Reminder of the Importance of Patient Identification and Counselling, Including for Deliveries Apr. 21, 2020

Reminder of the Importance of Patient Identification and Counselling, Including for Deliveries

Since the inception of the Practice Review Program, College Compliance Officers have found patient identification verification and counselling to be two of the top areas of non-compliance among pharmacy professionals, with counselling being the top area. 

Pharmacists have a duty and a responsibility to ensure that the right patient takes the right drug at the right dose at the right time AND in the right way to ensure effective drug therapy and patient safety. 

The College would like to remind pharmacists of the importance of positively identifying patients and ensuring that patients understand the medication they are taking and how to take it appropriately to optimize therapy, promote adherence and ensure safety. 

Additionally, to support continuity of care during the COVID-19 pandemic, many pharmacies are seeing an increased demand for medication delivery services. Registrants are reminded that positive patient identification and counselling are required for all medication deliveries. 

Learn More: Patient ID and Counselling during Medication Delivery

Patient Identification

Patient identification verification is always the first step to providing effective pharmacy care. The Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws require that the identity of the patient is confirmed before providing pharmacy services. 

Patient identification is a fundamental standard to ensure that the right patient gets the right drug. 

Learn More: PRP Insights – Patient ID in Community Pharmacy

At the time of dispensing, every prescription in community pharmacy must include written confirmation of the registrant who verified the patient’s identification, in order to take responsibility 

Verification of patient identification can be completed by either pharmacists or pharmacy technicians. 

For NEW patients in community pharmacy:

In cases where the patient is not known to the registrant, positive identification is best achieved by viewing one piece of primary identification or two pieces of secondary identification.  

For RETURNING patients in community pharmacy:

Where a patient is personally known to the registrant, the registrant may positively identify the patient.  Even if the registrant is familiar with and can positively identify the patient, asking open ended questions such as date of birth, address or phone number are still good practices that can further prevent possible mix-ups and errors. However, if a registrant is unfamiliar with a returning patient, as with a new patient, verification of patient identification should always involve requesting the patient present one piece of primary or two pieces of secondary ID.

Patients without primary or secondary ID 

Where a patient or patient’s representative does not have a primary or secondary ID, the registrant should use their professional judgement in identifying the patient or patient’s representative. These steps should be documented. 

The table below outlines various types of acceptable primary and secondary IDs

Counselling

Results from practice reviews show that counselling is the top area of non-compliance. Pharmacists are required to ensure that patients know about the medication they are taking and that they understand how to take it appropriately. The Health Professions Act (HPA) Bylaws require a fullpharmacist to consult with a patient or patient’s representative at the time of dispensing a new or refill prescription. 

Learn More: PRP Insights – Counselling in Community Pharmacy

Every prescription, both new and refill, requires counselling by the pharmacist on their respective requirements, and must include a written confirmation of the pharmacist who performed the consultation. Simply having the pharmacy assistant or technician ask the patient “Do you have any questions for the pharmacist?” is not acceptable. 

Similarly, when the pharmacist counsels, simply asking the patient if they have any questions without counselling on all requirements is not acceptable. A lack of questions from a patient is not considered declining a consultation. If a patient declines the consultation to the pharmacist, the pharmacist must document that the consultation was  declined. 

Counselling for NEW prescriptions must include:

• Confirmation of the identity of the patient
• Name and strength of drug 
• Purpose of the drug 
• Directions for use of the drug including the frequency, duration and route of therapy 
• Potential drug therapy problems, including any avoidance measures, and action recommended if they occur 
• Storage requirements
• Prescription refill information 
• How to monitor the response to therapy 
• Expected therapeutic outcomes 
• Action to be taken in the event of a missed dose 
• When to seek medical attention
• Issues the pharmacist considers relevant to the specific drug or patient 

Counselling for REFILL prescriptions must include:

• Confirmation of the identity of the patient
• Name and strength of drug 
• Purpose of the drug
• Directions for use of the drug including frequency and duration
• Whether the patient has experience a drug therapy problem

Patient ID and Counselling during Medication Delivery

To support continuity of care, some pharmacies are able to deliver medications,  and these services have seen increased demand during the COVID-19 pandemic. 

The College has also recently amended Professional Practice Policy-71 to allow pharmacists to use their professional judgement to deliver Opioid Agonist Treatment (OAT) drugs to a patient if they feel it is safe, appropriate and in the best interest of the patient to do so. 

The College would like to remind registrants that positive patient identification and counselling are required for all medication deliveries. 

Delivery of OAT by Non-Pharmacists 

Temporary amendments to Professional Practice Policy-71 allowing pharmacists to authorize regulated health professionals and, in exceptional circumstances, pharmacy employees (including pharmacy technicians and pharmacy assistants), to deliver OAT are now in effect. 

When giving this authorization, the pharmacist must ensure that the regulated health professional, or pharmacy employee has the appropriate knowledge and competence to properly identify the patient. 

Additionally, a pharmacist must provide proper counselling if not in person, then by phone before the authorized individual releases the dose to the patient. 

Questions 

For questions related to patient identification and counselling in community pharmacy practice, please contact the College’s Practice Support department at [email protected].