Transforming and Supporting Patient Care - Health Professions ...

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168Chapter 7 – Professions of Chiropody and Podiatryabsorption, distribution, biotransformation, excretion and relevance toclinical situations; principles of quantification of drug actions, includingdose-response studies, drug efficacy, potency and intrinsic activity;pharmacodynamic principles, including action of drugs at the molecular,cellular, organ and system levels and relevance to clinical situations; andsystems pharmacology. Other course elements deal specifically withtreatments of various foot conditions and anaesthesia and injectables.Design of a Bridging Program with The Michener InstituteThe CCO stated in its submission to HPRAC that until September 26, 2008 itdid not have an authorized list for drugs or substances and, therefore, didnot have any requirements in place with respect to continuing educationand training to ensure competency in prescribing or administering drugs,whether by injection or inhalation. In anticipation of proclamation of theregulation, the CCO initiated discussions with The Michener Institute todevelop a relevant “bridging course” for those who do not have therequisite competencies but would like to prescribe or administer drugs intheir practices as proposed in their submission. The program will belaunched as early as possible in 2009. 14The part-time bridging program includes three modules: pain managementand analgaesic agents, and antibiotics. It will be an independent studyprogram of approximately 39 to 65 hours, and will include both didactic(available online) and clinical components and an examination uponcompletion. 15The CCO also stated that if the expanded scope of practice and authorizedacts that will be proposed through the chiropody/podiatry review areimplemented, there will be wholesale revisions to the educationalprograms, including moving to a university-level degree in podiatry, pluscontinuing education and bridging programs for those who wish to practiseto the full scope but require additional competencies to do so. The bridgingcourses relating to prescribing or administering drugs would beincorporated in that wider reconfiguration of the educational component.What the Profession Has ProposedThe CCO, the OPMA and the OSC made a joint submission to HPRACrequesting additional authorized acts and changes to regulations under theChiropody Act, 1991 to enable them to:1. Administer substances by inhalation, mainly to handleemergency situations and to manage pain;2. Dispense drugs for their patients to use in-office and athome;14CCO, OPMA and OSC. Joint submission to HPRAC: Review of Non-Physician Prescribing: 22. Jointsubmission to HPRAC: Chiropody/Podiatry. November 14, 2008: 27.15HPRAC discussion with Sydney Redpath, Chair, Primary and Critical Care, The Michener Institutefor Applied Health Sciences. January 2009.HPRAC Critical Links January 2009
169Chapter 7 – Professions of Chiropody and Podiatry3. Include new drugs in current drug regulation; and4. Order laboratory tests.Preparing for New AuthoritiesThe CCO and the professions recognize the risk of harm associated withadministering substances by inhalation. That risk of harm would bemitigated by authorizing only those registrants who demonstrate therequisite competencies to perform that component of the controlled actsafely and effectively. A standard of practice would specify clearly thecircumstances and conditions under which inhalation could be used andhow the substances would be maintained and secured, backed up by theCCO’s quality assurance program.The risk of harm associated with inhalation, in the view of the CCO and theprofessions, is more than offset by the risk of harm in not being able to useinhalants when responding to emergencies that may occur when performingsurgical procedures in non-institutional settings and by the enhanced abilityto manage patient pain and stress. A CCO standard of practice and qualityassurance program will ensure that registrants are able to perform suchprocedures safely and effectively and that the substances involved aresafely and securely stored and maintained. 16The profession received approval of its drug regulation in September 2008,and as a result the CCO is currently developing standards of practice,guidelines, continuing education and quality assurance requirements forthe prescribing and administration of drugs, and expects to have themcompleted and in force by late 2009. 17In its written submission to HPRAC, the CCO explained that in order toensure that each chiropodist is competent to prescribe the drugs listed inthe new regulation safely and effectively, it is presently undertaking aregistrant-by-registrant investigation of competencies. The CCO’sinvestigation relies heavily on the pharmacotherapy education received aspart of each registrant’s diploma program and any subsequent post-graduateor continuing education programs successfully completed thereafter. Terms,conditions and limitations applying to prescribing will be attached to eachregistration, unless and until that registrant demonstrates full competenciesto the CCO’s satisfaction. The same process will be applied to anyexpanded authorities awarded to the profession. 18Until the assessment is completed, the CCO is uncertain of the number ofchiropody-trained members who may need a bridging program to becomeready for the authority to prescribe or administer drugs.The CCO stated in its written submission that those relatively recentgraduates of DPM programs who are practising in Ontario as chiropodists,16CCO, OPMA and OSC. Joint submission to HPRAC: Review of Non-Physician Prescribing: 21.17Ibid 22, 26-27.18Ibid. 23HPRAC Critical Links January 2009
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20Chapter 2 - Excellence in Health
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398Chapter 18 - Summary of Proposal
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