IIMOAT records in PharmaNet

Last updated on July 26, 2024

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 “(CLINIC)” in the SIG.

Clinic (ward) dose

If a community pharmacy is 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

TMUs in PharmaNet reference sheet: TMUs in PharmaNet for IIMOAT (PDF, 166KB)

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 prescribed safer 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 – IIMOAT CLINIC STOCK DOSE

Buprenorphine/naloxone induction doses given on site or “to-go” to an outpatient

PIN: 66128346 – IIMOAT BUP/NAL SL INDUCTION

Patient missed some or all doses at the clinic from the pharmacy-prepared prescription

PIN: 66128343 – IIMOAT MISSED DOSE @ CLINIC

Dose increased at clinic, and patient received a dose that was more than the pharmacy-prepared prescription

PIN: 66128344 – IIMOAT INCREASED DOSE @ CLINIC

Dose decreased and patient received a dose that was less than the pharmacy-prepared prescription

PIN: 66128345 – IIMOAT DECREASED DOSE @ CLINIC

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

PIN: 66128342

Directions: Fentanyl patches 100 mcg, apply to skin and replace every 3 days

Quantity: 1

Days supply:

Intervention code: SA   

Prescriber name: Dr Bond

PIN: 66128346

Directions:  Microdosing regimen, take home

Days’ supply: 5   

Intervention code: UA

Prescriber name: Dr. Tran

Patient has pharmacy-prepared diacetylmorphine iOAT three times daily

Example 1: 

  • PIN: 66128343
  • Directions: diacetylmorphine injectable, 100 mg dose 1 and 150 mg dose 2
  • Days’ supply: 1  
  • Intervention code: UA  
  • Prescriber name: Dr. Pate

Example 2:

  • PIN: 66128343
  • Directions: Kadian, 700mg, daily  
  • Days’ supply: 1  
  • Intervention code: UA        
  • Prescriber name: Dr. Day

Example 1: Patient has pharmacy-prepared Fentora 400 mcg qid

  • PIN: 66128344
  • Directions: Fentora, 600 mcg, 3rd and 4th doses
  • Days’ supply: 1
  • Intervention code: UA
  • Prescriber name: Dr. Da

Example 2: Patient has pharmacy-prepared suboxone 8 mg / 2 mg

  • PIN: 66128344
  • Directions: Suboxone 16mg/4mg
  • Days’ supply: 1
  • Intervention code: UA
  • Prescriber name: Dr. Fleur

Example: Patient has pharmacy-prepared sufentanil 1,000 mcg five times per day prn

  • PIN: 66128345
  • Directions: sufentanil, 900 mcg 5th dose, new Rx
  • Days’ supply: 1
  • Intervention code: UA
  • Prescriber name: Dr. Yu

For extended-release injectable buprenorphine, PharmaNet must be updated if a patient

  1. is given a dose from clinic (ward) stock
  2. receives a dose that differs from that dispensed by the pharmacy, or
  3. 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.