The guidance provided on this page is intended to support pharmacy professionals with information and advice for providing pharmacy services during the COVID-19 pandemic. This page will be updated as required.
|July 20, 2021||Updated information related to the Health Canada Subsection 56(1) class exemption|
Please click the link below to bring you to the appropriate section:
- Other provincial and national COVID-19 information pages
- Reduce the risk of exposure within the pharmacy environment
- Remember your duty to report notifiable communicable diseases
- Pharmacy service disruptions
- Practice specific issues
Please review the following websites for the latest updates:
- Government of Newfoundland and Labrador
- Regional Health Authorities
- Health Canada
- Pharmacists Association of Newfoundland and Labrador
- Canadian Pharmacists Association
Reduce the risk of exposure within the pharmacy environment
Pharmacies should follow guidance provided by Public Health for businesses, including in relation to the following:
- screening patrons and staff members, the handling of money and supplies, and the availability of washrooms, handwashing stations, and/or hand sanitizer
- physical distancing recommendations, including the use of barriers, visible signs, traffic arrows and other markings, separate entrance/exits, limiting the number of patrons, online/phone orders, and staggered check-outs/self service
- cleaning and disinfection protocols, including the choice of appropriate products and cleaning frequency
- the use of personal protective equipment, including the use of non-medical masks by patrons and staff members
Remember your duty to report notifiable communicable diseases
Registrants are reminded that the Public Health Protection and Promotion Act (PHPPA) and its associated regulations include measures for the early detection and management of health risks to the population of Newfoundland & Labrador, including measures to help monitor and minimize the spread of communicable disease.
In order to do so, the PHPPA mandates that healthcare professionals, including pharmacists, report SUSPECTED or CONFIRMED diagnosis of notifiable communicable diseases. Registrants are advised to review the Notifiable Disease List (linked below) where COVID-19 would be included under “all disease outbreaks, unusual disease clusters and unusual disease occurrences.” As a front-line healthcare professional, you may be the first one to suspect the presence of COVID-19 in a patient and you should be familiar with your duty to report.
Please review the documents below for more information:
Pharmacy service disruptions
During the course of the pandemic, pharmacy services may be disrupted. There may be human resource challenges related to self-isolation protocols or staff illness, or service delays related to increased demand for pharmacy services.
If it becomes apparent that an individual who has worked in or visited the pharmacy has tested positive for COVID-19, the pharmacy should immediately close temporarily in order to perform the necessary cleaning protocol. The Centre for Disease Control has valuable guidance on cleaning healthcare settings where an individual with COVID-19 has visited.
The pharmacist-in-charge should also notify NLPB if/when they have pharmacy staff members that test positive for COVID-19 so we can be aware of the situation and any potential impacts on pharmacy services.
Changes to hours of operation
If pharmacists-in-charge determine that it is necessary to change the pharmacy’s hours of operation, or, potentially, close temporarily during this time:
- if hours of operation are changed, revised hours must be posted in full view at the public entrance of the pharmacy, and, at the dispensary, if different. NLPB office does not need to be notified of this temporary change.
- if a temporary closure is required, the pharmacist-in-charge must follow the NLPB Temporary Pharmacy Closure policy.
In these situations, patients should be notified of the changes to pharmacy services at the earliest opportunity, and continuity of care must be considered.
When presented with a patient whose pharmacy is closed and the pharmacy staff and records are inaccessible, pharmacists are advised to utilize the information contained within Healthe NL to inform their prescribing and dispensing decisions. Please contact the NL Centre for Health Information (NLCHI) if you need assistance with accessing information or utilizing functions within Healthe NL or the Pharmacy Network.
Practice specific issues
Pharmacy professionals’ role in informing the public
Pharmacy professionals have a responsibility for informing and educating the public on health and other issues, including those related to the COVID-19 pandemic.
Pharmacists should advise patients who are showing symptoms consistent with COVID-19, including fever, cough or difficulty breathing to self-isolate and contact the 811 Healthline for further direction.
Current evidence suggests that those most at risk of serious complications from COVID-19 include the elderly, those with compromised immune systems, and those with underlying conditions. Pharmacy professionals who work in settings with these individuals should be especially vigilant to protect the safety and security of these populations. This includes:
- Providing direction to these patients on when and how to reach out for assistance.
- Encouraging at-risk patients, whenever practical, to access pharmacy services by telephone, use of a patient agent, home delivery, or other means that minimize direct contact.
- Providing elderly patients and those with more complex medical conditions or chronic illnesses with additional support to ensure their well-being and maintaining their access to an adequate level of patient care from the pharmacy.
Members of the public may also be referred to NLPB’s COVID-19 Guidance for the Public page.
The following resources may be helpful in having conversations with your patients about COVID-19 vaccinations:
- Health Canada COVID-19 Vaccines page
- National Advisory Committee on Immunization (NACI) Recommendations on the use of COVID-19 Vaccines
- Health Canada COVID-19 Vaccine Safety page
- NLPB Health Canada & ISMP Advisories page
The provincial government has also established a COVID-19 Vaccine Resources for Health Professionals page, which can be found at: https://www.gov.nl.ca/covid-19/vaccine/resources-for-health-care-professionals/.
Ensuring adequate access to medication
NLPB recognizes that the pandemic presents patient care challenges for both prescribers and pharmacy professionals. Pharmacists are encouraged to work with other care providers to identify the best possible solution to practice issues on a case-by-case basis, keeping the best possible outcome for the patient top of mind.
Pharmacists are expected to utilize their full scope of practice to assist patients with their medication needs and apply principles of professional judgement and ethical decision-making when responding to situations such as requests for early release, interim supplies or prescription extensions, prescription transfers, curbside pickup, delivery, and alternative prescription delivery methods, such as electronic prescribing.
Health Canada Subsection 56(1) Class Exemption
Registrants are advised that Health Canada has issued an exemption for certain provisions of the Controlled Drugs and Substances Act (CDSA) and its regulations, in light of the COVID-19 pandemic.
To help put this exemption into context, both Health Canada and NLPB have prepared answers to anticipated questions. See the FAQs below:
- Health Canada FAQ on the Subsection 56(1) Class Exemption
- NLPB FAQ on the Health Canada Subsection 56(1) Class Exemption
This exemption expires on the earliest of the following dates:
- September 30, 2026;
- The date that it is replaced by another exemption; or
- The date on which it is revoked
For the duration of this exemption, NL pharmacists CAN:
- Prescribe controlled substances for continued therapy within the framework of the NLPB Standards of Practice-Prescribing by Pharmacists (“Prescribing Standards”); the prescription must be filled at the pharmacy where the prescribing pharmacist is located and at the time it is written
- Transfer a prescription for a narcotic or controlled drug to another pharmacist within NL
- Transfer a prescription for a benzodiazepine or targeted substance (“BZ/TS”) more than once; interprovincial transfer of BZ/TS is permitted as this was already permissible prior to this exemption
- Delegate another appropriate individual to deliver controlled substances to a patient’s home or another location
NL pharmacists still CANNOT:
- Initiate treatment with a controlled substance
- Accept verbal orders for controlled substances subject to the Tamper Resistant Prescription Drug Pad (TRPP) Program
- Accept transfers for narcotics and controlled drugs from out of province
- Only pharmacists who are authorized to prescribe by NLPB can continue prescriptions for controlled substances during the duration of the Health Canada exemption.
- Only pharmacists who are authorized to participate in opioid maintenance treatment (OAMT) services by NLPB can continue prescriptions for OAMT medications. Additional restrictions apply – see the Opioid Agonist Maintenance Treatment (OAMT) below for more detail.
Opioid Agonist Maintenance Treatment (OAMT)
Pharmacists involved in the provision of OAMT should review the COVID-19 OAMT Guidance developed by NLPB as well as the following:
- Updated clinical and pharmacy-specific guidance for management of opioid use disorder during COVID-19 provided by the Centre for Addiction and Mental Health (CAMH).
- Guidance for opioid agonist treatment prepared by the College of Physicians and Surgeons of NL.
Pharmacists are encouraged to collaborate with OAMT prescribers and other members of the care team to prioritize both continuity of care and patient safety. Patients who need to self-isolate will still need access to their OAMT medications. While some pharmacists may elect to deliver medications to patients, this may not be a viable option in all cases. Pharmacists who are considering other solutions should contact the NLPB office to discuss the situation.
The Regional Opioid Treatment Centres throughout the province may be able to assist patients with treatment of opioid use disorder, including counselling services. Contact information for these centres can be found under “Mental Health and Addictions” on the Government of NL website.
Pharmacy professionals can also assist with other harm reduction measures, such as, providing take-home naloxone kits (or referring the patient to distribution sites for the government program), and advising patients on supports available in the community.
Finally, the Government of NL has developed information specific to individuals who need assistance related to opioid use disorder or OAMT. Patients can be directed to the COVID-19-Supporting people requiring opioid dependence treatment document for a list of recommended contacts or the toll-free Provincial Opioid Dependence Treatment line at 1-844-752-3588.