The PostScript Archives 2020

March is Pharmacy Awareness Month: #whatwedoinpharmacyNL

March 1-31 is Pharmacy Awareness Month and NLPB would like to try something different this year to create public awareness of pharmacy practice in Newfoundland and Labrador (NL).

Internationally, the social media hashtag “#whatwedoinpharmacy” has gained some popularity as a pharmacy public awareness campaign for pharmacy professionals to talk about their everyday activities with the goal of better explaining what it is they do.

During the month of March, NLPB will be using its Twitter and Facebook accounts to share messages about the role of the regulatory body in NL pharmacy.

We also encourage pharmacy professionals to get involved and engage by using the hashtag #whatwedoinpharmacyNL to provide insight on your daily activities and share how you contribute to patient safety and quality health care.

Let’s take this opportunity to educate the public on what pharmacy looks like in NL, and how pharmacy professionals contribute to safety and quality care in the province!

Board Member Elections 2020: We want your expertise on our Board!

NLPB’s job is to promote and protect the health and well-being of the people of Newfoundland and Labrador (NL) by regulating the pharmacy profession and advancing pharmacy practice. We have four positions on our Board that are up for grabs this year.

• In Zone 5, we need one pharmacist who is employed the majority of their time in a hospital.
• In Zone 6, we need one pharmacy technician.
• In Zone 7, there are two pharmacist positions available.

Registrants in these zones received an email on February 7, 2020 with the nomination form and links to information about the Board, NLPB’s strategic action plan and more. If you’re thinking about becoming involved with NLPB — this is a great opportunity to increase your knowledge about your regulatory body and to be a part of the movement to protect the public interest.

All nominees are required to review So you want to be a Board member before submitting a nomination form.

The deadline for nominations is March 8, 2020.

Electronic Prescription Requirements

With the continued roll-out of NLMA’s eDOCNL project and the release of other electronic prescribing systems, NLPB has received an increase in questions related to electronic prescriptions. A response to this question, among others, is included on the Frequently Asked Questions About Pharmacy Practice page and is updated as new information and technologies become available.

Pharmacy professionals are reminded that, as with all prescriptions, they must be able to ensure the authenticity of prescriptions that have been generated electronically and be confident that the document presented to them has not been replicated or altered.

At this time, prescriptions generated as follows are considered to be acceptable:

• Prescriptions generated electronically by a prescriber’s password-protected electronic medical record (EMR) and faxed directly to a pharmacy.
• Prescriptions generated electronically, printed, hand-signed by the prescriber, and faxed to a pharmacy from the prescriber’s/clinic’s fax machine.
• Prescriptions generated electronically, printed, hand-signed by the prescriber, and given to the patient to bring to their pharmacy.

The following would NOT be acceptable:

• Prescriptions generated electronically, with pre-printed signature images that are given to the patient to bring to their pharmacy, without being hand-signed or initialed by the prescriber.
• Prescriptions sent via email.
• Prescriptions for drugs referenced in section 4.(1) of the Pharmaceutical Services Regulations – i.e. the “Drugs Required to be Written on Tamper Resistant Pads”.

Provincial Drug Schedules Updated To Reflect NAPRA Policy Changes

Updates to the Newfoundland and Labrador Provincial Drug Schedules have taken place to reflect changes by NAPRA to their Natural Health Products (NHPs) policy.

The National Drug Schedules (NDS) were developed before Health Canada began regulating the sale of NHPs in Canada. When NHP regulations came into force in 2004, many products included in the NDS became reclassified as NHPs. Since NHPs are beyond the scope of NAPRA’s NDS, NAPRA has decided to remove NHPs currently listed within the NDS in a stepwise, risk-based approach. See NAPRA’s full explanation.

Changes are as follows:

1) Effective January 2, 2020: NHPs currently listed within the Unscheduled category and within Schedule III will be removed from the NDS.

2) Effective January 2, 2022: NHPs currently listed within Schedules I and II will be removed from the NDS.

As of 2022, all products with a Natural Product Number (NPN) or Drug Identification Number-Homeopathic Medicine (DIN-HM) from Health Canada will be considered outside the scope of NAPRA’s National Drug Schedules.

Please see the Provincial Drug Schedules page for more information.

Compounding Standards Implementation: Are you on track?

Based on recent results of QA assessments and questions received by NLPB, it seems that many registrants do not fully understand the requirements of the non-sterile compounding standards and the related implementation deadlines. Specifically, many pharmacies have yet to complete the activities of Phase 1, which should have been completed by December 31, 2019. It is critical that pharmacists-in-charge and compounding supervisors assess where they are with implementation of the standards and address deficiencies from Phase 1 early in the year so that they can still achieve full implementation of the applicable standards by the December 31, 2020 deadline.

Implementation of sterile compounding standards is primarily a focus for hospital pharmacies throughout the province. Pharmacists-in-charge and compounding supervisors of affected practice sites are expected to have an action plan in place to meet the implementation deadlines set out by the Board and are encouraged to submit an application for renovation as soon as possible. If you have questions about sterile compounding standards, contact NLPB Practice Site Assessor Ken Walsh at kwalsh@nlpb.ca.

Please review the full “Compounding: Are you on track?” article in the Winter 2020 Apothecary. We also have a new Compounding FAQ posted to nlpb.ca.

Assessing Appropriateness of Drug Therapy: Buprenorphine-naloxone for pain management

In recent months, NLPB has received inquiries from pharmacists regarding the prescribing and dispensing of the buprenorphine-naloxone combination product (Suboxone® or generic equivalent). As per the drug product monograph for Suboxone®, buprenorphine-naloxone is approved for the treatment of opioid dependence in adults. The intention of the naloxone component is to deter intravenous misuse. When used for the treatment of opioid use disorder, patients prescribed buprenorphine-naloxone should be carefully monitored within a framework of medical, social and psychological support as part of a comprehensive opioid dependence treatment program. While single entity buprenorphine (e.g., the transdermal patch Butrans®) is indicated for the treatment of pain, the combination therapy buprenorphine-naloxone has not been approved by Health Canada for pain management; therefore, prescribing of buprenorphine-naloxone for pain would be considered “off-label.” Furthermore, the NLPB Standards for the Safe and Effective Provision of Opioid Agonist Maintenance Treatment are not relevant to the use of buprenorphine-naloxone for pain management unless the patient has a concurrent opioid use disorder.

Faced with a situation where buprenorphine-naloxone is being prescribed for pain, pharmacists are expected to rely on their knowledge, skills, patient assessment and professional judgment to act in the best interest of the patient and determine the appropriateness of drug therapy, just as they would be expected to do so with any other prescription. Pharmacists may need to collect information regarding the rationale for treatment choice from the prescriber, as well as do their own research regarding when buprenorphine-naloxone may be considered an option for treatment of pain and suggested dosing for this indication. Supporting documentation for decision-making should be filed in a retrievable manner in the dispensary – ideally in the patient’s record.

Assessing the appropriateness of drug therapy is a core professional responsibility of pharmacists as described in the NLPB Standards of Pharmacy Operation and the Standards of Practice for Canadian Pharmacists. Pharmacists are encouraged to review these two documents to re-familiarize themselves with these expectations.

Important messages regarding COVID-19

1) Remember your duty to report notifiable communicable diseases

Given the current world outbreak of COVID-19, it’s important to remind registrants of the Public Health Protection and Promotion Act (PHPPA) and Public Health Protection and Promotion Regulations. The PHPPA creates measures for the early detection and management of health risks to the population of Newfoundland & Labrador, including measures to help monitor and minimize the spread of communicable disease.

In order to help monitor and minimize the spread of communicable disease, the PHPPA mandates that pharmacists, and other health care professionals, report SUSPECTED or CONFIRMED diagnosis of notifiable communicable diseases. A notifiable communicable disease is one found on the Notifiable Disease List (included below). As a front-line health care professional, you may be the first one to suspect the presence of a notifiable communicable disease in a patient and in this particular case, COVID-19 (which falls under “all disease outbreaks, unusual disease clusters and unusual disease occurrences” that have to be reported immediately to 1-866-270-7437).

2) Keep informed with messages from the Department of Health and Community Services

In particular, remember, if someone (you, a patient, a family member, a coworker) are experiencing symptoms: fever, coughing, difficulty breathing, pneumonia in both lungs — call 811 immediately and advise of your condition. They will direct you on how best to proceed given your situation.

3) Visit Health Canada’s COVID-19: For health professionals page

This page has up to date guidance on early recognition and source control, as well as precautions for preventing the transmission of infection in healthcare settings, and more.

Stay tuned for ongoing information and messages to be provided regarding COVID-19.

What you need to know about PrescribeIT as of March 2020

PrescribeIT is a national e-prescribing service developed by Canada Health Infoway. The service permits prescribers to transmit a prescription electronically between a prescriber’s electronic health record (EHR) and the pharmacy management system (PMS); it is important to note that PrescribeIT is not something that can be integrated directly into the Pharmacy Network — it is in fact a separate entity.

In January, PrescribeIT began a pilot in Newfoundland and Labrador (NL) at a community pharmacy in Bonavista. The pilot, or proof of concept, project is an opportunity to examine the functionality of PrescribeIT service in our province. In accordance with provincial stakeholders, namely Newfoundland & Labrador Centre for Health Information, NLPB wants to ensure that this solution is the best fit for our EHR environment before it is approved to officially launch in NL.

The pilot project is a “work with you approach” recognizing that our communities consist of other members of NL health care beyond physicians who are able to prescribe, such as nurse practitioners and pharmacists. In mid-March, an analysis of the pilot will be completed which will include the impact of workflow and patient safety risks. Once the results are in and reviewed thoroughly, NLPB will provide further updates regarding the use of PrescribeIT in NL from a pharmacy practice lens.

Until then, if you have any questions regarding the pilot project or the use of PrescribeIT in our province, feel free to email inforx@nlpb.ca.

Board Member Elections 2020: Nominations are IN!

Thanks to all registrants who put their names forward for Board Member Elections 2020, the deadline for nominations was March 8.

In accordance with the nominations we received this year, there will be elections in two zones — Zone 5 (Hospital) and Zone 7 (At large). Ballots will be circulated in these zones on April 9 with a deadline to vote on May 1. Viewing of the votes will take place on May 4. More information and details regarding the elections will be circulated closer to the election date.

If you are interested in joining the NLPB team as a Board or committee member, keep your eyes open and apply for opportunities.

COVID-19 office closure – we’ll keep you posted

As you may have already been aware, the NLPB office has been closed to the public due to the COVID-19 pandemic since March 18. Staff members have reconvened virtually from home and are still working regular business days to support you during this time. While things are operating a little differently right now, please know that NLPB is here to continue delivering activities in each of the portfolios–professional practice, quality assurance, complaints and discipline, and registration and licensing; although, the activities may have taken an alternate direction due to COVID-19 for now. As we proceed through this time, we ask that you have patience with us in terms of our replies because at any given moment we may be experiencing an influx of requests. Nevertheless, we will get back to you.

As for when the office will physically be open to the public again, that will be determined and announced at a later date when government direction and advice is provided. As soon as we have more information we will let you know. Until then, every day we are learning to exist and work collaboratively in a virtual environment.

2019 AGM, Annual Report, 2020 Board Elections

Our strategic goals and planning have also been affected by the pandemic. The beginning of May was scheduled to be our Annual General Meeting (AGM) and the release of our Annual Report for 2019. With current government lockdowns, and physical distancing measures in place, these things will look different this year. A new date for our AGM and the delivery of our Annual Report will be announced in the weeks to come. Our 2020 board elections will also be rescheduled to take place at a time when registrants will be better able to focus on the election. The decision to reschedule these events was made in part because the majority of our resources are presently dedicated to safely navigating through COVID-19, but also so we don’t subject you—our registrants—to an abundance of things that may distract from the already demanding task at hand.

Thank you for your cooperation and all of your efforts during this time.

National Volunteer Week 2020

We can’t let this week pass by without expressing how very thankful we are for all of the individuals who have volunteered their time to contribute to the advancement of self-regulation of pharmacy practice in Newfoundland & Labrador. Our volunteers consist of elected members, public appointments and registrant volunteers–thank you for your time and greatly valued contributions.

Administrative Professionals Day – Wednesday, April 22

April 22 this year was officially recognized as Administrative Professionals Day. NLPB staff would like to give a huge shout out to our small but mighty administrative team seen above. There is a good chance that you have spoken, or speak, to our administrative team quite often as they complete many important tasks in the run of a workday on behalf of NLPB.

Please join us in sending them a virtual THANK YOU for all that they do to keep things running for the rest of NLPB staff, registrants and the public!

2020 Board Elections–Cast your vote!

Voting in Zone 5 and 7 now open

Voting is open for NLPB Zone 5 and 7 Board Elections. The elections are held through our secure and confidential elections portal.

• To access the election portal, visit nlpb.ca and click on Registrant Login
• Once logged in, click on the link called View Candidates and Cast Your Vote

The deadline for casting your vote is 11:59 pm on August 7, 2020. The successful candidate will be announced at the NLPB Annual General Meeting (date to be announced in the coming weeks).

Extended Pharmacy Internship Information

Below is more information about pharmacy intern scope of practice, internship extension form and the emergency registration process that was sent to all interns on May 29

The COVID-19 pandemic has led public health officials to impose physical distancing requirements and restrict large group gatherings, which resulted in the postponement of Pharmacy Examining Board of Canada (PEBC) exams required for pharmacist registration. We understand that this is disappointing for new pharmacy graduates who are now delayed in starting their careers and who are looking for information about options while awaiting the opportunity to complete the required PEBC exams.

As communicated on May 21, the majority of NLPB’s registration requirements are set out in the Pharmacy Act, 2012 (Act), meaning that changes can only be made by the Government of NL and not by NLPB independently. On May 5, 2020, the NL House of Assembly passed a bill revising the Act to allow for emergency registration of pharmacists and pharmacy technicians in specific situations. The bill received Royal Assent and became law on May 6, 2020.

Based on provincial legislation, there are two options for new graduates in NL:

1) Practice as an intern under the supervision of a pharmacist until such time to successfully complete PEBC exams and meet the requirements for registration as a pharmacist.

2) Apply for emergency registration in collaboration with employer. NLPB can issue emergency registration only in very specific circumstances where there is an immediate need for pharmacist or pharmacy technician services due to an actual or potential threat to public safety, health, or welfare, or with a ministerial request.

If an intern wishes to continue practicing as an intern until fully able to meet the requirements for registration as a pharmacist, here are the next steps:

• • Register for and complete the NLPB Pharmacist Internship.
  • Once the NLPB Pharmacist Internship is completed, submit the Application to Extend Registration as an Intern to extend registration as a pharmacy intern until registered as a pharmacist, or December 31, 2020, whichever comes first. This registration can be further extended, if necessary.

It is the intern’s responsibility to ensure that liability insurance is maintained and meets the NLPB Professional Liability Insurance Requirements for Registration.

• If an intern wishes to be authorized to administer injections once registered as a pharmacist, the intern should use the Pharmacy Intern Record of Injections form to document each injection administered to demonstrate that the intern has remained competent. (See the FAQ for more information on this requirement)

For answers to specific questions about this extended registration as an intern and an intern’s scope of practice, see here.

NLPB Office Update

With the move to Level 2 of the provincial COVID-19 Alert Level System, NLPB staff have returned to working from the NLPB Office on Kelsey Drive. However, the office remains “closed” to non-staff members, except by appointment only, at this time. If you need to visit the NLPB Office, please call 753-5877 or email inforx@nlpb.ca to make an appointment before visiting.

We would also like to take this opportunity to welcome Sonya Doran to our team as Office Administrator (Leave Replacement). Sonya comes to us from the Powell Group of Companies and has experience in human resource management, as well as office and business administration. Sonya will replace Meghan Handrigan while she is on leave for the next 12 months. We also note that Communications Specialist, Amanda Martin, and Legal Counsel, Natalie Payne, are also on leave at this time.

2020 Board Elections–Cast your vote!

Voting is now open for NLPB Zone 5 (Hospital) and Zone 7 (At Large) Board Member Elections. The elections are held through our secure and confidential elections portal.

• To access the election portal, visit nlpb.ca and click on Registrant Login
• Once logged in, click on the link called View Candidates and Cast Your Vote

The deadline for casting your vote is 11:59 pm on August 7, 2020. The successful candidate will be announced at the NLPB Annual General Meeting (date to be announced in the coming weeks).

Clarification Regarding Medication Labelling Requirements

Recently, NLPB has received questions from registrants regarding the requirement to label medication containers that are contained within an outer package – for example, inhalers or eye drops.

Generally speaking, products contained within an outside container/package are expected to be appropriately labelled with all of the required information outlined in Section 3.6 c) of the Standards of Pharmacy Operation – Community Pharmacy (SOPO-Community). Furthermore, section 3.6 d) states that in the case a drug container is too small to accommodate a full label, a trimmed prescription label may be affixed that contains the minimum information – including prescription number, dispensing date, patient name, and medication name. The smaller product container should then be placed in a larger container/package with the complete prescription label and the patient should be counselled to keep the small container inside the larger one.

This requirement is intended to support patients in getting the most benefit from their medication by ensuring that the instructions for use are readily available for reference, even if the outer packaging is discarded inadvertently.

Memo from College of Registered Nurses of NL

Please see the attached MEMO from the College of Registered Nurses of Newfoundland and Labrador regarding prescriptions written by interim nurse practitioners.

Provincial Opioid Dependence Treatment (ODT) Centre of Excellence- Stay up-to-date!

The provincial ODT Centre of Excellence regularly distributes practice resources, newsletters, webinar invites, and other information pertinent to the treatment of opioid use disorder. If you would like to join their distribution list, contact Chelsea Hynes at 709-752-4298 or Chelsea.hynes@easternhealth.ca and she will add you to their list of over 600 contacts representing different stakeholder groups throughout the province.

2020 NLPB Election Results

As previously communicated, this year elections were held to elect registrants from Zones 5, 6, and 7 to the Newfoundland and Labrador Pharmacy Board. The election process began with a “Call for Nominations” that was emailed to all registered pharmacists in Zones 5 and 7 and to all registered pharmacy technicians in Zone 6 on February 9, 2020.

• Two nominations were received for Zone 5 – Brittany Churchill and Nicole MacDonald
• One nomination was received for Zone 6 – Jillian Thorne
• Three nominations were received for Zone 7 – Tim Buchanan, Taggarty Norris and Joan Roach

Voting commenced on June 2, 2020 and concluded on August 7, 2020.

The results of voting are as follows:

• Elected from Zone 5 – Nicole MacDonald
• Elected by acclamation from Zone 6 – Jillian Thorne
• Elected from Zone 7 – Tim Buchanan and Taggarty Norris

We would like to welcome all new members to the board and give our thanks and well wishes to out-going board members, Brittany Churchill, Chad Parsons, and Colleen Squires.

To view the NLPB board for 2020-21 in its entirety, please visit the Board Members page of the website.

August NLPB Board Meeting Update

On August 14, 2020, the NLPB board met via video conferencing in order to meet the business requirements of the NLPB while still limiting travel and maintaining physical distancing measures.

At this meeting, the board approved revisions to both the NLPB Code of Ethics for Pharmacists and Pharmacy Technicians and the Standards of Practice regarding the Facsimile Transmission of Prescriptions and Personal Health Information as detailed below:

• Code of Ethics – Following an internal and jurisdictional review, a number of the “Guidelines for Application” in the Code of Ethics have been either revised or relocated within the document. It is intended that these changes will fill a number of noted gaps as well as clarify sections that have been identified as confusing or ambiguous.
• Standards of Practice regarding the Facsimile Transmission of Prescriptions and Personal Health Information – In addition to language throughout the document being revised for currency and relevancy to practice, the following two sections were also deleted:
  • The requirement that registrants confirm ALL faxed prescriptions for drugs subject to the Tamper Resistant Prescription Drug Pad Program; requiring instead that registrants use their professional judgement to authenticate and validate prescriptions as they determine is appropriate.
  • The requirement for “Signed certification that the prescription represents the original of the prescription, the addressee is the only intended recipient and there are no others, and the original prescription will be invalidated or retained so that it cannot be re-issued.”

Please visit the Standards, Guidelines, Policies, and Positions page of the website to view the revised documents.

Emerald Award Recipients

Unfortunately the COVID-19 pandemic has prevented NLPB from holding its awards ceremony this year. We are disappointed that we are not able to celebrate awards recipients in person but would like to take this opportunity to recognize the following registrants for reaching 35 years of registration with the Newfoundland and Labrador Pharmacy Board:

Thank you for your service to the people of Newfoundland and Labrador and congratulations!

Sublocade: A New Option for Opioid Agonist Maintenance Treatment (OAMT)

Sublocade is a newer formulation of buprenorphine that is administered as a monthly injection into the abdomen. It is indicated for moderate to severe opioid use disorder and was recently approved for special authorization coverage under the Newfoundland and Labrador Prescription Drug Plan (NLPDP). To support health professionals in providing access to this additional treatment option, the Provincial Opioid Dependence Treatment Centre of Excellence released a Sublocade Bulletin on July 17, 2020. It includes general information about Sublocade and its place in therapy, training requirements for various health professionals, NLPDP coverage criteria, drug distribution information, and various practice resources.

Please note that in order to dispense Sublocade, pharmacists MUST:

• be authorized by NLPB to participate in OAMT;
• be dispensing it from a pharmacy that is registered with NLPB to provide OAMT services; and
• complete any education that is necessary to safely provide care to patients (e.g. the manufacturer-provided program available at http://www.sublocadecertification.ca/).

It is important for pharmacists to also be aware that Sublocade can only be purchased by pharmacies through a controlled distribution process established by the manufacturer and that, for safety reasons, pharmacists MUST dispense Sublocade directly to the prescriber or clinician authorized to administer the drug – i.e. the medication CANNOT be released to patients or their agents.

Section 56 Exemption Extended by Health Canada

Pharmacists are advised that Health Canada has extended the temporary Controlled Drugs and Substances Act (CDSA) Section 56(1) exemption authorizing pharmacists to:

• Prescribe controlled substances for continued therapy (within the framework of the NLPB Standards for Prescribing by Pharmacists.)
• Transfer prescriptions for controlled substances to other pharmacists within NL (prescriptions for narcotics and controlled drugs cannot be transferred from or to another province).
• Transfer prescriptions for benzodiazepines or targeted substances (“BZ/TS”) more than once.
• Permit another appropriate individual to deliver prescriptions for controlled substances to patients, providing the documentation requirements outlined in the exemption are followed.

The original exemption, which expires on September 30, 2020, will now be extended until September 30, 2021, or until such time as it is replaced by another exemption or revoked.

Updates to the Provincial Drug Schedules

The following additions to the Provincial Drug Schedules (in relation to a new product coming on the market) have been approved by the board, effective August 13, 2020 to reflect the NDSAC recommendation of June 26, 2020, finalized on July 28, 2020:

• “Acetaminophen and ibuprofen in oral, fixed-dose combinations, in package sizes containing either more than 20,000 mg of acetaminophen or more than 6,000 mg of ibuprofen” has been added to Schedule II.
• “Acetaminophen and ibuprofen in oral, fixed-dose combinations, in package sizes containing 20,000 mg or less of acetaminophen and 6,000 mg or less of ibuprofen” has been added to Schedule III.

As follow up to our previous PostScript article regarding revisions to the Drug Schedules to reflect changes to NAPRA’s Natural Health Products (NHPs) policy, NAPRA has indicated that while it was originally intended for the entries in Schedule III related to ephedrine and pseudoephedrine to be removed as of January 2, 2021, at Health Canada’s request, these entries will now be removed on January 2, 2022, along with the entries for the remaining NHPs in Schedules I and II.

Please see the Provincial Drug Schedules page for more the full current Provincial Drug Schedules.

Health Canada Controlled Substances Bulletin

Please see the linked Controlled Substances Bulletin from Health Canada pertaining to the availability of a list of health care practitioners and pharmacists named in a notice of restriction. This filterable database lists licensed practitioners and pharmacists across Canada whose privileges respecting controlled substances have been restricted in accordance with the Controlled Drugs and Substances Act and its associated regulations.

Proof of Continuous Professional Liability Insurance Coverage

Upload your documentation to your online registrant profile

In accordance with provincial legislation and the NLPB Policy – Professional Liability Insurance Requirements for Registration, all registrants are required to provide proof of continuous professional liability insurance coverage. Each year, when you renew your policy and receive a copy of the new certificate/policy, you must upload an electronic copy of this documentation to your registrant profile. If you are uncertain how to do so, please click on this link for instructions: How to Upload Documents.

Emails to NLPB staff with copies of your documentation will not be accepted – all documentation must be updated and uploaded on your online registrant profile.

First Aid/CPR Certification for Administering Injections

While earlier in the pandemic, first aid providers temporarily suspended in-person courses and extended existing certifications through September, NLPB has been informed by a number of the providers that they are back up and running and will not be offering any further extensions.

In accordance with the Standards for the Safe and Effective Administration of Drug Therapy by Inhalation or Injection, pharmacists must provide proof of current certification in CPR Level C or HCP, and Emergency or Standard First Aid from a recognized provider at the time of application to administer, and are also expected to maintain current certification at all times while administering inhalations or injections.

Extended Registration as an Intern

Pharmacy interns are reminded that in order to continue to practice in the capacity of an intern following completion of the NLPB Internship Period, you must apply to NLPB to extend your registration as an intern.

If this application is not received and approved, your registration will lapse following the completion of the approved internship period. This means that you would not be permitted to continue to practice as an intern and would be expected to restrict your duties to those associated with unregulated pharmacy personnel such as pharmacy assistants and clerks.

For access to the Application to Extend Registration as a Pharmacy Intern visit the Authorization and Registration Information for Registrants page of the website.

Pharmacy Interns Administering Injections

Pharmacy interns are reminded that if they intend to apply for authorization to administer injections once registered as a pharmacist, they should ensure that they are using the Pharmacy Intern Record of Injections form to document each injection administered during their internship. This document will be submitted, along with the rest of the required documentation, to demonstrate that the intern has remained competent in this scope despite the fact that it has been more than one year since the initial training was completed.

Pharmacy Interns are also reminded that, if administering an injection, they must:

• • be registered as a pharmacy intern with the NLPB (including maintaining appropriate professional liability insurance);
  • have successfully completed an education and training program on the administration of injections that has received CCCEP competency-based (stage 2) accreditation OR all education and training on the administration of injections are part of the pharmacy program core curriculum;
  • have current certification in CPR Level C or HCP, and Emergency or Standard First Aid from a recognized provider (e.g. St. John Ambulance, the Canadian Red Cross); and,
  • be under the direct supervision of a pharmacist who has received authorization from the NLPB to administer drug therapy by inhalation or injection.

For more information about this or other elements of an intern’s scope of practice, see the “Questions about Pharmacy Intern Practice” section of the Frequently-Asked Questions about Pharmacy Practice page.

Prescription Monitoring Program Compliance

As recently communicated by the NL Centre for Health Information (NLCHI), it has been noted that pharmacist compliance with section 8.(2) of the Prescription Monitoring Act has been quite low. As a reminder, this section of the Act states that “Before dispensing a monitored drug a dispenser shall…review the patient medication profile in the electronic health record relating to the individual for whom the monitored drug is being dispensed…”

Pharmacists are reminded that this is a legal requirement that cannot be delegated and is not replaced by the computerized drug utilization review (DUR).

A number of pharmacists have questioned whether or not the PMP requirements apply to the dispensing of medications related to opioid agonist maintenance treatment (OAMT) (daily and take-home doses) and the answer is – yes, it does. OAMT medications are not exempt from the PMP requirement noted above. In addition, the NLPB Standards for Safe and Effective Provision of Opioid Agonist Maintenance Treatment states that, prior to releasing each OAMT dose, pharmacists are expected to review the patient’s local profile, the Pharmacy Network profile, Administration Log, and any other applicable information necessary to determine that it is safe and appropriate to provide the patient with the prescribed dose.

Annual Registration and Licensing Renewal for 2021 – available online October 26th

Registration and Licensing renewal for 2021 will open on October 26, 2020. The deadline to renew registrant registrations and pharmacy licences is November 30, 2020. Registrants should note that fees can be paid by Visa, MasterCard, cheque, or money order – electronic funds transfer (EFT) is no longer an accepted method of payment. It should also be noted that no renewal is considered complete until the associated fee is received by NLPB. Please ensure that you allow sufficient time for your payment to be received and processed because, after the November 30 deadline, a late fee of 50% of the annual fee will be applied automatically. Registration fees are non-refundable.

Here are a few tips for registrants:

• You must have the minimum number of activities recorded in your learning portfolio before the system will allow you to renew. Registrants are advised to fully document each activity before renewing because there is a blackout period following renewal where you will not be able to edit your log. You will be notified by the end of January if you have been selected for the annual Professional Development audit.
• Before renewing, make sure you have your current professional liability insurance policy in an electronic format, ready to upload.
• Pharmacists who are authorized to administer injections will also need to upload their current first aid and CPR certificate(s).
• To change your registration category or notify the board of plans to lapse due to retirement, maternity leave, or other extended leave, please contact Aileen O’Keefe, Registration and Licensing Administrator, at aokeefe@nlpb.ca.

Pharmacists-in-charge should also note:

• Your own registration renewal must be completed before you will be able to renew the pharmacy licence.
• When renewing the pharmacy licence you will be asked to confirm pharmacy hours, staff, and ownership information (including owners’ contact information); to avoid delays, take the time to collect this information beforehand and have it ready to enter.

During the renewal period, the board office experiences a higher volume of calls and emails than usual; therefore, it may take more than the usual 2-3 business days to receive a response to your inquiry. To help expedite the process, please send registration and licensing inquiries via email to inforx@nlpb.ca so that we can efficiently triage your questions to the appropriate NLPB staff member.

Finally, please do not leave your renewal until the last minute. This could result in your registration or license renewal being delayed or having to pay extra fees if, for example, you don’t have all of the necessary information and/or documentation at hand or experience other difficulties that cannot be resolved before the deadline.

Registrants are also advised to review NLPB’s Annual Registration Renewal FAQ and Professional Development FAQ for additional information.

Update on Community Pharmacy Practice Site Assessment Program

NLPB has made the decision to resume community pharmacy practice site assessments during the last week of October 2020. In response to the ongoing COVID-19 pandemic, a modified process has been established allowing assessments to be partially completed by distance, reducing the amount of time NLPB assessors are on-site.

Key revisions include:

• A more extensive pre-assessment component.
• The Community Pharmacy Self-Assessment form will need to be submitted further in advance, two weeks prior to the assessment.
• Assessors may request that pharmacists-in-charge (PICs) submit additional information along with the self-assessment.
• Assessors will follow-up with PICs by telephone/email/video conference if additional clarification is needed before the on-site assessment.
• Assessors will spend less time on-site, ideally no more than 2 hours, focusing on assessing physical elements and documentation that cannot be appropriately assessed electronically.
• While on-site, NLPB assessors will follow Public Health orders as well as the pharmacy’s policy for COVID-19 risk mitigation, including wearing face masks and requiring pharmacy staff to wear face masks. Assessors will also travel with hand sanitizer and disinfectant wipes.
• Following the assessment, assessors will arrange a time to discuss the overall findings and areas for improvement with the PIC by telephone, email, or video conference.

The NLPB QA team is looking forward to working with pharmacy professionals on quality assurance initiatives again. On behalf of the board and NLPB staff, we thank you in advance for your patience and cooperation as we implement our revised processes.

October NLPB Board Meeting Update

On October 16, 2020, the NLPB board met via video conferencing technology. At this meeting, the board approved the Budget for 2021, revisions to the Standards for the Provision of Compliance Packages, and new Guidance for the Dispensing and Administration of Buprenorphine Extended-Release Injection (Sublocade®). This guidance document is supplementary to the Standards for the Safe and Effective Provision of Opioid Agonist Maintenance Treatment and the Standards for the Safe and Effective Administration of Drug Therapy by Injection or Inhalation.

Please visit the Standards, Guidelines, Policies, and Positions page of the website to view the full revised and new documents.

FAQ Recap – Do I have to be in my pharmacy to administer an injection to a patient?

The Injection Standards do not restrict pharmacists to performing injections within a pharmacy. The Standards were written intentionally to allow pharmacists to administer in locations other than a pharmacy, referencing the “location” where the injection is administered rather than the “pharmacy”.

Having said that, the expectation is that all of the standards are still met, and administering off-site could create certain challenges that the pharmacist would have to consider.

For example, the standards require the pharmacist to ensure that the location is designed and laid out to allow for all inhalations and injections to be provided in an environment that ensures visual and acoustical privacy and confidentiality, and that is clean, safe, and comfortably furnished for the patient. The area must also allow for suitable post-therapy observation and be equipped with all necessary emergency support equipment and supplies that may be required. Pharmacists administering off-site (whether that be in a private home, long-term care facility, outdoor area, etc.) would need to be sure the location meets these requirements and also consider what supplies they may need to bring with them.

Additionally, the assessment, documentation, and follow-up requirements of the standards must also be met. Pharmacists would have to plan for this and determine how they are going to meet this expectation, particularly if they need to access the electronic health record as part of their patient assessment or when completing documentation.

For more FAQs related to Pharmacy Practice, please visit the Frequently Asked Questions about Pharmacy Practice page of the website.

Recording Immunizations and Other Injections in the Electronic Health Record

Pharmacists are reminded that the Standards for the Safe and Effective Administration of Drug Therapy by Injection or Inhalation require pharmacists to record administration of injections in the provincial electronic health record.

Recently, in a memo sent to all pharmacists offering influenza vaccination, the Department of Health and Community Services communicated specific expectations for documentation of immunizations in the provincial electronic health record. Pharmacists are advised to contact the Service Desk at NLCHI if they have any questions about how to properly record the administration of the influenza vaccine, other vaccines, or other non-vaccine injections in the Pharmacy Network.

Health Canada Controlled Substances Bulletin

Please see the linked Controlled Substances Bulletin from Health Canada pertaining to post-consumer returns containing controlled substances.

Photos of Prescriptions are Not Enough

The NLPB is aware that mobile apps allowing an individual to forward an image of their prescription to a pharmacy in advance of picking up their medication are currently available. We would like to advise our registrants that these images are not equivalent to an original prescription and should not be used to prepare prescriptions in advance of receiving the original copy.

If an individual uses an app, text, or email to provide the pharmacy with a copy of a prescription, pharmacy team members may check their inventory to see if stock is available or offer an estimation on cost, but should not prepare the prescription before receiving the original, as this increases the risk of error and the possibility of creating inaccurate or duplicate records.

Did you know? – Compounding FAQ

Did you know that NLPB has an extensive list of Compounding FAQs on our Frequently-Asked Questions about Pharmacy Practice page?

For example,

• Can I continue to compound preparations that are assessed to be a higher level than my facility (for example, a Level B or C compound in a Level A space) until the final implementation deadline?

  That depends – can you safely make a high-quality compound? The high-level principle is that once you know better, the expectation is that you do better. If through the risk assessment process you determine that an ingredient in a compound poses a health risk to pharmacy staff, then you need to be able to mitigate that risk in order to continue compounding. Similarly, if you determine that you do not have the necessary information, equipment, or supplies to properly compound a given preparation, then the expectation is that you refer the patient to a pharmacy that has the capability to make a high-quality product. It is never okay to knowingly put patients or pharmacy personnel at risk.

For more FAQs related to Compounding and other Pharmacy Practice topics, visit the Frequently Asked Questions about Pharmacy Practice page of the website.

NLPB Staff Member Change

NLPB is pleased to announce that R.J. White has moved from part-time Practice Site Assessor (Community) to full-time Practice Consultant / Practice Site Assessor. In this position, in addition to conducting assessments of community pharmacies, R.J. is assisting with addressing practice questions from pharmacy professionals throughout the province and participating in other NLPB quality assurance and pharmacy practice initiatives. R.J. can be reached at rwhite@nlpb.ca or (709)753-5877, ext 108.

Regular reminders

• Registrant Contact Information – Registrants are responsible for ensuring that the contact information on their registrant profile, including email address and practice site, is accurate at all times. The NLPB primarily uses email communication to send newsletters, renewal reminders, practice site assessment information, professional development audit information, calls for interest for committees, and other alerts. If the email address on file is incorrect, important information may be missed and/or disclosed to the wrong person. If your contact information changes, please log into the NLPB Registrant Login to update your file with your new contact information as soon as you can.
• Forgot Your Password? – You can retrieve your NLPB Online Registrant Portal password at any time. Under the Login box, click the message that says, “Forgot your password? Click here to restore it.” On the next screen, enter your NLPB username, if you know it, or your email address. Click “Retrieve.” In a few minutes, you will receive an email with your username and password. Once you are logged into your profile, you can change your password.
• Receipts & Invoices – NLPB’s Registrant Portal maintains all receipts created by the system. If, for any reason, you need a receipt or to view an invoice, you can do so from your registrant profile. Once logged in, click on “Renewal Other/Invoices” and then select either “view invoice” or “print invoice” next to the one you are interested in.