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Friday Five (November 13, 2020)

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

Call for Relief Pharmacists, Technicians & Students

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:

  1. Pharmacist Relief List
  2. Pharmacy Technician / Assistant Relief List

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

Pharmacists Manitoba is also planning to create a list of pharmacy students available to provide relief in appropriate roles.

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).

 

Reminder: CPSM Standard of Practice for Benzodiazepines and Z-drugs

The College of Physicians and Surgeons of Manitoba (CPSM) Standard of Practice for Prescribing Benzodiazepines and Z-Drugs came into effect on November 1, 2020. Prescribers and pharmacy staff must be familiar with the Standard in its entirety.  The CPSM and the College of Pharmacists of Manitoba (CPhM) have received many questions from registrants and patients regarding its implementation.

Indicate Condition for Non-Application of Standard on Prescription

The new Standard establishes requirements for the safe prescribing of benzodiazepines and/or Z-drugs, including zopiclone and other drugs.  The Standard does not apply to the use of these drugs in the treatment of cancer, palliative and end-of-life patients, seizure disorders, bipolar/psychotic disorder, and acute alcohol withdrawal.  To prevent delays in these patients receiving their medication, prescribers should note the indication on the prescription so that the pharmacist is aware of why the prescription may not meet the requirements outlined in the Standard.

Dispensing Intervals and Refills

As of November 1, 2020, prescriptions for benzodiazepines and/or Z-drugs can only be written for a maximum of three months, with dispensing to be authorized for no more than a one-month supply, unless it is for infrequent use. A dispensing interval must be noted on the prescription.

Please note that the intent of the infrequent use exception is to permit patients who use VERY SMALL quantities of benzodiazepines or Z-drugs for flying or other rare occurrences, such as having a CT scan, to fill a SMALL supply of these medications for use over a longer period of time. Simply writing PRN on a prescription for a large quantity of these medications does not constitute infrequent use as intended by the Standard.

Pharmacists should use their professional judgement to assess the individual circumstances of the situation as to whether a prescription that has refills remaining should continue to be filled after the three-month period of time.  Referring the patient back to the prescriber for follow up may be appropriate if the directions for use or quantities to be filled need adjusting to accurately reflect how the patient is using the medication.

Dispensing Intervals for Remote or Travelling

On an exceptional basis, registrants may authorize a dispensing interval of up to three months for patients in remote communities or for travel, if the patient has been on a stable long-term prescription. The exception should be noted on the prescription. This limit also applies to those patients who may leave the country for longer than three months at a time (including “snowbirds”) – a maximum of three months supply of benzodiazepines or Z-drugs may be prescribed and dispensed at one time. This is identical to the Standard of Practice for Prescribing Opioids.

Patients should be reassessed before a prescription for benzodiazepines and/or Z-drugs is refilled.  Long term use of benzodiazepines and/or Z-drugs must be supported by current clinical evidence.

Prescribers and pharmacists must work collaboratively and are strongly encouraged to proactively review the profiles of those patients who have an active benzodiazepine prescription on file and to contact the appropriate member of the health care team when a revised care plan needs to be established. This includes instructions regarding a dispensing interval that meets the Standard. This also needs to be communicated and discussed with the patient.

Physicians to Explain Dispensing, Tapers, Changes

CPSM is asking its registrants NOT to simply instruct their patients to ask the pharmacy to fax a request for refills for benzodiazepines or Z-drugs. Nor should CPSM registrants expect pharmacists to carry the sole burden of initiating communication around existing benzodiazepine and Z-drug prescriptions that need to be adjusted to meet the Standard. A pro-actively arranged virtual or in-person conversation between the prescriber and the patient is the best way to explain the new Standard to existing patients, discuss tapers as appropriate, and alter or replace existing prescriptions, including dispensing intervals, to meet the new Standard.

Existing Prescriptions to be Dispensed under New Standard

Any prescriptions, even if written before November 1, 2020, must comply with the Standard.  If a prescription on file is written to be dispensed for more than a one-month supply, only a one-month supply can be dispensed, and a one-month interval noted. At the pharmacy, patients should be notified that they will need to follow up with their prescribers to get new prescriptions that meet the Standard, or the pharmacist can contact the prescriber on their behalf, when appropriate.  A prescriber or delegate at the clinic must be available to respond to both patient and pharmacy inquiries.

Benzodiazepines and Opioids

Only in exceptional circumstances can multiple benzodiazepines and/or Z-drugs, or opioids and benzodiazepines/Z-drugs be prescribed together. A past patient history of receiving medication prescribed in this way is not an exceptional circumstance.  Again, prescribers should note the exceptional circumstances on the prescription to prevent delays in the patient receiving their medication.

Resources to Assist

CPSM and CPhM thank registrants for their diligence and dedication to the safety of patients in Manitoba, especially during times of additional stresses associated with the COVID-19 pandemic.  Pharmacies are encouraged to offer delivery of medications to patients when appropriate, especially for those patients who may be the most compromised.  Please see the Guidance for Pharmacy Professionals: Delivery of Medications During the COVID-19 Pandemic for more information.

There are a number of resources in the Contextual Information and Resources at the end of the Standard that should be reviewed, including the Managing Benzodiazepine Use in Older Adults toolkit by the Centre for Effective Practice in Ontario.

 

Off-Site Pharmacy Flu Clinics 

Pharmacists can administer vaccinations outside the community pharmacy as long as they are following 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.

Manitoba Health, Seniors, and Active Living (MHSAL) has also instructed that pharmacies planning to hold off-site immunization clinics led by a pharmacy team must provide advance notice of the date and location of the clinic to the local Regional Health Authority (RHA) Public Health office. By contacting the RHA office in advance, the pharmacy can ensure that immunization efforts are not repeated. If necessary, you can arrange a different date or location. You can find a list of the RHA Public Health Offices and contact information here.

Pharmacies must also be registered with MHSAL as an immunization provider. The pharmacists providing injections must be certified by the College, and the off-site immunization clinic must meet the requirements of proper procedures, patient care, and patient confidentiality as outlined in the legislation and applicable Practice Directions.

Information on Manitoba’s 2020/21 Seasonal Influenza Immunization Program Plan can be found here.  Pharmacists who are holding clinics where a fridge may not be present, should review the Packing, Storage and Handling for Off-Site Immunization Clinics section of the Cold Chain Protocol to ensure that vaccines are stored properly and temperature of the vaccines is maintained throughout the time they are out of the fridge.

Please also review the Manitoba 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.

 

Safety Cycle – Analyze

Safety IQ includes four elements that create the Safety IQ continuous quality improvement (CQI) cycle: Report, Analyze, Share and Document. Medication incidents are rarely caused by a single event or the actions of a single person. Analysis of medication incidents and near-miss events often reveals a system failure that must be changed to prevent medication incidents. Analysis is the backbone of patient safety improvement planning and shared learning.

The analysis element of the Safety IQ cycle is made up of three key components:

  1. Analysis of medication incidents and near-miss events at the community pharmacy level

Community pharmacy team members should analyze individual incidents and near-misses as they occur while also paying attention to incident and near-miss trends over time. Your medication incident reporting platform must have the capability to summarize your medication incident and near-miss event data.

  1. Safety self-assessment

The pharmacy team also conducts a safety self-assessment within the first year of Safety IQ implementation and at least once every three years thereafter. The goal of the safety self-assessment is to proactively identify processes or systems within the pharmacy that have the potential to cause medication incidents.

  1. Analysis of aggregate data at the national level

The Medication Incident Reporting Platform Criteria requires reporting platforms to submit de-identified medication incident and near-miss event data to the National Incident Data Repository (NIDR) for Community Pharmacies, an Institute for Safe Medication Practices Canada (ISMP Canada)-led component of the Canadian Medication Incident Reporting and Prevention System (CMIRPS). Medication safety experts at ISMP Canada analyze aggregate data to identify incident and near-miss trends in community pharmacies across Canada and share evidence-based resources to help prevent medication incidents.

Each element of analysis should contribute to your pharmacy’s CQI plans. Pharmacy professionals use this information to identify gaps or risks in systems and processes so they can take targeted and measurable actions to reduce the chance of medication incidents.

 

Register for the PD Event – Lessons from Complaints: Trends and Expectations

The College is pleased to announce the first professional development program driven by the complaint resolution process learnings. This event, titled Lessons from Complaints: Trends and Expectations, will inform pharmacy staff on the common trends identified by the CPhM Complaints Committee and familiarize pharmacists with their role in the complaints resolution process. Actual case scenarios that the Complaints Committee has resolved will be presented in an anonymous format. These cases will provide participants with useful strategies they can apply to avoid pitfalls of professional practice. Consideration of actual deidentified case scenarios from the Complaints Committee will reinforce the program’s learnings and practical application.

 

WHEN:

Tuesday, November 24, 2020, from 7:00 to 9:00 p.m.

 

ACCREDITATION:

CPhM Accreditation pending.

 

SPEAKERS:

Rani Chatterjee-Mehta, B.Sc., B.Sc. (Pharm.), Deputy Registrar, CPhM

Brent M. Booker, B.Sc. (Pharm.), Pharm.D., Assistant Registrar – Review and Resolution, CPhM

Pat Trozzo, B.Sc. (Chem), B.Sc. (Pharm), Chair, CPhM Complaints Committee

Ms. Bharti Kapoor, Public Representative, CPhM Complaints Committee

OVERALL LEARNING OBJECTIVES:

  • Examine the roles of the College and pharmacists in resolving informal concerns and complaint matters
  • Distinguish between the separate avenues of resolution: informal concerns and formal complaints
  • Examine the possible outcomes of complaint resolution
  • Summarize the trends in the types of concerns and contributing factors of complaint matters
  • Examine a registrant’s duty to report
  • Describe the role of Public Representatives in the resolution process
  • Apply best practices for effective and professional communication with patients
     

REGISTRATION LINK: 

https://us02web.zoom.us/webinar/register/WN_szddssxGRGSCCEJJSdriKQ

This is a virtual event ONLY and is free to all attendees.  Deadline to register is November 23, 2020, at 4:30 p.m.

 

 

CPhM Office Hours

The College Pharmacists of Manitoba will observe the following holiday schedule:

  • Closed at 12:00 noon Thursday, December 24 through Monday, December 28, 2020
  • Open 8:30 a.m. to 4:30 p.m. Tuesday December 29 and Wednesday December 30, 2020
  • Closed at 12:00 noon on Thursday, December 31, 2020
  • Regular office hours resume on Monday January 4, 2021, 8:30 a.m. to 4:30 p.m.

Please be reminded that the CPhM office remains closed to visitors and continues to operate as a virtual office due to the COVID-19 pandemic.  All services continue, however adjustments in service delivery and delays may occur.

Documents may be left in the black deposit box to the left of the main entrance.  Email is the most efficient means by which to contact staff.

Thank you for your kind attention and cooperation.

Professional Development

For current professional development opportunities, click here.