1. Chapter 17: Institutional Pharmacy Jeffery D. Evans, Pharm.D. Associate Professor of Pharmacy Practice

2. Objectives At the end of this presentation, the student will be able to

3. Chapter 17 Purpose –To regulate the use and storage of medications outside of ‘traditional’ pharmacies Impact on Pharmacy Practice –The chapter sets out rules dealing with the interactions between pharmacies (pharmacists) and institutions

4. What does the board consider an institution? (1703) Nursing Home Rehabilitation center Drug Abuse treatment center Family planning clinic Penal Institution Athletic facilty

5. What is an institutional pharmacy (1703) Basically –The location of drugs, devices, and other stuff –Must be dedicated space –Not allowed to do other things (must be focused on institutional patients)

6. Are there special rules for an institutional pharmacy permit? Basically, everything that is in chapter 11 applies here.

7. What is a drug cabinet? (1707) These are medication storage areas usually outside of a pharmacy –Emergency use Should only be used when the pharmacy is closed –Security Must be locked when outside of a pharmacy Limited access –Inventory PIC decides what goes in Only quantities needed for acute issues should be there –Accountability and inspection A valid medical order must be provided for every medication Must be inspected at least every 30 days by the ‘pharmacy’

8. Are there special labeling requirements for medications in a drug cabinet? (1707) Not really, but the following must appear on the label –Drug name –Dosage form –Strength –Name and manufacturer –Manufacturers lot or batch number –Pharmacist’s initials (not name) –Expiration date

9. What is an emergency drug kit (EDK?) (1709) A kit that contains emergency drugs in LTCFs (not hospitals?) that meet an immediate need of a patient Emergency medications? –Medications used to reduce risk to a patient on an emergent basis –Delayed access to these medications could cause issues

10. Do I need an EDK permit? No if you are a –Hospital or –Have an institutional pharmacy permit Yes if you –Are not a hospital –Or do not have an institutional pharmacy permit

11. How do I apply for an EDK permit? (1711) This is odd –The provider pharmacy must apply –EDK permits are for specific institutions (not transferable) –One pharmacy may have an unlimited number of EDK permits –The pharmacist in charge is responsible for all EDKs

12. Is there anything special about EDKs? (1713) Security –Must have a tamper evident ability –Must be in a secure enclosure Labeling –Externally – Clearly labeled as an EDK –Medications need name, dosage form, strength, manufacturer’s name and lot, expiration date Storage –Must meet storage requirements of any drugs –May be stored outside of EDK if needed

13. What about accountability of the EDKs? (1713) There must be a way to ensure all medications taken from the EDK have a valid medical order –Including who prescribed and administered the medication, resident name, drug information, time and date of administration Inspection –Must be inspected by pharmacy every 30 days (+/- 5 days) –Must be available for the board to inspect

14. What is a Drug Abuse Treatment Center Pharmacy? (1715 – 1719) A place where drugs are dispensed and pharmacy primary care is provided in a drug abuse treatment center A DATC is an inpatient or outpatient clinic where patients are treated for abuse issues

15. Are there permits and special security rules for an DATCP? (1721 – 1723) Permit required –Process outlined in chapter 11 Special security –Sort of Persons enrolled in a drug abuse treatment center shall wait for their prescriptions in an area physically separated from the CDS storage and dispensing area.

16. What are the requirements for records and reports at a DATCP? (1725) Not really They are required to maintain a perpetual inventory –And they must keep the record of it

17. Can I donate medications to the penal system? (1727) Yes –PIC of prison pharmacy must Verify integrity of product Expiration date on package is the expiration date May not be redispensed –No controlled substances These medications may not be transferred to another location

18. What information must be gathered at the time of donation? (1727) Patient consent must be provided Patient’s name, rx number must be obliterated from the bottle Drug name, strength, and expiration date must remain An inventory list of medications donated must be created Expired drugs are not acceptable

19. Questions