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Dispensing

 

Dispensing

RTs do not have the legislative authority to dispense medication but can receive delegation to dispense. RTs may dispense medications when it’s in the best interest of the patient/client, such as a patient/client having difficulty accessing a pharmacy.

Dispensing is a controlled act that authorizes an RT to select, prepare and provide stock medication that has been prescribed to a patient/client (or his or her representative) for administration at a later time. The process of dispensing has both technical and cognitive components. The technical component includes tasks such as receiving and reading the prescription, selecting the drug to dispense, checking the expiry date, labeling the product, and record keeping.

The cognitive component of dispensing involves assessing the therapeutic appropriateness of the prescription, applying approved substitution policies, being able to make recommendations to the prescriber and advising the patient/client.

Example:

Allowing a patient/client to take home a properly labelled metered dose inhaler from the Emergency Department stock after counselling a patient/client about their prescription and medication.

When it’s Appropriate for an RT to Dispense

Registered Respiratory Therapists (RRTs) require delegation to dispense medication. It is important to note that Graduate Respiratory Therapists (GRTs) cannot accept delegation for any controlled act, including dispensing.

Depending on an RT’s personal scope of practice, it may be practical and in the best interest of the patient/client for an RT to accept delegation to dispense medications in certain practice settings, such as:

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hospital emergency departments;

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asthma care centres;

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pulmonary function laboratories;

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cystic fibrosis care centres;

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respiratory rehabilitation centres;

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COPD care centres;

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polysomnography laboratories; and

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Family Health Team (FHT).

Example:
Providing a patient/client with a pharmaceutically supplied sample of a medication to take home from an asthma clinic. (For more information, please see the section on Dispensing Samples.)

PLEASE NOTE:

Only RRT Members of the CRTO (subject to any terms, conditions and limitations on their certificate of registration that are related to accepting delegation and/or dispensing) may receive delegation to dispense medications.

Accepting Delegation to Dispense

The delegation to dispense medication requires the same steps as any other delegation process. For additional information, please see the CRTO Delegation PPG. The Regulated Health Professions Regulators of Ontario also has resource information and templates for developing delegation processes, which can be accessed here: templates for delegation.

Who an RT can accept delegation to dispense from

The following are health care professions authorized to dispense medication and can delegate dispensing to RT’s:

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Dentists;

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Physicians;

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Pharmacists*

*Pharmacists can dispense medication under the Regulated Health Professions Regulators of Ontario and can therefore delegate dispensing. However currently RT’s are not permitted to accept an order for from Members of the Ontario College of Pharmacists. For example, and physician can order a medication and a pharmacist may delegate the dispensing of the medication to a RT.

Midwives are not permitted to dispense, sell, or compound a drug, and therefore can not delegate dispensing. (College of Midwives of Ontario).

Nurse Practitioners can dispense medications however they cannot delegate prescribing, dispensing, selling, or compounding medication. (College of Nurses of Ontario).

PLEASE NOTE:

RNs and RPNs are authorized to dispense medications provided they have an order for the medication from an authorized provider. However, RNs/RPNs cannot delegate dispensing.

RTs require both a order for the medication AND an order to dispense the medication. However, it does not have to be same healthcare professional who provides both. For example, a physician can write the order for the medication and a pharmacist can delegate dispensing of that medication. For more information, please see TABLE 1.

Table 1: Who can order medication and who can order delegation to dispense medication.

Healthcare ProfessionalAbility to Order
Medication		Ability to Delegate the Dispensing of Medication
Physician✓✓
Nurse Practitioner✓✕
Midwife✓✕
Dentist✓✓
Pharmacist✓*✓
RN✕✕

*Pharmacists can perform the controlled act of “prescribing a drug” specified in the regulations (initiating therapy with varenicline or bupropion for smoking cessation) or in accordance with the regulations (adapting or renewing a previously prescribed prescription). Ref: Pharmacy Act; O. Reg. 202/94; Initiating, Adapting and Renewing Prescriptions Guideline.

Note that in a hospital setting, regulations under the Public Hospitals Act determine who can order treatments for patients: “physician, dentist, midwife or registered nurse in the extended class”. Ref: RRO 1990 Reg 965.

Orders for Dispensing

An order to dispense must include the following:

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order date,

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client name,

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medication name,

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dose in units,

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route,

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frequency,

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purpose, quantity to dispense; and

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prescriber’s name, signature, and designation.

Factors to Consider when Accepting Delegation to Dispense

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1. Is your certificate clear of any terms, conditions or limitations that prevent you from dispensing or accepting delegation to dispense?
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2. Do you reasonably believe that the person who delegated dispensing to you has the authority and the competence to do so?

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3.  Do you have the competence to dispense medication?

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4. Is it appropriate and in the best interest of the patient/client that you accept delegation to dispense medication, given the known risks and benefits?

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5. Are there other controlled acts involved and are you authorized to perform them?

REMINDER…

Respiratory Therapists are reminded that they are not obligated to accept delegation to dispense medications if it is, in their judgment, not appropriate to do so. For more information, please see the CRTO Delegation.

Labelling Dispensed Medication

If medication is being dispensed based on a prescription, the label must meet all the requirements outlined in the Drugs and Pharmacies Regulation Act (s.156 (3) – Identification Markings), which means that The container in which the drug is dispensed shall be marked with,:

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(a) the identification number that is on the prescription;

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(b) the name, address and telephone number of the pharmacy in which the prescription is dispensed (if applicable);

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(c) the identification of the drug as to its name (preferably both generic and trade name), its strength (where applicable) and its manufacturer, unless directed otherwise by the prescriber;

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(d) the quantity where the drug dispensed is in solid oral dosage form;

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(e) the name of the owner of the pharmacy (if applicable);

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(f) the date the prescription is dispensed;

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(g) the name of the prescriber (along with professional designation (e.g., MD);

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(h) the name of the person for whom it is prescribed;

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(i) the directions for use as prescribed.

PLEASE NOTE:

The label can be handwritten or computer generated. However, it’s important that:

 • the information contained on the label is legible; and

 • the dispensed medication is added to the patient’s/client’s record.

Safe Storage and Handling

If an RT is responsible for maintaining a supply of medication, they must be sure to:

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Keep an up-to-date inventory of all medication in stock;

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Ensure that the medication is stored securely;

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Check to see if medications require refrigeration;

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Discard any medication that has been discontinued or is expired; and

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Store the medication in a clean and well organized area (e.g., metered dose inhalers should be capped, clean aerosol holding chambers should be stored hygienically (as per manufacturer’s recommendation).

GLOSSARY

Administration (of a medication): the direct application of a drug to the body of a specific patient or research subject by injection, inhalation, ingestion, or any other means.

Authority: the right to act, as outlined in the legislation, usually related to terms, conditions or limitations imposed on a certificate of registration.

Controlled act: one of the 13 acts defined in the RHPA [section 27(2)]

Compounding: the act of combining two or more elements to create a distinct pharmaceutical product. Compounding is not authorized to Respiratory Therapists. Delegation is not required when combining elements to prepare a drug for administration. For example: mixing liquid bronchodilators in normal saline for aerosolized therapy.

Competence: having the requisite knowledge, skills and judgement/abilities to perform safely, effectively and ethically; and applying that knowledge, skills and judgement/abilities to ensure safe, effective and ethical outcomes for the patient/client.

Delegation: the transfer of the legal authority to perform a procedure within a controlled act to a person not otherwise authorized to perform the procedure.

Drug: as defined in the Drug and Pharmacies Regulation Act.

Labelling: the process of preparing and affixing a label to any drug container. Any such label shall include all information required by provincial regulations. In this context, labelling does not include the labelling by the manufacturer, packer or distributor of a non-prescription drug or commercially packaged drug or device.

Order: An “order” is the authority to undertake an intervention if the circumstances are appropriate and, in your professional judgement, it is appropriate to undertake the intervention. For more information of what constitutes a valid order, please see the Orders for Medication Care PPG.

Pharmacy: a premise in or in part of which prescriptions are compounded or dispensed for the public.

Prescriber: a person authorized to give a prescription within the scope of his or her practice of a health discipline or profession.

Prescription: an authorization from a prescriber permitting the dispensing of any drug or mixture of drugs for a designated person or animal.

Regulated health care professional — a health care provider who is a member of a CRTO and is regulated by the RHPA (e.g., nurse, physician, dentist, massage therapist, physiotherapist, dietitian, occupational therapist, etc).

Respiratory Therapists: Members of the CRTO (RRT, GRT, PRT).

REFERENCES
  1. National Association of Pharmacy Regulatory Authorities National Drug Schedules | NAPRA
  2. The Nine Rights of Medication Administration. British Journal of Nursing (2010) Vol.19, Number 5. Elliot, Liu. http://publicationslist.org/data/m.elliott/ref-2/Nine%20medication%20rights.pdf
  3. Hughes RG, Blegen MA. Medication Administration Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 37. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2656/
  4. Ontario College of Pharmacists (OCP). (2006). Policy Respecting the Distribution of Medication Samples. Retrieved from OCP website at http://www.ocpinfo.com/regulations-standards/policies-guidelines/distribution-samples/
  5. College of Physicians and Surgeons of Ontario. (2019). Prescribing drugs. CPSO Policies. Retrieved from https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs
  6. Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423.
  7. Ontario College of Pharmacists (OCP). (2006). Policy Respecting the Distribution of Medication Samples. Retrieved from OCP website at http://www.ocpinfo.com/regulations-standards/policies-guidelines/distribution-samples/
  8. College of Nurses of Ontario (CNO) Medication Practice Standard (2017). Retrieved from the CNO website at: https://www.cno.org/globalassets/docs/prac/41007_medication.pdf
  9. Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423.
  10. College of Nurses of Ontario (CNO). Nurse Practioner Practice Standard (2021). Retrieved from the CNO website at: https://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf
  11. College of Midwives of Ontario (CMO). Midwifery Scope of Practice (2021). Retrieved from the CMO website at: https://www.cmo.on.ca/wp-content/uploads/2021/04/Midwifery-Scope-of-Practice.pdf#:~:text=delivery%20of%20a%20baby4%20is%20authorized%20to%20physicians,manage%20labour%20and%20conduct%20spontaneous%20normal%20vaginal%20deliveries5.
  12. College of Nurses of Ontario (CNO). Authorizing Mechanisms (2020). Retrieved from the CNO website at: https://www.cno.org/globalassets/docs/prac/41075_authorizingmech.pdf
  13. Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. [Updated 2022 Jan 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/