Is an Electronic Signature on a Prescription Acceptable?

No, not at the moment. The Board supports the concept of e-prescribing, but at this time, requirements for securing patient confidentiality, verifying authenticity, and preventing diversion have not been defined.

A prescription generated via a prescriber’s computer system or PDA and physically given to a patient for eventual processing at a pharmacy must comply with the federal regulations regarding prescriptions and must include a valid signature. Rubber stamps, pre-signed forms, signature images or other forms of signatures that are not distinct for each transaction do not fulfill federal requirements. A pharmacist considering a prescription with one of these forms of signature cannot confirm that this is the one and only copy of the order (as identical copies of the order could have been produced by photocopy). To ensure that the prescription document presented by the patient is the original copy of the order written by the prescriber, the signature must be original.

A prescription generated via a prescriber’s computer system or PDA and faxed directly to a pharmacy for processing must comply with the NLPB Standards of Practice – Facsimile Transmission of Prescriptions and Personal Health Information (available on the Standards, Guidelines and Policies page). As with above, electronic “digitalized” signatures are not permitted since they are not distinct for each transaction. When prescriptions are transmitted by fax directly between a prescriber and a pharmacy, the prescription must still be manually signed prior to transmitting the prescription.

At this time, prescription authorization via email has not been approved by Health Canada.

For answers to more Pharmacy Practice questions like this one, see the Frequently-Asked Questions About Pharmacy Practice page of the website.

Regulations Now Posted on NLPB Website

NLPB is pleased to announce that Amendments to the Pharmacy Regulations, 2014 have been published and are now in effect.

2017 Registration Statistics

As of January 2017, there are 689 registered pharmacists in the province. This includes 533 community pharmacists, 118 hospital pharmacists and 38 pharmacists who are classified as “other” which includes academia, government, consultancy, etc. Of the 689 pharmacists, 73 are classified as “relief”.

There are currently 214 licensed pharmacies in the province, of which 196 are community pharmacies and 18 are hospital pharmacies.

In March 2015, NLPB registered the first regulated Pharmacy Technician. Since that time the number of Registered Pharmacy Technicians in Newfoundland and Labrador steadily increased. There are now 15 Registered Pharmacy Technicians. Another 45 candidates are currently undertaking practical training as part of the process to become registered in the province.

Save the Date – NLPB Symposium

Registration will soon be open for the 2017 NLPB Symposium, to be held at the Hampton Inn & Suites by Hilton in St. John’s on Saturday, May 6, 2017. The agenda for the day will include the 2017 Annual General Meeting, a Professional Development Program focused on current pharmacy practice issues and the NL Pharmacy Board Awards Luncheon. Registrants will be notified via email with direction on how to register for the symposium.

NL Pharmacy Board Awards – Call for Nominations

Nominations are now open for the 2017 NLPB Certificate of Recognition and Patient Safety Award. Details on the awards and a copy of the Nomination Form can be found at http://nlpb.ca/media/NLPB-Awards-and-Honours-Jan2017.pdf

These awards, along with the Emerald Achievement Award which recognizes NLPB registrants who have practiced pharmacy for at least 35 years, will be presented at the NL Pharmacy Board Awards Luncheon, taking place on May 6, 2017 during the NLPB Symposium.

Please consider nominating a fellow pharmacist or pharmacy technician today!

Verifying a Practitioner’s Authority to Prescribe

The NLPB Office is often contacted by registrants wishing to confirm whether or not a certain class of health care practitioner is authorized to prescribe. Over the past few months, we have been contacted several times regarding podiatrists, in particular. At this time, podiatrists do NOT have the authority to prescribe medication in Newfoundland and Labrador. If you receive a prescription from a podiatrist, you are advised to contact him or her to discuss the issue and, if necessary, refer them to the NLPB for further follow-up.

For future reference, the list of authorized prescribers in this province is listed on the Find A Registrant, Pharmacy Or Other Health Professional page of the website.

NL Pharmacy Board Awards – Nominations Now Open!

Nominations are now open for the NLPB Certificate of Recognition and Patient Safety Award. Details on the awards and a copy of the Nomination Form can be found at http://nlpb.ca/media/NLPB-Awards-and-Honours-Jan2017.pdf.

These awards, along with the Emerald Achievement Award which recognizes NLPB registrants who have practiced pharmacy for at least 35 years, will be presented at the NL Pharmacy Board Awards Luncheon, taking place on May 6, 2017 during the NLPB Symposium.

Please consider nominating a fellow pharmacist or pharmacy technician today!

2017 NLPB Board Elections – Call for Nominations in Zones 5, 6 and 7

It’s Board Election time again! The Call for Nominations for Zones 5, 6 and 7 will be circulated to all pharmacists practicing in those zones early February.

Please keep your eye out for the Call for Nominations email.

2017 NLPB Symposium

Registration will soon be open for the 2017 NLPB Symposium, to be held at the Hampton Inn & Suites by Hilton, St. John’s Airport on Saturday, May 6, 2017. The agenda for the day will include a Professional Development Program focused on current pharmacy practice issues, an open forum, the 2017 Annual General Meeting, and the NL Pharmacy Board 2017 Awards Luncheon. Registrants will be notified via email in the coming weeks with direction on how to register for the symposium.

March is Pharmacy Awareness Month!

There will be many opportunities to celebrate the profession during Pharmacy Awareness Month (PAM). Check out PANL and the School of Pharmacy Facebook and Twitter feeds for updates throughout the month. This year, NLPB is pleased to be hosting the concluding celebrations with a public open house at the James J. O’Mara Pharmacy Museum in Apothecary Hall. On March 26, members of the pharmacy community and the public can drop by the museum to see how the profession has evolved over the years. A visit to this restored heritage site, preserved by Newfoundland and Labrador pharmacists, is the perfect way to celebrate the history and the future of the profession.

The 2017 Safe Use and Handling of Oral Anti-Cancer Drugs (OACDs) in Community Pharmacy: A Pan-Canadian Consensus Guideline

In February, the Canadian Association of Provincial Cancer Agencies (CAPCA) released the Safe Use and Handling of Oral Anti-Cancer Drugs (OACDs) in Community Pharmacy: A Pan-Canadian Consensus Guideline. This guideline builds on the Oral Cancer Drug Therapy Safe Use and Handling Guideline that was provided by CAPCA in 2015. The latest recommendations were developed to address the safe handling of oral anti-cancer drugs in community pharmacies across the medication lifecycle, from manufacturer packaging to waste management and incident reporting.

Both the 2017 Safe Use and Handling of Oral Anti-Cancer Drugs (OACDs) in Community Pharmacy: A Pan-Canadian Consensus Guideline and the 2015 Oral Cancer Drug Therapy Safe Use and Handling Guideline can be accessed from http://www.capca.ca/current-issues/oral-cancer-drug-therapy.

Naloxone Nasal Spray Now Schedule II

At their most recent meeting, the Board approved a change to the Provincial Drug Schedules, adding Naloxone Nasal Spray to the list of Schedule II drugs. The Guidelines Regarding the Sale of Naloxone in Community Pharmacies has also been updated to reflect this addition. For more information on this addition to the drugs schedules, see “Drug Schedule Changes – approved February 18, 2017″ on the Provincial Drug Schedules page of the website.

The Board encourages all pharmacies to carry and dispense Naloxone kits to provide as many people as possible access to the drug.

Model Standards for Pharmacy Compounding – Hazardous Sterile Preparations

The Board has adopted national Model Standards for Pharmacy Compounding – Hazardous Sterile Preparations which can be found on the website at http://nlpb.ca/media/SOPP-Compounding-Sterile-Hazardous-Feb2017.pdf

NL Pharmacy Board Awards – Nominations Now Open!

Nominations are now open for the NLPB Certificate of Recognition and Patient Safety Award. Details on the awards and a copy of the Nomination Form can be found at: http://nlpb.ca/media/NLPB-Awards-and-Honours-Jan2017.pdf.

These awards, along with the Emerald Achievement Award which recognizes NLPB registrants who have practiced pharmacy for at least 35 years, will be presented at the NL Pharmacy Board Awards Luncheon, taking place on May 6, 2017 during the NLPB Symposium.

The deadline to send in your nominations is March 17, 2017. Please consider nominating a fellow pharmacist or pharmacy technician today!

2017 NLPB Board Elections – Call for Nominations in Zones 5, 6 and 7

The Call for Nominations for Zones 5 (Hospital Pharmacists), 6 (Pharmacy Technicians) and 7 (At Large) was circulated to all registrants practicing in those zones on February 5, 2017. The deadline to submit nominations is March 7, 2017

The Nomnation Form can be found at: http://nlpb.ca/nlpb-board-elections-call-nominations/. Please consider putting your name forward or nominating a fellow pharmacist or pharmacy technician today!

Mark your Calendars – 2017 NLPB Symposium!

Registration is now open for the 2017 NLPB Symposium, to be held at the Hampton Inn & Suites by Hilton, St. John’s Airport on Saturday, May 6, 2017.

We are finalizing the last pieces of the agenda for the day, which will include a Professional Development Program, an open forum, the 2017 Annual General Meeting, and the NL Pharmacy Board 2017 Awards Luncheon. A detailed email regarding the event will be sent to all registrants within the next week.

To register for the symposium, visit www.nlpb.ca, log in using your username and password and click the blue “Events” button located at the top of the Member Home screen. Once there, click on “View Upcoming Events” and then “NL Pharmacy Board Symposium” to complete the registration process.

Hope to see you there!

Ethical Decision-Making: Putting Patients’ Interests First

Recently, the NLPB has been alerted to several instances where pharmacists have acted inappropriately when faced with a prescription where the quantity prescribed was less than the full package size of the product. We have heard of situations where the pharmacist has refused to fill the prescription, falsely indicated to the patient that the product was back-ordered, contacted the original prescriber to revise the prescription, or adapted the prescription so that the quantity dispensed matched the package size.

Pharmacists are reminded that, as health care professionals, first and foremost, they are expected to place the health and well-being of their patients at the centre of their professional practice. Making clinical decisions or advising practitioners or patients based on business interests or financial benefit is a direct violation of the Code of Ethics.

Additionally, the Standards of Practice – Prescribing by Pharmacists specifically states:

• Prescribing decisions must be based on clinical suitability, cost-effectiveness and what is in the best interests of the patient. Prescribing decisions based on biased information or financial advantage may be regarded as constituting conduct deserving of sanction. (section 5.1 b) iv));
• A pharmacist may change the quantity of medication prescribed as long as doing so will not result in the patient receiving drug therapy for longer than the prescriber intended. (section 5.6 a) ii)); and
• The pharmacist must be reasonably satisfied that the original prescriber would not object to the adaptation (section 5.6 b) ii)).

Finally, in any situation where a prescription is adapted, pharmacists are also expected to:

• Obtain informed consent from the patient;
• Send notification describing the action taken to the original prescriber within one week; and
• Provide a copy of the documentation to the patient for their records.

Register Today – 2017 NLPB Symposium Registration Now Open!

Registration is now open for the 2017 NLPB Symposium, to be held at the Hampton Inn & Suites by Hilton, St. John’s Airport on Saturday, May 6, 2017.

Registrants are invited to join us in:

• gaining knowledge and sharing experiences during our Professional Development programs and Open Forum;
• hearing about the Board’s activities over the past year during the Board’s Annual General Meeting; and
• celebrating our colleagues’ accomplishments at the NLPB Awards Luncheon.

To view the full Schedule of Events as well as hotel and registration information, visit http://nlpb.ca/media/Symposium-Brochure-Mar2017.pdf

To register for the symposium, visit www.nlpb.ca, log in using your username and password, and click the blue “Events” button located at the top of the Member Home screen. Once there, click on “View Upcoming Events” and then “NL Pharmacy Board Symposium” to complete the registration process.

We hope to see you there!

Application Process for the Installation of Lock and Leave Enclosures

Pharmacists-in-charge are reminded that, as per Section 2.1 of the Standards of Pharmacy Operation-Community Pharmacy, prior to operating a pharmacy with a lock and leave enclosure, an application must be submitted to the Board using the designated form, indicating the anticipated hours that the lock and leave barrier will be in use and describing the physical construction of the enclosure.

In addition, installation of a lock and leave enclosure is considered a renovation to the pharmacy; therefore, an Application for Renovation to an Existing Pharmacy/Dispensary must accompany the Application for Lock and Leave Approval.

Please review the NLPB Policy-Requirements When Renovating a Pharmacy/Dispensary and the FAQ about Lock and Leave for more information regarding pharmacy renovations and the physical requirements and use of lock and leave enclosures.

2017 NLPB Board Elections – Voting in Zone 7 (At Large) Now Open

Voting is now open for the NLPB Board election. The election will be held through our secure, confidential elections portal.

To access the election portal, visit www.nlpb.ca, log in using your username and password and click on “View Candidates and Cast Your Vote”. The deadline for casting your vote is 11:59 pm, April 29, 2017. The successful candidates will be announced at the NLPB AGM on Saturday, May 6, 2017 during the NLPB Symposium.

If you have any questions please do not hesitate to contact Meghan at mhandrigan@nlpb.ca.

2017 NLPB Symposium Recap

This past weekend, the 2017 NLPB Annual Symposium was held at the Hampton Inn & Suites in St. John’s.

It was a great day filled with discussion on important matters facing the pharmacy profession and related to the role of pharmacy professionals in the delivery of health care in the province. The day started on a high note with a very engaging presentation from Janet O’Reilly from the Office of the Information and Privacy Commissioner on the Personal Health Information Act. We hope to have Janet back to deliver more presentations in the future.

Following this, Colleen Simms, Director of Mental Health and Addictions at the Department of Health and Community Services gave a brief overview of the province’s Opioid Strategy, particularly as it relates to the Take-Home Naloxone program. Colleen was followed by Noelle Patten from the NLPB who gave an overview of the NLPB Guidelines on the Sale of Naloxone in Community Pharmacies as well as a quick recap of some of the recent changes to the Board’s Standards Regarding the Sale of Exempted Codeine Products in Community Pharmacies

At lunchtime, we celebrated the achievements of our registrations with the NLPB Awards Luncheon with the presentation of the following awards:

Lunch was followed by an Open Forum during which attendees were given the opportunity to ask questions or bring issues to the Board’s attention. They were also given the opportunity to offer input into the Board’s strategic direction for the next two years. The discussion was very dynamic with great suggestions and constructive feedback offered by the attendees.

The day concluded with the NLPB Annual General Meeting, including an overview of the Board’s activities in 2016. To read more about these activities, please view the NLPB 2016 Annual Report.

Welcoming Natalie Payne

The Board is pleased to announce the appointment of Natalie Payne to the new position of Legal Counsel. Natalie will act as in-house counsel to the Board and will be responsible for providing a range of legal services and advice in the areas of health policy development, quality assurance programming, and the complaints process, just to name a few. Natalie’s experience as a Crown Attorney and Legal Counsel for the Human Rights Commission, coupled with her keen interest in administrative health law and policy, will be of great value to the Board as we incorporate this new role into the continued expansion of the pharmacy profession in the interest of public safety.

Changes to the Provincial Drug Schedules

Pharmacists are advised that at the May 5, 2017 meeting, the Board approved the following change to the Provincial Drug Schedules:

Moved from Schedule I to Schedule II: “human papillomavirus vaccine”

The updated Guide to the Provincial Drug Schedules and a notice of this change are posted on the Provincial Drug Schedules page of the website.

REMINDER: Buprenorphine-Naloxone Dispensing Requirements

In recent months, NLPB has received numerous questions and concerns from pharmacists and other healthcare providers regarding the prescribing and dispensing of the buprenorphine and 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. 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 buprenorphine-naloxone is generally considered a safer alternative to methadone for treatment of opioid dependence, it is important to note that buprenorphine-naloxone may not be the treatment of choice for all patients, and that concerns about diversion and misuse still exist.

Specifically, NLPB has received many inquiries regarding physician eligibility to prescribe buprenorphine-naloxone. Unlike methadone, an exemption from Health Canada is not required to prescribe buprenorphine-naloxone. However, the expectations of physicians in this regard are outlined in section 3.1.1 of the College of Physicians and Surgeons of NL (CPSNL) “Methadone Maintenance Treatment Standards and Guidelines”, which state:
      Physicians who prescribe buprenorphine shall have the appropriate knowledge, skills, and judgment to do so, including the following:
            a) the physician has taken an educational program on prescribing buprenorphine / Suboxone (i.e. Online Suboxone Education Program www.suboxonecme.ca)
            b) completion of the CAMH Opioid Dependence Core Course (or equivalent program acceptable to CPSNL).
            c) The physician has established a program for the regular testing of patients receiving buprenorphine for drugs of possible abuse; and
            d) ongoing continuing medical education (CME) in opioid-dependency treatment and/or addiction medicine.

Pharmacists are not expected to confirm with an external source that the physician has completed the training requirements of CPSNL related to buprenorphine prescribing. As for all prescriptions, pharmacists must assess the clinical appropriateness of the order at face value, and dispense the product in accordance with NLPB Standards and recognized clinical guidelines, such as the Centre for Addiction and Mental Health (CAMH) “Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline”.

PLEASE NOTE: While single entity buprenorphine (supplied as 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”. Faced with this situation, 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. Supporting documentation for decision-making should be filed in a retrievable manner in the dispensary so that it is easily accessible when required for consultation with other health care providers, NLPB practice site assessments, and audits conducted by Health Canada.

In-line with its approved indication, NLPB Standards for the Safe and Effective Provision of Medication for the Treatment of Opioid Dependence, require that:

• The pharmacist-in-charge must first apply to the NLPB to register the pharmacy as a site for opioid dependence treatment. Applications will be reviewed and, if approved, authorization will be issued.
• Pharmacists must apply to NLPB for authorization and provide proof of successful completion of an education program on the use of medication in the treatment of opioid dependence approved by the Board.
• Pharmacists are expected to assess prescriptions for buprenorphine-naloxone for clinical appropriateness. If pharmacists see doses being prescribed outside of clinical guidelines for buprenorphine-naloxone therapy and NLPB and CPSNL Standards, they should consult with the prescribing physician and document their rationale for deviation in the patient’s record.
• Pharmacists are required to witness the ingestion of buprenorphine-naloxone. This function may not be delegated to a pharmacy technician, pharmacy student or any other member of the pharmacy team. Pharmacists are to directly observe the patient ingesting the dose.
• Buprenorphine-naloxone tablets can take 1-10 minutes for the tablet(s) to dissolve completely and pharmacists are expected to ensure that the entire dose has been dissolved and ingested.
• Administration of doses and provision of take-home doses must be appropriately documented on the patient’s Administration Log.
• Pharmacists are expected to assess that prescriptions for take-home doses are prescribed in accordance with the criteria and schedules outlined in the Standards. Rationale for deviations from such should be documented in the patient’s record.
• Take-home doses must be appropriately labelled, include all necessary cautionary labels, and be provided directly to the patient. Pharmacists cannot release take-home doses to an agent designated by the patient to pick up take-home doses on their behalf.
• Patients should be instructed to return their empty vials with original labels intact to the pharmacy for inspection and destruction and return of vials documented on the patient’s Administration Log.

To view the Standards in their entirety, visit the Standards, Guidelines and Policies page of the NLPB website. If there are questions or concerns related to the dispensing of buprenorphine-naloxone, please contact NLPB for guidance.

Request for Expression of Interest to Serve on NLPB Quality Assurance Committee

The Quality Assurance Committee is a new committee of the Newfoundland and Labrador Pharmacy Board whose role is to investigate concerns that arise about the professional practice of pharmacists or pharmacy technicians. In fulfilling its role, the committee may:

• Conduct investigations when concerns arise, in accordance with the duties of the committee set out in the Pharmacy Act, 2012;
• Appoint assessors to assist in investigations when necessary;
• Review findings of investigations; and
• Resolve concerns with registrants, including referring matters on to the Complaints Authorization Committee when possible professional misconduct is discovered.

The Board is seeking at least one community pharmacist, one hospital pharmacist, and one pharmacy technician to serve on this committee. For more information, please contact the NLPB office to obtain a copy of the Quality Assurance Committee Terms of Reference.

If you are interested in being a member of this committee, please submit your name, contact information, a brief bio (including any experience you may have in quality assurance/improvement), and a few lines about why you are interested in being part of the committee by June 30, 2017. Thank you in advance for your interest in serving your profession.

Professional Development Sources for Pharmacy Technicians

The Board office has received a number of questions from pharmacy technicians over the past few months with regard to how the professional development standards apply to them and how/where they can access appropriate professional development programming. The following information is provided as general information. If you have questions specific to your circumstances, please feel free to contact us at any time.

With regard to accredited learning, there are a number of technician‐specific offerings to consider:

• The annual NLPB Symposium includes an educational component and is open to all registrants, including pharmacy technicians.
• Canadian Healthcare Network have a series of programs specific to pharmacy technicians. In particular, Tech Talk for Technicians has great content and is an excellent source of learning.
• The Canadian Association of Pharmacy Technicians (CAPT) has annual National and NL Conferences that are an excellent source of professional development specifically tailored to pharmacy technicians.
• Pharmacy technicians who have been registered for a minimum of one year can participate in the preceptor training program and become authorized to serve as a preceptor (http://nlpb.ca/media/Application‐Authorization‐Preceptor‐Feb2016.pdf) to pharmacy technician candidates.

Additionally, registrants can claim 15 credits upon successful completion of Parts I and II of the PEBC Qualifying Exam or 5 credits upon successful completion of Part II only. PLEASE NOTE that these exams must have been completed within the Professional Development year you are documenting.

Finally, while the Standards state that a minimum of 7.5 credits must be from accredited sources – the rest can be from self-directed learning. This can include service as a preceptor, acting as an OSPE or OSCE assessor, completing first aid and CPR courses or “Miscellaneous professional activities from which the registrant derives educational benefit”. Pharmacy technicians may have the opportunity to complete other programs throughout the year from which educational benefit is derived but which are not formally accredited. You would self‐assign credits at 1 credit per hour of learning and retain proof of participation in accordance with the Standards in your portfolio in case of audit. Please check the Standards of Practice – Professional Development for Pharmacists and Pharmacy Technicians for examples of what constitutes valid sources of learning and what would not be considered appropriate.

Don’t forget all registrants are required to document their learning in the NLPB online Registrant Portal which can be accessed through the “Registrant Login” on the NLPB website homepage and also retain Supporting Documentation for each program completed.

Notice to Physicians and Pharmacists: Requirements when prescribing and dispensing buprenorphine-naloxone (Suboxone®)

Recently, the College of Physicians and Surgeons NL (CPSNL) and NLPB have received an increased number of questions from physicians and pharmacists regarding requirements when prescribing and dispensing buprenorphine-naloxone (Suboxone®).

For clarification, physicians who prescribe buprenorphine-naloxone (Suboxone®) must have the appropriate knowledge, skills, and judgement to do so. At the present time, the CPSNL has a Standard of Practice which states that physicians:

• Complete an educational program on the prescribing of buprenorphine-naloxone (Suboxone®), such as the online Suboxone® Education Program available at www.suboxonecme.ca; and
• Complete the CAMH Opioid Dependence Core Course.

As previously communicated, pharmacists must also meet defined education requirements outlined in Section 3 of the NLPB Standards for the Safe and Effective Provision of Medications for the Treatment of Opioid Dependence [Insert link] and be authorized by NLPB to dispense medications for opioid dependence treatment, including buprenorphine-naloxone (Suboxone®).

CPSNL encourages physicians to contact pharmacists prior to sending the patient to the pharmacy with a prescription to determine if the pharmacy is able to dispense buprenorphine-naloxone and is accepting new patients. In cases where this does not occur, pharmacists should initiate a discussion with the prescriber upon receiving a prescription for opioid dependence treatment for a new patient. This is an opportunity for physicians and pharmacists to discuss relevant clinical information and the patient’s care plan, and to agree on an ongoing communication plan, particularly for emergency situations. Collaboration and regular communication between opioid dependence treatment prescribers and pharmacists reduces confusion and frustration among patients and care providers, increases patient safety and positive patient outcomes, and leads to a more positive experience for everyone involved.

The CPSNL has also prepared and circulated a similar “Notice to College Members”.

Returning to Work

Registrants are reminded that they are personally responsible for ensuring they are fully registered before returning to work after a leave of absence, including maternity or parental leave. This renewal should be initiated at least two weeks before the planned return to work date to allow for application processing.

To renew, the registrant must:

• Record a minimum of 15 continuing education units (CEUs) in the online Professional Development Learning Portfolio Record
• Ensure they have professional liability insurance coverage in accordance with the NLPB’s Professional Liability Insurance Requirements for Registration
• For pharmacists only: have current membership in the Pharmacists’ Association of Newfoundland and Labrador (PANL) as required by section 21(3)(a) of the Pharmacy Act, 2012
• Renew their registration online at nlpb.ca and pay the appropriate fee

Once all of these requirements are met, a registration certificate (“licence”) will be sent to the registrant’s personal email address on file.

Please Note: pharmacists-in-charge are responsible for verifying that pharmacy staff members have completed these steps and have been issued a new licence before beginning their first shift in the pharmacy, as required by section 12.(f) of the Pharmacy Regulations.
Please contact Aileen O’Keefe, Registration and Licensing Administrator at aokeefe@nlpb.ca or 709-753-5877(extension 201) for further information.

Patient Consultation Area Requirements

Section 1.3 e) of the Standards of Pharmacy Operation- Community Pharmacy, requires that: “The pharmacy must have a designated area for patient consultation that ensures visual and acoustical privacy and confidentiality and that is clean, safe, and comfortably furnished for the patient”. Recent practice site assessments have revealed that while some pharmacists-in-charge have declared that they have a private patient consultation area, there is actually no space within the pharmacy that is designated primarily for such purposes. In order for the requirements of the SOPO-Community to be met, the room or area must be available at all times for private consultations and must be appropriately furnished for provision of patient care.

Cannabis for Medical and Non-Medical Purposes

The Government of Canada has introduced legislation that would legalize non-medical cannabis use in the country. If passed, this legislation is expected to come into effect in July, 2018. For now, there is no change to access cannabis for medical purposes. Access will continue to follow the Access to Cannabis for Medical Purposes Regulations.

In addition to the federal legislation, the province will be establishing guidelines and making decisions related to where non-medical cannabis can be sold, who may purchase it, and whether certain laws should be updated or changed in the interests of public safety and health.

Recognizing that the landscape around cannabis is evolving rapidly, the national organization for pharmacy regulators, NAPRA, has released its position statement on cannabis and the role of pharmacy practitioners which can be found at http://napra.ca/policies-and-positions/cannabis-position-statement.

Update on Pharmacy Technician Appeals Process

As previously communicated in March 2017, the NLPB Board has been working on an appeal process for those pharmacy technician candidates who find themselves in a position of not being able to complete the full registration process by December 31, 2017. At the May Board meeting, a Pharmacy Technician Appeal Committee was formed to advise on the development of this process, review appeals once they are submitted, and make recommendations to the Board on whether or not each individual appeal should be granted.

Candidates are reminded that, based on legal opinion, appeals will be considered only for applicants who have:

• completed the four Bridging courses;
• completed the PEBC Evaluating Examination (or equivalent); and
• completed or are currently completing the NLPB practical training program.

It is important to note that meeting the criteria outlined above does not necessarily mean the appeal will be granted.

The Pharmacy Technician Appeal Committee has defined the following appeal application and decision process:

• Candidates will apply for the appeal using a standardized form (currently under development). This form will include a section where the applicant will declare that they have met the mandatory appeal criteria as well as space to describe the circumstances that led to them not being able to complete the full process by the deadline.
• NLPB office staff will review the applications for completeness and follow up with candidates if additional information is needed. Applications will also be de-identified at this time.
• The Pharmacy Technician Appeal Committee will meet to review the applications. Consideration will be given to candidates who, in addition to meeting the above criteria, have demonstrated they were acting in good faith to meet the deadline.
• The Committee’s recommendations will be presented to the NLPB Board for their decision. It is anticipated that the appeal decisions will be finalized in early 2018.

The Pharmacy Technician Appeal Committee will meet again before the end of the summer to finalize the details of the appeal process, including approving the application form and timelines. More information will be shared on this process in September.

The Sale of Exempted Codeine Products in Community Pharmacies

In recent months, NLPB has been heavily communicating the revised Standard of Practice for The Sale of Exempted Codeine Products in Community Pharmacies that was updated in September 2016.

In light of recent questions and discussions during practice site assessments, registrants are reminded that as per Section 3.1 of the Standard, only a pharmacist may authorize the sale of an exempted-codeine product (ECP). Prior to authorizing the sale of an ECP, the pharmacist must personally consult with the patient to determine the appropriateness of the request. It is important that the patient assessment includes obtaining a complete medication history and checking the patient’s Pharmacy Network profile. Patient assessments related to an ECP request cannot be delegated to any other member of the pharmacy team.

After assessing the patient, the onus is on the pharmacist to refuse the sale of an ECP, and refer the patient to another health care provider, if it is determined that:

• the condition or symptom(s) are chronic or serious in nature;
• the ECP will inadequately treat the medical or dental reason for use; or
• continued use of ECPs is not in the best interests of the patient.

If the sale of an ECP is authorized by the pharmacist, it must be fully documented in the patient’s medication profile, and the electronic health record via the Pharmacy Network, in accordance with section 3.5 of the SOPO-Community. It is critical that provision of an ECP to a patient is recorded accurately in the electronic health record using the patient’s MCP number so that other health professionals involved in the patient’s care can make informed decisions about the care they are providing.

Finally, while section 3.8 of the SOPO-Community requires pharmacists to provide education and counselling to patients only on the original filling of a prescription, due to the issues associated with the inappropriate use of ECPs, pharmacists are expected to consult with and counsel patients on each and every sale of an ECP.

To review the Standards in their entirety, please visit the Standards, Guidelines, and Policies page of the website.

Mandatory Patient Profile Information

Registrants are reminded that, in accordance with the Standards of Pharmacy Operation – Community Pharmacy, patient profiles MUST include all of the following information:

• full name;
• medical care plan (MCP) number; (Note – this is applicable for NL residents)
• mailing and/or street address;
• home and/or cell phone number, when available;
• date of birth;
• gender; and
• documentation of any notable clinical conditions, allergies, intolerances or adverse drug reactions.

Message from the Francophone Health Network

Currently, there are 3,015 individuals in Newfoundland and Labrador who have French as their mother tongue. However, many factors limit access to health services in their first language, including lack of knowledge of French-speaking health professionals. In order to improve this problem, the Francophone Health Network has updated the Directory of French-speaking Health Professionals, which is available on the Francophone community website. If you would like to be included in the directory, please contact the Francophone Health Network at Sante@fftnl.ca or at (709)757-2862.

The Pharmacists’ Role in Provision of Take-Home Naloxone Kits

In late November 2016, the take-home naloxone kit program was announced as part of the Government of Newfoundland and Labrador’s Opioid Action Plan. The initiative increases access to naloxone, a safe and effective opioid antagonist indicated for the complete or partial reversal of opioid overdose and its consequences. There are over 75 distribution sites where members of the public can access free take-home naloxone kits, including the Safe Works Access Program (SWAP) and its satellite sites, youth and adult correctional facilities, some public health clinics, and Regional Health Authority Mental Health and Addictions Offices.

While data can be difficult to capture due to the nature of situations in which naloxone kits are used, recent evaluation of the program indicates that, to date:

• 1033 kits have been reported as distributed, and 1297 people have been trained on how to use the kits,
• 38 replacement kits have been distributed, and
• At least 14 kits were used during an overdose, saving the lives of at least 10 opioid overdose victims.

Even though pharmacies are not yet included as distribution sites under the provincial program, pharmacists have a key role to play in increasing awareness about naloxone and in increasing access to this life-saving drug. Pharmacists can either provide a kit themselves or direct patients to the provincial program for a free kit.

Pharmacists who offer kits for sale are expected to follow the NLPB Guidelines for The Sale of Naloxone in Community Pharmacies. The guideline encourages pharmacists to consider providing naloxone to:

• any individual who is known to use, or who self-identifies as using opioids for either medical purposes or for recreational use;
• friends or family members of individuals identified as opioid users; or
• any person who knows an opioid user who would like to be prepared in the event of an overdose.




Keep in mind that, while it would be ideal for the pharmacist to personally consult with the patient (i.e. the person for whom the drug is intended) prior to providing naloxone, considering the nature of the drug and its intended use, this may not always be possible. Given the safe and effective nature of naloxone, it is very unlikely that there would be a situation where it would not be appropriate to provide the drug to someone who requests it.

If a patient or contact of an opioid user requires a free kit, they should be directed to call “811” for information about the nearest distribution site.

Finally, many business owners (such as gas stations, bars, and late-night restaurants) have expressed interest in purchasing naloxone kits, as well as arranging training for their staff in what to do if they encounter a suspected opioid overdose. It is reasonable that pharmacists could provide this service, if approached.

For more information, please view the NLPB Guidelines for The Sale of Naloxone in Community Pharmacies on the Standards, Guidelines, and Policies page or contact the NLPB office for guidance.

Professional Practice Webinars

The August Professional Practice webinar, “Buprenorphine-Naloxone for the Treatment of Opioid Dependence” is now available on the Professional Practice Webinars page of the NLPB website. The next webinar, Frequently-Asked Questions – Professional Development Standards and Online Portal, will take place on Tuesday, October 10, 2017 from 9:00 – 10:00 am and will be posted to the website shortly thereafter. Look for registration information in your email in the coming weeks.

Pharmacy Technician Registration Appeals

As communicated by the NL Pharmacy Board consistently over the past several years, the Registration deadline for bridging candidates is December 31, 2017.

Practically speaking, this means candidates must be fully registered with the board as a technician for the 2017 registration year. It does NOT mean applicants can pay by this date for registration for 2018. Once registered for 2017, registrants will be eligible to renew their registration for 2018 and will receive more information on the renewal process with other registrants later in the fall.

Applicants who find themselves in a position of not being able to complete the full process by December 31, 2017 may appeal to the Board for a limited extension ONLY IF they have done all of the following:

• completed the four Bridging courses;
• completed the PEBC Evaluating Examination (or equivalent); and
• completed, or are currently completing, the NLPB practical training program.

To apply for the appeal, download and complete the Pharmacy Technician Registration Appeal form (http://nlpb.ca/media/Application-Pharmacy-Technician-Appeal-FINAL-Oct2017.pdf), posted on the Authorization & Registration Information For Registrants page.

PLEASE NOTE that all appeal applications must be received at the NLPB Office no later than Friday, January 12, 2018.

CPD Reminder

With annual registration renewal quickly approaching, registrants are reminded that practicing Pharmacists and registered Pharmacy Technicians are required to enter all professional development activities into their online Professional Development (PD) logs no later than November 30, 2017 for the coming registration year.

To be eligible for registration renewal, registrants are required to participate in a minimum of 15 hours of professional development learning activities between December 1 and November 30 of each PD year. Of the 15 hours, a minimum of 7.5 must be from accredited learning activities (i.e. programs that have been accredited for no less than a total of 7.5 CEU’s) with a balance of 7.5 hours of participation in either accredited or non-accredited learning activities.

Further information can be found by visiting the Frequently-Asked Questions about Professional Development page of the website or by viewing the Standards of Practice – Professional Development for Pharmacists and Pharmacy Technicians, available on the Standards, Guidelines and Policies page.

Professional Practice Webinars

The August Professional Practice webinar, “Buprenorphine-Naloxone for the Treatment of Opioid Dependence” is now available on the Professional Practice Webinars page of the NLPB website. Please check your inbox for registration information for the next webinar, Frequently-Asked Questions – Professional Development Standards and Online Portal, taking place on Tuesday, October 10, 2017 from 9:00 – 10:00 am.

Registration and Licensing Renewal Now Open!

Annual renewals for the 2018 registration year have begun. An email has been sent to all registrants and Pharmacists-in-Charge with instructions on how to renew.

NEW THIS YEAR:

• Registrants will be asked to upload proof of professional liability insurance, in the form of a certificate of insurance obtained from their insurance provider. This document should bear the carrier name, policy number and expiry date for their policy. A user guide on how to upload the certificate can be found in the Library Section of your Member Home page.

REMINDERS:

• The deadline for renewals (including payment) is November 30, 2017.
• Pharmacists-in-Charge should be prepared to provide ownership information for the pharmacy.
• 2018 pharmacy licences will be mailed to each pharmacy and a certificate of registration will be emailed to each registrant who has renewed for 2018 in December, after the renewal period has ended.
• Registrants are advised to have all necessary information handy before beginning the online renewal process. Once the renewal is started it cannot be saved and resumed. Additionally, after two hours, the system will automatically log you out.
• Once the renewal is completed and paid, to print your receipt, please click View/Print Invoices and select the paid invoice as proof of payment.
• If you forget your username and/or password, click Registrant Login. Under “Forgot your username/password”, enter the email address associated with your profile. Your login information will be emailed to you shortly. Once logged in, you can change your username and password to something easier for you to remember.

Professional Liability Insurance and PANL Membership

It has come to the attention of the Board that some pharmacists inadvertently missed the renewal deadlines for their professional liability insurance and PANL membership this year. Registrants are reminded that they have an obligation to ensure that they obtain and maintain professional liability insurance as set out in section 14-17 of the Pharmacy Act, 2012 and sections 8-9 of the Pharmacy Regulations, 2014. Pharmacists also have an obligation to maintain membership with PANL as set out in section 21 of the Pharmacy Act, 2012. Please take this time to ensure that you have up to date membership with PANL and professional liability insurance that meets the requirements as outlined by the Board in the document, Professional Liability Insurance Requirements for Registration, available on the Registration & Authorization Information For Registrants page of the NLPB website.

Additionally, as of the upcoming 2017 annual renewal process, all registrants will be required to upload a copy of their active professional liability insurance certificate at annual renewal time as well as within 30 days of any update to the policy if that update occurs during the registration year.

CPD Reminder

Pharmacists and Pharmacy Technicians are reminded that in order to renew registration for 2018, all professional development activities must be first entered into their online Professional Development (PD) logs.

To be eligible for registration renewal, registrants are required to participate in a minimum of 15 hours of professional development learning activities between December 1 and November 30 of each PD year. Of these 15 hours, a minimum of 7.5 must be from accredited learning activities (i.e. programs that have been accredited for no less than a total of 7.5 CEUs) with a balance of 7.5 hours of participation in either accredited or non-accredited learning activities.

Further information can be found by visiting the Frequently-Asked Questions about Professional Development page of the website or by viewing the Standards of Practice – Professional Development for Pharmacists and Pharmacy Technicians, available on the Standards, Guidelines and Policies page.

Pharmacy Technician Registration Appeals

Pharmacy Technician applicants who find themselves in a position of not being able to complete the full process by December 31, 2017 may appeal to the Board for a limited extension.
The purpose of the special appeal is to ensure that candidates who are acting in good faith to complete the Pharmacy Technician registration process are not penalized due to circumstances that are out of their control. Candidates will need to demonstrate that they qualify for special consideration because of these circumstances.

The Pharmacy Technician Appeal Committee has defined the following appeal application and decision process:

• Candidates will apply for the appeal using the standardized form, posted on the Authorization & Registration Information For Registrants page, under Information for Pharmacy Technicians – Related Forms. All appeal applications must be submitted no later than Friday, January 12, 2018.
• NLPB office staff will review the applications for completeness and follow up with candidates if additional information is needed. Applications will also be de-identified at this time.
• The Pharmacy Technician Appeal Committee will meet to review the applications. Consideration will be given to candidates who have demonstrated they were acting in good faith to meet the deadline.
• The Committee’s recommendations will be presented to the NLPB Board for their decision. It is anticipated that the appeal decisions will be finalized in early 2018.

Health Professionals Questionnaire: Cannabis Public Education

Health Canada and the Public Health Agency of Canada will be developing resources that will provide information and advice on how to have informative and engaging conversations about cannabis with youth and vulnerable populations. These conversations might include the facts about cannabis use, the risks and the proposed changes to federal legislation. Health Canada and the Public Health Agency of Canada are seeking input from health professionals on the types of information that would be most helpful to you and to your patients. Please take a few moments to complete this short online survey. Your input will help inform the development of cannabis public education resources.

Link to Survey: https://na1se.voxco.com/SE/?st=xwjTYxFyhQdBv9a7z3iA%2b%2f1swcW62Xo%2f4V8%2b9N54xys%3d&lang=en. The survey should take you about 5 minutes to complete. Your participation is completely voluntary and your responses will be treated in confidence. The results of this survey will be reported in aggregate form and no answers will be attributed to specific individuals. For more information on Health Canada’s Privacy Policy, please visit http://www.hc-sc.gc.ca/home-accueil/important-eng.php

Professional Practice Webinars

The October Professional Practice webinar, “Frequently-Asked Questions – Professional Development Standards and Online Portal” is now available on the Professional Practice Webinars page of the NLPB website. The next webinar is scheduled for Tuesday, December 12, 2017. Topic and registration information will be emailed out to all registrants in the coming weeks.

Drug Information Centre at MUN has Reopened!

The Drug Information Centre at MUN has reopened! Just a phone call (709) 777-7584 or email (druginfo@mun.ca) away to your free, one stop resource for quick and comprehensive drug information. Follow on Twitter @MUNDrugInfo.

NLPB Season’s Greetings and Christmas Hours

As the year draws to an end and the Christmas Season approaches, we take this opportunity to wish you a very Merry Christmas and a Happy New Year. Best Wishes from the Board Members and Staff of the Newfoundland and Labrador Pharmacy Board.

In recognition of the Christmas and New Year holiday season, the Board office will be closed from Monday, December 25th to Monday, January 1st, inclusive.

If you need assistance during this time, please email inforx@nlpb.ca.

Role Distinction – Pharmacy Technician vs Pharmacy Assistant

Prescription Transfers

Registrants are reminded that, in accordance with Federal legislation (C.01.041.1 – C.01.041.3 of the Food and Drug Regulations), only Pharmacists or registered Pharmacy Technicians may participate in prescription transfers. Pharmacy Assistants may NOT participate in requesting transfers and may only participate in the clerical aspects of sending a transfer – for example, print a prescription copy suitable for fax once the pharmacist or pharmacy technician has authorized the transfer and faxing the copy to the requesting pharmacy.

Identification – Name Tags and Telephone Protocols

Pharmacists-in-charge are reminded that, in accordance with section 24.(2) of the Pharmacy Act, 2012, only registered Pharmacy Technicians may be identified or identify themselves as such. Other unregulated staff members may be referred to as Pharmacy Assistants or another suitable title.

Please Double-check Your Contact information

Registrants are asked to ensure that the contact information they provide for themselves and the pharmacy is accurate at all times. The NLPB primarily uses email communication to send newsletters, renewal reminders, practice site assessment notifications and related paperwork, professional development audit information, calsl for interest for committees, and other alerts (e.g. reports of lost or stolen TRPP pads). 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 at any time, please be sure to update your file with your new contact information at that time – you do not need to wait until the next renewal cycle.

Registrants are also reminded that they are obligated to check their email on a regular basis so that important notices do not go unread.

Pharmacy Technician Registration Appeals

Pharmacy Technician Bridging Program applicants who find themselves in a position of not being able to complete the full process by December 31, 2017 may file an appeal with the Board to be considered for a limited extension.
The purpose of the special appeal is to ensure that candidates who are acting in good faith to complete the Pharmacy Technician Bridging Program registration process are not penalized due to circumstances that are out of their control. Candidates will need to demonstrate that they qualify for special consideration because of these circumstances.

The Pharmacy Technician Appeal Committee has defined the following appeal application and decision process:

• Candidates will apply for the appeal using the standardized form, posted on the Authorization & Registration Information For Registrants page, under Information for Pharmacy Technicians – Related Forms. All appeal applications must be received at the Board office no later than Friday, January 12, 2018.
• NLPB office staff will review the applications for completeness and follow up with candidates if additional information is needed. Applications will also be de-identified at this time.
• The Pharmacy Technician Appeal Committee will meet to review the applications. Consideration will be given to candidates who have demonstrated they were acting in good faith to meet the deadline.
• The Committee’s recommendations will be presented to the Board for their decision. It is anticipated that the appeal decisions will be finalized in early February 2018.

REVISED – NLPB Policy regarding Pharmacy Students / Interns Administering Inhalations or Injections

Pharmacists, Pharmacy students and interns are advised that the NLPB Policy regarding Pharmacy Students / Interns Administering Inhalations or Injections has been revised to eliminate the requirement for the student or intern to be completing either the Internship portion of the NLPB Practical Training program, or a clinical placement as part of the Memorial University Pharmacy Program. The rest of the policy remains intact as follows:

Pharmacy Students or Interns may administer drug therapy by inhalation or injection under the following conditions:

The pharmacy student or intern MUST:

• be registered with the NLPB (including maintaining appropriate professional liability insurance);
• have successfully completed either 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.

In this context, when providing “direct supervision”, the pharmacist must be present when the activity is being performed and be able to observe and promptly intervene and stop or change the actions of the individual being supervised.

For reference, this policy is posted to the Standards, Guidelines and Policies page of the NLPB website.