Expanded Scope of Practice

The College is committed to protecting patient safety and promoting quality care as the role of pharmacy professionals expands. Working with the public, registrants, other health care professionals and health-system stakeholders is key to ensuring that patients receive appropriate and safe care at every point in their health care journey.

That’s why the College has taken a system-wide approach to developing regulations that will put patient safety first. It’s engaging and collaborating with registrants, patients, physicians, nurse practitioners and other health-care providers, public health experts, professional associations, other health profession regulators and others to provide insights and recommendations in the development of new regulations, as well as identifying necessary resources and guidance to support implementation and improve health outcomes and access to care in Ontario.

The provincial government has directed the College to submit draft regulations that would enable pharmacists to:

  1. Administer the flu vaccine to children as young as two years old;
  2. Renew prescriptions in quantities of up to a year’s supply;
  3. Administer certain substances by injection and/or inhalation for purposes that are in addition to patient education and demonstration;
  4. Perform point of care tests for certain chronic conditions; and
  5. Prescribe drugs for certain minor ailments.

Proposed regulatory amendments for the first four items of scope have been submitted to the government for consideration. The authority to perform point of care tests also requires regulatory changes to the Laboratory and Specimen Collection Centre Licensing Act, which will be managed by the Ministry of Health.

The government will determine when these proposed changes will take effect.

Minor Ailments

The College has been directed by the Minister of Health to submit draft regulations by June 30, 2020 to permit pharmacist prescribing for certain minor ailments.

As a result of this request, the College has sought feedback on proposed amendments to the General Regulation 202/94 of the Pharmacy Act, Part VII.3 (Controlled Acts).

The proposed amendments would enable pharmacists to prescribe medications in the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification system categories for the following 12 minor ailments:

CONDITION AHFS CLASSIFICATION
1. Urinary tract infection (uncomplicated)
  • Anti-infective Agents: Antibacterials. Sulfonamides (8:12.20)
  • Anti-infective Agents: Urinary Anti-infectives (8:36
2. Dermatitis (atopic/eczema, allergic and contact skin rashes)
  • Skin and Mucous Membrane Agents: Anti-inflammatory Agents. Corticosteroids (84:06.08)
3. Insect bites (including tick bites) and urticaria (hives)
  • Skin and Mucous Membrane Agents: Anti-inflammatory Agents. Corticosteroids (84:06.08)
  • Antibiotic Tetracyclines (8:12:24)
4. Conjunctivitis (bacterial, allergic, viral)
  • Eye, Ear, Nose, and Throat Preparations: Anti-infectives. Antibacterials (52:04.04)
  • Eye, Ear, Nose, and Throat Preparations: Antiallergic Agents (52:02)
5. Allergic rhinitis (nasal symptoms from allergies)
  • Eye, Ear, Nose and Throat Preparations: Anti-inflammatory Agents. Corticosteroids (52:08.08)
  • Eye, Ear, Nose and Throat Preparations: Antiallergic Agents (52:02)
6. Candidal stomatitis (oral thrush)
  • Skin and Mucous Membrane Agents: Anti-infectives. Antifungals. Polyenes (84:04.08.28)
7. Herpes labialis (cold sores)
  • Anti-infective Agents: Antivirals. Nucleosides and Nucleotides (8:18.32)
  • Skin and Mucous Membrane Agents: Anti-infectives. Antivirals (84:04.06)
  • Skin and Mucous Membrane Agents: Anti-inflammatory Agents. Corticosteroids (84:06.08)
8. Hemorrhoids
  • Skin and Mucous Membrane Agents: Anti-inflammatory Agents. Corticosteroids (84:06.08)
  • Skin and Mucous Membrane Agents: Antipruritics and Local Anesthetics (84:08)
  • Skin and Mucous Membrane Agents: Miscellaneous Skin and Mucous Membrane Agents (84:36)
9. Gastroesophageal reflux disease (GERD)
  • Gastrointestinal Drugs: Antiulcer Agents and Acid Suppressants. Histamine H2-Antagonists (56:28.12)
10. Dysmenorrhea (menstrual cramps)
  • Central Nervous System Agents: Analgesics and Antipyretics. Nonsteroidal Anti-inflammatory Agents. Other Nonsteroidal Anti-inflammatory Agents (28:08.04.92)
11. Musculosketelal sprains and strains
  • Central Nervous System agents: Analgesics and Antipyretics. Nonsteroidal Anti-inflammatory Agents. COX-2 inhibitors (28:08.04.08)
  • Central Nervous System agents: Analgesics and Antipyretics. Nonsteroidal Anti-inflammatory Agents. Other Nonsteroidal Anti-inflammatory Agents (28:08.04.92)
12. Impetigo (bacterial skin infection common in children)
  • Skin and Mucous Membrane Agents: Anti-infectives. Antibacterials (84:04.04)
  • Skin and Mucous Membrane Agents: Anti-inflammatory Agents. Corticosteroids (84:06.08)

 

This list was informed through the work of the Minor Ailments Advisory Group (MAAG), comprising patient advisors as well as experts in pharmacy, medicine, public health, health systems research, and anti-microbial stewardship. It was also informed by feedback and input received through a registrant survey administered in December 2019, numerous public focus groups and through an analysis of administrative data from the Institute for Clinical Evaluative Sciences (ICES).

OCP Board Approval of the Minor Ailment Regulations

At its June 15, 2020 meeting, the OCP Board of Directors (Council) reviewed the final regulatory amendments to enable pharmacist prescribing for certain minor ailments subsequent to the latest open consultation on the regulations which closed in late May. The latest consultation followed several months of engagement with stakeholders and input received from registrants, health system partners, other health professions and patients throughout the regulatory drafting process.

Following their review of the feedback received through the consultation and the final changes made to the draft regulations, the Board unanimously approved the regulations to move forward for submission to the Ministry of Health by June 30, 2020.

Please review the June 15, 2020 Board meeting briefing note for the complete details of the final regulatory amendments including a summary of the feedback received during the development of the regulations.

Next Steps on Minor Ailments

Board approval of the regulations for submission to government is the latest in a series of steps that are required before pharmacists can prescribe for minor ailments in Ontario. Once the regulations are submitted to the Ministry of Health, the government will review the submission and post the regulations on the provincial regulation registry for public consultation prior to any final government approval. No timeline has been established for when final government approval will be made.

In the meantime, the College is developing a comprehensive implementation plan aimed at supporting and informing the profession as well as the public and other health system stakeholders once regulations are approved.

For more information on the approval of the regulations, including the approval of a mandatory education requirement to support minor ailment prescribing in Ontario, please read the news post Board Approves Regulations Enabling Minor Ailment Prescribing for Submission to Government.

New mandatory education requirement to support pharmacist minor ailment prescribing in Ontario

As the College made proposed regulatory amendments to enable pharmacists to prescribe for certain minor ailments, it was committed to identifying the appropriate educational requirements that optimize the knowledge and skills of pharmacists in support of performance of this act and overall delivery of safe, high quality patient care.

At its latest meeting, the OCP Board reviewed proposed education requirements to support this expanded scope of practice once regulations are formally approved by government. In consideration of the need to ensure pharmacists fully understand their ethical, legal and professional obligations of prescribing for minor ailments while meeting standards of practice, the Board approved the requirement for all Part A pharmacists to complete mandatory education – free to registrants and not to exceed two hours in length – on prescribing for minor ailments and that the education be completed within one year of its availability and before engaging in such practice.

The mandatory education will be focused on ensuring pharmacists fully understand their ethical, legal and professional obligations of prescribing for minor ailments while meeting established standards and providing safe, quality care to their patients. The mandatory education requirement does not apply to clinical training; the College will continue to expect that pharmacists who engage in this new authority, once approved by government, will have the required knowledge, skills and judgement to do so safely and ethically and in accordance with the Standards of Practice, Code of Ethics, and all relevant regulations.

Please review the June 15, 2020 Board meeting briefing note for the complete details of the education requirement approved by the Board.

It is important to note that while other pieces of legislation, such as the Public Hospitals Act, may impact the ability of some pharmacists to practice to the full extent of this new authority, the regulations apply to the profession as a whole and are not specific to areas of practice.

Next steps

Further details regarding the mandatory education requirement for minor ailment prescribing will be communicated in the coming months as we prepare for government approval of the related regulations. Please stay tuned to e-Connect and the College website for updates.