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* PHARMACISTS
ASKEDQUESTTONS
FREQUENTLY
0.
who is employedin a communitypharmacythatprovidesMMT
A. Any pharmacymanageror pharmaoist
MMTTrainingProgram.
servicesis requiredto takethe mandatory

o.
all pharmacy
Treatment,
practicePolicy-66(PPP-66)Methadone
Maintenance
A. As per professional
relatedto
pharmacy
services
pharmacy
thatcurrentlyprovides
managersemployedin a community
whocurrentlyprovidecommunity
andall staffpharmacists
Treatmen,t
MethadoneMaintenance
Treatmentor thosepharmacymanagersor
Maintenance
pharmacyservicesrelatedto Methadone
pharmacy
servicesrelatedto Methadone
providing
community
whoanticipate
staffpharmacists
Treatment:
Maintenance
CPBCtrainingprogramby september30,2011
. successfully
completethe mandatory
in the CPBCMethadone
identified
practicerequirements
o lmplementall necessary
PolicyGuideby January1,2012
Treatment
Maintenance

0.
thatare describedin the PPP-66Policyand PolicyGuideshouldbe
A. All practicerequirements
no
trainingbutMUSTbe implemented
themandatory
as soonas youhavecompleted
implemented
butarenotlimitedto,thefollowing:
laterthanJanuary1,2012.Theyinclude,
.
o

PracticePolicy-66
as statedin Professional
Obtainall requiredreferences
purposesas discussed
for documentation
formsthatare necessary
Obtainall appropriate
(inWord
in thePolicyGuideandindividually
available
Session,
the MMTTraining
throughout
underKey
and PDFformat)on the Gollegewebsite(wvwv.bcpharmacists'orq)
Treatment(MMT)
Maintenance
lnitiatives/Methadone
as
equipment statedin the PolicyGuide,for exampleglasscylinders
Obtainany necessary

any pharmacy
Treatment,
practicePolicy-66(PPP-66)Methadone
Maintenance
A. As per professional
servicesrelatedto
pharmacy
thatwantsto providepharmacy
manageremployedin a community
provide
community
to
whowants
Treatmentandanystaffpharmacist
MethadoneMaintenance
Treatmentmust:
Maintenance
pharmacyservicesrelatedto Metfradone
CPBCtrainingprogramand haveall the necessary
. Successfully
completethe mandatory
TreatmentPolicy
Maintenance
as identifiedin the CPBCMethadone
practicerequirements,
Treatmentservices'
Maintenance
Guide,in place@t to providingMethadone

situationrelatedto
""'ln an emergency
A. The PPP-66PolicyGuide,Policy6.3,Principle6'3'1,states
who hascompletedthe
(ie.a pharmacist
continuityof care,wherea referralto a quaiitiedpharmacist
training'may
mandatory
who has notcomptetedthe
a pharmacist,
MMTtraining)is not possibte,
Professional
in
if theyadhereto the SevenFundamentalsestablished
dispensethe methadone

". The
as outtinedin the
PracticePolicy(PPP-58)- Adaptinga Prescription
Guidelineto this Principlegoeson to say" shouldthepatientrequireongoingcarethepharmacist
laid out in PPP-66.This
mustensurethat theycomply,as quicktyas possrb/e,withthe requirements
includes,but is not limitedto, the successfu/comptetionof the mandatorytrainingsessron..."

a.

them?
can be foundat thefollowing:
The requiredreferences
.

of BC's PPP-66MethadoneMaintenanceTreatment:Policv
The Collegeof Pharmacists
underKey
Guidecanbe foundon theCollegewebsite(www.bcpharmacists.orq)
(MMT)
Treatment
Maintenance
Initiatives/Methadone
and Surgeonsof BC'sMethadoneMaintenanceHandbook
The Collegeof Physicians
) underAboutthe College/Programs/BC
eo\gl is availableon theirwebsite(
Program
Methadone
A Pharmacist's
The Centrefor Addictionand MentalHealth'sMethadoneMaintenance:
Addictionand
for
purchase
Centre
the
on
for
is
available
Guideto Treatment,ld Edition
Publications/Substance
underPublications/CAMH
MentalHealth'swebsite(vyr,nnrv.camh.net)
Use

a.
TrainingSessionis
the 'ONLINE'
however
scheduled,
no 'LIVE'TrainingSessions
A. Therearecurrently
underKeylnitiatives/Methadone
availableon the Collegewebsite(unvw.bcpharmacists.orq)
'LIVE'sessions
willbe
pharmacists
becomeavailable,
(MIVT).
lf additional
Treatment
Maintenance
notifiedby email.

o.
,ONLINE,
foryouto viewat anytimeon theCollegewebsite
MMTTrainingSessionis available
(MMT)'The
Treatment
Maintenance
unOerKeyInitiatives/Methadone
(www.bcpharmacists.orq;
just
,oNLlrugrMur
presentation
PowerPoint
recorded,
Trainingsessionis an audio
formatof the
stop
to
able
participants
are
and
is required
24t7.No registration
overt hourin lengthandavailable
andstartthe sessionas necessary'

A. The

a,
websiteindefinitely'
on theCollege
willbe available
Session
MMTTraining
A. The'ONLINE,

0.

of
pleaseretainit in thefilesat yourprimarypharmacy
A. once you,vesignedthe Declaration,
employment.Youarery!requiredtoforwardacopytotheCol|ege'

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prease

prescription?
What is an ouoriginal"
ppp-sg orientationGuidea "new and/ororiginal"prescription
ln the glossaryof terms includedin the
be the beginningof a new drug
is defined as: the first fill of a prescriptionand does not need to
is required'
therapy.Althoughthis definitionremainsaccuratefurtherclarification
from any prescriber'In
An ',original"prescriptionmay be a new written,verbalor faxed authorization
may be a fax-backor verbal
addition,an "original"prescription
prescriber'
a
by
refillrequestauthorized

be used
which of the new clinical services fee intervention codes shotlld
for missing information?
however,depending
codefor missinginformation,
pharmaCarehas not defineda specificintervention
codethat bestfits
the
choose
and
on the situation,pharmacistsshoulduse theirprofessionaljudgment
For example:
the circumstance.
o
.

lf no dose or no quantitywas provided


- use Nl (dosagechange)
lf no directionswere Provided
- use NK (directionsfor use modified)

procedures refer to the


For more information regarding clinical services fee processes and
Newsletter
BCPharmaCare
December22'2008,Edition08-012

environment)what are the restrictions


medicalconAitionsfor adaptingprescriptions?
pharmacistmay adapta
Thereare differingguidelinesfor the threedistinctwaysin whicha community
varywith eachtypeof adaptation'
thereforethe restrictions
prescription(change,renewor substitute),
Change:
r

disease'
for: cancer,cardiovascular
will not changethe doseor regimenof a prescription
missing
complete
can
asthma,seizrlresor psychiatricconditions,howeverpharmacists
informationifthereishistoricalevidencetosupportit.

Renew:

whichare restrictedfrom
With the exceptionof narcoticsand/orcontrolledsubstances,
reservedfor pharmacists
are
which
and psychiatricmedications
any type oi ao'aptation
for renewalsas long
thereare no restrictions
environments
workingin multi-disciplinary

samemedication'without
as the conditionis stable,chronic(definedas beingon the
6
is up to approximately
renewal
change,for a minimumof 6 months).The maximum
monthsfrom the dateof the originalprescription'
TherapeuticSubstitution:
anti-inflammatory
o Limitedto: histamine2 receptorblockers(H2 blockers),non-steroidal
(ACE
inhibitors)'
inhibitors
enzyme
converting
angiotension
drugs(NSAlDs),nitrates,
pump
proton
ccBs) and
calciumchannelblockers(dihydropyridine
dihydropyridine
policies'
(PPls)- similarto government
inhibitors

What happensto the authorizedrefiltswhen a prescriptionls adapted?


The
for the adaptedprescriptionas well as the authorizedrefills'
The pharmacisttakes responsibility
but reduceor eliminatethe
pharmacistcouldchooseio providean initialadaptationof the prescription
rationalefor their decisionin their
authorizedrefills.lf they did this they would need to providethe
return to their physicianearlier than
documentationand inform the patient that they will need to
authorizedby the prescriber)'
intended(note: a pharmacistcannot add refillsthat were not initially
providedin the notificationto the
whatever the final decisionis, it must be properlydocumentedand
prescriber.
refills,when the patientreturns
lf the pharmacistadaptsthe prescriptionand maintainsthe authorized
any other refill prescription'The
for a refill the pharmacistwould processthe refill as they would
per se' so the
processingof a refill of an adapted prescriptionis not consideredan adaptation
of PPP-58do not apply'
and notificationrequirements
documentation
pharmacistis on duty that
Should the patient return to the pharmacyfor a refill and a different
it underthe adapting
pharmacistwould again processthe refillas they wouldany other refill,keeping
of the adaptedprescriptionthey
pharmacistslD. lf they have a concernabout the appropriateness
a prescription;refuseto fill'
should do what they normallydo if they have a concernabout refilling
patient
back to the adapting
providean emergencyfill if necessaryand in this case either refer the
pharmacistor to the originalprescriber.
prescriptionand maintainsthe
Finally it is importantto note that when a pharmacistadapts a
this the prescriptionis now
authorizedrefillsthey must informthe patientthat as a resultof themdoing
pharmacyin orderto get
which meansthe patientwill need to returnto this specific
non-transferable
theirrefills.

meanthat I cannotadaptor renewthis prescription?


regardinggenericsubstitution
Yes. Just like we honour notationslike this from prescriberstoday
Adapt" instructionson
pharmacistsare expected to honour hand-written"Do Not Renew 8/or
agreed that pre-printed
prescriptions. The college of Physicianand surgeons (CPSBC) have
producestheir prescriptionthey
prescriptionpads are not acceptableand if a physicianelectronically
mustsign or initialbesidethe notation
with a validnotationon a prescription'
It is importantto rememberthat shoulda pharmacist,presented
the patientthereare a numberof options
stillfeel that an adaptationor renewalis in the best interestof
permissionto adaptor renewthe prescriptionor
still availableto them:contactthe prescriberfor prior

providean emergencyfill (PPP-31)to ensurecontinuityof care


theirphysician.

givingthe patienttime to get in to see

to
What are the limits and conditions,includinglengthof time,with respect
renewingprescriptionsfor my patients?
for a patienta pharmacistmustensurethe
When consideringwhetheror not to renewa prescription
following:
is stillvalid' and
in theirpharmacyand the prescription
a. They havethe originalprescription
samemedication'
b. The patients,.onditionis stableand chronic(definedas beingon the
withoutchange,for a minimumof six months)'
fundamentals' couldprovide
Assumingtheseconditionsare met a pharmacist,by applyingthe seven
prescription.
a |."ne*al for up to six monthsfrom the dateof the original
Example(s):
25mg,daily,100- pharmacistcouldprovideone renewalof
e Hydrochlorothiazide
six
2Smg,oaity,too (note:althoughthisis slightlyoverthe maximum
Hydrochtorothiazide
CPSBC)
the
and
college
by
the
monthstimelineit is completelyacceptable
25mg,daily,30 - pharmacistcouldprovideone renewalfor
o Hydrochlorothiazide
provide
25mg,Oaily,tOO,ihen afterthe 100days,afterassessment'
Hydrochlorothiazide
a secondrenewalfor 60 daYs'
with respectto the typesof conditionsor drugs(otherthan narcotics
Althoughthereare no restrictions
to whicha pharmacistcould
and controlledsubstanceswhichare restrictedfor all adaptations)
to psychiatricmedications'
respect
shouldbe takenwith
considera renewal,specialconsideration

in which I
prescriptionsdose,formulationor reg
been establishedwhich
Assumingthat no collaborativerelationshipsor appropriateprotocolshave
substitutionin most typical
would provide more detailed patient medical information,therapeutic
(similarto governmentpolicies):
communitypracticesis limitedto the followingclassifications
o Histamine2 receptorblockers(H2 blockers),
o Non-steroidal
anti-inflammatorydrugs(NSAlDs)'
o Nitrates.
. Angiotensionconvertingenzymeinhibitors(ACE inhibitors),
ccBs), and
.
calciumchannelblockers(dihdropyridine
Dihydropyridine
o

(PPls)
Protonpumpinhibitors

pharmacistsworking in typical
With respectto making changesto a prescriptiondose or regimen,
for patientswith:
prescriptions
communitypracticesettings,as describedabove, would not adapt
psychiakic conditions. Changes to
cancer, cardio-vasculardisease, asthma, seizures or with
a tabletto a liquid' as
prescriptionformulationsto ensurecontinuityof care, such as switchingfrom
if there is historicalevidenceto supportit'
well as completingmissinginformationfrom a prescription,
wouldbe acceptable.

r
I
then renewit?
they must
existingprescription
No. In orderfor a pharmacistto evenconsideradaptingor renewingan
adapt or
to
order
in
,originalprescription'in their pharmacy.The reasonfor this is because
have the
and a
them
informationavailableto
renew a prescriptiona pharmacistmust have all relevant
'original'prescriptionwhich may have some
transferredprescriptiondoes not physicallytransferthe
prescriptionhas been adaptedit can not be
importantnotationson it. For similarreasons,once a
transferred.

Why did the College establish PPP-58?


activitiesnow, such as making
You probablyalready performmany prescriptionadaptation-related
interim supply of a medicationto
minor adjustmentsto prescriptiondetails or giving patientsan
today and gives pharmacists
maintaincontinuityof care. PPP-58 goes beyond what is available
and provides the
prescription
of a
independentauthorityand accountabilityfor the adaptation
frameworktoguidepharmacistsinsafeandeffectivepractice.
maximizetheir full educationaland
The policy, which providesthe opportunityfor pharmaciststo
the process of' exercising
professionalcompetencies,also provides structure to, and refines
pharmacistsevolve
in clinicalpractice.This becomesincreasinglyimportantas
professionaljudgment
theirrole as medicationexPerts'

Do I haveto adaPta PrescrlPtion?


or not is at the discretion
prescription
No. Authorizationdoes meanobligation.The decisionto adapta
however'the
prescription
to adapt a
of the individualpharmacist.Whenevera pharmacistchooses
within the limits of the pharmacist'sown
adaptationmust be done in accordancewith PPP-58and
competencies.

actice?
to adapt prescriptions'with your
It makes good practicalsense that pharmacistsare authorized
t r a i n i n g i n d r u g t h e r a p y , b e i n g a b | e t o a d a p t p r e s c r i p t i o n s m e a n s t h a t p a t i e nPatients
tswi||ha
veaccessto
will
than in the past'
medicationmanagementservicesfrom pharmacistsmore effectively
continuityof on-goingtherapy
have improvedaccessto drugtherapyrenewalsto ensureuninterrupted
the delaysassociatedwith contactinga
for chronicconditions.Pharmacistswill be able to eliminate
Pharmacist
or improvementof drugtherapywith a prescription'
modification
prescriberfor clarification,
documentation
communication'
will irnprou"inter-professional
involvementwith adaptingprescriptions
are all positivestepsfor health
which
consent,
and
of care and patientinvolvementin decision-making
c a r e . T h e b o t t o m | i n e i s t h a t B r i t i s h C o | u m b i a n s h a v e a s k e d f o r q u i c k eprocess
r , m o r eand
c o nhas
v e nthe
ientaccessto
first step in this
prescriptionrenewalsand optimaldrug therapies.PPP-58is the
potentia|toa|sofreeupphysiciantimetoseepatientsinneedoftheirservices.

Are there specialrequirementsneededin orderto adapta prescription?


the
yes. In orderto adapta prescription
in additionto havingreadand understood
a pharmacist,
liability
Guide,must possessprofessional
to the Orientation
Guideand Amendment
Orientation
a
for
adapting
(minimum
insurance
$2 million)and mustadhereto all of the sevenfundamentals
prescription
in PPP-58.
as outlined

will my patientsknow that I'm qualifiedto adaptprescriptions?

you are responsiblefor informingpatientsof your authorityto adapt a prescriptionand for deciding
whetheror not you are preparedto make an adaptationwhen appropriate.All pharmacistswho are
to the
licensedin BritishColumbiaare requiredto have read the OrientationGuideand Amendment
and
OrientationGuide by December31, 2008 and pharmacists'authorityto implementPPP-58,
ts effectiveJanuary1' 2009'
therebyadaptprescriptions,

How wilt the Collegeensurequalitymedicationmanagementactivitiesby


pharmacists?
providesafe and
The College'smissionis to protectthe publicby ensuringthat Gollegeregistrants
Outcome
effective pharmacy care to help people achieve better health. The College's Quality
in their
PPP-58
apply
to
procedures
required
processes
and
SpecialistStaffwill includea reviewof the
on-goingsite visits.

Will I be able to adaptprescriptionsfor narcotics?


for narcotics,controlleddrugs or
No. ppp-Sg does not authorizepharmaciststo adapt prescriptions
targetedsubstances.

plan,has directedcollege staffto


college councilrecently,throughinclusionin the college'sstrategic
,,developa plan to encouragethe governmentto authorize advanced professionalpractice for
pharmacists
in BC".

Do I haveto eompletethis orientationif I don't plan to adapt

prescriptions?

giventhat PPP-58enhances
prescription,
Yes. Althoughit is not mandatorythat a pharmacistadapta
that they have read
pharmacists,scope of practice,it is mandatorythat all registrantsacknowledge
Guide and the
orientation
the
in
and understoodPPP-58(by signingthe DeclarationForm included
Guide)by December31,2008'
to the Orientation
Amendment

PPP58FAQSv2011.1

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