5 pearls: pharmacist prescribing, optimized

When I started my career as a pharmacist over 25 years ago, I never would have imagined that prescribing would become such a huge part of my practice. While prescribing schedule II products has always been within our purview as a profession, the addition of schedule I products in most provinces has led many pharmacists to re-examine their practices and learn new skills and tools to meet the needs of our patients. About 6.5 million Canadians do not have a family physician or nurse practitioner that they see regularly.1 This has placed many pharmacists in the role of primary care provider and/or assessing patients for acute illnesses on a walk-in or appointment basis.Whether you have been prescribing for years or are just stepping more deeply into this role, here are five tips to help strengthen and support your prescribing skills.1. Use your teamWhen pharmacists are called upon for more patient-directed clinical work such as prescribing, they need a strong team around them to take any tasks that do not require pharmacist involvement off their shoulders. This would include everything but the clinical check.2 Examine your workflow and see where pharmacists’ time can be freed up and refocused into caring for patients and providing prescribing services.The other “team” that pharmacists can highly benefit from is your team of colleagues. Some of my best learning has come from discussing a patient case with a fellow pharmacist. “What would you do” or “What would you have done?” can lead to valuable learning. Checking with another pharmacist is a great way to grow more confident in your prescribing skills and clinical knowledge, as you are able to reflect on your decisions or receive input on a decision you are currently contemplating. Additionally, reaching out to a colleague in a specialty area that you are unfamiliar with is another great resource. An individual clinician cannot know everything. We can benefit from consulting with many of our colleagues who have expertise and experience in many niche areas of practice.2. Have resources at your fingertipsThere is nothing worse than having a patient in front of us and not being able to find or access the resources that will help us make a clinical decision with confidence. Keep your desktop organized, bookmark your most accessed resources, keep your mobile device handy if you use it in your practice, and keep your subscriptions to references up to date.3. Know your limits“Just because we can, doesn’t mean we have to” is something to keep in mind. It is important when prescribing for a patient that we keep our decisions within our own scope of knowledge and experience. Sometimes clinicians can fail to “not know what we don’t know.” Make sure to understand the red flags for referral in the areas you prescribe in and be sure to refer when it is in the patient’s best interest.4. Follow upSchedule a follow-up phone call with a patient after prescribing for them. Following up is not only best practice, but an immense opportunity to learn. You can monitor whether your recommended course of therapy has been effective or if the patient is experiencing any adverse reactions. You are able to confirm that your prescription was beneficial for the patient, and have the opportunity to refer to another prescriber or change therapy if the patient is not responding as you expected them to. This also presents a chance to build a stronger provider–patient relationship, while allowing the patient to share their experience and give feedback.5. Just startSometimes pharmacists can lack confidence in expanding prescribing services in their practice. They may be concerned about making a mistake, or about their relationship with physician colleagues, or about taking responsibility for the patient and the prescribing decision.It is important to remember that while prescribing is science-based, it is also somewhat of an art. Patient interview and assessment skills are learned through practise and use. Often there is no ONE right “answer.” Different prescribers in the same scenario with the same patient would often make different decisions.If you are just starting out, choose one therapeutic area to become comfortable with and allow your skills and confidence to grow. Then you can expand your services to include other therapeutic areas that you commonly encounter in your practice. Sometimes you just have to start. I am fond of the late American educator and author Stephen Covey’s quote, “ To learn something but not to do, is really not to learn.” It is only by doing and applying that knowledge and understanding are internalized.3SummaryPharmacists remain the most accessible primary healthcare providers across the country and are increasingly stepping up to fill the gaps in primary care. One in five Canadians lacks a family physician,1 and those who do have a family doctor often face long wait times for appointments. Pharmacists are increasingly providing timely and efficient care for patients while remaining collaborative with colleagues and other healthcare providers. Prescribing services are part of this expanding role and will continue to grow as our aging population and shortage of other primary care providers continues to put pressure on the healthcare system.Carlene Oleksyn is a pharmacist and managing partner at Mint Health + Drugs in Stony Plain, AB. She has been a prescribing pharmacist for over a decade and is also a consultant in the field of medical continuing education and pharmacy practice change. She can be found at colekPharm.com.References:Duong D, Vogel L. National survey highlights worsening primary care access. CMAJ 2023;195:E592-3. (accessed March 3, 2025).Oleksyn C. How I did it: Carlene Oleksyn explains how she implemented the ‘Pharmacist-First’ workflow. Canadian Healthcare Network; February 22, 2024. (accessed March 3, 2025).Covey SR. The 7 habits of highly effective people: powerful lessons in personal change. Free Press; November 9, 2004. Available at here. (accessed March 6, 2025).

5 pearls: pharmacist prescribing, optimized

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