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Directives and Prescriptions
I am a public health nurse working in a sexual health clinic. The clinic’s physician has written a medical directive which allows myself and the other nurses to provide contraception to clients. One of my clients wants to pick up her birth control pills at her pharmacy instead of our clinic. Under the directive, can I communicate the order to an external pharmacist to dispense the prescription to the client?
Yes, you can. Nurses and pharmacists who implement directives are not prescribing the medication, rather they are using the directive to provide medication to clients, provided the conditions and circumstances outlined in the directive have been met. It is your responsibility to ensure the directive is clear, complete and appropriate, as outlined in the Medication practice standard.
In this scenario you have the appropriate authorizing mechanism in place to implement the client’s treatment plan. The medical directive is the order for dispensing. This means to select, prepare and transfer stock medication for one or more prescribed medication dose to a client or the client’s representative for administration at a later time.
It is your responsibility to assess the client to make sure she meets the conditions outlined in the directive. If the conditions are met, you can request the pharmacist to dispense the medication to the client.
What should I consider before contacting the pharmacist?
Before you contact the pharmacy, review your organization’s policies on communicating prescriptions to pharmacists. These policies usually include procedures to make sure all information remains confidential, there is no miscommunication and the medications are safely dispensed. If your workplace doesn’t have any policies, we encourage you to work with your employer and other members of the healthcare team to help develop policies and procedures that support:
- Confidentiality and privacy,
- Safe dispensing of medications,
- Clear, effective communication, and
- Timely access to care.
For more information, please review:
- Directives practice guideline
- Medication practice standard
- Confidentiality and Privacy – Personal Health Information practice standard
- The Federation of Health Regulatory Colleges of Ontario (FHRCO)’s An Interprofessional Guide on the Use of Orders, Directives, and Delegation for Regulated Health Professionals in Ontario
- FHRCO’s Interprofessional Collaboration (IPC) eTool