Friday Five (August 06, 2021)

This week's Friday Five includes tips on identifying prescription forgeries, a Safety IQ training deadline reminder, and news on Midwife prescribing authority.

Identifying Prescription Forgeries  

Prescription forgeries are on the rise, and it is important for all pharmacy staff to be alert.   

While prescription forgeries continue to be presented to pharmacies in person, the College is increasingly receiving reports of forgeries being faxed or called in over the phone. Electronic or computer-generated prescription forgeries are becoming much more common; however, pharmacies continue to receive handwritten prescription forgeries, photocopies of legitimate prescriptions, altered or falsified written prescriptions and/or verbal order forgeries. Pharmacy staff are reminded to objectively review all prescriptions for potential signs of a forgery. 

Faxed Prescriptions  

  • Incorrect/missing clinic fax, phone number and address on the prescription header  
  • The fax number origin does not match that registered to the medical clinic or prescriber  
  • Missing the signed certification and confidentiality statement as per the Facsimile Transmission of Prescriptions Joint Statement  
  • The signature does not match that of the prescriber (if the signature is unknown to the pharmacist, it should be verified) 
  • The template looks different from the clinic’s typical template   

Verbal Prescription  

  • The individual providing the verbal order cannot answer identifying questions such as clinic information, the prescriber license number etc.   

Prescriptions Presented in Person 

  • White-out, overwriting, smudging, or different colour ink (especially if involving the date, drug quantity or the addition of a trailing zero) 
  • Changes without initials  
  • No ink signature or a photocopy of a signature (this is most easily identified before electronically scanning a prescription) 
  • The signature does not match that of the prescriber (if the signature is unknown to the pharmacist, it should be verified) 
  • The template looks different from the clinic’s typical template   

All types  

  • Spelling and/or punctuation mistakes, unusual abbreviations, symbols, terminology, sig codes used inappropriately  
  • Unusually large quantities  
  • The dosage or directions do not fall within guidelines/outside of the usual dosage patterns   
  • Directions are fully written out with no medical or appropriate abbreviations or terminology 
  • Changes in font size or type or other inconsistencies in formatting (margins, spacing) 
  • Evidence that the prescription was presented to another pharmacy and not filled

If a forgery is suspected, the prescriber must be contacted to confirm the prescription. Once a forgery is confirmed: 

1) Retain prescription. If patient demands prescription, make copy of prescription and mark original to alert the next pharmacy. Do not compromise safety of pharmacy staff or patients. 

2) Contact police. Provide a copy of original prescription to police if requested and allowed. 

3) Report all forgeries and attempted forgeries to CPhM using the forgery reporting tool in the College resource library  

4) *NEW* Report the forgery to the Health Canada Office of Control Substance ONLY if it was filled by completing and submitting a loss/theft reporting form

Midwife Prescribing Authority 

In September 2017, amendments to the Midwifery Regulations expanded the list of medications in Schedule B that a midwife can prescribe under the direction of a physician. Registrants were required to complete additional education in order be able to prescribe to the new authority.  Information regarding which midwives had prescribing authority was noted on the public register. Pharmacists could confirm if a midwife had any restrictions related to prescribing by checking the public register on the College of Midwives of Manitoba website. 

The College of Pharmacist of Manitoba has been advised by the College of Midwives of Manitoba that currently, all practicing midwives have completed the required education, and this has also been incorporated into midwife education programs. All currently registered and all newly registered midwives will have the authority to prescribe drugs under Schedule B of the Midwifery Regulations. Therefore, all registrants on the public register of the College of Midwives of Manitoba are authorized to prescribe and the previous notation, ‘Authorized to order and prescribe to new authority’ will be removed.   

For information on the prescribing authority of Manitoba healthcare professionals, please check the Prescribing Authority Table on the College website. 

Safety IQ Training Deadline – September 1, 2021 

College Council had extended the timeline for pharmacies to complete staff training on Safety IQ and the pharmacy’s incident reporting platform by September 1, 2021. 

For successful implementation of and engagement with Safety IQ, pharmacy staff must be trained on the reporting platform and the pharmacy’s process for entering medication incidents and what near-misses should be reported. The reporting platform chosen by the pharmacy is responsible for providing online training modules and ongoing support for pharmacy staff.  

The College has several resources available to assist pharmacy managers and staff to better understand their responsibilities: 

Proper training of all pharmacy staff, including new and relief staff, will ensure consistent and ongoing reporting and proper handling of medication incidents and near-miss events. 

June 1, 2021, marks the first step of the ongoing Safety IQ journey. The College will continue to provide resources to support pharmacy professionals to maximize the tools of Safety IQ for the benefit of your patients and your pharmacy. 

Reminder to Regularly check the CPSM Registered Members List for Prescribing Privileges 

The College of Physicians and Surgeons of Manitoba (CPSM) Registered Members List, available through the CPhM Registrant Portal, is updated periodically. Pharmacists are reminded to check this list frequently for prescribing privileges (e.g., methadone and/or buprenorphine-naloxone for opioid agonist treatment), as not all prescribers maintain their prescribing privileges.  

The information contained in this list is confidential, and is not to be downloaded, saved to a desktop, nor distributed.  Pharmacists must ensure they are logged out of the Registrant Portal when they are finished using it, and login information should never be shared. 


Final Recommendations on Scheduling of Non-Live Recombinant Herpes Zoster Vaccine and Bisacodyl 

On July 26, 2021, the National Association of Pharmacy Regulatory Authorities (NAPRA) Board of Directors approved the following recommendations made by the National Drug Scheduling Advisory Committee (NDSAC): 

  • Non-live recombinant herpes zoster vaccine – be granted Schedule II status  
  • Bisacodyl, when sold in strengths of 5mg or less per oral dosage unit, in package sizes containing no more than 105 mg of bisacodyl – be granted Unscheduled Status  
  • Bisacodyl, when sold in strengths of 10 mg or less per rectal dosage unit/suppository, in package sizes containing no more than 50 mg of bisacodyl – remain Unscheduled, and  
  • Bisacodyl and its salts, except when sold in strengths of 5 mg or less per oral dosage unit in package sizes containing no more than 105mg of bisacodyl and except when sold in strengths of 10mg or less per rectal dosage unit/suppository in package sizes containing no more than 50mg of bisacodyl – remain in Schedule III 

The National Drug Schedules have been revised to reflect the scheduling changes.  

Please note that although the non-live recombinant herpes zoster vaccine is now a NAPRA Schedule II vaccine, pharmacists in Manitoba still require a prescription from an authorized practitioner (a physician or a nurse practitioner) in order to administer the vaccine to a patient.  


Professional Development Opportunities & Events 

Pear Healthcare Injection Training Workshop 
August 12, 2021 
For more information and to enroll, click here 

Pharmacists Manitoba Fall Conference 
September 18, 2021  
View the full program and register here. 

ISMP Medications Safety Considerations for Compliance Packaging E-learning Module  

Complete the module here.