Week 10

Regulated Health Professions Act (RHPA) and Pharmacy Act (PA)

Provincial Legislation

  • Regulated Health Professions Act (RHPA)

  • Pharmacy Act (PA)

  • Drug and Pharmacies Regulation Act (DPRA)

  • Drug Interchangeability and Dispensing Fee Act (DIDFA)

  • Ontario Drug Benefit Act (ODBA)

  • Safeguarding Our Communities Act

  • The Protecting Patients Act

  • Narcotic Safety and Awareness Act (NSAA)

  • Personal Health Information and Protection Act (PHIPA)

  • Privacy Act

  • Ontario Labour Mobility Act

The Regulated Health Professions Act

  • A framework for the governance of health professions to protect the public interest.

  • Key aspects include:

    • Development and maintenance of standards for practice.

    • Implementation of quality assurance processes to ensure compliance with established standards.

Regulated Health Professions

  • A total of 26 health professions are regulated under the RHPA, which include but are not limited to:

    • Audiology and Speech Language Pathology

    • Chiropody

    • Chiropractic

    • Dental Hygiene

    • Dental Technology

    • Dentistry

    • Denturism

    • Dietetics

    • Homeopathy

    • Kinesiology

    • Massage Therapy

    • Medical Laboratory Technology

    • Medical Radiation and Imaging Technology

    • Medicine

    • Midwifery

    • Naturopathy

    • Nursing (BN, PN, NP)

    • Occupational Therapy

    • Opticianry

    • Optometry

    • Pharmacy (including Pharmacy Technicians)

    • Physiotherapy and Applied Behaviour Analysis

    • Psychology

    • Psychotherapy

    • Respiratory Therapy

    • Traditional Chinese Medicine

Self-Regulated Profession

  • Health professionals governed by a regulatory body are referred to as self-regulated professions.

  • Must have a governing body to manage conduct and standards.

    • Examples of governing bodies include:

    • Pharmacy: Ontario College of Pharmacists (OCP)

    • Medicine: College of Physicians and Surgeons

    • Nursing: College of Nurses

Regulations to the Act

  • The Regulated Health Professions Act includes several regulations that affect practice:

    • Procedures for the election of the Board of Directors.

    • The issuing of Certificates of Registration (licenses).

    • Governance of advertising practices.

    • Establishment of protocols for managing conflicts of interest.

    • Policies for addressing professional misconduct.

The Ontario College of Pharmacists (OCP)

  • Mission: To regulate pharmacy practice in Ontario, serving the public's interests, health, and well-being.

  • Vision: To be a trusted leader in protecting the public and improving pharmacy care.

  • Values:

    • Accountability

    • Integrity

    • Transparency

Role of the OCP

  • Patient Counselling: OCP ensures that pharmacists counsel patients effectively on their medications.

Six Ways OCP Serves and Protects the Public

  1. License and regulate pharmacy practices.

  2. Develop and enforce quality and safety standards along with a Code of Ethics.

  3. Assess pharmacies to ensure safety and quality in services rendered.

  4. Assess registrants (pharmacists and technicians) in their practice capabilities (Practice Assessment).

  5. Address and resolve complaints against pharmacy professionals.

  6. Communicate important information to the public.

Board of Directors

  • Composition:

    • 7 Registered Pharmacists

    • 2 Pharmacy Technicians

    • 9-16 Lay persons (non-pharmacists)

    • Dean of UofT and Waterloo pharmacy schools

  • A Chair and Vice Chair elected from among Board Members.

  • The Board is responsible for hiring a CEO to manage daily operations.

Committee Structure

  • Statutory Committees: Required by law, including:

    1. Accreditation

    2. Discipline

    3. Executive

    4. Fitness to Practice

    5. Inquiries, Complaints and Reports

    6. Patient Relations

    7. Quality Assurance

    8. Registration

  • Standing Committees: Formed by the Board under by-laws, including committees for:

    • Drug Preparation Premises

    • Finance & Audit

    • Governance

    • Screening

Committee Investigations

  • Each group is tasked to investigate a specific committee function and present findings to the class.

OCP Policies and Guidelines

  • OCP Framework includes:

    • POLICIES

    • LAWS

    • STANDARDS

    • COMPLIANCE

    • REGULATIONS

Complaints Process at OCP

Step 1: Initiation

  • Written complaint is received by the College.

    • Additional information may be requested from complainants or the pharmacy involved.

Step 2: Notice of Complaint

  • Issuance of a Notice of Complaint to the pharmacy/professional involved after review of received information.

  • They have 30 days to respond in writing.

Step 3: The Investigation

  • Each complaint is fully investigated by College staff.

    • Most investigations are completed within 150 days, but complex cases may take longer.

Step 4: Results of the Investigation

  • A panel from the Inquiries, Complaints, and Reports Committee (ICRC) reviews the investigation report.

    • Decisions follow based on ICRC's analysis of the findings.

Step 5: Decision Making

  • The ICRC has several options, including:

    • No action taken

    • Require remedial training

    • Refer to the Discipline Committee

    • Decisions are issued generally within one month of the meeting.

Step 6: ICRC Complaints Decisions and Review Process

  • Both complainant and respondent receive copies of the decision and reasons.

  • Decisions regarding cautions, remedial training or discipline are publicly displayed on the College's website.

  • Complaint submission procedures and contact details included for the public.

The Pharmacy Act

Overview

  • Defines the scope of practice in pharmacy.

  • Specifies controlled acts within the profession.

  • Establishes the Ontario College of Pharmacists (OCP) as the licensing body.

Scope of Practice

  • Involves:

    • Custody, compounding, dispensing, and prescribing of drugs.

    • Provision of health aids and devices.

    • Health education and information dissemination.

    • Disease prevention and treatment through monitoring therapy.

    • Assessment for the purpose of medication therapy management.

Controlled (Authorized) Acts

  • Specific actions authorized to pharmacists, which include:

    1. Dispensing, selling, compounding drugs, and supervising relevant pharmacy areas.

    2. Administering specified substances through injection or inhalation.

    3. Prescribing specified drugs under regulations.

    4. Performing skin procedures below dermis.

Minor Ailments

  • Starting from October 1, 2023, pharmacists can prescribe for several minor conditions, including:

    • Acne

    • Cold sores (Herpes labialis)

    • Allergic Rhinitis

    • Impetigo

    • Aphthous Ulcers

    • Insect Bites and Hives (Urticaria)

    • Oral Thrush (Candidal stomatitis)

    • Tick Bites and prophylaxis for Lyme disease

    • Conjunctivitis (various types)

    • Musculoskeletal Sprains and Strains

    • Dermatitis (multiple types)

    • Nausea and Vomiting in Pregnancy

    • Diaper Dermatitis

    • Pinworms

    • Dysmenorrhea

    • Urinary Tract Infections (uncomplicated)

    • GERD

    • Yeast Infections (Vulvovaginal candidiasis)

    • Hemorrhoids

Classes of Registration

  • Different classifications include:

    • Pharmacist (two parts)

    • Interns

    • Pharmacy Technician (two parts)

    • Intern Technician

    • Pharmacist (in Emergency Assignment)

    • Pharmacy Technician (in Emergency Assignment)

Restricted Titles

  • Certain titles can only be used by registrants of the OCP, such as:

    • Apothecary

    • Druggist

    • Pharmacist

    • Pharmacy Technician

    • Pharmaceutical Chemist

Professional Responsibilities

  • Key responsibilities include:

    • Maintaining Standards of Practice

    • Ensuring patient safety

    • Keeping accurate and complete records

    • Honesty in billing practices

    • Truthful communication

    • Cooperation during inspections

    • Keeping professional profiles current

    • Respect towards colleagues and the public

    • Always protecting the public interest

Opioid Management

Safeguarding our Communities Act

  • Key focus on opioid management, promoting responsible use and preventing abuse.

    • Management of controlled opioids like:

    • Hydrocodone

    • Meperidine

    • Methadone

    • Oxycodone

    • Fentanyl

    • Morphine

    • Codeine

Patch 4 Patch Fentanyl Return Program

  • Prescriber Responsibilities:

    • Record pharmacy details on the prescription, notify the pharmacy before writing prescriptions indicating it is a first-time prescription.

    • Ensure there are no other active prescriptions for the patches by other prescribers.

  • Dispensing Procedures:

    • Verify prescription details and that pharmacy is notified.

    • For non-first prescriptions, only dispense if the patient returns used patches.

    • Properly examine, store, and destroy used patches following OCP guidelines.

Patch Exchange Disposal Tool

  • Used for safe disposal of opioid patches. Involves providing a designated sheet for affixing returned patches to facilitate the exchange process.

  • Instructions for returning the sheet to the pharmacy for receiving the next supply.

Managing Lost, Stolen, or Tampered Patches

  • Lost Patches: Utilize professional judgment based on patient history. Document the incident and decision.

  • Stolen Patches: Require a police report from the patient.

  • Tampering/Diversion Suspicions: Balance police notification with patient privacy, notifying only when misuse is suspected.

The Protecting Patients Act (Effective May 1, 2018)

Main Features

  • Enhances prevention efforts against patient sexual abuse.

  • Heightens support and resources for victims.

  • Improves regulatory oversight of OCP's operations.

Case Example

  • Incident involving Johne M. in November 2021, where a pharmacist lost their license due to theft, fraudulent claims, and sexual abuse of a patient.

Definition of a Patient

  • A direct interaction is defined as meeting any of the following criteria:

    • Payment charged for a health service.

    • Contributions made to health records.

    • Consent given for services recommended.

    • Prescription written for controlled substances.

Minimum Time Period for Sexual Relationships

  • A minimum period of one year is established post-relationship during which sexual involvement with former patients is prohibited.

    • Engaging in a relationship within this timeframe results in mandatory license revocation.

Exceptions to the Time Limit

  • Relationships are permissible under specific conditions:

    • Pre-existing relationship before service began.

    • Service in emergency situations or if minor.

    • Professional transfers care to another member appropriately.

Criminal Code Offences

  • Violations leading to sexual offences under the Criminal Code trigger mandatory revocation, including:

    • Sexual assault and exploitation

    • Publication of intimate images

    • Offences involving minors

    • Voyeurism

  • Such violations must be noted in the public register.

Homework Assignments (Due November 16th)

  1. Complete the Role of the OCP e-learning module (2.5%)

  2. Complete the Self-Regulation e-learning module (2.5%)

  3. Pass the RHPA/PA Quiz (2%)