The College invests a lot of time engaging with the profession through its consultation processes to ensure practice standards are unambiguous and provide useful direction to physicians in active practice.
Safe prescribing
Safe Prescribing of Opioids and Sedatives, which was recirculated for a final consultation in late April, received extensive feedback from physicians, representatives from patient support groups, key health partners, the Ministry of Health, and members of the public.
Summary of changes made to the updated standard:
- As a result of the introduction of the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, the College has removed the clinical guidelines from the earlier version and it is now a standard only.
- Language has been strengthened to ensure that patients with complex care needs or patients who are on or seeking opioids and sedatives must not be discriminated against, nor abandoned.
- Greater clarity has been provided on the issue of dosage, tapering and discontinuing opioids and sedatives. Minimal standards around pharmacovigilance and stewardship of prescribed opioids and sedatives are set out.
- Stimulant medications have been removed from the standard. It now addresses safe prescribing of opioids and sedatives only.
- Greater clarity has been provided regarding dispensing tablets.
- The standard now clearly acknowledges that different diagnoses (sleep apnea, heart failure, etc.) will result in unique risks for patients.
- The standard continues to promote collaboration between the patient and physician in making decisions when possible, while allowing circumstances where a collaborative decision may not be possible.
- Minor changes have been made to specific words to reflect more current, objective terminology (e.g. changing the word marijuana to cannabis).
- Emphasis has been added that problems from excessive prescribing and the requirement to document discussions about safe storage and disposal apply to both short- and long-term care.
Read Safe Prescribing of Opioids and Sedatives here.
Continuity of care
Three revised standards were recently circulated as a package to the profession and members of the public for consultation under the banner of continuity of care.
Changes made to each standard include:
Care Coverage Outside Regular Office Hours
- The title of the standard was changed (a previous version was titled After-Hours Coverage).
- Content has been reframed so that it is clear that the context of the standard is urgent care.
- A description of “common law duty of care” has been added.
- More clarity has been included on how the standard applies to specialists.
- Utilization of the provincial health advice line (8-1-1) has been added, with clarity that this is not to replace the physician’s primary coverage method.
Read Care Coverage Outside Regular Office Hours here.
Leaving Practice
- An earlier version of this document was a guideline. It has now been elevated to a practice standard.
- The standard now provides increased clarity regarding the context of leaving practice (i.e. circumstances for which this standard is applicable).
- The standard has been reformatted into three distinct sections: notification; medical records; patients requiring ongoing care.
- A reminder has been added that physicians should have a contingency plan in place in the event of sudden death or other circumstances where they would abruptly leave practice.
Read Leaving Practice here.
Ending the Patient-Physician Relationship
- An earlier version of this document was a guideline. It has now been elevated to a practice standard.
- The standard now clearly states when it is/isn’t acceptable to end the patient-physician relationship, with specific, unambiguous examples.
Read Ending the Patient-Physician Relationship here.
I am very grateful to those of you who took the time to participate in our consultation processes. Ensuring that standards are relevant, clear and helpful to you in practice is critical in order to fulfill our shared goal of patient safety and well-being.
Heidi M. Oetter, MD
Registrar and CEO
Comments on this or any other article published in the College Connector can be submitted to the communications and public affairs department at communications@cpsbc.ca.