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What is Pharmacist
Prescribing?
Pharmacist prescribing involves…
• Going through a training and certification process to be able to
prescribe
• Collaborat...
Why is Pharmacist Prescribing
Important?
Risks to patient safety as a result of
drug-related problems or poor patient
outcomes are a growing concern
• An aging pop...
Medication experts play an important
role in protecting patients and
improving health outcomes
• Pharmacists can navigate ...
Examples of pharmacist prescribing
preventing harm and improving
patient outcomes includes
• Reduced risk factors for chro...
Expanding a Pharmacist’s Scope of
Practice to Protect Patient Safety
• We do not advocate for changes to scope of practice...
Pharmacist Prescribing is Needed in BC to…
• Improve patient outcomes
• Prevent drug-related problems
• Reduce unnecessary...
Framework for Pharmacist
Prescribing in BC
Developing the Framework for Pharmacist Prescribing
Framework for Pharmacist Prescribing Includes…
• Benefit to patient care
• Requirements for collaboration with other healt...
Collaborative Practice
Relationships
Collaborative Practice Relationships
Developing a relationship with a regulated health professional who
has the authority ...
Collaborative Practice Relationships
Diagnosis is still provided by physicians and nurse practitioners
(or other regulated...
Collaborative Practice Relationships
• Some environments may be more easily be able support the
requirements for collabora...
Collaboration and Team-based Care is Growing
• Collaboration and team-based care is growing between health
professionals n...
Access to
Health
Information
Access to Relevant Health Information
Information from the patient
• Current medication list including over-the-counter dr...
Access to Relevant Health Information
Information from PharmaNet
• Up-to-date list and date of filled medications
• Previo...
Access to Relevant Health Information
Information from Patient Medical Records
• Diagnoses and past medical history
• List...
Access to Relevant Health Information
Information from others involved in the patient’s care
• Case notes not otherwise in...
Care Plans,
Follow-ups and
Monitoring
Developing Care Plans
• Identify health goals with patient and others on the care team
• Develop evidence-based care plans...
Patient Follow-up and Monitoring
• Develop a monitoring and follow-up plan with the patient and
others on care team
• Moni...
Ongoing Follow-up and Monitoring
Pharmacist
Prescriber
Eligibility and
Certification
Pharmacist Educational Requirements
• Must have completed an undergraduate degree in pharmacy
• Bachelor of Science in Pha...
Pharmacists Already Being Trained to Prescribe
• Entry-to-practice-PharmD degrees being offered at many
Canadian Universit...
Eligibility Criteria
Pharmacists must meet the following criteria to be eligible to
become a Certified Pharmacist Prescrib...
Evidence Based Competency Evaluation
• Objective competency assessment to be able to prescribe in
collaborative practice
•...
Educational Program
Preparatory Courses for Certified Pharmacist Prescribers:
• Collaboration (including inter/intra profe...
Educational Program
• Prescribing responsibilities
(including standards, limits
and conditions)
• Patient informed consent...
Separating pharmacist prescribing
from dispensing and business interests
• A Certified Pharmacist Prescriber that prescrib...
Patient
Engagement
Informed Consent
• Pharmacists must have the patient or patient’s representative
informed consent before undertaking presc...
Patient Education and Resources
• Patients to be able to understand and know what to expect from
collaborative practice pr...
Patient Education and Resources
• How a Pharmacist Prescriber
can help provide care
• How to identify a Certified
Pharmaci...
Pharmacist
prescribing
in the community
A 40-year-old male visits a pharmacy to pick up his refills for anti-
hypertensives.
He shares with his pharmacist that he...
Collaborative Care Plan
• Establish collaborative relationship with patient’s GP
• Inform GP about patient unable to see G...
Benefit of Patient Receiving Additional Care from a Pharmacist
Prescriber
• Review of clinical effectiveness of patient’s ...
68 Tsuyuki R, Houle S, Charrois T, et al. A randomized trial of the effect of pharmacist prescribing on improving blood pr...
70 Rosenthal M, Tsuyuki R. A community-based approach to dyslipidemia management: pharmacist prescribing to achieve choles...
82 Al Hamarneh YN, Charrois T, Lewanczuk R, et al. Pharmacist intervention for glycaemic control in the community (the RxI...
Pharmacist
prescribing during a
hospital discharge
A 72-year-old male was recently discharged to a shelter as he had
no-fixed-address.
He was admitted to hospital 3 weeks ag...
Collaborative Care Plan
• Consult with other prescriber involved in patients care at team-based
primary care clinic
• Disc...
Benefit of Patient Receiving Additional Care from a Pharmacist
Prescriber
• Prevention of serious adverse effects /hospita...
72 Medication Reconciliation in Canada: Raising the Bar Progress to date and the course ahead. https://accreditation.ca/si...
What’s Next?
bcpharmacists.org/prescribing
Share your thoughts with us on
pharmacist prescribing
Survey open until October 8, 2017
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Framework for Pharmacist Prescribing in BC

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The framework for pharmacist prescribing in BC is focused on preventing patient harm by reducing preventable drug-related problems and providing safer transitions in care through increased involvement of pharmacists, as medication experts in the delivery of patient-centred collaborative care. Improving medication management and reducing preventable drug-related hospitalizations protects public safety and will improve patient outcomes.

Reduced risk factors for chronic disease, improved blood glucose, improved blood pressure, improved lipid levels, and reduced risk for major cardiovascular events are all examples of pharmacist prescribing in collaborative relationships preventing harm and improving patient outcomes in recent studies.

Earlier input from patients, pharmacists and other prescribers has been used to develop this new framework for pharmacist prescribing within collaborative practice.

Pharmacist prescribing is proposed to take place through interdisciplinary team-based care where physicians and nurse practitioners would continue to be responsible for the diagnosis, and access to health records and diagnostics, including lab tests, would be facilitated. Certified Pharmacist Prescribers would also be restricted from dispensing medications they prescribed for a patient. The framework also focuses closely on the benefit to patient care and identifies specific opportunities to prevent patient harm and improve patient outcomes.

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Framework for Pharmacist Prescribing in BC

  1. 1. What is Pharmacist Prescribing?
  2. 2. Pharmacist prescribing involves… • Going through a training and certification process to be able to prescribe • Collaborating with other health professionals (such as your GP) to work together on providing care • Working closely with patients to help them meet their health goals • Assessing the effectiveness medications and adjusting them as needed • Follow-up and monitoring plans with the patient • Ongoing communication back to a primary care provider (and others)
  3. 3. Why is Pharmacist Prescribing Important?
  4. 4. Risks to patient safety as a result of drug-related problems or poor patient outcomes are a growing concern • An aging population • Multi-medication use • Transfers in care • Chronic disease management • Timely access to care • Increasing complexity in patient care
  5. 5. Medication experts play an important role in protecting patients and improving health outcomes • Pharmacists can navigate the increasing complex care involved in providing patients with the care they need • Pharmacist-led drug therapy management improves clinical outcomes for patients
  6. 6. Examples of pharmacist prescribing preventing harm and improving patient outcomes includes • Reduced risk factors for chronic disease • Improved blood glucose • Improved blood pressure • Improved lipid levels (cholesterol) • Reduced risk for major cardiovascular events • Achieving comparable health outcomes to physicians when they managed a range of conditions with the authority to prescribe
  7. 7. Expanding a Pharmacist’s Scope of Practice to Protect Patient Safety • We do not advocate for changes to scope of practice for the advancement of the pharmacy profession • We do consider changes to pharmacy practice when they are in the best interests of patients by increasing public safety and improving patient outcomes • We do need to help pharmacists better care for their patients and protect them from preventable drug related problems • Previous expansion of scope for drug administration helped with prevention of disease, disorders or conditions, and treatment of anaphylaxis – now widely used for flu shots
  8. 8. Pharmacist Prescribing is Needed in BC to… • Improve patient outcomes • Prevent drug-related problems • Reduce unnecessary emergency room visits and hospitalizations, • Improve timely access to drug therapy • Improve continuity of care
  9. 9. Framework for Pharmacist Prescribing in BC
  10. 10. Developing the Framework for Pharmacist Prescribing
  11. 11. Framework for Pharmacist Prescribing Includes… • Benefit to patient care • Requirements for collaboration with other health professionals • Education, training and evidence based qualification process • Information access requirements • Protection from conflict of interest • Standards limits and conditions designed to protect patient safety • Patient education plan
  12. 12. Collaborative Practice Relationships
  13. 13. Collaborative Practice Relationships Developing a relationship with a regulated health professional who has the authority to prescribe to: • Facilitate communication • Determine mutual goals of therapy that are acceptable to the patient • Share relevant health information • Establish the expectations of each regulated health professional when working with a mutual patient
  14. 14. Collaborative Practice Relationships Diagnosis is still provided by physicians and nurse practitioners (or other regulated health professionals with prescribing authority).
  15. 15. Collaborative Practice Relationships • Some environments may be more easily be able support the requirements for collaborative relationships: • Hospitals • Urgent care centers • Collaborative relationships can take place in any environment where pharmacists can communicate and securely share information with others on the patient’s care team • Community pharmacies • Other clinics
  16. 16. Collaboration and Team-based Care is Growing • Collaboration and team-based care is growing between health professionals nationally and internationally • Research shows a team-based approach can improve efficiency and effectiveness of patient care • Jurisdictions, including BC, have taken measures to support and increase interprofessional collaboration • Currently, pharmacists in BC participate in interprofressional collaboration through working on care teams and recommending drug therapy plans to other prescribers involved in the patient’s care
  17. 17. Access to Health Information
  18. 18. Access to Relevant Health Information Information from the patient • Current medication list including over-the-counter drugs and natural remedies (herbal and vitamins) • Medications taken recently with long half-lives (amiodarone) • Previous reactions to medications including hypersensitivity reactions (anaphylaxis) and adverse drug reactions (such as nausea) • Medication adherence
  19. 19. Access to Relevant Health Information Information from PharmaNet • Up-to-date list and date of filled medications • Previous adverse drug reactions when recorded
  20. 20. Access to Relevant Health Information Information from Patient Medical Records • Diagnoses and past medical history • List of medications prescribed for the patient (not necessarily filled) • Trials of previous therapies • Previous adverse drug reactions • Diagnostics including laboratory tests
  21. 21. Access to Relevant Health Information Information from others involved in the patient’s care • Case notes not otherwise included in the medical record • Goals of drug therapy and history of effectiveness in meeting patient’s goals • Any other relevant insights into a patient’s ongoing care and condition(s)
  22. 22. Care Plans, Follow-ups and Monitoring
  23. 23. Developing Care Plans • Identify health goals with patient and others on the care team • Develop evidence-based care plans help patients meet health goals • Ongoing collaboration with the patient, caregiver and/or family, and primary care provider (and others on care team) • Make appropriate prescribing decisions to implement/adjust drug therapy based on care plan • Establish follow-up and monitoring plan
  24. 24. Patient Follow-up and Monitoring • Develop a monitoring and follow-up plan with the patient and others on care team • Monitor the effectiveness of the drug therapy • Assessments and diagnostics as needed • May be completed through collaboration with others on care team • Adjustments to drug therapy based on results of monitoring • Ongoing communication with the patient, caregiver and/or family, and primary care provider (and others on care team)
  25. 25. Ongoing Follow-up and Monitoring
  26. 26. Pharmacist Prescriber Eligibility and Certification
  27. 27. Pharmacist Educational Requirements • Must have completed an undergraduate degree in pharmacy • Bachelor of Science in Pharmacy BSC (Pharm) • Doctor of Pharmacy Degree (PharmD) • Jurisprudence Examination • Pharmacy Examining Board of Canada Exams
  28. 28. Pharmacists Already Being Trained to Prescribe • Entry-to-practice-PharmD degrees being offered at many Canadian Universities (including UBC) include additional focus on: • prescribing drug therapy • monitoring of drug therapy effectiveness • interprofessional team-based primary care • Pharmacy residencies and other PharmD programs (UBC Graduate PharmD degree /Flex PharmD degree) • provide already practicing pharmacists with knowledge skills and abilities to prescribe
  29. 29. Eligibility Criteria Pharmacists must meet the following criteria to be eligible to become a Certified Pharmacist Prescriber: • Have at least one year of full-time experience in direct patient care. • Have strong collaborative relationships with other regulated health professionals. • Have and maintain the necessary knowledge, skills, abilities and clinical judgment to enhance patient care. • Have the required supports in the practice environment to enable safe and effective management of drug therapy.
  30. 30. Evidence Based Competency Evaluation • Objective competency assessment to be able to prescribe in collaborative practice • Provide information about experience, education, and training • Show how their pharmacy practice supports collaborative practice, or how they will contribute to shaping their practice environment into one that supports collaborative relationships • Submit 3 real patient cases to demonstrate they clearly understand how to provide patient car through pharmacist prescribing in collaborative practice relationships
  31. 31. Educational Program Preparatory Courses for Certified Pharmacist Prescribers: • Collaboration (including inter/intra professional collaboration, and collaborative practice) • Patient Interviewing and assessment (including physical assessment) • Diagnostic interpretations (including laboratory results) • Evidence-based clinical decision making • Documentation • Patient Care skills
  32. 32. Educational Program • Prescribing responsibilities (including standards, limits and conditions) • Patient informed consent • Collaborative practice relationships • Sharing and accessing relevant health information • Medication history and patient assessment • Medication management role in pharmacists prescribing • Documentation and communication • Patient follow-up and progress reporting Responsibilities of Pharmacist Prescribing Course Program:
  33. 33. Separating pharmacist prescribing from dispensing and business interests • A Certified Pharmacist Prescriber that prescribes a medication for a patient must not dispense that medication. • Ensures a separate pharmacist reviews the patient’s profile and completes a clinical assessment of the prescription. • This clinical assessment by a pharmacist is a part of the College’s requirements for dispensing drugs
  34. 34. Patient Engagement
  35. 35. Informed Consent • Pharmacists must have the patient or patient’s representative informed consent before undertaking prescribing • Process for informed consent may vary depending on where the prescribing takes place. • may be part of the admissions process in Hospital or Residential Care, • may directly receive informed consent within acommunity pharmacy
  36. 36. Patient Education and Resources • Patients to be able to understand and know what to expect from collaborative practice prescribing. • A patient education plan and a communications strategy will be developed to build awareness and understanding of pharmacist prescribing in BC
  37. 37. Patient Education and Resources • How a Pharmacist Prescriber can help provide care • How to identify a Certified Pharmacists Prescriber • Patient informed consent • Collaborative practice • Sharing health information • Medication history and patient assessment • Ongoing medication management • Documentation and communication • Patient follow-up and progress reporting Patient education plan will focus on topics such as:
  38. 38. Pharmacist prescribing in the community
  39. 39. A 40-year-old male visits a pharmacy to pick up his refills for anti- hypertensives. He shares with his pharmacist that he concerned that his home blood pressure readings have been gradually increasing and he is wondering if his current meds are working. His home blood pressure readings have been consistently higher than 140/90 recently. Optimizing Blood Pressure
  40. 40. Collaborative Care Plan • Establish collaborative relationship with patient’s GP • Inform GP about patient unable to see GP in the next couple of months • Discuss patient’s blood pressure targets and risk to patient health • Review and discuss evidence of adding additional BP therapies is superior to maximizing doses of • Develop care plan to initiate additional drug therapy (amlodipine) • Set monitoring plan and follow-up in 2 weeks with the patient • Notify GP of results of monitoring and follow up Optimizing Blood Pressure
  41. 41. Benefit of Patient Receiving Additional Care from a Pharmacist Prescriber • Review of clinical effectiveness of patient’s current drug therapy • Care plan developed allows the Certified Pharmacist Prescriber to help optimize the patient’s blood pressure between visits to his GP every few months • Unnecessary emergency department, urgent care center or walk-in clinic visit averted • Timely initiation of drug therapy to control blood pressure • Increased collaboration on patient’s care team Optimizing Blood Pressure
  42. 42. 68 Tsuyuki R, Houle S, Charrois T, et al. A randomized trial of the effect of pharmacist prescribing on improving blood pressure in the community: the Alberta clinical trial in optimizing hypertension (RxACTION). Can Pharm J (Ott) 2014;147:S18. 69 McAlister FA, Majumdar SR, Padwal RS, et al. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ 2014;186:577-84
  43. 43. 70 Rosenthal M, Tsuyuki R. A community-based approach to dyslipidemia management: pharmacist prescribing to achieve cholesterol targets (RxACT Study). Can Pharm J (Ott) 2014;147(4):S20 71 Cochrane for Clinicians (2013). Appropriate use of polypharmacy for older patients. Am Fam Physician.2013Apr1;87(7):483-484.
  44. 44. 82 Al Hamarneh YN, Charrois T, Lewanczuk R, et al. Pharmacist intervention for glycaemic control in the community (the RxING study). BMJ Open 2013;3:e003154.
  45. 45. Pharmacist prescribing during a hospital discharge
  46. 46. A 72-year-old male was recently discharged to a shelter as he had no-fixed-address. He was admitted to hospital 3 weeks ago due ischemic right arm and bilateral leg ischemia. He was identified by the primary care clinic pharmacist for a medication review due to discharge 3 days ago from hospital. He is out of meds and has lost his discharge prescription. Medication Reconciliation at Discharge
  47. 47. Collaborative Care Plan • Consult with other prescriber involved in patients care at team-based primary care clinic • Discuss patient’s condition, how to reduce risks, improve outcome • Establish coordination of care between the primary care clinic and shelter • Develop care plan to restart/initiate recommend drug therapy • Set monitoring plan and follow-up in 2 weeks with the patient at shelter • Co-ordinate with others to order bloodwork and refer for possible echocardiogram in 3 months Medication Reconciliation at Discharge
  48. 48. Benefit of Patient Receiving Additional Care from a Pharmacist Prescriber • Prevention of serious adverse effects /hospitalization from any of his conditions. He could have deteriorated quickly • Care plan developed allows the Certified Pharmacist Prescriber to help manage/reduce risks for adverse event • Unnecessary emergency department visit for medications averted • Timely initiation of drug therapy • Increased collaboration on patient’s care team • Worked with his social supports to coordinate supportive services Medication Reconciliation at Discharge
  49. 49. 72 Medication Reconciliation in Canada: Raising the Bar Progress to date and the course ahead. https://accreditation.ca/sites/default/files/med-rec-en.pdf 73 National Patient Safety Agency. Rapid Response Report NPSA/2010/RRROO9: Reducing harm from omitted and delayed medicines in hospital. NPSA 2010 http://www.nrls.npsa.nhs.uk/alerts/?entryid45=66720 74 ISMP Canada Safety Bulletin, Delayed Treatment after Transitions in Care: A Multi-Incident Analysis, October 2016
  50. 50. What’s Next?
  51. 51. bcpharmacists.org/prescribing Share your thoughts with us on pharmacist prescribing Survey open until October 8, 2017

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