For the past several years, there has been a lot of talk about pharmacists’ scope of practice. Injections, prescribing and laboratory testing, among other services, have been termed expanded, advanced, or enhanced scope of practice activities. As discussed in a previous editorial, the terms we use to describe our profession are important.1 What messages do these terms send? Expanded scope and similar terms suggest that these are luxuries or upgrades, that they are somehow optional (“nice to have”) or exceptional. But, we know from the prodigious evidence (a focus of the Journal),2-7 that these services improve patient outcomes and that patients want them.8 Indeed, these are essential services. Services that all patients should expect and be entitled to receive. We call this “full scope” of pharmacy practice.
Full-scope pharmacist services include all proactive and comprehensive interventions that prevent or manage illness and are within an individual’s competency to perform independently. As the health professionals with the greatest depth and breadth of knowledge on drug therapy, this includes all forms of prescribing (common ambulatory conditions, adaptation [including therapeutic substitution], renewal, initiation of therapy and deprescribing), disease management and ordering and interpreting relevant tests (including point-of-care testing, laboratory testing and diagnostic tests such as pulmonary function). Injection authority under full scope includes all drugs and vaccines, including vaccines for travel. Finally, as front-line health professionals that the public interacts with most frequently, a pharmacist’s full scope also includes screening and prevention for both acute and chronic conditions and the ability to refer to other health professionals when indicated (see Figure 1). This is consistent with CPhA’s Canadian Pharmacists’ Scope 20/20 initiative (see page 348).
Figure 1.
This is not just a semantic argument. Don’t all of our patients deserve access to their pharmacist’s full scope of expertise, no matter where they live? Shouldn’t the full scope of pharmacist practice be defined by evidence, not outdated and restrictive legislation and policy that differ across provinces and workplaces? And don’t all pharmacists deserve to practise in a workplace that supports these activities?
It’s time to give up on “expanded scope” and recognize full scope as the new standard.
Acknowledgments
The authors would like to thank Sarah Gil for her work on the infographic.
References
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