Pharmacists must ensure they understand their authority under the Pharmacy Act to adapt a patient’s prescription, including the requirements and expectations outlined in the Initiating, Adapting and Renewing Prescriptions Guideline. Here are five key questions and answers about adapting prescriptions.
1. What can pharmacists adapt?
A pharmacist can alter the dose, dosage form, regimen or route of administration of the prescribed drug. Therapeutic substitution is NOT within the scope of practice for pharmacists in Ontario.
What Pharmacists Can Alter for a Prescription2. Who can adapt prescriptions?
Pharmacists, interns and registered pharmacy students under the supervision of a pharmacist have the independent authority to adapt a prescription for the purpose of continuity of care.
3. Who would be the prescriber?
When adapting a prescription, the pharmacist is prescribing and assumes responsibility for that prescription. The name, work address, telephone number, and College registration number of the pharmacist must be documented on the adapted prescription and in the dispensing record.
Prior to adapting the prescription, the pharmacist must obtain the patient or caregiver’s informed consent for the adaptation.
4. What should the pharmacist consider before adapting?
Pharmacists should assess the situation and consider the following:
- Risks and Benefits. What are the potential risks and benefits to the patient if the prescription is dispensed as originally written by the prescriber?
- Urgency. What other options exist to manage the patient’s needs?
- Therapeutic Appropriateness. Would the adapted prescription be therapeutically appropriate (i.e., indicated, safe and effective) for the patient? Would the patient be able to comply or adhere to the regimen? Consider using a structured thought process such as I.E.S.U. as part of the patient assessment.
- Purpose. Is adapting in the best interest of the patient? Is therapy optimized if the adaptation does not occur?
- Knowledge and Skills. Does the pharmacist possess sufficient knowledge and skills respecting the drug and the patient’s condition? Has the pharmacist consulted appropriate clinical resources to support or inform their decision-making?
- Patient Information. Does the pharmacist have sufficient knowledge about the patient’s health status and the disease or condition being treated to make the decision to adapt the prescription? Has the pharmacist consulted with the patient, the patient’s agent, other allied health care professionals and/or clinical viewers to gather relevant information and inform decision-making?
- Prescription Access. The pharmacist must possess a copy of the original prescription, or access to the information it contained.
5. What does the pharmacist need to document?
The pharmacist must document details of the adaptation, including the rationale for adapting the prescription, and follow up or monitoring plans. Documentation on the patient record should be thorough, yet concise, and reflect the factors influencing the decision. These factors may include results of the patient assessment, a review of medical history, lab tests results, potential drug therapy problems, references consulted and monitoring plans, among others. Documentation should be completed in a timely manner.
Prescriber notification is required if the pharmacist deems the adaptation to be clinically significant. Information provided as part of the communication to the prescriber could include patient consent, pharmacist rationale, patient assessment and follow-up.
- Initiating, Adapting and Renewing Prescriptions Guideline
- Prescribing and Providing Controlled Substances during the Coronavirus Pandemic Guidance
- Pharmacy 5in5 – Resources on Adaptation
- Pharmacy Connection – Promoting Safety Through Conversation: Patient Assessment (November 2022)
- Optimizing Patient Care: Prescriber Notebook
- OCP Sample Documentation Template