Transforming and Supporting Patient Care - Health Professions ...

81Chapter 3 - A New Drug Approvals Framework For OntarioThe second element is applying professional judgment. Professionaljudgment includes:(a) Determining the appropriateness of the medication therapy;(b) Consultation, if necessary, with other health professionals, and(c) Any communication or counselling provided to the patient orother health professionals. 40It is important to note that the policy does not require a dispensingphysician to follow a prescription. 41 This requirement is unnecessarybecause a physician is authorized both to prescribe and dispense.The Pharmacy Act, 1991 does not define dispensing, but the OCP publishedan interpretation of dispensing which is similar to the one published bythe CPSO. 42 Another interpretation has been put forward by professionsthat do not currently have the controlled act of dispensing. For example,the CNO recently published a practice standard that includes a definition ofdispensing: 43(1) Adjusting the order according to an approved policy, if appropriate;(2) Selecting the drug to dispense;(3) Checking the expiry date;(4) Labelling the product, and(5) Completing a final check to ensure the accuracy of thefinished product. 44This description does not include the cognitive element of dispensing.However, a recent issue of The Standard, a magazine produced by theCNO, states that prior to dispensing a medication, a nurse must have aprofessional relationship with the client, consider the client’s needs andbest interests, and make certain that the client’s condition warrants themedication. Nurses, based on knowledge and judgment about themedication, need to determine the appropriateness of the drug for theclient. The inference in this passage is that the CNO acknowledges thatdispensing involves a cognitive element. 45The main difference between the two interpretations is that the latterpresupposes that following a prescription is a necessary component ofdispensing. Therefore, providing drugs will be considered dispensing only ifthe provider is authorized to prescribe or act pursuant to a prescription.Based on these findings, HPRAC has concluded that dispensing as used inthe RHPA should be interpreted, in the context of drugs, to mean:40Ibid.41Ibid.42Ibid.43Ibid.44Ibid.45College of Nurses of Ontario. “You Asked Us” The Standard 33:2 (Summer 2008): 34.HPRAC Critical Links January 2009