Ordering of Tuberculosis Medication

Policy

Category: Control of Infectious Diseases
Subject: Ordering of Tuberculosis Medication
Division: Health Protection
Policy Number: CA.82.01.200
Effective Date: August 8, 2016

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) that a system of ordering, storing, and disposing of tuberculosis medication be maintained in such a way as to ensure available supplies, the proper processing for first and second line medications used to treat active and latent tuberculosis disease, and drug storage safety.

SCOPE

This policy applies to all Control of Infectious Diseases (CID) Public Health Nurses who are involved in ordering, storing, dispensing, and disposing of TB medications. It also applies to the Vaccine Coordinator who is responsible for ordering the medications from Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS) and the Finance Accounts Payable department responsible for directing money reimbursed from the Ministry of Health and Long-Term Care (MOHLTC) for second line medications to the TB budget line.

DEFINITIONS

First line medications – Medications supplied to WDGPH free of charge from Ontario Government and Pharmaceutical and Medical Supply Service (OGPMSS) for the treatment of active or latent TB.

Second line medications: Medications that are not supplied by OGPMSS but are filled through an independent pharmacy and reimbursed by MOHLTC. These medications are ordered for the treatment of active TB disease that is resistant to a first line drug choice.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.200 Ordering of Tuberculosis Medication
Health Protection and Promotion Act, 1990
Ontario Public Health Standards, 2008
Infectious Diseases Protocol (as current)
Canadian Tuberculosis Standards (as current, online edition)
Canadian Immunization Guide (as current, online edition)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection


Procedure

Category: Control of Infectious Diseases
Subject: Ordering of Tuberculosis Medication
Division: Health Protection
Procedure Number: CA.82.02.200
Effective Date: August 8, 2016

PROCEDURE

1. All tuberculosis (TB) drugs will be stored in a locked cabinet in each office.

2. The Public Health Nurse (PHN) will choose an appropriate range of maximum and minimum number of packages of medication to keep in stock/office. When the number of packages of any one medication falls below the minimum number, a Guelph PHN will give an order to the Vaccine Coordinator in the Guelph office to bring the stock of all medications up to the maximum number of packages.

The Guelph office will keep on the following minimum amounts of stock on hand to supply all three WDGPH offices as needed:

  • 6 bottles Pyridoxine 25 mg;
  • 1 bottle Isoniazid 100 mg;
  • 6 bottles Isoniazid 300 mg;
  • 1 bottle Isoniazid liquid;
  • 1 bottle Rifampin 150 mg;
  • 4 bottles Rifampin 300 mg;
  • 1 bottle Ethambutol 100 mg;
  • 2 bottles Ethambutol 400 mg; and
  • 2 bottles Pyrazinamide 500 mg.

3. To order first line TB drugs, the Vaccine Coordinator will:

  • Place the order via Panorama;
  • When order is delivered, confirm that the order is complete and send medication to the requesting PHN; and
  • Upon receipt of medication, the PHN will also confirm the order is complete and place in the designated locked medication cabinet.

4. If second line drugs are required, Wellington-Dufferin-Guelph Public Health (WDGPH) has an account with Prime Care Pharmacy Arboretum. The PHN will call the pharmacy to ensure medication is available and to arrange for the pharmacy to dispense medication. The PHN will fax the original prescription to the pharmacy and will determine how the patient will obtain their medication.

The pharmacy will submit bills to WDGPH marked to the attention of the TB Manager, and the PHN will fax the invoice with client iPHIS ID number to Public Health Ontario (PHO) (Fax 647-260-7600), requesting payment to WDGPH. The PHN will also complete a CA.30.01.210 Cheque Requisition form. The PHN will attach a copy of the invoice and send it to Finance Accounts Payable for payment to the pharmacy, and indicate the payment will be forthcoming from the Ministry of Health and Long-Term Care (MOHLTC).

5. For second line drugs which are not available through Prime Care Pharmacy Arboretum, the PHN will obtain them through the Special Access Program (SAP).  The PHN will obtain the form by calling 613-941-2108.

6. The PHN will return expired or partially used bottles of TB medications to the Vaccine Coordinator in the Guelph office to be returned to Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS).

RESPONSIBILITIES

Program Manager will:
  • Ensure employees understand and adhere to this policy and procedure;
  • Monitor policy compliance on a regular basis; and
  • Ensure payment of pharmacies for medications dispensed as second line treatments for active TB
CID Team Member will:
  • Review and adhere to this policy and procedure;
  • Be responsible for the procurement, management, security, dispensing, and return of medications used in the treatment of active and latent TB disease;
  • Ensure medications are dispensed according to CA.82.02.202 Dispensing of Tuberculosis Medication and at no cost to the client with active or latent TB;
  • Monitor client for side effects as well as compliance to prevent the further spread of disease and development of drug resistance; and
  • Ensure paperwork required for second line drug reimbursement is submitted to the MOHLTC and copies sent to business office as notification.
Vaccine Coordinator will:
  • Be responsible for tracking inventory and ordering TB medications from the OGPMSS when requested by CID program.
Finance Department will:
  • Be responsible for ensuring reimbursed payments received from the MOHLTC for second line medication are deposited into the TB program budget (037-204).

DEFINITIONS

First line medications – Medications supplied to WDGPH free of charge from OGPMSS for the treatment of active or latent TB.

Second line medications – Medications that are not supplied by OGPMSS but are filled through an independent pharmacy, paid by WDGPH, and reimbursed by MOHLTC. These medications are ordered for the treatment of active TB disease that is resistant to a first line drug choice.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.200 Ordering of Tuberculosis Medication

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection