COVID-19 Resources for Pharmacy Professionals

Yes, for the purposes of administering the COVID-19 vaccine in community pharmacies, all pharmacists wishing to participate must have an active certification of authorization to administer drugs and vaccines by injection from CPhM, including a current CPR level C and First Aid certification.

For more information on how to obtain authorization, please see the Administering Drugs and Vaccines by Injection Information Sheet.

Only certified pharmacists and certified pharmacy interns can administer COVID-19 vaccines in a pharmacy.

On April 6, 2021, a revised Ministerial Order under The Regulated Health Professions Act (vaccine administration) came into effect permitting certified pharmacy interns to administer COVID-19 vaccines in pharmacies.

Before a pharmacy intern can administer COVID-19 vaccines in a pharmacy, they MUST:

1. Fill out an Application for Intern Injection Authorization;
2. Scan and send it to the College by email to registration@cphm.ca; AND
3. Receive certification from the College.

Note that this certificate of authorization is only required if an intern wishes to participate in the COVID-19 vaccination efforts at the pharmacy.

Pharmacy students and pharmacy technicians are not permitted to administer COVID-19 vaccines in a pharmacy as per the Ministerial Order.

According to section 113 of the Pharmaceutical Regulation, pharmacists must make a drug administration record, which must be retained in the pharmacy for at least five years, containing the following information:

• the patient’s name and address;
• the name of the drug and total dose administered;
• for an advanced method or vaccination by any method, identification of the manufacturer, lot number and expiry date of the drug;
• for an advanced method, the route of administration and the location on the body where the drug was administered;
• the name of the member administering the drug;
• the date and the time of administration;
• any adverse events;
• the price, if there is a charge for administration.

All Records must be retrievable and auditable upon College request.

Pharmacists must also adhere to the practice direction on Administration of Drugs including Vaccines here.

It is up to the pharmacy’s discretion if they would like to enter a record into DPIN as well, although it is not required as long as all COVID-19 vaccines have been documented in PHIMS. If COVID-19 vaccines are entered into DPIN for pharmacy-specific reasons, they should be entered using the DU code. The inclusion of the PS code is not required for the COVID-19 vaccine. (NOTE: if the PS code is unintentionally entered, it will not be pulled into PHIMS to avoid duplicate entries).

No, direct data entry into PHIMS is sufficient. For more information about entering COVID-19 vaccine data into DPIN if this will be your practice, please see the MHSC website: https://manitoba.ca/covid19/vaccine/partners/faq.html

It is not mandatory to use the Manitoba Health COVID-19 Consent form.  An in-house consent form may be used if it adheres to all requirements as set out by the Public Health Act and the Informed Consent Guidelines that can be located at Immunization Program Manual. If a client presents with a completed Manitoba Health COVID-19 consent form, it is recommended to accept the form.

Yes, as long as the pharmacy records the immunizations provided into PHIMS and meets the guidelines for holding clinics during the COVID-19 pandemic. NACI released Guidance for Influenza Vaccine Delivery in the Presence of COVID-19 (https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-influenza-vaccine-delivery-covid-19.html) the same principles should be followed when administering COVID-19 vaccine.

In addition, the cold chain storage and handling of the vaccine during transport and on site should follow Manitoba’s Cold Chain Protocol and that the COVID-19 vaccines are managed so that vaccine doses are not wasted. These vaccines will have limited time for use once the vials are punctured, as they do not contain preservatives. Appropriate planning will be required.

Pharmacists must follow all the requirements of injection and vaccine administration outlined in the Practice Direction of Administration of Drugs Including Vaccines, such as readily accessible supplies for emergency situations, and monitoring patients after administration.

Please also review the Shared Health website for additional guidance for health care professionals on PPE and patient contact during the pandemic here. The CPhA website also has information on best practices for PPE and administration of injections that can be found here.

As of September 1, 2022, injection-certified pharmacists are now authorized to administer COVID-19 and seasonal influenza (flu) vaccines to individuals two (2) years of age and older effective immediately. This change also applies to pharmacy interns certified to administer COVID-19 vaccines through this application, and for flu vaccines.

At this time, the expansion to administer vaccines down to age two (2) is only for Health Canada approved COVID-19 vaccines and flu vaccines that are part of Manitoba’s annual Seasonal Influenza Immunization Program.

For all other vaccines, the age of administration remains at age seven (7) years and older.

The administration of these publicly-funded vaccines is as per the policies, protocols and guidelines of the Manitoba Immunization Program; please refer to the Immunization Program Manual for these resources.

There is no additional training required to administer vaccines to children two years and older if the pharmacist already holds and maintains Certification of Authorization from CPhM to administer drugs and vaccines by injection. However, CPhM strongly encourages pharmacists and interns to review the following resources to support the safe and effective administration of vaccines to children two (2) years of age and older:

• Administration of Injections to Young Children (Ages 2-5) Resource List
• Medication Incidents in COVID-19 Vaccine Administration in Children: Contributing Factors and Prevention Strategies

As always, pharmacists must practice within the scope of their competence, skill, and knowledge.

As of November 23, 2021, a Ministerial Order under The Regulated Health Professions Act (rapid testing) authorizes pharmacists to perform/administer rapid antigen tests and rapid molecular (non-PCR) COVID-19 tests for Manitobans for any reason, with the authorization for pharmacist test interpretation/communication of diagnosis. This order replaces the previous one that only permitted rapid testing for travel purposes.

Pharmacies electing to offer this service will be responsible for acquiring rapid testing supplies, training staff and advertising the service at their site. The COVID-19 rapid antigen tests may be self-administered by the individual seeking the test or administered by the pharmacist and conducted within the pharmacy facility, with pharmacist test interpretation/diagnosis and documentation provided. Pharmacists offering this service must comply with the minimum applicable documentation requirements outlined in section 106 of the Pharmaceutical Regulation, the Test Interpretation Practice Direction, and the Records and Information Practice Direction.

Please check the Government of Manitoba COVID-19 Vaccines,  COVID-19 Vaccine Information for Health Care Professionals  and Physician and Pharmacist Vaccination Partners sites for resources.

The Manitoba government launched a new website on March 17, 2021, to provide people with up-to-date information about the provincial COVID-19 vaccination campaign. Through protectmb.ca, Manitobans have easy access to eligibility criteria, immunization sites, and myth-busting information.

Manitobans also have the option of signing up to receive updates on the vaccination program directly to their email inbox. When there is a change in eligibility or supply, an urgent message can be sent to ensure people receive the timeliest information.

Visit protectmb.ca for more information.

Read the Government of Manitoba news release at the following link:

https://news.gov.mb.ca/news/index.html?item=51009&posted=2021-03-17

You can use the Public Health Agency of Canada (PHAC) COVID-19 Vaccination Toolkit for Healthcare Providers as a quick resource to help your patients and colleagues make informed decisions about COVID-19 vaccination by sharing credible information and resources with them.

Within the toolkit, you will find links to general information about COVID-19, an overview of authorized vaccines, guidance for managing COVID-19 vaccination clinics, an overview of vaccine safety, as well as a number of additional resources such as digital tools, communication materials, and provincial/territorial specific resources

• COVID-19 Guidance Documents – Health Professionals
• COVID-19 Vaccine Safety and Side Effects
• Public Health Agency of Canada (PHAC) Canada’s COVID-19 immunization plan
• Drug and vaccine authorizations for COVID-19
• National Advisory Committee on Immunization (NACI) Recommendations on the use of COVID-19 Vaccine(s)

Please review the following Safety Bulletin from the Institute for Safe Medication Practices Canada (ISMP Canada) for leading practices that facilitate the safe administration of a COVID-19 vaccine:

https://www.ismp-canada.org/download/safetyBulletins/2021/ISMPCSB2021-i2-COVID19-Vaccine-Error-Prevention.pdf

Please see the following resources to support educating patients and public about COVID-19 vaccines:

• Frequently Asked Questions about Vaccines – Manitoba Health
• Manitoba Health Resources and Forms – COVID-19 Vaccine Factsheet 
• CANVax COVID-19 Questions and Answers for Health Care Providers
• What you need to know about the COVD-19 vaccine (PHAC)
• Centre for Effective Practice – COVID-19 Vaccines (please note some of this information may be specific to Ontario)

• The US Pharmacopeia (USP) COVID-19 Vaccine Handling Toolkit: Operational Considerations for Healthcare Practitioners

• Administration of COVID-19 Vaccine in Allergic or Immunosuppressed Patients
• Open access COVID-19 Chapter  

*Adapted with permission from the College of Registered Nurses of Manitoba’s public statement on compliance with Public Health Orders

The COVID-19 pandemic has placed unprecedented pressure on the healthcare system and pharmacy professionals have provided unparalleled access for patients and the public during this time. Public health measures continue to evolve in step with new scientific evidence on the mitigation of the COVID-19 pandemic. It is critical that pharmacists understand their professional obligations to adhere to Public Health Orders and refrain from making public statements contrary to prevailing scientific evidence and public health measures.

Pharmacists are expected to practice in accordance with applicable competencies, federal and provincial legislation, practice directions, and the Code of Ethics. This includes expectations to

• Apply legal requirements to practice, including federal and provincial/territorial legislation, policies, by-laws, and standards [1];
• Apply federal and provincial/territorial workplace, occupational health and safety, and other related legislation to the practice setting [1];
• Respect the autonomy, values and dignity of each patient [2];
• Hold the health and safety of each patient to be of primary consideration [2]; and
• Act with honesty and integrity [2].

Speaking in Public Forums Including Social Media

Because pharmacists hold a position of leadership and trust within the health system and the community, any statements pharmacists make in public forums or on social media have the potential to influence the public and be taken as an expression of professional views or advice.

The College strongly encourages all pharmacists to reflect on these and all related professional obligations (including any applicable workplace policies) before engaging in a public forum, and to avoid expressing views that are not supported by evidence such as anti-masking or anti-vaccine viewpoints, or recommending unapproved treatments for COVID-19.

Social media posts that share inaccurate or outdated information about COVID-19 or the provincial vaccine campaign can spread misinformation and cause frustration for already stressed or fatigued Manitobans. If you decide to post about COVID-19 or the vaccine campaign, please consider the following tips:

• Provide only timely information on eligibility or access with links to the most up-to-date provincial information such as protectmb.ca or the Manitoba government website. Avoid posting eligibility or supply information directly in your posts as it can quickly become outdated.
• Promote vaccine awareness and competence by using sample posts or resources from credible sources such as the Government of Canada or CANVAX.
• Review links and information that you are re-posting from other sources to ensure those sources of information are accurate and credible.

Complying with Public Health Orders

All pharmacists are expected to observe and comply with all applicable Public Health Orders as set forth by the Chief Provincial Public Health Officer.

The latest Public Health Orders can be found at the following link:
https://www.gov.mb.ca/covid19/prs/orders/index.html

Patients and members of public who have concerns about a pharmacist’s conduct have a right to enquire about company or facility policies on COVID-19. They also have a right to make a complaint to the College or to the Health Protection Unit if they feel a pharmacist or other pharmacy employee is violating public health orders.

As with all concerns brought forward to the College, from members of the public, other governing agencies or employers, or from colleagues in healthcare, instances of noncompliance with Public Health Orders will be reviewed, and may be subject to investigation, with the registrant being held accountable for their conduct as outlined by The Pharmaceutical Act.

[1] Professional Competencies for Canadian Pharmacists at Entry to Practice section 1.1.1 and 1.1.2

[2] Code of Ethics

Introduction:
The College of Pharmacists of Manitoba (CPhM) has established the following ethical framework identifying the values for use in consideration of informed decision-making by Manitoba pharmacists during a significant health emergency, such as a pandemic. This ethical framework examines the values that should inform decision-making. Unlike a policy or guideline, it is not prescriptive and represents principles, rather than recommending a course of action. This framework was developed using the ethical values identified in Stand on Guard for Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza (Upshur, R. et al. 2005), a report developed by the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group.

These guiding principles are intended to inform pharmacy professionals of their responsibility to provide care, along with the values to be implemented in decisions that support and protect healthcare professionals as they deliver patient care under extraordinary circumstances, such as an emergency.

Research shows that many healthcare professionals have reservations, based on personal safety concerns, with reporting to work during an emergency such as a pandemic. Pharmacy professionals who are undecided about how much personal risk they will accept during an emergency, such as a pandemic, must take into account their professional Code of Ethics. The CPhM Code of Ethics includes Statement VII: “Pharmacists shall hold the health and safety of each patient to be a primary consideration” and Statement IX: “Pharmacists shall respect the rights of patients to receive healthcare”, whereby pharmacists must ensure the continuity of care for patients until it is no longer required, wanted, or until another suitable healthcare professional has assumed responsibility for that care.

Health emergencies represent exceptional situations that impose a serious threat to public health. They require collective efforts and appropriate timely strategies. In these situations, many of the high-level planning and policy decisions will be made by federal and provincial governments. Decisions regarding the delivery of health care and guidelines for healthcare professionals will be made by organizations such as public health agencies and health authorities. Despite this, pharmacy professionals will need to make many important decisions at an individual level and the time to decide one’s professional commitment in the face of threats to personal safety is not during a public health emergency, but before such an emergency occurs.

The report Stand on Guard for Thee identifies 10 substantive values that CPhM recommends pharmacists use in guiding decision-making in the event of a health emergency:

• Individual liberty: Canadians hold individual liberty as an important principle. Restrictions to individual liberty may be necessary and relevant in protecting the public from serious harm.
• Protection of the public from harm: Health organizations and public health authorities may be required to take actions that impinge on individual liberty.
• Proportionality: Restrictions to individual liberty and measures taken to protect the public from harm should use the least restrictive means to address the actual level of risk to the community and be applied without discrimination.
• Privacy: A right to privacy in the disclosure of health care information is central to an individual’s rights. Individual’s rights to privacy in health care may need to be weighed against the right to protect the public from serious harm. Private information should only be released if there are no less intrusive means to protect the health of the public.
• Duty to provide care: This principle is inherent in CPhM’s Code of Ethics, which states that a fundamental responsibility of a pharmacist is to hold the health and safety of each patient to be of primary consideration. Pharmacists will be met with significant challenges regarding resource allocation, scope of practice, professional liability, workplace conditions and addressing their personal risk versus their obligation to provide care for patients. This duty is qualified by the obligation of the employer, regulator, and/or public health authority to ensure adequate resources are available to support a safe environment that will minimize short- and long-term risks for the healthcare professional.
• Reciprocity: Society must support those who are required to take increased risks or face a disproportionate burden in protecting the public (healthcare professionals), and also take steps to minimize these burdens as much as possible. Social solidarity should flow in both directions. If, in the case of a health emergency, pharmacists have certain obligations towards society, then society has certain reciprocal obligations towards pharmacists. CPhM agrees that the federal and provincial governments and professional advocacy organizations play an important role in supporting this concept.
• Equity: As stated in the Canada Health Act, “The primary objective of Canadian health policy is to facilitate reasonable access to health services without financial or other barriers”. Due to resource limitations, the onset of a health emergency (such as a pandemic), will impose difficult decision-making regarding which health services will be maintained, and which will be deferred. During a pandemic, decision-makers must attempt to maintain the principle of equity when considering the interests of pandemic affected patients, as well as those requiring treatment for other chronic diseases.
• Trust: Trust is an essential component of the relationship between healthcare professionals, patients, staff and their organizations, and the public. Trust must be maintained with all stakeholders through the demonstration of transparency, accountability and ethical processes in all decisions.
• Solidarity: This process requires the use of collaborative approaches that set aside traditional values of self-interest or territoriality among healthcare professionals, services or institutions. Solidarity requires that decision-makers and pharmacists support positions arrived at by consensus and uphold them.
• Stewardship: Both institutions and individuals will be entrusted with control over scarce resources such as vaccines, antivirals, ventilators, personal protective equipment, hospital beds, and healthcare professionals. Those entrusted with this control are guided by ethical behavior and good decision-making based on evidence and reason that achieves the best patient and public health outcomes.

Obligation to Provide Care and Social Reciprocity
There is an ethical obligation for pharmacy professionals to care for patients, even in the face of personal risk. According to the Stand on Guard for Thee report, the duty to care for those in need is a primary ethical obligation for all healthcare professionals for several reasons, including the following:

• The ability of healthcare workers to provide care is greater than that of the public, thus increasing their obligation.
• By freely choosing a profession devoted to caring for the ill, they assume risks.
• The profession has a social contract that calls on members to be available in times of emergency.

CPhM agrees that pharmacy professionals have a professional and ethical obligation to help others in times of crisis. A pharmacist’s decision to not be involved during a health care emergency shifts the burden to others, including fellow pharmacists and other healthcare professionals and their facilities. It also places the public at risk.

Along with the healthcare professional’s obligation to provide care during a health emergency, it is the reciprocal obligation of society towards the healthcare professional. Reciprocity plays a key role in the social contract between pharmacy professionals and the public. Appropriate measures and resources must be in place during times of crisis for pharmacy professionals to face risks and provide care to those in need. Societal obligations extend to governments, employers, public health authorities, regional health authorities, and pharmacy advocacy groups, to ensure appropriate resources and policies are in place to support a safe environment.

All pharmacy professionals have the same ethical obligations to provide care during an emergency. There is also an obligation to take any steps required to protect themselves. It is recognized that some pharmacy professionals will have greater needs and challenges than others. There may be personal challenges or vulnerabilities that prevent some pharmacy professionals from assuming the same level of involvement in the provision of care to the public. It is expected that colleagues and employers will recognize and protect/support these pharmacy professionals.

Standards of Care during a Health Emergency
During a healthcare emergency, pharmacy professionals may be presented with an ethical dilemma, where the emergency has overwhelmed healthcare resources. This may require pharmacists to shift their standard of care from one that focuses on individual patients, to one that focuses on what is best for the greatest number of patients.

Allocation of Medications and Stockpiling
The needs of individuals must be balanced against that of the greater good. During a pandemic, pharmacy professionals are expected to continue using their knowledge, skills and professional judgement on an individual patient-basis when considering allocation of medications, which maintains the best interests of the patient and society as a whole. Unless otherwise directed by public health officials, during a pandemic, pharmacy professionals should consider all aspects of care for each patient in determining optimal allocation of medications. This includes ensuring patients are provided appropriate amounts of prescription medications, considering the patient’s access to pharmacy services, and potential strains on the national drug supply, which may lead to exacerbating drug shortages.

Pharmacy professionals must be cognizant of the issues associated with stockpiling medications and the consequences to provincial and national drug supply. For recent guidance on issues of stockpiling of medications, please refer here. For recent guidance from the Canadian Pharmacists Association on issues of stockpiling of medications, please refer here.

Conclusion
This ethical framework is intended to assist pharmacy professionals in understanding their professional and ethical responsibilities in the event of a health emergency. It is also intended to guide pharmacy professionals in their decision-making processes during such a crisis.

Pharmacy professionals must consider the 10 substantive values set out in the Stand on Guard for Thee report when developing their emergency processes and providing care. Ultimately, pharmacy professionals are free to make necessary independent decisions during the course of a health crisis, but they should be prepared to reasonably justify these decisions, if necessary.

Pharmacy managers must have a plan in place regarding the delivery of health care services during an emergency, disaster or pandemic.

This framework provides direction and substantive values for pharmacy professionals to use in careful consideration of the ethical decisions expected in the face of a health emergency, disaster, or pandemic.

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As a result of the COVID-19 pandemic, pharmacies must have plans in place to ensure
continuity of care for their patients in the event of unforeseen pharmacy staff shortages or
temporary closure.

There are various measures that pharmacies may put into place as part of their planning, which can include:

1. reduction of pharmacy hours
2. increased utilization of delivery services
3. limiting in-person contact with patients and their agents
4. employing additional staff, such as interns/recent graduates, and
5. utilization of centralized prescription filling services

A pharmacy can participate in central fill by either:
a. Providing central fill services to other pharmacies, or
b. Having prescriptions filled by a central fill pharmacy

Pharmacies that are looking to centralize part of the prescription filling process during the
COVID-19 pandemic are reminded to review the Central Fill Practice Direction on the College of Pharmacists of Manitoba’s website. The practice direction outlines the responsibilities of the patient contact pharmacy and the central fill pharmacy.
Compliance with the Central Fill Practice Direction is required from all pharmacies in Manitoba that provide centralized prescription processing services to another pharmacy or obtain centralized prescription processing services from another pharmacy.

Providing central fill services to other pharmacies:
Pharmacies wishing to provide central fill services to other pharmacies in Manitoba must have approval from the College for this added component to their community pharmacy license.

Patient-contact pharmacy seeking central fill pharmacy services:
If part of the pharmacy’s pandemic planning includes partnering with a central fill pharmacy to provide centralized prescription filling, the patient-contact pharmacy must ensure that there is a clear agreement in place, and patients are informed. It is important to review the responsibilities of the patient contact pharmacy described in the above linked practice direction.

There may be cases where a pharmacy is unable to continue to operate due to illness, self-isolation or other circumstances and must close temporarily. In these cases, the primary
consideration must be the continuity of care for the patients. Patients must be able to access their records and information in the event of a closure. If the pharmacy must close temporarily, please remember to review the Permanent and Temporary Pharmacy Closure Practice Direction, complete the Temporary Closure checklist and submit the information to the College.

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There is no evidence that either formulation of ivermectin (human or veterinary versions) is safe or effective when used for the prevention or treatment of COVID-19. In fact, the veterinary drug version of ivermectin, especially at high doses, can be dangerous to humans and may cause serious health problems. There have been multiple reports of patients in the U.S. being hospitalized after using ivermectin intended for livestock, and some feed stores across Canada are reporting increased sales of the drug. In response to this, Health Canada issued an advisory notice on August 31, 2021, to the public and all healthcare professionals outlining the potential serious health dangers posed.

The following resources may be helpful to healthcare practitioners in their conversations with the public:

• Prescribing and Dispensing of Drugs to Treat COVID-19 – Tri-College guidance document
• Can existing drugs, like ivermectin, help prevent or treat COVID-19? – Doctors Manitoba
• Ivermectin for preventing and treating COVID‐19 – Cochrane Library
• Drug treatments for covid-19: living systematic review and network meta-analysis – British Medical Journal
• WHO advises that ivermectin only be used to treat COVID-19 within clinical trials – World Health Organization
• Ivermectin in the Treatment and Prevention of COVID-19 – COVID-19 Scientific Advisory Group, Rapid Evidence Report, Alberta Health Services
• Misleading clinical evidence and systematic reviews on ivermectin for COVID-19 – British Medical Journal
• The British Columbia COVID-19 Therapeutics Committee – guidance on the most current research on the use of therapies in the management of COVID-19 – BC Centre for Disease Control
• Why you should not use Ivermectin to treat or prevent Covid-19 – USA Food & Drug Administration

As a temporary measure, M3P prescriptions may be faxed from prescribers directly to the pharmacy of the patient’s choice in accordance with the Ensuring Safe Access to M3P Prescriptions for Patients During the COVID-19 Outbreak guidance document.

Updates for pharmacists regarding the M3P program during the COVID-19 pandemic can be found on your Registrant Login

Please refer to the joint CPhM and CPSM guidance document titled Advice Regarding Take-Home Dosing (Carries) for Patients on Opioid Agonist Therapy with Methadone or Suboxone. 

You can access this document and other M3P-related information on your Registrant Login.

The Federal Subsection 56(1) class exemption of the Controlled Drugs and Substances Act (CDSA) for patients, practitioners and pharmacists prescribing and providing controlled substances in Canada during the coronavirus pandemic is NOT in effect in Manitoba, as it has not been fully enabled in the province. Health Canada has recently extended these exemptions until September 2026, and the College will continue working with the provincial government on the full implementation of these exemptions. Registrants will be informed of any updates once available.

In the meantime, please note that verbal orders and prescription transfers of narcotics and controlled drugs are not permitted between pharmacies within Manitoba. Manitoba pharmacies are also not permitted to accept verbal orders and prescription transfers of these drugs from pharmacies in other provinces.

The Joint Guidance to Physicians, Nurse Practitioners and Pharmacy Professionals: Narcotic and Controlled Drug Prescriptions for Personal Care Home Residents permits verbal orders from physicians and RN(NP)s of narcotics and controlled drugs under the CDSA for residents of personal care homes during the pandemic. The provincial regulation governing the Manitoba Prescribing Practices Program (M3P Program) does not apply to personal care homes, therefor the Subsection 56(1) class exemption for verbal orders of narcotic prescriptions is in effect for personal care homes only.

The Joint Guidance to Physicians, Nurse Practitioners and Pharmacy Professionals: Narcotic and Controlled Drug Prescriptions for Personal Care Home Residents, approved on April 7, 2020, permits verbal orders from physicians and RN(NP)s for narcotics and controlled drugs under the CDSA for residents of personal care homes during the pandemic. This joint statement is in line with the provisions granted in Health Canada’s Subsection 56(1) Class Exemption. This exemption has been extended and will remain in place until September 30, 2026, which may be reassessed upon expiry.  

Please be reminded that this exemption applies to residents of a personal care home only.  

In the spring of 2020, Manitoba Health and Seniors Care put a limit on the number and quantity of prescription drugs dispensed to only one month’s supply in order to stabilize the drug supply in Canada.

Although the broad restriction on all prescription drugs was lifted in May 2020, some restrictions are still in place for certain prescription medications that are at risk of a shortage.  Only drugs currently listed on the Manitoba Health Drug Shortage Quantity Restrictions List are subject to the one-month fill limit. This list is updated regularly.  

Provincial information on drug shortages and supply restrictions can be found at the following link:

https://www.gov.mb.ca/health/pharmacare/healthprofessionals.html

The following resource from ISMP Canada addresses patient safety gaps introduced by drug shortages:

https://cphm.ca/wp-content/uploads/Resource-Library/SafetyIQ/DrugShortage-May2018.pdf

• Manitoba Health Treatment for COVID-19  
• Shared Health Treatment Options for COVID-19 

CPhM Council has extended the exemption to Section 2.4 of the Prescribing Practice Direction, which requires that a pharmacist conduct an in-person or face-to-face patient assessment. The exemption permits a pharmacist to conduct a direct patient assessment via telephone, if appropriate, when a pharmacist is considering issuing a prescription within their scope of practice to a patient.

Council has extended this exemption indefinitely until a virtual care practice direction can be developed, approved, and implemented or until such a time that the exemption is re-evaluated and repealed by Council.

Although virtual care, including telephone prescribing assessments, provides an option for increased accessibility to health care services, it must be used/delivered in a supported manner to enhance and complement in-person patient care.

As CPhM develops a practice direction to outline the expected standards for virtual care, pharmacists are reminded that professional judgement is required to ensure a phone assessment is indicated and appropriate. Pharmacists must continue to meet all requirements as described in The Pharmaceutical Act, Pharmaceutical Regulation, and the Prescribing and Prescribing and Dispensing Practice Directions. Pharmacists are further reminded of the expectations within the Virtual Patient Care and Ensuring Patient Safety in Pharmacy Practice Position Statement.

Pharmacists Manitoba has established lists of individuals who are available for relief work in the event that pharmacies are short-staffed during the COVID-19 pandemic: 

• Pharmacist Relief List 
• Pharmacy Technician / Assistant Relief List
• Pharmacy Students 

The lists may be found on Pharmacists Manitoba website: COVID-19 resources page. 

To be added to one of the lists please forward your contact information to Danielle at info@pharmacistsmb.ca and indicate the appropriate list (Pharmacist, Pharmacy Technician / Assistant, or Student).

For information on Permanent and Temporary Pharmacy Closures, please review the Permanent and Temporary Pharmacy Closures – Practice Direction and the Ensuring Pharmacy Accessibility During a Health Crisis or Pandemic document.

If a pharmacy must close or cease to operate, either temporarily or permanently, the Registrar must be notified of the intended closure at least 30 days (or as soon as reasonably possible) prior to the closure date to ensure appropriate notification. This notification must also include information advising of where patient records will be securely stored and maintained in the case of a permanent closure, allowing for complete and uninterrupted patient access to care. 

The Permanent and Temporary Pharmacy Closures Checklist includes a clear process to ensure compliance and provide a seamless transition of care for your patients. Should further guidance about pharmacy closure requirements be required, please contact the College.  

A pharmacy manager can log onto their manager profile on the College website and update the hours of operation. Each pharmacy must complete this change online, and this will serve as the only required correspondence with the College required. Please also notify your patients of your change of hours of operation through signage (e.g., Primary Pharmacy entrance, dispensary counter, etc.), updating your website, and updating your phone messaging system.  

When you are determining your reduced operating hours, it is important to remember Section 34(2) of the Pharmaceutical Regulation:  

34(2) In addition to the requirements of subsection 30(1), an applicant for a community pharmacy licence must provide evidence satisfactory to the registrar that  

• • (a) the facility will be accessible to the public;  
  • (b) the hours of operation will meet the needs of the community served by the pharmacy as determined by an hours-of-operation policy set by the council;  
  • (c) the facility will be staffed and managed by members who have the requisite knowledge, skill and judgment to operate a community pharmacy; and  
  • (d) the facility will comply with practice directions respecting community pharmacies.

The pharmacy’s hours of operation must meet or exceed 25 hours a week over a 4-day period.  

Manitoba pharmacy professionals are experiencing an increase in patients, COVID-19 information and related practice changes, and medication and staffing shortages, which has lead to enormous stress and increased workload for pharmacy teams. It is important that you care for your mental health during COVID-19.

If you recognize that you or a colleague is in distress, it is best to seek support or encourage your colleague to do so. It may be advisable to temporarily step away from practice to receive the care and support necessary. It is always advisable to contact your professional regulator to best address your concerns. Please note, you must report your concerns to the regulator if patient safety or a colleague’s safety is a concern.

Resources

• Klinic Community Health Crisis Support
  For those needing immediate support, please do not hesitate to contact Klinic Crisis. They operate a variety of crisis phone lines and online support services, providing free and confidential counselling, support and referrals for people who are suicidal, in crisis or struggling to cope.
  • Manitoba Suicide Prevention & Support Line
    (24/7) Tollfree: 1-877-435-7170
    reasontolive.ca
  • Klinic Crisis Line (24/7)
    Phone: (204) 786-8686
    Tollfree: 1-888-322-3019
• Canadian Pharmacists Association – Pharmacy Workforce Wellness
• Canadian Psychological Association Psychology works for COVID-19 — psychologists giving back to front line service providers (free mental health support for health care workers)
• Mental Health Commission of Canada COVID-19 Resources
• Canadian Mental Health Association Tips for managing anxiety

As the COVID-19 pandemic and vaccine campaign continues, healthcare providers, including pharmacy professionals, have received increasing numbers of threats and intimidation related to COVID-19 public health orders and vaccine administration.  The College is concerned about this trend and wants to support pharmacy and patient safety as your team continues to provide healthcare services for Manitobans during this uncertain and stressful time.

During this time, it is important for pharmacies to have clear policies and procedures in place, along with regular team communication to support staff and patient safety. Please see the following guide, Pharmacy Professional Safety During the Pandemic, for some suggestions on keeping your team and patients safe (this information is posted at the following link under the ‘Health and Safety’ heading at the bottom of the page: https://cphm.ca/covid-19-resources-for-pharmacists/).

This Guide is adapted with permission from the Doctors Manitoba Guide to Physician Safety During the Pandemic. The College is thankful for the development and sharing of this excellent resource from our physician colleagues.

Pharmacy Professional Safety During the Pandemic: What should you do?

There are several steps that pharmacy professionals and managers can take to promote a safe and respectful workplace and reduce the chances of pandemic or vaccine related threats.

1. Understand the level of risk for you, your peers, and your staff

• Reflect on your experience and ask your peers and employees about their experience. Has anyone faced any bullying, threats, intimidation, disrespect or aggression related to COVID-19 or vaccination? Don’t brush off past disrespectful behaviours as they can escalate in the future. Do not assume nothing has happened just because you haven’t heard about it.
• Consider views about the pandemic and vaccination in your local community. Are there signs of disrespectful or threatening behaviour occurring, even if not directed at pharmacy professionals?
• Contemplate what could reasonably happen in waiting and counselling areas, as well as protests, threatening phone calls or correspondence.

2. Review and update existing safety policies and procedures

• Train all pharmacy staff on tactics to de-escalate potentially serious incidents. Maintain an empathetic, non-judgmental, and non-confrontational approach with patients and visitors whenever possible, including those with strong views about pandemic restrictions or vaccination. This can help to avoid threatening and unsafe situations. Pharmacy staff should reinforce that they use medical evidence to guide the advice they offer to patients, and they respect personal choice and informed consent. Avoid labels and terms that could escalate a situation, including ​“vaccine hesitant,” ​“anti-vaxxer,” ​“anti-masker,” or ​“COVID denier.” For an additional resource on communication and conflict resolution, please see the College Communication and Conflict Resolution. If you or your pharmacy team are at risk of violence, call the police immediately.
• Develop a plan for situations that could become unsafe. This could involve a plan for what to do if patients start yelling or becoming threatening, and what to do if protestors show up (e.g., lock the door, call the police, do your best to ensure your patients are aware of the protest and how they can safely access care). It could also involve considering patient counselling/care spaces to promote pharmacy staff safety, such as placement of furniture in counselling rooms and ensuring the provider is closest to the door. In some places where the risk has been higher, panic buttons have been used.
• Consider posting notices in highly visible locations about respect and safety. This can help you and your staff to de-escalate situations by referring to the pharmacy position on disrespectful behaviour or threats. Use a message that is easy to understand such as, ‘This a safe space for patients, staff, and pharmacists. Any form of bullying, verbal abuse, or threats of violence will not be tolerated.’ Refer to the College’s Respectful Communication Statement as an example.
• In some jurisdictions, health care workers avoid wearing clinical clothing and ID outside of the workplace to avoid potentially hostile interactions.

3. Communicate the plan with all pharmacy staff.

Take the time to communicate safety plans with pharmacy staff. Invite questions and create an open dialogue to ensure the safety plan remains up to date.

4. Report incidents to police.

If there is an immediate threat to health or safety, contact the police immediately.

5. Seek support and promote psychological safety.

While avoiding physical abuse and violence is a priority, do not underestimate the impact of verbal abuse, harassment, and intimidation. These tactics can take a toll and should not be brushed off.

The following resources can support pharmacy and healthcare professionals during the pandemic:

• Supporting pharmacists’ mental health and wellness during COVID-19 (CPhA)
• Psychology works for COVID-19. Psychologists giving back to front line service providers (free counselling and mental health support from the Canadian Psychological Association)
• Klinic Community Health Crisis Support – For immediate support if you are in crisis (24/7) you can call 204-786-8686 (toll free: 1-888-322-3019)

6. Ending a patient relationship when all other options are exhausted.

According to the College Code of Ethics,

• Pharmacists shall hold the health and safety of each patient to be of primary consideration; and
• Pharmacists shall respect the autonomy, values and dignity of each patient.

Unfortunately, there may be cases when a patient’s behaviour threatens the safety of the pharmacist and pharmacy staff. Occasionally, the best way to protect yourself or your staff is to terminate a relationship with a patient. In these cases, you should consider the Pharmacy Professional’s Duty during an Emergency, Disaster or Pandemic Ethical Framework and you must follow the Termination of Relationship with a Patient practice direction.