Board Highlights - February 15, 2019

Board Highlights - February 15, 2019

Highlights from this meeting include the Patient Relations Program Standard, amalgamation of committees, PODSA ownership update, guest presentations from the Therapeutics Initiative and BC Drug and Poison Information Centre, injection authority and more.

Board Welcomes New Public Members

The College of Pharmacists of British Columbia welcomes the appointment of two public representatives to its Board.

Anne Peterson and Katie Skelton were appointed in December 2018, by Minister of Health, Adrian Dix, to serve as public board members for a term of two years.

The Board would like to thank outgoing public members Jeremy Walden and Ryan Hoag for their years of service and many contributions to the College's ongoing efforts to protect public safety. 

Learn more: ReadLinks – College Welcomes New Public Board Members

Reserve Policy

The Board approved updates to the College’s reserve fund policy. The reserve helps to ensure long-term financial stability and allows the College to respond to varying economic conditions and changes affecting the College’s financial position.

The current Reserve Policy was approved at the February 2018 Board meeting, however, since then, the College’s Audit and Finance Committee has noticed that the Deferred Revenue Funds provide adequate cash flow. This, combined with the College’s 30 percent ownership share of College Place (its office building), and assurance of an easily obtained line of credit if needed, led the Committee to decide that the current reserve balance of $3,000,000 appears to be higher than necessary.

As a result, the Board has approved the Committee’s proposal to lower the reserve fund amount to $2,000,000.

Budget 2019/2020

The Board approved the proposed 2019/2020 budget. This budget continues to fund strategic plan activities while proposing nominal (i.e., a 2 percent cost of living adjustment) fee increases. 

The budget continues to draw upon reserve funds in order to minimize fee increases and permit a more gradual approach to accommodating the loss of revenue resulting from the loss of the PharmaNet contract, and to build up revenue from fees. 

The approved budget includes: 

• A nominal fee increase – approximately matching the Cost of Living Adjustment rate for BC, and matching the 2 percent increase projected in last year’s approved budget multi-year forecast. 
• Forecast for steady growth in reserves over time, allowing the College to avoid a rapid increase in the surplus in later years. 

Major Initiatives in 2019/2020

• PODSA Modernization bylaw review and process review.
• Continued review and improvements re PODSA Ownership processes.
• Excellence Canada Silver Certification submission and verification completed.
• Records management processes and staff training continue being rolled out.
• IT improvements to security (role-based access), moving cloud storage, iMIS upgrade, database improvements, and electronic records management implementation planned.
• Quality Assurance project – continue auditing CE credits.
• Finalizing the next Strategic Plan.
• Medication error reporting planning.
• Office expansion – for additional meeting room space.
• Implementation of Human Resources Management System (HRMS).

Patient Relations Program Standard

The Board approved a proposed Patient Relations Program Standard (“the Standard”) to be included under Schedule “A” – Code of Ethics of the Health Professions Act Bylaws, for a 60-day filing period with the Ministry of Health. 

The development of the Standard fulfills a requirement of the College to develop a patient relations program to prevent professional misconduct of a sexual nature, as outlined in s.16(2) of the Health Professions Act and s. 84 of the Health Professions Act Bylaws.

The Standard was developed using internationally identified best practices for patient relations, and aligns with the principles of the BC Health Regulators Framework for Patient-Practitioner Relationships. The Standard applies these principles to pharmacy practice, and enhances regulatory safeguards for protecting patients and patient relations by outlining registrant responsibilities in relation to:

• Professional boundaries and dual relationships; 
• Relationships with former patients; and, 
• The duty to report sexual misconduct.

It also raises awareness of registrants’ responsibility to educate themselves on professional ethics.

The Board originally approved the proposed Standard for a 90-day public posting period at its September 2018 meeting, during which only comment was received. 

Recognized Pharmacy Education Programs

The Board approved housekeeping amendments to Schedule “C” under the Health Professions Act (HPA) Bylaws on Recognized Pharmacy Education Programs, for a 90-day public posting period. Schedule “C” lists recognized pharmacy education programs in Canada and the United States, injection/intranasal drug administration programs, and recognized pharmacy technician programs in British Columbia.

The housekeeping amendments address changes to the list of recognized pharmacy education programs brought upon by the development of new programs, program name changes, and the discontinuation of some programs.

Share your comments by May 16, 2019.

Amalgamation of Committees

The Board approved the amalgamation of the Community Pharmacy Advisory Committee, the Hospital Pharmacy Advisory Committee and the Residential Care Advisory Committee into one committee to be called the “Pharmacy Advisory Committee.” This amalgamation will be effective on April 12, 2019.

While each of the three pharmacy advisory committees focus respectively on reviewing issues and providing recommendations within a specific practice area, their roles are virtually the same, and many of the issues they are asked to address are common to all types of pharmacy practice. As a result, amalgamating these committees will enable the College to make more efficient use of its resources. 

The new Pharmacy Advisory Committee Responsibilities are;

• To meet from time to time to review issues related to the practice of pharmacy that have been directed to the committee by the Board or the Registrar.
• Assist in the development of policies, procedures, guidelines and proposed legislation pertaining to pharmacy practice and standards.
• Assist in the development of information materials for circulation to practicing registrants.
• Recommend appropriate action to the Board or the Registrar regarding pharmacy practice issues.
• Work collaboratively across practice areas (e.g., community, hospital, residential care) to ensure a cohesive approach to common practice issues.

The new Pharmacy Advisory Committee will be effective on April 12, 2019, which aligns with the College’s annual recruitment of volunteer committee members. The Terms of Reference for the Community, Hospital and Residential Care Pharmacy Advisory Committees will be rescinded at that time.

Approval of Information Sharing Agreement

The Board approved an Information Sharing Agreement between the College and the Ministry of Health, to identify information that will be shared between the two parties, and demonstrate compliance with the Freedom of Information and Protection of Privacy Act.

The agreement enables the College to obtain information from the Ministry of Health to fulfill its duties under the Health Professions Act, the Pharmacy Operations and Drug Scheduling Act, and the bylaws made pursuant to these Acts and other related legislation. Similarly, the Ministry may wish to obtain information from the College, for instance, during investigations.

The Information Sharing Agreement outlines how requests will be made, how the information will be exchanged, as well as security considerations that each party will undertake with the shared information. In some cases it will stipulate or limit the purpose of the information request.

PODSA Ownership Update

Board Vice Chair and Chair of the Application Committee, Christine Antler provided the Board with an update on the progress of the new ownership requirements under the Pharmacy Operations and Drug Scheduling Act, introduced on April 1, 2018.

These changes permit the College to know the identity of all pharmacy owners, determine their suitability for pharmacy ownership and hold them accountable for providing safe and effective care by ensuring their pharmacies are compliant with legislative requirements for pharmacies in BC.

As of January 3, 2019, 750 licensed pharmacies have gone through the renewal process under the new ownership requirements, representing over 50% of the total number of pharmacies in the province. The College has also identified 531 Direct Owners of these pharmacies.

Learn more: bcpharmacists.org/ownership

The History and Future of the Therapeutics Initiative

James (Jim) Wright, Co-Managing Director of the Therapeutics Initiative, presented to the Board on the History and Future of UBC’s Therapeutics Initiative. 

The Therapeutics Initiative was established in 1994 by the Department of Pharmacology and Therapeutics in cooperation with the Department of Family Practice at UBC with a mission to provide physicians and pharmacists with up-to-date, evidence-based, practice information on prescription drug therapy. 

Mr. Wright outlined various interventions and policies that have been implemented by UBC’s TI over the years. Since its inception, UBC’s TI has produced a Therapeutics Letter and provided it to physicians and pharmacists 6 times a year providing the best available evidence and information regarding the benefits, harms and costs of different drugs.

Learn more about UBC’s Therapeutics Initiative on their website at: www.ti.ubc.ca 

BC Drug and Poison Information Centre: Who we are and what we do

Debra Kent and Raymond Li presented to the Board a brief overview of the BC Drug and Poison Information Centre (DPIC).

The BC Drug and Poison Information Centre is the provincial drug and poison information centre, a unit within the Environmental Health Services Division at the BC Centre for Disease Control. DPIC is a multidisciplinary service staffed by specially trained pharmacists, nurses and medical toxicologists.

DPIC pharmacists provide accurate unbiased therapeutic advice to healthcare professionals on questions regarding drug interactions, side effects, drugs in pregnancy and lactation, complex drug therapy, and alternative medication options. DPIC pharmacists and nurses respond to the poison information line 24-hours a day by providing first aid and treatment recommendations, often assisting in the decision making process regarding treatment strategies of the poisoned and overdosed patient.

DPIC also teaches and provides clinical rotations in toxicology for students and residents in pharmacy, emergency medicine and internal medicine. Drug information newsletters and overdose treatment guidelines are written for health professionals and poison prevention education and materials are provided for the public.

Working closely with public health agencies, DPIC’s expertise and data has helped inform and alert public health on issues such as the opioid crisis and ecstasy overdoses, foodborne illnesses, product safety, occupational poisonings, and emerging environmental threats. DPIC is monitoring adverse reactions to cannabis products. Recent DPIC research has focused on medication errors with insulin and drugs with narrow therapeutic margins, as well as drug interactions.

Injection Authority

Based on recommendations from the Drug Administration Committee, the Board directed the Registrar to remove current restrictions on pharmacist injection and intranasal administration of medications, while restricting the administration of injections for cosmetic purposes and retaining current age limit restrictions. 

The existing limits placed on injection drug administration are such that a practising pharmacist must not administer a drug by injection or intranasal route unless it is for the purpose of immunization. 

The Drug Administration Committee met in October and December 2018 to discuss whether there should be a broad removal of restrictions on injection authority or whether there should be an exclusion list of medications that a pharmacist should not administer. They also discussed if there should be a step-wise approach in removing the restrictions on injection authority. The committee concluded that more information was needed on the experience to-date of other pharmacy regulatory authorities (PRAs) in Canada that have granted broad injection authority. 

In order to gather this information, the Committee sent out a questionnaire to all PRAs in Canada who grant broad injection authority, to learn of their experiences and patient safety considerations. 
 
Based on the results of the questionnaire, the Drug Administration Committee recommended the following amendments to the Health Professions Act (“HPA”) Bylaws, Schedule “F”, Part 4 “Certified Practice: Drug Administration by Injection and Intranasal Route, Standards, Limits and Conditions”: 

• Amend the “Limits” to allow for injection and intranasal administration of any Schedule I and II medication with the exception of Schedule 1A. 
• Amend the “Limits” to restrict pharmacists from administering injections for cosmetic purposes. 
• Amend the “Conditions” to outline new training requirements for injecting drugs and substances beyond immunizations, if required. 
• Maintain the existing “Limits” on the age restrictions for injection and intranasal drug administration. 

Moving forward, the College will draft bylaw amendments based on the Drug Administration Committee’s recommendations and facilitate further engagement on the proposed changes and related accredited training requirements. The proposed bylaw amendments will then be brought to the September 2019 Board meeting to seek approval for a 60-day filing period with the Ministry of Health. 

Committee Updates

The following College Committees provided updates on their activities since the previous Board meeting:

• Governance Committee
• Hospital Pharmacy Advisory Committee
• Inquiry Committee
• Practice Review Committee
• Audit and Finance Committee
• Quality Assurance Committee
• Community Pharmacy Advisory Committee
• Jurisprudent Examination Subcommittee
• Discipline Committee
• Registration Committee
• Application Committee
• Ethics Advisory Committee
• Residential Care Advisory Committee

Recap of the Board Meeting on Social Media