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Legislation and Supporting Documents Practice Resources Pharmacy Technicians Expanded Scope of Practice Forms & Pharmacy Signs Implementation of the December 2006 Pharmaceutical Act

Pharmacy Practice


The College of Pharmacists of Manitoba (formerly known as the “Manitoba Pharmaceutical Association”) continues to adapt the content on www.cphm.ca in order to reflect the December 2006 Pharmaceutical Act , implemented January 1, 2014. The documents on the website with “Manitoba Pharmaceutical Association” or “MPhA” have not been updated and may not be consistent with the current legislation. Questions on this content can be directed to the College office.

   

Legislation and Supporting Documents

Provincial  

A Guide to Pharmacy Practice in Manitoba

A Guide to Pharmacy Practice in Manitoba replaces Orientation to the New Practice Framework. The updated Guide outlines the legislation, standards of practice, practice directions and code of ethics which form a framework for daily pharmacy practice in our province.

December 2006 the Pharmaceutical Act (posted January 3, 2014)

Manitoba Pharmaceutical Regulation (July 2013) (posted January 3, 2014) - NOTE: Government to amalgamate with Pharmaceutical Regulation, amendment (see next item)

Manitoba Pharmaceutical Regulation, amendment (posted September 30, 2016) - NOTE: Government to amalgamate with Pharmaceutical Regulation (see item above)

Manitoba By-Laws to The Pharmaceutical Act

Code of Ethics (January 1, 2014)     
The Code of Ethics governs the conduct of members, students, interns and owners. 

Prescription Drug Cost Assistance Act

Outline of Prescription Drug Regulations

Outline of M3P Prescription Drug Regulations

Prescription Drugs Payment of Benefits Regulation

Manitoba Drug Benefits and Interchangeability Formulary

Manitoba Drug Benefits and Interchangeability Formulary List

The Apology Act

The Fair Registration Practices Act

Non-Potable Intoxicating Substances, Stomach Bitters and Rubbing Alcohol Regulation

Non-Smokers Health Protection Amendment Act

Pharmaceutical (General Matters) Regulation (in which a pharmacist is designated as a practitioner) (posted March 4, 2014)

Personal Health Information Act and Regulations   

The Protection for Persons in Care Act

Minimum Pharmacy Policy and Procedures Manual Content

Workplace Safety and Health Act

The Public Health Act and Regulations


Federal

Food and Drugs Act & Regulations

Controlled Drugs and Substances Act
& Regulations


Narcotic Control Regulations

Health Canada Prescription Drug List


Prescribers

Prescribing Authority Table  


Clinical & Physician Assistants

Clinical & Physician Assistant: Prescribing Authority (updated November 2016)
For a list of Clinical and Physician Assistants, please click here.

Dentists

For an updated list of Dentists, please click here.


Midwives

The Midwifery Act

Medications & Devices that a Midwife May Prescribe & Administer (Schedule B to the Midwifery Regulations of The Midwifery Act)

For a list of Midwives, please click here.


Pharmacists

Prescribing Authority for Pharmacists

Available Drugs for Prescribing under Schedule 3 to the Manitoba Pharmaceutical Regulation


Physicians

For the Physician Directory, Currently Licensed and Practising in the Province please click here .


Registered Nurses (Extended Practice)

RN(EP) (Extended Practice Registered Nurses) and NP (Nurse Practitioners)

have expanded prescriptive authority

View the CRNM Nurse Check (Extended Practice)

Letter to Manitoba Pharmacists from CRNM.


Veterinarians

For a list of Veterinarians, please click here.


Optometrists

Optometrists Prescribing Authority (June 4, 2015)

Optometrists Drug List (Schedule A) 

To verify an Optometrist's therapeutic licence, please click here .


Standards of Practice and Practice Directions

A practice direction is a written statement made by Council for the purpose of giving direction to members and owners about the conduct of their practice and pharmacy operations. Compliance with approved practice directions is required under The Pharmaceutical Act .    

Practice Directions Policy Statement
 


National Association of Pharmacy Regulatory Authorities (NAPRA) Model Standards 

The following pharmacy practice standards were developed by the National Association of Pharmacy Regulatory Authorities (NAPRA). Following member consultation, as outlined in the Practice Directions Policy Statement, the Practice Directions listed below were approved by College Council.

NAPRA Model Standards for Pharmacy Compounding of Non-Hazardous Sterile Preparations

NAPRA Model Standards for Pharmacy Compounding of Hazardous Sterile Preparations *

*For more information on the current compounding guidelines and the implementation schedule and deadlines for Manitoba compounding pharmacies for the NAPRA Model Standards for Pharmacy Compounding of Non-Hazardous and Hazardous Sterile Preparations, please the the following section titled 'Pharmacy Compounding.'


Pharmacy Compounding

The current standards for pharmacy compounding in Manitoba are as follows:

With a stepwise approach, the College will replace the Extemporaneous Compounding Guideline and the Guidelines on Sterile Production in Pharmacies and Handling and Disposal of Hazardous Pharmaceuticals with a suite of model pharmacy compounding standards developed by the National Association of Pharmacy Regulatory Authorities (NAPRA). Please see the following section for more information.

NAPRA Model Standards for Pharmacy Compounding of Non-Hazardous and Hazardous Sterile Preparations

On February 6, 2017, College Council approved an implementation schedule for the NAPRA Standards for Pharmacy Compounding of Non-hazardous and Hazardous Sterile Preparations with the following motion:

Council approved a phased-in implementation schedule, with the first implementation requirement date of January 1, 2019, with the expectation for total compliance throughout Manitoba by January 1, 2021, for the NAPRA Model Standards for the Compounding of Non-Hazardous Sterile Preparations and the Compounding of Hazardous Sterile Preparations.

To review the NAPRA model standards for pharmacy compounding, please visit the following links:

All pharmacies engaged in non-hazardous and/or hazardous sterile preparation are required to transition to the NAPRA Model Standards according to the implementation schedules below:  


NAPRA Guidance document for pharmacy compounding of non-sterile preparations

NAPRA Model standards for Pharmacy compounding of non-sterile preparations.


Interim Standards of Practice and Practice Directions 

In 2011, Council made the decision to accept the then current Standards of Practice documents as practice directions under the new legislation in order for the Standards of Practice Committee to focus on the creation of new practice directions that were needed under the new regulations and expanded scope of practice for pharmacists. The Standards of Practice listed below are now considered "practice directions" and will be reviewed by the Standards of Practice Committee in due course. 


International Prescription Service Pharmacy Standards of Practice

Hospital Standards of Practice and Guidelines [practice direction] 

Personal Care Home - Long-Term Care Standards of Practice [practice direction]


Approved Standards of Practice and Practice Directions

After a series of Special General Meetings and opportunities for member feedback, as per the Practice Directions Policy Statement, the following practice directions have been approved by Council.

Adaptation of a Prescription
[effective January 1, 2014]

Administration of Drugs including Vaccines [Standard of Practice #5 [updated and posted June 25, 2014]

Advertising in Manitoba Pharmacies [effective February 8, 2016]

Alternate Verification Program: Drug Packaging [effective April 24, 2015]

Central Fill [effective April 11, 2014]

Clinical Practice Pharmacies Practice Direction [effective October 5, 2015]

Conscientious Objection [effective July 27, 2018]

Delegation of Dispensing to Other Health Professionals Practice Direction
[effective December 18, 2015]

Drug Distribution Practice Direction [effective July 8, 2016]

Ensuring Patient Safety [updated document is effective March 13, 2015]

Exempted Codeine Practice Direction [effective February 1, 2016]

Aids to the Exempted Codeine Practice Direction: 

Incidents and Discrepancies Practice Direction [effective July 8, 2016]

Lock and Leave Component [effective January 1, 2014]

Manitoba Prescribing Practices Program (M3P) Information Entered into DPIN [effective January 1, 2014]

Pharmacy Facilities [Standard of Practice #15] [effective December 10, 2018]

Patient Counselling [effective October 10, 2014]

Patient Profiles [effective October 10, 2014]

Permanent and Temporary Pharmacy Closure   [effective July 4, 2014]

Prescribing [amended October 6, 2014]

Prescribing and Dispensing [Standard of Practice #4] [effective January 1, 2014]

Records and Information [Standard of Practice #12] [effective January 1, 2014]

Referring a Patient

Refill History Recording System [effective February 13, 2015]

Sale of Schedule 2 Drugs [effective January 1, 2014]

Sale of Schedule 3 Drugs [effective January 1, 2014]

Secondary Hospital Services Component Practice Direction [effective December 18, 2015]

Termination of Patient Relationship [Standard of Practice #11] [effective July 4, 2014]

Test Interpretation [Standard of Practice #7] [effective January 1, 2014]

Transfer of Patient care [Standard of Practice #10] [effective January 1, 2014]

Supervision [effective July 4, 2014]

 *This practice direction serves as a guideline for pharmacy managers considering submission of a proposal for Council approval to implement an Alternate Verification Program in their pharmacy. Please be advised that pharmacy managers must receive prior approval by Council of their proposal before an Alternate Verification Program can be initiated in their pharmacy.


Draft Practice Directions Open for Member Consultation and Feedback

A Practice Direction is a written statement made by Council for the purposes of giving direction to members and owners about the conduct of their practice and pharmacy operations. Before a Practice Direction is approved by Council, members are provided with the opportunity to review and provide their feedback on draft practice directions, for consideration at Council. Compliance with approved Practice Directions is required under The  Pharmaceutical Act .

The following draft practice direction is open for member and stakeholder consultation and feedback:

Members can send feedback on these draft practice directions via email to feedback@cphm.ca.


Guidelines

Practice Guidelines

On April 25, 2014, Council passed a motion to accept the document’s proposed requirements for the PPMS used by pharmacy professionals for compliance in Manitoba pharmacies by January 1, 2016, in conjunction with NAPRA’s effective date. The following guidelines are approved by Council. They are policies and practice indicators developed under the old legislation and are still valid under the new legislation. These documents will be reviewed by Council in due course.

Position Statement on Non-Medical (Recreational) Cannabis

Adverse Drug Reaction Guidelines

Guidelines for Pharmacists Dispensing Mifegymiso in Manitoba

Guidelines for pharmacy licence holders wanting to use more than one name for their pharmacy 

Guidelines on sterile production in pharmacies, and handling and disposal of hazardous pharmaceuticals 

Narcotic and Controlled Drug Accountability Guidelines


Needle Stick Injury Guideline (added June 30, 2015)

Position Statement on Non-Medical (Recreational) Cannabis

Position Statement on Injection of Neuromodulators and Dermal Fillers

Procedures in the Event of a Robbery or Burglary
[updated December 2014]

Satellite  Pharmacy Component Criteria

Self-Testing Product Guidelines

Practice Direction for Advertising* 

* Requested by Council to be revised and transitioned by the Standards of Practice Committee with consultation by the members and stakeholders. Consultation has closed and Council has referred feedback received on this practice direction consultation to the Standards of Practice Committee for further review and consideration and asked the  Registrar to provide additional information for the consideration of the Committee.  


 Opioid Replacement Therapy Guidelines for Manitoba Pharmacists *

The Opioid Replacement Therapy Guidelines for Manitoba Pharmacists (ORT Guidelines) replaces the Principles for the Provision of Opioid Dependence Treatment by Manitoba Pharmacists guideline document .

Please note (August 10, 2018):

Health Canada recently published a Summary Safety Review on Methadose and Metadol-D assessing the potential risk of serious harm in children exposed to methadone through breast milk.  Pharmacists dispensing methadone or providing care for patients on methadone are strongly encouraged to read the Summary Safety Review which can be found on the Health Canada website.

It is important that pharmacists continue to work collaboratively with both the methadone prescriber and patient to identify and assess the potential benefits and risks of breastfeeding while on methadone maintenance therapy.

ORT Guidelines is a new title that corresponds with the interprofessional Opioid Replacement Therapy 101 workshop which is required education for at least one pharmacist at each pharmacy that is dispensing methadone or buprenorphine. Other changes include:

  • new buprenorphine-naloxone (Suboxone®) training requirements for pharmacists;
  • new buprenorphine-naloxone exemption process for prescribers; and
  • removal of Suboxone ® (Buprenorphine/Naloxone) – Important Practice Notes for Pharmacists (no longer current).

At least one pharmacist within a pharmacy dispensing methadone and/or buprenorphine must be extensively knowledgeable on ORT. The pharmacist with specialized training at a pharmacy is responsible for training all pharmacists who will be dispensing methadone and/or buprenorphine. Please see the ORT Guidelines for more information on the accepted training programs. It is strongly recommended that all pharmacists dispensing methadone and/or buprenorphine/naloxone also complete the theoretical training, “Opioid Replacement Therapy 101: An introduction to clinical practice”, to gain additional insight on the interprofessional collaborative approach to opioid replacement therapy. All pharmacists providing ORT services must review the Opioid Replacement Therapy Guidelines for Manitoba Pharmacists.

If you are interested in taking an Opioid Replacement Therapy 101 workshop, the University of Manitoba Continuing Professional Development (CPD) Department is now accepting applicants. Please visit the Upcoming Professional Development Opportunities page to see the dates this workshop is available.

Additional recommended readings for pharmacists dispensing opioid replacement therapy include:

For additional resources on dispensing and administering naloxone please review the section below.

*Recent changes to the Narcotic Control Regulations removed the methadone exemption requirement and the ORT Guidelines have been updated to reflect this change. Practitioners of medicine, dentists, veterinarians, and nurse practitioners no longer need to a federal methadone exemption to prescribe methadone; however, prescribers must have approval from their respective provincial regulatory college to prescribe methadone and/or buprenorphine-naloxone for ORT or analgesia. Please review the ORT Guidelines or Health Canada's release for complete details.


Naloxone 

Manitoba, along with the rest of Canada, has seen a rise in the number of opioid overdose deaths in recent years. As a result, some pharmacies in the province have begun selling naloxone kits and providing education to people and organizations in need of this life-saving drug that can temporarily reverse the effects of an overdose.

The College encourages all pharmacies to carry naloxone kits to support the province-wide effort to address the opioid crisis. Pharmacies selling naloxone must comply with the Guidelines for Pharmacists Selling Naloxone as a Schedule II Drug   (Guidelines).

Please review the Guidelines for more information about selling naloxone, including:

  • Training requirements

  • Relevant practice directions

  • Patient counselling

If your pharmacy carries naloxone kits and you would like to be added to the publically available College listing of Pharmacies Carrying Naloxone Kits , please email your pharmacy's name, address, and telephone number to Rachel Carlson, Communications Coordinator, at rcarlson@cphm.ca

For additional information and resources on opioid overdose and naloxone, please see the resources below:

College of Pharmacists of Manitoba Resources*:

Naloxone Listing - College of Pharmacists of Manitoba   

College of Pharmacists of Manitoba Checklist for Naloxone Injection Training

College of Pharmacists of Manitoba Checklist for Naloxone Nasal Spray

Naloxone Brochure for Ampoules (black and white)

Naloxone Brochure for Ampoules (colour)

College of Pharmacists of Manitoba Naloxone FAQ 

University of Waterloo, School of Pharmacy Resources

Naloxone Administration  (by injection) (video) 

Naloxone Administration  (by nasal spray) (video) 

5 Things to Know About Naloxone  (video) 

Giving Naloxone  (video) 

External Resources:

Overdose and Prevention Response Training Manual
  

Street Connections: Overdose

Naloxone Saves Lives, Hello Cool World  (video)

Manitoba Addictions Knowledge Exchange

*The Naloxone educational information included above was developed through a partnership between the College of Pharmacists of BC, the BC Centre of Disease Control and the Province of BC's Ministry of Health.

This work is licensed under a  Creative Commons Attribution-ShareAlike 4.0 International License .

The naloxone educational resources above are available under the Creative Commons Attribution-ShareAlike License to use and remix as needed to help provide patients and pharmacy professionals with important information on the use of this life saving drug. 


  Medical Assistance In Dying (MAID) (formerly physician assisted dying)

Notice to Pharmacy Managers and Pharmacists


Emergency Contraception 

Emergency Contraception Care Guidelines 

Duty of Pharmacists to Report Issues in the Course of Counseling and Providing Emergency Contraception Care for Minors


  Manitoba Prescribing Practices Program (M3P)

Manitoba Prescribing Practices Program (M3P Information Entered into DPIN Practice Direction 

M3P Questions and Answers [updated August, 2016] 


List of Drugs Covered by the Multiple Prescription Program  (Updated October 2018)

Removal of lisdexamfetamine (Vyvanse®), methylphenidate OROS (Concerta®), and methylphenidate MLR (Biphentin®) from the M3P Program (October 24, 2018)

Regulations Governing the Multiple Prescription Program 

Prescriptions from other Provinces 

Newsletter Items Relating to M3P 

M3P DPIN Entry Information 


Emergency Preparedness

Emergency Preparedness Resource Kit for Pharmacists


Field Office Information

Permanent and Temporary Pharmacy Closure [effective July 4, 2014]

Procedures in the Event of a Robbery or Burglary

Prescription Forgeries [from the Summer 2013 Newsletter]


PHIA Pledge of Confidentiality

Distance Care IPS Disclaimer

Manitoba Medications Return Program Website

Manitoba Medication Return Program FAQ [updated November 3, 2014]

Frequently Asked Questions: Patient Record Destruction  


Joint Statements

Healthcare professionals from various disciplines, including pharmacy, are often jointly involved in the care of a common patient even though individual professionals are not in direct contact with one another. Joint statements are developed between healthcare professions to maintain patient safety and ensure collaborative patient care. 

Prescribing Practices: Doctor/Pharmacist Relationships  (updated to reflect the requirement for retention of records for five years)

Electronic Transmission of Prescriptions

Facsimile Transmission of Prescriptions

Facsimile Transmission of Prescriptions Template  (pdf template)


Facsimile Transmission of Prescriptions Template  (word template)


Q and A: Electronic and Facsimile Transmission of Prescriptions  

Rural, Remote and Underserved Populations: Access to Prescribed Medications