Kristen Morse is a second-year PharmD candidate at the Idaho State University College of Pharmacy.
Pharmacists’ prescriptive authority is growing throughout the country, with Idaho being one of the most advanced states in this area.1 In Idaho, pharmacists have prescriptive authority for conditions that do not require a new diagnosis or in emergency situations, minor/self-limiting conditions, or conditions diagnosed through a Clinical Laboratory Improvement Amendments–waived test.
Idaho ranks 49th in the nation for provider-to-patient ratio, meaning most areas are medically underserved areas or health professional shortage areas.2 Since pharmacists are the most accessible and affordable health care providers, this expansion in pharmacy practice allows pharmacists to provide needed services to fill gaps in health care.3 As advanced services are new for most community pharmacy settings, the creation of standardized protocols would allow structure and guidance to help pharmacies implement these services.
No project is too small
As a student pharmacist intern at the Idaho State University (ISU) College of Pharmacy, I recently worked closely with a clinical pharmacist in creating and disseminating standardized prescribing protocols. The creation of standardized protocols allows for new services to be more easily implemented into pharmacy workflow. Subsequent utilization of pharmacy services provides patients with the means to receive convenient, timely, and cost-effective health care while closing a gap in health care access to underserved areas in Idaho.
Protocols were created by gathering examples from local pharmacies, making updates, and standardizing formats. Each protocol was updated by reviewing guidelines to ensure treatment was up-to-date and clinically reviewed for appropriateness by ISU clinical pharmacy staff and community pharmacists. Protocols included patient intake questionnaires, service inclusion and exclusion criteria, pharmacist and patient education, prescription labels, billing templates, case vignettes, and questionnaire interpretation to guide treatment and referral decisions.
Through this student-driven work, 19 standardized prescribing protocols for the following conditions have been finalized: cold sores, canker sores, sunburns/mild burns, pinworms, emergency contraceptive, erectile dysfunction, flu treatment and prophylaxis, strep throat, mild acne, acute migraine, uncomplicated UTI, pink eye, naloxone, motion sickness, hemorrhoids, asthma, diabetes, and COVID-19. They have been disseminated and implemented in a select number of pharmacies in Pocatello, ID. Current outreach is being done to share them with state professional organizations so that they can be posted on their website for pharmacies interested in implementing these advanced services.
Making a personal impact
Seeing the protocols in practice and the impact they have on patients’ lives was personally fulfilling. For example, a family of five came to the pharmacy because they were exposed to strep over the December holidays. They presented feeling unwell, were tested, and were prescribed medications at the pharmacy. For the children who were too young per protocol, the pharmacist contacted the children’s provider and explained the situation. The provider then faxed over a prescription for the children. This saved the parents time, money, and stress; plus, it prevented spreading of a disease to others as the family had an upcoming party. The family expressed how grateful they were for the pharmacy’s services and their ability to receive all of their care in one place.
Get involved
Student pharmacists can advocate for and participate in the advancement of pharmacy practice through different ways. For example, consider working with your local pharmacies, college of pharmacy, or professional organizations on projects and campaigns. I encourage all student pharmacists to get involved with the advancement of pharmacy practice in their states. The practice of pharmacy is evolving, and it is important to gain advocacy and implementation experience now so you are able to contribute to practice change!
References
- Engelen K. Mapping U.S. statewide protocols for pharmacist prescriptive authority. RxLive. https://rxlive.com/blog/mapping-u-s-statewide-protocols-for-pharmacist-prescriptive-authority
- Association of American Medical Colleges. Idaho physician workforce profile. AAMC. www.aamc.org/media/58171/download
- Manolakis PG, Skelton JB. Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: The emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ. 2010;74(10):S7.