Guidelines

Continued Care Prescriptions

Situations may arise where a patient requires a renewal or refill of a prescribed medication yet is temporarily unable to contact the prescribing physician. 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 physician would in all likelihood provide the authorization were the pharmacist able to contact the physician.

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 most recent 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 or 30 days supply whichever is the lesser amount.

8. All medication dispensed pursuant to a continued care prescription must be:

a) recorded by the pharmacist at the time of dispensing,
b) 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 physician, i.e. a temporary delegation of function where an urgent need for patient drug therapy management has arisen and the prescribing physician is unavailable to provide refill authorization.

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