Board Highlights - April 17, 2020

Board Highlights - APRIL 17, 2020

Topics include an update on the College's response to COVID-19; amendments to the Health Professions Act bylaws regarding verbal orders; and a medication delegation request.

Along with organizations across Canada, College staff and Board members have been doing our part to reduce the spread of COVID-19 by working remotely. As such, this month’s Board meeting was conducted virtually, via video conference.

COVID-19 UPDATE

Since our last meeting, the world has become a different place. On March 11, 2020, the World Health Organization declared the novel coronavirus, COVID-19, a pandemic, citing concern over alarming levels of spread and severity across the globe. In BC, our Provincial Health Officer, Dr. Bonnie Henry, declared a public health emergency on March 17, 2020. 

This crisis has created a number of challenges that we continue to address as part of the health system in BC. I want to first recognize all of BC’s pharmacy professionals for the indispensable role they are playing on the frontlines of this pandemic, ensuring that British Columbians continue to receive the highest standard of pharmacy care. 

The College Board and Staff have been working tirelessly over the past few weeks, developing measures to reduce any unnecessary strain on BC’s pharmacies, and provide our pharmacy professionals broader latitude to use their professional judgement and provide continuity of care during this challenging time. 

Notably, we have activated temporary registration for former and non-practicing pharmacy professionals, as well as issued a number of temporary authorizations for verbal prescription orders and delivery of OAT by non-pharmacists. 

We have also issued PDAP exemptions to all pharmacy professionals in BC and provided guidance to pharmacies on addressing potential exposures, staff shortages, and providing emergency refills to patients. And we will continue to work to support BC’s pharmacy professionals as this situation evolves. 

For a full list of these updates, as well as the most current COVID-19 information for the public and pharmacy professionals, please visit bcpharmacists.org/COVID19. 

I encourage you all to use the comprehensive COVID-19 resources we’ve provided on our website, and to stay up-to-date on the latest practice and policy changes. 

Along with organizations across Canada, College staff and Board members have been doing our part to reduce the spread of COVID-19 by only meeting remotely. As such, this month’s Board meeting was conducted virtually, via video conference. 

- Christine Antler, Board Chair

COVID-19 Impact on the College Budget

The impact of COVID-19 on Canadian Society has been significant. In addition to the strain it continues to place on our healthcare system, the novel coronavirus has also had a profound impact on the finances of Canadians. 

In recognition of this impact, the Board conducted a review the College’s projected 2020/2021 budget and decided not to proceed with operationalizing the planned registrant fee increases. 

The Board approved the College’s 2020/2021 budget at its February 14, 2020 meeting which reflected: 

• Strategic Plan activities 
• Continuing to implement best business practices throughout the organization 
• The multi-year budget and the impact on the closing reserve balance 
• Reviewing the College processes, looking for efficiencies and cost savings 
• Annual fee increases in order to generate additional revenue in the following year 

While the Board approved the budget for the 2020/21 fiscal year, the planned fee increases would primarily generate additional revenue in the next fiscal year, as they were originally slated to take effect late this year. These planned fee increases were required to support the College’s operational functions and strategic priorities, while maintaining an acceptable reserve balance. 

The bylaw changes required for these planned fee increases were originally slated for discussion at this board meeting. 

However, one month after this budget and the accompanying fee increases were approved, our world and operational plans changed drastically as a result of the impact of COVID-19.

Without knowing the full extent of the impact COVID-19 will have on the College, or how long this situation will last, the College will not proceed with operationalizing the fee increases approved in the 2020/2021 budget. Instead, the College will review the financial impact of COVID-19 once the state of emergency has been lifted, or when deemed appropriate. 

Amendments to HPA Standards of Practice - Pharmacist Verbal Orders

The Board approved proposed amendments to the Health Professionals Act Bylaws Schedule F Part 1 – Community Pharmacy Standards of Practice (CSOP) and Part 3 – Residential Care Facilities and Homes Standards of Practice (RCSOP) regarding the receipt of a written record of a verbal prescription. 

The amendments are intended to address a barrier that was identified where hospital discharge prescriptions written by pharmacists via verbal authorization from a physician are often not accepted by community pharmacies and residential care facilities as they do not meet the prescription requirements in the CSOP. 

Prescription requirements in the CSOP previously required that all prescriptions include the signature of the practitioner. However, verbal prescriptions written by a hospital pharmacist, via verbal authorization from a practitioner, do not include a practitioner signature and, as such, do not meet the CSOP prescription requirements.  

In order to address this barrier, the proposed amendments provide an additional subsection acknowledging verbal prescriptions as valid if the written record includes: 

• The name and regulatory college identification number of the practitioner 
• The name, college identification number and signature or initial of the registrant who received the verbal prescription 

Ensuring these requirements are included on the written record ensures accountability and traceability. 

Provisions within the RCSOP mirror the language for prescription requirements within the CSOP. As such, consequential amendments to the RCSOP are required. Additional minor amendments were also approved in order to address redundancies and ensure consistency throughout each document.

The proposed amendments will been submitted for filing to the Ministry of Health. Stay tuned for further communications on this coming change.

Medical Delegation Request: Anticoagulation Management Clinic

The Board approved a delegation request to authorize pharmacists at the Anticoagulation Management Clinic at the Jim Pattison Outpatient Care and Surgery Centre at Surrey Memorial Hospital to administer low molecular weight heparin (LMWH) injections as delegated by Dr. Mir I. Ali. 

The Anticoagulation Management Clinic (AMC) at Surrey Memorial Hospital is a pharmacist-led, physician-supported program that services patients diagnosed with acute venous thromboembolism. Pharmacists working at the AMC are required to be certified to administer injections and receive specialized training to inject subcutaneous LWMH injections. 

Delegation of a Medical Act
The College of Physicians and Surgeons of BC (CPSBC) allows persons other than physicians to be entrusted with performing a medical act via a Delegation of a Medical Act. When a medical act that is outside the scope of practice of another discipline is delegated, the responsibility for that act is shared. This means that the physician who delegates the act still has a responsibility to the patient, and the person who carries out the act must do so with care and diligence and is legally liable if negligent. 

The CPSBC and CPBC Boards must approve the delegation request for it to become effective. 

On March 5, 2020, the CPSBC Board approved this request from Dr. Ali to delegate pharmacists the administration of LMWH injections at the Anticoagulation Medical Clinic. 

Currently, the administration of injections, except for the purposes of immunization, is beyond the scope of practice of B.C. pharmacists, as per section 4(1) of the Pharmacists Regulation under the Health Professions Act. As such, a Delegation of a Medical Act is required to allow for pharmacists to administer LWMH injections.