MedSTEP NL Program – Upcoming Deadlines
Upcoming implementation deadlines for the MedSTEP NL program include training staff by June 30, 2024, and begin reporting medication incidents and near-miss events by July 1, 2024.
Please review the steps below that must be completed by the indicated implementation deadlines:
To complete this implementation step, community pharmacies must ensure the following:
- Train Staff by June 30, 2024
- PIC appoints a CQI coordinator (in addition to themselves), if feasible, to help ensure the policy and procedure manual is updated as required, training is ongoing, and medication incidents and near-misses are reported in a timely matter.
- PIC engages with all pharmacy staff in discussions on processes to report incidents and near-miss events and ensures all staff are trained and comfortable with the pharmacy’s policy and procedure manual and reporting platform.
- PIC ensures all pharmacy staff have completed the training provided by the MIR.
- Complete Implementation by July 1, 2024
- Pharmacy starts reporting medication incidents and near-miss events as per NLPB’s Standards of Practice for CQI and MIR.
Visit the website, nlpb.ca/medstep-nl for an overview of the program, requirements, implementation, and more.
New Standards for the Provision of OAT Medications Implementation Deadline
The implementation deadline for the new Standards for the Provision of Opioid Agonist Therapy Medications is no later than July 1, 2024.
These new standards, which replace the former Standards for the Safe and Effective Provision of Opioid Agonist Maintenance Treatment (2018), were approved by the NLPB board of directors at their March 2024 meeting.
Some highlights of changes from the previous version of the standards include:
- In the interests of reducing barriers to care and stigma, pharmacists and pharmacists-in-charge are no longer required to become authorized to participate in or offer opioid agonist treatment (OAT) services. Pharmacy professionals are still expected to gain and maintain the necessary knowledge and skills, as identified in section 4, and pharmacies must still meet the operational standards identified in section 5 prior to participating in OAT.
- References specific to releasing doses of medications and witnessing patient self-administration have been revised to distinguish between the clinical and technical aspects of these activities and allow for a pharmacist to delegate the actual witnessing of the self-administration of a witnessed dose (section 6.7 b)) or the provision of take-home doses to the patient (section 6.8 b)) to a pharmacy technician.
- References to the Health Canada subsection 56(1) class exemption specific to prescription transfers and pharmacist prescribing have been added (section 8.4).
- New sections have been added specific to ethical considerations, including principles of stigma, trauma-informed care, and harm reduction (section 2).
Registered Nurse Prescribing
On April 3, 2023, the NL Provincial Government announced amendments to the Registered Nurses (RN) Regulations to permit RN prescribing. Once an RN has obtained the required education, authorization, and competence, the RN is authorized by the College of Registered Nurses of Newfoundland and Labrador (CRNNL), within the parameters outlined by an employer sponsor, to prescribe medications, order laboratory and diagnostic tests and/or other non-pharmacological interventions, and make referrals, within a practice setting or identified client population.
An individual who has been granted this authorization will display on the CRNNL’s member search, under the details section of their profile, that they have the Specialization of RN Prescribing. Pharmacy professionals can access the member search at the following link: https://crnnl.ca/member-search/
For more information on RN prescribing and the education courses required, please visit CRNNL’s webpage: https://crnnl.ca/practice/practice-resources/practice-topics/rn-prescribing/
NL Health Services Diabetes Outreach Team Prescribing Practices
The Diabetes Outreach Team is sharing the following information with pharmacists regarding patients with Type 1 diabetes mellitus under the care of the Janeway Diabetes team.
Insulin Dose
Insulin needs of children for both long- and rapid-acting insulins increase over time for many reasons, including complete failure of beta cell function and physical growth. The need for additional insulin is assessed and adjusted regularly by the diabetes team. Therefore, insulin is prescribed “to be administered as directed.” To allow for the anticipated increase in need, the amount prescribed is higher than the current dose.
Point: At the time of dispensing, it is not necessary to confirm the exact doses of insulin being given as it will likely be different than prescribed and may lead to parental confusion.
Long-acting Insulin
In young children, the insulin preference is Levemir as it can be given in divided doses. In the early days after diagnosis, it is not uncommon to not need insulin in the overnight period. This is gradually added over time, when required.
Point: Substituting to other 24-hour formulations in young children is not recommended as there is significant and increased risk of nocturnal hypoglycemia.
Rapid-acting Biosimilar Insulin Substitution
At diagnosis, all children are given a ½ unit reusable insulin pen and cartridges for rapid-acting insulin administration with either Humalog® or NovoRapid® (this prescribing choice is expected to change once biosimilar insulins are approved for in-hospital use).
Point: If substitution is required, continue with cartridges of either of the biosimilar insulins and provide a ½ unit-increment SoloStar Junior® pen when cartridges are dispensed. Do not substitute cartridges with a disposable pen (which delivers in increments of 1.0 units).
If you have any questions, please contact the Diabetes Outreach Team at 709-777-4680.
Ephedrine and Pseudoephedrine Removed from the National Drug Schedule
Now that Health Canada has implemented an Interim Order to govern the sale of single-ingredient ephedrine and pseudoephedrine, NAPRA has proceeded with the removal of these products from the National Drug Schedule (NDS).
All products with a Natural Product Number (NPN) or Drug Identification Number – Homeopathic Medicine (DIN_HM) from Health Canada are outside the scope of NAPRA’s NDS.
Please note that the Interim Order, in effect as of May 17, 2024, is an urgent, but temporary, measure that will allow Health Canada to manage risk while they continue to work on a long-term solution.
NDSAC Interim Recommendations on Desloratadine for Use in Children 2-11 Years
The National Drug Scheduling Advisory Committee (NDSAC) has issued the following interim recommendations:
- Desloratadine and its salts and preparations in products labeled for use in children aged 2 to 11 years, in package sizes containing greater than 35mg of desloratadine, remain in Schedule III
- Desloratadine and its salts and preparations in products labeled for use in children aged 2 to 11, in package sizes containing no more than 35mg of desloratadine, be granted Unscheduled status
Any objections to these interim recommendations must be received by the NAPRA office by end of day July 10, 2024. Questions or comments should be directed to the NDSAC Secretariat via email at ndsac@napra.ca.
These recommendations are not yet in effect. If NAPRA receives no objections, a final recommendation will be published at a later date.
Professional Liability Insurance – Coverage and Documentation
Is your professional liability insurance (PLI) coverage coming up for renewal? All registered pharmacy professionals, whether or not you are currently practicing, are required to carry sufficient PLI as per NLPB’s Professional Liability Insurance Requirements for Registration.
Upon policy renewal, you are required to upload an annual certificate of coverage and update your policy information in your NLPB profile. To upload your insurance certificate and update your policy information, log into the Registrant Portal and select Professional Liability Insurance from the menu. For specific instructions, refer to the NLPB Registrant Portal User Guide – Adding/Updating Professional Liability Insurance.
Please note that all registered pharmacy professionals are required to ensure their policy contains a clause that the insurer will notify NLPB if the policy is canceled, expires, or no longer meets NLPB requirements. If you have chosen to change insurance providers, please ensure your updated certificate is uploaded to the NLPB Registrant Portal.
Keep your insurance up to date to protect the public and protect your practice.
IAC Seeking Applications for Public Representatives for NLPB Board and Disciplinary Panel
| If you are aware of any person who would be interested in either of the positions listed below, we encourage you to share this information. |
The Independent Appointments Commission is seeking interested public members to serve as public representatives with the Newfoundland and Labrador Pharmacy Board on its Disciplinary Panel and Board of Directors.
These positions cannot be held by pharmacists or pharmacy technicians but rather by individuals with diverse backgrounds and skill sets who can bring patient and other perspectives. These skill sets and areas of experience include but are not limited to governance, human rights, legal expertise, ethics, conflict resolution, business or public administration, human resources, finance, or human resources.
For more information regarding the three vacant positions on the Disciplinary Panel, visit https://www.exec-abc.gov.nl.ca/public/agency/detail/?id=635
For more information regarding the vacant position on the Board of Directors, visit https://www.exec-abc.gov.nl.ca/public/agency/detail/?id=636
Call for Expression of Interest – Quality Assurance Committee
NLPB is currently seeking a hospital pharmacist to join the Quality Assurance Committee.
The Quality Assurance Committee is a standing committee of the Newfoundland and Labrador Pharmacy Board whose role is to investigate quality assurance concerns that arise about the 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 to the Complaints Authorization Committee when possible professional misconduct is discovered.
If you are interested, please submit your name, contact information, a brief bio, and a few lines about why you are interested in being part of the committee to inforx@nlpb.ca.
Thank you in advance for your interest in serving your profession.
Regular reminders
- Registrant Contact Information – Registrants are responsible for ensuring that the contact information on their registrant profile, including email address and practice site, is accurate at all times. The NLPB primarily uses email communication to send newsletters, renewal reminders, practice site assessment information, professional development audit information, calls for interest for committees, and other alerts. 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, please update your information on file by logging into the NLPB Registrant Portal.
- Application Submission – NLPB receives many applications for processing. Unfortunately, some of the applications submitted are illegible, incomplete, or missing supporting documentation or payment, leading to delays in processing and approving the application. In order to ensure that your application is processed in a timely manner, please take a moment before submission to ensure that all fields are completed and legible and that all supporting documentation is included. All supporting documentation should adhere to NLPB’s Scanning Guidelines and Checklist for Document Submissions Policy. These small steps will help improve the process for both the applicant and NLPB.
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 NLPB that all registrants are aware of the matters contained therein.
