Prescriptions - EPNMP.04

To create a prescription on PharmaNet, enter the prescription in your software application as you normally would. As soon as you authorize the prescription, it is sent to PharmaNet (unless you specify otherwise) to update your patient’s prescription information and the record becomes visible to authorized care providers.

Note: If PharmaNet is down:

• you must opt not to send the prescription to PharmaNet, and
• the patient will need to present a printed, signed prescription at their pharmacy.

If the pharmacy has access to PharmaNet ePrescribing functionality, the pharmacist can enter the prescription; if not, the prescription will be dispensed using the paper prescription.

If you submit a prescription to PharmaNet and it is not validated, you will receive an error message. You must correct and resubmit the prescription.

Record a Prescription (ePrescribe)

1. Confirm the patient’s identity: Whenever you open a chart during a patient interaction, you must confirm the patient’s demographic information through the Client Registry. As long as the demographics in your patient’s chart match those in the Client Registry you will have access to their PharmaNet data.
2. Review the medication profile: Review the patient’s medication profile before creating a prescription so you are aware of the patient’s medication history.
3. Create the ePrescription:  Create the prescription in your local software application.
4. Indication Code: It is recommended that you enter an indication code for the prescription. In PharmaNet, this will provide valuable information to other providers when they review a patient’s medication profile.
5. Directions for use: For clarity, when entering directions for use, you should not use abbreviations (such as “PRN” for “as required”) unless your software is capable of translating those abbreviations into full text before the prescription is sent to PharmaNet.
6. Send to PharmaNet:  Once you complete the prescription, it is is sent to PharmaNet unless you specify not to send it (i.e., in the case of the network not being available).
7. Interaction Checking or Drug Use Evaluations (DUE): When prescribing a medication you should request a DUE check before submitting the prescription to PharmaNet.

Note: If your EMR provides its own interaction checking you will be displayed a drug use evaluation warning prior to submission to PharmaNet.

You must review this warning before deciding on the next clinical steps.

If a DUE warning is displayed before you submit the prescription to PharmaNet, and you choose to prescribe the medication despite the warning, you must enter a reason in the Prescriber Notes field to alert the pharmacy (as the pharmacy will also receive a warning when dispensing the medication).

If a DUE warning is displayed after you submit the prescription to PharmaNet, you can choose to revoke it or leave it as is.

8. Print the Prescription: Your patients will require a printed, signed prescription to take to the pharmacy.
   
   Note: This will be necessary until all pharmacies have implemented ePrescribing functionality.

Prescription Record for Your Patient

Patient’s may also be given a printed copy of ePrescription information for their own records. When you print the prescription record, it will include the following statement

 “THIS IS NOT A PRESCRIPTION. IT IS FOR PATIENT INFORMATION ONLY.”

It includes:

• PharmaNet Prescription Identifier;
• Prescription Date;
• Patient name, address and PHN;
• The name of the drug or ingredients and strength, if applicable; and
• The name and identification number of the prescribing practitioner.

Medical Device Prescriptions

When you create a prescription for a medical device, you must:

• include the name of the device; and
• indicate that you are prescribing a device and not a medication.

Narcotic or Controlled Substance Prescriptions

When you prescribe narcotics that are part of the College of Physicians & Surgeons Prescription Review Program, you must:

• follow all requirements of the BC College of Physicians & Surgeons, including completion and retention of the duplicate prescription form;
• include the pre-printed folio number from the duplicate prescription form when recording the prescription in your software application; and
• provide your patient with their copy of the signed duplicate prescription form to present at the pharmacy.

Prescriptions Created by Non-prescribers

If a non-prescribing user delegated to prepare prescriptions, such as a resident or a nurse, creates a prescription for a physician, the physician must approve the prescription as soon as possible to ensure it is sent to PharmaNet before the patient arrives at the pharmacy.

When PharmaNet is Unavailable

If you receive a system message that PharmaNet is not available, you must record the prescription in your EMR and choose not to send it to PharmaNet. The patient must be given a signed, paper prescription to take to the pharmacy.

Revoking an ePrescription

If you submit an ePrescription to PharmNet in error, revoke it immediately.

Revoking the PharmaNet prescription:

• updates the status of the prescription to “revoked”, preventing it from being dispensed; and
• removes the prescription from subsequent PharmaNet DUE checking.

Revoke an ePrescription if you:

• make an error in recording the prescription;
• decide not to prescribe the medication; or
• change your decision to prescribe based on a PharmaNet DUE message.

Note: Your software application may provide drug interaction checking on prescriptions before you approve and submit them to PharmaNet. You do not have to revoke the prescription if you have not sent it to PharmaNet.

To revoke a prescription:

• Revoke the prescription in your local system and select a reason to revoke from the list provided.
• If you gave the patient a paper prescription containing an error, contact the patient to recall the prescription. If the patient confirms that they have not filled the prescription, revoke the prescription on PharmaNet.

Note: The system will refuse the request to revoke the ePrescription if the patient has already filled the prescription. If a prescription has already been dispensed, you cannot revoke it. Instead, you must stop the prescription as described in the following section.

Stop Refills on a Prescription

If a prescription has already been dispensed, but you do not wish the patient to refill the prescription, “stop” the prescription on PharmaNet. 

When you stop an ePrescription, PharmaNet sets the prescription status to “obsolete”, preventing further dispensing.

You will be provided with a list from which to select a reason to stop the prescription.

If you dispensed the medication (e.g., gave the patient an office use medication):

• “Stop” the prescription from your local system and discontinue the dispense record.

If the medication was dispensed by a pharmacy:

• Stop the prescription and,
• Contact the pharmacy to advise them to discontinue the dispense record (so that the medication will be removed from DUE checking according to the clinical rules of the DUE system).

Important: If the pharmacy does not yet have access to the ePrescribing functionality, they will have the paper prescription on file and will not know that you entered a “stop” on the prescription. The pharmacy may therefore refill the prescription for any balance of medication.

Only a pharmacy can “discontinue” the dispense record in PharmaNet. If the medication is not flagged as discontinued in the patient’s PharmaNet record (indicated by a change in the end date) the medication will continue to be included in DUE checking and other health care providers may assume the patient is still taking the medication.

Retrieve a Patient’s Prescriptions

A patient’s prescription must be retrieved to:

• Review a prescription for correctness;
• Stop a prescription; and
• Revoke a prescription.

You can retrieve all a patient’s prescriptions directly from the patient’s chart, but you can also specify a certain selection by using:

• the PharmaNet Prescription ID; or
• any combination of
  • Prescription Date
  • Prescription Status
  • Dispense Status
  • Adapted Indicator
  • Adaptation Indicator
  • Location Identifier