Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This board is amending section (3) of this
rule by adding subsection (H) to delineate requirements for compounding
medication for office use/administration by a Missouri licensed veterinarian
for animal patients.
(1)
Radiological Services.
(A) All veterinary
facilities must have adequate diagnostic radiological services, unless there
exists a written agreement to provide these services through another
facility.
(B) A radiograph is the
property of the veterinarian or the veterinary facility which originally
ordered it to be prepared. However, the radiograph or a copy of it shall be
released within a reasonable time period upon the request of another treating
veterinarian who has the authorization of the owner of the animal to which it
pertains or directly to the owner or owner's agent. An original radiograph
shall be returned to the originating veterinarian within a reasonable time
period after written request. Radiographs originating at an emergency hospital
or clinic become the property of the next attending veterinary facility upon
receipt. Documented proof of transfers of radiographs shall be
verifiable.
(C) Radiographs should
be stored and maintained for a minimum of five (5) years from the date the
radiograph was taken. All exposed radiographic films shall have a permanent
identification, legibly exposed in the film emulsion, which will include the
following:
1. The hospital or clinic name or
facility permit number;
2. The
identity of the person taking the radiograph;
3. Client identification;
4. Patient identification; and
5. The date the radiograph was
taken.
(2)
Laboratory Services and Equipment.
(A)
Clinical pathology and histopathology diagnostic laboratory services must be
available within the veterinary facility or through outside services.
(B) Laboratory data is the property of the
veterinarian or the veterinary facility which originally ordered it to be
prepared and a copy shall be released within a reasonable time period upon the
request of another veterinarian who has the authorization of the owner of the
animal to which it pertains or directly to the owner or owner's
agent.
(C) A laboratory must be
equipped with a microscope.
(3) Dispensed Drug Labeling.
(A) No legend drug or biologic shall be
prescribed, dispensed or administered without the establishment of a
veterinarian-client-patient relationship or the direct order of a licensed
veterinarian who has an established veterinarian-client-patient relationship
with that animal(s).
(B) The
veterinarian in charge is responsible for assuring that any legend drugs and
biologicals prescribed for use in the veterinary facility are properly
administered, for maintaining accurate records to include strength, dosage and
quantity of all medications used or prescribed and for instructions to clients
on the administration of drugs when the veterinarian will not be providing
direct supervision.
(C) All drugs
and biologicals shall be maintained, administered, dispensed and prescribed in
compliance with state and federal laws.
(D) All repackaged legend drugs dispensed for
companion animals shall be in approved safety closure containers, except that
this provision shall not apply to drugs dispensed to any person who requests
that the medication not be placed in these containers, or in those cases in
which the medication is of a form or size that it cannot be dispensed
reasonably in these containers.
(E)
All drugs dispensed shall be labeled in compliance with all state and federal
laws and as a minimum include:
1. Name,
address and telephone number of the facility;
2. Patient's name;
3. Date dispensed;
4. Directions for use;
5. Name, strength (if more than one (1)
dosage form exists), and quantity of drug and the expiration date when
available; and
6. Name of
prescribing veterinarian.
(F) All clients shall have the right to
receive a written prescription from their veterinarian to take to the pharmacy
of their choice so long as a valid veterinarian-patient-client relationship
exists.
(G) Records shall be
maintained of all medications prescribed and dispensed for any animal or group
of animals in that animal's individual record or the herd owner's record. These
pharmacy records may be transferred, in whole or in part, from one veterinarian
to another, in writing or by telephone, at the request of the client/owner or
owner's agent, when necessary to continue treatment or disease prevention
medication started by the original attending veterinarian.
(H) A veterinarian may dispense no more than
a seven- (7-) day supply per patient from an office stock compounded
preparation provided by a licensed pharmacy. A patient-specific prescription
must be issued to continue treatment beyond seven (7) days and comply with all
other requirements under this rule.
(4) Vaccinations.
(A) A vaccination is the administration of a
vaccine to an animal in an attempt to prevent disease.
(B) A veterinarian-client-patient
relationship must exist prior to administration or dispensing of a vaccine for
diseases which are communicable to humans and which are of a public health
significance in order to ensure that the patient is medically fit to receive
it. In order to implement the exemption provisions of section 340.216.1(5),
RSMo, the board recognizes that the following diseases are communicable to
humans and are of public health significance, and that only a veterinarian may
immunize or treat an animal for these diseases:
1. Brucellosis; and
2. Rabies.
(C) A plan for initial vaccination and
subsequent revaccinations shall be formulated and communicated to the
client.
(D) No vaccine shall be
dispensed or administered unless provision has been made for treatment of
vaccination-related emergencies. If this treatment is not to be provided
on-site, clients will be advised where emergency service is provided.
(5) Disposal of Dead Animals.
Sanitary methods for the disposal of deceased animals shall be provided and
maintained. When the owner or owner's agent of a deceased animal has not given
the veterinarian authorization to dispose of his/her animal, the veterinarian
shall be required to retain the carcass for at least three (3) days following
the death or three (3) days after notification to the owner or owner's agent,
whichever is longer, in accordance with section 340.288.4, RSMo.
(6) Anesthesia Services.
(A) General anesthesia is a condition caused
by the administration of a drug or combination of drugs sufficient to produce a
state of unconsciousness or dissociation and blocked response to a given pain
or alarming stimulus. Appropriate and humane methods of anesthesia, analgesia
and sedation shall be utilized to minimize pain and distress during surgical
procedures.
(B) A veterinarian
shall comply with the following standards when administering a general
anesthetic:
1. Every animal shall be given a
physical examination within twelve (12) hours prior to the administration of an
anesthetic; and
2. The animal under
general anesthesia shall be under continuous observation until at least the
swallowing reflex has returned and not be released to the client until the
animal demonstrates a righting reflex. This shall not preclude direct transfer
of an animal under anesthesia to a suitable facility for referred
observation.
(C)
Equipment.
1. Anesthetic equipment in
accordance with the level of surgery performed will be available at all times.
The minimum amount of support equipment required for the delivery of assisted
ventilation will be-
A. Resuscitation bags of
appropriate volumes; and
B. An
assortment of endotracheal tubes with cuffs in working condition.
2. Oxygen equipment will be
available at all times.
3. Some
method of respiratory monitoring is mandatory, such as observing chest
movements, watching the rebreathing bag or use of a respirometer. Some method
of cardiac monitoring is recommended and may include use of a stethoscope or
electrocardiographic monitor.
(D) Effective means shall be provided for
exhausting waste gases from hospital areas in which inhalation anesthesia is
used. These means shall comply with existing federal, state and local
regulations and may include use of filtration canisters, gravitational or
negative-suction venting, or a combination of these.
(E) Anesthetic equipment will be maintained
in proper working condition.
(7) Surgical Services.
(A) Sterile surgery shall be defined as
procedures in which aseptic technique is practiced in patient preparation,
instrumentation and surgical attire.
(B) Surgery Room.
1. A room shall be designated for aseptic
surgery and it shall be clean, orderly and properly maintained.
2. Nothing in this section shall preclude
performance of emergency aseptic surgical procedures in another room when the
room designated for that purpose is already occupied.
3. The surgery room will be well-lighted and
will be provided with effective emergency lighting.
4. The floors, table tops and counter tops of
the surgery room will be of a material suitable for regular disinfection and
cleaning, and will be cleaned and disinfected regularly.
(C) Instruments and Equipment.
1. Instruments and equipment will be-
A. Adequate for the type of surgical service
provided; and
B. Sterilized by a
method acceptable for the type of surgery for which they will be
used.
2. In any sterile
procedure, a sterile pack will be used.
(D) Sterilization. Aseptic surgery requires
sterilization of all appropriate equipment. An acceptable method of
sterilization must be used on all instruments, packs and equipment intended for
use in aseptic surgical procedures.
(E) Attire for surgical service. When
performing clean surgery, the surgeon(s) and ancillary personnel shall wear
clean clothing.
(8)
Dental Service.
(A) Dental operation means-
1. The application or use of any instrument
or device to any portion of an animal's tooth, gum, or any related tissue for
the prevention, cure or relief of any wound, fracture, injury, or disease of an
animal's tooth, gum, or related tissue; and
2. Preventive dental procedures including,
but not limited to, the removal of calculus, soft deposits, plaque, stains, or
the smoothing, filing, or polishing of tooth surfaces.
(B) Nothing in this rule shall prohibit any
person from utilizing cotton swabs, gauze, dental floss, dentifrice,
toothbrushes or similar items to clean an animal's teeth.
*Original authority: 340.200, RSMo 1992, amended 1999, 2004
and 340.210, RSMo 1992, amended 1993, 1995,
1999.