacy program), and then will be able to choose your student from a pre-screened list. You will receive complete CVs and motivational letters from several candidates.
Once you select a student, CAPSI will ensure the student has accommodations, social events, and all necessary travel documents. Leave all the work to us!
Deadline for 2011 (May-September): February 15, 2011
I hope that you will strongly consider sharing your experiences, knowledge, and ideas with an international students. For more information on how you can host a student please contact:
Kendell Langejans IPSF-CAPSI National Student Exchange Officer [email protected] 403-988-9767
Recent Updates to the NLPB Website For Your Information The Environmental Impact Initiative Division of About the Board Health Canada will be conducting a survey in 2011 Board Meeting Minutes Sept 18th & 19th added to develop a better understanding of Canadian Contact Us (Find A…) pharmacies’ current collection and disposal practices Committee Terms of Reference updated of pharmaceutical waste. The information gathered Pharmacists & Pharmacies Registers updated through this survey will be used as supporting Optometrists Register updated documentation for a consultation process with Veterinarians Register updated Canadian stakeholders, such as pharmacies and the “The Apothecary” & Other Communications pharmaceutical industry. The survey will be MedEffect advisories added available in mid January 2011 and all pharmacists Registration & Licensing are encouraged to look out for it and Application for a New Business License updated participate. By completing the survey you will be Blank Pharmacist and Pharmacy Renewal Forms helping Health Canada in the research of how to added reduce the exposure of the environment to Policy & Forms Regarding Pharmacy Relocation pharmaceuticals. and Pharmacy (Dispensary) Renovation added Sofia Rodriguez Gallagher Standards, Policies & Guidelines Analyst Environmental Impact Initiative Standard of Pharmacy Practice - Security and Policy, Planning and International Affairs Directorate Accountability Procedures for Narcotics and Health Products and Food Branch, Health Canada Controlled Drugs in Community Pharmacies [email protected] added Tel: 613-941-6194 Fax: 613-957-3468
Newfoundland and Labrador Pharmacy Board
BOARD STAFF Don Rowe, Ph.C., Secretary Registrar...... [email protected] Arlene Crane, Ph.C., Deputy Registrar...... [email protected] Melanie Healey, Ph.C., Professional Affairs Coordinator ...... [email protected] The Apothecary Aileen O’Keefe, Registration & Licensing Administrator...... [email protected] Meghan Handrigan, Office Administrator ...... [email protected] published quarterly by the General Information...... [email protected] Newfoundland and Labrador Pharmacy Board Apothecary Hall BOARD MEMBERS Elected Members 488 Water Street Zone 1...... Debbie Kelly St. John's, NL A1E 1B3 Zone 2...... Ray Gulliver Zone 3...... Dorothy Ainsworth Tel: 709-753-5877 Zone 4...... Christina Tulk Toll Free: 1-877-453-5877 At Large...... Keith Bailey, Brian Healy, Linda Hensman Fax: 555-753-8615 Appointed Members E-mail: [email protected] ...... Don Mifflin ...... Eugene Toope Observer We’re on the Web!! MUPS Representative...... Andrew Sweetapple
www.nlpb.ca EXECUTIVE COMMITTEE Chair...... Christina Tulk Vice-Chair ...... Debbie Kelly Executive Member ...... Linda Hensman Past Chair...... Keith Bailey