Statement on Pharmacist Prescribing    

Board Approval September 26,  2007

Background

Several studies including the Romanow Report and the Fujitsu Report have cited the benefits of an expanded role or a more optimal use for the profession of pharmacist.

In recent years, there have been numerous international developments and developments within other Canadian provinces which have enabled pharmacist prescribing.

Numerous studies including many from CIHI have noted that the status quo is not serving us well. Too many Canadians are going to Emergency Rooms as a result of adverse drug events, or inappropriate use of medication.

Pharmacists are the medication experts. Pharmacists have had to complete many years of university study in the area of drug utilization in order to earn their accreditation.

With a university degree specializing in medications and their use, pharmacists have the knowledge and skills to manage medications and optimize drug therapy to improve health outcomes of Canadians. Pharmacists like all health care professionals, act in accordance with the codes of ethics and standards of practice of their profession. These require pharmacists to be responsible, accountable and act in the best interest of the patient.

What is prescribing?

First let’s acknowledge that pharmacists are already prescribing medications today.

Since 2003, New Brunswick pharmacists have been prescribing medications under a Continuing Care Protocol for patients in an emergency basis, who have been unable to contact a physician, and whose medication has expired.

Pharmacists’ prescribing could cover a wide range of activities such as:

o       Prescribing over the counter drugs to treat minor, self diagnosed or self-limiting disease conditions.

o       Prescribing Schedule II drugs to patients with chronic disease such as diabetes, or to patients who are managing pain (codeine). 

o       Monitoring and authorizing the refill of existing prescriptions to ensure appropriate effective continuity of care.

o       Modifying a prescription initiated by another prescriber to alter dosage, formulation, regimen or duration of the prescribed drug.

o       Modifying a prescription initiated by another prescriber to provide a therapeutic alternative to improve drug therapy or provide continuity of therapy.

o       Prescribing medications for patients through delegated authority and collaborative practice agreements, or by using protocols established by institutions or jurisdictions.

o       Initiating or discontinuing a medication where a pharmacist, in collaboration with the physician and/or health care professionals, provides comprehensive drug therapy management.

Pharmacists are qualified to do these things today.

Pharmacists in institutional settings have long had a prescriber role in Canada. In fact many studies show that when hospital pharmacists are engaged in collaborative prescriptive roles, patient outcomes improve and adverse events diminish significantly.

Going forward, community pharmacists will need to take on a greater role in the delivery of health care. Medication usage is becoming the primary treatment option, especially with an aging demographic. Pharmacists as the medication experts, will be more involved in the decision making process.

Communication is essential to the success of collaborative health care teams. When physicians prescribe medication today, they assume that patients are compliant but have no way of validating this. Going forward, when pharmacists make changes to drug regimens, other people should know. Pharmacists take this responsibility seriously and are committed to maintaining records of their interactions, and to communicating these changes to those appropriate health professionals who are willing and able to receive the information.

The NBPA is committed to obtaining recognition and authority for pharmacists to practice at a level that makes best use of their skills and knowledge in order to improve the quality of health care in New Brunswick. This means enabling pharmacists to play a larger role in ensuring the quality of medication use and optimizing drug therapy to help patients achieve health outcomes that will improve their quality of life.

NBPA Position on Pharmacist Prescribing

1)      Decisions related to medication management, including prescribing, should be collaborative, patient centred and with a focus on addressing the health care needs of the patient.

2)      Collaboration with other health providers is an important and integral part of pharmacist prescribing and medication management. This includes close contact and on-going two-way communication and documentation regarding drug therapy decisions. Prescribing by pharmacists should complement care provided by other health professionals.

3)      Pharmacists are medication experts. They play a significant role in the prescribing and monitoring of medication to ensure safe and optimal use. Pharmacists will take on increased responsibility for results oriented patient centred care.

4)      Pharmacists, by having the ability to initiate, continue and modify prescriptions, can improve the safety and effectiveness of drug therapy. As the most accessible health professional, pharmacists will be able to improve access in a timely manner to appropriate medication therapy for patients.

5)      A patient pharmacist relationship is essential to allow a pharmacist to prescribe optimally and carry out ‘follow up’ activities.

6)      Pharmacists who prescribe should do so within their area of competence, scope of practice and with sufficient critical knowledge of the patient.

7)      To support optimal medication management, pharmacists require access to the patient’s relevant health information, which may include diagnosis, therapeutic intent and laboratory results. Pharmacists should also have the authority to order laboratory tests for the purposes of monitoring drug therapy outcomes.

8)      Actions related to prescribing medication management need to be communicated verbally, in writing or through electronic media when appropriate, to other health professionals in the circle of care. All actions should be supported by documentation. A shared electronic health record will facilitate this communication.

9)      Legislation and accompanying regulations should enable, rather than oblige pharmacists to prescribe.

10)  Governments must ensure that legislation that enables pharmacists to prescribe is consistent with other policies in health care. This includes recognition of the pharmacist as prescriber for the purpose of reimbursement through public and private insurance plans.

Board Approval September 26, 2007

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              For more information on this position, contact Paul Blanchard Executive Director (506) 459-6008

             or nbpa@nbnet.nb.ca.

             The New Brunswick Pharmacists’ Association is the voice of pharmacists in the province, committed

             to providing leadership for the profession and improving the health of New Brunswickers.