Of the more than 6,600 pharmacists on Alberta’s clinical pharmacist register, 66 per cent (4,334)1 hold additional prescribing authorization (APA).2 The remaining 34 per cent of pharmacists (2,270) are not authorized to prescribe at initial access. Obtaining APA allows pharmacists to further support Albertans by expanding access to timely care—all pharmacists working in direct patient care environments are encouraged to pursue APA.
One of the expectations for pharmacists is to provide a health assessment for Albertans who present to the pharmacy. Because not all pharmacists hold APA, Albertans may at times be assessed by a pharmacist who cannot prescribe medication, except in emergencies or when adapting an existing prescription. Albertans may not be aware of the different levels of prescribing authority that pharmacists can have and they might assume and expect that the pharmacist they are seeing can prescribe at initial access.
ACP has become aware of situations where pharmacists without APA have attempted to bypass their prescribing limitations by contacting an off-site pharmacist who does hold APA, and requesting an initial access prescription based solely on the assessment of the pharmacist without additional prescribing authorization.
This practice is not supported by the standards of practice. APA prescribing must be based on the assessment of a pharmacist who holds APA and not the assessment of a pharmacist who does not have additional prescribing authorization.
The Standards of Practice for Pharmacists and Pharmacy Technicians require that a pharmacist with APA who is prescribing must see the patient in person, or must have seen the patient previously and have an established, current professional relationship over a period of time.
In addition, the Standards for the Operation of Licensed Pharmacies require pharmacists to provide professional services while physically present in the pharmacy, unless they are offsite to see the patient in person.
Virtual care provided while working remotely is only allowed in the case of emergency or if the pharmacy is closed. The Standards of Practice for Virtual Care do not expand this capacity. Therefore, a pharmacist with APA who has not seen or assessed the patient personally cannot prescribe, even if another pharmacist has already assessed the patient.
The standards do allow participation in a collaborative, team-based assessment with other regulated health professionals. However, this is intended to supplement the pharmacist’s own assessment. The standards do not enable another pharmacist without APA to perform an assessment on their behalf.
Pharmacists who cannot prescribe referring a patient to a pharmacist with APA
If a pharmacist who cannot prescribe at initial access refers a patient to a pharmacist with APA for an in-person assessment, the first pharmacist (who cannot prescribe at initial access) must document their initial assessment and referral. The pharmacist with APA may refer to the initial assessment but must clearly identify and document what they independently verified to support their prescribing decision.
All documentation and communication must clearly outline each pharmacist’s role, and patients must be informed of who was involved in their care and in what capacity. The pharmacist with APA is responsible and accountable for their prescribing decision.
Emergency prescribing by pharmacists who do not have APA
A pharmacist without APA may prescribe in emergencies, consistent with the SPPPT. In such cases, the pharmacist must
- independently assess the patient,
- determine that delaying therapy would pose a risk to the patient, and
- take full responsibility for the prescribing decision and the associated documentation.
Emergency prescribing is a limited, exceptional authority to support patient care but cannot be used routinely as a substitute for APA.
Pharmacists working in direct patient care environments are encouraged to apply for APA. This authorization allows pharmacy teams to provide quality care for Albertans. Albertans deserve the best from pharmacy teams and APA authorization is an important and accessible service that should be available in every pharmacy.
