Minor Ailments Practice Topic

Yes, and yes. Pharmacists may prescribe for minor ailments, regardless of the nature of their workplace. For example, pharmacists in a Family Health Team (FHT) or Nurse Practitioner Led Clinic (NPLC) can issue a prescription for a minor ailment to be dispensed at the patient’s chosen pharmacy.  

However, in a hospital setting, regulations under the Public Hospitals Act do not permit pharmacists to ‘order treatment’ for inpatients or outpatients. Pharmacists practicing in hospitals may wish to explore delegation of authority to prescribe, such as a medical directive, in accordance with organizational policies.

Yes. The regulations and College guidelines do not specifically address or prohibit refills. However, it is important to remember that a minor ailment is usually a short-term condition where only minimal or short-term follow-up is required, and that if the prescribed treatment is not effective, further assessment and/or a referral to another health care professional may be warranted. 
 
The pharmacist should use their professional judgment to determine whether issuing refills at the time of prescribing is clinically appropriate for the indication and document their rationale. For example, the amount of topical cream the patient might need for their expected duration of treatment can be approximated, but not necessarily exactly calculated, and the pharmacist may decide prescribing an initial quantity with a refill is appropriate. The follow-up and monitoring plan should ensure that the intended timeframe of the patient’s therapy is adhered to. A pharmacist dispensing a refill for a minor ailment must evaluate the request in accordance with the Standards of Practice, taking into account the ongoing need considering the minor ailment and an assessment of the patient. 
 
If a patient chooses to have a lesser amount than the prescribed quantity dispensed, they should be advised if additional dispensing fees will be charged and the patient must authorize this request in writing (as per the Drug Interchangeability and Dispensing Fee Act [DIDFA]). 

Having the legislated authority to prescribe for minor ailments does not mean all pharmacists must provide this service. Patients are encouraged to speak to their pharmacist to find out what healthcare services they offer. 

Pharmacists have an ethical obligation to ensure that they only practice when they are competent to do so, as self-assessed with respect to both relevant knowledge and skill as well as physical, emotional and mental capacity. The practice environment must also meet the Standards of Operation and be conducive to the safe and appropriate provision of pharmacy services. As such, pharmacists have the autonomy to incorporate minor ailments prescribing into their practice as they see appropriate, which may include a staggered implementation of minor ailment prescribing, or offering services for some, but not all, minor ailments. When unable to provide a requested pharmacy service, the pharmacist assumes responsibility for making reasonable efforts to ensure continuity of patient care, such as a referral to another pharmacist or practitioner.

As with other services that are not covered by a publicly funded program and which are over and above the services included in the usual and customary dispensing fee, pharmacists may charge fees for professional pharmacy services in accordance with the College's Fees for Professional Pharmacy Services Policy. For example, it should be clear to the patient what the fee is for, and the charge should be reasonable for the service provided.

Patients with private insurance or health benefits may inquire with their provider regarding possible reimbursement of any fees for minor ailment services, and pharmacists are encouraged to provide an invoice or receipt upon request for patients to use for this or other purposes.

The Code of Ethics, Standards of Practice, and relevant policies and guidelines, including the College’s Virtual Care Policy, apply when providing minor ailment services virtually. Importantly, the pharmacist must first determine that the manner in which virtual care is provided is suitable for the patient assessment and will enable them to meet all legal and professional obligations. 
 
For the minor ailment service to be eligible for reimbursement through a publicly funded program, the service must be provided in accordance with requirements as set out by the Ministry of Health (see the latest Ontario Public Drug Programs — Executive Officer Communications). 

Registered pharmacy interns have the same scope of practice as a pharmacist, subject to the supervision requirements set out in the terms, conditions, and limitations on their certificate of registration. Please refer to the Supervision of Pharmacy Personnel Policy for more information. 

As with any area of practice, the supervising pharmacist must assess the registrant’s competence to provide a service and engage in patient care, and the degree of supervision required, to do so safely and effectively. In addition, the registrant is expected to complete the Mandatory Orientation for Minor Ailments (Ailment) Prescribing module to ensure they understand their ethical, legal, and professional obligations associated with this new scope.

While the regulations authorizing pharmacists to prescribe for minor ailments do not include age restrictions, it is possible that characteristics such as age may be relevant to the treatment of specific minor ailments. Pharmacists should conduct a patient assessment and use their knowledge, skills and judgment along with available clinical treatment algorithms to determine whether age or any other factor might indicate that prescribing for a particular minor ailment is contraindicated. If a decision is made not to prescribe, that decision must be explained to the patient along with a follow-up plan for monitoring and/or next steps. This could include a referral to another healthcare provider. 

Yes. The Standards of Practice expect pharmacists to use evidence from relevant sources to inform their activities and to critically evaluate medication and related information. Pharmacists have an ethical obligation to ensure information provided to patients is current and consistent with the best available evidence. 

In pharmacies, it is a standard of accreditation to have available the references and resources pharmacists require to meet the standards of practice of the profession and to support the pharmacy services provided. Pharmacists may choose to subscribe to or use any clinical resources that will enable them to provide safe and effective patient care.

Yes. Pharmacists can only prescribe a drug in listed in Column 3 of Schedule 4 for the respective minor ailment, even if it is in a combination product. Each drug found in the combination must be listed in Schedule 4 of O. Reg. 256/24; this was taken into consideration when the proposed regulations were submitted to the Ministry.

No. Pharmacists are only authorized to prescribe the specified drugs listed in Column 3. At this time, expert clinical opinion advises against prescribing high-potency topical corticosteroids and ophthalmic fluoroquinolones for their respective minor ailments, and as such, they are not listed in Column 3.

The Orientation for Minor Ailments Prescribing module helps ensure that all Part A pharmacists and interns fully understand their ethical, legal, and professional obligations when prescribing for minor ailments. The content is not clinical in nature, although optional continuing education courses are available for registrants. 

The Orientation for Minor Ailments Prescribing module is presented in an online browser-based format that can be accessed through any web browser on a desktop computer, tablet, or smartphone. The module is narrated and will require audio capability; however a transcript of the narration is also available in the module’s menu tab. Knowledge-check quizzes  are embedded within the module, however scores are not recorded and there is no minimum grade required to complete the orientation module.   

The module takes approximately one hour to complete, and it does not have to be completed in a single session. Users may pause and resume their progress at any time. 

To support understanding of this scope of practice change, all Part A pharmacists must complete the mandatory Orientation for Minor Ailments Prescribing module about their ethical, legal, and professional obligations before prescribing for minor ailments. Completion is required regardless of a pharmacist’s practice setting or whether they choose to prescribe for minor ailments. This decision was made by the Board in June 2020, based on the fact that the regulation change applies to the profession as a whole rather than to a specific to area of practice.

Pharmacy interns have the same  scope of practice as a pharmacist, subject to the supervision requirements set out in the terms, conditions, and limitations on their certificate of registration. The mandatory orientation module is designed to ensure registrants fully understand their ethical and legal requirements of prescribing for minor ailments prior to engaging in this practice.  It is the expectation of the College that they also have the necessary knowledge, skills and judgment to safely deliver this service when providing patient care.

No. Pharmacists and interns are no longer required to notify the College that they have completed the Orientation for Minor Ailments Prescribing module.  

However, before prescribing for minor ailments, the College expects that pharmacists and interns:  

• Understand their ethical, legal, and professional obligations described in the module
• Have the required knowledge, clinical skills, and professional judgment to safely assess and prescribe medications for minor ailments.  

It is the expectation of the College that pharmacists possess the required clinical skills, judgment and knowledge of legislative requirements and practice standards to safely prescribe medications for minor ailments. To refresh their clinical knowledge and increase their comfort in assessing and prescribing for minor ailments, pharmacists may consider additional education opportunities. A list of online continuing education courses related to minor ailments are available on the College’s website. These clinical education courses are optional, and pharmacists will not be expected to attest to their completion.