The college is still fielding lots of questions about adapting. The most asked:
What is the limit on how many doses or days of therapy pharmacists can provide when adapting to extend therapy?
There is no limit. Neither the regulations nor the standards specify limits.
One of the main goals of pharmacist adapting is to improve continuity of treatment for patients and reduce stress on the health system. If your assessment indicates that there is no need for any changes to a patient’s treatment regime, it is appropriate to provide a quantity of medication that is at least equivalent to the amount previously received (i.e., if they typically receive a 90-day fill, provide the same).
When providing the medication, remind the patient that they must see their original prescriber before the next fill will be needed and ensure that the patient’s care is managed during the period for which you have provided the medication.
What must pharmacists do when adapting?
DO assess the patient and their therapy each time you adapt a prescription. You must be able to answer ‘yes’ to at least these four questions before adapting a prescription.
- Is the patient’s treatment current?
- Do you have enough information about the patient’s condition?
- Are you familiar with the patient and their health history?
- In your professional judgment, is adapting the prescription in the patient’s best interest?
Use Chat, Check and Chart to guide your assessments.
DO follow the standards. In particular, Standards 11 and 12 of the Standards of Practice for Pharmacists and Pharmacy Technicians outline what pharmacists must consider when adapting a prescription.
DO keep your practice within the limits of your personal competence. In addition to following the Standards and the Code of Ethics, you must only practice within the limits of your personal competence. If you don`t feel that you have enough information about the patient, the condition, or the drug, you should not adapt a prescription.
DO complete the required documentation. When adapting a prescription, you must:
- reduce your prescription to writing,
- include a reference to the original prescription,
- retain a copy of both prescriptions,
- sign and enter the prescription with yourself as the prescriber, and
- notify the original prescriber.
Refer to Standard 12 of the Standards of Practice for Pharmacists and Pharmacy Technicians for full details.
What must pharmacists NOT do when adapting?
DO NOT keep the prescription under the physician’s signature, even if you just make a minor change to a prescription. If you adapt the prescription, you must sign your name as the prescriber and fulfill all the requirements of prescribing.
For example, if a doctor sends you a note saying she is going away for several weeks, and tells you that you may refill her patients’ prescriptions while she is away, the prescriber on those refilled prescriptions should be you. Why?
A prescription, as defined by the Food and Drug Regulations means “an order given by a practitioner directing that a stated amount of any drug or mixture of drugs specified therein be dispensed for the person named in the order.”
Although the doctor has communicated her intentions, her notification does not meet the definition of a prescription. When you adapt a prescription by extending refills, you are responsible for assessing the patient and the appropriateness of extending the prescription.
Take responsibility for this prescription by signing your name; then notify the prescriber that in her absence, you used your judgment and modified the following prescriptions.