Protecting patients with suicidal ideation when prescribing or dispensing medications

A note from the Collège des médecins du Québec reminds physicians and pharmacists to make sure patients with suicidal ideation don’t have access to a large quantity of prescribed medications that could cause harm. It also suggests healthcare professionals communicate with each other about prescriptions for patients at risk of death by suicide.The reminder comes after the college received several recommendations from a coroner’s investigation into a 25-year-old woman’s death by suicide. The coroner found that the woman had a considerable quantity of medications in her possession and that there was poor communication between her healthcare professionals about her care.The coroner made recommendations to the college, the Ordre des pharmaciens du Québec and Quebec’s health ministry as an outcome of the inquiry.The first was to identify the best way healthcare professionals can work together to monitor and intervene on the level of access a patient at risk of death by suicide has to medications that could be used for harm. This has to be done while protecting a patients’ privacy.The coroner also said that the college and Ordre des pharmaciens du Québec should train and inform members about practice recommendations on suicide prevention, and how to limit and monitor access to medications that could be used for harm. The order should also support and train its member pharmacists on how to evaluate a patient’s mental state, including an evaluation of risk of death by suicide. Nursing regulatory bodies could also take part in discussions about this issue, the coroner said. The college noted that a physician or nurse practitioner must inform the pharmacist of a patient’s clinical condition, especially in cases of suicidal ideation or planning. This must be done with the patient’s consent.However, a healthcare professional can lift their responsibility of confidentiality when they believe that there is a real and urgent risk of serious harm, as laid out in section 60.4 of the province’s Professional Code.A physician or nurse practitioner prescribing medication must adjust the quantity of medications that the pharmacist can dispense to a patient based on their risk of suicidal ideation or planning, the college said. For example, a doctor may make the prescription for seven days instead of 30. The pharmacist can also choose to only dispense a small amount at a time.The college noted that a pharmacist can encourage a patient to return surplus medications to the pharmacy to reduce the amount of medications in their possession, although the patient has a right to refuse.The college is planning a workshop on suicide prevention and will announce the date when available.Read: Advocacy groups decry federal government’s shutdown of mental health website, app

Protecting patients with suicidal ideation when prescribing or dispensing medications

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