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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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EC PHARMACY UPDATEThere is currently no known activity promoting direct pharmacy access to EC. Nebraska is currently focused on contraceptive equity and support for EC in general has been limited. Title X clinics all provide EC except one in the northwest corner of the state. Anecdotal evidence suggests that physicians are reluctant to provide EC and EC information is greatly needed in the private provider community. EC tends to be available in a very limited way: clients have to know “the right nurse” to ask “the right doctor.” For press coverage in this state, click here.
CONTACTSJoni Cover Paula Eurek Chris Funk
USEFUL LINKSBoard of Pharmacy Examiners Nebraska Pharmacist Association Nebraska Legislature
PROTOCOL ENVIRONMENTPossible Environment: Revision to Existing Authority Required This state permits collaborative practice agreements or a similar agreement between physicians and pharmacists. However, some modification of existing statutes and/or regulations is required to allow pharmacists to initiate EC for the general community. Pharmacist initiation of EC would require:
PHARMACY PRACTICE ACTPharmacy Practice Act Regulatory and Statutory Authority Note: The text presented below has been prepared by the American Pharmacists Association for the Pharmacy Access Partnership and reflects legislation or regulation promulgated as of June 15, 2003. NEBRASKA An individual pharmacist in any practice setting may enter into a patient-specific agreement with an individual physician to implement and monitor a therapeutic plan based on a written protocol that does not require external review (although it must be made available upon request, and written notice to the Board must be given at the initiation of the agreement or upon a change in the protocol.) The scope of practice is outlined in the protocol with no limitations on disease state management opportunities. The agreement expires after one year. Pharmacists may administer immunizations, via any route of delivery, pursuant to a prescription order which need not be patient-specific. Pharmacists must document each administration, monitor the patient, and take appropriate action if a side effect or other response occurs. Statutory authority: Provided in relevant statutory definitions Neb. Rev. Stat. §§ 71-1,142 and 1,146.01 Regulatory authority: Provided in definitions and rules governing practice agreements and pharmaceutical care, Neb Admin. Code 172-128-001 – 002, 007, and 175-8-001 – 002.
NEBRASKA STATUTE 71-1,142 Terms, defined. For purposes of sections 71-1,142 to 71-1,151 and elsewhere in the Uniform Licensing Law, unless the context otherwise requires: (1) Practice of pharmacy means (a) the interpretation, evaluation, and implementation of a medical order, (b) the dispensing of drugs and devices, (c) drug product selection, (d) the administration of drugs or devices, (e) drug utilization review, (f) patient counseling, (g) the provision of pharmaceutical care, and (h) the responsibility for compounding and labeling of dispensed or repackaged drugs and devices, proper and safe storage of drugs and devices, and maintenance of proper records. The active practice of pharmacy means the performance of the functions set out in this subdivision by a pharmacist as his or her principal or ordinary occupation; (2) Administer means to directly apply a drug or device by injection, inhalation, ingestion, or other means to the body of a patient or research subject; … (20) Medical order means a prescription, a chart order, or an order for pharmaceutical care issued by a practitioner; (21) Pharmaceutical care means the provision of drug therapy for the purpose of achieving therapeutic outcomes that improve a patient's quality of life. Such outcomes include (a) the cure of disease, (b) the elimination or reduction of a patient's symptomatology, (c) the arrest or slowing of a disease process, or (d) the prevention of a disease or symptomatology. Pharmaceutical care includes the process through which the pharmacist works in concert with the patient and his or her caregiver, physician, or other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient; … (25) Patient counseling means the verbal communication by a pharmacist, pharmacist intern, or practitioner, in a manner reflecting dignity and the right of the patient to a reasonable degree of privacy, of information to the patient or caregiver in order to improve therapeutic outcomes by maximizing proper use of prescription drugs and devices and also includes the duties set out in section 71-1,147.35; (32) Prescription means an order for a drug or device issued by a practitioner for a specific patient, for emergency use, or for use in immunizations. Prescription does not include a chart order; Chapter 71. Public Health and Welfare. 71-1,146.01 Medical order; duration; dispensing; transmission. (1) All medical orders shall be valid for the period stated in the medical order, except that (a) if the medical order is for a controlled substance listed in section 28-405, such period shall not exceed six months from the date of issuance at which time the medical order shall expire and (b) if the medical order is for a drug or device which is not a controlled substance listed in section 28-405 or is an order issued by a practitioner for pharmaceutical care, such period shall not exceed twelve months from the date of issuance at which time the medical order shall expire.
NEBRASKA REGULATIONS NEBRASKA HEALTH AND HUMAN SERVICES REGULATION AND LICENSURE 175 NAC 8 TITLE 175 HEALTH CARE FACIILTIES AND SERVICES LICENSURE CHAPTER 8 PHARMACIES 8-002 DEFINITIONS Administer means to directly apply a drug or device by injection, inhalation, ingestion, or other means to the body of a patient or research subject. Administration means the act of:
* * * Medical Order means a prescription, or chart order, or an order for pharmaceutical care issued by a practitioner. A chart order cannot be filled unless the patient is an inpatient of a hospital. * * * Pharmaceutical care means the provision of drug therapy for the purpose of achieving therapeutic outcomes that improve a patient’s quality of life. Such outcomes include:
Pharmaceutical care includes the process through which the pharmacist works in concert with the patient and his/her caregiver, physician, or other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient. * * * Practice of Pharmacy means the
* * * Prescription means an order for a drug or device issued by a practitioner for a specific patient, for emergency use, or for use in immunizations. Prescription does not include a chart order. TITLE 172, CHAPTER 128 PRACTICE OF PHARMACY 128-001 SCOPE AND AUTHORITY These regulations govern the practice of pharmacy pursuant to Neb. Rev. Stat. Sections 28-401 to 28-445, 28-1437 to 28-1439.01, 71-1,142 to 71-1,147.61, 71-2401 to 71-2409, 71-5401 to 71-5408, 71-101 to 71-172.02, 71-1,198 to 71-1,205, and 71-1,339 to 71-1,343. 128-002 DEFINITIONS: In addition to the definitions found in Nebraska Statutes 28-401 and 71-1,142, the following definitions apply to 172 NAC 128: * * * ‘Practice agreement’ means a document signed by a pharmacist and a medical practitioner, wherein the pharmacist agrees to implement and monitor a therapeutic plan based on a written protocol. * * * ‘Prescription means’ a medical order from a practitioner for a drug, device, biological or pharmaceutical care for a specific patient or for emergency use or use in immunizations, but does not include a chart order. * * * 128-007 PHARMACEUTICAL CARE REQUIREMENTS 128-007.01 A pharmacist may enter into a practice agreement with a licensed medical practitioner to provide pharmaceutical care according to written protocols. 128-007.02 The pharmacist shall assure that the Board is notified of any practice agreement. Such notice shall be given to both the Board of Pharmacy and the medical practitioner’s professional Board. Such notice shall contain the names of the pharmacist(s) and the licensed medical practitioner(s) and a description of the therapy being monitored or initiated. 1. A copy of the practice agreement and written protocols shall be available for review by any representative of the Department, and 2. A copy of the practice agreement or written protocols shall be sent to the Board upon request from the Board. 3. Written notice shall be given to the Board at initiation and at any time there is a change in parties or protocols. 128-007.03 Practice agreements and written protocols must be signed by the pharmacist and the medical practitioner and shall be reviewed, signed, and dated every 12 months. 128-007.04 Practice agreements and written protocols shall cease immediately upon: 1. The death of either the pharmacist or the licensed medical practitioner, or 2. Loss of license of either the pharmacist or the medical practitioner, or 3. Disciplinary action limiting the ability of either the pharmacist or the medical practitioner to enter into practice agreements, or 4. Individual decision or mutual agreement of the pharmacist(s) or medical practitioner(s) to end the agreement. 128-007.05 Nothing in these agreements will allow a pharmacist to practice beyond his/her scope of practice. TITLE 175 HEALTH CARE FACIILTIES AND SERVICES LICENSURE [Effective date April 1, 2002] CHAPTER 8 PHARMACIES 8-001 SCOPE AND AUTHORITY: These regulations govern licensure of Pharmacies. The regulations are authorized by and implement the Health Care Facility Licensure Act, Neb. Rev. Stat. sections 71-401 to 71-462 and Laws 2001, LB 398. 8-002 DEFINITIONS Administer means to directly apply a drug or device by injection, inhalation, ingestion, or other means to the body of a patient or research subject. Administration means the act of:
* * * Medical Order means a prescription, or chart order, or an order for pharmaceutical care issued by a practitioner. A chart order cannot be filled unless the patient is an inpatient of a hospital. * * * Pharmaceutical care means the provision of drug therapy for the purpose of achieving therapeutic outcomes that improve a patient’s quality of life. Such outcomes include:
Pharmaceutical care includes the process through which the pharmacist works in concert with the patient and his/her caregiver, physician, or other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient. * * * Practice of Pharmacy means the
* * * Prescription means an order for a drug or device issued by a practitioner for a specific patient, for emergency use, or for use in immunizations. Prescription does not include a chart order.
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