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Friday Five (May 1, 2020)

This week's edition of the Friday Five is now available.

AGM Reminder/Annual Report Released

The College of Pharmacists of Manitoba Annual General Meeting (AGM) and Awards Presentation will be held at 9:00 am on May 9, 2020 via webinar.

The 2019 Annual Report is are now available.

Patient Transfers during the COVID-19 Pandemic

With the ongoing COVID-19 pandemic, it is anticipated that the increase in patient transfer requests will continue as a result of changes in pharmacy hours and the roll-out of new public health order.

Pharmacists are reminded of the importance of conducting a Drug Programs Information Network (DPIN) history search for patients receiving any narcotic, controlled, or targeted substances if the patient is new to the pharmacy. In addition, pharmacists are encouraged to verify a patient’s DPIN profile, as required, when filling a prescription for any medication to check for interactions or limited dispensing frequency.  Checking a patient’s DPIN profile should always be part of the process when accepting a transfer from another pharmacy.

COVID-19 and Substance Abuse

The current climate of physical distancing, and requirements for self-isolation within our province have brought about many sudden changes for Manitobans resulting in an increase in stress, anxiety, and fear for many individuals. For those suffering from mental health concerns (including substance abuse or addiction), this stress is further compounded.

These unprecedented times can result in changes in habits which are not always beneficial to overall health. The Canadian Centre on Substance Use and Addiction recently published an article entitled“Open versus Closed: The Risks Associated with Retail Liquor Stores during COVID-19 citing that many jurisdictions have seen a significant increase in alcohol sales, as much as 40%, with the onset of social distancing measures aimed at flattening the curve of the virus’s spread.

Pharmacists are reminded of their obligation to address health concerns of both patients and peers. A change in behaviour may be an indication of either a new mental health concern, such as addictive behaviours, or a relapse in an individual who had previously struggled with a substance use disorder.

What are the obligations of a pharmacist when concerns arise for a patient or a peer?

Patient Concerns:

Pharmacists are in a unique position within the healthcare team, as they are very easily accessible and often have regular direct contact with their patients. Based on this accessibility and direct contact, pharmacists can frequently identify a change in a patient’s behaviour. The pharmacist must engage in conversation with the patient to understand the reason for any observed changes and determine if an assessment or follow-up with the prescriber is required. Pharmacists must also employ a method for documenting discussions with patients and/or prescribers regarding these concerns.

Peer Concerns:

A professional approach in broaching the subject with a colleague can be intimidating, however, an open and honest expression of concern is important. Ensuring that the colleague is supported by appropriate supports such as an addiction specialist, group support meetings, an addiction sponsor, counsellor, or practitioner is also important.

It is of upmost importance for pharmacists to recognize their Duty to Report (section 97(1) of The Pharmaceutical Act) when another pharmacist may be suffering from a physical or mental health concern (including substance abuse) that may cause that pharmacist to be unfit for practice or present risk to patient safety.

In both situations, an open and non-judgmental communication style is paramount to supporting the individual. If you aren’t sure how to manage your concern, discussing the matter with your direct supervisor may provide support, or contacting the College for guidance.

The following links may provide additional useful resources related to substance use:

Patients with a Manitoba Personal Health Information Number (PHIN)

The College was notified of a situation where a patient has presented a prescription for a controlled drug to a pharmacy and claimed they were from out of province and therefore did not have a Manitoba Health Card or PHIN.   The pharmacy, as is customary, entered the prescription under the required pseudo-PHIN for an out of province patient, and dispensed the controlled drug.   It should be noted that processing a medication using an out of province pseudo-PHIN is not trackable to a particular individual.  It was later identified that this patient was filling medications from multiple physicians at multiple pharmacies.

Best practice for when a patient indicates they are from out of province and thus do not have a PHIN is as follows;

  • Ask the patient for photo identification containing their date of birth.  This information can be used to contact DPIN to double check whether the patient has a valid PHIN.
  • Contact the prescriber’s office to verify the patient does not have a Manitoba Health Card.

If pharmacists find that a patient is frequently presenting controlled substance prescriptions without providing a PHIN, it is appropriate to contact other pharmacies in the area to alert them. It is ultimately in the best interest of the individual’s safety and the safety of others to deter this behaviour.

Reminder: Temporary Exemption – Faxing of Prescriptions for Medications on the M3P Program

The College of Physicians and Surgeons of Manitoba (CPSM), College of Registered Nurses of Manitoba (CRNM) and the College of Pharmacists of Manitoba (CPhM) continue to receive inquiries regarding the temporary exemption allowing the faxing of Manitoba Prescribing Practices Program (M3P) drugs during the COVID-19 outbreak.

Please review the guidance document regarding drugs that usually require an M3P form.   M3P drugs not written on an M3P form can be faxed but MUST meet all the information requirements of an M3P form and of the Joint Statement Facsimile Transmission of Prescriptions.  As well, because of restrictions in the Pharmaceutical Regulation, only one drug can be prescribed on a form (even if generated by the EMR or handwritten).

This temporary exemption also applies to medications used for opioid agonist therapy (OAT), methadone and buprenorphine/naloxone. The requirement to include the total dose written both numerically and alphabetically applies to OAT prescriptions as well.  Please see the Opioid Agonist Therapy Guidelines for Manitoba Pharmacists for more information.

Message from the Dean of the College of Pharmacy

Our province is facing a critical public health situation with respect to the impacts of COVID-19, and it continues to affect everything we do.

On behalf of students, faculty and staff at the College of Pharmacy, I would like to thank our family of pharmacists across the province for your essential work.

Your dedication, caring and commitment to the people of Manitoba during this unprecedented time is truly appreciated, and does not go unnoticed.

The College of Pharmacy recognizes and values your ongoing efforts and professionalism, especially during these challenging circumstances. We are closely monitoring and adapting to the threats posed by COVID-19, and everyone’s safety and wellness remains our top priority.

As you continue to serve our communities, please take care of yourselves, your families and each other.

Dr. Lalitha Raman-Wilms

Dean

College of Pharmacy

Rady Faculty of Health Sciences