For the past several years, CPhA has observed the expansion of pharmacists’ scope of practice in Canada. Because of how the pharmacy profession is regulated and how pharmacy services are reimbursed provincially, the expansion of professional scope has been variable across the country, with some provinces enjoying both considerable expansion and appropriate reimbursement of pharmacist services, while others have seen less.
This divergence in scope across the country has created confusion for patients, other health care professionals and governments, both federal and provincial; the result is that in many provinces, pharmacists are not able to fully practise to meet the needs of patients.
CPhA has embarked on a major initiative to address this lack of scope congruence by committing to define, articulate and drive a future-forward harmonized scope of practice for Canadian pharmacists. To achieve this goal, CPhA has convened the Professional Practice Working Group (PPWG). Each member of the working group has significant expertise in full-scope, front-line practice, advocacy, regulation and education.
Having met twice so far in 2018, the PPWG has created 4 pillars that will serve as the foundation of this initiative, which has been titled CPS 20/20, or Canadian Pharmacists Scope 20/20. The pillars are as follows:
- Prescriptive Authority: Pharmacists can prescribe medications
- No limitations to drug classes
- Authorization for controlled substances under the Controlled Drugs and Substances Act
- Dispensing Authority: Pharmacists can dispense medications
- Retention and maintenance of current authority
- Clear description and differentiation between technical and clinical dispensing functions, including the evaluation of appropriateness, safe dosage and contraindications together with the review of the patient’s medication profile
- Medication Administration Authority: Pharmacists can administer medications
- An expansion to include broad authority, not limited to subcutaneous or intramuscular injections
- Health Test Authority
- Pharmacists can enhance their clinical assessment of patients by having the authority to order, receive, conduct and interpret health tests, including, but not limited to labs, electrocardiograms, blood pressure and spirometry.
In arriving at the above pillars, the working group was unequivocal in its commitment to the following guiding principles. The harmonized scope of practice must be
Patient centred
Focused on patient care improvement and/or improved access to care
Supportive of patient safety
Supportive of improved interdisciplinary collaboration with other health care professionals
Supportive of improved access to information, especially lab results and drug information from electronic health records
Supportive of professional autonomy
Sufficiently flexible so as to support current clinical priorities, such as the opioid crisis
Supportive of the role of pharmacists as medication management experts
Most important, the harmonized scope of practice must be forward looking and not erode the current scope of practice of any jurisdiction across Canada.
This is truly an exciting and game-changing initiative for the pharmacy profession in Canada, which will allow pharmacists to better meet the needs of their patients and also enhance professional fulfillment by permitting pharmacists to fully use their knowledge and skills. CPhA is fully committed to this initiative, which is completely aligned with our mission statement: Advancing the health and well-being of Canadians through excellence in pharmacist care.
As we near the end of 2018, the PPWG will move forward with CPS 20/20 by further developing each pillar and focusing on the evidence supporting the value for identified pharmacist services. We look forward to sharing this work with you as it is developed and believe that Canadian pharmacists will value the outcomes as CPS 20/20 comes to fruition.