COVID-19 Guidance for Pharmacy Professionals

March 31st, 2020

 

The COVID-19 situation is evolving rapidly. The guidance provided on this page is intended to support pharmacy professionals with foundational information and advice. This page will be regularly updated on an ongoing basis.

Page last updated on May 28, 2020, at 12:45 p.m. NDT.

Recent updates:


Please click the link below to bring you to the appropriate section:


 

Please review the following websites for the latest updates:

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General

There are several things that pharmacists-in-charge can do to help prevent themselves, their staff, and patients from becoming infected with COVID-19.

 

Reduce the risk of exposure within the pharmacy environment

Post signage (see below) on the public entrance(s) to the pharmacy area requiring individuals to self-identify if they:

  • are experiencing symptoms including fever, cough, difficulty breathing, or extreme tiredness;
  • have a travel history outside of Canada in the last 14 days; or
  • have had contact with a person who has either the above travel history or has been confirmed to have COVID-19.

Patients who meet the above criteria or who have tested positive for COVID-19 should be advised to:

  • not enter the pharmacy;
  • immediately self-isolate;
  • contact the 811 HealthLine for further advice; and
  • contact the pharmacy from a telephone or email (if applicable) to arrange access to their prescriptions.

Similar messaging should be communicated on telephone messages, websites and social media.

There should also be alcohol-based hand sanitizer, tissues, and a lined waste container available to patients when visiting a pharmacy.

Posters:

  • Poster 1: ATTN! 811
  • Poster 2: ATTN! Reduce the risk of exposure
  • Poster 3: How to wash your hands (via GovNL)
  • Poster 4: Remember to wash your hands (via GovNL)
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      Pharmacy cleaning guidance

      • Use appropriate cleaners and disinfectants:
        • ​Use products with a Drug Identification Number (DIN) and that are labeled as a broad-spectrum virucide.
        • Effective agents against COVID-19:
          • 70% ethyl or isopropyl alcohol
          • A mixture of 1-part household bleach to 9-parts water
          • Accelerated hydrogen peroxide 0.5% (Virox®)
      • Clean more often:
        • Clean general areas a minimum of TWICE DAILY (desks, counters, swinging doors leading to the dispensary, tables, seating areas)
        • Clean frequently touched surfaces​ EVERY 30-60 MINUTES and IMMEDIATELY after interaction if dealing with a patient who has screened positive for COVID-19 (telephones, pill counting machines, faucets, debit machine keypads, cash registers, pens, door handles, patient buzzers, computer keyboards and mouse, switches)
      • Other tips:
        • Set timers/alarms as reminders to clean
        • Consider establishing a cleaning log
        • Use disposable gloves when cleaning; once cleaning is completed, discard the gloves and wash hands with soap and water for 20 seconds or use hand sanitizer
      • Poster: Pharmacy Cleaning Guidelines
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        Pharmacy staff

        The best defence against the spread of COVID-19 is proper hand hygiene and cleaning procedures. Because COVID-19 can be transmitted via droplets and contact, any areas of pharmacies that may have been contaminated with the virus should be disinfected. Pharmacy professionals should be familiar with infection prevention and control guidelines, and ensure policies and procedures are in place for staff and that they are followed. The following references may be helpful:

        Front-line pharmacy staff could possibly be exposed to the SARS-CoV-2 virus as they are interacting with patients who may be infected; therefore, personal protective measures should be in place. The Government of Canada website for health professionals indicates that health care workers should use a risk assessment approach before and during each patient interaction to evaluate the likelihood of exposure.

        As noted above, pharmacy professionals should aim to prevent exposure; however, if a pharmacy professional is in a position where they need to provide direct patient care to someone who may be experiencing COVID-19, they should follow the recommended contact and droplet precautions for health professionals. This includes the appropriate use of the following personal protective equipment (PPE):

        • gloves
        • a long-sleeved gown
        • facial protection, such as surgical/procedural mask and eye protection, face shield, or surgical/procedural mask with visor attachment

        Keep in mind that hand hygiene should be performed during and after removal of PPE and after leaving the patient care environment.

        Pharmacists-in-charge should obtain reasonable quantities of PPE supply from their suppliers to have on hand if or when it is required. It is not recommended to stockpile PPE as this may lead to immediate shortages.

         

        Remember your duty to report notifiable communicable diseases

        Given the current world outbreak of COVID-19, it’s important to remind registrants of the Public Health Protection and Promotion Act (PHPPA) and Public Health Protection and Promotion Regulations. The PHPPA creates 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 help monitor and minimize the spread of communicable disease, the PHPPA mandates that pharmacists, and other healthcare professionals, report SUSPECTED or CONFIRMED diagnosis of notifiable communicable diseases. A notifiable communicable disease is one found on the Notifiable Disease List (included below). As a front-line healthcare professional, you may be the first one to suspect the presence of a notifiable communicable disease in a patient and in this particular case, COVID-19 (which falls under “all disease outbreaks, unusual disease clusters and unusual disease occurrences” that have to be reported immediately to 1-866-270-7437).

        The documents below are from the Chief Public Health Officer of Canada. Please review to ensure that you are familiar with your duty to report:

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        Pharmacy professionals role in informing the public

        Pharmacy professionals have a shared responsibility for informing and educating the public on health and other issues 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. Pharmacists should alert patients that the 811 Healthline may experience significant delays as the situation continues to develop and recommend that self-isolation measures be undertaken as a precaution, until specific guidance is obtained.

        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 hypervigilant 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 the 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 to maintain an adequate level of pharmacy patient care.

        You can also refer the public to NLPB’s COVID-19 Guidance for the Public page that is now available. It is being updated regularly with helpful pharmacy information on how to safely navigate through this situation as it evolves.

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        Ensuring adequate access to medication

        Pharmacy professionals are expected to advise and assist their patients with respect to obtaining prescriptions for medications and a sufficient on-hand supply to manage their health condition(s).

        There will likely be situations arising from COVID-19 where patients are unable to access their usual prescriber for prescriptions. Pharmacists should utilize their full prescribing scope (see Prescribing by Pharmacists) to assist patients with their medication needs, consulting with primary health care providers by phone or other means, where necessary and possible. In all likelihood, pharmacists will be faced with situations where they will need to use their professional judgement to make the best decision they can under the circumstances, in the interests of meeting the healthcare needs of patients.

        As of May 4, 2020, due to a nationwide effort to protect the drug supply since mid-March, medication inventories appear to be stabilizing and returning to pre-pandemic quantities.

        After collaboration with the Pharmacists’ Association of Newfoundland & Labrador (PANL) and other healthcare partners, we have decided to ease away from the 30-day supply recommendation over the next two weeks. This time period is intended to give pharmacists the support and flexibility they need to adjust to the situation as we are aware it has been challenging and will remain to be so for the next little while.

        See a copy of the official public statement here: 30-Day Medication Supply Update

        Pharmacists-in-charge should also manage their pharmacy’s inventory to avoid stockpiling as all pharmacies need to be able to provide medications to their patients during this time.

        Patients should be informed about the risks of stockpiling medications, as well as other critical products such as diabetic supplies, as this could restrict access to vulnerable populations as well as trigger widespread shortages.

        If self-isolated patients require medications, they should be advised to have someone who is not ill and has not been exposed to act as their agent to visit the pharmacy on their behalf. If this is not possible, medications may be delivered to the patient, but processes should be developed to prevent direct contact with the patient, while maintaining security of the drugs and patient confidentiality. NLPB requirements regarding prescription delivery are outlined in Section 2.2 of the Standards of Pharmacy Operation-Community Pharmacy, and section 2.8 of the Standards of Pharmacy Operation-Hospital Pharmacy. Written delegation to an agent may not be possible to obtain from a patient during isolation. Pharmacy professionals may collect the necessary information to assure patient confidentiality by telephone or email from the patient.

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        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.

        The gov.nl.ca website indicates that individuals should self-isolate at home if they:

        • have been diagnosed with COVID-19;
        • are a close contact of someone diagnosed with COVID-19;
        • have been assessed by Public Health for COVID-19 and/or are waiting to hear the results of a laboratory test for COVID-19;
        • have travelled anywhere outside of Newfoundland and Labrador (self-isolate for 14 days upon return to the province); or,
        • have been advised to self-isolate for any other reason by Public Health.

        *This guidance applies to pharmacy staff members.

        If pharmacy staff members are experiencing symptoms such as fever, cough, difficulty breathing, or extreme tiredness they should not enter the pharmacy until they seek advice related to COVID-19.

        In the situations above, pharmacy staff should immediately contact the 811 Healthline, identifying themselves as someone who works in a pharmacy. Health authorities will then direct next steps with respect to COVID-19 testing and assessing risk to other staff and patrons of the pharmacy. The advice of Public Health officials must always be followed.

        If a patient and/or pharmacy staff test positive for COVID-19

        If a pharmacy staff member becomes aware that an individual who has COVID-19 has worked in or visited the pharmacy, 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: Cleaning and disinfection for community facilities. Also, see NLPB’s “pharmacy cleaning guidance” above.

        A pharmacy that has to close for a temporary period of time for cleaning must follow the NLPB Temporary Pharmacy Closure policy. The pharmacist-in-charge is also expected to 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 impacts to pharmacy services.

         

        Changes to hours of operation

        Due to issues related to the COVID-19 pandemic, pharmacists-in-charge may determine that it is necessary to change the pharmacy’s hours of operation, or, potentially, close temporarily.

        • 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 patients whose pharmacies are closed and the pharmacy staff and records are inaccessible, pharmacists are advised to utilize the information contained within Healthe NL to inform their decision-making and the Pharmacy Network with regard to completion of prescription transfers. 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.

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        Practice specific issues

         

        Patient consultation

        Pharmacy professionals will need to exercise their professional judgement regarding the best way to communicate health and medication information to patients. Wherever possible, social distancing measures should be employed. Medication counselling may be best completed by telephone to reduce exposure of pharmacy staff and patients. NLPB supports pharmacy professionals in making the necessary adjustments to their practices in order to manage personal protective measures alongside patient needs.

         

        Prescriptions for controlled substances

        NLPB recognizes that prescribers and pharmacy professionals are working under exceptional circumstances to provide care to patients. During this time, it may not be possible to fully meet some of the prescription requirements for controlled substances (which includes narcotics, controlled drugs, benzodiazepines and targeted substances). Pharmacists are encouraged to work with other care providers to identify the best possible solution to practice issues on a case-by-case basis, with the best possible outcome for the patient top of mind.

        It is likely that pharmacists will encounter patients requesting access to refills for controlled substances earlier than their usual interval. Pharmacists are encouraged to use their professional judgement with respect to early release, considering the issues the pandemic presents and individual patient situations, consulting with primary health care providers (where necessary and possible). As a reminder, pharmacists should document the rationale for their prescribing decisions in the patient record.

        Health Canada Subsection 56 (1) Class Exemption for Patients, Pharmacists Prescribing and Providing Controlled Substances in Newfoundland and Labrador *as of March 27, 2020

        In light of the COVID-19 pandemic, please be advised that Health Canada has issued a pharmacy exemption for certain provisions of the Controlled Drugs and Substances Act (CDSA) and its regulations.

        See CDSA Exemption and interpretive guide for controlled substances.

        To help you put this exemption into context, we, as well as Health Canada, have prepared answers to anticipated questions. See the FAQs below:

        This exemption expires on the earliest of the following dates:

        • September 30, 2020
        • The date that it is replaced by another exemption
        • The date on which it is revoked

        This exemption enables pharmacists to:

        • Prescribe controlled substances for continued therapy (within the framework of the NLPB Standards for Prescribing by Pharmacists)
        • Transfer prescriptions for controlled substances to other pharmacists within NL (prescriptions for narcotics and controlled drugs cannot be transferred from or to another province)
        • Permit pharmacy employees to deliver prescriptions for controlled substances to patient’s homes or other
          locations where they may be (i.e. self-isolating)

        A pharmacist CANNOT:

        • Initiate treatment with a controlled substance
        • Accept verbal orders for medications subject to the Tamper Resistant Drug Pad Program

        NOTE:

        • Only pharmacists who have been issued a general authorization 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 may continue prescriptions for methadone or buprenorphine-naloxone, and certain restrictions apply.

        *see the COVID-19 OAMT guidance document for specific details

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        Loss/theft reporting for controlled substances

        Health Canada has advised provincial regulators that staff have been working remotely in order to practice physical distancing recommendations – this has affected the ability to monitor fax machines on a routine basis.

        At this time, if you are not already doing so, pharmacy professionals are asked to submit their loss or theft reports via email instead of fax. This is especially important if a pharmacist/pharmacy receives a non-deliverable message from their submitted fax.

        Loss or theft reporting information can easily be accessed at: Loss or theft

        The online form can be submitted directly by filling out a loss or theft report form.

        If the Health Canada website is inaccessible, a copy of the form can be obtained and sent directly to:
        hc.ocs.reporting-rapporter.bsc.sc@canada.ca
        *This email can also be used to relay questions or concerns.

         

        Opioid Agonist Maintenance Treatment (OAMT)

        During the COVID-19 situation, individuals who require OAMT may face unique challenges with medication access, and with managing their opioid use disorder in the setting of stressors and additional health concerns.

        To aid with the provision of OAMT during this time, we have developed a detailed OAMT Guidance Document.

        Pharmacists should consider the following:

        • There may be situations where it is appropriate to temporarily deviate from the usual recommendations for witnessed dosing and maximum number of take-home doses as stated in clinical practice guidelines. 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. Where possible, a pharmacist may elect to deliver such medications to patients, keeping personal protective measures in mind. However, this may not be a viable service option for all pharmacies. Pharmacists may determine other solutions to this issue-contact NLPB office to discuss proposed solutions, where necessary.
        • Contact information for the Regional Opioid Treatment Centres throughout the province can be found under “Mental Health and Addictions” on the Government of NL website. These centres may be able to assist patients with treatment of opioid use disorder, including counselling services.
        • Pharmacy professionals can assist with other harm reduction measures, which are particularly important during times of increased stress; 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.

        The Government of NL has produced information for individuals who need assistance related to opioid use disorder or OAMT. At this time, individuals should not be directed to go to their local emergency department in order to receive methadone or buprenorphine/naloxone, unless they are seriously ill. Please see the COVID-19–Supporting people requiring opioid dependence treatment document for a list of recommended contacts.

        As of April 13, there is a new toll-free Provincial Opioid Dependence Treatment line available for those seeking support for their opiate use, for their families and for healthcare providers. The number is 1-844-752-3588 and is available Monday-Friday 8:30 am – 4:30 pm.

        The Centre for Addiction and Mental Health has provided clinical and pharmacy-specific guidance for management of opioid use disorder during COVID-19. Refer to the CAMH website for the most up-to-date recommendations. In addition, the College of Physicians and Surgeons of NL released an adapted version of CAMH’s clinical guidance document on April 3, 2020. Review these practice guidelines to assist with OAMT decision-making during this time.

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        Implementation of compounding standards

        As PPE becomes increasingly less available, it is critical that compounders use conservation measures to minimize waste and maximize efficiencies while maintaining compound quality and ensuring patient safety. Develop appropriate policy and procedures, and ensure staff are adequately trained.

        Pharmacists should assess the urgency and criticality of the products being compounded and consider if it is appropriate to collaborate with the prescriber to consider another medication or dosage form if available.
        Ideally, masks and other single-use PPE should never be reused, but if this becomes a necessity, consider the following strategies:

        • Ensure each compounder has their own mask. Do NOT share masks
        • Each mask should be labeled with the compounder’s initials and stored in a small, labeled, paper bag
        • Replace the storage bag after each use of the mask
        • Complete hand hygiene after donning the “dirty” mask
        • Do NOT touch mask once it is donned until task completion
        • The amount of times a mask can be worn is determined by using judgement based on:
          • condition of mask,
          • if the mask is visibly soiled, and
          • handling technique.
        • Do not reuse shoe covers. In the event of a shoe cover shortage, implement a facility-dedicated shoe policy with shoes that are readily washable or cleanable
        • Gowns may be reused for up to one week. When reusing gowns, consider the following points:
          • Minimize the number of compounding personnel and gowns needed
          • Add non-sterile sleeves when wearing a reused gown
          • Discard the gown if it becomes visibly soiled of was used during cleaning activities
        • Do not reuse PPE that was used for hazardous compounding or for cleaning


        Extensions to implementation schedules for sterile and non-sterile compounding standards

        The conditions of COVID-19 have created further challenges for registrants to implement the requirements of sterile and non-sterile compounding standards on schedule. NLPB has decided to extend Phase 2 and 3 implementation deadlines by one year for both sterile and non-sterile compounding standards.

        The Implementation Schedule for Non-sterile Compounding Standards and the Implementation Schedule for Sterile Compounding Standards have been revised to include these updated completion deadlines:

        • Phase 2 – Complete by December 31, 2021
        • Phase 3 – Complete by December 31, 2022

        Keep in mind that pharmacy management and personnel are still responsible to ensure the safety and quality of pharmacy practice, and to mitigate any risks that compounding activities may pose to patients and personnel throughout the implementation process. Registrants are expected to make every effort to fully meet the compounding standards applicable to their site at the earliest possible date.

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        Compounding hand sanitizer

        Due to the urgent need for disinfectants and hand sanitizers during the COVID-19 pandemic, pharmacists may be called upon to compound hand sanitizer. The bulk preparation of hand sanitizers and disinfectants would normally require authorization from Health Canada. However, while shortages continue to exist, Health Canada has informed pharmacy regulators that it will not prioritize enforcement of the condition that compounded hand sanitizer can only be distributed as part of a practitioner-patient relationship. Registrants are reminded that any compounded disinfectants or hand sanitizers must be from a reputable formula, such as one published by the World Health Organization, and NLPB’s Standards for Pharmacy Compounding of Non-Sterile Preparations must be followed.

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        Administering injections

        It is expected that pharmacists will continue to be asked to provide administration of routine injections. When deciding whether or not to administer an injection to a patient, pharmacists should consider the following:

        • Prior to deciding to administer an injection, pharmacists should practice social distancing principles while screening the patient for symptoms and/or exposure criteria consistent with COVID-19.
        • Any patient presenting with symptoms and/or exposure criteria consistent with COVID-19 should be directed to immediately self-isolate, call the 811 Healthline and await further instructions.
        • For patients who do not exhibit symptoms and/or have exposure criteria consistent with COVID-19, pharmacists should use a risk assessment approach to determining whether or not it is appropriate to administer the injection:
          • Consider postponing the administration of injections that are part of a series which have a possible range of time (“2-6 months”, “6-12 months”) to later in the schedule.
          • Prioritize injections that are part of a regular schedule and require continuity of care or where the patient may be negatively impacted if they do not receive the injection (such as antipsychotics and medroxyprogesterone).
        • If the decision is made to administer the injection, while the risk to pharmacists administering an injection to a healthy patient is low, pharmacists should still approach the interaction with caution, practicing good hand hygiene, and paying particular attention to the proper use of personal protective equipment (PPE).

        It is also important to consider that pharmacists may have unknowingly come in contact with COVID-19 and protective measures are necessary to protect patients. If pharmacists do not have access to the required PPE, they should not administer the injection and refer the patient to another pharmacist or health professional who can safely assist.

         

        Prescribing/dispensing medications for treatment of COVID-19 (e.g. chloroquine or hydroxychloroquine)

        There has been increased reports across the country of noticeable growth in demand for prescriptions for chloroquine, hydroxychloroquine or the combination of the two, and the belief that they treat COVID-19. Research is currently ongoing regarding potential treatments for COVID-19; however, there is no evidence-based treatment available at this time.

        While research and testing are ongoing, it is important to acknowledge the potential risks that exist with unrestricted prescribing and dispensing of these two drugs. These medications should continue to be used for treatment of those who are currently sick and who require these specific drugs.

        As with any other prescription, pharmacists are advised to use their professional judgment to question the appropriateness of the prescription, particularly if they seem to be outside the usual indications and COVID-19 treatment recommendations. This is important to ensure patients receive appropriate treatment for COVID-19, to protect patients from unnecessary adverse effects, and to protect the supply of these medications so that they are available to patients who currently use them to treat other health conditions and others who become ill.

        The College of Physicians and Surgeons of NL has released a Notice to College Members: Unproven and misleading treatments for COVID-19. This notice summarizes that presently there is no existing proven treatment for COVID-19; there is no evidence that anti-malarial, antibiotic and HIV as well as other anti-viral medications are effective in prophylaxis of COVID-19. Physicians and nurse practitioners have been directed to not prescribe these therapies for COVID-19 outside the context of a clinical trial. Given this directive, pharmacists should not dispense them if they do.

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        Electronic/alternative prescribing methods

        For advice on electronic prescribing see Frequently-Asked Questions about Pharmacy Practice.

        Under normal circumstances the following is acceptable:

        • Prescriptions generated electronically by a prescriber’s password-protected electronic medical record (EMR) and faxed directly to a pharmacy.
        • Prescriptions generated electronically, printed, and faxed to a pharmacy from the prescriber’s/clinic’s fax machine, in accordance with the NLPB Standards of Practice-Facsimilie Transmission of Prescriptions and Personal Health Information.
        • Prescriptions generated electronically, printed, hand-signed by the prescriber, and given to the patient to bring to their pharmacy.

        Under ideal conditions, the prescription should be sent directly from the prescriber to the pharmacy to help ensure that a duplicate is not in circulation.

        We understand during the pandemic many physicians are providing virtual care to their patients and may not have access to their EMRs and fax machines. During this time, pharmacy professionals may have to deviate from this guidance, however, they are expected to validate prescriptions and ensure authenticity to the best of their ability.

        At this time, this advice does not apply to drugs referenced in section 4.(1) of the Pharmaceutical Services Regulations – i.e. the “Drugs Required to be Written on Tamper Resistant Pads” which must still be written on the approved pad before being given to the patient or faxed to the pharmacy.

         

        First aid/CPR certification

        The Canadian Red Cross and St. John Ambulance have temporarily suspended in-person courses. First Aid certifications expiring through June 30, 2020 have been given a temporary 90-day extension. You can refer to the Canadian Red Cross’ statement related to this matter on their website.

        In addition, WorkplaceNL has advised they are extending the validity of certification safety training certificates as training courses may not be available during the COVID-19 pandemic. A worker’s safety training certificate that expired on or after February 28, 2020 will remain valid until June 30, 2020. The worker will then have to recertify by August 30, 2020. Please view their full public advisory here. This extension also includes first aid certifications with the Lifesaving Society NL.

        While these extensions are in place, pharmacy professionals should still maintain competence in first aid training relevant to their practice; check for alternative course delivery options (online programs) to support training and continue to check course provider websites for the next available recertification program.

         

        Provision of services to personal care homes (PCHs)

        The Government of NL has issued key messages with respect to PCH visitation and services during COVID-19.

        As of March 23, 2020, PCHs have been advised to limit all non-essential visitations, and so pharmacy professionals should exercise reduced physical contact service to PCHs to the greatest extent possible. Consider the following:

        • Pharmacy staff should not enter the PCH when delivering medications. Ideally, PCH staff and pharmacy personnel should arrange safe medication order retrieval at the door–ensure physical distancing. The pharmacy is not required to obtain signatures of PCH staff to confirm delivery as exchange of paper should be limited.
        • If a medication order changes before the next cycle, PCH staff are not permitted under their own standards to re-label medications, and pharmacy staff should not enter the home to do this. Depending on the service agreements in place, the medication that requires relabelling can be returned to the pharmacy by the home or picked up by a pharmacy staff member and a new label affixed. A new label can be provided to PCH staff for the Medication Administration Record.
        • Medication storage and medication safety audits should not be carried out at this time unless there are particular safety concerns that need to be addressed.
        • Annual medication reviews for residents should not be done onsite at this time. Pharmacists may elect to postpone a comprehensive medication review due to limited PCH staff, pharmacist, and other health provider availability to assess and implement recommendations.

        If it is determined a pharmacy professional must enter the PCH to provide essential services, appropriate infection prevention and control measures must be taken in accordance with public health recommendations.

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