An Information Paper on Pharmacist Prescribing Within a Health Care Facility

Abstract

INTRODUCTION

In the traditional model of health care, physicians have the authority to prescribe medications, order laboratory tests, and conduct or supervise procedures consistent with a patient’s diagnosis. More recently, prescribing privileges have been extended to other health care professionals, such as nurse practitioners (NP), expanded role nurses (ERN), clinical nurse specialists (CNS), registered midwives, and optometrists. While the roles of some of these health care professionals have evolved to fill gaps in the health care system where physicians are unavailable, most work within a hospital or specialized clinic affiliated with a health care facility. There is a continuing attempt in Canadian health care to contain or reduce costs by reducing patient length of stay in hospital and eliminating inefficiencies and duplication of effort. Pharmacists are increasingly aware that the current process of delivering health care to patients frequently results in drug therapy outcomes that are not as effective, appropriate, safe, or economical as possible and desirable.1-3 They have a responsibility to work toward establishing a better system that could improve the outcomes and cost-effectiveness of drug therapy. It has been postulated that by granting prescribing authority to pharmacists the fragmented and disjointed process of health care delivery could be improved. Improved medication management and continuity of care may be achieved by decreasing the number of steps a patient must take to obtain the optimal medication regimen for their condition.4 It has been argued that if pharmacists truly intend to practise and implement pharmaceutical care, then every pharmacist should be able to maximally utilize their extensive pharmaceutical knowledge by prescribing drugs.5 Having the authority to prescribe medications would facilitate the delivery of more effective pharmaceutical care by some pharmacists. Yet, given the present practice of most pharmacists, it has also been suggested that those with delegated prescribing authority have little advantage over those without it in the overall delivery of pharmaceutical care to patients.6 Currently, many pharmacists in organized health care settings in Canada have some form of authority and responsibility for prescribing. It is important to note that in a survey of Canadian institutions, the Canadian Society of Hospital Pharmacists Task Force on Pharmacist Prescribing found a significant amount of pharmacist prescribing occurring with limited control or regulation7 (see below). This paper is not intended to examine the current state of provincial legislation regarding prescribing authority in Canada. Various degrees of prescribing authority for pharmacists are currently being examined and implemented in a number of provinces (e.g., specially instructed and certified pharmacists prescribing post-coital contraception).