Professional Documents
Culture Documents
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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
.
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
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.
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.
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,
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