Low-dose Codeine in Manitoba:

Transcription

1 Recte et Suaviter Low-dose Codeine in Manitoba: The Case for Pharmacy Care and Patient Safety In February 2016, Manitoba became one of only a few provinces in Canada to apply further restrictions on the provision of exempted codeine products (or low-dose codeine products). With implementation of the practice direction on Exempted Codeine Preparations, pharmacists may only dispense low-dose codeine products that have been prescribed by a practitioner, as defined in the federal Controlled Drugs and Substances Act (CDSA) or a pharmacist. This practice direction was developed with the specific goal of supporting pharmacists to reduce the use, misuse and abuse of low-dose codeine products. The success of this initiative has been great and is demonstrated in the adjacent graphic. WINTER 2017 Manitoba has seen a 90 per cent decrease in the number of units of low-dose codeine products purchased by Manitoba pharmacies since the introduction of the Exempted Codeine Preparations practice direction in 2015 (Quintiles IMS Canadian Drug Store and Hospital Purchases Audit (CDH)). The practice direction provides pharmacists with the authority to prescribe low-dose codeine products only for patients they have seen and assessed in person, and have conducted a careful review of the risks and benefits relevant to the patient s care and safety. Pharmacists are also required to advise patients of therapeutic alternatives and provide additional information to help patients make informed decisions. Should a patient s symptoms be more serious in nature, or if treatment with a low-dose codeine product is inadequate, pharmacists must refer the patient to the appropriate health provider. Pharmacists must enter all low-dose codeine prescriptions into the Drug Program Information Network (DPIN), review the patient s profile for previous low-dose codeine products and other narcotic or controlled drug use, and identify potential drug interactions. When low-dose codeine prescriptions are entered into DPIN, Manitoba patients receive added health benefits by improving medication safety and preventing the misuse of these drugs. With the introduction of the practice direction on Exempted Codeine Preparations, Manitoba s pharmacists have proven themselves to be valuable contributors to the healthcare system s efforts to reduce the harms of opioids. Health Canada has since recognized the potential for a national strategy to mitigate the harms of low-dose codeine (cont d on page five).

2 Table of Contents Features 1. Low-dose Codeine in Manitoba: The Case for Pharmacy Care and Patient Safety 4. President s Message Pharmacy Technicians 6. New Deadlines for Pharmacy Assistants and Pharmacy Technician Graduates Practice Advisories 9. Methotrexate: Reducing Risk in Pharmacy Practice 11. Notice of Suspension Focus on Patient Safety Hazardous Drugs: How to Protect Yourself and Your Patients Website Updates: Pharmacy Compounding Standards Quality Assurance 20. SPEP Resource Document: A New Resource for Pharmacy Students, Interns, and Preceptors Safety IQ 23. Safety IQ News: equipped enewsletter Sign-up Open Discipline Decisions 24. Discipline Decision News and Events By-Law Update: Enabling Electronic Voting College of Pharmacists of Manitoba Awards 2018 Young Leader Awards 2017 White Coat Ceremony 14. Fentanyl Test Strips 14. Updated Opioid Resources Ensuring Holiday Safety: Counselling Patients About Medication Storage 16. ISMP Updates 19. Protecting Children (Information Sharing) Act Update Pharmacy Student Awards Save-the-Date: 2018 Annual General Meeting Staff Update College Receives Annual Patient Safety Grant In Memoriam

3 THIS NEWSLETTER is published four times per year by the College of Pharmacists of Manitoba (the College) and is forwarded to every licenced pharmacist and pharmacy owner in the Province of Manitoba. Decisions of the College of Pharmacists of Manitoba regarding all matters such as regulations, drug-related incidents, etc. are published in the newsletter. The College therefore assumes that all pharmacists and pharmacy owners are aware of these matters. OFFICERS Jennifer Ludwig, President, Brandon Kevin Hamilton, Vice President, Winkler Petr Prochazka, Executive Treasurer, Winnipeg Glenda Marsh, Past President, Brandon COUNCILLORS Wendy Clark, Carman Donna Forbes, Public Representative Travis Giavedoni, Public Representative Geoff Namaka, Winnipeg Rik Panciera, Public Representative Sonal Purohit, Winnipeg Dr. Lalitha Raman-Wilms, Dean, College of Pharmacy Derrick Sanderson, The Pas Dinah Santos, Winnipeg Audra Taylor, Public Representative Cheryl Zelenitsky, Public Representative LIAISONS TO COUNCIL Susan Balagus, Pharmacy Technician Dr. Patricia Caetano, Manitoba Health, Active Living and Seniors Grazia Prochazka, C.S.H.P. (MB. Branch) Dr. Brenna Shearer, Pharmacists Manitoba Michael Szelemej, Student Representative, College of Pharmacy Our mission is to protect the health and well-being of the public by ensuring and promoting safe, patientcentred and progressive pharmacy practice in collaboration with other health-care providers. COLLEGE STAFF Susan Lessard-Friesen, Registrar Jill Hardy, Deputy Registrar Rani Chatterjee-Mehta, Assistant Registrar for Quality Assurance Kathy Hunter, Assistant Registrar for Field Operations Kim McIntosh, Assistant Registrar for Qualifications and Practice Development Ronda Eros, Practice Consultant Rose Lyons, Practice Consultant Kathy Klimasara, Executive Assistant to the Registrar Stacey Hjorleifson, Senior Administrative Assistant Bev Robinson, Registration Officer Brittany Delaquis, Administrative Assistant Megan Noonan, Office Assistant Rachel Carlson, Communications & Quality Assurance Coordinator 200 Taché Avenue, Winnipeg, MB Phone: (204) Fax: (204) CPhM WINTER

4 President s Message Dear Members, We have much to celebrate as we enter 2018, the College s 140th year of pharmacy practice innovation, patient care, and interprofessional collaboration. Pharmacy professionals have maintained a remarkable history of public trust and protection in Manitoba and my experiences as Council President inspire my confidence and anticipation for the future of pharmacy in the province. It has been an incredible time to contribute to our profession by making a difference that will improve patient care and safety. The opioid crisis continues unabated and the news is filled with sobering data and personal stories of the people touched by its tragedy. College Council and staff have taken some important steps to support pharmacy professionals, patients, and the public in reducing opioid-related harms and to look for innovative proactive, rather than solely reactive, responses to this growing health emergency. As outlined in the feature article, Low-dose Codeine in Manitoba, we have done great and forwardthinking work to reduce the harms of low-dose codeine products in the province. In this, we have shown ourselves to be leaders on the national stage of pharmacy practice. Our present work also includes collaborating with other healthcare providers to develop and implement innovative programs such as Opioid Replacement Therapy training and guidelines, opioid-focused practice resources, and Naloxone supports for pharmacy professionals and the public. As the opioid crisis grows, we will continue to expand and strengthen our efforts. College Council and staff are working toward consolidating our opioid crisis strategy with evidence-based tactics to reduce opioid harms in Manitoba. We can take heart in the strides we have made to enhance pharmacy practice and improve patient safety. It is with pride that we announce the College as one of the recipients of the Manitoba Institute 4. CPhM WINTER 2017 Sincerely, Jennifer Ludwig, BSc. (Pharm.) President, College of Pharmacists of Manitoba for Patient Safety s Dr. John Wade Patient Safety Intiatives Grant for Please review the article on page 38 for more information on this exciting initiative. If you or someone you know deserves some recognition for their contributions to the pharmacy profession, submit a nomination or application for a College of Pharmacists of Manitoba Award or Young Leader Award. We are excited to offer ten newly enhanced Young Leader Awards to pharmacy practice trailblazers in Manitoba. Turn to pages 34 and 35 for more information. These awards will be celebrated at our annual Awards Luncheon on Saturday, May 12, 2018, at the Manitoba Club. This will be an event that you will not want to miss, so mark your calendars and plan on attending the celebration. In closing, I am excited to report that College Council has made progress on electronic voting. Many members identified electronic voting as a priority to enhance member engagement and improve our democratic process. Please review the article on page 25 for an overview of the by-law changes that have made electronic voting possible. In a spirit of hopefulness and gratitude for the hard work of College staff, members, volunteers, and stakeholders, I wish you a wonderful holiday and a Happy New Year.

5 Feature Low-dose Codeine in Manitoba (Cont d) In September 2017, Health Canada requested stakeholders to provide comments on a Notice to Interested Parties in Canada Gazette, Part I, on potential changes to the Narcotic Control Regulations (NCR) that would require all products containing codeine, including low-dose codeine products, to be sold by prescription only. The College participated by submitting a letter in support of the necessary change to require all products containing codeine to be sold by prescription only in Canada. In addition, and equally important, the College requested consideration to be made for an amendment to the New Class of Practitioners Regulation under the CDSA, to designate pharmacists as practitioners. Pharmacists are not currently recognized as practitioners under the CDSA. With the proposed changes to the NCR, they would no longer be authorized to prescribe low-dose codeine products. Health Canada s proposed change to remove the exemption of low-dose codeine preparations has therefore prompted considerable discussion on a national and provincial regulatory level surrounding the practitioner designation for pharmacists. patients and potentially provide additional levels of support for patients who want or need to taper and discontinue opioids safely. It is clear that more research and data is needed to complete the picture of opioid misuse and abuse in the province and to demonstrate the ways pharmacy professionals could potentially assist in reducing the harms of opioid use. With a designation of practitioner under the CDSA, pharmacists, as some of the most accessible healthcare providers, can play an even greater role in reducing opioid harms in Manitoba. References: Canada Gazette Part I, Vol. 151, No. 36. September 9, In keeping with its mandate of patient safety and public protection, the College plans to assist in bringing forward an application to amend the New Classes of Practitioners Regulations under the CDSA to designate pharmacists as practitioners. With this designation, pharmacists would maintain their authority to assist other practitioners in monitoring the safe use of low-dose codeine products by CPhM WINTER

6 Pharmacy Technicians New Deadlines for Pharmacy Assistants and Pharmacy Technician Program Graduates There are two pathways for individuals who wish to become pharmacy technicians in Manitoba: Option A: For individuals who have graduated from a Canadian Council for Accreditation of Pharmacy Programs (CCAPP)-accredited pharmacy technician program. Option B: For pharmacy assistants who have worked at least 2000 hours as a member of a pharmacy team within the last three years. Students who graduated from a CCAPP accredited pharmacy technician program after January 1, 2014, have five years immediately following their graduation to complete all the steps to being listed with the College as a pharmacy technician. Within these time-frames, the graduate must successfully complete the: pharmacy technician-in-training application; Each of these pathways have important upcoming deadlines. Option A Deadlines Students of a CCAPP-accredited pharmacy technician program who graduated before January 1, 2014, must be listed as pharmacy technician with the College by January 1, Structured Practical Training Program; Jurisprudence Examination; PEBC Qualifying Examination Parts I and II; and application to be listed as a pharmacy technician with the College. If a graduate does not complete all of the components under Option A in the time-frame provided above, they will be required to complete a CCAPP-accredited pharmacy technician program again to pursue listing as a pharmacy technician in Manitoba. It is important that graduates review all of the information for the Option A requirements as there are multiple obligations and deadlines to manage. 6. CPhM WINTER 2017

7 Option B Deadlines Across Canada, pharmacy regulatory bodies have set deadlines for pharmacy assistants to become registered as pharmacy technicians through the PEBC Evaluating Exam and NAPRA National Pharmacy Technician Bridging Education Program (Option B pathway). At the November 27, 2017, Council meeting, College Council set a deadline for the Option B pathway of December 31, 2019, with the following motion: THAT Council approves December 31, 2019, as the deadline for individuals currently working as a pharmacy assistant to complete and submit all requirements for listing as a pharmacy technician in Manitoba. After December 31, 2019, all applicants wishing to become pharmacy technicians would be required to have graduated from an accredited pharmacy technician education program. It is important that Option B candidates review all of the information for the Option B requirements as there are multiple obligations and deadlines to manage. For more information, please visit: pharmacytechnicians?nav=practice#steps Note: On November 27, 2017, Council established expiry dates for PEBC exams and jurisprudence exam results for pharmacy technicians which match those expiries set for pharmacists. An expiry date of 3 years is in place on PEBC qualification examination results and a 2-year expiry for the jurisprudence exam results (cont d on page 8). This means that by the end of 2019, a pharmacy assistant in Manitoba who wants to become listed as a pharmacy technician through this transition pathway must successfully complete the: PEBC Evaluating Examination; NAPRA National Pharmacy Technician Bridging Education Program; pharmacy technician-in-training application; Structured Practical Training Program; Jurisprudence Examination; PEBC Qualifying Examination Parts I and II; and application to be listed as a pharmacy technician with the College. CPhM WINTER

8 Pharmacy Technicians New Deadlines for Pharmacy Assistants and Pharmacy Technician Program Graduates (Cont d) PEBC Deadlines Manitoba pharmacy assistants have just two opportunities left to write and pass The Pharmacy Examining Board of Canada (PEBC) Evaluating Examination. The deadline for successfully completing the PEBC Pharmacy Technician Evaluating Examination is December 31, The upcoming dates for the PEBC Pharmacy Technician Evaluating Examinations are as follows: Sunday, April 29, 2018, application deadline is Friday, January 12, 2018 (Winnipeg site available) NAPRA National Pharmacy Technician Bridging Education Program In addition to completing the PEBC Evaluating Exam, pharmacy assistants who did not graduate from a CCAPP-accredited program must also complete the NAPRA National Pharmacy Technician Bridging Education Program which allows experienced pharmacy assistants working in a pharmacy to become a listed pharmacy technician without enrolling in a full-time pharmacy technician program. Please visit the NAPRA website for more information. Saturday, October 13, 2018, application deadline is Friday, June 22, 2018 (Winnipeg site available) Applications must be received by the PEBC office no later than the application deadline. Please visit the PEBC website for information about Evaluating Exam schedules, the minimum qualifications required for admission, deadlines and locations, application procedures, examination costs, and what to expect during the exam. The College recommends that individuals who want to take the Evaluating Examination review PEBC s website well in advance of their prospective exam application deadline. Pharmacy assistants who wish to be listed as pharmacy technicians, but do not pass the Evaluating Exam prior to December 31, 2018, will be required to complete a CCAPP-accredited pharmacy technician program to become pharmacy technicians. Please visit the CCAPP website for more information on accredited pharmacy technician programs. A pharmacy assistant must complete all of the College of Pharmacists of Manitoba requirements to become listed as a pharmacy technician by December 31, Courses that fulfill the education requirement for the NAPRA Bridging Education Program are available online through Selkirk College or in-class through Robertson College and Manitoba Institute of Trades and Technology. For more information on the steps to becoming a pharmacy technician through a CCAPP-accredited pharmacy technician program or as an experienced pharmacy assistant, please see the Pharmacy Technician page of the College website or the Pharmacy Technician Resource Guide. 8. CPhM WINTER 2017

9 Practice Advisories Methotrexate: Reducing Risk in Pharmacy Practice Methotrexate is an antineoplastic antimetabolite drug with immunosuppressant properties. It has been used for many years in the treatment of autoimmune disorders such as rheumatoid arthritis and psoriasis, and is the preferred diseasemodifying anti-rheumatic drug for rheumatoid arthritis with respect to efficacy and safety. It is typically taken once weekly for the treatment of autoimmune conditions. The Institute for Safe Medication Practices Canada (ISMP Canada) considers methotrexate to be a high-alert medication in both hospital and community settings because unintentional daily dosing can lead to serious patient harm. Unintentional daily administration, even at low doses, can cause severe adverse events affecting the bone marrow, liver, and other organ systems, and even death. The most common cause of patient harm occurs when a prescriber unintentionally prescribes methotrexate for daily dosing rather than once a week, with a pharmacist dispensing it according to the prescription without verifying the prescription with the physician. Incorrect pharmacist interpretation of a prescription and lack of patient education and understanding of the medication-dosing schedule may also contribute to patient harm. Most adverse effects associated with low-dose oral methotrexate include nausea and stomatitis and are due to the inhibition of folate metabolism. Oral folic acid tablets (5mg once a week, on a separate day from methotrexate) can reduce these symptoms. Hypoalbuminemia, renal dysfunction and certain concomitant medications such as non-steroidal anti-inflammatory drugs and protein pump inhibitors all increase a patient s risk of developing toxic effects. Severe adverse effects are more common with higher doses of methotrexate used for antineoplastic indications. Rheumatoid Arthritis guidelines recommend that a CBC, liver enzyme and creatinine levels be obtained before methotrexate is initiated. These parameters should be monitored at regular intervals throughout the duration of therapy and practitioners should take note of any unusual changes as well as any consistent trends. The Colleges Complaints Committee has received recent reports of patient harm as a result of methotrexate dosing errors, and ISMP Canada has received multiple reports of severe harm or death in patients taking methotrexate for rheumatoid and Toxicity symptoms may present as bone marrow suppression (i.e. fever, sore throat), hepatotoxicity (i.e. abdominal pain, jaundice) or pulmonary toxicity (i.e. chest pain, new onset dyspnoea). CPhM WINTER

10 Practice Advisories Methotrexate (Cont d) other autoimmune diseases (cont d on page 10). Pharmacists can reduce the risk of methotrexate dispensing errors by: ensuring that every patient on methotrexate receives counselling that includes clear instructions about how and when to take their dose. Medication dosing leaflets may also be valuable, depending on the patient, and should reference the weekly dosing schedule and not a daily dosing schedule. The day of the week, in full, should also be printed on the label; emphasizing the importance of adhering to the prescribed dose and to obtain the monitoring tests ordered by the prescriber as scheduled; ensuring the patient understands that the medication should not be used as needed for symptom control and that taking extra doses is dangerous; dispensing a four-week supply of methotrexate at a time, when possible; asking patients or caregivers about the use of specific prescription and over-the-counter medications that can influence methotrexate toxicity; advising the patient to report any adverse effects or any toxicity symptoms; following up with the prescriber if folate has not been prescribed to suggest initiation of this supplement; and methotrexate. Two medication incidents reported to ISMP Canada are shared below to highlight the opportunities to improve safety in methotrexate dispensing. Incident 1: A patient with renal dysfunction and hypoalbuminemia was experiencing worsening rheumatoid arthritis symptoms. To address these symptoms, the patient doubled his weekly methotrexate dose from 10 mg to 20 mg, which happened to coincide with the end of a treatment course of amoxicillin for an infection. The next day, the rheumatologist started another Disease-Modifying Anti-Rheumatic Drug (DMARD), leflunomide. Within a week, the patient presented to the hospital with pancytopenia, and despite aggressive treatment, he died. The patient s baseline risk factors for methotrexate toxicity, the intentional doubling of the methotrexate dose by the patient without the prescriber s knowledge, and drug interactions related to the concomitant use of amoxicillin and leflunomide all contributed to the development of severe toxic effects. Incident 2: Methotrexate 15 mg once weekly was prescribed for treatment of an autoimmune disorder in an elderly patient. The community pharmacy dispensed a three-month supply of medication, but gave instructions to take 15 mg (6 x 2.5mg tablets) once daily. The error was discovered during pharmacist counselling when the patient requested a refill three weeks later. The error resulted in severe harm, which led to a long hospital stay, including treatment with the antidote folinic acid. providing the patient with the free ISMP high-alert medication consumer leaflet on 10. CPhM WINTER 2017

11 Notice of Suspension On September 16, 2017, the practicing licence of Mr. Haider Sharfi (CPhM Licence No ) was cancelled pursuant to section 23(2) of The Pharmaceutical Act (Act) for falsely declaring his place of employment. This cancellation is in effect until further notice. This notice is published in accordance with section 23(5) of the Act and section 132(3) of the Regulation to the Act. CPhM WINTER

12 Focus on Patient Safety Hazardous Drugs: How to Protect Yourself and Your Patients Hazardous drugs are medications that are known or suspected to cause adverse health effects from exposure in the workplace. Hazardous drugs include cytotoxic medications used for cancer and other diseases, medications to treat autoimmune diseases, and can also include antiviral medications, hormones, bioengineered medications, and other miscellaneous medications. The National Institute for Occupational Safety and Health (NIOSH), considers a drug to be hazardous if it exhibits one or more of the following characteristics: It is important for pharmacists to know which medications are considered hazardous. The Winnipeg Regional Health Authority (WRHA) maintains a hazardous drug list, and the most recent list can be found on the College of Pharmacists of Manitoba website here. Safe handling precautions can vary between types of hazardous drugs and formulations. Both cytotoxic and non-cytotoxic agents may pose risks to pharmacy staff, other healthcare professionals (ie. homecare nurses), patients and their loved ones in the event of unintended exposure. carcinogenicity; teratogenicity or developmental toxicity; reproductive toxicity in humans; organ toxicity at low dose in humans or animals; genotoxicity; or new drugs that mimic existing hazardous drugs in structure or toxicity. 1 An increasing number of cytotoxic chemotherapy agents and other hazardous medications are manufactured in oral formulations and many of these new oral agents are dispensed from community pharmacies in Manitoba. 1 United States Pharmacopeial Convention, Inc. <800> Hazardous Drugs-Handling in Healthcare Settings. United States Pharmacopeia 39-National Formulary 34. 1st supplement. Rockville, MD: US Pharmacopeial Convention, Inc., The following precautions can help prevent exposure to, and cross contamination of, hazardous drugs: all hazardous drugs should be clearly identified and properly labelled to prevent improper handling; all staff should be aware of the personal protective equipment required when handling and dispensing a hazardous drug; if a separate designated counting tray is to be used for counting hazardous medications, this tray should be cleaned regularly with soap and water. Wiping the tray with isopropyl alcohol does not adequately clean the tray. Using isopropyl alcohol will sterilize the counting tray, but will not remove the hazardous drug residue. Washing with a detergent removes the hazardous drug residue; 12. CPhM WINTER 2017

13 pharmacy staff should practice good hand hygiene when counting hazardous drugs. This includes wearing gloves that meet ASTM International standards; hazardous drugs must not be placed in an automated counting device as the risk of exposure is increased. Automated counting devices place increased stress on the tablet and may introduce powdered contaminants to the device; and when blister packaging cytotoxic medications, it is important to dispense cytotoxic medications in a separate blister pack with a cytotoxic auxiliary label. The Canadian Association of Provincial Cancer Agencies (CAPRA) released its new Recommendations for the Safe Use and Handling of Oral Anti-Cancer Drugs (OACDs) in Community Pharmacy: A Pan-Canadian Consensus Guideline. This guideline can be found here: capca.ca/current-issues/oral-cancer-drug-therapy/ recommendations. This guidance document provides valuable recommendations for community pharmacies, including receiving and unpacking procedures, storage, drug preparation and handling, verification and dispensing, personal protective equipment, disposal and waste management, spill protocol, training and education, staffing, and incident reporting. Website Updates: Pharmacy Compounding Standards The College has updated its website to improve the organization and access to information on pharmacy compounding. To review the current and upcoming standards and practice directions for pharmacy compounding, please visit: Current standards and guidelines for pharmacy compounding of sterile preparations are also posted on the College website and remain in place until the new Model Standards for Pharmacy Compounding come into effect. legislation?nav=practice#standards CPhM WINTER

14 Focus on Patient Safety Fentanyl Test Strips In the past, the College has advised against the sale of Rapid Response FYL Test Strips (Liquid, Powder, produced by BTNXINC.) by Manitoba pharmacies for sale to the public for the purpose of detecting fentanyl in recreational or street drugs. These test strips have received significant media coverage recently. Even though there have been some minor modifications to the product since the College originally advised pharmacists against selling the strips, the College continues to stand by its assertion that the strips can create a false sense of safety for patients and the public. Updated Opioid Resources To address the opioid crisis, the College wants to ensure that pharmacy professionals in Manitoba have access to trusted resources to support their efforts. In addition to Resources on Naloxone and updated Opioid Replacement Therapy Guidelines, the College has developed a collection of practice resources related to opioids. For a full listing of the resources including opioid stewardship and pain management, please visit: practiceresources?nav=practice The College continues to advise all pharmacies in Manitoba against the sale of Rapid Response FYL Test Strips for off label use by the public. Key points to consider on this issue are: the product packaging clearly states these test strips are intended for forensic use only. In fact, the product insert warns against their use outside of forensic applications. While these cautions protect the manufacturer from potential liability, it may pose a safety risk to the public and a legal risk to the pharmacy; there is currently no published evidence that the strips can detect carfentanil. We know that carfentanil is prevalent in Winnipeg. In fact, there have been more deaths due to carfentanil than fentanyl in Winnipeg in recent months. A negative test for fentanyl is therefore not at all reassuring that a sample is not still high risk for overdose due to carfentanil or another fentanyl analogue; and the product does not detect the quantity of fentanyl present in a sample, and cannot screen for all fentanyl analogues. Significant changes to this product or its delivery to the public will be considered by the College as needed. If you have questions on this matter, please the College office by phone ( ), or by (info@cphm.ca). Please see Health Canada s recent Information Update for additional details: CPhM WINTER 2017

15 Ensuring Holiday Safety Counselling Patients About Medication Storage The holiday season is a busy time when many homes are filled with gatherings of friends and family. It is also a time when young children may be visiting homes where medication may not be stored as securely and out of reach as in their own homes. The reality of these dangers struck an Ontario family in 2016 when a toddler wandered into an open bedroom at a home his family was visiting and it is believed he ingested a single pill. Tragically, the boy died two days after the incident. make sure safety caps on all medication are locked teach children about medicine safety follow any special instructions, for medication storage such as those for cancer treatment medicines be informed about what to do in the event an emergency occurs. The College reminds all pharmacists to stress the importance of proper medication storage when counselling patients, especially during the holidays. Please remind your patients to For more information on counselling patients on safe medication storage, please see the College Practice Direction on Patient Counselling. store medication where children cannot reach it put medication safely away after each use CPhM WINTER

16 Focus on Patient Safety The Institute for Safe Medication Practices Canada is an independent national not-for-profit organization committed to the advancement of medication safety in all healthcare settings. ISMP Canada works collaboratively with the healthcare community, regulatory agencies and policy makers, provincial, national and international patient safety organizations, the pharmaceutical industry and the public to promote safe medication practices. ISMP Canada s mandate includes analyzing medication incidents, making recommendations for the prevention of harmful medication incidents, and facilitating quality improvement initiatives. ISMP Newsletter Subscriptions ISMP Canada Safety Bulletins are designed to disseminate timely, targeted information to reduce the risk of medication incidents. The purpose of the bulletins is to confidentially share the information received about medication incidents which have occurred and to suggest medication system improvement strategies for enhancing patient safety. The bulletins will also share alerts and warnings specific to the Canadian market place. The following ISMP Canada Safety Bulletins have been issued since the last issue of the Newsletter: ISMP Canada Safety Bulletins for Practitioners, Volume 17: SafeMedicationUse.ca Newsletters and Alerts for Consumers, Volume 8: Save a Life -- Get a Naloxone Kit to Treat an Opioid Overdose Keep your Vaccinations Up to Date Talking to Your Pharmacist May Prevent Harm All issues of the ISMP Canada Safety Bulletins, including those issued in previous years, are freely downloadable from the ISMP Canada website at ISMP Canada is pleased to distribute The Medication Safety Alert! (US) newsletters along with ISMP Canada Safety Bulletins to Canadian practitioners and corporations. To subscribe and for more information on all ISMP Canada s publications, events and services visit the ISMP Canada website at Alert: Polyethylene Glycol and Propylene Glycol Mix-Up Causes Harm The Second Victim: Sharing the Journey toward Healing 16. CPhM WINTER 2017

17 The Canadian Medication Incident Reporting and Prevention System (CMIRPS) is a collaborative pan- Canadian program of Health Canada, the Canadian Institute for Health Information (CIHI), the Institute for Safe Medication Practices Canada (ISMP Canada) and the Canadian Patient Safety Institute (CPSI). The goal of CMIRPS is to reduce and prevent harmful medication incidents in Canada. Report medication incidents (including near misses): Online: Phone: ISMP Canada strives to ensure confidentiality and security of information received, and respects the wishes of the reporter as to the level of detail to be included in publications. Sign up: To receive this publication or other medication safety publications, sign up at: For more information, visit CMIRPS, call , or cmirps@ismp-canada.org. Building awareness for the systems that can lead to adverse events, changing the culture to reporting and learning from medication incidents, are some of the key factors in improving patient safety. CPhM WINTER

18 Focus on Patient Safety The Protecting Children (Information Sharing) Act Update In the September 22, 2017, edition of the Friday Five, the College provided members and stakeholders with information about The Protecting Children (Information Sharing) Act (PCISA). The PCISA allows service providers to collect, use and share personal information, including personal health information (PHI), about supported children, their parents and legal guardians with other service providers The College has received clarifying information from Manitoba Health, Seniors and Active Living on what responsibilities pharmacists acting as trustees or service providers would have under this new legislation. Here are some key points: Ultimately, it would be prudent for pharmacists to direct this type of PHI request directly to Manitoba Health, where a service provider can request access to a full medication history through DPIN. The interpretation of PCISA for pharmacists will vary depending on the place of employment and therefore, pharmacists would be advised to consult Manitoba Health prior to releasing any information under this legislation. Questions regarding PCISA can be ed to LSP.Directors@gov.mb.ca. Please see the following definitions chart for important PCISA definitions of supported children, service providers and trustees. Pharmacists are trustees of PHI under The Personal Health Information Act (PHIA) when they work for an independent or corporate-owned pharmacy in community practice. Pharmacists are service providers when they receive funding from the government or a government agency to provide services or benefits for supported children. Pharmacists are not trustees of personal health information under PHIA when they are employed by a trustee (e.g. pharmacists employed by health care facilities or hospitals). The employer in this instance is considered to be the trustee. Pharmacists are not service providers when they work for a service provider. Pharmacists cannot access information in the Drug Program Information Network (DPIN) for disclosure under the PCISA as Manitoba Health, Seniors and Active Living is the trustee of that information. 18. CPhM WINTER 2017

19 The Protecting Children (Information Sharing) Act Definitions Supported Children Trustee Service Provider Supported children are defined as children under the age of 18 who: are in the care of a Child and Family Services (CFS) agency are receiving or whose family is receiving services from a CFS agency are receiving or are entitled to receive mental health services or addiction services provided by or on behalf of a public body as defined in The Freedom of Information and Protection of Privacy Act or a health care facility as defined in PHIA. are receiving or are entitled to receive disability services provided by or on behalf of government are in custody or under supervision with the youth criminal justice system have or are eligible to have an individual education plan are receiving or whose family is receiving family conciliation services provided by or on behalf of government, or are receiving or whose family is receiving victim support services; this includes services provided for children or their families by or on behalf of government for: victims of crime witnesses involved in criminal prosecutions individuals and families who are affected by domestic violence, as that term is used in The Domestic Violence and Stalking Act A trustee is defined by PHIA to be a health professional, healthcare facility, public body, or health services agency that collects or maintains person health information. A service provider is defined as any person, organization or agency receiving funding from the provincial government or government agency, to work with supported children. The definition also includes provincial government departments. Examples include: CFS agencies and authorities foster parents schools police services regional health authorities youth criminal justice authorities community-based agencies non-profit organizations children who are sexually exploited or at risk of sexual exploitation. CPhM WINTER

20 Quality Assurance SPEP Resource Document: A New Resource for Pharmacy Students, Interns, and Preceptors SPEP and Scope of Practice The Structured Practical Experiential Program (SPEP) at the University of Manitoba College of Pharmacy provides its students with important pharmacy practice experience in their journey to becoming a pharmacist. Preceptors mentor students as they move from being students to 4th year pharmacy interns to post graduate interns before becoming pharmacists. Each of these phases has a distinct scope of practice that governs student activities during SPEP rotations whether they occur in community or hospital pharmacy settings. The scope of practice chart on pages 21 and 22 outlines the tasks and conditions for students and interns during their SPEP rotations. Strengthening Relationships: New College of Pharmacy Resource Document for Preceptors, Students, and 4th Year Interns The Structured Practical Experiential Training (SPEP) rotations for College of Pharmacy students provide a vital learning experience not only for students and interns, but also for their preceptors. During SPEP rotations, preceptors have the opportunity to demonstrate the important role pharmacists play in delivering healthcare services to patients that promote health and healing and prevent disease. Preceptors not only prepare students for safe, effective pharmacy practice, but they also gain new perspectives and knowledge from their pupils that re-energizes continuous learning. Additionally, preceptors may document significant learning experiences gained during student rotations in their professional development logs for the practice year. Please visit the College of Pharmacists of Manitoba s (CPhM) website for more information. At the same time, SPEP provides students and interns with the opportunity to apply the knowledge and skills from their university studies to diverse settings in community pharmacy, hospital pharmacy and primary care environments. The SPEP rotations are much more than a learning experience they shape the future of pharmacy practice in Manitoba and build a strong community of mutual respect and collegiality. To strengthen these relationships and advance pharmacy practice in Manitoba, CPhM in collaboration with the College of Pharmacy at the University of Manitoba has developed a resource document for preceptors of pharmacy students and fourth year interns. The resource document includes information on supervision requirements and the responsibilities of both the preceptor/supervising pharmacist as well as the student/intern. Preceptors are the foundation of the program, playing a significant role in shaping the professional development of students. 20. CPhM WINTER 2017

21 Pharmacist Pharmacy Student¹ (during BScPharm years 1, 2 & 3 SPEP Rotations) Pharmacy Intern² (during BScPharm year 4 SPEP rotations & post-graduate internship) Receive verbal prescriptions Yes Yes Assess and approve a prescription for filling or refilling No Yes Provide or receive a written or verbal transfer of a prescription Yes Yes Educate a person or health care professional about a drug or drug therapy Yes Yes Perform a final check on a prescription (Upon successful completion of Demonstration of Product Release Proficiency 200 checks without error verified by preceptor) No Yes Identify and assess drug therapy problems and make recommendations to prevent or resolve Yes Yes Prescribe a Schedule II or III drug a medical device approved by Health Canada a continued care prescription No Yes³ ¹ Under direct supervision of a pharmacist ² Under direct or indirect supervision of a pharmacist as determined by the preceptor ³ Prescriptions would require name and signature of intern and name of supervising pharmacist Cont d on page 22 CPhM WINTER

22 Quality Assurance Pharmacist Pharmacy Student¹ (during BScPharm years 1, 2 & 3 SPEP Rotations) Pharmacy Intern² (during BScPharm year 4 SPEP rotations & post-graduate internship) Prescribe for drugs for Self-Limiting Conditions *with approved training & under supervision of a pharmacist authorized to prescribe for SLC No Yes³ Adaptation of existing prescription following applicable practice direction No Yes³ Interpret results of patient administered automated tests No Yes Administer a drug orally, topically or via inhalation No Yes Administer a drug through injection * with approved training, and under supervision (direct or indirect) of a pharmacist authorized to administer injections Yes 4 Yes Order and receive the results of a screening or diagnostic test *with approved training and under supervision of a pharmacist trained in ordering lab tests No Yes ¹ Under direct supervision of a pharmacist ² Under direct or indirect supervision of a pharmacist as determined by the preceptor ³ Prescriptions would require name and signature of intern and name of supervising pharmacist 4 Pharmacy students under the Regulations cannot administer injections; however, once students have completed their injections training, students may administer injections during their university SPEP rotation ONLY and under direct supervision of a pharmacist. 22. CPhM WINTER 2017

23 Safety IQ Safety IQ News: equipped enewsletter Sign-up Open The Safety IQ Pilot is well underway with fulsome participation from volunteer pharmacies. In an effort to ensure the entire membership can access Safety IQ resources and updates, we invite you to sign up for equipped, the short, quarterly enewsletter for the Safety IQ Pilot. Signing up is free, easy, and completely voluntary! Each quarter, you will receive feature articles, continuous quality improvement resources, and updates on the progress of the Pilot. Please click the link below and enter your first and last name and your preferred address: Feel free to share this link with your contacts! CPhM WINTER

24 Discipline Decision Discipline Decision: Kaur Sidhu Pursuant to a Notice of Hearing (the Notice ) dated the 26th day of September, 2014, it was alleged that Mr. Kaur Singh Sidhu, being a pharmacist under the provisions of The Pharmaceutical Act, C.C.S.M. c. P60 ( The Act ) and a registrant of the College of Pharmacists of Manitoba (the College ), was guilty of professional misconduct, conduct unbecoming a member, or had displayed a lack of skill or judgment in the practice of pharmacy or operation of a pharmacy, or any of the above, as described in section 54 of The Act. On Tuesday, July 11, 2017, the Discipline Committee convened to address the charges. Mr. Jeff Hirsch appeared as counsel on behalf of the Complaints Committee. Mr. Ken Muys appeared with and as legal counsel for Mr. Sidhu. Mr. Sidhu entered a guilty plea to the following charges in that: 1. on or about May 15, 2014, Mr. Sidhu dispensed a prescription for Levodopa / Carbidopa 250/25mg instead of Levodopa / Carbidopa 100/25mg for patient XX without confirming the accuracy of the prescription in accordance with section 83 of The Pharmaceutical Regulation, Man Reg 185/2013 (the Regulation ), and Statement VII of the College Code of Ethics (the Code ); 2. in or about June 2014, upon being informed by patient XX that he had been dispensed and had ingested the wrong medication and upon dispensing the correct medication, Mr. Sidhu failed to provide proper patient medication counseling to patient XX in accordance with section 56(1)1 of The Regulation; After having had the opportunity to review the authorities provided to the Discipline Committee and having considered the submissions of legal counsel, the Discipline Committee was of the view that the sanctions contained in the submitted joint disposition should serve to satisfy that the public s interest is protected and the public s confidence is retained. As a result, and in accordance with sections 54, 55 and 56 of The Act, the Discipline Committee ordered that: 1. Mr. Sidhu pay a fine in the amount of $750.00; and 2. Mr. Sidhu pay a contribution to the costs of the investigation and the prosecution in the amount of $ In arriving at its decision, the Discipline Committee took into consideration that Mr. Sidhu: 1. implemented changes to his pharmacy practice to reduce the possibility of future medication errors of this type; 2. communicates with his staff on an ongoing basis regarding medication errors and near misses, both within their pharmacy and those discussed in the media; and 3. co-operated with the College throughout the investigation process. Although the Committee found the fine and contribution to costs to be low, it was encouraged by the additional safety measures implemented and suggested the establishment of a true record of medication errors and near misses within Mr. Sidhu s practice and that the record be shared with the pharmacy staff. 24. CPhM WINTER 2017

25 News and Events By-Law Updates: We are pleased to report that College Council has made the necessary changes to the College By-Laws to enable electronic voting for members as outlined in the following November 27, 2017, Council Meeting motion: THAT the amended bylaws, including the provision and structure for electronic voting, be approved by Council. These changes signal greater efficiency and accessibility for pharmacy professionals in By-Law Update Summary Chart Enabling Electronic Voting the province when it comes to the democratic processes and consultations that govern the work of the College Council. Please review the By-Law Update Summary Chart below for details (pages 25-33). Red text highlights the changed part of a given by-law. You can download a copy of the updated College of Pharmacists of Manitoba By-Laws to The Pharmaceutical Act here, or on the College website. Current Bylaw New Bylaw Rationale for Change 1.01 (e)(ii) Committees, Internal mean the following committees of the College: (ii) the elections/ballot committee 1.01 (e)(ii) Committees, Internal mean the following committees of the College: (ii) the ballot committee Renames the election/ballot committee. Not Applicable 1.01 (j) Address means an address utilized solely by a Voting Member New definition required to operationalize by-laws allowing electronic voting Council may conduct votes, for the purpose of conducting a Contested Election or on any other matter relating to the College, by: (a) mail-in ballot in accordance with the procedure set out in section 4.04 hereof; or 4.01 Council may conduct votes, for the purpose of conducting a Contested Election or on any other matter relating to the College, by mail-in ballot or any other means or any combination of means that maintains the security of the voting process and the anonymity of the votes cast by the Voting Members including, without limitation, electronic ballot, in accordance with the procedures set out in section Less verbose; however, accomplishes the requirement that anonymity of votes must be maintained. CPhM WINTER

26 By-Law Update Summary Chart Cont d Current Bylaw New Bylaw Rationale for Change (b) any other means or any combination of means that maintain the security of the voting process including, without limitation, mail-in ballot and electronic ballot; for the sake of clarity, such other means or combination thereof must ensure the anonymity of the votes cast by the Voting Members (b) the Voting Members must (i) in the case of a Contested Election, vote by placing a cross (X) upon the electoral ballot beside the name of the candidate for whom the Voting Member wishes to vote; or (ii) in any other case, vote by placing a cross (X) upon the propositional ballot where marked yes, no, or abstain; 4.04 (b) the Voting Members must vote by marking the ballot to clearly show their intent Less verbose. Adjusted language required to operationalize electronic voting (c) After voting in accordance with subsection 4.04(b) hereof, the Voting Members must place the electoral ballot or propositional ballot in the envelope marked Ballot, seal the envelope, and make no other markings thereon. Subsequently, the Voting Members must place the envelope marked Ballot into another envelope, which is addressed to the Election/ Ballot Committee and states their respective names, licence numbers, and return addresses, and seal said envelope (c) After voting in accordance with subsection 4.04(b), the Voting Members must: (i) in the case of a mail-in ballot, place the ballot, electoral ballot or propositional ballot in the envelope marked Ballot, seal the envelope, and make no other markings thereon. Subsequently, the Voting Members must place the envelope marked Ballot into another envelope, which is addressed to the Ballot Committee and states their respective names, licence number, and return address, and seal said envelope ;or Subsection (i) renames the Elections/Ballot Committee to Ballot Committee. 26.CPhM WINTER 2017

27 Current Bylaw New Bylaw Rationale for Change (ii) in the case of an electronic ballot, submit the ballot, electoral ballot or propositional ballot as required by the electronic voting platform as set out in the instruction provided within the Voting Materials Subsection (ii) is a new section added to name all types of ballots and was included for consistency with other sections of the by-law. This addition also permits Council to adjust the instructions in the Voting Materials as technology changes and improves The Registrar must send the Mail-in Voting Materials or the Alternative Voting Materials to the Voting Members: (a) in the case of a Contested Election, at least forty-nine (49) days in advance of the annual general meeting; 4.05 The Registrar must send the Voting Materials to the Voting Members: (a) in the case of a Contested Election, at least forty-seven (47) days in advance of the annual general meeting Revised deadline ensures deadline occurs on a weekday The Voting Members must make and deliver their votes The Voting Members must make and submit their votes,. Adjusted language required to operationalize electronic voting In any vote held in accordance with subsection 4.01(a) hereof, the envelopes marked Election/Ballot Committee, received by the Registrar, must remain unopened until they have been delivered to the members of the Elections Committee or the Ballot Committee by the Registrar In any vote held in accordance with subsection 4.01: (a) in the case of mail-in ballot, the envelopes marked Ballot Committee, received by the Registrar, must remain unopened until they have been delivered to the members of the Ballot Committee by the Registrar. Subsection (a) renames the Ballot/Elections Committee to Ballot Committee. Subsection (b) included to ensure interim updates during an electronic vote are not provided to the Registrar. (b) in the case of an electronic ballot, the results of the electronic voting will not be reported by the Ballot Committee to the Registrar for delivery to the President until the closing of the election as indicated in the Voting Materials. CPhM WINTER

28 By-Law Update Summary Chart Cont d Current Bylaw New Bylaw Rationale for Change 5.01 The Council of the College must consist of:... (b) Subject to the provisions of section 5.16 hereof, (ii) either the dean of the faculty of pharmacy of the University of Manitoba or the dean s designate, 5.01 The Council of the College must consist of:... (b) Subject to the provisions of section 5.15 hereof,... (ii) either the dean of the College of Pharmacy of the University of Manitoba or the dean s designate, Renames the Faculty of Pharmacy of the University of Manitoba to the College of Pharmacy of the University of Manitoba Council must announce a forthcoming election at least 77 days prior to the date of the annual general meeting of the College at which the term of the Voting Members elected to Council expires Council must announce a forthcoming election at least seventy-five (75) days prior to the date of the annual general meeting of the College at which the term of the Voting Members elected to Council expires. Revised deadline ensures deadline occurs on a weekday A nomination of a Voting Member, pursuant to subsection 5.06(d) hereof, is only valid if it:... (e) is received by the Registrar through personal delivery, regular mail, or electronic mail by 4:00 pm CST not less than fifty-seven (57) days before the date of the annual general meeting A nomination of a Voting Member, pursuant to subsection 5.05(d) hereof, is only valid if it:... (e) is received by the Registrar through personal delivery, regular mail, or electronic mail by 4:00 pm CST not less than fifty-nine (59) days before the date of the annual general meeting. Revised deadline ensures deadline occurs on a weekday If there is a tie between two or more candidates in a Contested Election and it is not possible to determine the four Voting Members elected from each Electoral District in accordance with section 5.12 hereof: (a) If it is possible to determine the one, two, or three candidates who have received the most votes in each Electoral District, their elections will be acclaimed; and 28.CPhM WINTER If there is a tie between two or more candidates in a Contested Election and it is not possible to determine the four Voting Members elected from each Electoral District in accordance with section 5.11 hereof: (a) If it is possible to determine the one, two, or three candidates who have received the most votes in each Electoral District, their elections will be acclaimed; and

29 Current Bylaw New Bylaw Rationale for Change (b) There will be a run-off election between the tied candidates in accordance with the following procedures: (i) The Registrar will re-send the Mail-in Voting Materials or the Alternative Voting Materials to the Voting Members in accordance with the provisions of subsection 4.04(a) or section 4.05 hereof, but not subject to section 4.06 hereof, within five days after the Elections Committee has finished counting the ballots; and (ii) The Voting Members must make and deliver their votes, in accordance with the applicable instructions sent to them pursuant to subsection 4.04(a) (ii) or subsection 4.05(b) hereof no later than 4:00 pm CST on the tenth day after the Mail-in Voting Materials or the Alternative Voting Materials were sent to them by the Registrar. (b) There will be a run-off election between the tied candidates in accordance with the following procedures: (i) Notwithstanding subsection 4.05, the Registrar will re-send the Voting Materials to the Voting Members in accordance with the provisions of subsection 4.04 hereof, within five days after the Ballot Committee has finished counting the ballots; and (ii) The Voting Members must make and submit their votes, in accordance with the applicable instructions sent to them pursuant to subsection 4.04 no later than 4:00 pm CST on the twenty-first day after the Voting Materials were sent to them by the Registrar. Subsection (i) renames to Voting Materials and can include all types of voting (both Mail-In vote, and Alternative Votes) Subsection (i) renames the Elections Committee to Ballot Committee. Subsection (ii) provides enough time to re-submit the ballot in a run-off election. If a mail-in ballot was necessary, 10 days was not enough time to ensure the ballots return mail to the College in time to comply with the by-law Subject to the provisions of section 5.15 hereof, the term of Voting Members elected to Council will begin on the date of the annual general meeting at which their election is announced and end prior to commencement of business on the date of the annual general meeting at which the result of the next election of Voting Members to Council is announced. Subject to the provisions of section 5.16 hereof, the term of the appointed members of Council will begin when they are appointed in accordance with subsection 5.01(c) or 5.02(c) hereof and end prior to commencement of business on the date of the annual general meeting at which the result of the next election of Voting Members to Council is announced Subject to the provisions of section 5.14 hereof, the term of Voting Members elected to Council will begin at the conclusion of the annual general meeting and end at the conclusion of business on the date of the second annual general meeting thereafter. Subject to the provisions of section 5.15 hereof, the term of the appointed members of Council will begin when they are appointed in accordance with subsection 5.01(c) and end at the conclusion of business on the date of the second annual general meeting thereafter. This revision clarifies the beginning and end of a Councillor s term. CPhM WINTER

30 By-Law Update Summary Chart Cont d Current Bylaw New Bylaw Rationale for Change 5.20 In the event of the resignation, disqualification, or removal of the dean of the faculty of pharmacy of the University of Manitoba or the dean s designate, the remaining members of Council may appoint another member of the faculty of pharmacy of the University of Manitoba to fill the vacancy and the person so appointed will hold office until such time as the remaining members of Council deem appropriate In the event of the resignation, disqualification, or removal of the dean of the College of Pharmacy of the University of Manitoba or the dean s designate, the remaining members of Council may appoint another member of the College of Pharmacy of the University of Manitoba to fill the vacancy and the person so appointed will hold office until such time as the remaining members of Council deem appropriate. Renames the Faculty of Pharmacy of the University of Manitoba to the College of Pharmacy of the University of Manitoba Election/Ballot Committee: (a) Prior to a Contested Election, the President must appoint an Election Committee of three Voting Members to count the votes at the election. (b) Before the ballot count of any vote by Voting Members on an issue (i.e. not a Contested Election), the President must appoint a Ballot Committee of three Voting Members. (c) A majority of the members of the Election Committee or the Ballot Committee will constitute a quorum thereof. The duties of the Election Committee or the Ballot Committee may be performed by a quorum thereof. (d) The Election Committee and the Ballot Committee will perform their duties with the assistance of the Registrar Ballot Committee (a) Prior to a vote for the purpose of conducting a Contested Election or any other matter relating to the College, the President must appoint a Ballot Committee of three Voting Members. (b) A majority of the members of the Ballot Committee will constitute a quorum thereof. The duties of the Ballot Committee may be performed by a quorum thereof. (c) The Ballot Committee will perform their duties with the assistance of the Registrar. (d) In the case of a mail-in ballot: Subsection (a) includes all types of voting, not just elections. The statement indicating to count the votes of at the election has been removed because, in an electronic election, the Ballot Committee would not count the ballots. That duty would be completed by the thirdparty software provider. 30.CPhM WINTER 2017

31 Current Bylaw New Bylaw Rationale for Change (e) In the case of a vote held in accordance with subsection 4.01(a) hereof: (i) the Elections Committee or the Ballot Committee must scrutinize the envelopes marked Elections/ Ballot Committee and ascertain that the persons voting are Voting Members; (ii) Subsequently, the Elections Committee or the Ballot Committee must open the envelopes marked Elections/Ballot Committee, remove the envelopes marked Ballot therefrom, and place all envelopes marked Ballot in the same box; and (iii) Finally, the Elections Committee or the Ballot Committee must open the envelopes marked Ballot and count the valid votes. (i) the Ballot Committee must scrutinize the envelopes marked Ballot Committee and ascertain that the persons voting are Voting Members; (ii) Subsequently, the Ballot Committee must open the envelopes marked Ballot Committee, remove the envelopes marked Ballot therefrom, and place all envelopes marked Ballot in the same box; and (iii) Finally, the Ballot Committee must open the envelopes marked Ballot and count the valid votes. (e) In the case of an electronic ballot, the Ballot Committee prepare and sign a report which must be delivered to the Registrar, confirming that it has reviewed and approved the ballot results received directly from the electronic voting service provider. The Registrar must deliver such report to the President who must cause the results of the election to be reported to the Voting Members, as well as announce them at the annual general meeting. CPhM WINTER

32 By-Law Update Summary Chart Cont d Current Bylaw New Bylaw Rationale for Change (f) In the case of a vote held in accordance with subsection 4.01(b) hereof: (i) the Election Committee or the Ballot Committee must ascertain that the persons voting are Voting Members and have voted in accordance with these bylaws; and (ii) Count or tally the valid votes. (g) The Election Committee must prepare and sign a report setting forth the names of the persons elected to the Council on a Contested Election, and must deliver the report to the Registrar. The Registrar must deliver such report, together with the report of the names of any persons elected to the Council without contest, to the President who must report the results of the election to the Voting Members and announce them at the annual general meeting. (h) The Registrar must report the outcome of any votes counted by the Ballot Committee to the Council, which in turn must direct the President to report the outcome to the Voting Members of the College. (f) In the case of a contested election conducted by mail-in ballot, the Ballot Committee must prepare and sign a report setting forth the names of the persons elected to the Council on a Contested Election, and must deliver the report to the Registrar. The Registrar must deliver such report, together with the report of the names of any persons elected to the Council without contest, to the President who must cause the results of the election to be reported to the Voting Members, as well as announce them at the annual general meeting. (g) For a vote held on any other matter relating to the College, the Ballot Committee must prepare and sign a report setting forth the outcome of the vote. The Registrar must report the outcome of any votes reported by the Ballot Committee to the President who must cause the results of vote to be reported to the Voting Members of the College. Subsection (e) was added to clarify the duties of the Ballot Committee in an electronic vote. This is a new provision to permit electronic voting. Subsection (f) was modified for clarity in the event a mailin ballot was ever needed by the College. Additionally, the results of an election have, in recent years, been announced to the members in advance of the AGM. This revision outlines that the official formal announcement is to occur at the AGM; however, notification prior to the AGM is also to occur. Subsection (g) was modified to permit a smoother operationalization and notification to the members Board of Examiners: (a) (ii) Subject to provisions of section 5.16 hereof, the Dean of the Faculty of Pharmacy, University of Manitoba, or his or her designate, or, in the alternative, any substitute appointed for the Dean or his or her designate in accordance with the provisions of section 5.20 hereof; 32.CPhM WINTER Board of Examiners (a) (ii) Subject to provisions of section 5.15 hereof, the Dean of the College of Pharmacy, University of Manitoba, or his or her designate, or, in the alternative, any substitute appointed for the Dean or his or her designate in accordance with the provisions of section 5.19 hereof; Renames the Faculty of Pharmacy of the University of Manitoba to the College of Pharmacy of the University of Manitoba.

33 Current Bylaw New Bylaw Rationale for Change 8.06 Appeals Panel: (a) Within sixty (60) days of the receipt of an appeal by the complainant, the Chair of Council must name an appeals panel in accordance with section 39 of the Act. (b) The Chair of Council must appoint a chair of the appeals panel, in accordance with subsection 39(3) of the Act, as well as a vice-chair thereof. (c) The time at which and the place where meetings of the appeals panel will be held must be determined by the chair of the appeals panel and must be held within thirty (30) days of the appointment of the appeals panel. (d) A majority of the members of the appeals panel, including at least one public representative, will constitute a quorum thereof Appeals Panel (a) Within thirty (30) days of the receipt of an appeal by the complainant, the Chair of Council must name an appeals panel in accordance with section 39 of the Act. (b) The Chair of Council must appoint a chair of the appeals panel, in accordance with subsection 39(3) of the Act, as well as a vice-chair thereof. (c) The time at which and the place where meetings of the appeals panel will be held must be determined by the chair of the appeals panel and must be held within sixty (60) days of the appointment of the appeals panel. (d) A majority of the members of the appeals panel, including at least one public representative, will constitute a quorum thereof. This revision allows for a smoother process for scheduling an Appeal Panel, while accomplishing the duties of the Appeal Panel within the same amount of time (90 days). Not Applicable AMENDING THE BY- LAWS Council may amend any by-law at a meeting of Council, provided that the proposed amendment is sent to all members of Council in advance of the meeting. Notice of the proposed amendment can be sent to the members of Council by regular post, or fax. This is a new section that formalizes the previous process of amending the bylaws. CPhM WINTER

34 News and Events College of Pharmacists of Manitoba Awards The College of Pharmacists of Manitoba (College) is now accepting nominations and applications for the following awards: Pharmacist of the Year Bowl of Hygeia Bonnie Schultz Memorial Award for Pharmacy Practice Excellence Patient Safety Award Honorary Life Members Honorary Members Centennial Award If you or a pharmacist you know, has made a noteworthy contribution to patient care and safety or the practice of pharmacy, please consider submitting a nomination or application for one of the awards listed in the College Awards brochure. The deadline for submitting nominations and applications for the 2018 College Awards is Tuesday, January 16, The College has created award submission guidelines for your consideration prior to forwarding your nomination to the College s Awards & Nominating Committee. Please send all nominations or applications to: College of Pharmacists of Manitoba Attention: The Awards & Nominating Committee CPhM Awards 200 Taché Avenue Winnipeg, MB R2H 1A7 info@cphm.ca with the subject line: Attention: The Awards & Nominating Committee CPhM Awards Awards will be presented during the 2018 Awards Luncheon on Saturday, May 12, 2018, at the Manitoba Club in Winnipeg. 34. CPhM WINTER 2017

35 20 Young 18 Leader Awards The Young Leader Awards celebrate the efforts of up to ten leaders in pharmacy practice. The recipients will receive a plaque to commemorate their contributions to the pharmacy profession and a $500 cash prize. The awards are open to recently licensed pharmacists (practicing one to five years postgraduation) and to pharmacy students (interns) in their final year of study who have made a professional contribution to patient care, the pharmacy profession or amongst their colleagues and peers at the University of Manitoba s College of Pharmacy. If you or someone you know meet these criteria, please submit a nomination or application package including the nominee or applicant s Curriculum Vitae and a summary of their activities and contributions within pharmacy practice or within the University of Manitoba s College of Pharmacy. The deadline for nominations or applications is Tuesday, January 16, Please submit all nominations or applications to the College of Pharmacists of Manitoba: By regular mail or Mail: College of Pharmacists of Manitoba Attention: The Awards & Nominating Committee Young Leader Awards 200 Taché Avenue Winnipeg, MB R2H 1A7 info@cphm.ca with the subject line: Attention: The Awards & Nominating Committee Young Leader Awards Awards will be presented during the 2018 Awards Luncheon on Saturday, May 12, 2018, at the Manitoba Club in Winnipeg. CPhM WINTER

36 News and Events 2017 White Coat Ceremony The College of Pharmacists of Manitoba (the College) plays a key role in supporting pharmacy students as they enter and complete their studies at the University of Manitoba College of Pharmacy. The College of Pharmacists presents more than ten awards and honours to deserving students throughout the academic year. While many of these awards recognize excellence, they also provide students with additional financial support during their studies. On September 29, 2017, College President Jennifer Ludwig, along with Registrar Susan Lessard-Friesen, joined pharmacy professionals and University of Manitoba faculty and staff in acknowledging 55 new students of the College of Pharmacy. The annual White Coat Ceremony, where each student is presented with a white lab coat, serves as a formal welcome from the regulatory body and the faculty to students entering their first year of pharmacy studies. Ms. Ludwig, Ms. Lessard-Friesen and Dr. Dan Sitar, Alumnus of Distinction, Class of 1966, served as guest speakers, while Dr. Lalitha Raman-Wilms, Dean of Pharmacy, acted as Master of Ceremonies. The College and the University also recognized academic and professional excellence with a number of awards presented to faculty staff and students. The College extends special congratulations to the students who were awarded scholarships founded by Mr. William Eamer and the College of Pharmacists of Manitoba. College of Pharmacy Class of Photo courtesy of the University of Manitoba. 36. CPhM WINTER 2017

37 2017 Pharmacy Student Awards Congratulations to all of the award recipients, including students and staff and faculty, who were recognized for their excellence in the fall and winter of Lane Sokolowski College of Pharmacists of Manitoba Silver Medal in 3rd Year Pharmacy Awarded to the student with the highest academic standing in third year pharmacy. Snimar Bali (Entering Year One) Jenna-Julie Esteban (Year One) Kelly Yeo (Year Two) Jennifer Butler (Year Three) Mackenzie Murray Flexon Silver Medal Awarded to the student with the highest academic standing in Medicinal Chemistry courses. Marikka Lee Bletcher Memorial Scholarship William G. Eamer/College of Pharmacists of Manitoba Scholarships for Student Excellence in Pharmacy Awarded to students who are enrolled full-time in their year of study at the College of Pharmacy, have achieved high academic standing, and have demonstrated social responsibility and community service. Awarded to a second-year pharmacy student with high academic standing. Michelle Ernest College of Pharmacists of Manitoba Scholarship Awarded to a student of outstanding merit in second year pharmacy. Mr. William Eamer and Ms. Susan Lessard-Friesen present Ms. Snimar Bali with the William G. Eamer/ College of Pharmacists of Manitoba Scholarship for Student Excellence in Pharmacy. Photo courtesy of the University of Manitoba. Victoria Bertram Stewart G. Wilcox Award Awarded to the student of highest academic standing in Pharmacy Skills Lab 2 (Jurisprudence Section). Sai Krishna Gudi College of Pharmacists of Manitoba/ William G. Eamer Graduate Scholarship in Pharmacy Awarded to an individual of high academic standing who is enrolled as a full-time Masters or Ph.D. student in any year of the Faculty of Graduate studies, and whose research project is conducted in the Faculty of Pharmacy. This student will have made a significant contribution to their profession, university, and community. CPhM WINTER

38 News and Events Save-the-Date! The 2018 Annual General Meeting (AGM) marks the 140th AGM of the College of Pharmacists of Manitoba. Please join us in celebrating this important milestone. Mark your calendars for Saturday, May 12, 2018, at the Manitoba Club in Winnipeg for our 140th AGM and the 2018 Awards Luncheon! Staff Updates The College of Pharmacists extends its gratitude to Jodi Pagaduan for her many contributions over the last several weeks. Jodi joined the College as part of her Structured Practical Experiential Program rotations with the University of Manitoba College of Pharmacy during which she has conducted research on current pharmacy practice issues, presented findings to staff, and authored a number of written reports, including articles in this issue of the College of Pharmacists Newsletter. Thank you Jodi, and good luck with rest of your studies and your entrance into pharmacy practice! College Receives Annual Patient Safety Grant The College is pleased to report it has been selected to receive one of two Dr. John Wade Patient Safety Initiatives Grants (Grant) for 2018 by the Manitoba Institute for Patient Safety (MIPS). The College will receive a $6,200 grant to create a Just/Safe Toolkit for community pharmacies to help support a cultural shift from a blame-and-shame to a just-and-safe approach to medication incidents and near misses throughout the province. The College offers its sincere gratitude to the selection committee and MIPS for this opportunity to enhance pharmacy practice and patient safety in Manitoba. For more information on the Grant, please see MIPS media release and website. 38. CPhM WINTER 2017