Statement No. 806 - Continued Care Prescriptions From Practitioners

The College of Physicians & Surgeons of Manitoba, The College of Registered Nurses of Manitoba and The Manitoba Pharmaceutical Association
(Joint Statement)

Situations may arise where a patient requires a renewal or refill of a prescribed medication and the pharmacist is unable to contact the prescribing practitioner (the definition of practitioner now includes a Registered Nurse (Extended Practice) and would include prescriptions issued by Clinical Assistants (under the delegated authority of a practitioner). In such a situation, the pharmacist may be asked to provide a renewal or refill of the prescription (a “continued care prescription”). Pharmacists who are asked to provide a continued care prescriptions should consider the following principles:

	1.	Continued care prescriptions cannot and do not take the place of ongoing medical care.
	2.	Each request for a continued care prescription must be judged on the individual nature of the patient's need and that patient's history.

Pharmacists may provide a continued care prescription only where the following conditions are met:

	1.	The pharmacist must be satisfied that the prescribing practitioner would in all likelihood provide the authorization were the pharmacist able to contact the prescribing practitioner.
	2.	The medication to be continued must be for a chronic or long-term condition.
	3.	The patient must have an established stable history (no recent changes to dosages or drug therapy) with that medication.
	4.	The original prescription must have been filled at that particular pharmacy, and the patient must be within the care of the pharmacist.
	5.	Narcotics or controlled substances must not be provided by a continued care prescription.
	6.	Benzodiazepines must not be provided by a continued care prescription unless:

	a.	the medication is being used for management of convulsive disorders or
	b.	there is a legitimate risk of seizure due to sudden withdrawal.

	7.	The amount of medication provided must be determined by the pharmacist based upon the circumstances of the particular patient, but must not exceed the previous amount filled.
	8.	All medication dispensed pursuant to a continued care prescription must be:

	a.	recorded by the pharmacist at the time of dispensing,
	b.	reported no later than the next business day by telephone or facsimile to the original prescribing practitioner and to the primary care practitioner if different from the original prescribing practitioner,
	c.	entered into the Drug Program Information Network, and,
	d.	documented in the patient record.

Provided these conditions are met, the continued care prescription will be viewed as a "collaborative practice agreement" between the pharmacist and the prescribing practitioner, where an urgent need for patient drug therapy management has arisen and the prescribing practitioner is unavailable to provide refill authorization prior to the issuance of the medication.

First Print	EXEC	04-02
Revision	EXEC	04-06

A statement is a formal position of the College with which members shall comply.