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Do pharmacists have to provide laboratory test services?
Pharmacists must always act in their clients' best interests. This includes evaluating whether they possess the necessary capacity and specific skill sets to order, receive, and interpret laboratory tests for clients. If a pharmacist decides not to offer this service, they should be prepared to explain the rationale behind their decision to the client.
Similar to other pharmacy services, pharmacists may refuse to provide laboratory test services in circumstances where they do not possess the necessary knowledge, skills, or abilities, where it is not appropriate according to their professional judgment, or in situations where they lack any of the following:
- A professional relationship with the client
- The education, training, and competence necessary to correctly order the test and interpret the results.
- The client’s or client representative’s informed and voluntary consent
- Relevant client information, including the client’s record, PharmaNet record and/or information provided by the client or client’s representative.
- Previous laboratory test results, where applicable
- A system in place to ensure appropriate follow-up of ordered laboratory test results.
- Procedures for receiving critical test results that have been ordered
In addition to the Standards, Limits and Conditions outlined in the Health Professional Act - BYLAWS Schedule F, Part 9, when providing laboratory test services, pharmacists are required to comply with CPBC’s Code of Ethics.
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Under what circumstances can a pharmacist refuse to order labs for a patient?
Similar to other pharmacy services, pharmacists may refuse to provide laboratory test services in circumstances where they do not possess the necessary knowledge, skills, or abilities, where it is not appropriate according to their professional judgment, or in situations where they lack any of the following:
- A professional relationship with the client
- The education, training, and competence necessary to correctly order the test and interpret the results.
- The client’s or client representative’s informed and voluntary consent
- Relevant client information, including the client’s record, PharmaNet record and/or information provided by the client or client’s representative.
- Previous laboratory test results, where applicable
- A system in place to ensure appropriate follow-up of ordered laboratory test results.
- Procedures for receiving critical test results that have been ordered
In addition to the Standards, Limits and Conditions outlined in the Health Professional Act - BYLAWS Schedule F, Part 9, pharmacists providing laboratory test services must also comply with CPBC’s Code of Ethics.
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Which laboratory tests are covered as health benefits? (i.e. will not incur an out-of-pocket expense for clients)
Laboratory tests listed in the Pharmacists Laboratory Services Referral Schedule established by the Minister of Health are considered health benefits and can be ordered by pharmacists for medication management without incurring an out-of-pocket cost for clients.
Laboratory tests that are not on this schedule may only be ordered if they support services that fit within pharmacists’ current scope of practice, however clients will be subject to an out-of-pocket cost for them.
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When does a pharmacist need to notify a primary healthcare provider about laboratory test results?
A pharmacist must use their professional judgment and take appropriate action based on laboratory test results. This may include discussing the results with other healthcare professionals or advising the client to seek medical attention when the results are outside the pharmacist's knowledge and competencies, or beyond their legislated scope of practice.
The pharmacist must always discuss with the client or the client's representative the distribution of results to other healthcare professionals.
If the client does not have a primary healthcare provider, and the pharmacist lacks the knowledge and/or competencies to interpret or address the test results, the pharmacist should advise the client to seek further medical attention and inform them about available healthcare resources, as appropriate for the situation.
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Are there any aspects of ordering, receiving and interpreting laboratory tests that can be delegated to pharmacy technicians or other non-registrant pharmacy staff?
No. Under the Board-approved SLC’s, only full pharmacists can order, receive and interpret laboratory tests for the purposes of medication management.
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What should a pharmacist do if a client declines a test that the pharmacist considers necessary or important? Can the pharmacist inform the patient's primary healthcare provider?
A pharmacist must always obtain the client’s or client representative’s informed and voluntary consent before ordering a laboratory test. If a recommended test is declined, the pharmacist may notify the client’s primary healthcare provider of this decision. If the client does not have a primary healthcare provider, the pharmacist should advise the client to seek further medical attention and inform them about available healthcare resources, as appropriate for the situation.
In these cases, the pharmacist must document that the laboratory test was recommended and declined, along with any notification of the primary healthcare provider regarding the decision. The pharmacist should also ensure regular and appropriate monitoring to maintain client safety.
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What are the documentation requirements for pharmacists when ordering, receiving and interpreting laboratory tests?
Pharmacist must document any decision, action, and/or recommendation as a result of interpreting the test results in the client record.
A pharmacist who orders and receives the results of a laboratory test must document and retain a record of the following in a timely manner based on clinical judgement:
- Client information, including personal health number (PHN), if available.
- Acknowledgment of informed consent.
- The test ordered and the reason for ordering it.
- The name of the pharmacist ordering the test.
- The date the test was ordered.
- The results of the test and the date they were received.
- The practitioner to whom the results were forwarded (if at all).
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Are pharmacists required to use laboratory test results when providing patient care, even if they did not order those specific tests?
When asked by the client to interpret tests ordered by another health care professional, the pharmacist must redirect the client to the ordering health care professional or to another health care professional who understands the context in which the test was ordered. The only exception is if the test results are directly relevant to a pharmacy service being provided by the pharmacist.
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How can I access my laboratory test results if no pharmacist is available to interpret them?
A pharmacist who orders a laboratory test must have a system in place that is available 24/7 to ensure appropriate follow-up for the ordered tests. This includes having procedures for receiving and responding to critical test results, with after-hours and emergency contact information to ensure timely response. This responsibility lies with the ordering pharmacist.
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What if the client needs their test results interpreted, but the test was ordered by another healthcare professional?
When asked by the client to interpret tests ordered by another health care professional, the pharmacist must redirect the client to the ordering health care professional or to another health care professional who understands the context in which the test was ordered. The only exception is if the test results are directly relevant to a pharmacy service being provided by the pharmacist.
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Am I obligated to interpret the test results of a client when the ordering pharmacist is not present?
Another pharmacist is not obligated to interpret the results unless they have been identified as part of the system established by the ordering pharmacist for appropriate follow-up. Pharmacists should not refuse to provide service without referral. If they lack the necessary knowledge or context, they should refer the client to someone who can provide the appropriate interpretation.
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How do I obtain my Medical Services Plan (MSP) practitioner number to provide laboratory test services?
Pharmacists must apply to receive a unique Medical Services Plan (MSP) practitioner number. The practitioner number authorizes pharmacists to order selected laboratory medicine tests for eligible MSP beneficiaries and allows laboratories performing these services to submit claims to MSP for remittance. Training information, procedures and other information relevant to pharmacist ordering of laboratory tests will be provided by the Ministry of Health as they become available.
Please visit the Government of BC’s website for more information.