Ethical Decision-Making: Putting Patients’ Interests First

Recently, the NLPB has been alerted to several instances where pharmacists have acted inappropriately when faced with a prescription where the quantity prescribed was less than the full package size of the product. We have heard of situations where the pharmacist has refused to fill the prescription, falsely indicated to the patient that the product was back-ordered, contacted the original prescriber to revise the prescription, or adapted the prescription so that the quantity dispensed matched the package size.

Pharmacists are reminded that, as health care professionals, first and foremost, they are expected to place the health and well-being of their patients at the centre of their professional practice. Making clinical decisions or advising practitioners or patients based on business interests or financial benefit is a direct violation of the Code of Ethics.

Additionally, the Standards of Practice – Prescribing by Pharmacists specifically states:

  • Prescribing decisions must be based on clinical suitability, cost-effectiveness and what is in the best interests of the patient. Prescribing decisions based on biased information or financial advantage may be regarded as constituting conduct deserving of sanction. (section 5.1 b) iv));
  • A pharmacist may change the quantity of medication prescribed as long as doing so will not result in the patient receiving drug therapy for longer than the prescriber intended. (section 5.6 a) ii)); and
  • The pharmacist must be reasonably satisfied that the original prescriber would not object to the adaptation (section 5.6 b) ii)).

Finally, in any situation where a prescription is adapted, pharmacists are also expected to:

  • Obtain informed consent from the patient;
  • Send notification describing the action taken to the original prescriber within one week; and
  • Provide a copy of the documentation to the patient for their records.


Register Today – 2017 NLPB Symposium Registration Now Open!

Registration is now open for the 2017 NLPB Symposium, to be held at the Hampton Inn & Suites by Hilton, St. John’s Airport on Saturday, May 6, 2017.

Registrants are invited to join us in:

  • gaining knowledge and sharing experiences during our Professional Development programs and Open Forum;
  • hearing about the Board’s activities over the past year during the Board’s Annual General Meeting; and
  • celebrating our colleagues’ accomplishments at the NLPB Awards Luncheon.

Schedule of Events
8:00 – 9:00 am Check-In (with Continental Breakfast)
9:00 – 10:45 am Professional Development Program – Personal Health Information Act: A Primer
10:45 – 11:00 am Break
11:00 am – 12:00 pm Professional Development Program – Current Issues – Exempted Codeine & Naloxone
12:00 – 1:30 pm Awards Luncheon
1:30 – 2:15 pm Open Forum
2:15 – 3:00 pm Annual General Meeting

To view the full Schedule of Events as well as hotel and registration information, visit http://www.nlpb.ca/media/Symposium-Brochure-Mar2017.pdf

To register for the symposium, visit www.nlpb.ca, log in using your username and password, and click the blue “Events” button located at the top of the Member Home screen. Once there, click on “View Upcoming Events” and then “NL Pharmacy Board Symposium” to complete the registration process.

We hope to see you there!

Physician Suspension

The NLPB advises registrants that we have been notified that on March 24, 2017, the Registrar of the College of Physicians and Surgeons of Newfoundland and Labrador and Dr. Cyril Riche signed a settlement agreement pertaining to an allegation made against Dr. Riche, which was referred by the Complaints Authorization Committee to the Registrar for alternative dispute resolution in accordance with s. 44(1)(a) of the Medical Act, 2011.

In this settlement agreement, the parties agreed that Dr. Cyril Riche’s licence to practice medicine would be suspended for a period of 30 days. This suspension will be served from May 1 – May 31, 2017.

A summary of the settlement agreement has been posted to the College’s website.

For pharmacists wondering whether or not they can continue to fill Dr. Riche’s prescriptions, in accordance with the Board’s previous advice (as posted on the FAQ page), as long as the prescriber was licensed at the time the prescription was written, it can be assumed that the prescription was written in good faith. As such, as long as the prescription is not more than a year old, it would still be considered a legal prescription. The real question in this instance is whether filling or re-filling the prescription is appropriate – which needs to be assessed on a case-by-case basis.

Therefore, the Board advises pharmacists who receive such requests that it is their professional responsibility to evaluate the appropriateness of the prescription in each individual situation, considering questions related to patient assessment and the patient’s best interests. Questions to consider include, but are not limited to:

  • How long ago was the prescription written? Was it intended to be a short-term therapy?
  • Is the medication for a condition that is considered to be chronic or long-term? If so, does the patient have an established, stable, compliant history with the medication?
  • Is the patient unable to visit a new primary health care provider in a timely manner?
  • Is the patient at an increased risk of harm by filling or refilling the medication? (Or conversely, is the patient at an increased risk of harm if the medication is not provided in accordance with the original prescription?)
  • If the prescriber was still practicing, would I have consulted with the prescriber for any reason before filling or refilling the medication?
  • Is there another option? Would providing an interim supply or prescription extension be appropriate, if indicated?

Regardless of the pharmacist’s decision, the patient should be advised to find a new or interim prescriber as soon as possible.

Application Process for the Installation of Lock and Leave Enclosures

Pharmacists-in-charge are reminded that, as per Section 2.1 of the Standards of Pharmacy Operation-Community Pharmacy, prior to operating a pharmacy with a lock and leave enclosure, an application must be submitted to the Board using the designated form, indicating the anticipated hours that the lock and leave barrier will be in use and describing the physical construction of the enclosure.

In addition, installation of a lock and leave enclosure is considered a renovation to the pharmacy; therefore, an Application for Renovation to an Existing Pharmacy/Dispensary must accompany the Application for Lock and Leave Approval.

Please review the NLPB Policy-Requirements When Renovating a Pharmacy/Dispensary and the FAQ about Lock and Leave for more information regarding pharmacy renovations and the physical requirements and use of lock and leave enclosures.

2017 NLPB Board Elections – Voting in Zone 7 (At Large) Now Open

Voting is now open for the NLPB Board election. The election will be held through our secure, confidential elections portal.

To access the election portal, visit www.nlpb.ca, log in using your username and password and click on “View Candidates and Cast Your Vote”. The deadline for casting your vote is 11:59 pm, April 29, 2017. The successful candidates will be announced at the NLPB AGM on Saturday, May 6, 2017 during the NLPB Symposium.

If you have any questions please do not hesitate to contact Meghan at mhandrigan@nlpb.ca.

This e-newsletter contains information on a wide variety of topics intended to enhance the practice of pharmacy in the province of Newfoundland and Labrador. As it is published and circulated to all registrants on a monthly basis, it is the expectation of the NLPB that all registrants are aware of the matters contained therein.

©2017 Newfoundland & Labrador Pharmacy Board