Ending the Pharmacist-Patient Relationship

GUIDELINE

Approved: September 2014

Legislative references:

  • Pharmacy Act, 1991
  • Ontario Regulation 130/17

Additional references:

  • Drug and Pharmacies Regulation Act, General
  • O Reg 264/16, Part IV: Standards for Accreditation s.20-21
  • Personal Health Information Protection Act, 2004, SO 2004, c 3, Sch A.; s.12(1)

College Contact: Pharmacy Practice


Introduction

A member’s practice is performed within the context of legislation, regulation, the Code of Ethics and Standards of Practice. All decisions affecting the care and treatment of patients are taken within the context of this legal and ethical framework. Pharmacists have the authority to exercise professional and clinical judgment, including the choice to terminate a pharmacist/patient relationship where warranted. Patients are entitled to dignity and respect when interacting with health professionals. The decision to terminate a pharmacist/patient relationship is a serious one, most often taken because a therapeutic relationship has been compromised and/or there are issues that cannot be resolved and which impact on the ability to provide appropriate pharmaceutical care to the patient.

The following guidance will assist the pharmacist when, in his or her professional judgment, it is in the patient’s best interest to terminate the pharmacist/patient relationship. This guidance does not apply in circumstances where the patient’s care moves to another pharmacy/pharmacist in a planned transfer of services, or when the patient initiates the termination/transfer of prescriptions. The decision to terminate the pharmacist/patient relationship is not the same as declining to provide products or services for moral or ethical reasons.


Guideline

The pharmacist will consider the patient’s condition and availability of alternative services when making the decision to terminate the pharmacist/patient relationship. The patient relationship cannot be terminated without good reason, proper notice, and an opportunity given to the patient to obtain another pharmacist’s/pharmacy’s services before discontinuation. The pharmacist must ensure that the decision to terminate care does not infringe a prohibited ground within the meaning of the Ontario Human Rights Code.

Where several pharmacists work together, it may be appropriate to plan in advance how terminations will be executed, and whether another member is available to provide patient care.

1. Communicate the decision

Depending on the reason for the termination, the member will communicate the decision to terminate service in writing, unless the patient has no fixed address or the pharmacy does not have a current address on file. When communicating the decision in person, it is important to maintain acoustical privacy while ensuring that both the patient and staff members are safe.

The patient should be clear about the availability of refills or other professional services until he or she is able to obtain services from another pharmacist. Based on an evaluation of the patient’s condition, determine whether to notify his/her prescriber(s) of the change in pharmacy or rely on the patient to do so.


2. Provide a reasonable amount of time for the patient to find a new pharmacist

The amount of time provided for the patient to find a new pharmacist will be reflective of the condition of the patient, his or her special needs and availability of services in the local community. Advise the patient of measures that will assist the transition including record transfers and providing information directly to the next provider, as required. If no refills remain on file, provide the patient with a patient profile report/medication history for his/her information.


3. Document

Document the decision and rationale for the termination according to the Documentation Guidelines and retain a copy of the patient’s letter. A summary of the type of information that could be included in the patient’s letter is attached (Appendix 1).

4. Advise staff members

Let the appropriate staff members know of the decision to terminate the patient relationship and the period in which services will continue to be provided, if any.


Appendix 1

Summary Information – Letter of Termination

A written communication to the patient regarding a termination of the pharmacist/patient relationship contains the patient’s name, the pharmacist’s name and the name of the pharmacy; and additional information including, for example:

  • Affirmation and rationale for the decision to terminate the relationship and date chosen as the last day of care;
  • Direction to the patient to obtain services at another pharmacy and offer to transfer prescriptions;
  • Confirmation that prescriber(s) will be informed of the decision in the event that verbal prescriptions are received, if relevant, and/or a recommendation that the patient inform his/her prescriber(s) directly;
  • Acknowledge attachment of patient profile/medication history (if applicable); and
  • Any other information considered relevant.