RPNAS Statement: Long-Term Care (LTC) – Authorized Prescriptions
On January 24, 2024, the Saskatchewan College of Pharmacy Professionals (SCPP) released a statement identifying an interpretation of legislation applicable to Pharmacy Professionals. Provincially, each regulatory body has legislation which indicates who may provide and receive orders/authorizations/prescriptions. The statement identifies who Pharmacists may receive orders from regarding the dispensing of prescriptions.
The RPNAS has recently been notified of this directive, and we are sharing the following information to help clarify the process for RPNs regarding receiving and communicating medication orders/prescriptions for Long Term Care homes to pharmacists:
Background:
The Saskatchewan College of Pharmacy Professionals (SCPP) is the regulator of Pharmacy Professionals in Saskatchewan and has the authority to interpret and enforce legislation pertinent to the functioning of its members. In accordance with SCPP interpretation, all prescriptions must be communicated directly between an authorized prescriber (Physician, Nurse Practitioner, nurses authorized to prescribe, dentists, etc.) and a licensed pharmacy professional for the purpose of dispensing. As Registered Psychiatric Nurses do not have prescribing authority at this time, when an authorized prescriber issues a telephone or verbal order in a long-term care home, the authorized prescriber must ensure that the prescription is directly communicated to a licensed pharmacy professional, rather than through intermediaries, such as nursing staff.
Pharmacists:
- Must receive orders to dispense a prescription directly from an authorized prescriber.
- Dispense prescriptions only when telephone, verbal communication, fax, or electronic orders are provided by, or signed by, an authorized prescriber (Physician, Nurse Practitioner, nurses authorized to prescribe, dentists, etc.).
- When an RPN sends a transcribed order by fax or electronic means, it serves only as a communication signal to the pharmacist that an order from an authorized prescriber should be expected. This alerts the pharmacist to follow up with the prescriber if the prescription is not received.
- The pharmacist will only proceed with dispensing the prescription once the authorized prescriber communicates the order directly with the pharmacy or when the order is received with the prescriber’s signature.
Physicians:
- May provide RPNs with a telephone/verbal order to facilitate timely patient care.
- Must directly provide the prescription to a pharmacist so that it may be dispensed. The prescription will not be dispensed without a signature from an authorized prescriber.
Registered Psychiatric Nurses:
- It is within the scope of practice for RPNs to take telephone/verbal orders from an authorized prescriber. However, the SCPP only allows pharmacists to accept prescription from an authorized prescriber.
- RPNs may be send transcribed medication orders by fax or electronic means to the pharmacist for communication purposes, in accordance with employer policy. However, the pharmacist will not dispense an order sent from a LTC home without first receiving the prescription from an authorized prescriber.
The RPNAS highlights that the directive from the SCPP for its pharmacy members does not inform the scope of practice of RPN members, or the capability of an RPN to safely accept and transcribe verbal or telephone orders. This directive’s primary focus is regarding the procedure for dispensing medication orders from an authorized prescriber to a pharmacy professional for LTC homes.
Key Points:
- Authorized prescribers may still issue RPNs with verbal or telephone orders, allowing the RPN to promptly address patient needs and ensure timely delivery of care within their scope of practice.
- Pharmacists must directly receive the medication order from the authorized prescriber:
- A verbal/phone or faxed/electronic original prescription, signed by an authorized prescriber, is required.
- Medication orders taken by RPNs from an authorized prescriber and sent to pharmacy via fax or electronic means serve as a communication tool, enabling pharmacists to anticipate an incoming order from an authorized prescriber.
- Authorized prescribers are required to directly provide pharmacists with a formal order before the prescription can be dispensed by the pharmacy.
In summary, a pharmacist is only permitted to accept and dispense a telephone/verbal order from a LTC home when it is signed by the authorized prescriber. The pharmacist is not allowed to accept a telephone/verbal or faxed/electronically transcribed order from an RPN for the purposes of dispensing. RPNs are expected to follow all employer policies on this matter and be familiar with agency policies/procedures. RPNs within the environment play an essential role in the collaborative development and adherence to policies to support safe, timely delivery of care.
An RPNAS Nursing Practice Advisor is available should you have any questions at info@rpnas.com