Transforming and Supporting Patient Care - Health Professions ...

85Chapter 3 - A New Drug Approvals Framework For OntarioPrescribing and dispensing are both controlled acts under the RHPA. Theycan only be performed by health professionals with the legislative authorityor by those to whom they have delegated the acts.HPRAC concluded that the provision of free drug samples should not be anexception to the general rule on dispensing prescription drugs. Samplesshould be dispensed under a prescription. This ensures that patients willreceive drugs that are appropriate for their individual therapeutic needs,that the drugs respond to an assessment or diagnosis, and that the patienthas been counselled on the use of the drug. Further, when drugs, includingsamples, are dispensed under a prescription, the patient has addedassurance that the drugs have been inspected for quality, stored properly,and the date of expiry has not passed.Since providing a drug sample to a patient constitutes dispensing, the samerules that apply to dispensing in general should apply to dispensing drugsamples. For these reasons, health professionals should not be allowed todistribute free samples of drugs unless they are authorized to dispensedrugs. Even with this authorization, professionals should only beauthorized to provide drug samples under a prescription.As well, professionals who are able to dispense samples of drugs should beheld to the same minimum standards as physicians, and should setstandards of practice for dispensing samples.v. Drug Dispensing MachinesDrug dispensing machines are relatively new innovations in the drugdistribution system in Ontario, and are being piloted in hospitals in theprovince. These machines are drug storage devices or cabinets thatelectronically dispense medications in a controlled fashion. The machinescarry an inventory of branded and generic drugs in preset doses ready fordispensing.The following is one example of the operation of a drug dispensingmachine. Following a patient visit, a physician or other prescriber faxes aprescription to a pharmacist who makes an entry into a computer, and thensends an electronic message to the dispensing machine. The patient’sprofile is displayed on the machine to the pharmacist assistant at themachine’s location. The assistant is provided with a password to access themachine, retrieves the pre-filled bottle, and affixes a label with relevantinformation and warnings that are specific to the patient. The patient mayspeak directly to a pharmacist through technology built into the machine orby direct personal contact.In Ontario, several hospitals are investigating the use of drug dispensingmachines. Sunnybrook Health Sciences Centre has two machines in use foroutpatients and one for inpatients and it is evaluating the benefits of thisautomated dispensing system. Currently drug dispensing machines are inoperation in physicians’ offices, clinics, emergency rooms and other healthfacilities in the United States.HPRAC Critical Links January 2009