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Pharmacists request authority to order lab tests

July 28, 2009

Although pharmacists are trained to use lab data to monitor and determine appropriate drug therapy, their timely access to lab data has been limited. Netcare PORTAL allows pharmacists to read existing lab data, but still does not adequately support them actively managing drug therapy.

Being able to order appropriate tests can facilitate pharmacists more proactively meeting patient needs and a more efficient use of other health professionals’ time and resources.

ACP has worked with Alberta Health and Wellness (AHW) to clarify steps required to assign pharmacists Practitioner Identification numbers (PRAC IDs). Concurrently, ACP has drafted guidelines for pharmacists using laboratory data.

The College of Physicians & Surgeons of Alberta (CPSA) accredits medical laboratories. The CPSA by‑laws identify regulated professions for whom a laboratory director (typically a physician) may conduct a laboratory examination and provide results. Pharmacists are not currently on the list of identified professionals. ACP has requested that CPSA:

  • add pharmacists to the list of regulated health professionals for whom a laboratory director may conduct a lab test and provide results; and,
  • review and comment on our draft Guidelines for Pharmacists Using Laboratory Data.
  • Following is a summary of ACP’s answers to questions asked by CPSA when considering our request: 

1. What education do pharmacists receive in the interpretation of lab test results and their use in pharmacy practice?

The use of laboratory data is taught, and examined, throughout the undergraduate curriculum at the Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta (the faculty), which has full accreditation status through the Canadian Council on the Accreditation of Pharmacy Programs (CCAPP).

Through ACP’s partnership with the faculty, Practice Development provides comprehensive learning and professional development experiences for current practitioners to enhance their skills and confidence in delivering patient care. Most programs include the use of laboratory data in the context of the subject being studied. A specific program, “Practice Skills: Monitoring drug therapy using laboratory values,” is also offered.

Other programs addressing this subject are available through the professional development programs offered by other faculties of pharmacy and pharmacy organizations across Canada and the United States.

2. How are pharmacists’ competencies with regard to the interpretation of lab results assessed?

As outlined in Question 1, competencies around the use of laboratory data are taught and examined throughout the undergraduate curriculum and in context with the subject matters being studied.

3. What specific tests or range of tests are pharmacists seeking authority to order?

The draft guidelines outline the purpose and scope for which pharmacists use laboratory information. Some purposes for which pharmacists may consider lab data include:

  • ensuring that the drug and the dose ordered are appropriate for the individual patient,
  • monitoring patients’ responses to therapy to ensure optimal outcomes,
  • monitoring for adverse effects to ensure patients’ safety, and
  • screening patients for untreated health conditions where there are preliminary indicators for such screening (e.g., dyslipidemia as a secondary condition in diabetes).

Examples where a review of lab data is indicated include but are not limited to:

a) Ensuring that the drug and the dose ordered is appropriate for the individual patient

b) Monitoring patients’ response to therapy to ensure optimal outcomes

c) Monitoring for adverse effects to ensure patient safety

d) Screening patients for untreated health conditions

4. What measures are in place to ensure the ability of the pharmacist to respond to critical test results reported after hours and to ensure timely follow-up of all test results?

The draft guidelines state: “Pharmacists must be available and accessible 24/7 or have alternate arrangements in place to respond to and act upon any critical lab results that are reported.”

5. What are the means by which duplicate testing will be avoided when a patient is attending both a physician and a pharmacist?

The draft guidelines state: “Pharmacists must review all alternative sources of current lab data available to them about a patient prior to ordering a test for the patient (e.g., electronic health record).

The draft guidelines also specify that: “Pharmacists must record lab data ordered by them on the pharmacy patient record of care, and should include it in any correspondence communicated to other appropriate members of the patient’s care team about the care they have provided.”

Look to future editions of The Link and acpnews for details about applying for PRAC ID numbers and considerations that pharmacists must make when ordering and using lab data.

Originally published in the July 28, 2009, issue of The Link