Scope of Practice for Pharmacists - What Can Pharmacists Really Do?

Pharmacists are an invaluable healthcare resource, widely available for the purposes of medication management. It’s important for the public to understand what a pharmacist does, and how they can improve the health of patients and communities. As medication experts, pharmacists take on many roles and responsibilities while upholding a high standard of excellence for the profession.  

‍

Scope of practice for pharmacists, as defined by the American Pharmacists Association, refers to the ‘boundaries within which a health professional may practice.’ This definition is not only true in a legal context, individual pharmacists also need to assess if their own skills and comfort level in performing the desired task or service is sufficient to ensure that the patient is able to derive benefit. In Canada, pharmacist scope of practice varies between different provinces. We will delve into each category and discuss how this impacts not only patients, but also prescribers and allied healthcare workers.  

Beginning with prescriptive authority for Schedule 1 drugs, it is evident that most activities falling under this category have not been implemented in British Columbia (BC). Prescriptive authority refers to the authority to prescribe drugs and Schedule 1 drugs refer to medications that require a prescription written by a licensed prescriber to be dispensed. Practicing pharmacists in BC can only prescribe in an emergency, which is otherwise known as giving an emergency supply of medication. Doing so facilitates continuity of care for patients, which means that those who take medications regularly will not run out of medication if, for instance, they are unable to obtain a new prescription before they run out of their current supply. Pharmacists do need to exercise professional judgement when prescribing in an emergency, to ensure the health and safety of their patients.  

Under the adapt/manage category, practicing pharmacists in BC are able to make therapeutic substitutions, change drug dosage, formulation, regimen, etc., and renew or extend prescriptions for continuity of care.  

• Therapeutic substitutions are a substitution of a drug with a different drug within the same therapeutic class that is expected to have the same therapeutic effect. One example of when this would be necessary is during drug shortages of one particular drug, allowing pharmacists to substitute the shorted drug with another one that is supposed to provide the same amount of health benefit.  

• Changing drug dosages, formulations, regimens, etc. should be done with the goal of enhancing patient outcomes in mind. When a certain dosage or formulation is not commercially available, or if a patient is more likely to experience adverse effects from the dosage or formulation that was initially prescribed, pharmacists can make this change for patients.  

• Finally, renewing/extending prescriptions means that the same drug, if on a stable dose and taken chronically, can be extended by a pharmacist until it expires.  It is important to note that there are exceptions to these rules, such as pharmacists not being allowed to perform adaptations for certain classes of medications unless they are working in environments with the appropriate protocol.

‍

‍

‍

In terms of injection authority, practicing pharmacists in BC can administer vaccines to patients. While they are not yet allowed to inject medications, this is currently pending legislation, regulation or policy by relevant organizations and regulatory bodies. At this time, they also cannot order and interpret lab tests.  

‍

Pharmacists are known as the medication experts, and have a wide range of knowledge and skills to live up to that expectation. The specifics of pharmacist scope varies from province to province, but it is clear that pharmacists add an abundance of value to the healthcare system. There is still a lot of work that needs to be done in order to ensure that pharmacists across Canada are practicing to their full scope and maximizing the value that they add. Today, pharmacists in many different provinces are continuing to advocate for an increased scope of practice to better care for their patients and positively influence the landscape of healthcare.  

‍

References:

1. Scope of Practice [Internet]. American Pharmacists Association. [cited 2022 Mar 27]. Available from: https://www.pharmacist.com/Practice/Practice-Resources/Scope-of-Practice
2. Scope of Practice - English [Internet]. [cited 2022 Mar 27]. Available from: https://www.pharmacists.ca/advocacy/scope-of-practice/
3. Medication Management (Adapting a Prescription) [Internet]. College of Pharmacists of British Columbia. 2015 [cited 2022 Mar 27]. Available from: http://www.bcpharmacists.org/medication-management-adapting-prescription