COVID-19 and Influenza Vaccines in Community Pharmacies for Children Five Years of Age and Older

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Friday Five (October 29, 2021)

This week's edition of the Friday Five includes new NAPRA Model Standards, new CPSM Standard of Practice for Virtual Medicine, and travelers (snowbirds) and prescribing for Opioids and Benzodiazepines & Z-Drugs. 

NAPRA Model Standards for Continuous Quality Improvement and Medication Incident Reporting 

On September 24, 2021, Council approved that the College adopt the NAPRA Model Standards for Continuous Quality Improvement (CQI) and Medication Incident Reporting (MIR). This document supplements the Model Standards of Practice for Canadian Pharmacists and Pharmacy technicians and represents the minimum expected practice standards for continuous quality improvement and medication incident reporting. The NAPRA Model Standards for CQI and MIR outline the responsibilities of pharmacy managers and pharmacy professionals in relation to continuous quality improvement, management of medication incidents and near misses, and handling of medication incidents. 

The Model Standards for CQI and MIR reflect many of the principles of Safety IQ as well as the College’s Medication Incidents and Near Miss Events practice direction. In Manitoba, the NAPRA Model Standards are already implemented with the launch of Safety IQ and updated practice direction on June 1, 2021.  

Only one section of the NAPRA Model Standards for CQI and MIR does not coincide with College expectations regarding the responsibility of the pharmacist to inform the patient’s prescriber of a medication incident under the Medication Incidents and Near Miss Events practice direction. The NAPRA Model Standards (2.2.1.3) state that the medication incident information should be shared with the prescriber as appropriate, while the CPhM practice direction (3.2.1.6) indicates that the prescriber should always be informed of a medication incident.  

The end goal of Safety IQ and the NAPRA Standards is to promote continuous quality improvement processes that contribute to patient safety and enhance patient trust in the safety of pharmacy practice. 

CPhM 2022 Licence Renewal Reminder 

Please be reminded that all current licences issued by the College of Pharmacists of Manitoba expire on December 31, 2021. 

Pharmacists and Pharmacy Managers are reminded to renew their corresponding practice licence using the online renewal process. 

The deadline to complete the renewal process is Monday, November 15, 2021. Late penalties are automatically assessed after the deadline. Failure to renew a licence on or before the November 15 deadline will result in a late penalty, equal to 50% of the original licence fee, being added. 

Pharmacists are reminded to upload all professional development (PD) activities to your online profile prior to November 30, 2021. To be eligible for licence renewal, pharmacists must participate in a minimum of 25 hours of PD learning activities annually between November 1 and October 31. A minimum of 15 of the 25 hours must be from accredited learning activities.  

 Please take the time to ensure PD activities are logged accurately in the correct PD year. As a reminder: 

  •  Tech talk programs cannot be claimed as accredited learning activities. These activities are only accredited for pharmacy technicians. You can identify technician-accredited learning as the accreditation numbers end in “T.”  
  • Preceptor hours can only be claimed when there is new learning completed, and the learning must be documented. 
  • Pharmacists may only claim CEU for First Aid/CPR training for the actual number of hours attended, excluding breaks. 

Pharmacy Managers are reminded that all supporting documents must be submitted in order for a pharmacy licence renewal to be processed: 

  • Owner’s Declaration Form, signed by the Signing Officer 
  • Annual Return of Information 
  • Proof of Commercial General Liability Insurance 

PAYMENT 

As per its COVID-response plan, the CPhM office remains closed to visitors; registrants are encouraged to pay for licence renewal online. Cheques or money orders may be mailed to the CPhM office or dropped in the secure, black drop-box to the left of the office’s main entrance. Enclose a copy of your invoice if paying by cheque or money order. 

Remember: a licence that is not renewed by December 31, 2021, is expired and invalid. A pharmacist or pharmacy that fails to renew a licence and continues to practice is in contravention of Manitoba law and will be referred to the Complaints Committee. 

Thank you for your prompt attention and cooperation in the renewal process. Avoid unnecessary late penalties. Renew your licence promptly. 

College of Physicians and Surgeons of Manitoba (CPSM) new Standard of Practice for Virtual Medicine  

The College of Physicians and Surgeons of Manitoba (CPSM) has introduced the new Standard of Practice for Virtual Medicine, effective November 1, 2021. The Standard applies to all CPSM members engaging in virtual medicine to any extent in Manitoba. The general provision is:  

Virtual Medicine is the provision of medical care by means of electronic communication (telephone, video, email, text, or other internet hosted service or app) where the patient and the member [physician] are at different locations, including but not limited to treating, advising, interviewing, or examining the patient. 

Each CPSM member’s (e.g., physician) practice of medicine must include timely in-person care when clinically indicated or requested by the patient. It is not an acceptable standard of care to solely practice virtual medicine. A blended model of care balancing in-person and virtual medicine is required if providing virtual medicine.  

Although this practice direction applies to virtual care provided by CPSM members it is still important that pharmacists review the standard to understand how it may impact their pharmacy practice. It should be noted that this standard does not apply to medical consultations or communications between CPSM members, nor to communications between CPSM members and other regulated health professionals.   

It also clearly states that members using virtual medicine are not to prescribe opioids or benzodiazepines or Z-Drugs or authorize cannabis for medical purposes to patients whom they have not examined in person, or with whom they do not have a longitudinal treating relationship, unless they are in direct communication with another regulated healthcare professional who has examined the patient.  

Regardless of practice modality, it is essential that pharmacists continue to respect patient autonomy and allow patients to select their pharmacy of choice when filling a prescription. 

Safety IQ Update: NIDR for Community Pharmacies Shares First Manitoba Safety Brief  

By June 1, 2021, community pharmacies across Manitoba were reporting medication incidents and near-miss events to their incident reporting platforms. Your de-identified reports have been sent to the National Incident Data Repository (NIDR) for Community Pharmacies hosted by ISMP Canada. Medication safety experts at ISMP Canada analyze the aggregate data from across the country to share learning and recommendations with pharmacy professionals and other health care providers via Safety Bulletins and other communications.  

In the spirit of knowledge dissemination and shared learning, the NIDR has communicated its first Manitoba Safety Brief. This report includes:  

  • Number of incidents received by the NIDR; 
  • Top five types of incidents reported; and 
  • Level of harm from reported incidents. 

In addition, the report shares medication safety recommendations for you to consider. 

You will note that the number of “No Error/Near Miss” reports is almost three-times the number of incidents that have reached a patient. This confirms that pharmacy professionals serve as a safety net for patients and that pharmacy professionals see the value in reporting and learning from near-miss events to continuously improve quality. We commend you for your efforts to prevent patient harm. For information on what near-miss events should be reported, please review the Safety IQ Quick Guide: Reporting Medication Incidents and Near-Miss Events

Travellers or “Snowbirds” and the Standards of Practice for Prescribing Opioids and Benzodiazepines & Z-Drugs  

The College of Physicians and Surgeons of Manitoba (CPSM) Standards for Prescribing Opioids and Benzodiazepines and Z-Drugs came into effect on September 30, 2018, and November 1, 2020, respectively. The College of Registered Nurses of Manitoba (CRNM) Practice Direction for RN(NP) Opioid Prescribing to Treat Non-Cancer Pain has been in effect since March 2020. On April 15, 2021, the College of Pharmacists of Manitoba (CPhM) Companion Document to the CPSM Standards of Practice was also approved. 

On an exceptional basis, prescribers may only 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”.   

Although patients may be approved by Manitoba Health and Seniors Care to receive six months’ worth of medication for out-of-country travel, prescribing or supplying more than three months of opioids, benzodiazepines, and/or Z-drugs is not acceptable.  

Travellers or “snowbirds” who will be away for longer than three months, and who will need a refill while away, are to see a practitioner in the country where they are travelling for proper assessment to receive a valid prescription, as appropriate. Seeing a provider is part of the cost of such extended international travel, including the health insurance needed for such travel.  

The legal interpretation of the Regulated Health Professions Act, Regulations, and common law concludes that the location of medical care in Manitoba is the location of the patient. The CPSM Standard of Practice for Virtual Medicine, effective November 1, 2021, reinforces this. The CRNM also has resources for Telepractice and Guidance on Telepractice, developed with other Manitoba regulatory colleges.  

A Manitoba prescriber cannot provide care to a Manitoba patient in another country by virtual care/phone call to renew or adjust a prescription while the patient is travelling. CPSM registration does not extend to the provision of medical care in that country. Likewise, medical liability insurance may not cover a Manitoba physician or RN(Nurse Practitioner) who provides care to a patient while in another country. Similarly, CPSM registration does not extend to the provision of medical care in another province. Manitoba-licensed physicians wanting to provide care in another province will need to be aware of and comply with licensing and liability requirements in that Canadian jurisdiction. RN(NP)s are expected to contact the regulatory body in the province/territory where the client lives to determine if they need to be registered in that jurisdiction before providing healthcare services to the client in that location.  

It is important for providers to make their patients aware of this before they travel. The Info Sheet on Virtual Medicine Across Provincial & International Boarders may be a helpful resource for physicians and pharmacists providing care to travelling patients.  

Note that shipping narcotics, controlled drugs and substances, and/or targeted substances from Canada to other countries is not advised and may not be legal. 

A large interprofessional working group of experts diligently reviewed all available evidence and data related to prescribing and dispensing practices of these medications to create the CPSM Standards. Robust public and professional consultation phase followed this work, and feedback was incorporated into the Standards. The CPSM Standards, CRNM Practice Direction, and associated CPhM Companion Document all balance the risks and benefits of various difficult decisions, in the interest of patient and public safety.  

New Government Measures Allow Rapid Testing for COVID-19 at Pharmacies for Manitoba Travellers  

On October 18, 2021, two new Ministerial Orders (here and here) under the Emergency Measures Act and the Regulated Health Professions Act by the Manitoba government came into effect, allowing pharmacists to perform/administer rapid antigen tests and rapid molecular (non-PCR) COVID-19 tests for Manitoba travellers, with the authorization for pharmacist test interpretation/diagnosis. Of note, this new Ministerial Order does not include authorization for COVID-19 PCR testing by pharmacists and does not include nasopharyngeal swabbing, which remains a reserved act. This means pharmacists may only perform nasal swabbing in the shallow anterior nasal passage up to the point where the nasal passages narrow.  

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 for travel purposes 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.   

To request a COVID-19 rapid antigen test, the province requires individuals to show the pharmacist documentation of their travel plans, such as a plane or train ticket or hotel booking. Manitobans will be required to pay for these tests and fees set by each pharmacy providing the service.  

The Manitoba government News Release is available at the following 

link: https://news.gov.mb.ca/news/index.html?item=52638&posted=2021-10-18   

Register for the 2021 Medical Examiner Professional Development Event 

The College is pleased to announce its third annual Medical Examiner Professional Development event: Overdose in the Era of COVID-19 and Approaching Mental Health in Pharmacy Practice  

WHEN: Tuesday, November 23rd, 2021, from 7:00 to 8:45 pm. 

REGISTRATION LINK: https://us02web.zoom.us/webinar/register/WN_eYDrOfI9Rn6kd3ZeFAYKqA

  • This is a virtual event ONLY, and is free to attend for pharmacists and pharmacy staff 
  • Deadline to register is November 22nd at 4:30pm 

ACCREDITATION: Accreditation pending. 

SPEAKERS: 

  • Dr. Marina Reinecke MBChB, CCFP(AM), ISAM, Medical Consultant, Prescribing Practices Program, College of Physicians and Surgeons of Manitoba 
  • Dr. Christine Leong, B.Sc. (Gen), B.Sc. (Pharm), Pharm.D., Assistant Professor, College of Pharmacy, Rady Faculty of Health Sciences 

LEARNING OBJECTIVES: 

  • Discuss historic and recent trends/changes in Manitoba overdose death data reported by substance. 
  • Recognize shifting overdose death data trends in the context of the pandemic, including potential reasons for the changes. 
  • Demonstrate how existing frontline addiction services that can impact survival are strained. 
  • Briefly propose an appropriate health system response to address the overdose crisis by applying accepted evidence-based & cost-effective interventions. 
  • Recognize the signs and symptoms of someone experiencing a mental health crisis. 
  • Describe the pharmacist’s role in helping patients experiencing a mental health crisis. 
  • Explore strategies for communicating with patients experiencing a mental health crisis. 
  • Identify resources for patients in need of mental health support. 

NDSAC Recruitment Notice 

The National Drug Scheduling Advisory Committee (NDSAC) is a committee of the National Association of Pharmacy Regulatory Authorities (NAPRA), which serves to advise NAPRA on matters relating to the National Drug Schedules (NDS) program. The primary function of the eight-member committee is to review and analyze submissions regarding scheduling placements for non-prescription drugs and to make recommendations for scheduling. 

NAPRA will have two vacancies on the NDSAC arising in 2022 and is inviting applications for the following positions: 

  1. A practicing pharmacist or physician with experience in a collaborative practice setting such as a family health team clinic 
  2. An individual with expertise in toxicology and drug information 

The deadline for application is November 5, 2021. For further information, please view the invitation for application here. 

Upcoming Events & Professional Development Opportunities

Overdose in the Era of COVID-19 & Approaching Mental Health in Pharmacy Practice 

Tuesday, November 23, 2021

Register here.

Canadian Society of Hospital Pharmacists: Hot Topics!

Thursday, November 25, 2021

Register here.