College of Dietitians of British ColumbiaCollege of Dietitians of British Columbia

Update:

Inter-Professional Agreement -CDBC and College of Pharmacists

of BCOctober 23, 2009

Background• what RDs said…• what is the issue?• Dietitians Regulation• pharmacists’ legislation• the problem and a possible solution

Current status of IPA• signed Agreement• Professional Practice Policy• outcomes

Next steps?

OverviewOverview

Conversations on Health (2007)• changes to health care system desired by the public… • the need for collaborative practice…

Provincial Government Throne Speech (2008)• …changes needed for more efficient and effective health care delivery…

Registrant liaison sessions (2008/09)• enhance practice/expand scope • identify barriers to practicing full scope

BackgroundBackground

Masset

Terrace

Smithers

Fort St. John

Revelstoke

FernieCranton

Trail

Chase/ Salmon Arm

Oliver

Penticton

Merritt

Port Hardy

Campbell River

Port Alberni

Burnaby/ New West/ Surrey

Chilliwack

White RockLangley/ Ridge Meadows Duncan

Nanaimo

Courtenay/Comox

Powell River

Sechelt

Aging populationAging population

Chronic diseaseChronic disease

Inter-professional practiceInter-professional practice

• Perceived barriers – public domain practices, misperceptions about role/scope of RD practice

• Actual practice barriers – practice is within the RD role/scope of practice but a barrier exists with another health care professional’s legislation

What RDs said…What RDs said…

What is the issue?What is the issue?

Pharmacists and parenteral nutrition ingredients

Dietitians RegulationDietitians Regulation

Restricted Activities:

…a registrant who meets additional qualifications may…

(b) design therapeutic diets if nutrition is administered through parenteral means

(Note: CDBC interpretation: “design” includes “re-design” which is the same as “adjust”)

Pharmacists’ legislationPharmacists’ legislation

• Pharmacists may only dispense drugs on order from “authorized practitioners” – physicians, nurse practitioners, dentists, mid-wives, veterinarians

Pharmacists’ legislationPharmacists’ legislation

Drug Schedules Act (2008)

• Schedule I - Prescription• Schedule IA - Controlled Prescription Program• Schedule II - Professional Service Area (eg. insulin,

oral hypoglycemics)• Schedule III - Professional Products Area• Schedule IV - Prescription by Pharmacist• Non-scheduled (eg. vitamins, minerals to a specified

dose)

www.bcpharmacists.org

The problemThe problem

• In a parenteral formula: – vitamins/minerals that are normally unscheduled are

considered Schedule I drugs– insulin and oral hypoglycemics that are normally Schedule

II drugs are considered Schedule I drugs

• Schedule I drugs require a prescription from an “authorized practitioner”

• Dietitians are not “authorized practitioners”

• Therefore pharmacists cannot accept an RD’s “order” or request to adjust (re-design) a therapeutic diet

A possible solution… A possible solution…

Develop an Inter-professional Agreement (IPA) between the CDBC and College of Pharmacists of BC (CPBC), with…

• limits and conditions that allow:– Pharmacists: to accept dietitians’ authority to relay the

physician’s original order, – Physicians: to rely on the dietitian to send in the therapeutic

diet ordered and monitor the patient’s response– Dietitians: to relay the physician’s order to the pharmacist

without going back to the physician or requesting the assistance of another health care professional

Current status of the IPACurrent status of the IPA

Signed June 17, 2009 by CDBC & CPBC Registrars:

The CDBC and CPBC agree that, 1) on the direct request of a Registered Dietitian, Pharmacists

may dispense:• oral vitamins and minerals (un-scheduled), or• insulin (Schedule 2)

AND2) when a practitioner orders a RD to assess and design a

nutritional or therapeutic care plan, the RD has the authority to request the Pharmacist to accept and dispense macronutrients, micronutrients, insulin and oral hypoglycemic agents when…

Current status of the IPACurrent status of the IPA

• the RD’s authority is consistent with practice setting policies/protocols,

• the Pharmacist meets CPBC’s Professional Practice Policy, and

• the RD:

• has received an order from a practitioner for a nutritional or therapeutic care plan,

• complies with the CDBC’s Professional Practice Policy, and

• meets CDBC’s standards for professional judgment as outlined in the Code of Ethics and Standards for Practice.

Current status of IPACurrent status of IPA

Examples of orders from practitioners:

• Parenteral feeding: TPN as per RD

• Diabetic client: Adjust insulin/ OH as per RD

• Iron deficiency: assess for supplements as per RD

Current status of IPACurrent status of IPA

To note:

Practices within RD role/scope of practice may always be defined or restricted by facility policies/protocols…

… including a facility not allowing physicians, pharmacists and RDs to participate in this Agreement

CDBC’s Professional Practice PolicyCDBC’s Professional Practice Policy

Appropriate Information

Notification

Documentation

Limits and Conditions

Informed Consent

Consultation

Competence

OutcomesOutcomes

Client outcomes:Client outcomes:Increase clients’ timely access to therapeutic

nutritional ingredients that optimize their ability to attain health

Practice outcome:Practice outcome: Removal of role/scope barrier for RDs

Government outcome:Government outcome:From the 2008 Throne Speech… there’s a need “for

more efficient and effective health care delivery”

Next steps?Next steps?

• draft Inter-professional Agreement between the CDBC and CPBC

• CDBC committee review and feedback • CDBC Board approval in principle • CPBC official consultations • signatures of both College Registrars • acceptance from the government (or an amendment to the

pharmacists’ legislation)• common education materials developed by CDBC and CPBC

and circulate to registrants of both Colleges as an approved change in practice (with limits and conditions)

• Liaison sessions to explain the Agreement and practice implications

Questions?Questions?

Fern Hubbard, RegistrarCollege of Dietitians of BCPhone: 604.736.2016Toll free in BC: 1.877.736.2016info@collegeofdietitiansbc.org