South Dakota News: Emergency Room Dispensing

January 1, 2006 8:50 am

Published in the January 2006 South Dakota State Board of Pharmacy Newsletter

Many pharmacists have questions regarding dispensing of emergency room (ER) medications. The Department of Health requires that licensed health care facilities ensure that their employees and contracted providers comply with their respective professional practice acts as well as other state statutes and regulations. Administrative Rule of South Dakota (ARSD) 44:04:08:03 states that all medication or drugs administered to patients in hospitals or nursing facilities must be ordered in writing and signed by the prescribing practitioners.

Telephone orders for medication may be taken only where there is an urgent need to initiate or change an order, and the telephone orders may only be accepted by a pharmacist or licensed nurse in the hospital or nursing facility. The practitioner must sign the verbal order at the next visit to the hospital or nursing facility.

ARSD 44:04:08:02 states that policies and procedures shall be established to direct the manner of issuance, storage, control, accountability, and procedure for administering medication or drugs to patients in each hospital or nursing facility.
ARSD 44:04:08:06 addresses the pharmaceutical services of all state-licensed hospital or nursing facilities with a full or parttime pharmacy license. It further states that only prepackaged drugs or a single unit-dose may be removed from the pharmacy when the pharmacist is not available.

ARSD 20:51:15:13 addresses the procedure that must be followed when the pharmacist is not available. Most hospitals and nursing facilities do not have 24-hour pharmacy coverage and must follow these regulations when a medication is needed, the pharmacist is not available, and the pharmacy is closed.

ARSD 20:1:15:15 clarifies the responsibility of the pharmacist and procedure for supplying emergency drugs to meet the immediate therapeutic needs of patients so as to prevent harm or delay of treatment. The hospital pharmacist may provide medications or drugs in limited quantities that are properly labeled, supplied, and stored in an ER. In a nursing facility the quantity and types of medication provided for emergency kits is discussed in ARSD 20:51:15:15.01.

It is in the best interest of patients to begin many medications at the time of an ER visit. Since most South Dakota hospitals do not have overnight and/or weekend pharmacy coverage, the pharmacist responsible for medication provision should develop a list of potential take-home medications in collaboration with the hospital medical staff. Any take-home medications should be limited to 48- to 72-hour quantities where possible, properly labeled, and placed in appropriate safety containers. If the onsite prescriber wants the patient to have additional quantities of medication, they should provide a written prescription to the patient.

The boards of Medication Examiners, Nursing, and Pharmacy agreed that no violation of rule or statute occurs when the onsite licensed practitioner gives a licensed nurse an order to issue prepackaged, properly labeled medication to a patient registered and examined in the ER.

Practitioners with prescriptive authority are permitted to dispense drugs in an emergency setting, and may label medication for the licensed nurse to hand to a patient under certain circumstances. The nurse may not package or label drugs for the patient. This would be considered dispensing and a violation of the Nurse Practice Act, which does not permit a nurse to dispense medications.
A licensed emergency room nurse may not prepare and dispense medications to a patient pursuant to an after-hours phone call from an off-site practitioner.

If you have any questions pertaining to this topic, please contact the South Dakota State Board of Pharmacy office.