New Prescription Adaptation Protocols for Pharmacists in Effect on August 1, 2024

New Prescription Adaptation Protocols for Pharmacists in Effect on August 1, 2024

On June 27, 2024, the Board of the College of Pharmacists of British Columbia (CPBC) approved amendments to Professional Practice Policy 58: Adapting a Prescription (PPP-58) enabling pharmacists to adapt for more medications. Additionally, these amendments include changes requested by the Ministry of Health (the Ministry), and the Ministry of Mental Health and Addictions to contribute to work being done to address BC’s toxic drug crisis.

These amendments will come into effect on August 1, 2024.

PPP-58 guides pharmacists in safely and effectively adapting existing prescriptions, enabling them to use their professional judgement to change the dose, formulation, or regimen of a prescription; renew a prescription for continuity of care; and make therapeutic drug substitutions. Adaptation activities are enabled under the Health Professions Act.

During the COVID-19 pandemic, the Ministry urgently requested that CPBC implement changes to allow pharmacists to adapt more medications. As such, changes to PPP-58 were implemented in October 2022 enabling pharmacists to perform adaptations for any prescription with a few exceptions including narcotics, controlled drugs, or targeted substances.  However, due to the urgent nature of the 2022 changes, several potentially beneficial modifications to PPP-58 were deferred, as they required further policy work and consultation.

The recently approved changes continue this work, addressing several key areas to offer greater flexibility and continuity of care for British Columbians.

These changes are outlined below:

Pharmacists may now adapt prescriptions that have been previously adapted.

• When adapting previously adapted prescriptions, pharmacists should keep in mind the following:
  • Every adaptation of a prescription is a new adaptation.
  • An adaptation of a prescription does not create a new prescription or replace the prescription issued by the practitioner.
  • When adapting a prescription that has been previously adapted, it is not the adaptation that is adapted, it is the prescription issued by the practitioner that is adapted again.
    • This means that when adapting a previously adapted prescription, pharmacists must locate and refer to the prescription issued by the practitioner within their pharmacy management software system.
• When transferring a prescription that has been adapted, it is the prescription not the adaptation that is transferred.

Pharmacists may now adapt a prescription from a former practitioner (i.e. a practitioner who is no longer practicing), as long as the prescription at the time of adaptation is otherwise valid.

Pharmacists may now, for continuity of care, renew prescriptions for a narcotic, controlled drug, or targeted substance for a duration that may be longer than prescribed.

• Controlled substances, including Opioid Agonist Treatment drugs, may be renewed for a period that does not exceed the same duration as prescribed, or 30 days, whichever is greater.
• Renewals of prescriptions for narcotic, controlled drug, or targeted substances are only permitted under a section 56 exemption

Pharmacists may now change the dose, formulation or regimen for a prescription for a narcotic, controlled drug, or targeted substance as long as the quantity dispensed does not exceed the stated amount authorized in the prescription.

• Changes to the dose, formulation or regimen for a narcotic, controlled drug, or targeted substance prescription are permitted for the same clinical reasons already specified in PPP-58 for other drugs.
• As is already the case for other drugs, pharmacists may change the dose, formulation, or regimen of a prescription for a narcotic, controlled drug, or targeted substance if the provided information is incomplete or ambiguous. In such cases, the intended treatment must be determined through consultation with the client and a review of the client’s record.

Whenever renewing a prescription for continuity of care, pharmacists must now exercise clinical judgement to determine that there has been no clinically significant change to the prescription for a minimum of three to six months.

• The assessment of whether there has been a clinically significant change must be made at the time of each renewal and this assessment must be based on accepted clinical practices applicable to the condition being treated.

Additional Minor Changes

• Updates have been made to the post-adaptation notification requirements to address the issue of notifying practitioners that are not available to be notified.
• Miscellaneous technical edits have been made to improve clarity and readability of PPP-58.
• The term ‘patient’ has been deleted and replaced with ‘client’ wherever it appears.

Enhancing Cultural Safety and Client-Centered Care in CPBC Standards

As part of the changes to PPP-58, the term "patient" has been replaced with "client" wherever it appears.

This updated language reflects a conscious shift away from the use of the term "patient” to address a more holistic perspective on the relationship between health professionals and those they serve. The term "patient" implies a power imbalance between the caregiver and the recipient of care and has historically been associated with trauma and mistreatment of Indigenous Peoples within the healthcare system.  The term "client" enables agency and supports individual identity in a more collaborative, equitable approach where the individual actively participates in their healthcare decisions. The shift to "client" signals a move towards person-centered care that emphasizes empowerment, autonomy, and partnership.

Going forward, all CPBC bylaws and policies will be incrementally updated to use “client” in place of “patient,” with PPP-58 being among the first to reflect this shift.

This change is a first step towards a deeper integration of CPBC’s Indigenous Cultural Safety, Humility, and Anti-Racism Practice Standard within our regulatory framework.