Pharmacists must seek out, and then take proper action on, appropriate information when providing service to a patient

A recent hearing tribunal issued its written decision on the merit and orders regarding the conduct of a pharmacist who was found to have inappropriately prescribed and dispensed large quantities of zopiclone to a patient on multiple occasions over a short period of time.

The hearing tribunal accepted that the quantities of zopiclone prescribed and dispensed by the pharmacist were so large that it would not be clinically possible for one individual to ingest these quantities and showed that the patient was clearly diverting zopiclone far beyond her personal use. The hearing tribunal noted that the pharmacist should have exercised greater judgement in his provision of pharmacy services to the patient, both before and after he considered information from the patient’s electronic health record (Netcare/PIN).

Although the tribunal accepted the pharmacist had eventually accessed the patient’s electronic health record, and had documented some of his rationale and care plans, the tribunal still found that the pharmacist’s conduct was unprofessional, contributed to a broader diversion of zopiclone, and warranted sanctions. In not exercising greater professional judgement, the hearing tribunal found that the pharmacist breached his duty to the patient, society, and the profession.

In this matter, the tribunal imposed significant penalties. The tribunal ordered:

• a 3-month suspension, with 2 months held in abeyance on the condition that the pharmacist fulfills the other orders of the hearing tribunal and maintains good conduct,
• a condition that upon restatement the pharmacist must practice under direct supervision for a minimum of 300 hours and until the supervising pharmacist is satisfied that the pharmacist has completed the patient assessment requirements of the Structured Practical Training program and is able to practice in a manner such that the conduct proven in this matter is unlikely to recur,
• the successful completion of a course in pharmacist assessment,
• the costs of the investigation and hearing to a maximum of $20,000, and
• the pharmacist must disclose the tribunal’s written decision to any pharmacy employer for a period of 3 years.

Rationale for the tribunal’s decision is reflected in its following statements:

From the tribunal’s decision:

Standard 4 (Pharmacists must determine whether a patient has or is likely to have a drug therapy problem):… Poorly completed care plans, such as the one completed by [the pharmacist] for [the patient], substantially diminish the value of such interventions for the residents of this province and examples such as this CACP are detrimental to the profession of pharmacy in general. Assessments such as the CACP must be completed accurately and completely in order to provide value to the public.

Standard 14 (Prescribing at initial access or to manage ongoing therapy): … Pharmacists that prescribe drug therapy under Standard 14 have a great responsibility to the public to ensure that prescribing is in the best interests of the patient, must conduct a patient assessment, and must collaborate with other regulated health professionals whose care of the patient may be affected by their prescribing decision. Standard 14 is also clear that the pharmacist must develop a follow up plan, including parameters that will be monitored, expected outcome and timeframes. Pharmacists must respect the tremendous privilege Additional Prescribing Authorization affords them and pharmacists must take full responsibility for their prescribing decisions. When a pharmacist prescribes drug therapy pursuant to Standard 14, they assume responsibility for that decision and the implications of that decision on the patient’s overall health. The public must be assured that when pharmacists prescribe drug therapy it will be done based on a complete and thorough assessment of the patient.

Standard 5 (Take appropriate action if there is a drug therapy problem)… Pharmacists must be aware of the abuse potential of certain prescribed medications. They must be prepared to not only simply notify, but actively collaborate with patients’ other regulated health care providers to support patients that may be addicted or abusing these medications. The hearing tribunal recognizes that individuals who abuse or are addicted to medications are a vulnerable population. Pharmacists have a responsibility to recognize patients at risk and to support their safety. Pharmacists are uniquely positioned within the health care system to assess, screen, and refer patients to appropriate care when untreated addiction or mental health issues are flagged.

Pharmacists – Review your ethical duties to our profession and yourself

1. Review and discuss with colleagues your fundamental professional obligations in prescribing and dispensing medications. Principles 1 to 5 of the Code of Ethics and Standards 3, 4, 5 and 14 of the Standards of Practice for Pharmacists and Pharmacy Technicians will provide you with valuable guidance in this respect.
2. Understand that the when you initially prescribe a drug you are directly responsible for managing the patient’s drug therapy in full compliance with the standards of practice and in collaboration with other members of the patient’s health care team.
3. Do not just seek out appropriate information, but act upon it in a responsible and appropriate manner.
4. Incorporate ACP’s Opioid Guidelines into your daily practice.
5. Incorporate ACP’s Vital Behaviours into your daily practice.
6. Incorporate other ACP patient care tools, such as the Vital to Chat/Check/Chart tool card and Prescribing Algorithms, into your daily practice.