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Friday Five (June 12, 2020)

This week's edition of the Friday Five.

Personal Protective Equipment Recommendations for Pharmacists

Shared Health has released Provincial Personal Protective Equipment Requirements. The requirements intend to guide appropriate use and conservation of supply for the duration of the pandemic. Generally speaking, according to these principles, anyone who cannot maintain 6 feet of separation during interactions should be wearing a mask and eye protection as well as washing hands between encounters.

Pharmacists are asked to use their professional judgment regarding using personal protective equipment (PPE). Some tasks, such as stocking inventory, do not involve close contact with patients and thus may not require PPE; however, other tasks, such as administering injections require proper PPE at all times. To guide your professional judgment, it may be helpful to read through Shared Health’s protocol on Point of Care Risk Assessment.

The College previously put out guidance that pharmacists should ensure good hand hygiene and proper use of PPE when administering injections. If pharmacists do not have PPE for injection administration, patients should be referred to another healthcare provider or pharmacy to ensure safety.

The Canadian Pharmacists Association has also previously released suggested best practices for PPE in pharmacies, including when it should be used and how PPE should be donned.

PR/First Aid Reminder

The College continues to receive questions from pharmacists who have injection authorization and are unable to re-certify in CPR and First Aid due to the COVID-19 pandemic.  Pharmacists who have certification of authorization to administer drugs by injection must possess and maintain current certification in CPR Level C (or HCP) and Emergency or Standard First Aid from an in-person training program that is recognized as an approved first aid training agency/program/provider by the Workplace Safety and Health (WSH) Branch of the Manitoba government.

The Manitoba government has the following statement on their WSH Approved Training Providers webpage:

“IMPORTANT NOTE:

Due to the COVID-19 (coronavirus) outbreak, Workplace Safety and Health is granting extensions on any workplace first aid, or flagperson certificates, that are due to expire between March 1, 2020 and June 30, 2020. These certificates will now be acceptable in the workplace for 90 days beyond their original expiry date.”

Pharmacists should confirm with their CPR and First Aid provider that your existing certification has been extended and retain documentation of such extension.  Once you have done this, you can change your CPR/First Aid expiry date in your member homepage, and you will need to recertify as soon as courses are available.  Online CPR and First Aid courses are not accepted by the College.

COVID-19 Update

As the province prepares to move into phase three of its Restoring Safe Services Together approach to re-opening, it is important for pharmacy professionals to stay updated.

The government’s website updates daily with new information that may affect your pharmacy such as capacity guidelines and workplace guidance.

Pre-filling Insulin Syringes

The National Association of Pharmacy Regulatory Authorities (NAPRA) Model Standards for Pharmacy Compounding of Hazardous and Non-Hazardous Sterile Preparations highlight that greater attention must be paid to the environment in which compounded sterile preparations are prepared, the training of personnel and quality assurance procedures necessary in order to protect patients and pharmacy personnel.

A sterile environment is required for the production of compounded sterile products and the manipulation of sterile products.  A sterile drug product that is transferred from vials or ampoules into sterile final containers with syringe and needle is classified as a sterile compound.

Pharmacies that are engaged in sterile compounding are required to meet the NAPRA Model Standards for Pharmacy Compounding of Hazardous and/or Non-Hazardous Sterile Preparations.   Some of the requirements for sterile compounding facilities include an ISO 5 environment maintained in a primary engineering control (PEC) and maintenance of an ISO 7 or better clean room or segregated compounding area.

Pharmacists engaged in sterile compounding must ensure they have the appropriate facilities and competence when providing sterile compounds. Repackaging of sterile products, including the preparation of pre-filled syringes containing medications such as insulin is a sterile compounding activity.

Pharmacists who are asked to dispense pre-filled syringes and do not have the sterile compounding equipment and facilities to prepare in accordance with the NAPRA Standards must refer the patients to a pharmacy with the necessary resources to prepare them safely.