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TEXAS Pharmacy Technician Continuing Education
Elite Learning
Mandatory courses included in this book: Overview of Texas Pharmacy Law, 2nd Edition Recognizing and Responding to Human Trafficking in Texas
ELITELEARNING.COM/BOOK Complete this book online with book code: RPTTX2024 20.5-hour Continuing Education Package $49.95
WHAT’S INSIDE
THIS COURSE FULFILLS THE REQUIREMENT FOR TEXAS PHARMACY LAWS OR RULES Chapter 1: Overview of Texas Pharmacy Law, 2nd Edition (Mandatory) [1 contact hour] This continuing education course provides important background information on the Texas State Board of Pharmacy, their role in revising and adopting changes to the law, and important Texas State Pharmacy Law updates from Early 2021 through the first half of 2023. THIS COURSE FULFILLS THE REQUIREMENT FOR HUMAN TRAFFICKING PREVENTION Chapter 2: Recognizing and Responding to Human Trafficking in Texas (Mandatory) [1 contact hour] This course focuses on how human trafficking occurs, ways to identify those who may be trafficked, safety protocols, and victim resources. This course meets the Human Trafficking requirement for Texas Professionals and is approved by the Texas Health and Human Services Commission. Chapter 3: Common Envenomations: Snakes, Lizards, Marine Life and Arthropods [3 contact hours] Many people use venomous and poisonous interchangeably, but there are significant differences. Venoms are endogenously produced by the animal and actively introduced into the victim through a wound created by a fang, stinger, pincer, or spike. The clinical scenarios in which these occur are referred to as envenomations or envenomings. This course will focus exclusively on the most clinically relevant terrestrial and marine venomous animals native to the U.S., including vertebrates (e.g., snakes, lizards, and fishes) and invertebrates (e.g., cnidarians and arthropods). Common myths will be dispelled, and learners will be provided with evidence-based treatment guidelines. Chapter 4: Illicit Drug Usage in the United States [3 contact hours] This course provides the status of drug misuse in the United States and presents common substances, triggers, and interventions that are proving to have successful impacts. Chapter 5: Management of Drug Challenges: Generic vs. Branded Drugs, 2nd Edition
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[1 contact hour] Written program is designed to help healthcare professionals best understand the generic drug environment, recognize when substitution is warranted, and work with their patients to fully understand and appreciate the process. Chapter 6: Noninsulin Antihyperglycemic Agents for the Treatment of Type 2 Diabetes 60 [2.5 contact hours] Heart failure is a complex clinical syndrome associated with increasing morbidity, mortality, and economic burden. Despite evidence supporting guideline-directed therapy and management for reduction of morbidity and mortality, these medications are still underprescribed. According to the CHAMP-HF registry, among eligible patients, only 22% were prescribed essential heart failure medications per guideline recommendations ((Greene et al., 2018). Healthcare providers have an essential role in improving outcomes with heart failure by bridging the gap between guideline- directed recommendations and actual clinical practice. The learning outcomes of this activity will help clinicians understand this healthcare gap by reviewing the current evidence-based pharmacotherapy recommendations for HF treatment through analyzing clinical trials and guidelines.
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PHARMACY TECHNICIAN CONTINUING EDUCATION
Book code: RPTTX2024
WHAT’S INSIDE
Chapter 7: Prescribing Strategies for Older Adults
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[3 contact hours] This course will explore the intricacies of pharmacological principles and their profound impact on choosing the perfect medications enhancing the learners’ ability to effectively apply pharmacologic principles to the medication selection process for the older adult. It will examine the age-related changes influencing medication effectiveness and adverse drug effects. The course addresses the challenges and complexities of medication management in the aging population, considering factors such as disease burdens, cognitive and organ system decline, and social determinants of health. Chapter 8: The Essentials of Infection Prevention [4 contact hours] The COVID-19 pandemic made all healthcare workers acutely aware of infection prevention and control measures. The pandemic has highlighted the need for ongoing education to maintain a knowledge and skill level appropriate for implementing strategies to prevent healthcare-associated infections and to prepare for the next pandemic. Understanding where reservoirs are harboring pathogens and strategies to prevent transmission in healthcare settings is critical. This course will examine best practices for infection prevention, such as hand hygiene, personal protective equipment, [2 contact hours] Anxiety disorders are the most commonly diagnosed psychiatric disorders, with an estimated 264 million persons globally suffering from an anxiety disorder. It’s estimated that 19.1% of adults in the United States (U.S.) are affected by at least one anxiety disorder; this number increases to 31.9% in U.S. adolescents. Common anxiety disorders include generalized anxiety disorder (GAD), panic disorder (PD), specific phobias, agoraphobia, social anxiety disorder (SAD), and separation anxiety disorder. This course reviews the diagnosis and pharmacological management of anxiety disorders, as well as medications which can cause or exacerbate anxiety symptoms. Final Examination Answer Sheet transmission-based precautions, cleaning and disinfection, and injection safety Chapter 9: The Pharmacologic Management of Anxiety in Adults
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©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
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Book code: RPTTX2024
PHARMACY TECHNICIAN CONTINUING EDUCATION
FREQUENTLY ASKED QUESTIONS What are the requirements for license renewal? Licenses Expire Contact Hours
Mandatory Subjects
1 hr Texas Pharmacy Laws or Rules One (1) Texas HHSC-approved course on Human Trafficking prevention each renewal period
20 (All hours are allowed through home-study)
Every two years on or before the last day of the month that original registration was issued.
How much will it cost? If you are only completing individual courses in this book, enter the code that corresponds to the course below online.
COURSE TITLE
HOURS PRICE COURSE CODE
Chapter 1: Overview of Texas Pharmacy Law, 2nd Edition (Mandatory)
1 1 3 3
$9.95
RPTTX01TL RPTTX01RR RPTTX03CE RPTTX03DU RPTTX01DC RPTTX02NA RPTTX03PA RPTTX04EP RPTTX02AA
Chapter 2: Recognizing and Responding to Human Trafficking in Texas (Mandatory) Chapter 3: Common Envenomations: Snakes, Lizards, Marine Life and Arthropods
$11.95 $19.95 $19.95
Chapter 4: Illicit Drug Usage in the United States
Chapter 5: Management Of Drug Challenges: Generic vs Branded Drugs, 2nd Edition 1 Chapter 6: Noninsulin Antihyperglycemic Agents for the Treatment of Type 2 Diabetes 2.5
$5.00
$19.95 $19.95 $24.95 $14.95
Chapter 7: Prescribing Strategies for Older Adults Chapter 8: The Essentials of Infection Prevention
3 4 2
Chapter 9: The Pharmacologic Management of Anxiety in Adults
Best Value - Save $96.65 - All 20.5 Hours
20.5 $49.95 RPTTX2024
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you approved by ACPE?
Colibri Healthcare, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. (Provider #0607). Your hours will be reported to CPE Monitor within 10 business days after course completion. Colibri’s Recognizing and Responding to Human Trafficking in Texas course has been approved by
the Texas Health and Human Services Commission (HHSC). Are my contact hours reported to my state board?
Yes, we report your hours electronically to CPE Monitor as early as within 10 business days after course completion and no later than 60 days after the event. CPE Monitor is a national online continuing pharmacy education (CPE) tracking service that will authenticate and store data for completed CPE units and allow you to easily track your ACPE-accredited CPE units electronically. It is a collaborative effort between the National Association of Boards of Pharmacy® (NABP®), the Accredited Council for Pharmacy Education (ACPE), and accredited continuing pharmacy education (CPE) providers. Keep your certificate in a safe place for your records. Please provide your license #, date of birth, and NABP ID. This is necessary to report your completion. Missing information can delay reporting and result in additional fees after 60-days of completion. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Pharmacy-Technician you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-666-9053, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
Licensing board contact information: Texas State Board of Pharmacy 1801 Congress Avenue, Suite 13.100 | Austin, Texas 78701-1319 I Phone (512) 305-8000 I Fax (512) 305-8082 Website: https://www.pharmacy.texas.gov/licensees/technician-main.asp
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PHARMACY TECHNICIAN CONTINUING EDUCATION
Book code: RPTTX2024
HOW TO COMPLETE THIS BOOK FOR CREDIT
Please read these instructions before proceeding. IF YOU’RE COMPLETING ALL COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code RPTTX2024 in the book code box, then click GO . • If you already have an account created, sign in with your username and password. If you don’t have an account, you’ll be able to create one now.
RPTTX2024
• Follow the online instructions to complete your final exam. Once you finish your purchase, you’ll receive access to your completion certificate. IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code that corresponds to the course below, then click GO . Each course will need completed individually
COURSES YOU’VE COMPLETED
HOURS PRICE CODE TO ENTER
All 15 hours in this correspondence book
20.5 $49.95 RPTTX2024
Overview of Texas Pharmacy Law, 2nd Edition (Mandatory)
1
$9.95
RPTTX01TL
Recognizing and Responding to Human Trafficking in Texas (Mandatory)
1
$11.95
RPTTX01RR
Common Envenomations: Snakes, Lizards, Marine Life and Arthropods
3
$19.95
RPTTX03CE
Illicit Drug Usage in the United States
3
$19.95
RPTTX03DU
Management Of Drug Challenges: Generic vs Branded Drugs, 2nd Edition
1
$5.00
RPTTX01DC
Noninsulin Antihyperglycemic Agents for the Treatment of Type 2 Diabetes
2.5
$19.95
RPTTX02NA
Prescribing Strategies for Older Adults
3
$19.95
RPTTX03PA
The Essentials of Infection Prevention
4
$24.95
RPTTX04EP
The Pharmacologic Management of Anxiety in Adults
2
$14.95
RPTTX02AA
By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
By fax • Fill out the answer sheet and evaluation found in the back of this booklet. Please include credit card information and e-mail address. Fax to (386) 673-3563 . • All completions will be processed within 2 business days of receipt and certificates e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
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Book code: RPTTX2024
PHARMACY TECHNICIAN CONTINUING EDUCATION
Chapter 1: Overview of Texas Pharmacy Law, 2nd Edition (Mandatory) 1 Contact Hour
By: Patricia Weiser, PharmD Author Disclosure: Patricia Weiser, PharmD, and Colibri Healthcare, LLC do not have any actual or potential conflicts of interest in relation to this lesson. Universal Activity Number UAN: 0607-0000-23-017-H03-T Target Audience: Pharmacists in a community-based setting. To Obtain Credit: A minimum test score of 75 percent is needed to obtain a credit. Please submit your answers either by mail, fax, or online at EliteLearning.com/Book Questions regarding statements of credit and other customer service issues should be directed to 1-888-666-9053. This lesson is $9.95. Activity Type: Knowledge-based Initial Release Date: 7/26/2023 Expiration Date: 7/26/2026 Learning objectives After completing this course, the learner should be able to: Describe the eligibility qualifications and make-up of the Texas State Board of Pharmacy. Explain the powers and duties of the Texas State Board of Pharmacy. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give les s attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing Introduction The Texas State Board of Pharmacy is the regulatory and disciplinary body responsible for management of the pharmacy profession in the state of Texas. This organization is responsible for providing rules, regulations, and guidance regarding all areas of pharmacy practice. It is the responsibility of pharmacists, pharmacy interns, and pharmacy technicians to maintain competency in understanding and applying these rules to their daily pharmacy practice. This continuing education course provides important background information on the Texas State Board of Pharmacy, its role in revising and adopting changes to the law, and important Texas state pharmacy law updates from early 2021 through the first half of 2023. When the Board adopts changes or updates to Texas pharmacy law, these changes are enacted in the following locations: Texas State Board of Pharmacy The Texas State Board of Pharmacy has 11 members and is responsible for the management and regulation of the pharmacy profession within the state of Texas. The Board provides legislative policy and guidance regarding practice, licensing,
Colibri Healthcare, LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 1 contact hour (0.1 CEU) submitted to CPE Monitor as early as within 10 business days after course completion and no later than 60 days after the event. Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time. The participant is accountable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days. List the steps required to propose updates to Texas state pharmacy law and where to find information from the Board regarding confirmed and proposed updates. Discuss important updates to Texas state pharmacy law adopted between February 2021 and May 2023. implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics. ● Texas Administrative Code, Chapters 281–315: https://www. sos.state.tx.us/tac/index.shtml ● Texas Occupational Code, Chapters 551–569 (Texas Pharmacy Act): https://www.sos.state.tx.us/tac/index.shtml The Board publishes adopted revisions to the Texas state pharmacy law, as well as any proposed rule changes that are up for Board approval, in quarterly issues of the Texas Register , a weekly publication that presents news from various regulatory agencies across the state of Texas. The content of this course is current as of April 30, 2023. Because the Texas State Board of Pharmacy implements changes to state law on a quarterly basis each year, it is important to check each February, May, August, and November to learn about any updates.
OVERVIEW OF TEXAS PHARMACY LAW UPDATES
and interprofessional collaboration. The Texas Occupational Code Chapter 552 describes the Texas State Board of Pharmacy, including membership, responsibilities, and powers.
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Book Code: RPTTX2024
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Who serves on the Texas State Board of Pharmacy? The Texas State Board of Pharmacy consists of 11 members. The governor appoints members, to be approved by the Senate, with the following guidelines: ● Seven of the members must be licensed pharmacists. ● One member must be a pharmacy technician. ● Three members represent community and public interest and are not pharmacists. Eligibility for Texas State Board of Pharmacy appointment Texas Occupational Code Sec. 552.002 breaks down the qualifications and eligibility requirements for serving on the Texas State Board of Pharmacy. Sec. 552.002 explains the following requirements: A pharmacist Board member must, at the time of appointment: ● Be a resident of the state of Texas. ● Have at least five years of pharmacy licensure. ● Be in good standing regarding pharmacy practice within the state of Texas. Powers and duties of Texas State Board of Pharmacy Texas Occupational Code (TOC) Chapter 554 outlines the various powers held by the Texas State Board of Pharmacy. In general, this section discusses the legislative and regulatory power of the Board. TOC Sec. 554.001 permits the Board to: ● Administer and enforce the rules contained within the TOC and the Texas Administrative Code. ● Appoint committees from the Board’s membership, as well as an advisory committee from non-Board members of the pharmacy profession. Process for proposing updates to Texas Pharmacy Law Texas Administrative Code Chapter 281 describes Texas State Board of Pharmacy action requirements and procedures. TAC §281.5, specifically, focuses on the process for initiating proceedings before the Board. According to TAC §281.5: ● Any interested person may petition the Board requesting the adoption of a rule. ● Petitions must be sent to the executive director or secretary of the Board. ● Within 60 days of petition submission, the Board must either deny the suggested petition in writing with explanation regarding the denial or shall initiate rulemaking procedure. Where to find proposed and adopted changes Emergency, proposed, and adopted rule changes are published by the Board in the Texas Register , a weekly publication that contains bulletins regarding the state’s various rulemaking agencies, including the Texas State Board of Pharmacy. The Texas Register is managed by the Office of the Secretary of State and can be found here: http://www.sos.state.tx.us/texreg/index. shtml
Members of the Texas State Board of Pharmacy serve six-year terms staggered with three or four terms expiring every other year. Board members may not serve more than two consecutive full terms. In the case of a vacancy, the governor appoints a replacement that will complete the term.
● Be actively practicing pharmacy in Texas. A pharmacy technician Board member must, at the time of appointment: ● Be a resident of the state of Texas. ● Have five years of registered pharmacy technician experience preceding the appointment date. ● Be in good practice standing as a pharmacy technician in the state of Texas. ● Be currently practicing as a pharmacy technician in Texas. ● Inspect facilities licensed as pharmacies to determine compliance with code. ● Suspend, revoke, retire, or otherwise restrict a pharmacist or pharmacy license when considered necessary. ● Adopt rules involved in promoting the health and safety of citizens of the state of Texas.
UPDATES TO TEXAS STATE PHARMACY LEGISLATION
Petitions are considered adequate if they contain all of the following: ● The exact wording of the new, changed, or amended proposed rule. ● Specific reference to the existing rule that is proposed to be changed or amended in the case of a changed or amended rule. ● A justification for the proposed action, in narrative form, with specific detail and background to inform the Board, as well as other interested parties, of the reasons and arguments on which the petitioner is relying. This publication also includes any withdrawn or repealed rules, rule reviews, and other regulatory information deemed important by the Texas State Board of Pharmacy. The Board welcomes all comments regarding proposed rule changes, and there is a deadline of five business days prior to any Board meeting for any submitted comments to reach the Board.
TEXAS STATE PHARMACY LAW UPDATES
Pharmacist licensure eligibility In order to be eligible for pharmacy licensure in the state of Texas, the Texas State Board of Pharmacy outlines various minimum qualifications in Chapter 558 of the Texas Occupations Code. These eligibility requirements include being a minimum of 18 years of age, successful graduation from an accredited pharmacy practice program, and passing of the licensing exams selected by the Board. While most of this information reflects no change from previous Board policy, a few important updates have been adopted regarding initial licensure eligibility. In August 2021, the Board adopted amendments to Texas Administrative Code (TAC) §283.4, which pertains to internship requirements. At this time, the number of internship hours required for license eligibility was altered to reflect Accreditation
Council for Pharmacy Education (ACPE) standards for intern hours. As of May 2023, ACPE requires 1,440 hours of APPE hours for successful accreditation; however, if the ACPE changes the requirements, then the hours requirement in Texas will also change. The Board updated their extended-internship policy, also found in TAC §283.4, in February 2022. An extended-internship position fills the time following professional program graduation but prior to taking the Board-mandated licensing exams. This position may be used to complete unfulfilled internship hours, among other situations. However, the Board updated this policy to prohibit an extended-internship position to be utilized by a pharmacy resident who has not successfully passed their licensing exams in the time allotted by their residency program.
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Book Code: RPTTX2024
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Verifying and dispensing requirements The bulk of the pharmacy-specific aspects of the Texas Administrative Code focus on elements of pharmacy practice, such as the responsibilities and obligations for providing safe and effective care to patients. While the role of the pharmacist varies depending on the position they hold, the TAC contains information regarding appropriate and approved practice for every pharmacist. An important role of a pharmacist is verifying the validity of a prescription. TAC §291.29 outlines various requirements for prescription validity, including determining script authenticity, medically legitimate reasoning for prescribing, and identifying potentially inappropriate prescribing patterns in the community. As pharmacy practice scope and technology advance, however, pharmacists must adapt to continue performing this role successfully. In February 2022, the Board provided guidance on how to validate prescriptions originating from a teledentistry or telemedicine visit. An update to TAC §291.29 noted that teledentistry and telemedicine prescriptions must follow all in-person-visit-originating prescription requirements. Therefore, these prescriptions must be issued for a medically appropriate reason and meet all other applicable laws, such as the Controlled Substances Act, if necessary. Another aspect of pharmacy practice involves emergency refills of medication. If a prescriber is unable to be reached, a pharmacist may use professional judgement in determining the necessity of an emergency refill of medication. According to TAC §291.34, an emergency refill may be issued when: ● Failure to refill the prescription could result in patient suffering. ● Failure to refill the prescription may lead to a disturbance in a therapeutic regimen. ● The pharmacist does not dispense an amount of medication exceeding a 72-hour supply. ● The pharmacist informs the patient that the refill is provided without authorization, and practitioner authorization will be mandated for future refills. ● The pharmacist informs the prescriber of an emergency fill as soon as possible. ● The pharmacist maintains a record of the emergency refill, including all information regularly required for a prescription record. While these guidelines establish clear parameters for the emergency refill procedure, questions remained about specific scenarios related to deciding to dispense an emergency refill. Considering the importance of insulin therapy to patient health, the Board updated TAC §291.34 to reflect specific instructions for managing insulin emergency refills. Similar to other emergency refills, the pharmacist must attempt to contact the prescriber and assess the patient’s remaining insulin to determine the necessity of an emergency refill. However, unlike other emergency fills, insulin may be filled with up to a 30- day supply rather than a 72- hour supply. This also applies to supplies needed for administration of insulin. November 2022 Board proceedings resulted in various updates to Texas Administrative Code §291.33 and §291.8 regarding the redispensing of medications returned to a pharmacy. Chapters 431 and 442 of the Texas Health and Safety Code outline requirements for a returned medication to be redispensed to a charitable medical clinic. Chapter 431, which is the Texas Food, Drug, and Cosmetic Act, explains that for re-dispensing eligibility, a returned drug must: ● Be a drug that requires a prescription; however, no controlled substances are eligible for return and redispensing. ● Be a drug approved by the federal Food and Drug Administration.
● Be sealed in the manufacturer’s unopened original tamper- evident packaging and meet the following (as appropriate
depending on the medication): ○ Be individually packaged. ○ Be packaged in unit-dose packaging.
○ Be oral or parenteral medication in sealed single-dose containers designed with approval of the federal Food and Drug Administration. ○ Be a topical or inhalant medication in sealed units-of- use containers approved by the federal Food and Drug Administration. ○ Be a parenteral drug in a multidose container with no doses yet withdrawn. ○ Not be subjected to any recall initiated by state or federal agency, drug seller, or manufacturer. ○ Only be dispensed: ■ Before the expiration or within recommend use date of the drug. ■ After a licensed pharmacist has thoroughly inspected the medication and ensured acceptable integrity. Board updates to TAC §291.33 and §291.8 adopted this set of requirements for accepting returned medication, albeit in different situations than a charitable medical clinic. According to TAC §291.8, the requirements described in the Texas Food, Drug, and Cosmetic Act also apply to pharmacies accepting returned drugs from healthcare facilities and penal institutions. Assuming the aforementioned eligibility is met, such as remaining in an unopened, tamper-evident manufacturer container, a medication returned from a healthcare institution or penal institution may be redispensed by the pharmacist following a thorough inspection and confirmation of medication integrity. Self-Assessment Quiz Question #1 For noninsulin emergency refills, what quantity of medication are pharmacists able to dispense?
a. 15-day supply. b. 30-day supply. c. 3-day supply. d. 1-day supply.
Pharmacy practice involving controlled substances represents the most heavily legislated and regulated aspect of patient care. This is designed to improve patient safety, as well as protect healthcare practitioners from mismanaging these potentially dangerous medications. However, despite the vast set of rules regarding controlled substances, additions and alterations are routinely made to pharmacy practice legislation. At the federal level, prescriptions written for medications belonging to the Schedule II controlled substance class were considered valid for 30 days from the date the prescription was written. Some common medications in this class include oxycodone, hydromorphone, and methylphenidate. In Texas, however, the period during which prescriptions for Schedule II controlled substances were valid was much shorter. In May 2021, the Texas State Board of Pharmacy adopted changes to TAC §315.3 and §315.5 to make Texas pharmacy requirements consistent with federal law. Therefore, prescriptions for Schedule II controlled substances are valid for up to 30 days from the written date. This update is also reflected in the dispensing of multiple controlled substance prescriptions. If a prescriber writes multiple prescriptions for a Schedule II substance to give the patient a 90- day supply, the prescriptions are valid only within 30 days of the date written on the prescription.
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More recently, the Texas State Board of Pharmacy updated the 30-day window for Schedule II prescription validity again. Previously, this legislation applied only to in-state prescribers; prescriptions for Schedule II medications written outside of Controlled substance management and dispensing The final update to controlled substance law in Texas went into effect in February 2023. TAC §315.6 reflects that, in conjunction with the Texas Prescription Monitoring Program, by the next business day following the dispensing, pharmacists are required to report each controlled substance dispensed. In an update to TAC §315.6, the Board included directions for what to report, which can be found in another Board publication, the Data Submission Guide for Dispensers. This guide explains the various steps for establishing regular reports through the Texas Prescription Monitoring system. Following this guide ensures that pharmacies are in compliance with all Board requirements for controlled substance reporting. Pharmacy Practice Consideration: It is important to verify the legitimacy of controlled substance prescriptions before dispensing them. The Texas State Board of Pharmacy provides a list of “Red Flags” that may assist in determining if a pharmacy has become a target for invalid prescriptions. For instance, if numerous people come to the pharmacy with the same controlled substance prescriptions written by the same provider, the lack of individualized drug therapy may indicate that these prescriptions are fraudulent. For a full list of Red Flags, visit https://www.pharmacy.texas.gov/files_pdf/ You_might_be_a_pill_mill_if.pdf Drug disposal TAC §303.1 outlines the requirements that must be followed when disposing of dangerous drugs or controlled substances. In hospitals and other healthcare facilities, there are strict steps involving an inventory, a witness, and which medications may be destroyed. In a February 2023 update to TAC §303.1, the Texas State Board of Pharmacy adopted a new policy for healthcare facilities utilizing an independent, third-party medical waste disposal service. This update removes inventory-keeping requirements and allows for disposal of both dangerous and controlled substances in the same container as permitted by the Drug Enforcement Agency as long as: Nonsterile compounding TAC §291.131 provides guidance for pharmacies participating in compounding nonsterile products. This rule includes important definitions, operational standards, and approved compounding situations. In August 2022, the Texas State Board of Pharmacy adopted a number of revisions focusing on training and the compounding environment. Regarding training, TAC §291.131 outlines: ● All training must be documented and covered by standard operating practices. ● All personnel involved in nonsterile compounding should be well trained and must undergo continued training, as is relevant. ● Training must include demonstration and education of the following: ○ Hand hygiene. ○ Garbing. ○ Cleaning and sanitizing. ○ Handling and transporting components of and compounded nonsterile preparations. ○ Measuring and mixing. ○ Properly using equipment used in nonsterile compounding. ○ Completely documenting the compounding process.
Texas remained valid for the shorter period of time. Starting in February 2022, however, out-of-state practitioners were ncluded in the update, allowing for 30-day prescription validity for Schedule II controlled substances.
Self-Assessment Quiz Question #2 When an out-of-state prescriber writes a prescription for a Schedule II controlled substance, how many days after it is written is the prescription valid for?
a. 30 days. b. 60 days. c. 14 days. d. 7 days.
● The waste disposal service abides by all rules of the Texas Commission on Environmental Quality and the U.S. Environmental Protection Agency. ● The pharmacist seals the container of disposal-ready medications in the presence of an approved witness (administrator, director, etc.) and seals the container with tamper- resistant tape. ● Records of the container’s transfer to the waste disposal service, as well as subsequent proof of destruction, must be maintained for two years and include: ○ Date of transfer. ○ Name and address of the waste disposal service. ○ Signature of the individual transferring the container to the service. Each nonsterile compounding pharmacy location must have a pharmacist in charge, who is responsible for confirming the completeness and adequacy of the training on an individual basis. This pharmacist should also determine appropriate content and a timeline for continued education in nonsterile compounding methods and safety. The Board also updated requirements for the nonsterile compounding environment within the pharmacy. To this end, TAC §291.131. Pharmacies participating in compounding must have a specific, designated area for non- sterile compounding. This area must be adequately-sized and possess the correct equipment for safe and orderly compounding. Only personnel authorized by a pharmacist-in-charge or responsible pharmacist should be in the area during non-sterile compounding. Non-sterile compounding environments must include a clean, well-maintained sink with hot and cold running water, and must be exclusive from facilities in a rest room. Supplies necessary for adequate washing must be in the immediate area of the sink and include: ● Soap or detergent. ● Air-driers or single-use towels.
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Book Code: RPTTX2024
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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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Book Code: RPTTX2024
Page 5
OVERVIEW OF TEXAS PHARMACY LAW, 2ND EDITION Self-Assessment Answers and Rationales
1. The correct answer is C. Rationale: Pharmacists are allowed to dispense a 72-hour supply in emergency refill situations for noninsulin medications. Texas Administrative Code §291.34 outlines that to protect patients from unnecessary refills, pharmacist emergency fills are capped at 3-day supplies. 2. The correct answer is A. Rationale: When the Texas State Board of Pharmacy updated Schedule II controlled substance prescription validity windows, they initially left out-of-state prescribers out of the 30-day window extension. However, in a February 2022 update to TAC §291.34, out-of-state prescribers were included in this provision to match federal Drug Enforcement Agency standards.
3. The correct answer is B. Rationale: In both institutional (Class C) pharmacies and freestanding emergency center (Class F) satellite pharmacies, pharmacists must verify controlled substance dispense orders from automated dispensing cabinets within 72 hours of the controlled substance being pulled. This information is found in Rationale: Emergency medication kits are intended to provide healthcare professionals who are proficiently trained in life- saving measures with resources to perform emergency medicine without pharmacist oversight. In this case, earlier limitations prevented staff from effectively handling all potential emergency situations, and removing this limitation allows for best patient care outcomes. TAC §291.76 and §291.151. 4. The correct answer is B. 7. When disposing of dangerous medications or controlled substances with a waste disposal service in a Class C pharmacy setting, which of the following is no longer required following Board revisions? a. Proof of destruction of drugs sent to waste disposal company. b. Record of when disposed drugs were sealed in the disposal container. c. Proof of witness to drug disposal in waste service containers. d. Inventory of each medication disposed of, including dates, disposer, and witnesses. 8. Which of the following are requirements listed under Texas Administrative Code regarding mandatory training for nonsterile compounding? a. Proper hand hygiene. b. Measuring and mixing procedures. c. Completing documentation of the nonsterile compounding process. d. Methods of cleaning and sanitizing compounding space. e. All of the above. 9. Which healthcare staff member was granted expanded use of an automated pharmacy dispensing system in an August 2021 update to TAC §291.121? a. Physician assistants. b. Licensed nurses, with pharmacist authorization. c. Licensed nurses. d. Hospital or healthcare facility administration. 10. Which of the following is not an acceptable reason for placement in an extended internship position? a. An individual has received a pharmacy practice degree but has not taken necessary licensing exams. b. An individual has not successfully completed the required internship hours required by the state of Texas but has completed a pharmacy practice degree program. c. An individual has completed a pharmacy practice degree but failed at least one required licensing exam. d. None of the above.
OVERVIEW OF TEXAS PHARMACY LAW, 2ND EDITION Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 123, or complete your test online at EliteLearning.com/Book 1. How long is a Texas State Board of Pharmacy membership term?
a. 9 years. b. 6 years. c. 12 years. d. 3 years. 2. How many hours of pharmacy internship experience does the state of Texas require? a. 1,880. b. 500. c. 1,200. d. 1,440. 3. If a pharmacist determines a patient requires an emergency refill of an insulin product, what is the maximum days’ supply the pharmacist may dispense? 4. Which of the following is not a requirement for a returned medication to be acceptable for redispensing under Texas Administrative Code? a. The returned medication is in the original manufacturer packaging with an intact tamper-evident seal. b. The returned medication is not a controlled substance. c. The returned medication is expired or past the beyond- use date. d. The returned medication is thoroughly inspected by a pharmacist to ensure integrity. 5. How many days is a Schedule II controlled substance prescription valid for past the original written date? a. 7 days. a. 14-day supply. b. 3-day supply. c. 7-day supply. d. 30-day supply. 6. The reference pharmacists must use in Texas to ensure accurate reporting of controlled substance dispensing is called the: a. Texas Pharmacy Act. b. Data Submission Guide for Dispensers. c. Texas Controlled Substances Act. d. Texas Administrative Code. b. 21 days. c. 90 days. d. 30 days.
Course Code: RPTTX01TL
Page 6
Book Code: RPTTX2024
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Chapter 2: Recognizing and Responding to Human Trafficking in Texas (Mandatory) 1 Contact Hour
By: John Makopoulos, MD and Dawn Demangone-Yoon, MD Author Disclosure : John Makopoulos, Dawn Demangone-Yoon and Colibri Healthcare, LLC do not have any actual or potential conflicts of interest in relation to this lesson. Universal Activity Number (UAN) : 0607-0000-22-044-H99-T Activity Type : Knowledge-based Initial Release Date : September 29, 2022 Expiration Date : September 29, 2024 Target Audience: Pharmacy Technicians in a community-based setting. To Obtain Credit: A minimum test score of 75 percent is needed to obtain a credit. Please submit your answers online at EliteLearning.com/Book Questions regarding statements of credit and other customer service issues should be directed to 1-888-666-9053. This lesson is $11.95. Learning objectives After completing this course, the learner will be able to: Describe the types and venues of human trafficking in the United States. Discuss communication strategies to assist with identification of trafficked persons. Course overview Human trafficking has been called a form of modern-day slavery. 1,2 It is a crime involving the exploitation of someone for the purpose of compelled labor or a commercial sex act through the use of force, fraud, or coercion. 1 Victims can be women or men, adults or children, citizens or noncitizens and occurs across the United States and throughout the world. Human trafficking does not require crossing of international or state borders. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing
Colibri Healthcare, LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 1 contact hour
(0.1 CEU) submitted to CPE Monitor as early as 14 days after the event and no later than 60 days after the event. Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time. The participant is accountable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days.
Discuss the importance of safety planning and protocols. Identify resources for reporting suspected victims of human trafficking.
For clinicians and health care workers, human trafficking can be viewed as a serious health risk associated with significant physical and psychological harms. 3 The abuses suffered by people who are trafficked include many forms of physical violence or abuse (e.g., beating, burning, rape, confinement) as well as many psychologically damaging tactics such as threats to themselves or their family members, blackmail, extortion, lies about the person’s rights, and confiscation of vital identity documents. 3 implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
What Is human trafficking? Human trafficking is defined as:
The phrase “human smuggling” is often confused with “human trafficking” but they are two quite different crimes. Human smuggling involves the provision of a service—typically transportation or fraudulent documents—to an individual who voluntarily seeks illegal entry into a foreign country. 5 Also sometimes confused is the difference between sex trafficking and consensual commercial sex (sex work). Sex trafficking is when an adult takes part in the sale of sex through threat,
“The recruitment, transportation, transfer, harboring or receipt of persons by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.” 4
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Book Code: RPTTX2024
Page 7
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