Montana News: Dispensing of Outpatient Medications in Emergency Department by Licensed Nurses

August 1, 2008 11:10 AM

Reprinted from the August 2008 Montana Board of Pharmacy Newsletter.

July 2008 Joint Position Statement of the Montana Boards of Pharmacy, Medical Examiners, and Nursing

This joint position statement addresses the role of licensed nurses functioning in the Emergency Department (ED) setting in the issuance of take-home medications to patients upon the order of a licensed health professional with prescribing authority. This agreement pertains to such practices when there is no open pharmacy within a 10-mile radius and when there is no staff pharmacist on duty at the time such services are necessary.

All three boards agree that no violation of rule or statute occurs when a licensed prescriber gives a licensed nurse an order for medications to be taken home by a registered ED patient. Pharmacists and practitioners holding prescribing authority may package and label medications for home use in this setting.

Because patients are best served by receiving these outpatient prescriptions at the point of care, the boards support the following procedures that are designed to safeguard public health and provide necessary services under these conditions.

Pharmacists who are responsible for medication provision in such facilities are required to establish procedures that support this practice in collaboration with their Pharmacy and Therapeutics Committee, hospital administration, staff physicians, [advanced practice registered nurses], [physician assistants], and nurses. Procedures should include the identification of common medications typically prescribed for such purposes, and define appropriate quantities, packaging, and labeling requirements.

The pharmacist and/or the licensed prescriber are responsible for the following procedures:
 proper packaging, such as placing the medication in moisture and light resistant, childproof containers
 expiration date is noted on the packaging
 appropriate quantities of the medications are included based on typical utilization practices (medications, such as some antibiotics, that require reconstitution may be packaged together with a labeled bottle containing the correct amount of water and specific instructions for reconstitution)
 enclose/attach complete patient instructions (standard drug information/counseling sheet) with the package
 provide name of the medication, strength/dose, and quantity of the medication on the package label
 place auxiliary labels on the package as applicable
 provide a place to write the date, prescriber, and patient’s name on the label

Upon receiving an order for one of the prepared, packaged outpatient prescriptions, the licensed nurse must write the prescriber’s full name, the date, and the patient’s full name on the package label and document the action in the patient’s medical record. The nurse must also extend an offer for medication counseling from either the pharmacist or the prescriber and explain how that may occur based on the organization’s established policies and procedures.

We believe that this statement clarifies a formerly gray area without sacrificing patient safety. Please direct any questions you may have to your respective board.

Ronald Klein, RPh
Executive Director
Board of Pharmacy

Barbara Swehla, MN, RN
Executive Director
Board of Nursing

Jeanne Worsech
Executive Director
Board of Medical Examiners