RULE 070.00.97-008 - Regulation 37 - Emergency kits for long-term care facilities

RULE 070.00.97-008. Regulation 37 - Emergency kits for long-term care facilities

37.

(A) With recognition of D.E.A.'s statement of policy regarding emergency kits for long-term-care facilities, the following regulation is adopted.to meet D.E.A. requirements to permit controlled substances to be stored in emergency kits in long-term-care facilities in Arkansas.

REQUIREMENTS:

1. All contents of the emergency kit will be provided by one pharmacy designated by the long-term-care facility. This pharmacy must-be properly registered with D.E.A.

2. The emergency kit shall be properly sealed, stored, and accessible only to authorized personnel.

3. The emergency kit contents may be administered by authorized personnel acting on order of a physician in compliance with 21 CFR 1306.11 and 21 CFR 1306.21.

4. The Board of pharmacy will establish a standerd list of drug categories to be contained the emergency kit. The contents of the kit shall be determined by the Pharmaceutical Services committee, at the long term care facility and reviewed by the Executive Director of the Board of Pharmacy Any exception to the established standard categories must be approved by the Board of Pharmacy. A list of contents shall be kept in the kit.

5. The facility's licensed consultant pharmacist shall be responsible for the accountability of the content of the kit and the facility's licensed consultant pharmacist shall check the kit periodically for outdated drugs, etc.

6. Legend drugs administered from the kit will be replaced within 72 hours by the designated provider pharmacy based on a prescription for the patient to whom the drugs were administered.

7. If the requirements of this regulation are violated, the violation shall be good cause to revoke, deny, or suspend permission for the facility to maintain an emergency Kit.

8. Violation of this regulation shall be just cause to suspend or revoke the consulting license of the responsible pharmacist.

9. Emergency kit drugs shall be of such a nature that the absence of such drugs would detrimentally affect the health of the patient. 10/14/81

(B) Recognizing the emergency and or unanticipated need for certain legend (non-controlled) drugs to be available to nurses employed by Arkansas Licensed Home Health Agencies, an Arkansas Licensed Pharmacy may provide certain medications under the following conditions:

1. A written contract must exist between the Arkansas Licensed Home Health Agency and the Arkansas Licensed Pharmacy, and this must be available for review by the Board of Pharmacy upon request.

2. The legend drugs remain the property of and under the responsibility of the Arkansas Licensed Pharmacy.

3. All medications are administered only on physician's orders and medications administered from the nurse's supply must be recorded as a prescription by the pharmacy prior to the pharmacy's replacement of the drug in the emergency supply.

4. All medication records must be maintained as required by law, and out of date drugs must be properly destroyed by the pharmacy.

5. The emergency supply may be carried by each nurse or an emergency kit may be provided for each patient's home.

6. Careful patient planning should be a cooperative effort between the pharmacy and the nursing agency to make all medications available and this emergency supply should ONLY be used for emergency or unanticipated needs and shall NOT become a routine source or supply.

7. The following medications can be supplied by the pharmacy in sufficient but limited quantities:

Heparin Flush - Pediatric (one strength)

Heparin Plush - Adult (one strength)

Sterile Water For Injection - small volume

Sodium Chloride For Injection - small volume

Adrenalin (Epinephrine) Injection - ampoules only

Benadryl (Diphenhydramine) Injection - ampoules only

* Note: For Heparin, Adrenalin and Benadryl, all patients should have a precalculated dose.

* If a container is opened and partially used it is intended that any unused portion be immediately discarded.

This list can be expanded only by the Board of Pharmacy; and if expanded, notice will be provided in the Board's Newsletter.

8. The pharmacy is responsible to assure compliance with this regulation, and any abuse or misuse of the intent of this regulation shall be immediately reported to the Board of Pharmacy.

9. The pharmacy and the agency shall develop policy and procedures to address storage conditions for medications.

(Revised 10/12/93)

37.

(A) With recognition of D.E.A.'s statement of policy regarding emergency kits for long-term-care facilities, the following regulation is adopted to meet D.E.A. requirements to permit controlled substances to be stored in emergency kits in long-term-care facilities in Arkansas.

REQUIREMENTS:

1. All contents of the emergency kit will be provided by one pharmacy designated by the long-term-care facility. This pharmacy must be properly registered with D.E.A.

2. The emergency kit shall be properly sealed, stored, and accessible only to authorized personnel.

3. The emergency kit contents may be administered by authorized personnel acting on order of a physician in compliance with 21 CFR 1306.11 and 21 CFR 1306.21.

4. The Board of Pharmacy will establish a standard list of drug categories to be contained in the emergency kit. The contents of the kit shall be determined by the Pharmaceutical Services Committee at the long-term care facility, and reviewed by the Executive Director of the Board of Pharmacy. Any exceptions to the established standard categories must be approved by the Board of Pharmacy. A list of contents shall be kept in the kit.

5. The facility's licensed consultant pharmacist shall be responsible for the accountability of the content of the kit and the facility's licensed consultant pharmacist shall check the kit periodically for outdated drugs, etc.

6. Legend drugs administered from the kit will be replaced within 72 hours by the designated provider pharmacy based on a prescription for the patient to whom the drugs were administered.

7. If the requirements of this regulation are violated, the violation shall be good cause to revoke, deny, or suspend permission for the faculty to maintain an emergency kit.

8. Violation of this regulation shall be just cause to suspend or revoke the consulting license of the responsible pharmacist.

9. Emergency kit drugs shall be of such a nature that the absence of such drugs would detrimentally affect the health of the patient. 10/14/81

(B) Recognizing the emergency and or unanticipated need for certain legend (non-controlled) drugs to be available to nurses employed by Arkansas Licensed Home Health Agencies, an Arkansas Licensed Pharmacy may provide certain medications under the following conditions:

1. A written contract must exist between the Arkansas Licensed Home Health Agency and the Arkansas Licensed Pharmacy, and this must be available for review by the Board of Pharmacy upon request.

2. The legend drugs remain the property of and under the responsibility of the Arkansas Licensed Pharmacy.

3. All medications are administered only on physician's orders and medications administered from the nurse's supply must be recorded as a prescription by the pharmacy prior to the pharmacy's replacement of the drug in the emergency supply.

4. All medication records must be maintained as required by law, and out of date drugs must be properly destroyed by the pharmacy.

5. The emergency supply may be carried by each nurse or an emergency kit may be provided for each patient's home.

6. Careful patient planning should be a cooperative effort between the pharmacy and the nursing agency to make all medications available and this emergency supply should ONLY be used for emergency or unanticipated needs and shall NOT become a routine source or supply.

7. The following medications can be supplied by the pharmacy in sufficient but limited quantities:

Heparin Flush - Pediatric (one strength)

Heparin Flush - Adult (one strength)

Sterile Water For Injection - small volume

Sodium Chloride For Injection - small volume

Adrenalin (Epinephrine) Injection - ampoules only

Benadryl (Diphenhydramine) Injection - ampoules only

* Note: For Heparin, Adrenalin and Benadryl, all patients should have a precalculated dose.

* If a container is opened and partially used it is intended that any unused portion be immediately discarded.

This list can be expanded only by the Board of Pharmacy; and if expanded, notice will be provided in the Board's Newsletter.

8. The pharmacy is responsible to assure compliance with this regulation, and any abuse or misuse of the intent of this regulation shall be immediately reported to the Board of Pharmacy.

9. The pharmacy and the agency shall develop policy and procedures to address storage conditions for medications.

(Revised 10/12/93)

DRUG CATEGORIES FOR EMERGENCY KITS IN LONG-TERM CARE FACILITIES

The following is a list of categories of drugs which are acceptable in emergency kits in long-term care facilities in accordance with Regulation 37 (4) of the Arkansas State Board of Pharmacy. In every instance where injectables are indicated, only single-dose injectables are acceptable.

ANALGESICS. CONTROLLED DRUGS

Schedule II-Injectable-

Limit: one (1)

Maximum quantity: two (2)

Schedule II, IV, or V-

Limit: three (3)

Maximum quantity: If oral: six (6) If Injectable: two (2)

ANTTBIOTTCS

Oral Doses-

Limit: five (5)

Maximum quantity: ten (5)

Parenteral Doses-

Limit: three

Maximum quantity: one (1)

ANTICOAGULANT

Limit: one (1)

Maximum quantity: three (3)

ANTIDIARRHEALS

Limit: one (1)

Maximum quantity: ten (10)

ANTIHISTAMINE INJECTABLES

Limit: two (2)

Maximum quantity: four (4)

ANTTNAUSEANTS

Limit: three (3)

Maximum quantity: four (4)

ANTTPSYCHOTIC INJECTABLES

Limit: two (2)

Maximum quantity: four (4)

ANXIOLYTICS

Limit: one (1)

Maximum quantity: four (4)

CARDIAC LIFE SUPPORT MEDICATIONS

Injectables:

The content and quantity of injectable cardiac life support medications is to be recommended by the Pharmacy Services Committee at the Long-term Care facility and approved by the Executive Director of the Arkansas State Board of Pharmacy.

Hypertensive Crisis Oral Medications:

Limit: three (3)

Maximum quantity: eight (8)*

*When nitroglycerine sublinqual is used: quantity -1 bottle of 25

HYPOGLYCEMICS

Limit: three (3)

Maximum quantity: two (2)

INJECTABLE SEIZURE CONTROL MEDICATIONS

Limit: two (2)

Maximum quantity: four (4)

LARGE VOLUME PARENTERALS

Limit: three (3)

Maximum quantity: two (2)

POISON CONTROL

Limit: two

Maximum quantity: two (2)

(11/7/1997)

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