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College of Pharmacists of Manitoba

Practically Perfect Prescribing

Learning Objectives
• Summarize important background information on DPIN,
Pharmacare, drug coverage, and drug legislation
• Apply the three components of safe and effective prescription
writing
• Describe the information that should be included on a
prescription
• Summarize prescription formatting/writing tips
• Reflect on the awareness of patient safety in prescribing

Drug Programs Information

Network (DPIN)
• Was created for managing the
Manitoba Pharmacare program
• All Manitoba residents (patients)
currently have, or are able to have,
all their prescribed medications
listed in one central provincial
database known as DPIN
• Medication history is compiled using
the patient’s PHIN (Personal Health
Information Number) found on their
Manitoba Health Card

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Drug Programs Information

Network (DPIN) – continued
• When a prescription gets filled,
that information gets submitted
into DPIN (only if the patient
provides PHIN)
• DPIN shows name, strength,
quantity, days supply, and
prescriber for medications

Drug Programs Information

Network (DPIN) – continued
• Does not include OTC (over the
counter) medications
• Does not include medications
received as inpatient in hospital
• Only shows medication history of
past 6 months
• Does not show dosage
instructions

Drug Programs Information

Network (DPIN) – continued
• Out of province patients won’t
have a DPIN history because
they don’t have a PHIN
• DPIN is not a complete resource
or history

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Drug Programs Information

Network (DPIN) – continued
• Physicians can access DPIN
through DPIN-ER and eCharts
• Also have the option of calling
the patient’s pharmacy to ask the
pharmacist to access DPIN
• Pharmacist will ask information
about who you are, what
information you need, and why
• DPIN has some ability to flag
drug interactions

Manitoba Pharmacare
• Provides drug cost assistance to eligible Manitobans
• Income based program
• Deductible is calculated based on the total adjusted family income
• Once a registrant (family) pays their yearly deductible, they will not have
to pay for eligible (specified) drugs during the balance of the benefit year.

Manitoba Pharmacare – continued

• Benefit year is April 1 to March 31
• Deductible Instalment Payment Program
• Not all Drugs are covered under Pharmacare
• ”Eligible drug" means a drug or other item that is specified as covered by
Pharmacare

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Pharmacare Drug Benefits List

Three classes of eligible drugs:
• Part 1 - Covered in all situations

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Pharmacare Drug Benefits List – continued

Three classes of eligible drugs:
• Part 2 - Covered in some
situations

http://web2.gov.mb.ca/laws/regs/current/_pdf-regs.php?reg=6/95

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Pharmacare Drug Benefits List – continued

Three classes of eligible drugs:
• Part 2 - Covered in some
situations
• Pharmacists can assign
• May require pharmacist to
contact prescriber to ask if
patient meets criteria
• Always helpful if prescribed
writes indication and whether
patient is eligible for Part 2
coverage on the prescription
http://web2.gov.mb.ca/laws/regs/current/_pdf-regs.php?reg=6/95

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Pharmacare Drug Benefits List – continued

Three classes of eligible drugs:
• Part 3 Exception Drug Status (EDS) - Only covered in
specific circumstances

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Pharmacare Drug Benefits List – continued

Three classes of eligible drugs
• Part 3 Exception Drug Status - Only covered in specific
circumstances
• As you get more integrated into your practice, you’ll
become familiar with the criteria for all different drugs

https://www.gov.mb.ca/health/mdbif/docs/edsnotice.pdf

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Pharmacare Drug Benefits List – continued

• https://www.gov.mb.ca/health/mdbif/index.html

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Manitoba Drug Interchangeability Formulary

• Includes the eligible drugs that are interchangeable with one
another.

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Manitoba Drug Interchangeability Formulary

– continued
• If a brand name product is prescribed, the drug will be
automatically substituted to the generic according to the
provincial legislation
• Generic substitution is a common practice in Manitoba

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Manitoba Drug Benefits and

Interchangeability Formulary – continued

https://www.gov.mb.ca/health/mdbif/docs/schedule.pdf

• The prescriber or the patient can override generic

interchangeability by requesting "no substitution“ in writing or
verbally.

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Drugs and Federal Legislation

• Controlled Drugs and Substances Act (CDSA)
• Federal legislation for narcotics, controlled drugs and benzodiazepines
• Food and Drugs Act (FDA)
• Federal legislation for all other “drugs”

*For example, Optometrists cannot prescribe under the CDSA (in any province), but can
prescribe under the FDA (in MB and most other provinces).

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Drugs and Federal Legislation – continued

• Controlled Drugs and Substances Act (CDSA)
• Federal legislation for narcotics, controlled drugs and benzodiazepines
• Food and Drugs Act (FDA)
• Federal legislation for all other “drugs”

*For example, Optometrists cannot prescribe under the CDSA (in any province) but can
prescribe under the FDA (in MB and most other provinces).

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Drug Scheduling
• Schedule I
• Prescription medications (included on Health Canada’s
Prescription Drug List)
• Schedule II and III
• Pharmacists can prescribe
• Can only be sold from a pharmacy
• Unscheduled
• Can be sold from any retail outlet (e.g. gas station)

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Practically Perfect Prescribing:

Three Components

Thought

Word

Drug and Patient Care

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Thought
• Right drug, right dose, right patient
• Prescribing drugs relevant to the scope of practice and area of
knowledge

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Thought – continued
• Applying knowledge of pharmacology and best practice
standards in selecting and monitoring drug therapy
• Applying knowledge of contraindications, drug/food interactions,
side effects and concurrent conditions and diseases.

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Thought – continued
• Consulting and collaborating with other health care professionals
(physicians, pharmacists, nurses, etc.) and referring as appropriate
(“collaborative prescribing”)
• Consulting with the patient

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Thought – continued
• Prescribing drugs that meet the needs of the patient’s third-party
coverage
• Drug shortages

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Thought – continued
• Prescribing drugs that meet the needs of the patient’s third-party
coverage
• Drug shortages

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Word
• Completes prescriptions accurately, completely and legibly
including the following information:

a) date of issue;
b) name and address of the person for whom the drug is prescribed;
c) the weight of the client or the age of the client if it has a bearing on the
dosage of the prescribed drug;

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Word – continued
• Complete prescriptions accurately, completely and legibly
including the following information:

d) name, strength and quantity (words and numbers) of the prescribed

drug; (Residents cannot prescribe more than three-month supply.)
e) directions for use, including the frequency, route of administration,
duration of drug therapy, and special instructions;

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Word – continued
• Complete prescriptions accurately, completely and legibly
including the following information:

f) directions for number of allowable refills and interval between refills,

where applicable. (If a prescription includes more than one drug, any
drug that may be refilled must be clearly identified with the number of
allowable refills for each drug);
g) prescriber ’s name, address and telephone number;

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Word – continued
• Complete prescriptions accurately, completely and legibly
including the following information:

h) the treatment goal and/or diagnosis and/or clinical indication;

i) the prescriber ’s hand signature (prescriptions produced by computer
must be hand-signed or with an electronic signature that is hand-
initialed). (Residents must include their telephone number, year of
training, and the name of the Supervising Practitioner.)

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Word – continued
• Complete prescriptions accurately, completely and legibly
including the following information:

h) the treatment goal and/or diagnosis and/or clinical indication;

i) the prescriber ’s hand signature (prescriptions produced by computer
must be hand-signed or with an electronic signature that is hand-
initialed). (Residents must include their telephone number, year of
training, and the name of the Supervising Practitioner.)

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Word – continued
• Prescriptions can be verbal or written orders or sent through “fax”
machine or “electronically”
• The patient should not be directed to a particular pharmacy.

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Word – continued
• Physicians must not prescribe for family members or for
themselves (emergency treatment is an exception).
• Computer-generated prescriptions

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Word – continued
• Computer-generated prescriptions

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Word – continued
• Tall Man Lettering (eg. hydrOXYzine and hydralazine)

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Resident Prescribing Conditions for

Outpatients
• Prescriptions must include:
• Name of resident
• Signature of resident
• Year of training
• Contact phone number or pager
• Name of supervising physician
• Treatment goal &/or diagnosis &/or clinical indication
• Prescription quantity cannot exceed 3 month supply

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Word: Focus on Patient Safety

• Former Manitoba Institute for Patient Safety

• It’s Safe to Ask encourages patients and families to request the

information they need in order to become active participants in their
care. It includes easy-to-read materials for patients, as well as information
kits for healthcare providers and organizations.

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Word: Focus on Patient Safety – continued

• Patient Safety is in YOUR Hand!
Improves patient safety and reduce harm to patients from medication errors, Improves
communication between health care providers and eliminates the use specified dangerous
abbreviations, symbols and dose designations

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See ISMP’s list of error-prone abbreviations, symbols and dose designations at:
www.ismp.org/tools/errorproneabbreviations.pdf

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Manitoba Prescribing Practices Program

(M3P)
• A special prescription form that must be used for certain narcotics
and controlled drugs
• Reference list of drugs covered by the M3P program can be
found here: https://cphm.ca/wp-content/uploads/Resource-
Library/M3P/Drugs-Covered-M3P.pdf

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Manitoba Prescribing Practices Program

(M3P) – continued
• Promotes and supports appropriate drug use management by
decreasing the amount of prescription forgeries and alterations, double
doctoring and injudicious prescribing.
• M3P forms are available from the College of Pharmacists and must be
used for prescribing the narcotic and controlled drugs covered by the
program.
• Due to the pandemic, it is temporarily permissible to fax prescriptions for all
drugs on the M3P schedule directly to the pharmacy, without sending the
original. Further flexibility was also extended to prescribers regarding how the
M3P prescriptions could be written.
• M3P forms are personalized for each prescriber and they all have a
unique identifier number

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Manitoba Prescribing Practices Program

(M3P) – continued
• Only one drug per form
• Must be entered into the DPIN
• Required for outpatient prescribing only.
• Not needed for hospital inpatients or residents of personal care home

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Manitoba Prescribing Practices Program

(M3P) – continued
• Only valid for three days from the date the prescription was
issued (3 days +1 day)
• Should the pharmacist be concerned the prescription has not
been issued consistent with the scope of practice and standards of
care, the pharmacist must intervene and collaborate with the
patient and/or authorized prescriber to resolve the concern.

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Manitoba Prescribing Practices Program

(M3P) – continued
• Keep all prescription forms (M3P and regular) SECURE!

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Drug and Patient Care

• Pharmacists will assess all prescriptions for authenticity (source
and scope), legibility, therapy (DPIN profile), dosage, interactions,
safety, eligibility (third party coverage) and compliance.
• Pharmacists will counsel the patient on proper use, compliance,
side effects, medication management, storage instruction and
refill information

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Drug and Patient Care

• Pharmacists are trustees under the Personal Health Information
Act (PHIA)
• Pharmacists will consult the prescriber on matters of concern in any of
the above areas
• Team approach!

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References
• College of Pharmacists of Manitoba. Provincial Prescription Regulation Summary Chart. Web. June 2022.
https://cphm.ca/resource-library/?_sf_s=provincial%20prescription
• College of Pharmacists of Manitoba. Prescribing Authority Table. Web. June 2022. https://cphm.ca/resource-
library/?_sf_s=prescribing%20authority
• Government of Canada. Controlled Drugs and Substances Act. Web. April 2020. http://laws-lois.justice.gc.ca/eng/acts/c-
38.8/
• Government of Canada. Food and Drugs Act. Web. April 2020. http://laws.justice.gc.ca/eng/acts/F-27/
• Manitoba Health, Seniors and Active Living. Manitoba Pharmacare Program. Web. April 2020.
http://www.gov.mb.ca/health/pharmacare/index.html
• Manitoba Health, Seniors and Active Living. Manitoba Drug Benefits and Interchangeability Formulary. Web. April 2020.
http://www.gov.mb.ca/health/mdbif/index.html
• Manitoba Health, Seniors and Active Living. Deductible Instalment Payment Program for Pharmacare. Web. April 2020.
http://www.gov.mb.ca/health/pharmacare/dippp.html
• Shared Health Patient Safety. Resources and Tips. Web. June 2023. https://sharedhealthmb.ca/patient-care/quality-patient-
safety-learning/patient-safety/
• MedScape. Seven (Potentially) D3eadly Prescribing Errors. April 2020.
http://www.medscape.com/features/slideshow/prescribing-
errors?src=WNL_infoc_160703_MSCPEDIT_v2&uac=64839DZ&impID=1144195&faf=1#page=16

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Questions?
College of Pharmacists of Manitoba
200 Taché Avenue
Winnipeg, MB R2H 1A7

Email: info@cphm.ca
Phone: 204-233-1411

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