Current through September 24, 2024
1. In the
dispensing of drugs, the pharmacist shall have the following responsibilities:
A. In a pharmacy, it shall be the
responsibility of the pharmacist on duty at the facility to insure that only a
pharmacist provides professional consultation with the patients and/or other
licensed health care professionals, and that only a pharmacist accepts
telephoned or orally prescribed medication orders or prescriptions; or gives
information in any manner relative to prescriptions or prescription drugs. The
provisions of this paragraph shall not apply to an extern or intern working
under the supervision of a pharmacist.
B. In the dispensing of drugs from a
pharmacy, it shall be the responsibility of the supervising pharmacist to
prevent the pharmacy technician from performing those functions relative to
dispensing which are functions based on a judgment for which the pharmacy
technician has not been prepared by education or authorized by law or
regulation.
C. In the dispensing
of medications for ambulatory (or outpatients):
(1) The pharmacist shall be responsible for
all activities of the pharmacy technician in the preparation of the drug for
delivery to the patient;
(2) The
pharmacist shall be present and personally supervising the activities of the
pharmacy technician at all times;
(3) When a data processor or computerized
order entry system is used, pharmacy technicians may enter information into the
database and prepare labels, but it shall be the responsibility of the
pharmacist to verify the accuracy of the information entered and the
prescription information produced;
(4) When refilling a prescription, it shall
be the responsibility of the pharmacist to make the determination whether or
not to refill the prescription;
(5) A pharmacist shall not actively supervise
more than three pharmacy technicians at one time. Externs/Interns are not
included in this quota calculation;
(6) Pharmacy Technicians in the dispensing
area shall be readily identifiable.
D. In all instances where the services of
pharmacy technicians are utilized in the preparation of a drug for delivery to
a patient, a pharmacist shall be present and personally supervise the pharmacy
technician and shall be responsible for the correct preparation and delivery of
the drug to the patient. All drugs dispensed utilizing the services of a
pharmacy technician shall be properly labeled and identify the responsible
supervising pharmacist.
E. In the
event of a loss or suspected loss of a controlled substance, it is the
responsibility of the discovering pharmacist to report the loss or suspected
loss directly to the Board at the time of discovery.
F. In the interest of the public health the
pharmacist shall, where appropriate, counsel patients and review their
medication profiles to improve patient understanding and compliance.
2. Patient Records:
A. A system for documenting medications,
prescribed and dispensed, shall be maintained by all pharmacies licensed to
dispense medications. The patient record system shall allow the immediate
retrieval of information necessary for the dispensing pharmacist to identify
previously dispensed drugs at the time a prescription drug order is presented
for dispensing. The pharmacist or the pharmacist's agent shall make a
reasonable effort to obtain, record, and maintain the following information:
(1) Full name of the patient for whom the
drug is intended;
(2) Address and
telephone number of the patient;
(3) Patient's age or date of birth;
(4) Patient's gender;
(5) A record of all Prescription Drug Orders
obtained by the patient at the pharmacy maintaining the patient record during
the preceding 2 years displaying the name of the drug or device, prescription
number, name and strength of the drug, the quantity and date received, and the
name of the prescriber;
(6)
Pharmacist's comments relevant to the individual's drug therapy, including any
other information peculiar to the specific patient or drug; and
B. The pharmacist or pharmacist's
agent shall make a reasonable effort to obtain from the patient or the
patient's agent and shall record any known allergies, drug reactions,
idiosyncrasies, and chronic conditions or disease states of the patient and the
identity of any other drugs, including over-the-counter drugs or devices,
currently being used by the patient which may relate to Prospective Drug Use
Review (DUR).
3.
Prospective Drug Use Review:
Before a prescription is dispensed, delivered, or distributed,
a pharmacist shall review the patient record and each Prescription Drug Order
presented for dispensing for purposes of promoting therapeutic appropriateness
by screening:
A. Over-utilization or
under-utilization;
B. Therapeutic
duplication;
C. Drug-disease
contraindications;
D. Drug-drug
interactions;
E. Incorrect drug
dosage or duration of drug treatment;
F. Drug-allergy interactions; and,
G. Clinical abuse/misuse.
Upon recognizing any of the above, the pharmacist shall take
appropriate steps to avoid or resolve the problem which shall, if necessary,
include consultation with the prescriber.
4. Patient Counseling:
A. Upon receipt of an outpatient prescription
drug order and following a review of the patient's record, it is the pharmacist
or the pharmacist's agent's responsibility to make the offer to discuss matters
which are deemed significant in the pharmacist's professional judgment. The
pharmacist must provide the patient counseling. If patient or caregiver is not
available, the pharmacist shall make known the fact that patient counseling is
available and how he/she may be reached. Such discussion may include the
following:
(1) Name and description of the
drug;
(2) Dosage form, dose, route
of administration, and duration of therapy;
(3) Intended use of the drug and expected
action;
(4) Special directions and
precautions for preparation, administration, and use by the patient;
(5) Common severe side or adverse effects or
interactions and therapeutic contraindications that may be encountered,
including their avoidance, and the action required if they occur;
(6) Techniques for self-monitoring drug
therapy;
(7) Proper storage;
(8) Prescription refill
information;
(9) Action to be
taken in the event of a missed dose; and
(10) Pharmacist comments relevant to the
individual's drug therapy, including any other information peculiar to the
specific patient or drug.
B. Alternative forms of patient information
may be used to supplement verbal patient counseling when appropriate, such as
written information, leaflets, pictogram labels, video programs, auxiliary
labels on the prescription vials, etc.
C. Patient counseling, as described above and
defined in the Act, shall not be required for inpatients of a hospital or
institution where other licensed health care professionals are authorized to
administer the drug(s).
D. A
pharmacist that dispenses prescriptions that are to be delivered to the patient
or the patient's caregiver by U.S. Mail, UPS, Federal Express, or any other
carrier or by any employee or agent of the pharmacy shall comply with the
following:
(1) Provide printed information
with the delivery which supplies at a minimum the name, address and telephone
number of the dispensing pharmacist and all information as outlined in
paragraph 4., (A), of this ARTICLE.
E. A pharmacist shall not be required to
counsel a patient or caregiver when the patient or caregiver refuses such
consultation.
F. A pharmacist may
refuse to fill a prescription for a variety of reasons outlined within these
regulations. Additionally, a pharmacist may decline to fill or refill a
prescription or provide a service when the costs of providing those products or
services exceeds the reimbursement obtained from a third-party payer. If a
pharmacist declines to fill a prescription or provide a service because the
costs associated with suppling the product or service exceeds the reimbursement
for the product or service, he/she shall provide the patient with a list of
pharmacies in the area that may provide the product or service.
5. Confidentiality:
Patient information obtained by the pharmacist or his agent is
for the purpose of patient record maintenance, prospective drug review,
retrospective drug use review and patient counseling shall be considered
confidential information (see Definition Section).
Personally identifiable confidential patient information in
the patient medication record may be released to the patient, the prescriber,
other licensed practitioners then caring for the patient, another licensed
pharmacist caring for the patient, the Board or its representatives or any
person duly authorized by law to receive such information. This personally
identifiable confidential information in the patient medication record may be
released to others only on written release by the patient.
The pharmacist-in-charge shall be responsible for written
policies and procedures for maintaining the integrity and confidentiality of
prescription and patient health care information. All employees of the pharmacy
with access to any such information shall be required to read and attest that
they will comply with the established policies and procedures.
All pharmacies, pharmacists, pharmacy technicians, and other
pharmacy employees shall attest that they will comply with the provisions of
the Health Insurance Portability and Protection Act (HIPPA).
