The PostScript Archives 2016

Expectations for Inventory Management of Narcotics, Controlled Drugs, Benzodiazepines and Targeted Substances

Pharmacists-in-charge, as well as staff pharmacists and pharmacy technicians, are responsible to ensure the security of narcotic, controlled drug, and benzodiazepine and targeted substance inventory in the pharmacy. Security of the inventory must be maintained from the time drugs are received at the pharmacy to the point where they are dispensed to the patient or removed from inventory, until the point of destruction.

The applicable federal legislation and NLPB Standards includes:

• Food and Drugs Act and Regulations;
• Controlled Drugs and Substances Act;
• Narcotic Control Regulations;
• Benzodiazepines and Other Targeted Substances Regulations; and
• NLPB Standards of Pharmacy Operation

While Health Canada’s requirements for benzodiazepines and targeted substances may be less specific than for narcotics, documentation of purchases and sales is still required (the form is not specified) as well as loss/theft reporting. For this reason, in order to meet the loss/theft reporting requirements pharmacists need to include benzodiazepines in physical inventory counts, reconciliations and auditing procedures.

A reconciliation is a detailed audit of the perpetual inventory for a given drug (quantity of drug purchased minus the quantity of drug dispensed) compared to the current physical inventory on hand in order to assess for any shortages or overages. The next issue of The Apothecary will include a detailed description of how to properly conduct a reconciliation.

Any shortages or overages of narcotics, controlled drugs, or benzodiazepines or targeted substances must be investigated. Shortages must be reported to the Office of Controlled Substances within 10 days of discovery, using the Health Canada Loss or Theft Report Form (available on the Pharmacy Practice Resources page of the NLPB website.

Following detection and investigation of discrepancies, changes should be implemented in the pharmacy to prevent such occurrences in the future. All documentation related to narcotic, controlled drug, and benzodiazepine purchases, sales, physical counts, reconciliations, audits, and reported losses or thefts must be retained by the pharmacy in a retrievable manner for 2 years.

CCCEP Launches New Initiative to Increase Continuing Education Opportunities for Pharmacy Technicians

The Canadian Council on Continuing Education in Pharmacy (CCCEP) has announced a new initiative to create more continuing education opportunities for Canada’s licensed pharmacy technicians. “In an effort to help bring more learning activities to practicing pharmacy technicians, our Board recently approved an initiative to make it administratively and fiscally beneficial to our program providers to consider developing continuing education for pharmacy technicians,” said Barbara Thomas, CCCEP President.

The technician continuing education initiative will include a number of elements that will be implements over the next six to twelve months. The first step, launched on December 1, 2015,is to provide a discount on the accreditation fees for learning activities for technicians. The second step is expected to be launched in March 2016. CCCEP has also committed to work with pharmacy technician associations across Canada to identify and implement ways to increase the number of continuing education for pharmacy technicians. CCCEP will be meeting with representatives for provincial and national technician associations to discuss ways to work together to support continuing education for this new and emerging pharmacy profession.

“We are very excited to start this initiative,” began Arthur Whetstone, CCCEP Executive Director. “We believe this is an excellent first step to encourage the growth of continuing education learning activities for pharmacy technicians. We will be actively promoting this initiative to our returning and new program providers to raise awareness and promote the wide range of incentives.”

For more information, please visit the CCCEP website at www.cccep.ca or contact the CCCEP office.

Reminder Regarding Registered Pharmacy Technicians and Prescriptions for Benzodiazepines

While the Food and Drug Regulations were amended in 2013 to recognize pharmacy technicians and allow them to accept verbal prescriptions and perform prescription transfers, amendments have not yet been made to the Controlled Drugs and Substances Act and its related regulations. This means that, at this time, while registered pharmacy technicians may accept verbal prescriptions and perform prescription transfers for most prescriptions, they may not accept verbal prescriptions for narcotics, controlled drugs, benzodiazepines or targeted substances or participate in the transfer of prescriptions for benzodiazepines.

Standards of Pharmacy Operation- Community Pharmacy- Upcoming Implementation Dates

As per the Standards of Pharmacy Operation- Community Pharmacy ALL community pharmacies must have the following in place by January 1, 2017, to be declared upon renewal in November 2016:

• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• a connection to the provincial electronic health record through the Pharmacy Network;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards.

Pharmacists-in-charge are strongly encouraged to make arrangements to have these requirements in place as soon as possible to ensure that operational requirements are met by the given deadlines.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website.

Clarifications Regarding Schedule II Products and the Prescribing Standards

The Board office has received a number of questions from pharmacists regarding Schedule II products and the Standards of Practice – Prescribing by Pharmacists.

It should be noted that adding a Schedule II product to a patient’s profile for the purposes of meeting the record-keeping requirements of the Standards of Pharmacy Operation – Community Pharmacy is not considered to be prescribing. In addition, adding an exempted codeine product (ECP) to a patient’s profile for the purposes of meeting the record-keeping requirements of the Standards of Practice – The Sale of Exempted Codeine Products in Community Pharmacies is also not considered to be prescribing.

In order to be considered prescribing, in accordance with the Prescribing Standards, a pharmacist would have to be:

• initiating a prescription for a Schedule I, II, III or Unscheduled product to treat a Minor Ailment or
• initiating a prescription for a Schedule II, III or Unscheduled product to facilitate adherence or to facilitate coverage through the patient’s third party drug benefit plan




While it could be argued that a pharmacist could prescribe an ECP for mild headache or minor joint pain under #1 above, at this time, the Prescribing Regulations and Standards specifically limit pharmacists from prescribing Narcotics, Controlled Drugs, Benzodiazepines and Other Targeted Substances.

Ultimately, it is important to keep in mind that the Prescribing Regulations and Standards are meant to be enabling; they were not intended to restrict activities that pharmacists were always able to do, but rather allow pharmacists to do more to help their patients.

Provincial Drug Schedules

Recently, the Board office has received a number of questions regarding the scheduling status of a number of drug products.

Pharmacists are reminded to refer to A Guide to Understanding the Provincial Drug Schedules for information regarding the drug scheduling process, as well as, the status of individual drugs.

In addition, “Appendix D: Vaccines and Immune Globulins Quick Reference” has been updated to clarify the scheduling status of various vaccines.

Pharmacy Renovations

Pharmacists-in-charge are reminded that they are responsible for completing and submitting an Application for Renovation of an Existing Pharmacy/Dispensary at least 15 days prior to initiating any physical alterations to the dispensary, patient consultation area(s), and/or the professional products area(s) of an existing pharmacy location (including renovations required for “Lock & Leave”). A detailed diagram of the layout of the renovated pharmacy/dispensary, as well as the associated fee, must accompany the application. Once the application has been reviewed, the pharmacist-in-charge will be notified of the application approval and contacted to schedule an assessment of the completed renovations. The pharmacist-in-charge may be required to complete and submit a self-assessment of the renovated pharmacy/dispensary prior to the scheduled inspection. If so, the pharmacy will not be inspected until the self-assessment has been received and reviewed by NLPB staff.

Tip: When completing significant renovations or relocations, it is also recommended to advise the NLCHI Pharmacy Network to ensure continuous connectivity.

Although this reminder was also included in the June 2015 edition of The Postscript, it has come to the Board’s attention that over the past couple months a number of renovations have occurred, for which no application was submitted. In this case, upon becoming aware of the renovation, the NLPB will require the pharmacist-in-charge to submit a retroactive renovation application and fee, and a renovation assessment will be scheduled. Additional renovations may be required if the revisions to the pharmacy are not in-line with Board Standards.

Standards of Pharmacy Operation- Community Pharmacy- Upcoming Implementation Dates

As per the Standards of Pharmacy Operation- Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017, to be declared upon renewal in November 2016:

• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• a connection to the provincial electronic health record through the Pharmacy Network;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards.




Pharmacists-in-charge are strongly encouraged to make arrangements to have these requirements in place as soon as possible to ensure that operational requirements are met by the given deadlines.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website.

Preceptor Training and Authorization

This is a reminder to pharmacists who are planning to preceptor a student, intern, or pharmacy technician candidate. Board-approved training must be completed and an application for authorization to act as a preceptor must be submitted and approval received before any practical training period will be approved by the board. Training programs may be found at http://preceptor.healthprofessions.dal.ca/. Note that the Dalhousie program is now accredited for five CEUs and may be used toward your annual Professional Development requirement. The Application for Authorization to Serve as a Preceptor is on the Registration and Authorization page of the NLPB website. Please allow 2-3 days for processing.

Standards of Pharmacy Operation – Community Pharmacy – Upcoming Implementation Dates

As per the Standards of Pharmacy Operation – Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017, to be declared upon renewal in November 2016:

• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• a connection to the provincial electronic health record through the Pharmacy Network;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards.

Pharmacists-in-charge are strongly encouraged to make arrangements to have these requirements in place as soon as possible to ensure that operational requirements are met by the given deadlines.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website.

Update on the Scheduling Status of Naloxone for Emergency Use for Opioid Overdose

On March 22, 2016, Health Canada issued a public notice indicating that the Prescription Drug List (PDL) was modified for the listing of naloxone. The PDL listing now reads as follows:

• Naloxone or its salts, including (but not limited to) naloxone hydrochloride, except when indicated for emergency use for opioid overdose outside hospital settings.




The next step in the process is for the manufacturer to submit a request to revise the National Drug Schedules to the National Drug Scheduling Advisory Committee (NDSAC). Once NDSAC reviews the request, it will recommend placement on the National Drug Schedules. The NLPB Board reviews NDSAC recommendations at each Board meeting and, if warranted, makes changes to the NL Provincial Drug Schedules, available on the Provincial Drug Schedules page of the website. No recommendation is finalized and implemented in this province until it has received Board approval.

The NLPB will be working with provincial stakeholders to determine how this potential change in scheduling would be implemented in community pharmacies in NL, and will keep you updated as more information becomes available.

Preceptor Training and Authorization

Registrants are reminded that prior to acting as a preceptor to a pharmacy student, intern, or pharmacy technician candidate, an Application for Authorization to Serve as a Preceptor must be submitted and approved by the Board. This approval MUST be received prior to the start of the practical training period. As part of the application process, the registrant must provide proof of completion of a Board-approved preceptor training program. While the NLPB recommends the Dalhousie University Preceptor Education Program which has been accredited for five CEUs, other programs may also be considered acceptable. The Application for Authorization to Serve as a Preceptor is found on the Registration and Authorization page of the NLPB website. Please allow 2-3 days for processing.

Frequently-Asked Questions About Registration & Licensing

Registrants are advised that a new page – Frequently-Asked Questions About Registration & Licensing has been added to the NLPB website. This page mirrors existing pages on the site such as Frequently-Asked Questions About Complaints & Discipline and Frequently-Asked Questions About Pharmacy Practice. The page will be divided into several sections and will attempt to answer a number of questions on registration- and licensing-related topics. The first section – Questions about Lock and Leave is now live. Future sections will be added over the coming months.

Standards of Pharmacy Operation – Community Pharmacy – January 1, 2017 Deadline

Pharmacists-in-Charge are reminded that the deadline for all pharmacies to be compliant with the Standards of Pharmacy Operation-Community Pharmacy is fast approaching. Please be advised that ALL community pharmacies in the province are required to meet these standards and extensions to the deadline will not be granted.

Standards of Pharmacy Operation – Community Pharmacy – January 1, 2017 Deadline Approaching

Once again, we would like to remind Pharmacists-in-Charge that, as per the Standards of Pharmacy Operation – Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017:

• a connection to the provincial electronic health record through the Pharmacy Network;
• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards (for example, a purpose-built refrigerator or a “modified” domestic frost-free refrigerator). PLEASE NOTE: traditional “bar” or “mini” fridges will no longer be acceptable.




During pharmacy licence renewal in October-November of this year, Pharmacists-in-Charge will be asked to declare that these Standards are met. The inability to do so may impact whether or not the pharmacy license may be renewed.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s on-going Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website.

NLPB Practical Training Program

Over the past few months, the NLPB office has received many questions from students and registrants about preceptor requirements. For this reason, we would like to clarify eligibility requirements for registrants to serve as preceptors to pharmacy students, pharmacy interns or pharmacy technician candidates who are completing NLPB Practical Training Programs.

In order to serve as a preceptor for the NLPB Practical Training Program, registrants must:

• Meet the requirement for preceptor education and training through completion (within the previous 3 years) of either:
  • the MUN preceptor training program, or

  • the Dalhousie University Preceptor Education Program;
• Complete and submit an Application for Authorization to Serve as a Preceptor, along with proof of training completion; and
• Receive notification of approval from NLPB prior to accepting students.




PLEASE NOTE: The preceptor requirements outlined above are specific to the NLPB Practical Training Program, and do not necessarily apply to the MUN School of Pharmacy Structured Practice Experience (SPE) Program.

Once a registrant is approved as a preceptor, the next steps for a student to start practical training are:

• The student must log into their NLPB online profile and initiate a request to begin practical training by entering the start and end dates, and selecting an approved preceptor from the list.
• The preceptor then logs into their personal online profile and accepts the request. To electronically sign the request, type your name into the “Preceptor’s Signature” field and select today’s date. Click “Next” to review the information and click “Save” if everything is satisfactory. This submits the form.
• No paperwork needs to be sent to the NLPB office as the request is completed through the online system.




If you have further questions, please contact Aileen O’Keefe, Registration and Licensing Administrator, at aokeefe@nlpb.ca for assistance.

Thank you for your continued cooperation and support of the NLPB Practical Training Program.

Medical Assistance in Dying

The provision of Medical Assistance in Dying (MAiD) is an evolving topic with new information emerging daily. It is important for pharmacists to continually monitor information from NLPB on this topic. Any development in policies, legislation and regulations will be communicated to the profession as it unfolds.

Legislative update:

Bill C-14 (An Act to amend the Criminal Code and to make related amendments to other Acts [medical assistance in dying]) was assented to on June 17, 2016. Among other things, this enactment created exemptions in the Criminal Code to permit medical practitioners and nurse practitioners to provide MAiD and to permit pharmacists and other persons to assist in the process. The legislation also specifies the eligibility criteria, safeguards and documentation requirements that must be respected when MAiD is provided.

NLPB update:

The Board, along with PANL and other health professional organizations, has been involved in a provincial government working group developing guidelines for a provincial program for the safe and effective provision of MAiD. Pharmacists will be notified once this work are completed. In the meantime, we offer the following practical guidance:

• The pharmacist may wish to consult legal counsel to advise them throughout the process.
• The pharmacist should consider each situation in light of the Code of Ethics, be familiar with the patient and his or her condition and understand that he or she is expected to practice within their scope and the limits of their professional competence.
• Until such time as formal guidelines or standards are approved by the Board, any pharmacist who is considering a request to participate in caring for a patient engaging in MAiD should contact the Board Office for support.

Destruction of Expired or Unusable Narcotics and Controlled Drugs

Pharmacists are advised that NLPB has been notified that the Office of Controlled Substances (OCS) will no longer require pharmacists to obtain permission prior to destroying narcotics and controlled drugs. Pharmacists can now destroy narcotics and controlled drugs locally without obtaining prior permission from OCS, as long as they document appropriately and it is witnessed by 2 health professionals. Pharmacists may also choose to return narcotics and controlled drugs to a licensed dealer authorized to destroy them under the Section 56 Class Exemption.

NLPB will be updating its Interpretation Guide related to the destruction of these drugs and will provide additional guidance on the subject in the next issue of The Apothecary.

Pharmacy Technician Bridging Update

Pharmacy Technician Bridging candidates are reminded that ALL STEPS in the registration process must be completed by December 31, 2017 in order to be eligible to be registered by NLPB as a Pharmacy Technician. After that date, completion of a CCAPP-accredited Pharmacy Technician program will be required for licensure.

Please also note the following:

• There are only TWO remaining NL sittings of the Evaluating Exam – October 2016 (registration deadline has passed) and April 2017.
• The Bridging Courses are not a prerequisite to the Evaluating Exam.
• You must be successful in completing the Evaluating Exam before being permitted to sit the PEBC Qualifying Exam.
• Both the Evaluating Exam and the Bridging Courses must be completed before being permitted to site the NLPB Registration Exam or start the NLPB Practical Training Program.

For further information about PEBC Evaluating and Qualifying Examinations, please visit the PEBC website.

For further information about the Pharmacy Technician Bridging Education program, please visit the NAPRA website.

For more information on the pharmacy technician registration process, please visit our dedicated Pharmacy Technician Registration Information page or contact us at any time with any questions you may have.

If you are interested in receiving monthly email updates on pharmacy technician regulation news, please send your name and email address to inforx@nlpb.ca.

Standards of Pharmacy Operation – Community Pharmacy – January 1, 2017 Deadline Approaching

Once again, we would like to remind Pharmacists-in-Charge that, as per the Standards of Pharmacy Operation – Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017:

• a connection to the provincial electronic health record through the Pharmacy Network;
• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards (for example, a purpose-built refrigerator or a “modified” domestic frost-free refrigerator). PLEASE NOTE: traditional “bar” or “mini” fridges will no longer be acceptable.

During pharmacy licence renewal in October-November of this year, Pharmacists-in-Charge will be asked to declare that these Standards are met. The inability to do so may impact whether or not the pharmacy license may be renewed.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s on-going Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website.

Interim Dean Appointed

Dr. Lisa Bishop has been appointed acting dean of the School of Pharmacy effective August 1, 2016, until a permanent dean is recruited. Dr. Bishop replaces Dr. Carlo Marra who has accepted the role of dean of the School of Pharmacy at the University of Otago in New Zealand.

Dr. Bishop is an associate professor with the School of Pharmacy. She is an accomplished scholar and educator, with contributions to a number of peer-reviewed journals and other publications, posters and oral presentations to her credit. Since 2014 she has led the curriculum change of the pharmacy program through her position as director of the new Doctor of Pharmacy (PharmD) program.

“We have achieved some great milestones over the past two years here in the School of Pharmacy, and I am looking forward to leading our strong team of faculty, staff and students to continue these initiatives, primarily the upcoming PharmD program, the Working Professional PharmD Program, and our Medication Therapy Services (MTS) Clinic,” she remarked.

Dr. Bishop began her pharmacy career as a student in Memorial’s bachelor of science (pharmacy) program. Upon graduation she began working as a hospital pharmacist in St. John’s. She completed a hospital pharmacy residency at St. Joseph’s Hospital in Hamilton, Ontario and then returned to Newfoundland and Labrador in 1998 and began working as a critical care pharmacist, a position she held until 2006, at which time she joined Memorial University as assistant professor. She completed a Pharm.D from the University of Colorado in 2007.

Dr. Bishop holds a cross-appointment with Memorial’s Faculty of Medicine where she provides clinical services to one of the academic family medicine clinics. She has been co-leading a community-based participatory research project on youth mental health and wellness through the clinic.

Dr. Bishop has held a variety of leadership positions with a number of professional organizations including the Canadian Society of Hospital Pharmacists and the Association of Faculties of Pharmacy of Canada. She has been the recipient of the Award for Teaching Excellence from Memorial’s School of Pharmacy on two occasions, and is the recipient of numerous other institutional and national accolades, including the President’s Award for Public Engagement, the Isabel E. Stauffer Meritorious Service Award, and the Leadership in Pharmacy Practice Award.

Dr. Bishop begins her appointment effective August 1, 2016, until a permanent dean is recruited.

NLPB Eliminating Fax Communications

Please be advised that the NLPB Office will no longer be communicating to pharmacies via fax transmission. Going forward, notices that would have previously been faxed to the pharmacy will now be sent via email to the pharmacist-in-charge’s primary email address as noted in the pharmacy’s online profile. Pharmacists-in-charge are expected to check this account at least daily to stay abreast of important notices. To ensure communications are not interrupted, please make sure that this email address is always kept up-to-date.

Standards of Pharmacy Operation – Community Pharmacy – January 1, 2017 Deadline Approaching

Once again, we would like to remind Pharmacists-in-Charge that, as per the Standards of Pharmacy Operation – Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017:

• a connection to the provincial electronic health record through the Pharmacy Network;
• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards (for example, a purpose-built refrigerator or a “modified” domestic frost-free refrigerator). PLEASE NOTE: traditional “bar” or “mini” fridges will no longer be acceptable.

During pharmacy licence renewal in October-November of this year, Pharmacists-in-Charge will be asked to declare that these Standards are met. The inability to do so may impact whether or not the pharmacy license may be renewed.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s on-going Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website.

Destruction of Narcotics

The regulations regarding narcotics, controlled drugs, benzodiazepines and targeted substances require that pharmacists take all steps necessary to protect these drugs while they are in their possession. This includes ensuring that the drugs are accounted for and the inventory is accurate. Damaged, unserviceable or outdated drugs are considered part of the pharmacy’s inventory. As such, pharmacies need to account for these drugs as well as those returned by patients.

As communicated in the July 7, 2016 issue of The PostScript, Health Canada no longer requires pharmacies to have pre-authorization for destruction of expired or unusable narcotics and controlled drugs. However, auditable records must still be maintained in accordance with the applicable legislation.

There are options available to pharmacists in dealing with these expired or unusable drugs. The pharmacist may choose to destroy the drugs on-site, return the drugs to the licensed dealer who initially provided them or choose to sell or provide the drugs to a licensed dealer who is licensed to destroy them. For more information on these methods of destruction and the related documentation requirements, please see the NLPB Interpretation Guide – Destruction of Expired or Unusable Narcotics and Controlled Drugs and the sample record of destruction form posted on the Pharmacy Practice Resources page of the NLPB website.

Documenting Service as a Preceptor in Your Online Portfolio

The Standards of Practice – Professional Development for Pharmacists and Pharmacy Technicians allows registrants to self-assign 0.5 credits per week up to a maximum of 6 credits per year for service as a preceptor. Registrants who self-assign credits for acting as a preceptor must first complete the form, Documentation of Self-Assigned Credits for Service as a Preceptor (retaining this form for supporting documentation in case of audit) and then document the credits in their online Learning Portfolio. A separate form and entry must be used if acting as preceptor to more than one student, intern or technician candidate in a given year.

To record these credits on your online record, enter the following information:

New Practice Guidelines

Registrants are advised of the following new guidelines, approved by the Board at their meeting on September 9th:

• Guidelines for Participating in Medical Assistance in Dying
• Guidelines Regarding the Sale of Naloxone Injection in Community Pharmacies

In addition, several changes were made to the Provincial Drug Schedules. To review these changes, please see “Drug Schedule Changes – approved September 9, 2016” on the Provincial Drug Schedules page of the website.

Opioid Dependence Treatment Standards of Practice Revised

The NLPB Standards of Practice for the Safe and Effective Provision of Medication for the Treatment of Opioid Dependence were recently revised to incorporate the following changes:

• Section 5.6 d) related to vomited doses of methadone was revised to more clearly define the need for the pharmacist to request and receive a prescription before any replacement dose is administered to the patient. The Prescriber Fax Notification Form has also been revised to more clearly reflect this requirement.
• The former section 6.3 a) related to confirming the eligibility of a physician to prescribe buprenorphine-naloxone for the purposes of opioid dependence treatment has been deleted. This section discussed the need for the pharmacist to contact the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) to confirm that the physician is eligible to prescribe buprenorphine-naloxone for this purpose prior to dispensing the product. The CPSNL no longer requires physicians to register with them prior to prescribing buprenorphine-naloxone for opioid dependence treatment.




The full revised Standards can be found on the Standards, Guidelines and Policies page of the website.

Sound Alike, Look Alike

The office has been notified of two recent situations where pharmacists have dispensed Clomipramine for Clomiphene. The Institute for Safe Medication Practices (ISMP) has a variety of tools and recommendations for decreasing errors associated with sound alike, look alike drug names such as posting look-alike/sound-alike labels to alert staff to the possibility of a mix-up. For a list of often confused drug names please see ISMP’s List of Confused Drug Names.

Scope of Practice of a Pharmacy Student

It has come to the NLPB’s attention that pharmacy students may be practicing beyond their scope defined in the Pharmacy Act, 2012 during times that they are employed by a pharmacy, but not completing a structured practice experience (SPE) as part of an accredited pharmacy program, or participating in the NLPB practical training program.

For this reason, pharmacists and pharmacy students are reminded that while registration gives the student the right to perform tasks within the scope of practice of a pharmacist, they must be directly supervised by a pharmacist while doing so. When providing “direct supervision”, the pharmacist must be present when the activity is being performed and be able to observe and promptly intervene and stop or change the actions of the individual being supervised.

Additionally, pharmacy students must identify themselves as pharmacy students when communicating or working with the public or members of the pharmacy profession (i.e. wear appropriate name tag, lab coat, etc.).

Standards of Pharmacy Operation – Community Pharmacy – January 1, 2017 Deadline Approaching

Once again, we would like to remind Pharmacists-in-Charge that, as per the Standards of Pharmacy Operation – Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017:

• a connection to the provincial electronic health record through the Pharmacy Network;
• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards (for example, a purpose-built refrigerator or a “modified” domestic frost-free refrigerator). PLEASE NOTE: traditional “bar” or “mini” fridges will no longer be acceptable.

During pharmacy licence renewal in October-November of this year, Pharmacists-in-Charge will be asked to declare that these Standards are met. The inability to do so may impact whether or not the pharmacy license may be renewed.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s on-going Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the website.

REMINDER – Conditional Licence Application Deadline is Next Friday, October 14, 2016

As communicated to all Pharmacists-in-Charge via email on September 19, 2016, the NLPB has established a conditional license process for those pharmacies which, due to extenuating circumstances, will be unable to be fully compliant with the Standards of Pharmacy Operation-Community Pharmacy by the end of 2016.

Pharmacists-in-Charge who wish to apply for a conditional licence can find the application at http://nlpb.ca/media/Application-Conditional-Licence-Sept2016.pdf or on the Licencing Information for Pharmacies page of the website. Applications for 2017 conditional licences must be received by the Board by October 14, 2016.

PLEASE NOTE: submission of an application does not necessarily mean a conditional licence will be granted by the Board. All applications will be considered individually. Eligibility for a conditional licence will be considered ONLY in circumstances in which the Pharmacists-in-Charge can tangibly demonstrate a detailed plan to meet compliance requirements of the Standards within the specified timeframe.

To view the Bylaw regarding conditional licensure, visit the Legislation page of the website.

Standards of Pharmacy Operation – Community Pharmacy – January 1, 2017 Deadline Approaching

Once again, we would like to remind Pharmacists-in-Charge that, as per the Standards of Pharmacy Operation – Community Pharmacy, ALL community pharmacies must have the following in place by January 1, 2017:

• a connection to the provincial electronic health record through the Pharmacy Network;
• a private patient consultation area that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient;
• suitable equipment that allows the staff to scan documents (including prescriptions and other patient records) and store them electronically (for example, a scanner); and
• a refrigerator for the exclusive storage of drugs requiring refrigeration that meets cold chain requirements defined by the Board in Appendix II of the Standards (for example, a purpose-built refrigerator or a “modified” domestic frost-free refrigerator). PLEASE NOTE: traditional “bar” or “mini” fridges will no longer be acceptable.

During the annual pharmacy licence renewal in October and November, Pharmacists-in-Charge will be asked to declare that these Standards are met. The inability to do so may impact whether or not the pharmacy license will be renewed.

All other operational requirements outlined in the Standards are currently in effect and will be audited during practice site assessments as part of the Board’s on-going Quality Assurance Program.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the website.

Questions Related to Physician Suspension / Withdrawal From Practice

We are regularly asked by pharmacists whether or not they are able to continue to fill prescriptions from physicians who are no longer or not currently practicing. Of course, this question comes up even more frequently shortly after such an event occurs, as it has recently. The following FAQ is posted along with many others on the Frequently-Asked Questions About Pharmacy Practice page of the website and is re-printed below for your convenience.

• How should I handle new prescriptions or requests for refills when a prescriber passes away, retires or otherwise ceases practice?

  Historically, it was felt that since the prescriber-patient relationship no longer exists and the patient is no longer under the practitioner’s care, the prescription should be no longer considered valid. However, this is not always practical in today’s world, since it can often take an extended period of time for a patient to obtain the services of another primary health care provider. In many cases, a prescriber will intentionally write prescriptions for a period of time that extends beyond his or her retirement to specifically cover off such situations.

  Technically, as long as the prescriber was licensed at the time the prescription was written, it can be assumed that the prescription was written in good faith. As such, as long as the prescription is not more than a year old, it would still be considered a legal prescription. The real question in this instance is whether filling or re-filling the prescription is appropriate – which needs to be assessed on case-by-case basis.

  Therefore, the Board advises pharmacists who receive such requests that it is their professional responsibility to evaluate the appropriateness of the prescription in each individual situation, considering questions related to patient assessment and the patient’s best interests. Questions to consider include, but are not limited to:

  • How long ago was the prescription written? Was it intended to be a short-term therapy?
  • Is the medication for a condition that is considered to be chronic or long-term? If so, does the patient have an established stable, compliant history with the medication?
  • Is the patient unable to visit a new primary health care provider in a timely manner?
  • Is the patient at an increased risk of harm by filling or refilling the medication? (Or conversely, is the patient at an increased risk of harm if the medication is not provided in accordance with the original prescription?)
  • If the prescriber was still practicing, would I have consulted with the prescriber for any reason before filling or refilling the medication?
  • Is there another option? Would providing an interim supply or prescription extension, be appropriate, if indicated?

  Regardless of the pharmacist’s decision, the patient should be advised to find a new or interim prescriber as soon as possible.

CPD Reminder

With annual registration renewal quickly approaching, registrants are reminded that practicing Pharmacists and registered Pharmacy Technicians are required to enter all professional development activities into their online Professional Development (PD) logs no later than November 30, 2016 for the coming registration year.

To be eligible for registration renewal, registrants are required to participate in a minimum of 15 hours of professional development learning activities between December 1 and November 30 of each PD year. Of the 15 hours, a minimum of 7.5 must be from accredited learning activities (i.e. programs that have been accredited for no less than a total of 7.5 CEU’s) with a balance of 7.5 hours of participation in either accredited or non-accredited learning activities.

Further information can be found by visiting the Professional Development page of the website or by viewing the Standards of Practice – Professional Development for Pharmacists and Pharmacy Technicians, available on the Standards, Guidelines and Policies page of the website.

2017 Annual Renewals

Annual renewals for the 2017 registration year have begun. An email has been sent to all registrants and Pharmacists-in-Charge with instructions on how to renew.

REMINDERS:

• Registrants will be asked to provide the carrier name, policy number and expiry date for their professional liability insurance.
• Pharmacists-in-Charge will be asked to provide pharmacy ownership information.
• Pharmacists-in-charge who have applied for conditional licence do not need to renew the pharmacy licence at this time.




Registrants are advised to have this information handy before beginning the online renewal process. Once the renewal is started it cannot be saved and resumed. Additionally, after two hours, the system will automatically log you out. Once completed, to print your receipt, please click View/Print Invoices and select the paid invoice as proof of payment.

Professional Development Reminder & FAQ

Pharmacists and Pharmacy Technicians are reminded that they will be required to enter all professional development activities into their online Professional Development (PD) logs no later than November 30, 2016 in order to be eligible to renew their registration.

Registrants are required to participate in a minimum of 15 hours of professional development activities between December 1 and November 30 of each PD year. Of the 15 hours, a minimum of 7.5 must be from accredited learning activities (i.e. programs that have been accredited for no less than a total of 7.5 CEUs) with a balance of 7.5 hours of participation in either accredited or self-assigned learning activities.

Can I claim all 15 CEUs from one source?

Yes, there is no restriction against this. While pharmacists are encouraged to obtain professional development from a variety of sources, it is not mandatory. If you have completed one course or program that fulfills the full requirement you may enter it as such. The exception is that a maximum of 5 CEUs per year may be claimed for completion of the Pharmacist’s Letter CE-in-the-Letter.

I took a program with several learning modules. Do I need to record each module individually?

The Documentation section of the Professional Development page offers specific advice on recording programs with multiple modules where one certificate of completion was assigned.

How many CEUs can I claim for taking First Aid or CPR?

In accordance with the Professional Development Standards of Practice, a registrant may self-assign 1 CEU per year for completion of CPR or First Aid courses.

How do I document my service as a preceptor?

Registrants may self-assign 0.5 credits per week for service as a preceptor up to a maximum of 6 credits per year. The instructions to enter this online can be found at http://nlpb.ca/media/Recording-Service-as-a-Preceptor-on-Your-Online-Learning-Portfolio-Sept2015.pdf

I wrote the PEBC Qualifying exam in 2016. How many CEUs may I claim and how do I document it on my learning portfolio record?

You may claim 15 CEUs upon successful completion of Parts I and II, or 5 CEUs upon successful completion of Part II only. It can be documented as follows:

• Program Title: PEBC Qualifying Exam, Parts I and II
• Provider: PEBC
• Speaker/Author: N/A
• Program Approved By: Select “Other” and type PEBC in the blank field
• Number of CEU’s Accredited: 15
• For all of the Learning Objectives: Type N/A

Further information, including good examples of how to document your learning, can be found by visiting the Professional Development page of the website. To view the Standards of Practice – Professional Development for Pharmacists and Pharmacy Technicians in their entirety, visit the Standards, Guidelines and Policies page of the website.