IIMOAT records in PharmaNet
Last updated: December 23, 2022
The Integrated Interdisciplinary Model of Opioid Agonist Treatment (IIMOAT) was launched in December 2022 by the BC Centre on Substance Use (BCCSU). This model outlines the responsibilities of healthcare professionals involved in the care of people using opioid agonist treatment (OAT).
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IIMOAT
The Integrated Interdisciplinary Model of Opioid Agonist Treatment (IIMOAT) was launched on December 21, 2022 by the BC Centre on Substance Use (BCCSU). IIMOAT seeks to improve patient care and health outcomes by reducing the number of places people need to visit to get medication and support for OAT.
The College of Pharmacists of BC has updated Professional Practice Policy 66 – Opioid Agonist Treatment to allow pharmacists to share the responsibility of providing OAT with community health facilities, to support patients where they are at and to provide patient-specific OAT and clinic stock of OAT drugs. Read more about the PPP 66 updates.
IIMOAT applies to all outpatient settings, including ambulatory care and outpatient clinics of hospitals. Correctional facilities are not included. This interdisciplinary model for OAT is available to all healthcare professionals involved in OAT care, including pharmacists, nurses (RNs, RPNs and LPNs), nurse practitioners, physicians and nurse prescribers.
For detailed information about IIMOAT, visit the BCCSU website.
For sites that adopt IIMOAT, these are some of the key changes:
- Nurses can witness ingestion and provide take-home doses of pharmacy-prepared patient-specific medication when authorized in writing on the patient’s OAT prescription
- Nurses must document any changes they make to pharmacy-prepared patient-specific medication—such as increased doses, decreased doses, or missed doses—on PharmaNet using the transaction medication update (TMU). This must be done by the end of the clinic day or shift. See below for TMUs. TMU entry is not a pharmacy responsibility.
- If a patient needs a dose or a take-home dose (e.g., bupe-to-go induction packages) and a pharmacy is not able to prepare it, nursing can prepare and provide it through clinic stock.
- This must be documented and entered in PharmaNet by using the TMU function
Pharmacy actions
Patient-specific dose
If a pharmacy-prepared dose is delivered to a community health facility to be witnessed there, pharmacists will enter the relevant methadone PIN for without direct interaction.
If providing a patient-specific pharmacy-prepared dose to a community health facility, enter “Sent to clinic” in the SIG.
Clinic (ward) dose
If providing clinic (ward) stock to an outpatient health facility for purchase, enter under the pharmacy’s O-Med PHN. As per usual, patient-specific doses are not to replace clinic (ward) stock.
TMU entry is not a pharmacy responsibility. The TMU PINs below are for clinicians at outpatient health facilities.
To ensure continuity of care and patient safety, healthcare professionals must maintain up-to-date patient medication histories in PharmaNet.
When providing OAT, prescribers should update PharmaNet patient histories by entering TMUs – transaction medication updates. This is required when:
- An emergency department provides a take-home dose, such as bupe-to-go
- A clinic or ER dispenses clinic (ward) stock
- A patient receives a higher or lower dose than the pharmacy-prepared dose
- A patient misses one or more doses of OAT
The tables below show how to record controlled substance dispenses in TMUs (e.g., for opioids, stimulants or benzodiazepines). Different vendors may have different processes, so consult your PharmaNet software vendor (e.g., Medinet) for more detailed instructions on entering TMUs.
PharmaNet entry instructions
All entries must be made by end of clinic day or end of emergency department shift during which the action occurred.
Note that the TMU Directions field has an 80-character maximum.
TMU entry is not a pharmacy responsibility. The TMU PINs below are for clinicians at outpatient health facilities.
Intervention Codes are a mandatory field in TMU, please use:
- SA = safer alternative - prescribed safer supply every fill/dispense, OR
- UA= consulted prescriber and filled Rx as written (not safer prescribed supply)
| Clinic (ward) stock used (enter PIN in DIN field) | Changes made to patient-specific pharmacy-prepared doses (enter PIN in DIN field) | ||||
|---|---|---|---|---|---|
| Situation |
Providing a dose when there is no pharmacy-prepared prescription PIN: 66128342 – clinic (ward) stock dose |
Buprenorphine/naloxone induction doses given on site or “to-go” to an outpatient PIN: 66128346 – buprenorphine/naloxone induction doses |
Patient missed some or all doses at the clinic from the pharmacy-prepared prescription PIN: 66128343 – missed dose |
Dose increased at clinic, and patient received a dose that was more than the pharmacy-prepared prescription PIN: 66128344 – dose increased at clinic visit |
Dose decreased and patient received a dose that was less than the pharmacy-prepared prescription PIN: 66128345 – dose decreased at clinic visit |
| What to enter in PharmaNet |
PIN: 66128342 Directions: drug, dose and directions, time Quantity: # of tablets / capsules / patches, volume of injection (mL) Days’ supply: 1 Intervention code: UA or SA *Please do an entry for each molecule/drug provided by clinic stock (excluding bup/nlx - see below) |
PIN: 66128346 Directions: standard dosing, microdosing or total dose taken/provided Days’ supply: as appropriate Intervention code: UA |
PIN: 66128343 Directions: drug, which dose(s) missed Days’ supply: as appropriate Intervention code: UA |
PIN: 66128344 Directions: Drug name, total dose taken Days’ supply: as appropriate Intervention code: UA *Only use this one PIN, even if providing with clinic stock |
PIN: 66128345 Directions: Drug name, total dose taken Days’ supply: as appropriate Intervention code: UA |
| Sample PharmaNet entry |
|
|
Patient has pharmacy-prepared diacetylmorphine iOAT three times daily Example 1:
Example 2:
|
Example 1: Patient has pharmacy-prepared Fentora 400 mcg qid
Example 2: Patient has pharmacy-prepared suboxone 8 mg / 2 mg
|
Example: Patient has pharmacy-prepared sufentanil 1,000 mcg five times per day prn
|
For extended-release injectable buprenorphine, PharmaNet must be updated if a patient
- is given a dose from clinic (ward) stock
- receives a dose that differs from that dispensed by the pharmacy, or
- missed a dose, i.e., the patient did not receive the pharmacy-prepared dose within the clinic protocol or within a clinically appropriate treatment interval
Access to PharmaNet
Prescribers and nurses must be authorized to access PharmaNet to view and add notes to patient profiles. Request access by enrolling in PRIME. Be sure to select the correct care setting, e.g., health authority or private community health practice. Learn more at PRIME.
"SA" for safer alternative
Prescribers and pharmacists are reminded to add the letters “SA” (for safer alternative) to prescriptions and PharmaNet entries for prescribed harm-reduction drugs. When writing a prescription for a drug as an alternative to the toxic street supply (i.e., for risk mitigation or as a safer supply option), clearly write or type “SA” at the bottom of the Directions for Use section of the BC Controlled Drugs Prescription form. This alerts the dispensing pharmacist to tag the prescription with a (non-public) identifying code in PharmaNet for program evaluation purposes.
