Pharmacist advanced authorities

Pharmacist’s permissions or authorities, that is the professional’s legislated abilities vary from province to province.   Since 2010 in Alberta, Pharmacists have been legislated the authority to use their knowledge of drug therapy to become intimately involved in the healthcare of Albertans.  These authorities include the adaptation of prescriptions; extending prescriptions, emergency prescribing as well as initial prescribing after a certification process through the Alberta College of Pharmacists (ACP).   Our skill-sets have also been expanded with the ability to give injections, which means a pharmacist can administer drugs by injection whether it be intradermal, subcutaneous or intramuscular.   This also means the pharmacist can administer a long list of vaccinations from season flu shots to travel vaccinations such as Hepatitis A and B,  Tetanus, and many others.

The authority to provide these services come with the Pharmacists’ Alberta License when registering with the provincial licensing body.   The authorization to provide injections and to prescribe new therapy requires additional certification done after some continuing education and application to the College of Pharmacists for the prescribing authority.   There is no doubt that as a pharmacist, to gain the credentialing required to prescribe initial drug therapy requires some effort.  This includes some self study and an application that is very thorough and includes the presentation of patient cases as well as a defense of the application for prescribing authority.

To better explain pharmacist prescribing the following is a Q&A prepared by the Alberta College of Pharmacists as an explanation to the lay person.

What is pharmacist prescribing?

Prescribing by pharmacists differs from what is currently understood as prescribing by other health professions.

Pharmacist prescribing describes a wide range of activities. It includes:

  • prescribing drugs to treat minor, self-diagnosed or self-limiting disease conditions;
  • adjusting dosages and dosage forms;
  • monitoring and refilling prescriptions to ensure appropriate and effective care;
  • providing emergency supplies of previously prescribed medication;
  • providing comprehensive drug therapy management where the pharmacist, working with other health professionals, takes full responsibility for establishing and maintaining a patient’s chronic drug therapy; and
  • substituting another drug that is expected to have a similar therapeutic effect.

Pharmacists will assess and triage each patient as required. If the pharmacist has the competencies and appropriate information to initiate drug therapy for minor, self-limiting or self-diagnosed conditions, he or she may initiate treatment. Alternatively, the pharmacist may refer the patient to another part of the health system.

What kinds of prescribing can pharmacists do?

Prescribing activities can be grouped into three general categories:

  • initial access prescribing—prescribing when a patient chooses a pharmacist for advice about and treatment of minor, self-limiting or self-diagnosed conditions, about wellness programs, or in urgent or emergency situations
  • prescription modification—modifying a prescription written by another prescriber to alter dosage, formulation, regimen or duration of the prescribed drug, or provide a therapeutic alternative to improve drug therapy or provide continuity of therapy
  • comprehensive drug therapy management—initiating, maintaining, modifying or changing drug therapy based on referral from another health provider who has made the diagnosis or upon the request of the patient upon receiving a diagnosis. Comprehensive drug therapy management will occur only in a collaborative health team environment wherein sufficient information is available to the pharmacist for him or her to make a recommendation for drug therapy.

What issues will affect how or if a pharmacist prescribes?

  • Pharmacists prescribing is dependent on good communication between the pharmacist, the patient, and the other health professionals on the patient’s health care team. Patient health and safety always come first.
  • Only pharmacists on the clinical register (a new registration category under the Health Professions Act) are eligible to prescribe.
  • All pharmacists on the clinical register are required to participate in an orientation program designed by the Alberta College of Pharmacists (ACP) before exercising prescribing privileges.
  • Each pharmacist must limit their prescribing to their areas of professional competence.
  • Pharmacists must meet additional specific criteria set by the college to be authorized to initiate new drug therapy and/or to manage ongoing therapy.

Pharmacists will only prescribe if they have sufficient information to make decisions on safe and effective drug therapy.

For additional information about the pharmacy profession and what pharmacists are working to deliver as part of a community based healthcare team, visit the College website.

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