The intent of this rule is to improve pharmaceutical care by defining
basic standards of care. Pharmacy care/pharmaceutical care is defined as the
responsible provision of drug therapy for the purpose of achieving definite
outcomes that improve a patient's quality of life. These outcomes are:
(4)
preventing a disease or symptomatology.
Pharmaceutical care (clinical pharmacy) involves four major functions
on behalf of the patient:
(4) optimizing
patient therapy outcomes. It is recognized that the patient might be best
served if medication is not provided.
(a)
Patient information (profile)
In order to effectively counsel patients, the pharmacist must, through
communication with the patient or caregiver, make a reasonable effort to
obtain, record, and maintain the following information for each patient. It is
recognized that most of this can be obtained using pharmacy technicians and
designed forms, etc.
(1) Name,
address, telephone number;
(2) Date
of birth (age);
(3)
Gender;
(4) Medical history
(A) Significant patient health problems known
to the pharmacist;
(B) Prescription
drug reactions/prescription drug allergies;
(C) List of prescription medications and
legend drug administration devices known to the pharmacist.
(5) Transitory patients or
situations where the pharmacy will only provide medication one time
In obtaining patient information, if the pharmacist knows or is
informed by the patient that this is a one-time situation, the pharmacist may
forego the above requirement to record and maintain the information.
(6) Pharmacist comments
(b) Drug use evaluation for new
and refill prescriptions
Drug use evaluation or drug utilization review includes the following
activities:
(1) The pharmacist shall
evaluate the prescription or medication order for:
(A) Reasonable dose and route of
administration;
(B) Reasonable
directions for use.
(2)
The pharmacist shall evaluate medication orders and patient information for:
(A) Duplication of therapy - is the patient
taking the same or similar medication(s)?;
(B) Prescription drug-prescription drug
interactions;
(C) Proper
utilization (over or underutilization);
(D) Known drug allergies.
(3) Drug-drug contraindications as
defined by the Board. (Is this medication contraindicated with another
medication the patient is taking?)
(4) It is recognized that the ultimate
decision to use the medication or not use the medication rests with the
physician who has more complete patient information. It is the pharmacist's
responsibility to monitor the patient's medication therapy in the areas
addressed in this rule and inform the physician of the suspected
problem.
(5) If a problem is
suspected and the physician is informed, the pharmacist shall document the
process.
(c) Patient
counseling:
(1) A pharmacist shall counsel the
patient or caregiver "face to face" if the patient or caregiver is in the
pharmacy. If not, a pharmacist shall make a reasonable effort to counsel the
patient or caregiver;
(2)
Alternative forms of patient information may be used to supplement, but not
replace face-to-face patient counseling;
(3) Patient counseling, as described herein,
shall also be required for outpatients of hospitals and institutions when
medications are dispensed on discharge from the hospital or
institution.
(4) Patient counseling
as described in this rule shall not be required for inpatients of a hospital or
institution where a nurse or other licensed health care professional is
authorized to administer the medication. However, the pharmacist shall provide
drug therapy counseling it is when professionally deemed to be appropriate and
when medications are provided by the pharmacy, and when a pharmacist is on duty
and a patient is discharged from the hospital or institution.
(5) The pharmacist shall maintain and make
available to all patients appropriate patient-oriented reference materials
USP-DI or Facts and Comparisons Patient Drug Facts or an
equivalent or better publication as determined by the Board.
(6) It is recognized that the ultimate
decision to not provide patient counseling rests with the physician. If the
physician in specific instances (blanket requests not accepted) requests that
information NOT be provided to the patient and gives reason, the pharmacist
should honor that request in almost all instances.
(d) "Patient counseling" shall mean the
effective communication by the pharmacist of information, as defined in this
act to the patient or caregiver, in order to improve therapeutic outcome by
encouraging proper use of prescription medications and drug delivery devices.
(1) For original prescription medication
orders, (excluding renewed or updated prescriptions the patient has been
recently taking) and orders for legend devices, specific areas of counseling
shall include:
(A) Name and general
description of the medication dispensed, i.e. antibiotic, antihistamine, blood
pressure medicine, etc.
(B) Name,
general description and directions for use of drug delivery devices, i.e.,
insulin syringes, morphine pump, etc.
(C) Explanation of route of administration,
dosage, times of administration, and continuity of therapy;
(D) Special directions for storage as deemed
necessary by the pharmacist;
(E) If
the drug has been determined to have a significant side effect by the Board of
Pharmacy, the patient shall be properly counseled to the extent deemed
necessary by the pharmacist.
(F)
When the prescription drug dispensed has a significant side effect, if taken
with over-the-counter drugs, the pharmacist should counsel the patient about
that interaction. (Example: coumadin with aspirin )
(G) If the prescription medication is
significantly affected by food or diet, the pharmacist should so advise the
patient. (Example: tetracycline with milk or food)
(H) The pharmacist shall inform the patient
or caregiver that he/she is available to answer questions about medications or
general health information.
(2) Refills--On refills the pharmacist shall
present the opportunity for the patient or caregiver to ask questions. However,
counseling on refills is not required except when needed in the professional
judgment of the pharmacist.
(d) Drug interactions - significant side
effects
Recognizing that a pharmacist cannot be expected to recognize all
possible drug interactions and also recognizing that the pharmacist and the
patient do not have time to explain the numerous side effects of drugs, the
pharmacy shall maintain a computer program which will identify significant drug
interactions. (These are drugs with side effects which may be managed most
effectively if the patient is aware of the specific side effect and what to do
if it occurs.) The pharmacist in charge will be responsible for assuring that
the computer system adequately flags and warns the pharmacist of any occurrence
of significant drug interactions or significant side effects. (If a pharmacy
was in business before September 1, 1997, and at that time, did not have a
computer system, said pharmacy may substitute Patient Drug
Facts or other drug interaction manuals to reference drug interactions
and side effects for effective patient counseling. This method should only be
used until such time as the pharmacy acquires an adequate computer program as
described in this section.) The pharmacist will be responsible for counseling
the patient on these interactions with verbal and, where appropriate, written
information. (2/12/91, 2/10/98, 07/15/2004 and 5/10/2022)
