|Narcotic or controlled drug
No refills or transfers permitted. All “re-orders” must be new written prescriptions. Part fills allowed; for part fills, prescriber must indicate the total amount of medication, quantity for each part fill, and intervals between fills.
Control Drugs Part I
No refills allowed if original prescription is verbal. If written, the original prescription may be repeated if the prescriber has indicated in writing the number of refills and the intervals between refills. Transfers not permitted.
Control Drugs Part II & III
An original written or verbal prescription may only be refilled if the prescriber has authorized, verbally or in writing, the number of refills and the intervals between refills. Transfers not permitted.
Refer to the Health Canada's Quick reference guide for pharmacists dispensing and purchasing controlled substances for more information.
Never, at the moment. However, you may accept prescriptions faxed directly to your pharmacy from a physician's EMR. In the absence of a handwritten signature, the physician's password access to their EMR may be considered the prescriber's direct authorization (i.e. meets the requirements for a signature in ACP's standards).
Electronic transmission of prescriptions in limited circumstances became acceptable when the College of Physicians and Surgeons of Alberta (CPSA) standard entitled Prescribing came into effect in March 2016. The CPSA standard is designed to allow electronic transmission of prescriptions in the future when approved or official secure, system-to-system messaging between physicians' Electronic Medical Records (EMR) and Netcare and/or Pharmacy systems become available.
The obligation for a pharmacist or pharmacy technician to determine the authenticity of prescriptions has not been removed. It is expected that you will assess the authenticity of the prescription as you have done in the past for prescriptions faxed to your pharmacy. If you have any doubts or concerns about the authenticity of a prescription, you should contact the prescriber for confirmation.
- Prescriptions faxed directly to a pharmacy from a physician's password-protected EMR.
- Prescriptions produced by computer and hand-signed by the prescriber or with an electronic signature that is then signed or initialled by the prescriber and delivered by the patient are acceptable. However, it is your responsibility to ensure the prescription is authentic, just as you would for a prescription which is handwritten.
- Prescriptions that are produced by computer and hand-signed by the prescriber, or with an electronic signature and signed or initialled by the prescriber, that are then faxed to the pharmacy.
- Prescriptions emailed to you.
- Prescriptions produced by computer but not signed by the prescriber, or prescriptions with an electronic signature that is not signed or initialled by the prescriber (unless faxed directly from physician's EMR). There are insufficient security measures in place to ensure the validity of prescriptions sent electronically.
For best practices, refer to Ensuring Safe & Efficient Communication of Medication Prescriptions.
No. The audit trail must identify all staff members who were involved in filling the prescription.
(Standard 7.16, Standards of Practice for Pharmacists and Pharmacy Technicians)
Drug incident: any event that may cause or lead to inappropriate drug use or patient harm.
Adverse drug event: an unexpected and undesired incident that results in patient harm such as injury, adverse outcome or death.
Drug error: an adverse drug event or a drug incident where the drug has been released to the patient(Standard 6, Standards for the Operation of Licensed Pharmacies)
Yes. All adverse drug events must be recorded as part of the pharmacy’s quality assurance process.
(Standard 6, Standards for the Operation of Licensed Pharmacies)
No. You are not required to record a drug incident if it is discovered and corrected before the drug is released to the patient.
However, if the drug incident is not discovered until after the drug has been released to the patient, it must be recorded as part of the quality assurance process. Recording is required even if the patient did not ingest any of the drug. However, you may wish to record these "near misses" to prevent them from recurring.
Note: if the drug incident is not discovered until after the drug has been released to the patient, it must be recorded as part of the quality assurance process. Recording is required even if the patient did not ingest any of the drug.(Standard 6, Standards for the Operation of Licensed Pharmacies)
You are required to have a dialogue or a conversation with a patient or a patient’s agent in each of the following circumstances:
- When a Schedule 1 drug is dispensed to a patient for the first time. (This includes switching dosage forms such as regular-release to long-acting or vice versa)
- When a Schedule 2 drug is sold to a patient for the first time.
- If a patient requests counselling.
- If, in your professional opinion, a dialogue is needed to resolve a drug-related problem or to ensure the patient has enough information to receive the intended benefit of the medication.
(Standard 8.3, Standards of Practice for Pharmacists and Pharmacy Technicians)
Dialogue is not required if the drug will only be administered by a regulated health professional to the patient. This scenario includes patients in hospitals, nursing homes, and other care facilities.
(Standard 8.4, Standards of Practice for Pharmacists and Pharmacy Technicians)
Is a dialogue required if the patient is a resident of a facility or group home and the drug will be administered by someone other than a regulated health professional?
Your goal is to ensure the person who administers the drug has sufficient information to enable the patient to receive the intended benefit of the drug therapy, including proper administration of the drugs. If someone other than a regulated health professional is administering the drug, that person may be considered the patient’s agent. The standards allow you to deal with the patient’s agent when it is in the best interest of the patient. Therefore, a dialogue with the care giver responsible for administering the drug is recommended.
Some facilities have a nurse or another regulated health professional who supervises the work of non-regulated staff members. In these circumstances, you should work with the regulated person responsible for supervising the administration of drugs to ensure that the appropriate training and policies and procedures are in place to meet the goal of enabling the patient to receive the intended benefit of the drug therapy. This may include consideration of other provincial standards, such as those relating to long-term care facilities.
If a dialogue is only required when a Schedule 2 drug is sold to a patient for the first time, can a technician sell Schedule 2 drugs on subsequent occasions?
How do pharmacists deal with prescriptions and refills if they were written by a prescriber whose practice is cancelled, suspended, or made subject to conditions in relation to prescribing?
Under the Health Professions Act, there is now a range of health professionals who can prescribe Schedule 1 drugs. Disciplinary decisions can result in the cancellation or suspension of a prescriber’s practice permit or conditions that limit or bar prescribing in whole or in part. There are also other forms of suspension which do not result from a finding of unprofessional conduct. These may include an order under section 65 of the Health Professions Act suspending a practice permit or imposing condition on a practice permit pending an investigation and discipline proceeding, or an order relating to incapacity under section 118 of the Health Professions Act. Where the college is aware of these orders, notice will be provided to the regulated members in order to allow them to ensure that
- they do not fill prescriptions from a prescription issued after the date that the prescriber’s ability to prescribe has been restricted by cancellation, suspension, or a specific condition on a practice permit that prohibits prescribing activities; and
- they carefully review any prescription issued before the date that the prescriber’s ability to prescribe has been restricted by cancellation, suspension, or a specific condition relating to prescribing. The obligation to carefully review any prescription and determine whether it is appropriate applies to every prescription, but it applies with greater emphasis where there are orders under the HPA prohibiting or restrict prescribing. This does not mean that prescriptions, issued before the date of an order prohibiting or restricting prescribing, are invalid. It simply means that the pharmacist must pay particular attention to the pharmacist’s duties under Standard 6 of the Standards of Practice for Pharmacists and Pharmacy Technicians.