Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment adds a new section (2) which
allows pharmacy technicians to perform additional duties relating to the
authentication of medications selected by other pharmacy technicians and
perform other duties remotely if performed under the visual and auditory
supervision of a pharmacist.
(1) There shall be evidence of the education,
training, experience, and demonstrated competency for all duties assigned in
the pharmacy technicians' personnel records.
(2) In addition to other authorized duties, a
pharmacy technician may perform the following duties:
(A) Authenticate medication selected by
another pharmacy technician when a pharmacist is present for purposes of
distribution within the hospital for subsequent administration by hospital
staff authorized to administer medication, provided the final product is
verified by authorized hospital staff prior to administration. A pharmacy
technician shall not be authorized to authenticate compounded medications or
the repackaging activities of another pharmacy technician. In order to
authenticate medication as described in this section, the pharmacy technician
must-
1. Hold an active pharmacy technician
certification issued by a certification entity accredited by the National
Commission for Certifying Agencies;
2. Have an initial and annual documented
assessment of competency; and
3.
Have assisted in the practice of pharmacy as a registered or licensed pharmacy
technician in the state of Missouri or another U.S. state or territory for a
minimum of one (1) year; and
(B) Perform assigned duties under visual and
auditory supervision of a pharmacist at a different site, including, technology
assisted medication authentication. Documentation of electronic authentication
shall be maintained at the dispensing site.
1.
The pharmacy technician shall have a current certificate issued by a
certification entity accredited by the National Commission for Certifying
Agencies.
2. The pharmacy
technician shall have completed training and documented competency in the
assigned responsibilities being performed remotely as attested by the director
of pharmacy.
3. The director of
pharmacy is responsible for developing and implementing standards to ensure
adequate supervision of electronically supervised technicians.
(3) An intern
pharmacist licensed by the Board of Pharmacy may also perform any activity
authorized for pharmacy technicians pursuant to this rule.
(4) Persons involved in compounding, repackaging,
dispensing, administration, and controlled substance disposal shall be
identified and the records shall be retrievable. Retention time for records of
bulk compounding, repackaging, administration, and all controlled substance
transactions shall be a minimum of two (2) years. Retention time for records of
dispensing and extemporaneous compounding, including sterile medications, shall
be a minimum of six (6) months.
(5) All variances, discrepancies, inconsistencies, or
non-compliance involving controlled substances-including inventory, audits,
security, record keeping, administration, and disposal-shall be reported to the
director of pharmacy services for review and investigation.
(6) Patient medications may be received from an
authorized provider. The medications shall-
(A) Be delivered directly to the pharmacy and
not to a patient care area unless the pharmacist is not available;
(B) When a pharmacist is present, be
identified, determined suitable for use and documented by the pharmacist. When
a pharmacist is not present, be identified and documented by an authorized
practitioner. Unused doses of medication shall be identified by the pharmacist
when the pharmacist is present; and
(C) The pharmacy may compound, repackage, or
re-label medications received from an outside provider, including prescriptions
dispensed by a pharmacy, as necessary for proper distribution and
administration. Records of compounding, repackaging, or relabeling of
prescriptions dispensed by a pharmacy shall allow identification of the
original prescription.
(7) Sample medications, if allowed, shall be received
and distributed only by the pharmacy.
(8) Medications may be provided to patients for use
outside the hospital, by persons other than the pharmacist.
(A) When the patient is a registered patient
of the emergency department or is being discharged from the hospital-
1. Medications shall be provided according to
the hospital's policies and procedures, including:
A. Circumstances when medications may be
provided;
B. Practitioners
authorized to order;
C. Specific
medications;
D. Limited
quantities;
E. Prepackaging and
labeling by the pharmacist;
F.
Final labeling to facilitate correct administration;
G. Delivery;
H. Counseling; and
I. A transaction record;
2. Medications shall be labeled with the
date, patient's name, prescriber's name, name and address of the hospital,
exact medication name and strength, instructions for use, and other pertinent
information;
3. Medications may be
provided only when prescription services from a pharmacy are not reasonably
available. Reasonably available includes a pharmacist on duty in the hospital
or a community pharmacy that is reasonably accessible to the patient;
4. The medication provided shall be limited
to urgently needed treatment;
5.
The quantity of medication provided shall be limited to the amount necessary
until pharmacy services are available;
6. The provisions of paragraph (A)3. and
paragraph (A)5. of this subsection shall not apply when the patient is being
treated for an acute condition and it is believed that the immediate health and
welfare of the patient and/or the community are in jeopardy. The quantity limit
may be extended to provide single-course therapy; and
7. Final labeling, delivery, and counseling
shall be performed by a pharmacist, the prescriber or a registered nurse,
except that final labeling and delivery may be performed by an automated
dispensing system.
(B)
Automated dispensing systems may be used in accordance with all requirements of
this section-
1. When the automated dispensing
system is controlled by the prescriber it may be used only during times when no
pharmacy services are reasonably available, except as allowed in paragraph
(A)6. of this section; and
2. When
the automated dispensing system is controlled by a pharmacy according to
regulations of the Missouri Board of Pharmacy, including, but not limited to
20 CSR
2220-2.900.
(C) Medications in multidose containers that
were administered to or used for the patient during the patient's hospital stay
may be sent with the patient at discharge when so ordered by an authorized
practitioner.
1. Examples of multidose
medication containers include, but are not limited to, inhalers, ointments,
creams, medications requiring the original container for dispensing, insulin
pens, eye drops, ear drops, and infusions that are currently connected to the
patient's infusion device.
2.
Written instructions for use shall be provided by a pharmacist, prescriber, or
registered nurse at the time of discharge.
3. Controlled substances shall not be sent
with the patient, except that controlled substance infusions or continuous
delivery systems currently connected to the patient may be sent as follows:
A. The medication is necessary for
administration during transport of the patient; and
B. The quantity of controlled substance sent
is documented in the patient's medical record by the person sending the
medication.
(9) The director of pharmacy services or his/her
pharmacist designee shall be an active member of the pharmacy and therapeutics
committee or its equivalent, which shall advise the medical staff on all
medication matters.
(10)
Medications shall be ordered only by practitioners who have independent
statutory authority to prescribe or who are authorized to order medications by
their professional licensing agency as provided by state law. Authority to
order medications may be granted to a non-physician licensed practitioner in
accordance with state law.
(11)
Medications in the possession of the patient at time of admission shall be
given to the patient's representative unless there is an identified need to
retain them.
(A) Medications that are not
given to the patient's representative and that are not to be administered shall
be documented, sealed, and stored in a locked area accessible only to
individuals authorized to access medications.
(B) Controlled substances shall be security
sealed and stored in a locked area accessible only to individuals authorized to
administer controlled substances or to authorized pharmacy
personnel.
*Original authority: 192.006, RSMo 1993, amended 1995;
197.080, RSMo 1953, amended 1993, 1995; and 197.154, RSMo
2004.
