Forged Prescriptions - Be on Alert!
There has been a vast increase in the number and quality of forged prescriptions for narcotic-containing substances in pharmacy practice. With the advancements in technology, it is essential that registrants remain alert and vigilant in identifying the validity of prescriptions and ensuring that forged prescriptions are not dispensed to the public. Releasing unauthorized narcotic containing substances to patients can have serious negative implications on a patient’s health and public safety as a whole. Given the current opioid crisis, it is imperative that registrants ensure these medications are dispensed appropriately and as intended by a patient’s prescriber.
Though this applies to all prescriptions, whether narcotic, controlled, or otherwise, the College has noticed a large percentage of confirmed forged prescriptions specifically for RATIO-COTRIDIN.
As such, please be reminded of the following legislative requirements regarding prescription authenticity outlined in the Health Professions Act, Bylaws, Schedule F, Part 1 – Community Pharmacy Standards of Practice:
6 (1) – Prescription
A registrant must ensure that a prescription is authentic.
10 (3) – Dispensing
If a registrant doubts the authenticity of a prescription, the registrant may refuse to dispense the drug.
Best Practices for dealing with forged prescriptions
What to do if you suspect a forged/unauthentic prescription?
- Confirm the patient’s identification - Patients presenting a forged prescription don’t always use their own information. As required when dispensing any prescription, confirm the patient’s identification by reviewing picture ID and checking patient identifiers. (Please refer to Professional Practice Policy – 54: Identifying Patients for PharmaNet Purposes);
- Review the patient’s PharmaNet profile - Identify if the forged prescription has been filled elsewhere, identify any pattern of prescribing or dispensing that is questionable, or if there are notes made by other pharmacies (Note: If a patient misrepresents themselves as another person, accessing the named patient’s information on PharmaNet may be considered a breach of confidentiality); and
- Contact the documented prescriber - Patients often use prescribers of whom they are not a patient. The prescriber’s office will be able to provide you with this information and confirm if the prescription in question is legitimate.
What to do once a forgery has been confirmed?
- Keep the prescription - If the patient is adamant and the original prescription cannot be kept, make a copy and retain it for your records;
- Mark the prescription - Provide your pharmacy information on the original prescription and make written notations such as “refused to fill” to flag the prescription and to alert other pharmacies of the forgery;
- Document on the PharmaNet profile - Make an entry on the patient’s PharmaNet profile as a “refusal to fill” and an indication of the forgery in the “sig” section. PharmaNet must be reviewed by a registrant each time a prescription product is dispensed to a patient, so by entering this information on the patient’s PharmaNet profile, you are providing this information to all other pharmacies. If the same patient profile were used in an attempt to fill the forged prescription elsewhere, this information would be available to them;
- Document on your local profile - Make notes on the patient’s local profile. Busy pharmacies can have a large number of staff members or relief pharmacists working from time to time. By making notes on a patient’s local patient profile, you alert all pharmacy staff to important information and ensure they are aware of any concerns or incidents that may have occurred with a particular patient or patient profile. If your software allows, set the alert to pop-up each time the patient’s profile is selected; and
- Contact local pharmacies - Often patients will attempt to fill forged prescriptions at more than one pharmacy in a local area, especially once it has been refused at one location. By contacting your local pharmacies, you ensure that they are aware and on alert for the forged prescription and increase the possibility of it being identified prior to dispensing.
What to do if a forgery has been dispensed?
- Contact the documented prescriber - It is important that prescribers are made aware when their name is used for a forged prescription so they can be on high alert for these types of incidents and take appropriate steps to aid in preventing similar incidents from recurring; and
- Complete an incident report - It is important to document a record of the incident when an unauthorized prescription has been dispensed. This serves not only to inform all pharmacy staff of the incident, but acts as a learning tool to identify gaps and make systemic and impactful changes to a pharmacy’s processes if necessary.
Should you come across any of these situations, please contact the Complaints and Investigations Department of the College of Pharmacists of BC. We want to know what challenges you are facing in pharmacy practice. By informing the College, you aid our ability in making effective and necessary changes to prevent inappropriate practice and ensure public safety.
The PharmaNet fan out program regarding forgeries is currently not active, therefore, it is even more essential for registrants to be on alert for forgeries and ensure that they are not dispensed to the public.
Please note, that critical information about issues other than lost or stolen prescription pads may be reviewed for FanOut by PharmaNet Support Services on a case-by-case basis.