Board Highlights - February 11, 2022

Board Highlights - February 11, 2022

Topics include the budget 2022/23, amendments to Drug Schedules Regulation, amendments to Telepharmacy Schedule "G", and amendments to the Drug Administration by Injection and Intranasal Route Standards, Limits and Conditions, and more.

How to Watch

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.

A recording of the February Board Meeting is available here:

LAND ACKNOWLEDGEMENT 

On behalf of the College of Pharmacists of BC, Board Chair Steven Hopp, acknowledged and thanked the Sylix Okanagan people on whose unceded traditional territories she chaired the February 11, 2022 meeting. With Board members meeting virtually in different locations across BC, Steven Hopp also acknowledged that Indigenous Peoples are the traditional stewards of the lands and waters from which each member attended the meeting from. 

To the Indigenous peoples of this place we now call British Columbia: We turn our minds to you and to your ancestors. You have kept your unceded homelands strong. We are grateful to live and work here.

The College Stands with the Williams Lake First Nation

Board Chair Steven Hopp offered the following statement on the recent discovery at the site of the former St. Joseph’s Mission Residential School in Williams Lake, BC.  

This past month, we were deeply saddened to learn of the discovery of 93 potential graves at the site of the former St. Joseph’s Mission Residential School in Williams Lake, BC.  

Speaking on behalf of the College Board, we offer our unwavering support and solidarity to the Williams Lake First Nation and all Indigenous People in BC and Canada as they continue to process this news.  

I’d also like to reiterate how vitally important it is for all health professionals to practice vigilant cultural humility and safety. To learn about and understand the impacts of residential schools on First Nations Communities in Canada; to acknowledge and reflect on the social issues faced by Indigenous Peoples, and to understand the historical contexts from which these issues originate. 

Read the statement from Murray Rankin, Minister of Indigenous Relations and Reconciliation.

Black History Month 

Board Chair, Steven Hopp, offered the following statement on Black History Month in Canada:

Black History Month is about honouring and celebrating the contributions that Black People have made and continue to make within Canadian history, culture and society.  

The 2022 theme for Black History Month in Canada is “February and Forever” which reminds us that actively recognizing and acknowledging the innumerable achievements on Black Canadians is something that we should be doing all year long, and not just in February.  

Which is why, on behalf of the College Board, I encourage you all to celebrate the role of Black Canadians in making BC and Canada a more culturally diverse, compassionate, and prosperous place to live.  

You can learn more about Black History Month at 

bcpharmacists.org/BlackHistoryMonth 

Budget 2022/23

The Board approved the 2022/2023 budget in order to support significant College work and initiatives over the coming fiscal year. 

The College has an essential role to play in regulating pharmacy practice in British Columbia, and ensuring public safety is protected – a role made even more vital by the COVID-19 pandemic and illicit toxic drug crisis. Regulation, along with patient needs and the healthcare environment have grown increasingly complex, resulting in increasing cost pressures to fulfill its legislated duty. 

Over the past year, where possible, College staff continued to reduce expenditures. However, there are new activities, including Strategic Plan activities, investigating information system changes with iMIS Cloud, and legal cases that require additional expenditures. 

Access to the reserve funds enables the College to appropriately address the College’s identified highest risks on our risk register, namely ensuring currency of College IT infrastructure given evolving IT and cybersecurity risks and appropriate planning for current legal risks. At the same time, the College needs to continue to build up acceptable reserve balances as part of its muti-year budgeting process to ensure the College is financially secure and fiscally responsible. 

The new budget provides a modest fee increase for registrants and will help to return College finances to a balanced budget and fully funded reserves, while enabling operations to meet the College’s Mandate and enabling staff to achieve the Strategic Plan’s goals. 

In developing the 2022/2023 budget, particular attention was paid to the following areas:

• COVID-19 – Public Health Officer Orders, new case projections and vaccination roll-out and the impact this would have on operations and the budget.
• The Multi-Year Plan (particularly the Reserve balances in 2023/24 and 2024/25).
• The inclusion of Strategic Plan and operational large projects activities, timelines and resource requirements.
• Continuous improvement, innovation, and the use of best practices.
• Feedback from Customer Satisfaction Surveys and Employee Engagement Surveys as well as the quarterly Staff Pulse Surveys.
• Increased inflation forecast for 2022 and the impact that will have on the College.

As such, in order to earn sufficient revenue to support the 2021/2022 budget, the approved registrant fees are as follows: 

Drug Schedules Regulation - Amendments

The Board approved amending the Drug Schedules Regulation (DSR) under the Pharmacy Operations and Drug Scheduling Act (PODSA) to improve alignment with the National Drug Schedules (NDS) and the Prescription Drug List made under the Food and Drugs Act (Canada). 

In September 2020, the Board directed the Registrar to remove natural health products (NHPs) from the DSR in a stepwise manner to align with the removal of NHPs from the NDS. In September 2021, the Board approved the removal of 20 Schedule III NHPs from the DSR. These changes came into effect on November 23, 2021.

To align with the Schedule I and II NHP removals from the NDS that occurred on January 2, 2022, these amendments remove the corresponding Schedule I and II NHPs from the DSR. NHPs that are administered by injection do not meet the definition of a NHP in the Natural Health Products Regulations. NAPRA determined these products would remain scheduled on the NDS, though their listings were updated to clarify that the listing applies only to products in injectable form. As such, corresponding amendments to the DSR were made to reflect this. 

Other amendments include the addition of esketamine to the DSR as a Schedule I product. Esketamine is an enantiomer of ketamine and was approved for use by Health Canada in 2020. It requires a prescription for sale as it is considered a narcotic under the federal Narcotic Control Regulations. 

Lastly, the Board approved amendments to the DSR to align with scheduling changes made to other non-prescription products listed in the NDS, as well as changes to the Prescription Drug List. 

View the list of amendments to the Drug Schedules Regulation and their expected in force dates on the College website.

Defining "Special Resolution"

The Board approved an amendment to the Health Professions Act ("HPA") Bylaws to define the term ‘special resolution.’ 

At the November 2021 Board meeting, the Governance Committee brought forward an agenda item on the guidelines governing Board meetings. In response, the Board directed the Registrar to bring forward new Board meeting guidelines, based on those from the British Columbia College of Nurses and Midwives, and associated bylaw amendments for consideration at the February 2022 Board meeting.

In developing the HPA Bylaw amendments for the Board meeting guidelines, College staff identified a gap. The term ‘special resolution’ is used in the HPA Bylaws, but it is not defined.
 

After conducting a scan of the bylaws from other colleges established under the HPA, it was found that all but three of BC’s regulatory colleges define the term ‘special resolution’ within their bylaws. 

The Board approved the motion to define the term ‘special resolution’ as requiring at least two-thirds of the votes cast. This definition is consistent with the requirement under s.17.11(5) of the HPA and aligns with other similar colleges established under the HPA. 
 
These Bylaw amendments have now been filed with the Ministry of Health for a period of 60 days, and are expected to come into effect at the beginning of April. 

Amendments to Telepharmacy Schedule “G”

The Board approved for public posting amendments to Schedule “G” under the Pharmacy Operations and Drug Scheduling Act (“PODSA”) to reflect an anticipated address change of the McBride Telepharmacy site. The Board also directed the Registrar to conduct a review of the telepharmacy regulatory framework within two years with a focus on standardizing requirements including the removal of Schedule “G”. 

The McBride Telepharmacy, currently operates as a full-time telepharmacy in McBride out of leased space at a Northern Health Authority acute care facility. However, the Northern Health Authority is terminating the lease for the McBride Telepharmacy, in order to use the space for other purposes. As such, the McBride Telepharmacy is required to relocate.

While Schedule ‘G’ was not originally intended to be amended, in light of the current opioid overdose epidemic, issues regarding continuity of care for patients requiring opioid agonist treatment (OAT) via the McBride Telepharmacy are concerning. It has been noted that there are patients receiving daily witnessed ingestion for OAT at the McBride Telepharmacy, whose care will likely be disrupted should the telepharmacy close. 

As such, due to the extenuating circumstances associated with the current request, the Board approved amending Schedule “G” to change the address of the McBride Telepharmacy

These amendments have been posted on the College’s website for a 90-day public comment period. All feedback will be reviewed and brought forward to the Board at their June 2022 meeting for approval to file the amendments with the Minister of Health for a 60-day period. The amendments would be expected to take effect in August 2022. 

In addition, to address the public safety concerns regarding the telepharmacy unregulated staffing model and potential additional proposed amendments to Schedule “G”, and to ensure decision-making is consistent with the original intent of Schedule "G", the Board directed the Registrar to conduct a review of the telepharmacy regulatory framework within two years with a focus on standardizing requirements across all telepharmacies, including the removal of Schedule “G”. However, that direction is not part of this Bylaw amendment package. Further information will be provided as that review moves forward.

Board Meeting Guidelines: Robert’s Rules to Adapted BCCNM Board Meeting Guidelines

The Board approved amendments to the Health Professions Act Bylaws to remove Robert’s Rules of Order as the document that governs the procedures of College Board meetings, and to replace it with a new College of Pharmacists of British Columbia Board Meeting Guidelines document, based on guidelines followed by the BC College of Nurses and Midwives. 

These changes were first introduced at the November 2021 meeting, when the Board directed the Registrar to “… bring forward Board meeting guidelines, based on those from the British Columbia College of Nurses and Midwives, and associated bylaw amendments for the February 2022 meeting.”

With regards to Board member decision-making procedures, the new Meeting Guidelines move to consensus decision-making and no longer require a seconder for most Board motions. 

These Bylaw amendments have now been filed with the Ministry of Health for a period of 60 days, and are expected to come into effect at the beginning of April. 

Approval of Board Composition Working Group Terms of Reference and Appointment of Members

The Board approved the establishment of the Board Composition Committee, along with the appointment of members to that Committee. 

The aim of the Board Composition Committee will be to develop a Board Competency Matrix, and that Committee will sunset once that Matrix is completed and approved by the Board. More specifically, the mandate of the proposed Board Composition Committee is to develop a list of competencies against which those wishing to serve as Board members, Board chairs and Board vice chairs will be assessed.

The Board Composition Committee will be comprised of the following Board members: 

• The Board Chair 
• The Board Vice Chair 
• Three Board members-at-large of which a minimum of two will be public Board members. 

To fulfill the above noted membership requirements, the following individuals have been appointed to the Board Composition Committee: 

• Steven Hopp, Board Chair 
• Andrea Silver, Board Vice-Chair 
• Katie Skelton, Board Public Representative (Committee Chair)
• Tracey Hagkull, Board Public Representative (Committee Vice-Chair)
• Eric Sletmoen, Board Member-at-large

Drug Administration Committee: Amendments to Drug Administration by Injection and Intranasal Route Standards, Limits and Conditions

The Board approved amendments to the Drug Administration by Injection and Intranasal Route Standards, Limits and Conditions (Standards, Limits and Conditions) to lower the age limit for drug administration by Injection to 4 years of age. 

As discussed at the November 2021 meeting, many public health resources have been prioritized for the COVID-19 pandemic response, which have impacted immunization services for children in some regions, including school entry vaccinations. There are two vaccines recommended for children aged 4-6 prior to entering school.  Certain pharmacies in British Columbia already provided and continue to provide school-entry vaccines to children aged 5 and up in partnership with health authorities.

While school-entry vaccines are not mandatory for children and there is flexibility as to when they may be given, it is recommended that they are given as soon as a child is eligible to provide protection from vaccine-preventable diseases. A change to the Standards, Limits and Conditions to reduce the patient age limit could have a beneficial impact on those seeking school-entry vaccines from pharmacies. 

Pharmacists in BC have been involved in administering publicly funded vaccines to patients 5 years and older for many years. The technique required to administer an injection to a 4-year-old is not significantly different than the technique for administering an injection to a 5-year-old. The College expects that registrants practice within the scope of their education, training, and competence, and expects registrants to act professionally which includes seeking out the knowledge and expertise they need to provide competent care, if needed. There are Canadian Council on Continuing Education in Pharmacy accredited training programs that focus on drug administration for young children available to pharmacists, if needed Other minor updates to strengthen requirements and improve clarity were also part of the amendments, which include (but are not limited to) the following:

• New clear standards requiring pharmacists to act in best interest of the patient, to take all appropriate steps to ensure the drug is administered safely, and to only administer a drug within the scope of their education, training and competence.
• Clarified requirements for the pharmacist following drug administration, including a requirement to ensure the patient is appropriately monitored, and to ensure the safe and appropriate disposal of devices, supplies and remaining drug, following administration.
• Added documentation requirements, including documenting the expiry date of the drug, the identification of pharmacist who administered the drug, and the patient response to drug administration.
• Amendments to the emergency measures requirements to make them more principle-based, with an updated requirement for the pharmacist to ensure there is access to the drugs and supplies needed to manage adverse reactions (and removal of specific examples of emergency measures), and an updated requirement to respond appropriately to complications and emergencies if they arise.

These amendments will now be submitted to the Ministry of Health for a filing period of 60 days.