If any drug product requires special attention to prevent contamination, such as penicillin, appropriate measures must be taken to avoid cross-contamination. This could include establishing drug-specific equipment for certain substances or diligently cleaning equipment following use of a potential Remote pharmacy practice Driven by technological advances and the coronavirus pandemic, the remote, or off-site, role of the pharmacist has greatly increased within the past five years. As a result, the Texas State Board of Pharmacy has adopted a number of revisions related to the remote practice of pharmacy. TAC §291.121 regulates various remote pharmacy services. Remote pharmacy services are defined as any aspect of pharmacy practice provided by a community pharmacy (Class A) or institutional pharmacy (Class C) that occurs in a facility separate from the actual pharmacy. In an August 2021 update, the Board approved pharmacy services that are provided via an automated pharmacy dispensing system, which is a mechanical system that dispenses drugs remotely and records all dispensing transactions. Further changes regarding automated pharmacy dispensing systems were adopted in August 2021, as well. TAC §291.76 provides guidelines for the management of institutional pharmacies (Class C) located in a freestanding ambulatory surgical center. TAC §291.151 refers to pharmacies located in a freestanding emergency medical care facility (Class F). Each of these subchapters were revised to include licensed nurses in the management and use of automated pharmacy dispensing systems. Following these updates, licensed nurses with pharmacist authorization may load medications into automated dispensing systems. In conjunction with automated pharmacy dispensing system changes, the Board provided direction regarding pharmacist verification of automatically dispensed medication. When a controlled substance is dispensed from an automated dispensing system, the pharmacist will verify this withdrawal as soon as reasonably possible, but no more than 72 hours following dispensing. When a dangerous drug is dispensed from an automated dispensing system, the pharmacist will verify this withdrawal as soon as reasonably possible, but no more than one calendar week following dispensing. Pharmacists must verify all withdrawals at the soonest reasonable time, but no less than once every calendar week that the pharmacy is open. In some Class C pharmacies located in a freestanding ambulatory surgical center, a stock of controlled substances is maintained to provide quick and easily accessible medication when needed for emergent situations. TAC §291.76 overviews the requirements associated with maintaining this stock of controlled substances. While freestanding ambulatory surgical Conclusion Remaining competent and up to date with all Texas state pharmacy laws is an important part of providing safe and effective pharmacy care. The rules and regulations, while often revised and fine-tuned, are designed to encourage patient safety outcomes and protect the interests of pharmacists, pharmacy
contaminant drug. Cleaning and sanitizing of surfaces within the non-sterile compounding environment must occur on a regular basis, and should be specified in each pharmacy’s standard operating practices.
centers have always been required to maintain a log of controlled substance use, as of February 2023, pharmacists are now responsible for ensuring this perpetual inventory of controlled substances is both complete and accurately reconciled. Another remote service provided by pharmacies is emergency medication kits. These kits include specific medications required for life-saving measures and may reside in facilities without an established pharmacy. TAC §291.121 lists requirements for maintaining an emergency medication kit, including how to apply to provide an emergency kit, the process for stocking, and reporting use of the kit. Beginning in May 2022, the Texas State Board of Pharmacy removed restrictions on duplicating drugs within emergency medication kits, which allows pharmacies to place duplicate medications in the kit in the case of multiple crises or wasted doses of crucial medication. Self-Assessment Quiz Question #3 When a controlled substance is dispensed from an automated pharmacy dispensing system, how long does a pharmacist have to verify the order? a. 7 days. b. 72 hours. c. 5 days. d. 24 hours. Self-Assessment Quiz Question #4 The Texas State Board of Pharmacy recently removed limitations on placing duplicates of medications in emergency medication kits located at remote sites. What was the reasoning behind this change? a. Save the pharmacist time by limiting the number of times medications need to be replaced. b. Allow for an adequate supply of medication in case of multiple crises or wasted drugs. c. Extend beyond-use dating of the kit by allowing remote staff to remove expired drugs and replace with duplicates. d. Expand the practice capabilities of the remote site and remove the need for pharmacist verification of drugs in nonemergent situations.
interns, and pharmacy technicians within the healthcare field. As such, frequently referring to both the Texas Administrative Code and Texas Pharmacy Act will further cement concepts of lawful pharmacy practice.
References •
Accreditation Council for Pharmacy Education (ACPE). (2016). Accreditation standards and key elements for the professional program in pharmacy leading to the Doctor of Pharmacy degree . https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf • State of Texas. (2019). Constitution and Statutes . 3 Tex. Occup. Code . §551-569. Texas State Government. https://statutes.capitol.texas.gov/?link=OC • State of Texas. (2019). Constitution and Statutes . 6 Tex. Health. Code. §431, 442. https:// statutes.capitol.texas.gov/Docs/HS/htm/HS.431.htm • State of Texas. (2023). Constitution and Statutes. 22 Tex. Admin . Code. §281-315. https:// texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=3&ti=22&pt=15 •
Texas Prescription Monitoring Program. (2020). Data submission guide for dispensers. Appriss Health . https://www.pharmacy.texas.gov/files_pdf/TX_PMP_AWARxE_ DispenserGuide.pdf • Texas State Board of Pharmacy. (February 2018). “ Red flags” checklist for pharmacists . https://www.pharmacy.texas.gov/files_pdf/You_might_be_a_pill_mill_if.pdf
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