Providing Healthcare in a Public Health Emergency Part 1: Avoiding Missteps and Professional Consequences in Prescription Practices

Introduction

During a public health emergency, such as the COVID-19 pandemic, the demands on health care providers (HCPs) can be extreme. In addition to the dangers presented by the virus itself, changing professional expectations are challenging to navigate, and failure to meet those expectations can lead to serious professional consequences, including disciplinary action by an HCPs employer or regulatory college. To date, our national and provincial strategic response to COVID-19 has included numerous public health directives, orders, and shifts in policy by the government and organizations throughout the health care sector. HCPs have a professional responsibility to stay up to date on these changes and to follow public health directives, guidelines, and other policies to keep their clients/patients, colleagues, and the public safe.

In this blog series, we will discuss how HCPs can avoid missteps and professional consequences while providing health care in a public health emergency. As we will illustrate in this blog series, there are several ways in which professional risks can arise in this ever-evolving situation. In this first installment, we will discuss recent changes in prescription practices in Ontario.

Prescription Practices

As gatekeepers for access to prescription medication, HCPs who prescribe or dispense drugs have a duty to help prevent drug shortages and to keep potentially dangerous drugs out of the hands of the public. This duty was highlighted by several regulatory colleges and professional associations in late March in relation to the prescription of hydroxychloroquine. Hydroxychloroquine is a prescription drug which has gained notoriety as potential treatment for COVID-19, in no small part due to comments by US president Donald Trump, who expressed high hopes for the drug during a press briefing.

Despite the hype, the usefulness of this drug in treating COVID-19 is yet to be proven, and using it outside of a medically supervised setting is dangerous. Regardless, there is now public demand for the drug, creating shortages for those who use it already to manage lupus and rheumatoid arthritis, and creating a risk of serious side effects for those using the drug without medical supervision. This has prompted regulatory bodies in Canada and the United States to issue strict prescription guidelines.The Ontario Medical Association, Ontario Pharmacists Association, and the Registered Nurses’ Association of Ontario have issued a joint statement on the use of the drugs hydroxychloroquine and azithromycin for COVID-19 prophylaxis that calls on nurses, physicians and pharmacists to stop the pre-emptive prescription of these drugs.

The College of Physicians and Surgeons of Ontario (CPSO), the College of Nurses of Ontario (CNO), and the Ontario College of Pharmacists (COP) have each also released statements regarding prescription practices and the prevention of drug shortages. The CNO advised against prescribing hydroxychloroquine, reminding nurses of their obligation to ensure that their practice and any treatment they prescribe is evidence-informed. The CPSO stated that maintaining a stockpile of drugs in anticipation that they may treat COVID-19 or prescribing them for oneself or one’s family is inappropriate and “dramatically departs from the core values of medical professionalism”.

This is one example of how acts of professional misconduct may arise in the context of a public health emergency, and why, now more than ever, HCPs should ensure that they are up-to-date and familiar with professional standards. This includes public health directives and other policies that affect how HCPs deliver health services during the current public health emergency.

If you or your organization have questions regarding how to implement public health directives and other COVID-19 related policy changes, please contact us.

Additional resources for HCPs:

• Ministry of Health and Long-Term Care “COVID-19: Guidance for the Health Sector”

• College of Physicians and Surgeons “Covid-19: Information for Physicians”

• College of Nurses of Ontario “Covid-19: Information for nurses”

• Ontario College of Pharmacists “Novel Coronavirus (COVID-19) for Pharmacy Professionals”