Board Highlights - June 23, 2017

BOARD HIGHLIGHTS – JUNE 23, 2017 

Highlights from this meeting include the approval of the College’s audited financial statements for 2016/2017; new focus areas in the Pharmacy Professionals Review for pharmacy technicians in community practice; amendments to the Pharmacy Operations and Drug Scheduling Act bylaws that support the new pharmacy ownership requirements; Practice Review Program updates, and ongoing work on the Certified Pharmacist Prescriber Initiative.

Barbara Gobis presented learnings from the UBC Pharmacists Clinic team and the Board reviewed NAPRA’s position on Cannabis for Medical and Non-Medical Purposes.

The Board also provided direction for the development of bylaws and/or practice standards for Medication Reviews as well as requirements and training tools for pharmacy managers.

Livestream

You can re-watch all the June Board meeting presentations through the College’s Periscope Channel.

Auditor's Report

The Board approved the audited financial statements for fiscal year 2016/2017. These statements will be made available in the College’s 2016/2017 Annual Report. 

Practice Review Program

Practice Review Progress

Kris Gustavson, Practice Review Committee Chair, provided an update on the progress and ongoing work happening within the Practice Review Program for community and hospital practice. Next steps for the Practice Review Program include finalizing a report on the past year’s community pharmacy practice reviews and new monitoring of results and trends from hospital practice reviews.

Pharmacy Professionals Review Focus Areas for Pharmacy Technicians 

The Board also approved modifying the Pharmacy Professionals Review focus areas for pharmacy technicians in community practice to better reflect pharmacy technicians’ scope of practice

New Pharmacy Ownership Requirements – PODSA Bylaws Public Posting

The Board approved amendments to the bylaws, forms and schedules under the Pharmacy Operations and Drug Scheduling Act Bylaws that support the new pharmacy ownership requirements for a public posting period of 90 days.

In May 2016, the Provincial Government approved amendments to the Pharmacy Operations and Drug Scheduling Act (Bill 6) which included significant changes regarding the provisions for pharmacy ownership.

The amendments 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.

While these amendments are not yet in force, the College has been working with the Ministry of Health to align the implementation of new pharmacy ownership requirements in the Act with corresponding College bylaws.

The new requirements are scheduled to come into effect on March 1, 2018. 

Amendments to the Pharmacy Operations and Drug Scheduling Act Bylaws

• Distinguishing between “direct owners” and “indirect owners.”
• Broadening the meaning of “pharmacy” and “pharmacy license.”
• Harmonizing requirements and processes for issuing, renewing and reinstating a pharmacy licence.
• Setting eligibility requirements to hold a pharmacy license.
• Establishing a new Application Committee to review license applications that do not meet the requirements of the Act and bylaws.
• Clarifying that ownership of a pharmacy must be direct.
• Adding requirements for direct owners, indirect owners and managers to provide a Criminal Record History.
• Requiring direct owners, indirect owners and managers to comply with duties under the Pharmacy Operations and Drug Scheduling Act and Health Professions Act.
• Requiring direct owners, indirect owners and managers to give notice to the Registrar if certain events occur.

A more detailed summary of the PODSA amendments can be found on the College's dedicated resource page at bcpharmacists.org/ownership.

Engagement Process

Earlier this year, the College engaged with pharmacy owners and managers through workshops, discussions, and an online survey, to seek input on the new draft pharmacy licensing bylaws. Feedback was used to help inform the amendments to the Pharmacy Operations and Drug Scheduling Act Bylaws as well as the operational processes and IT enhancements needed to support the new requirements. A summary of the feedback provided has been published in the New Pharmacy Ownership Requirements Engagement Report.

The bylaw amendments will now go through a 90 day public posting period before finalizing the bylaws for filing with the Ministry of Health.

What’s Next?

The College will review and analyze the feedback received through the public posting and update the draft bylaws as needed. The amendments will be brought back to the College Board for a decision to file the bylaws with the Minister of Health in time for them to come in effect by March 1, 2018.

College staff are continuing to work on updating the pharmacy licensure process (including operational and IT changes) to support the new requirements. The College will also be developing resources to help guide registrants through the new pharmacy licensure processes, with a particular emphasis on helping all pharmacies move through the transition period.

To provide feedback on the bylaw amendments, visit bcpharmacists.org/bylaws-comment.

To learn more about the new pharmacy ownership requirements, visit bcpharmacists.org/ownership. 

Board Terms of Office Public Posting 

The Board approved amendments to the Health Professions Act bylaws for public posting to change the terms of office for elected board members to three years with a maximum of two consecutive terms (total of six consecutive years). The proposed changes are planned to be effective for the 2018 election.

Currently, the terms of office for elected board members are two years with a maximum of three consecutive terms (total of six consecutive years).

To facilitate this change, the Board also approved corresponding Board election cycle amendments whereby elections for four electoral districts are held in each of the first two years, and in the third year, no election is held. 

Standards for Medication Review Services

The Board directed the Registrar to develop bylaws and/or practice standards for Medication Reviews and to enforce mandatory training for pharmacists who wish to conduct them.

Medication Review services were introduced by PharmaCare in April 2011, with the objective to have pharmacists assist patients to better understand their medications and through this improve their health outcomes.

Medication Review Services provides patients with a one-on-one consultation with a pharmacist in a semi-private area of the pharmacy to discuss their prescription medications, as well as any over-the-counter medications, including vitamins and natural heath products they are taking. The service was introduced by PharmaCare in April 2011 with the aim of improving the health outcomes of patients who have been prescribed at least five medications in the last six months by helping them to better understand their medications. This service is of no cost to patients, but the pharmacy providing the service can claim a fee from PharmaCare by entering a record of a Medication Review on a patient’s PharmaNet record.

After reviewing hundreds of Medication Review documents that were the subject of complaints, the Inquiry Committee has observed an apparent pattern of this service being abused. In many instances, pharmacists have been found to be more concerned with patients meeting the eligibility criteria so they can bill for a Medication Review, even when those patients have no clinical need for one. Additionally, the Inquiry Committee has found a number of instances where patients were recorded as having received medication reviews without their prior knowledge or consent. 

Pharmacy Managers Requirements and Training 

The Board directed the Registrar to develop requirements and training tools as it pertains to the role and responsibilities of the pharmacy manager.

A pharmacy manager’s role holds significant responsibilities and cannot be taken lightly. Pharmacy managers must personally manage and be responsible for the operation of a pharmacy. As a result, more stringent eligibility requirements and rigorous training are needed to ensure safe and effective pharmacy practices for the public user.

The Inquiry Committee has come across a number of cases where it is apparent that some pharmacy managers do not understand their responsibilities and obligations to comply with legislation, as well as the consequences that can arise when they fail to monitor policies and procedures. The lack of understanding displayed by some pharmacy managers has resulted in complaints that could have otherwise been avoided. 

UBC Pharmacists Clinic Update

Barbara Gobis, Director of the Pharmacists Clinic in the Faculty of Pharmaceutical Sciences at UBC presented some of the literature and practical lessons learned by the UBC Pharmacists Clinic team. 

Certified Pharmacist Prescriber Draft Framework Update

The Board was given an update on the work happening on the Certified Pharmacist Prescriber Draft Framework to narrow the scope of pharmacist prescribing to within collaborative practice.

The work on the framework follows the November 2016 Board decision to amend the Certified Pharmacist Prescriber Draft Framework by narrowing the scope of pharmacist prescribing to within collaborative practice.

Collaborative Practice Pharmacist Prescribing

Pharmacist prescribing within collaborative practice would take place through interdisciplinary team-based care where physicians and nurse practitioners would continue to be responsible for the diagnosis, and have access to health records and diagnostics, including lab tests. Certified Pharmacist Prescribers would also be restricted from dispensing medications they prescribed for a patient.

Reasons for restricting pharmacist prescribing to collaborative practice:

• Interdisciplinary team-based settings
  Collaborative practice settings involve working closely in an interdisciplinary team to care for patients. In this setting, physicians or nurse practitioners provide the diagnosis – an area many other prescribers felt pharmacist prescribers would not have the expertise to do.
• Access to patient health information and lab tests
  Pharmacists working in collaborative practice settings already have access to patient health information and lab tests. Lack of access to patient information, and diagnostic tests (including lab tests) outside of interdisciplinary settings was a key point of concern identified by many pharmacists and other prescribers.
• Conflict of Interest
  Separating pharmacist prescribing from dispensing and business interests removes the concern for a potential business conflict of interest – a frequent point of concern for respondents.

The extensive feedback received through the 2016 engagement on pharmacist prescribing is also being used to revise the framework. It is also being revised to focus more closely on the benefit pharmacist prescribing brings to patient care.

Certified Pharmacist Prescriber Draft Framework

With this significant change in scope to the proposal for pharmacist prescribing in BC, the College needs to engage with stakeholders to solicit feedback on the revised Draft Framework.

Engagement is required to: 

• Learn how stakeholders feel about introducing pharmacist prescribing within collaborative practice in British Columbia.
• Hear from stakeholders on any risks that have not been identified and planned for in the revised Draft Framework, and identify any gaps that have not been addressed.
• Validate that by narrowing the scope of   pharmacist prescribing to within collaborative practice addresses initial concerns raised. 
• Receive feedback on how pharmacist prescribing could work in BC within collaborative practice.
• Provide the College Board with feedback on how stakeholders feel about pharmacist prescribing within collaborative practice, to help in decision making on next steps.

Analysis on the results of the engagement will be summarized in an Engagement Report and presented to the College Board in the fall of 2017.

Engagement Process

The final Certified Pharmacist Prescriber Framework will be presented to the Board together with the results of the engagement in the fall.

To follow this initiative’s progress and learn how to provide input, visit bcpharmacists.org/prescribing.

NAPRA’s Position on Cannabis for Medical and Non-Medical Purposes

The Board supports National Association of Pharmacy Regulatory Authorities (NAPRA)’s position on Cannabis for Medical and Non-Medical Purposes.

On April 13, 2017, the Government of Canada introduced the Cannabis Act, which would create a strict legal framework for controlling the production, distribution, sale and possession of cannabis across Canada. The proposed legislation focuses primarily on cannabis for non-medical purposes; the current program for accessing cannabis for medical purposes would continue under the new Act. The Act is currently not in force; it is being debated in the House of Commons. 

In May of 2017, NAPRA issued a memorandum  to its member organizations entitled NAPRA Statement on Cannabis, which sets out NAPRA’s position on the role of pharmacy practitioners in the distribution of cannabis for medical and non-medical purposes and summarizes the discussions of a meeting of the Council of Pharmacy Registrars of Canada on March 30, 2017.

NAPRA’s key position is that pharmacy practitioners must not be involved in the distribution of cannabis for non-medical purposes.

The NAPRA Board approved the above-noted Position Statement, in principle, at its meeting on April 26, 2017. The approval was provided with the caveat that NAPRA consult with its member organizations on the Position Statement, before it is finalized and released. 

Excellence Canada Update

College Registrar Bob Nakagawa provided an update on the College's work with Excellence Canada.

Using the Excellence, Innovation and Wellness (EIW) Standard, the College continues to see success in ensuring its organizational needs are being addressed, and its strategic initiatives are being realized.

The College is pursuing achieving the Silver Level of Excellence in the Canada Awards for Excellence by 2019.

​RECAP OF THE BOARD MEETING ON SOCIAL MEDIA