Frequently Asked Questions from Pharmacy Practice – Winter 2018

The legislation (O. Reg 202/94) states “Every certificate of registration as a pharmacy technician is subject to the following terms, conditions and limitations: 1. The member shall only engage in the practice of pharmacy (…) when practising in a pharmacy to which the Drug and Pharmacies Regulation Act applies, other than a remote dispensing location, while under the direct supervision of a member holding a certificate of registration as a pharmacist…”

A technician can check any/all prescriptions for technical accuracy and completeness. Every prescription – new and refill, regardless of how they are packaged – must have both the technical and therapeutic check completed prior to release to the patient. Please refer to the page “Understanding What a Technician Can Do” for more details; note that the term “co-signing” is not used, as each member is performing an independent “check” for different purposes.

A suitable method for documenting both “checks” for a given prescription may be signatures (or some other identifying mechanism) from both members on every hardcopy. However, other methods may be suitable to document the respective actions and associated responsibilities in the dispensing process. As software, workflow, personnel, etc. can vary from pharmacy to pharmacy, the information presented on our website is not meant to be entirely prescriptive for how a pharmacy achieves the desired end result, which is to ensure the patient receives a prescription that is both technically accurate and therapeutically appropriate.

Ultimately, members remain accountable for their respective roles in dispensing a prescription, and documentation on the patient record should reliably demonstrate that every prescription has been reviewed for both technical and therapeutic aspects before it is dispensed. It should be readily retrievable, auditable, and be unambiguous. When and how these functions occur, and what form they take (i.e. operational procedures) are at the discretion of the pharmacist and technician in consultation with the Designated Manager.

As outlined in our MMT and Dispensing Policy under the section Administration of Methadone Dose and in the CAMH course, the pharmacist is responsible for patient assessment, witnessing doses as well as the therapeutic check of the prescription. These functions cannot be delegated to a technician. More information can also be found in the CAMH guide Opioid Agonist Maintenance Treatment: A Pharmacist’s Guide to Methadone and Buprenorphine for Opioid Use.

Registered pharmacy technicians have the independent authority to check the accuracy of the technical components of methadone prescriptions. Pharmacy technicians may also be responsible for other tasks in the workflow that fall under their job descriptions and competencies, such as dose preparation, assisting with documentation and inventory management.

As explained in our Fact Sheet on Destruction of Narcotics, Controlled Drugs, and Targeted Substances, registered pharmacy technicians can witness the destruction of narcotics.

There may be more than one way to dispense a prescription to ensure the patient receives the correct drug, dose and total quantity, such as in the situation you describe. The College cannot provide a specific answer on the action the pharmacist should take; it is the member’s responsibility to assess the prescription and decide the best course of action based on all the information at their disposal.

In situations where a specific dose or strength indicated on a prescription does not exist, is unavailable, or is not the most appropriate option for the patient, the pharmacist, in exercising their professional judgment, may choose to use available dosage forms to make up the prescribed strength/dose. Alternatively, the pharmacist may choose to contact the prescriber for clarification — either in writing or verbally — when presented with a prescription that is ambiguous or the intent of the prescriber is not clear.

Depending on the specific scenario, it may be important to ascertain if there was a clinical reason for prescribing a particular strength or dosage form. If there are different options, what does the patient prefer? Or, if the drug does not exist in a given strength, is it possible an error was made in the name of the drug or the dose?

When deciding whether or not it is appropriate to split the tablets prior to dispensing, pharmacy professionals should apply their knowledge to determine whether or not the medication is amenable to splitting (e.g. scored or not, accuracy of resulting dose, stability, tablet integrity) and keep the patient’s health outcomes, best interest and safety in mind.

Documentation of one’s rationale is important, in addition to documentation of dialogue with the patient, their understanding of the changes, and their informed consent. Pharmacy professionals are encouraged to reach out to their peers for timely guidance with practice-related questions as well, to leverage their practical experience and get advice on how they approach situations like this, assess the prescription, and exercise professional judgement.