Scope of Practice

Managing Drug Shortages

Patient and pharmacist
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There has been a sizable increase in the number of drug shortages in Canada. The inability to access the ideal medication can cause significant, and potentially harmful, effects to patients. Drug shortages also present dilemmas for pharmacy professionals and prescribers who are trying to meet the needs of their patients in a challenging practice environment.

The following article addresses some common questions the College receives from registrants and the public about how drug shortages can be managed in the pharmacy. Pharmacists are encouraged to reflect upon the considerations and the ethical obligations outlined below.

Key Considerations for Pharmacists

Pharmacists are always relied upon to practice within the limits of their knowledge, skills and judgment, while also consulting evidence-based resources, drug interaction services and/or manufacturers as needed.

When 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, using their professional judgment, can consider the following:

Are there available strengths that can be used to make up the prescribed strength/dose?

Does the prescriber need to be contacted for clarification? This may be especially important if the prescription is ambiguous, or the prescriber’s intent is not clear.

Is there a clinical reason for prescribing a particular strength or dosage form?

If there are multiple options to address the issue, what does the patient prefer?

If there is a drug shortage, what is the status of the shortage and when might it be resolved? Does the shortage affect several drugs of a particular drug class? (e.g., will any potential options to address this issue be affected by the drug shortage?)

Pharmacists in Ontario have the independent authority to adapt a prescription based on the individual circumstances of the patient by altering the dose, dosage form, regimen or route of administration to address the patient’s unique needs and circumstances. The original prescriber should be informed of a clinically significant change in the patient’s prescription.

There will not be an absolute right or wrong answer in all circumstances. The best possible alternative for a particular shortage may vary over time as the situation changes.

Shared Decision-Making with the Patient and the Prescriber

Every situation and set of circumstances will be different and should be addressed individually.

Optimal patient outcomes require collaborating with the patient, including engaging them in the decision-making process. Urgency, convenience, cost, ease of administration and past prescription history may influence patient preferences.

Appropriate, adequate and timely follow up with the patient, especially in the case of new drugs or changes to dosing, is important. Decisions made with the patient and/or prescriber and the counselling provided to the patient must be documented.

Pharmacists should collaborate with the prescriber to share concerns and ensure updated patient records.

As with any issue that arises in practice for which there is no clear direction, pharmacists may have different assessments of the situation, and may arrive at different decisions. This is why effective communication and documentation of one’s rationale is important – both for the physician and/or patient to understand any concerns the pharmacist is addressing, and for other members of the pharmacy team to understand in the future.

Ethical Practice During Shortages

Pharmacy professionals must ensure that they abide by the Code of Ethics during drug shortages. For example, pharmacists and pharmacy technicians must:

  • not influence, persuade or pressure patients to accept pharmacy services in order to retain (or gain) the patient’s business
  • ensure that their patient’s best interests must always override their own interests or the interests of the business which the registrant owns, has a financial interest in or is employed by
  • make fair decisions about the allocation of resources under their control based on the needs of persons, groups or communities to whom they are providing care and services
  • make reasonable efforts to ensure continuity of patient care when they are unable or unwilling to provide requested pharmacy services
Resources on Drug Shortages

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