Reminders Regarding the Provision of Take-Home Naloxone Kits

Registrants are reminded that the NLPB has published guidance on the sale of naloxone in community pharmacies – http://nlpb.ca/media/Guidelines-Naloxone-Sept2016-revised-Feb2017.pdf. Pharmacists are expected to consider these guidelines when dispensing naloxone, in addition to meeting the usual expectations related to the provision of a Schedule II medication.

The guidelines also describe the expectations for the contents of a “naloxone kit” whether that kit be purchased from a distributor or assembled at the pharmacy itself. This includes:

  • i) two 1 mL single-use ampoules or vials of naloxone hydrochloride 0.4mg/ml solution or two doses of naloxone hydrochloride 4mg/0.1ml nasal spray;
  • ii) two 3cc syringes with auto-retractable 25G needles attached (1” length recommended) (for injectable naloxone);
  • iii) alcohol swabs (for injectable naloxone);
  • iv) latex or vinyl gloves;
  • v) ampoule opening device (optional);
  • vi) rescue breathing barrier with one-way valve (optional); and
  • vii) step-wise instructions for recognizing and responding to an opioid overdose including written and visual instructions for administering naloxone administration.

Registrants are advised to follow best practices when verifying the contents of these kits when assembled, and again at the time of dispense and release to the patient.


Look-Alike / Sound-Alike – Xarelto and Xatral

A pharmacist recently reported that their pharmacy staff detected a “near miss” error between Xarelto (rivaroxaban) and Xatral (alfuzosin hydrochloride).

The Institute for Safe Medication Practices (ISMP) has issued a warning regarding the potential for this error in 2009 – https://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2009-6-NationalCollaborative-Top5DrugsReported.pdf. They point out in the article (on page 4 of the bulletin) that this risk is particularly high since both products are available in 10 mg tablets, and both have a recommended daily dosage of 10 mg once daily. Additionally, since Xarelto is seen more often, there is the issue of “confirmation bias” where the mind sees what it wants to see, rather than what is actually there.

In order to mitigate the risk of this mix-up, ISMP advises health professionals to:

  • use the generic name in addition to the brand name where applicable;
  • include the indication for the medication when prescriptions are communicated;
  • verify the indication for the drug with the patient whenever possible;
  • clearly distinguish the 2 drugs in the product selection screen of computerized order entry systems; and
  • add a warning where these drugs are stored.

Registrants are also encouraged to utilize independent double checks wherever possible, but particularly in relation to high-risk drugs – https://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2005-01.pdf.


Photos of Prescriptions are Not Enough

The NLPB is aware that mobile apps allowing an individual to forward an image of their prescription to a pharmacy in advance of picking up their medication are currently available. We would like to advise our registrants that these images are not equivalent to an original prescription.

In the future, electronic prescribing will be available to help facilitate the transmission of a prescription directly from a prescriber to a pharmacy using the electronic health record, as required by legislation. Until that time, in order for the pharmacist or pharmacy technician to ensure that the prescription is authentic and clear and to allow the pharmacist to conduct an appropriate patient assessment, the original prescription must be obtained in person, or received via fax or verbally directly from the prescriber, in accordance with the Standards of Pharmacy Operation – Community Pharmacy, before being prepared and dispensed.

If an individual uses an app, text, or email to provide the pharmacy with a copy of a prescription, pharmacy team members may check their inventory to see if stock is available or offer an estimation on cost, but should not prepare the prescription before receiving the original, as this increases the risk of error and the possibility of creating inaccurate or duplicate records.


Reporting of Losses, Thefts and Forgeries

The Compliance Monitoring and Liaison Division of the Health Canada Office of Controlled Substances recently updated their guidance on reporting the losses, thefts and forgeries of controlled substances and precursors. Links to this guidance as well copies of the reporting forms can be found on the NLPB’s Professional Practice Resources page or on Health Canada’s website at: https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/controlled-substances/compliance-monitoring/loss-theft-forgery.html


Expectations When a Patient Receiving ODT Switches Pharmacies or Attends a Secondary Pharmacy

Pharmacists are reminded that, prior to dispensing methadone or buprenorphine-naloxone to a patient who previously attended another pharmacy, they need to speak with a pharmacist at the previous site to confirm the date, time, and dosage of the last dose. This information is necessary in order to assess the appropriateness of the prescription, and to determine whether it is safe to release the next methadone or buprenorphine-naloxone dose to the patient. Viewing the patient’s medication profile in the Pharmacy Network would not be sufficient to meet this expectation.

The Standards for the Safe and Effective Provision of Medication for the Treatment of Opioid Dependence state that “prior to releasing methadone or buprenorphine-naloxone to a patient, pharmacists are expected to review the patient’s profile and Administration Log for notes, missed doses, documentation of returned vials (if applicable), or any other applicable information.” If the Administration Log is located at another pharmacy, the pharmacist at the patient’s new pharmacy must confirm the details of the Administration Log with a pharmacist at the previous site. This would include instances where a patient is receiving continuation of methadone or buprenorphine-naloxone therapy in hospital. The Pharmacy Network profile does not contain the necessary specific details noted above, such as the time the patient received the dose and any noted concerns.

In addition, pharmacists are reminded that if a patient misses a dose of methadone or buprenorphine-naloxone, the dose should be cancelled on that day so that the patient’s medication profile contained within the Pharmacy Network is accurate with respect to the last date the patient received medication.


MUN School of Pharmacy Activities for Pharmacy Awareness Month

From ‘PAM’cake breakfasts, to testing seniors’ blood pressure, to educating high school students on the dangers of prescription drug abuse and beyond, MUN School of Pharmacy students have once again created a jam-packed calendar of activities for the month of March: Pharmacist Awareness Month (PAM).

For a schedule of events taking place throughout the month, see https://gazette.mun.ca/campus-and-community/think-pharmacists/ and follow the School of Pharmacy on Facebook and Twitter for PAM updates throughout March.


NL Pharmacy Board Awards – Call for Nominations

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 Awards recognizing 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 12, 2018 during the NLPB Symposium.

The deadline to send in your nominations is March 9, 2018. Please consider nominating a fellow pharmacist or pharmacy technician today!


NLPB Symposium – Registration Now Open!

Registration is now open for the 2018 NLPB Symposium, to be held at the Comfort Inn Airport in St. John’s on Saturday, May 12, 2018. The day will include the 2018 Annual General Meeting, a Professional Development Program, an Open Forum, and will end with the NL Pharmacy Board Awards Luncheon.

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.

Preliminary Schedule of Events
8:00 – 9:00 am Check-In (with Continental Breakfast)
9:00 – 10:45 am Professional Development Program – Social Media and Your Professional Reputation (Speaker: Ronalda Walsh, Nine Island Communications)
10:45 – 11:00 am Break
11:00 am – 12:00 pm Open Forum
12:00 – 1:00 pm Annual General Meeting
1:00 – 2:00 pm NLPB Awards Luncheon

To register for the symposium, click on “Registrant Login” on the main menu, 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 look forward to seeing you there!


Forgot Your Password?

From the main menu, click Registrant Login. Under the Login box, click the message that says, “Forgot your password? Click here to restore it.”

On the next screen, enter your NLPB username if you know it, or the email address on your file. Click Retrieve. In a few minutes you will receive an email with your username and password. Once you’re logged in to your profile you are able to change your password if desired.


NLPB Receipts

NLPB’s registration portal maintains all receipts created by the system. If for any reason you need a copy of your paid invoice, you can log in anytime by visiting www.nlpb.ca and clicking on Registrant Login. Once logged in, click on the link called Renewal Other/Invoices and then select either view or print.


This e-newsletter contains information on a wide variety of topics intended to enhance the practice of pharmacy in the province of Newfoundland and Labrador. As it is published and circulated to all registrants on a monthly basis, it is the expectation of the NLPB that all registrants are aware of the matters contained therein.

©2018 Newfoundland & Labrador Pharmacy Board