Pharmacist Duties, Delegation, Supervision, Counseling, and Collaborative Practice
Pharmacist-only functions
Maryland reserves to the pharmacist the final verification of a dispensed prescription, patient counseling, clinical judgment, and professional discretion. Technicians and interns work under a pharmacist's supervision and cannot independently perform those functions.
Delegation and supervision
- Delegable tasks include data entry, counting, labeling, stock management, and, under supervision, compounding and vaccine preparation.
- Supervision level matters: direct supervision means a pharmacist is physically present and immediately available; general supervision permits off-site oversight only where regulations allow it.
- The pharmacist-in-charge writes policies and procedures, trains staff, and remains accountable for compliance.
Counseling
Counseling is a conversation, not a label. It should cover directions, expected effects, significant risks, interactions, storage, and when to call the prescriber. Offer it on every new prescription and on refills when the pharmacist judges it necessary; document refusals.
Collaborative practice agreements
A CPA is a written agreement with a prescriber defining the drugs and conditions the pharmacist may manage, permitted actions (initiate, adjust, discontinue, order and interpret labs), documentation and communication requirements, patient consent, and termination. Maryland also authorizes protocol-based services, including naloxone dispensing without an individual prescription and pharmacist prescribing of self-administered hormonal contraceptives; vaccine authority depends on patient age and protocol.
Worked example
A physician and community pharmacist sign a CPA for hypertension management. The pharmacist may adjust lisinopril within the agreed range, order a basic metabolic panel, document the encounter, and notify the physician within the agreed interval. Starting a drug outside the agreement's list would exceed the CPA.
Traps
Treating a CPA as open-ended authority; delegating counseling to a technician; assuming an off-site pharmacist can supervise tasks that require physical presence.