NOTE: The following article has been updated to correct information in the example and expectations of pharmacists.
ACP has learned of instances where prescriptions for injectable drugs were dispensed, compounded, or administered in a formulation that does not align with the formulation written in the prescription, without a comprehensive, evidence-informed [1] assessment. For example, ACP has been informed of several instances where methotrexate formulations, with Health Canada approved routes of administration of intramuscular, intraarterial, or intravascular injection, were dispensed for prescriptions written for a subcutaneous methotrexate injection. The pharmacists were unable to provide an explanation about how their decisions to dispense the drug outside of the Health Canada approved indication was evidence informed.
ACP’s new Standards of Practice for Pharmacists and Pharmacy Technicians outline that a pharmacist must only prescribe, dispense, sell, or recommend drugs for a patient that are
- used for indications approved by Health Canada;
- considered a best practice or accepted clinical practice in evidence-based [2], peer-reviewed clinical literature; or
- part of an approved research protocol.
In the above example, dispensing an intramuscular, intraarterial, or intravascular methotrexate formulation for subcutaneous injection would NOT be appropriate unless the pharmacist completed a comprehensive assessment where the chosen therapy is considered a best practice or accepted clinical practice in evidence-based, peer-reviewed clinical literature.
When making clinical decisions (such as dispensing drugs that are not proposed to be administered via a route approved by Health Canada), pharmacists must consult evidence-based resources and professional guidelines and protocols that are relevant to the patient to formulate person-centred solutions. Pharmacists must also ensure the evidence-informed rationale for any decisions or recommendations made is documented on the patient record and is available to be shared with other relevant members of the patient’s health care team.
[1] Evidence informed means the ongoing process that incorporates best available evidence from research findings, clinical expertise, patient preferences, values, and circumstances to inform decisions that are made about a patient.
[2] Evidence-based information means information that is based on research from credible and reliable sources that is applicable to the particular problem or situation being considered.
