Manitoba Public Health Order on COVID-19 Vaccination and Testing
A new provincial Public Health Order that requires all front-line public servants (“Designated Persons”) who have contact with patients, residents, and clients to be fully vaccinated for COVID-19 will come into effect on October 18, 2021. After that date, all designated persons who do not provide proof of full vaccination will be required to undergo regular COVID-19 testing and provide proof of a negative test result before they can resume working.
This order includes but is not limited to physicians, nurses, allied health professionals (including pharmacy professionals), and support staff who have ongoing contact with vulnerable populations at certain facilities.
Please review the Public Health Order here, and the Manitoba Health and Seniors Care press release here for more information on “Designated Persons,” and for any updates. If you are unsure if your facility falls under the Order, please contact your employer to confirm vaccination and testing requirements.
The College continues to strongly encourage all pharmacy professionals and staff to receive both doses of a COVID-19 vaccine as part of evidence-informed practice. Vaccination is a safe and effective way to fight COVID-19, and we have a collective responsibility to reduce the strain it has placed on our healthcare system. Private employers are encouraged to implement vaccination and testing requirements to protect the patients they serve and their pharmacy personnel, and to preserve the essential health services that pharmacy professionals provide to the public.
New Council Motions
Extension of Exemption to Prescribing Practice Direction
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. This exemption was originally approved by Council and implemented on March 17, 2020, and it has now been further extended to September 30, 2022, and may be re-assessed upon expiry.
All other requirements must be met as described in the Act, Regulation, and the Prescribing and Prescribing and Dispensing Practice Directions.
Extension of Joint Guidance to Physicians, Nurse Practitioners & Pharmacy Professionals: Narcotic and Controlled Drug Prescriptions for Personal Care Home Residents
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, which were set to expire on September 30, 2021, but have been extended to September 30, 2026. CPhM Council has likewise extended the expiry of this joint guidance document to September 30, 2026.
Please be reminded that this exemption applies to residents of a personal care home only.
Dilution Requirements of the Newly Listed Generic Methadone Products
The current Opioid Agonist Therapy Guidelines for Manitoba Pharmacists (https://cphm.ca/wp-content/uploads/Resource-Library/Opioid-Agonist-Therapy/OAT-Guidelines-MB-Pharmacists.pdf) require that pharmacists dilute Metadol-D® 10mg/mL oral concentrate and MethadoseTM (Sugar-Free) 10mg/mL oral concentrate with a crystalline liquid (e.g., Tang) in order to deter injection. Conversely, the guidelines do not require pharmacists to dilute MethadoseTM (cherry flavoured) 10mg/mL oral concentrate since it is already in a vehicle that does not lend itself to injection.
Effective August 5, 2021, Manitoba Health has listed four generic methadone 10mg/mL oral concentrates as unrestricted Part 1 benefits for Opioid Agonist Therapy (https://www.gov.mb.ca/health/pharmacare/profdocs/csp_methadone.pdf). Pharmacists must determine whether these new methadone products need to be diluted with a crystalline liquid.
There are four physical properties of the oral concentrate that will, in combination, help to deter injection and/or facilitate oral consumption:
- Hypertonicity – Causes pain upon IV injection due to the creation of an osmotic gradient that moves fluid out of the interstitial space. This can be achieved with a sufficient amount of any solute, such as sucrose or xylitol.
- Viscosity – Inhibits the ability to draw up the solution into a hypodermic needle. This can be accomplished with a thickening agent, such as hydroxyethylcellulose.
- Flavour – Encourages oral consumption by masking the bitter taste of the medicinal ingredient.
- Dye – Creates a better visual on the amount of liquid being measured and consumed.
A methadone 10mg/mL oral concentrate that possesses these four physical properties in sufficient magnitude will not lend itself to injection and is acceptable for oral consumption without further dilution.
This chart, prepared by a Manitoba pharmacist and adapted by the College, compares the physical properties of the seven different methadone 10mg/mL oral concentrates that are approved for coverage by Manitoba Health for opioid agonist therapy. Three products from this chart meet all the above-mentioned criteria to be dispensed without further dilution:
- MethadoseTM (cherry flavored) 10mg/mL oral concentrate – DIN 02394596
- ODAN Methadone (cherry flavored) 10mg/mL oral concentrate – DIN 02495872
- SANDOZ Methadone (sugar free, cherry flavoured) 10mg/mL oral concentrate – DIN 02481979
The following four products MUST be diluted with a crystalline liquid (e.g., Tang) in order to deter injection and facilitate oral consumption:
- ODAN Methadone (sugar free, unflavored) 10 mg/ml oral concentrate – DIN 02495880
- MethadoseTM Sugar Free 10mg/ml oral concentrate – DIN 2394618
- Metadol-D® 10 mg/ml oral concentrate – DIN 2244290
- JAMP Methadone 10 mg/ml oral concentrate – DIN 2495783 be diluted because of its lack of flavouring and lack of information on how well it meets the other criteria.
Until such time that the Opioid Agonist Therapy Guidelines for Manitoba Pharmacists are updated, pharmacists can rely on this guidance to make decisions about diluting the newly listed generic methadone products.
New Prairie Mountain Health Medication Reconciliation Policy
Prairie Mountain Health has implemented a new Medication Reconciliation policy as of September 27, 2021th. As part of the medication reconciliation policy, new Transfer Medication Reconciliation and Discharge Medication Reconciliation Forms were developed. These forms may either be generated from the inpatient pharmacy software or written out by hand. These forms will be used in all Prairie Mountain Health facilities for transfers and discharges.
The Discharge Medication Reconciliation Form has a column for “Use Rx from other Prescriber,” which is meant for when a hospital physician wants a patient to continue their existing medications from home but does not want to override any current prescriptions. Medications covered by the Manitoba Prescribing Practices Program will show up on this form but will have a reference to the M3P form.
If you have any questions about these forms or the Prairie Mountain Health Medication reconciliation process, please contact Mike Mitchell at mmitchell3@pmh-mb.ca.
Pause Before You Post: Social Media Module
The College of Pharmacists of Manitoba has collaborated with seven other regulators from the Manitoba Alliance of Health Regulatory Colleges (MAHRC) to develop an educational professional development (PD) module on social media and professionalism. The module is titled Pause Before You Post: Social Media Awareness and is available on the registrant homepage for all pharmacists and pharmacy technicians to complete. It is the first annual PD module that pharmacists and technicians need to complete for license renewal.
All pharmacists are required to complete this module before October 31, 2021. If you completed the module last year and retained your statement of participation as proof of completion, you do not need to complete the module again.
The module has been accredited by the College for up to 1.50 CEU. To access the module, please log into your Registrant Portal from the CPhM website. If you have questions, please contact the College at info@cphm.ca.
A Consultation on Barriers and Enablers for Attaining and Maintaining an Extended Practice Pharmacist (EPPh) Designation
The College Board of Examiners (Board) would like to hear from pharmacists about their perceptions of existing and potential barriers and enablers to attaining and maintaining an EPPh designation.
A consultation was sent out to all practicing pharmacists via email on September 10, 2021, and it will remain open until October 4, 2021. The consultation takes approximately 20 minutes to complete.
The information gathered will help inform the Board’s next steps on further facilitating the attainment of the EPPh designation within the current legislative framework while ensuring that EPPhs continue to provide the highest quality of safe and effective care to the public.
Consultation link: https://www.surveymonkey.com/r/9G2RHNH
Upcoming Events & Professional Development Opportunities
Lessons from Complaints: Navigating Mental Health and Addiction
Accreditation pending | 7:00-9:00 p.m. on Wednesday, October 27
Guest speaker: Dr. Michael Loudon, MB.Ch.B
ISMP Medications Safety Considerations for Compliance Packaging E-learning Module
Complete the module here.
Community Connectors Workshops
For a list of accredited workshops and dates, click here.