WSR 17-01-108
(Pharmacy Quality Assurance Commission)
[Filed December 19, 2016, 2:04 p.m., effective January 19, 2017]
Effective Date of Rule: Thirty-one days after filing.
Purpose: WAC 246-873-060 Emergency outpatient medication, RCW 70.41.480 enacted in 2015, created an inconsistency with WAC 246-873-060. The adopted rule will align with and implement the statute. Adopting the rule will improve public health by removing barriers and facilitating patient's access to appropriate medication therapy when pharmacy services are not available.
Citation of Existing Rules Affected by this Order: Amending WAC 246-873-060.
Statutory Authority for Adoption: RCW 18.64.005.
Other Authority: RCW 70.41.480.
Adopted under notice filed as WSR 16-20-074 on October 3, 2016.
Changes Other than Editing from Proposed to Adopted Version: No changes were applied to rule language beyond editing.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: November 10, 2016.
Tim Lynch, PharmD, MS, Chair
Pharmacy Quality Assurance Commission
AMENDATORY SECTION (Amending WSR 92-12-035, filed 5/28/92, effective 6/28/92)
WAC 246-873-060 Provision of emergency ((outpatient)) department discharge medications when pharmacy services are unavailable.
The ((director of pharmacy)) responsible manager, as defined in WAC 246-869-070, of a hospital ((shall)) or free standing emergency department may, in ((concert)) collaboration with the appropriate medical staff committee of the hospital ((medical staff)), develop policies and procedures((,)) in compliance with RCW 70.41.480 which ((shall)) must be implemented((,)) to provide ((emergency pharmaceuticals to outpatients)) discharge medications to patients released from hospital emergency departments during hours when ((normal)) community or outpatient hospital pharmacy services are not available. The delivery of a single dose for immediate administration to the patient ((shall not be)) is not subject to this regulation. Such policies shall allow the ((designated)) practitioner or registered ((nurse(s) to deliver)) nurse to distribute medications ((other than controlled substances)), pursuant to the policies and procedures ((which shall require that)), as specified in RCW 70.41.480 and the following:
(1) An order of a practitioner authorized to prescribe a drug is presented. Oral or electronically transmitted orders must be verified by the ((prescriber)) practitioner in writing within ((72)) seventy-two hours.
(2) ((The)) A department credentialed pharmacy technician or a licensed pharmacist shall prepackage the medication. Medication ((is)) prepackaged by a ((pharmacist and has a label)) department credentialed pharmacy technician must be checked by a licensed pharmacist. The prepackaged medication must contain any supplemental material provided and an affixed label that contains:
(a) Name, address, and telephone number of the hospital.
(b) The name of the drug (as required by chapter 246-899 WAC), strength and number of units.
(c) Cautionary information as required for patient safety and information on use is provided.
(d) An expiration date after which the patient should not use the medication.
(e) Directions for use.
(3) No more than a ((24-hour)) forty-eight hour supply is provided to the patient except when the pharmacist has informed appropriate hospital personnel that normal services will not be available within ((24)) forty-eight hours. A final quantity of medication supply shall not exceed ninety-six hours.
(4) The ((container is labeled by the designated)) practitioner or registered ((nurse(s))) nurse will ensure the container is labeled before presenting to the patient and shows the following:
(a) Name of patient;
(b) ((Directions for use by the patient;)) Complete directions for use, which should include at a minimum the number of units distributed, frequency, and route of administration;
(c) Date of distribution;
(d) Identifying number (i.e., RX number or similar indicator);
(e) Name of prescribing practitioner;
(f) Initials of the practitioner or registered nurse((;)) who distributed the medication.
(5) A registered nurse or practitioner will distribute prepackaged emergency medications to patients only after a practitioner has counseled the patient on the medication.
(6) The original ((or a direct copy of the)) hard copy or electronically transmitted order by the ((prescriber)) practitioner is retained for verification by the pharmacist after completion by the ((designated)) practitioner or registered ((nurse(s))) nurse and shall ((bear)) contain:
(a) Name and address of patient if not already listed in the medical record;
(b) Date of issuance;
(c) Units issued;
(d) Initials of ((designated)) practitioner or registered nurse.
(((6))) (7) The medications ((to be delivered as emergency pharmaceuticals shall be kept in a secure place)) distributed as discharge medications must be stored in compliance with the laws concerning security and access. They must be stored in or near the emergency ((room)) department in such a manner as to preclude the necessity for entry into the pharmacy when pharmacy services are not available.
(((7) The procedures outlined in this rule may not be used for controlled substances except at the following rural hospitals which met all three of the rural access project criteria on May 17, 1989:
Lake Chelan Community Hospital
St. Joseph's Hospital
Whitman Community Hospital
Lincoln Hospital
Dayton General Hospital
Ocean Beach Hospital
Newport Community Hospital
Jefferson General Hospital
Port Townsend
Ritzville Memorial Hospital
Willapa Harbor Hospital
South Bend))