March 2021 NLPB Board Meeting Update
On March 5, 2021, the NLPB board met via video conferencing technology. Among other business, at this meeting, the board approved:
- a revision to the NLPB Code of Ethics related to inducements (section 6.7) as well as a new accompanying Interpretation Guide regarding the Prohibition on Inducements.
- a revision to Appendix B to the Standards of Practice – Prescribing by Pharmacists to add COVID-19 to the list of Preventable Diseases approved by the board.
- updates to the Standards of Practice – Administration of Drug Therapy by Inhalation or Injection.
Please visit the Standards, Guidelines, Policies, and Positions page of the website to view the full revised and new documents.
Clozapine: A Pharmacist’s Role in Providing Treatment
This information is being shared courtesy of Brittany Churchill, Pharm D, Waterford Hospital, Eastern Health
Clozapine is an antipsychotic used for treatment-resistant schizophrenia, and may be initiated and dispensed on an inpatient or outpatient basis. Due to a < 1% risk of potentially life-threatening agranulocytosis, dispensing clozapine requires monitoring of patient white blood cell counts. ANY pharmacist can participate in clozapine dispensing and monitoring once they are registered with an associated monitoring program and have access to patient bloodwork (HEALTHe NL). In fact, across the country clozapine is typically dispensed and monitored by community pharmacists. We are encouraging this transition in NL as it aligns with best practice with having patients receive all of their medication from a single pharmacy, where possible.
It’s important to note that there is no central registry for clozapine monitoring in Canada. Monitoring systems are associated with the brand purchased. (For example, Gen-Can for generic Gen-Clozapine). Once a patient is registered with a particular monitoring system, if a patient were to switch brands, they would need to be registered with the new monitoring system. This document will focus on the Gen-Can monitoring system as this is currently used by pharmacists in NL.
Initiation and Registration:
- 1. Pharmacy and Prescriber complete and sign Gen-Can patient registration forms (pharmacist fills out section 3 only)
- a. If you are a pharmacist not currently registered for Gen-Can, you can fill out section 3 on the patient registration form (found on gencan.ca) and fax to Gen-Can or call 1-888-955-1622.
- b. They will notify you once you are registered with a username and password. You will then be partnered with a clinical nurse coordinator who will be available as a clinical support throughout treatment and monitoring.
- 2. Once Gen-Can has received the patient registration forms both physician and pharmacist will receive notification registration. Treatment should only be started upon receipt of this notification.
- 3. After registration, the responsibility of the pharmacist is to ensure patient is getting regular bloodwork. It is best practice for the pharmacist to review recent bloodwork and monitor for the presence of any signs or symptoms of infection. On gencan.ca, see “Hematological Guidelines” under the Forms & Resources tab for specific monitoring details.
Outpatient pharmacists must ensure patients are getting bloodwork using the Gen-Can database / HEALTHe NL following this schedule mandated by Health Canada:
- Weekly x 26 weeks
- Biweekly x 26 weeks
- Monthly indefinitely
Monitoring and treatment status would continue based on the hematological guidelines chart. On Gen-Can’s website, please see “Protocol for Outpatient Starts” and “Treatment Plan and Guide” under the Forms & Resources tab for more detailed information on treatment initiation and monitoring. Throughout treatment, Gen-Can provides ongoing clinical support.
If you have any questions or would like any resources regarding dispensing and monitoring clozapine as a community pharmacist, you can contact the Waterford Hospital Pharmacy at 777-3549 or Gen-Can at 1-888-955-1622.
Recent Changes to Health Canada’s Special Access Program
In the fall of 2020, Health Canada made several revisions to the Special Access Program. Among these changes are a streamlined application process and the ability for drugs to be shipped to other locations, including community pharmacies.
For more information on these changes, see the Canada Gazette, Part II, Volume 154, Number 21 and the Health Canada Guidance Document for Industry and Practitioners.
Invitation to Participate in Project ECHO NL: Opioid Use Disorder
What is Project ECHO (Extension for Community Healthcare Outcomes)?
- Project ECHO NL: Opioid Use Disorder is a virtual community advancing care and treatment for opioid use disorder in Newfoundland and Labrador.
- This project offers free, virtual learning sessions using Zoom to link health care providers with an interdisciplinary team of mentors with expertise in managing substance use care.
- All sessions include a brief lecture on the session topic, followed by the presentation and discussion of a de-identified patient case.
Session 8: Opioids and Benzodiazepines
Tuesday, March 16, 2021 (12:00 – 1:00 pm NDT)
Speaker: Stephanie Delaney, BSc (Pharm), RPh, PharmD (c) (Pharmacist, Opioid Treatment Centre/Recovery Centre and NuCare Pharmacy)
To register for Session 8, please contact Chelsea Hynes at firstname.lastname@example.org by Friday, March 12th.
Session 9: Transitioning between Pharmacotherapies (Advanced)
Tuesday, March 30, 2021 (8:30 – 9:30 am NDT)
Speaker: Dr. Jennifer Wyman, MD, FCFP, DABAM, MPH (Associate Medical Director, Substance Use Service, Women’s College Hospital, Toronto)
To register for Session 9, please contact Chelsea Hynes at email@example.com by Friday, March 26th.
Session 10: Special Populations: Youth and Young Adults (Advanced)
Tuesday, April 13, 2021 (12:00 – 1:00 pm NDT)
Speaker: Dr. Sharon Cirone, MD, FCFPC, CAC(AM) (Family Physician and Addictions Consultant, Child and Adolescent Mental Health Team, St. Joseph’s Health Centre, Toronto)
To register for Session 10, please contact Chelsea Hynes at firstname.lastname@example.org by Friday, April 9th.
- Primary: Pharmacists and prescribers (family physicians and nurse practitioners)
- This 1 credit-per-hour Group Learning program has been certified by the College of Family Physicians of Canada and the Newfoundland and Labrador chapter for up to 10 Mainpro+ credits (1.0 Mainpro+ Certified Group Learning credit per session)
- Mainpro+ certified programs are considered acceptable accredited learning activities by the Newfoundland and Labrador Pharmacy Board
- Secondary: Other health care professionals providing care for individuals with opioid use disorder, including registered nurses, licensed practical nurses, social workers, and addictions counsellors.
More information about Project ECHO NL: Opioid Use Disorder, including frequently asked questions, can be found online here.
- 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 log into the NLPB Online Registrant Portal to update your file with your new contact information as soon as you can.
- Forgot Your Password? – You can retrieve your NLPB Online Registrant Portal password at any time. 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 your email address. Click “Retrieve.” In a few minutes, you will receive an email with your username and password. Once you are logged into your profile, you can change your password.
- Receipts & Invoices – NLPB’s Online Registrant Portal maintains all receipts created by the system. If for any reason, you need a receipt or to view an invoice, you can do so from your registrant profile. Once logged in, click on “Renewal Other/Invoices” and then select either “view invoice” or “print invoice” next to the one you are interested in.
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.