This document discusses the potential for pharmacists in British Columbia to prescribe medications. It outlines the training, certification process, and framework that would be required for pharmacist prescribing, including collaborative relationships with other healthcare providers, access to patient health information, developing care plans and follow-up monitoring. Examples are provided of how pharmacist prescribing could improve patient outcomes in community and hospital settings by optimizing medications and ensuring continuity of care during transitions. The overall goal is to expand the pharmacist's role in a safe and regulated manner to better protect patient safety and improve health outcomes.

1. What is Pharmacist
Prescribing?

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. Why is Pharmacist Prescribing
Important?

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. 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. 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. 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. 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. Framework for Pharmacist
Prescribing in BC

10. Developing the Framework for Pharmacist Prescribing

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. Collaborative Practice
Relationships

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. Collaborative Practice Relationships
Diagnosis is still provided by physicians and nurse practitioners
(or other regulated health professionals with prescribing authority).

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. 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. Access to
Health
Information

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. Access to Relevant Health Information
Information from PharmaNet
• Up-to-date list and date of filled medications
• Previous adverse drug reactions when recorded

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. 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. Care Plans,
Follow-ups and
Monitoring

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. 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. Ongoing Follow-up and Monitoring

26. Pharmacist
Prescriber
Eligibility and
Certification

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. 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. 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. 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. 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. 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. 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. Patient
Engagement

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. 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. 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. Pharmacist
prescribing
in the community

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. 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. 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. 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. 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. 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. Pharmacist
prescribing during a
hospital discharge

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. 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. 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. 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. What’s Next?

51. bcpharmacists.org/prescribing
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