2798-S AMH LAMB H4728.3

SHB 2798 - H AMD 429 ADOPTED 2-9-2000

By Representative Lambert

    Strike everything after the enacting clause and insert the following:

    "NEW SECTION. Sec. 1.  The legislature finds that we have one of the finest health care systems in the world and excellent professionals to deliver that care.  However, there are incidents of medication errors that are avoidable and serious mistakes that are preventable.  Medical errors throughout the health care system constitute one of the nation's leading causes of death and injury resulting in over seven thousand deaths a year, according to a recent report from the institute of medicine.  The majority of medical errors do not result from individual recklessness, but from basic flaws in the way the health system is organized.  There is a need for a comprehensive strategy for government, industry, consumers, and health providers to reduce medical errors.  The legislature declares a need to bring about greater safety for patients in this state who depend on prescription drugs.

    It is the intent of the legislature to promote medical safety as a top priority for all citizens of our state.

    Sec. 2.  RCW 69.41.010 and 1998 c 222 s 1 and 1998 c 70 s 2 are each reenacted and amended to read as follows:

    As used in this chapter, the following terms have the meanings indicated unless the context clearly requires otherwise:

    (1) "Administer" means the direct application of a legend drug whether by injection, inhalation, ingestion, or any other means, to the body of a patient or research subject by:

    (a) A practitioner; or

    (b) The patient or research subject at the direction of the practitioner.

    (2) "Deliver" or "delivery" means the actual, constructive, or attempted transfer from one person to another of a legend drug, whether or not there is an agency relationship.

    (3) "Department" means the department of health.

    (4) "Dispense" means the interpretation of a prescription or order for a legend drug and, pursuant to that prescription or order, the proper selection, measuring, compounding, labeling, or packaging necessary to prepare that prescription or order for delivery.

    (5) "Dispenser" means a practitioner who dispenses.

    (6) "Distribute" means to deliver other than by administering or dispensing a legend drug.

    (7) "Distributor" means a person who distributes.

    (8) "Drug" means:

    (a) Substances recognized as drugs in the official United States pharmacopoeia, official homeopathic pharmacopoeia of the United States, or official national formulary, or any supplement to any of them;

    (b) Substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or animals;

    (c) Substances (other than food, minerals or vitamins) intended to affect the structure or any function of the body of man or animals; and

    (d) Substances intended for use as a component of any article specified in clause (a), (b), or (c) of this subsection.  It does not include devices or their components, parts, or accessories.

    (9) "Electronic communication of prescription information" means the communication of prescription information by computer, or the transmission of an exact visual image of a prescription by facsimile, or other electronic means for original prescription information or prescription refill information for a legend drug between an authorized practitioner and a pharmacy or the transfer of prescription information for a legend drug from one pharmacy to another pharmacy.

    (10) "Legend drugs" means any drugs which are required by state law or regulation of the state board of pharmacy to be dispensed on prescription only or are restricted to use by practitioners only.

    (11) "Legible prescription" means a prescription or medication order issued by a practitioner that is capable of being read and understood by the pharmacist filling the prescription or the nurse or other practitioner implementing the medication order.

(12) "Medication assistance" means assistance rendered by a nonpractitioner to an individual residing in a community-based setting specified in RCW 69.41.085 to facilitate the individual's self-administration of a legend drug or controlled substance.  It includes reminding or coaching the individual, handing the medication container to the individual, opening the individual's medication container, using an enabler, or placing the medication in the individual's hand, and such other means of medication assistance as defined by rule adopted by the department.  The nonpractitioner may help in the preparation of legend drugs or controlled substances for self-administration where a practitioner has determined, in consultation with the individual or the individual's representative, that such medication assistance is necessary and appropriate.  Medication assistance shall not include assistance with intravenous medications or injectable medications.

    (((12))) (13) "Person" means individual, corporation, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity.

    (((13))) (14) "Practitioner" means:

    (a) A physician under chapter 18.71 RCW, an osteopathic physician or an osteopathic physician and surgeon under chapter 18.57 RCW, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a registered nurse, advanced registered nurse practitioner, or licensed practical nurse under chapter 18.79 RCW, an optometrist under chapter 18.53 RCW who is certified by the optometry board under RCW 18.53.010, an osteopathic physician assistant under chapter 18.57A RCW, a physician assistant under chapter 18.71A RCW, a naturopath licensed under chapter 18.36A RCW, or a pharmacist under chapter 18.64 RCW;

    (b) A pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer a legend drug in the course of professional practice or research in this state; and

    (c) A physician licensed to practice medicine and surgery or a physician licensed to practice osteopathic medicine and surgery in any state, or province of Canada, which shares a common border with the state of Washington.

    (((14))) (15) "Secretary" means the secretary of health or the secretary's designee.

    Sec. 3.  RCW 69.41.120 and 1990 c 218 s 1 are each amended to read as follows:

    Every drug prescription shall contain an instruction on whether or not a therapeutically equivalent generic drug may be substituted in its place, unless substitution is permitted under a prior-consent authorization.

    If a written prescription is involved, the prescription must be legible and the form shall have two signature lines at opposite ends on the bottom of the form.  Under the line at the right side shall be clearly printed the words "DISPENSE AS WRITTEN".  Under the line at the left side shall be clearly printed the words "SUBSTITUTION PERMITTED".  The practitioner shall communicate the instructions to the pharmacist by signing the appropriate line.  No prescription shall be valid without the signature of the practitioner on one of these lines.  In the case of a prescription issued by a practitioner in another state that uses a one-line prescription form or variation thereof, the pharmacist may substitute a therapeutically equivalent generic drug unless otherwise instructed by the practitioner through the use of the words "dispense as written", words of similar meaning, or some other indication.

    If an oral prescription is involved, the practitioner or the practitioner's agent shall instruct the pharmacist as to whether or not a therapeutically equivalent generic drug may be substituted in its place.  The pharmacist shall note the instructions on the file copy of the prescription.

    The pharmacist shall note the manufacturer of the drug dispensed on the file copy of a written or oral prescription.

NEW SECTION. Sec. 4.  A new section is added to chapter 69.41 RCW to read as follows:

    (1) In consultation with the board of pharmacy and professional licensing boards of providers with prescribing authority, the department will develop recommendations on methods for reducing medication errors including:

    (a) Increasing prescription legibility;

    (b) Minimizing confusion in prescription drug labeling and packaging;

    (c) Developing medication error reporting plans;

    (d) Encouraging hospitals and health care organizations to implement proven medication safety practices, including the use of automated drug-ordering systems;

    (e) Reducing confusion created by similar-sounding drug names; and

    (f) Increasing patient education on the medications they are prescribed.

    (2) The department shall submit its recommendations to the legislature by December 31, 2000.

    (3) This section expires June 30, 2001."

    Correct the title.

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