Date of Adoption: January 28, 2004.

     Purpose: In response to 2003 legislation, optometrists may be certified to use or prescribe oral medications, and/or administer epinephrine to patients in the event of anaphylactic shock. These rules describe the required training.

     Statutory Authority for Adoption: Chapter 142, Laws of 2003.

     Other Authority: RCW 18.54.072(2).

      Adopted under notice filed as WSR 04-01-201 on December 24, 2003.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 2, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 2, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

January 28, 2004

R. Richard Ryan, Jr., O.D.

Chair, Board of Optometry

OTS-6664.5

NEW SECTION
WAC 246-851-570   Certification required for use or prescription of drugs administered orally for diagnostic or therapeutic purposes.   (1) To qualify for certification to use or prescribe drugs administered orally for diagnostic or therapeutic purposes, licensed optometrists must provide documentation that he or she:

     (a) Are certified under RCW 18.53.010 (2)(b) to use or prescribe topical drugs for diagnostic and therapeutic purposes.

     (b) Have successfully completed a minimum of sixteen hours of didactic and eight hours of supervised clinical instruction from an institution of higher learning, accredited by those agencies recognized by the United States Office of Education or the Council on Postsecondary Accreditation.

     (2) The didactic instruction must include a minimum of sixteen hours in the following subject area:

     (a) Basic principles of systemic drug therapy;

     (b) Side effects, adverse reactions and drug interactions in systemic therapy;

     (c) Review of oral pharmaceuticals:

     (i) Prescription writing;

     (ii) Legal regulations in oral prescription writing;

     (iii) Systemic antibacterials in primary eye care;

     (iv) Systemic antivirals in eye care;

     (v) Systemic antifungal in eye care;

     (vi) Systemic antihistamines and decongestants and their uses in eye care;

     (vii) Oral dry eye agents;

     (viii) Anti-emetics and their use in eye care;

     (ix) Systemic diuretics and their management of elevated IOP;

     (x) Systemic epinephrine;

     (d) Review of systemic medication in ocular pain management:

     (i) Legal regulations with scheduled medication;

     (ii) Systemic nonsteroidal anti-inflammatory drugs (NSAIDS);

     (iii) Systemic noncontrolled analgesics;

     (iv) Systemic controlled substances;

     (e) Review of oral medications used for sedation and anti-anxiety properties in eye care:

     (i) Controlled anti-anxiety/sedative substances;

     (ii) Legal ramifications of prescribing anti-anxiety drugs;

     (f) Review of systemic medications used during pregnancy and in pediatric eye care:

     (i) Legal ramifications in prescribing to this population;

     (ii) Dosage equivalent with pregnancy and pediatrics;

     (iii) Medications to avoid with pregnancy and pediatrics;

     (g) Applied systemic pharmacology:

     (i) Eyelid and adnexal tissue;

     (ii) Lacrimal system and peri-orbital sinuses;

     (iii) Conjunctival and corneal disorders;

     (iv) Iris and anterior chamber disorders;

     (v) Posterior segment disorders;

     (vi) Optic nerve disease;

     (vii) Peripheral vascular disease and its relationship with ocular disease;

     (viii) Atherosclerotic disease;

     (ix) Other/course review.

     (3) The supervised clinical instruction must include at least eight hours in the following subject areas:

     (a) Vital signs;

     (b) Auscultation;

     (c) Ear, nose and throat;

     (d) Screening neurological exam.

     (4) Written examination to cover required curriculum.

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     (a) Are certified under RCW 18.53.010 (2)(b) to use or prescribe topical drugs for diagnostic and therapeutic purposes.

     (b) Have successfully completed a minimum of four hours of didactic and supervised clinical instruction from an institution of higher learning, accredited by those agencies recognized by the United States Office of Education or the Council on Postsecondary Accreditation to qualify for certification by the optometry board to administer epinephrine by injection.

     (2) The didactic instruction must include the following subject area:

     (a) Review of urgencies, emergencies and emergency-use agents;

     (b) Ocular urgencies:

     (i) Thermal burns-direct and photosensitivity-based ultraviolet burn;

     (ii) Electrical injury;

     (iii) Cryo-injury and frostbite;

     (iv) Insect stings and bites;

     (v) Punctures, perforations, and lacerations;

     (c) General urgencies and emergencies:

     (i) Anaphylaxis;

     (ii) Hypoglycemic crisis;

     (iii) Narcotic overdose.

     (3) The supervised clinical instruction must include the following subject areas:

     (a) Instrumentation;

     (b) Informed consent;

     (c) Preparation (patient and equipment);

     (d) All routes of injections.

     (4) With the exception of the administration of epinephrine by injection for treatment of anaphylactic shock, no injections or infusions may be administered by an optometrist.

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