Source: http://regulations.delaware.gov/register/july2009/proposed/13%20DE%20Reg%2057%2007-01-09.htm
Timestamp: 2019-05-21 19:25:56
Document Index: 429784107

Matched Legal Cases: ['§ 2509', '§2515', '§2518', '§2507', '§2534', '§2534', '§2536']

13 DE Reg 57 07-01-09
The Delaware Board of Pharmacy ("the Board"), in accordance with 24 Del.C. § 2509, is proposing to amend regulations 1.0 Pharmacist Licensure Requirements, 3.0 Pharmacy Requirements, 5.0 Dispensing, 11.0 Pharmaceutical Services in Nursing Homes and 15.0 Automated Pharmacy Systems. In addition, the Board is proposing to add new regulations 18.0 Storage and Dispensing of Medical Gases, 20.0 Technicians: Qualifications, Training and Duties and 21.0 Specialty Institutional Pharmacy Licenses.
A public hearing is scheduled for Wednesday, August 19, 2009, at 10:00 a.m. in the second floor Conference Room A of the Cannon Building, 861 Silver Lake Boulevard, Dover, DE 19904.
Members of the public may offer verbal comments on the proposal at the hearing. Written comments may be submitted to the Board prior to the hearing care of Nancy Fields, Administrative Specialist II, at the above address.
Written comments may be submitted until the public hearing begins. Anyone wishing to obtain a copy of the proposal or to make comments at the public hearing should contact Nancy Fields at the above address or call (302) 677-7318.
1.0 Pharmacist and Pharmacy Licensure Requirements
1.12 Examination Requirements
1.12.1 In order to be eligible for examination for licensure, an applicant must provide proof of completion of all requirements for graduation from an approved school or college. An approved school or college of pharmacy is an institution which has established standards in its undergraduate degree program which are at least equivalent to the minimum standards for accreditation established by the American Council on Pharmaceutical Education. Provided, however, that graduates of schools or colleges of pharmacy located outside of the United States, which have not established standards in their respective undergraduate degree programs which are at least equivalent to the minimum standards for accreditation established by the American Council on Pharmaceutical Education, shall be deemed eligible for examination for licensure by providing evidence satisfactory to the Board of Pharmacy of graduation from such school or college and by successfully passing an equivalency examination recognized by the Board of Pharmacy. Certification by the National Association of Boards of Pharmacy (NABP) Foreign Pharmacy Graduate Examination Committee (FPGEC) meets the equivalency examination requirement.
1.12.2 Candidates must obtain a passing grade as determined by the National Association of Boards of Pharmacy (NABP) on the North American Pharmacist Licensure Examination (NAPLEX) and the Multistate Pharmacy Jurisprudence Examination for Delaware (MPJE) to be eligible for a license to practice. A candidate must take an examination within 365 days of the determination of eligibility by the Board. The Secretary will supply the grades obtained to the candidate upon receipt of a written request from that person.
1.12.3 The Board will re-confirm the eligibility of an applicant who fails the NAPLEX. The applicant shall be entitled to take a re-examination at least ninety-one (91) days following the date of the failure. If an applicant has failed the examination three times, he/she shall be eligible to re-take the NAPLEX, provided that he/she produces evidence of working full-time as an intern for a period of six months or has attended an accredited college of pharmacy as a registered student for a minimum of one semester consisting of 12 credits during the interim. A certification of satisfactory completion of such work shall be furnished by the Dean of the College or the preceptor as the case may be.
1.12.4 The Board will re-confirm the eligibility of an applicant who fails the MPJE. The applicant shall be entitled to re-take the MJPE at least thirty-one (31) days following the date of the failure. If an applicant has failed the examination three times, he or she shall be eligible to re-take the examination, provided that he or she produces evidence of working full-time as an intern for a period of three months or has completed a one semester college course on jurisprudence.
1.23 Practical Experience Requirements
1.23.1 An applicant for registration as an intern must submit an application for registration of Internship after entering the first professional year of college of pharmacy which includes an “Affidavit of Class Standing” and “Affidavit of Preceptor.” This application must be obtained from the Board of Pharmacy. If the applicant is a graduate of a foreign pharmacy school, he/she must produce evidence that he/she has passed an equivalency examination by the Board.
1.23.2 Persons who register as interns in the State of Delaware shall, in accordance with the requirements of 24 Del.C. §2515, complete not less than 1500 hours of Board approved practical experience under the supervision of a licensed pharmacist. A minimum of 1000 hours shall be obtained in the community or hospital settings. The remaining 500 hours may be obtained in other recognized fields of practice, e.g.: Industrial Pharmacist, Drug Information Pharmacist, Military Pharmacist, Mail Order Pharmacist, HMO Pharmacist, Consultant Pharmacist (Nursing Home, Infusion, Medicaid DUR, Etc.), Home Health Care Pharmacist (may include Durable Medical Equipment, etc.), Nuclear Pharmacist, Compliance Pharmacist, Government Pharmacist, Clinical Pharmacist, Contracted Pharmacy Services.
1.23.3 Practical experience must be acquired under the supervision of a licensed pharmacist known as a Preceptor. The Preceptor must be a pharmacist licensed in this State or any other State and must have a minimum of two years of pharmacy practice. A pharmacist affiliated with a College of Pharmacy shall serve as the preceptor for a student participating in the coordinated practical experience program. The Preceptor must certify that the intern has successfully completed all the requirements outlined in the Responsibilities of the Intern professional assessment form.
1.23.4 Practical experience acquired in another State is acceptable if the State Board in which the applicant acquired the hours submits a letter of certification, or if the applicant’s preceptor completes the Delaware State Board of Pharmacy’s Affidavit of Intern Experience form. Applicants who have not completed all the practical experience requirements, but who have graduated from an accredited college or have been certified by the NABP Foreign Pharmacy Graduate Examination Committee are eligible to take the examination. However, applicants will not be fully licensed until all the requirements of the Statutes and Regulations are completed.
1.23.5 The hours accrued during the College of Pharmacy Practical Experience Program may be applied to the 1500 hours total. These hours shall be recorded on the College Practical Experience Affidavit supplied by the Board. Registration as an intern in this State is not required for school experience.
1.23.6 An intern must notify the Board of Pharmacy in writing within ten (10) days of a change or preceptor. A change of preceptor affidavit must be completed and filed with the Board.
1.34 Continuing Education Requirements
1.34.1 A pharmacist must acquire 3.0 C.E.U.'s (30 hours) per biennial licensure period. No carry over of credit from one registration period to another period is permitted.
1.34.2 Hardship - Hardship exemptions may be granted by the Board of Pharmacy upon receipt of evidence that the individual was unable to complete the requirements due to circumstances beyond his control.
1.34.3 Criteria for Hardship Exemption as Recommended by the Board of Pharmacy:
1.34.3.1 Applicant must notify the Board in writing concerning the nature of the hardship and the time needed for an extension. In case of medical disability, a letter from the physician with supporting documentation to corroborate the condition and the length of time of extension needed.
1.34.3.2 The Board of Pharmacy will review requests.
1.34.3.3 The Board will notify the registrant of its decision.
1.34.4 Persons who are newly licensed after the registration period begins, must complete continuing education units proportional to the total number of continuing education units required for the biennial licensure renewal. (1.25 hours/per month).
1.45 Continuing Professional Educational Programs
1.45.1 Topics of Study
1.45.2 Approved Provider
1.45.2.1 Any provider approved by ACPE.
1.45.2.2 In-state organization which meets criteria approved by the Board.
1.45.3 Application for Delaware State Provider
1.45.3.1 Any in-state organization may apply to the Board on forms provided by the Board for initial qualification as an approved provider. The Board shall accept or reject any such application by written notice to such organization within 60 days after receipt of its application. If an organization is approved, the Board will issue a certificate or other notification of qualification to it, which approval shall be effective for a period of two years and shall be renewable upon the fulfillment of all requirements for renewal as set forth by the Board.
1.45.3.2 The Board may revoke or suspend an approval of a provider or refuse to renew such approval if the provider fails to maintain the standards and specifications required. The Board shall serve written notice on the provider by mail or personal delivery at its address as shown on its most current application specifying the reason for suspension, revocation, or failure to renew. The provider so affected shall, upon written request to the Board within ten days after service of the notice, be granted a prompt hearing before the Board at which time it will be permitted to introduce matters in person, or by its counsel, to defend itself against such revocation, suspension, or failure to renew, in accordance with the provisions set forth in the State's Administrative Procedures Act.
1.45.4 Criteria for Approval of Delaware State Providers. Only applicants who are located within the State of Delaware are eligible. Such Continuing Education providers shall provide evidence of ability to meet the following criteria or approval as a Continuing Pharmaceutical Education Provider. Other persons must apply through ACPE for approval or be acceptable to other Boards of Pharmacy that certify continuing education for relicensure.
1.45.4.1 Administration and Organization
1.45.4.1.1 The person who is in charge of making sure that the program meets the quality standards must have a background in the administration of education programs.
1.45.4.1.2 There shall be an identifiable person or persons charged with the responsibility of administering the continuing pharmaceutical education program.
1.45.4.1.3 Such personnel shall be qualified for such responsibilities by virtue of experience and background.
1.45.4.1.4 If an approved provider presents programs in co-sponsorship with other non-approved provider(s), the approved provider has the total responsibility for assurance of quality of that program. If more than one approved provider co-sponsors a program, they have the joint responsibility for assuring quality.
1.45.4.1.5 Administrative Requirements include:
1.45.4.1.5.1 The development of promotional materials which state:
1.45.4.1.5.1.1 Educational objectives.
1.45.4.1.5.1.2 The target audience.
1.45.4.1.5.1.3 The time schedule of the activities.
1.45.4.1.5.1.4 Cost to the participant/covered items.
1.45.4.1.5.1.5 Amount of C.E. credit which will be awarded.
1.45.4.1.5.1.6 Credentials of the faculty, presenters, and speakers.
1.45.4.1.5.1.7 Self-evaluation instruments.
1.45.4.1.5.2 Compliance with a quantitative measure for C.E. credit.
1.45.4.1.5.2.1 The number of C.E.U.'s to be awarded for successful completion shall be determined by the provider and reported in the promotional materials.
1.45.4.1.5.2.2 In cases where the participants' physical presence is required, C.E. credit will only be awarded for that portion of the program which concerns itself with the lecture(s), evaluation and question and answer segments.
1.45.4.1.5.2.3 The measure of credit shall be a fifty-minute contact hour. In the case of other programs such as home study courses, the amount of credit awarded shall be determined by assessing the amount of time the activity would require for completion by the participant if delivered in a more formal and structured format.
1.45.4.1.5.2.4 The provider must provide the Board upon request with appropriate records of successful participation in previous continuing education activities.
1.45.4.1.5.2.5 The provider must present to the participant a form or certificate as documentation of the completion of the program. The form must be at least 4" x 6" and no larger than 8 1/2" x 11". That certificate must show the name, address, and license number of the participant, the name of the provider, the title and date of the program, the number of credits earned, and an authorized signature from the provider.
1.45.4.2 Program Faculty. The selection of program faculty must be based upon proved competency in the subject matter and an ability to communicate in order to achieve a learning experience.
1.45.4.3 Program Content Development
1.45.4.3.1 Such programs shall involve effective advance planning. A statement of educational goals and/or behaviors must be included in promotional materials. Such objectives and goals must be measurable and accessible to evaluation. In determining program content, providers shall involve appropriate members of the intended audience in order to satisfy the educational needs of the participants. All programs of approved providers should pertain to the general areas of professional pharmacy practices which should include, but not be limited to:
1.45.4.3.1.1 The social, economic, behavioral, and legal aspects of health care,
1.45.4.3.1.2 the properties and actions of drugs and drug dosage forms,
1.45.4.3.1.3 the etiology, characteristics, therapeutics and prevention of the disease state,
1.45.4.3.1.4 pharmaceutical monitoring and management of patients.
1.45.4.3.2 All ancillary teaching tools shall be suitable and appropriate to the topic.
1.45.4.3.3 All materials shall be updated periodically to include up-to-date-practice setting.
1.45.4.3.4 It is the responsibility of the provider to be sure that the programs are continuously upgraded to meet educational objectives of the Practice of Pharmacy. The needs of the pharmacist participant must be considered in choosing the method of delivery. Innovation in presentations is encouraged within the limits of budget resources and facilities. Whatever method of delivery is used, it must include the participation of the pharmacist as much as possible within the program, i.e. questions and answers, workshops, etc.
1.45.4.4 Facilities. The facilities shall be adequate for the size of the audience, properly equipped (all appropriate audio/-visual media materials), well lighted and ventilated to induce a proper learning experience.
1.45.4.5 Evaluation. Effective evaluation of programs is essential and is the responsibility of both the provider and participant.
1.45.4.5.1 Participant - Some evaluation mechanisms must be developed by the provider to allow the participant to assess his/her own achievement per the program.
1.45.4.5.2 Provider evaluation - a provider shall also develop an instrument for the use of the participant in evaluating the effectiveness of the program including the level of fulfillment of stated objectives.
1.45.5 Criteria for Awarding Continuing Education Credits. Individual programs must meet the criteria for provider approval in order to be considered. In those cases where the provider is not an ACPE provider, nor a Board of Pharmacy approved provider, a registrant may complete an application provided by the Board for approval of individual programs.
1.45.5.1 In order to receive full credit for non-ACPE approved programs of one-to-two hour lengths, evidence of a post test must be presented. An automatic 25% deduction if no post test presented.
1.45.5.2 In order to receive full credit for non ACPE approved programs of three or more hours in length, evidence of a pre and post test must be presented. Automatic 25% deduction if no pre and post test presented.
1.45.5.3 Credit will be assigned only for the core content of the program which explicitly relates to the contemporary practice of Pharmacy.
1.45.5.4 A maximum of 2 credit hours will be awarded for First Aid, attendance at a Board of Pharmacy meeting and CPR/BCLS courses one time only per registration period.
1.45.5.5 Credit for Instructors of Continuing Education
1.45.5.5.1 Any pharmacist whose primary responsibility is not the education of health professionals, who leads, instructs or lectures to groups of nurses, physicians, pharmacists or others on pharmacy related topics in organized continuing education or inservice programs, shall be granted continuing education credit for such time expended during actual presentation, upon adequate documentation to the Delaware Board of Pharmacy.
1.45.5.5.2 Any pharmacist whose primary responsibility is the education of health professionals shall be granted continuing education credit only for time expended in leading, instructing, or lecturing to groups of physicians, pharmacists, nurses or others on pharmacy related topics outside his/her formal course responsibilities (that is, lectures or instructions must be prepared specifically for each program) in a learning institution.
1.45.5.5.3 Credit for presentations of in-service training programs or other lectures shall be granted only for topics meeting the criteria for continuing pharmacy education, and shall be granted only once for any given program or lecture. (Any topic completely revised would be eligible for consideration.)
1.45.5.5.4 A maximum of 6 hours (0.6 C.E.U.'s) in this category may be applied toward fulfilling the total biennial continuing education requirements.
1.45.5.6 Credit for On the Job Training:
1.45.5.6.1 The Board of Pharmacy does not as a general rule encourage the submission of "on the job training" for fulfilling the continuing education requirements. All programs meeting this definition shall be reviewed on an individual basis.
1.45.5.6.2 All programs that are submitted for credit must meet the criteria for continuing pharmacy education.
1.45.5.6.3 No credit shall be awarded for programs required by an employer for continued employment of the employee. (Examples OSHA training, Infection Control Education required by JCAHO.)
1.45.5.6.4 A maximum of 4 hours (0.4 C.E.U.'s) in this category may be applied toward fulfilling the total biennial continuing education requirements.
1.56 The Verification of Continuing Education - A pharmacist shall retain the supporting documentation, such as certification of completion for a minimum of six years. The Board will randomly audit the documentation of at least 10% of licensed pharmacists every biennial term. Supporting documentation may be requested for up to six years. Pharmacists who were not selected for audit do not send supporting documentation to the Board. Submitting a false documentation may constitute grounds for discipline under 24 Del.C. §2518 (a)(1).
1.67 Reciprocal Requirements
1.67.1 An applicant for licensure by reciprocity shall be of good moral character and shall:
1.67.1.1 submit proof that he or she was qualified for licensure in Delaware at the time of initial licensure by examination;
1.67.1.2 submit proof of licensure in good standing from each state where he or she is or has been licensed; and
1.67.1.3 obtain a passing score on the MPJE on the laws applicable in this State as provided in Regulation 1.1.
1.67.2 Reciprocity applicants who took examinations after June 1, 1979, must have passed the NAPLEX or an examination deemed equivalent by the Board and obtained scores required for applicants for licensure by examination.
1.67.3 Applicants who are licensed by reciprocity must begin accruing continuing education units at a rate of 1.25 hours/per month beginning with the month of licensure.
1.78 Late Renewal - If a pharmacist license or pharmacy permit expire for failure to renew before the deadline, the license or permit may be renewed at any time within the 60 days immediately following expiration upon application and payment of the renewal fee and a late fee. In accordance with 24 Del.C. §§2507 and 2526, it is unlawful for a licensee or permittee to practice or operate while their license or permit is expired. All late pharmacist license renewals will be audited for compliance with the CE renewal requirement.
3.4.3 The pharmacy department or prescription area must contain a sink with hot and cold running water. It must be large enough to accommodate the equipment required by the Board so that the utensils can be properly washed and sanitized appropriate to the individual pharmacy practice.
A sign with letters not less than 3/4" in height in the vicinity of the prescription department visible to the public which shows the name of the pharmacists employed at that pharmacy or the name of the pharmacist on duty.
3.5.1 The requirements listed in §2534(f)(1) through (4) 2533(e).
3.5.4 The floor plans must include the type of alarm system to be installed, and the name, address and phone number of alarm provider. The alarm system, as required by Regulation 5 of the Delaware Controlled Substance Act, must be reviewed and approved for compliance by the Office of Narcotics and Dangerous Drugs Controlled Substances.
3.6 Security. When the pharmacist is not physically present and the operation is open for business, the pharmacy department shall be physically or electronically secured from floor to ceiling. The partitioned off section required by 24 Del.C. §2534 2533 must be five feet high measured from the floor. A conspicuous sign with letters not less than three inches in height, reading "PRESCRIPTION LABORATORY TEMPORARILY CLOSED, NO PROFESSIONAL SERVICES RENDERED," or words of similar import, must be posted in the front section of the operation or in front of the prescription area, room or partitioned off section where it can be seen by the public.
“Agent” An employee of the pharmacy supervised by the pharmacist or a person acting on behalf of the ultimate user.
“Automated Data Processing System (ADP)” A system utilizing computer software and hardware for the purposes of recordkeeping.
“Cell” Any container which holds the medication for automatic dispensing.
“Central Prescription Processing” The processing by a Pharmacy of a request from another Pharmacy to fill or refill a prescription drug order or to perform processing functions such as dispensing, DUR, claims adjudication, refill authorizations and therapeutic interventions.
“Common Data Base” A file or data base created by ADP that enables authorized users to have common access to this file regardless of physical location.
“Compounding” The art of the extemporaneous preparation and manipulation of drugs as a result of a practitioner's prescription order or initiative based on the practitioner/patient/pharmacist relationship in the course of professional practice, including the preparation of drugs in anticipation of drug orders based on routine, regularly observed prescribing patterns. Pharmaceutical compounding must be in compliance with FFDCA Section 503A and any regulations promulgated by FDA concerning compounding, pertaining to this section.
“Computer” Programmable electronic device, capable of multifunctions including but not limited to storage, retrieval and processing of information.
“Controlled Substance” Those drug items regulated by Federal (CSA of 1970) and/or State Controlled (dangerous) Substances Act.
“CRT” Cathode Ray Tube used to impose visual information on a screen.
“Delivery” The transfer of a dispensed prescription to the ultimate user (patient) or his/her agent.
“Dispensing” To furnish or deliver a drug to an ultimate user by or pursuant to the lawful order of a practitioner; including the preparation, packaging, labeling or compounding necessary to prepare the drug for that delivery.
“Downtime” That period of time when a computer is not operable.
“Facsimile (FAX) Prescription” A facsimile prescription is an order which is transmitted by an electronic device over telephone lines which sends an exact copy image to the receiver (pharmacy).
“Final Container” is that which holds the article, designed to hold a quantity of drug product intended for administration as a single dose, multiple dose, or a single finished device intended for use promptly after the container is opened.
“New Medication” A medication not previously dispensed by the pharmacy for the ultimate user.
“Patient Counseling” The offer to discuss the patient's prescription made by the pharmacist or the pharmacist's designee in a face-to-face communication with the patient or his/her agent, unless in the professional judgment of the pharmacist it is deemed impracticable and in such instances, it would be permissible for the offer to counsel to be made through alternative means.
“Pertinent Patient Medication Information” Information which increases the patient's ability to minimize the risks and enhance the benefits of drug use. The type of information the pharmacist should consider is contained in the latest edition of USP DI "Advice for the Patient."
“Prescriber” A practitioner authorized to prescribe and acting within the scope of this authorization.
“Prescription” An order for medication which is dispensed to or for an ultimate user, but does not include an order for medication which is dispensed for immediate administration to the ultimate user, (e.g., an order to dispense a drug to a bed patient for immediate administration in a hospital is not a prescription.) A written order from a practitioner authorized to prescribe and acting within the scope of this authorization, (other terminology: prescription order) or a telephone order reduced to writing by the pharmacist.
“Printout” A hard copy produced by computer that is readable without the aid of any special device.
“Reduced to Writing”
For new prescriptions this means the preparation of a paper document containing all the information required for a written prescription including the State requirement (Section 2553)for drug product selection;
“Regulatory Agency” Any Federal or State agency charged with enforcement of pharmacy or drug laws and regulations.
“Stop Date” A date established by an appropriate authority which indicates when medication will no longer be administered or dispensed in the absence of a specific time period directed by the prescriber.
“Supportive personnel” A person who is not registered as an intern or pharmacist with the Board who may perform tasks as authorized by this Regulation.
5.21 The practice of dispensing shall include, but not be limited to the following acts which shall be performed only by a pharmacist, or a pharmacy intern or student participating in an approved College of Pharmacy coordinated, practical experience program under the direct supervision of a pharmacist.
5.21.1 Receive oral prescriptions and reduce them immediately to writing.
5.21.2 Certification of the prescription order - (This involves authenticating the prescription, confirming proper dosage and instructions, and reviewing for incompatibility, etc.)
5.21.3 The pharmacist, intern or student who dispenses the original prescription shall hand-sign or initial the prescription. Initials mechanically or electronically generated are acceptable in lieu of the above provided that the individual verifies either on a daily printout or in a bound log book daily that the information on the prescription is correct. The verification must be hand-signed and dated by the individual.
5.32 Patient Counseling
5.32.1 Before dispensing or delivering a new medication to a patient or his or her agent, a pharmacist or pharmacy intern under the direct supervision of the pharmacist, shall conduct a prospective drug review. A pharmacist or pharmacy intern or student participating in an approved College of Pharmacy coordinated practical experience program and working under the direct supervision of the pharmacist, shall conduct a prospective drug review. A prospective drug review may be conducted before refilling a prescription to the extent deemed appropriate. A prospective drug review shall include screening for potential drug therapy problems due to therapeutic duplication, drug-drug interactions, including serious interactions with over-the-counter drugs, drug-disease contraindications, if disease is known, incorrect drug dosage or duration of drug treatment, drug-allergy interactions, and clinical abuse or misuse based on available information received by the pharmacist.
5.32.2 A pharmacist, or a pharmacy intern or student participating in an approved College of Pharmacy coordinated practical experience program and working under the direct supervision of a pharmacist shall, with each new medication dispensed, provide verbal counseling to the patient or the patient's agent on pertinent medication information. The counseling may include, but not be limited to the following:
5.32.2.1 the name and description of the prescribed drug;
5.32.2.2 the dosage and the dosage form;
5.32.2.3 the method and route of administration;
5.32.2.4 the duration of the prescribed drug therapy;
5.32.2.5 any special directions and precautions for preparation, administration, and use by the patient that the pharmacist determines are necessary;
5.32.2.6 common severe side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, how to avoid them, and what actions should be taken if they occur;
5.32.2.7 patient techniques for self-monitoring of the drug therapy;
5.32.2.8 proper storage;
5.32.2.9 prescription refill information;
5.32.2.10 the action to be taken in the event of a missed dose; and
5.32.2.11 current over-the-counter medication use.
5.32.3 This section does not apply to a pharmacist dispensing drugs for inpatient use in a hospital or other institution where the drug is to be administered by a nurse or other appropriate health care provider.
5.32.4 Nothing in this section requires a pharmacist or pharmacy intern or student participating in an approved College of Pharmacy coordinated practical experience program and working under the direct supervision of a pharmacist, to provide patient counseling when a patient or the patient's agent refuses the counseling. There must be a record in a uniform place that documents a patient's acceptance or refusal of counseling.
5.32.5 If the dispensed prescription is delivered by an agent of the pharmacy when the pharmacist is not present (i.e. home delivery, pharmacist off duty and non-resident pharmacies) written or printed information shall be included with the prescription. The patient or his/her agent shall be informed that the pharmacist will be available for consultation.
5.4 Supportive personnel
5.4.1 Qualifications and training
5.4.1.1 The pharmacist-in-charge is responsible for ensuring proper training of all supportive personnel. The actual training may be delegated to a pharmacist or other trained supportive personnel.
5.4.1.2 The areas of training required are to be determined by the pharmacist-in-charge and will be appropriate to the practice site and responsibilities assigned to the supportive personnel. Areas of training shall include:
5.4.1.2.1 general drug and dosage form knowledge
5.4.1.2.2 medical terminology
5.4.1.2.3 pharmaceutical calculations
5.4.1.2.4 prescription labeling requirements
5.4.1.2.5 general filling/dispensing responsibilities
5.4.1.2.6 patient profile record system requirements
5.4.1.2.7 requirements for patient counseling
5.4.1.2.8 confidentiality
5.4.1.2.9 safety practices
5.4.1.2.10 inventory functions
5.4.1.2.11 knowledge of applicable State and Federal Statutes and Regulations
5.4.1.2.12 other site-specific parameters
5.4.1.3 The general content of the training program must be maintained in the policy and procedure manual.
5.4.1.4 Documentation of successful training in specific areas by oral or written evaluation will be maintained and will be available for inspection by the Board of Pharmacy.
5.4.2 Supervision. Supportive personnel must be supervised by a registered pharmacist who will be responsible for the activities of these persons.
5.4.3 Activities allowed
5.4.3.1 Supportive personnel will be allowed to perform only those duties permitted by this regulation.
5.4.3.2 Supportive personnel may aid in the dispensing of prescriptions as authorized in Section 2513 under the supervision of a pharmacist by performing the following tasks:
5.4.3.2.1 Obtaining the medication from stock.
5.4.3.2.2 Typing the label after the pharmacist has interpreted the directions.
5.4.3.2.3 Counting, pouring and selecting prefabricated medications and selecting individual prepackaged unit dose medication provided that these are not in conflict with the state and federal law (Federal Comprehensive Controlled Substances Act) and that a final check by the pharmacist is made after the medication is placed in the final container prior to dispensing and administration to the patient. There will be a final check by a licensed pharmacist prior to dispensing and administration, except where the Board of Pharmacy grants, in writing, an exemption for good cause shown.
5.4.3.3 Compounding is the responsibility of the pharmacist or pharmacy intern under the direct supervision of the pharmacist. All compounding must be in compliance with FFDCA Section 503A and any regulations promulgated by FDA concerning compounding pertaining to this section. The pharmacist may utilize the assistance of supportive personnel if the following is performed:
5.4.3.3.1 The formulation is developed by the pharmacist before proceeding with the compounding.
5.4.3.3.2 The compounding ingredients are checked by the pharmacist before proceeding with the compounding.
5.4.3.3.3 Every weight and measurement is checked by the pharmacist before proceeding with the compounding.
5.4.3.3.4 The finished product is checked by the pharmacist before dispensing.
5.4.3.3.5 A log is maintained showing the identity of the person actually compounding the medication and the identity of the pharmacist who has performed each of the checks indicated above for each step of the procedure. If policies and procedures are in place ensuring adequate checks by the pharmacist per regulation, the requirement for a log will be waived.
5.4.3.4 Only supportive personnel or persons being trained as supportive personnel as required by this regulation, may perform the activities defined by this regulation.
5.54 Automatic Dispensing Devices. If any automatic counting device is used by a pharmacy, each cell shall have clearly displayed thereon, the date filled, the name of the drug, the batch number, the manufacturer's name, and the expiration date of the particular batch number. No drug can be added to the cell until the present supply is depleted.
5.65 Authorization for renewal of prescriptions. A prescription written for medication which, pursuant to State and Federal law, may be sold, dispensed, or furnished only upon prescription, shall not be renewed without specific authorization of the prescriber. The pharmacist shall in his/her professional judgment refill prescriptions in keeping with the number of doses ordered and the directions for use. Refills beyond one year of the date of the original prescription shall not be dispensed without further authorization of the prescriber.
5.76 Mandatory Patient Profile Record System
5.76.1 A patient profile record system must be maintained at all pharmacies for persons for whom prescriptions are dispensed. The patient profile system shall be devised so as to entitle the immediate retrieval of information necessary to enable the dispensing pharmacist to identify previously dispensed medication at the time a prescription is presented for dispensing.
5.76.2 The following information shall be recorded by a pharmacist or designee:
5.76.2.1 The family name and first name of the person for whom the medication is intended (the patient);
5.76.2.2 The address of the patient and phone number;
5.76.2.3 The patient's age, or date of birth, and gender;
5.76.2.4 The original date the medication is dispensed pursuant to the receipt of a prescriber’s prescription;
5.76.2.5 The number or designation identifying the prescription;
5.76.2.6 The prescriber's name;
5.76.2.7 The name, strength, quantity, directions and refill information of the drug dispensed;
5.76.2.8 The initials of the dispensing pharmacist and the date of dispensing medication as a renewal (refill) if said initials and such date are not recorded on the original prescription;
5.76.2.9 If the patient refuses to give all or part of the required information, the pharmacist shall so indicate and initial in the appropriate area.
5.76.2.10 Pharmacist comments relevant to the patient's drug therapy, including any other information peculiar to the specific patient or drug.
5.76.3 The pharmacist or pharmacy intern under the direct supervision of a pharmacist shall attempt to ascertain and shall record any allergies and idiosyncrasies of the patient and any chronic disease states and frequently used over-the-counter medication as communicated to the pharmacist by the patient. If the answer is none, this must be indicated on the profile.
5.76.4 Upon receipt of a new prescription, a pharmacist, pharmacy intern, or student participating in a College of Pharmacy practical experience program under the direct supervision of a pharmacist must examine the patient’s profile record before dispensing the medication to determine the possibility of a harmful drug interaction or reaction. Upon recognizing a potential harmful reaction or interaction, the pharmacist shall take appropriate action to avoid or minimize the problem with shall, if necessary, include consultation with the prescriber.
5.76.5 A patient profile record must be maintained for a period of not less than one year from the date of the last entry in the profile record unless it is also used as a dispensing record.
5.87 Exchange of Valid Non-Controlled Prescriptions Between Pharmacies
5.87.1 Verbal Exchange of Prescriptions - When a pharmacy receives a verbal request for a prescription transfer, it may be honored provided that:
5.87.1.1 The request comes from a registered pharmacist.
5.87.1.2 The copy is immediately reduced to writing and contains the information required on a written prescription as listed in Regulation 5.0, and includes the first and last name of the pharmacist transmitting the information.
5.87.1.3 The prescription used for refills must be clearly identified as a copy.
5.87.1.4 The copy shows the date and the file number of the original prescription and indicates the name and address of the pharmacy providing the copy.
5.87.1.5 The copy shows the last date of dispensing.
5.87.1.6 Only the actual number of refills remaining are indicated.
5.87.1.7 A notation indicating a copy was given and refills are no longer valid must be placed on either the original prescription or patient profile. The document used must be the same one used for the recording of refills per the pharmacy's policy.
5.87.2 A copy prepared or transmitted that does not meet the requirements of this Regulation is deemed to be an invalid prescription.
5.87.3 Written copies of prescriptions are for information only and are not valid for refilling.
5.98 Automated Data Processing Systems
5.98.1 Profiles. When ADP's are used to maintain patient profile records, all the requirements of Delaware Pharmacy Regulation 5.0 must be met.
5.98.2 Prescription (Drug Order) Information. Prescription information (drug order) shall include, but not be limited to:
5.98.2.1 Original dispensing date
5.98.2.2 Name and address of patient (patient location if in an institution)
5.98.2.3 Name of prescriber
5.98.2.4 DEA number of prescriber in the case of a controlled substance
5.98.2.5 Name, strength, dosage form and quantity, (or Stop Date), and route of administration if other than oral form of drug prescribed
5.98.2.6 Renewals authorized
5.98.2.7 Directions of use for patient
5.98.3 Records of Dispensing. Records of dispensing for original and refill prescriptions are to be made and kept by pharmacies for three years. Information must be immediately accessible for a period of not less than one year from the date of last entry. Information beyond one year but up to three years from the date of last entry may be maintained off-line but must be produced no later than five days upon request from proper authorities. The information shall include, but not be limited to:
5.98.3.1 Quantity dispensed
5.98.3.2 Date of dispensing
5.98.3.3 Serial Number (or equivalent if an institution)
5.98.3.4 The identification of the pharmacist responsible for dispensing
5.98.3.5 Record of renewals to date
5.98.3.6 Name and strength of medicine
5.98.4 Record Retrieval (Documentation of Activity). Any such ADP system must provide via CRT display and or hard copy printout a current history of all authorized prescription activity. This information shall include, but not be limited to:
5.98.4.1 Serial number of prescription (equivalent if an institution)
5.98.4.2 Date of processing
5.98.4.3 Quantity dispensed
5.98.4.4 The identification of the pharmacist responsible for dispensing
5.98.4.5 Medication dispensed
5.98.5 Auxiliary Recordkeeping System. An auxiliary recordkeeping system shall be established for the documentation of renewals if the ADP is inoperative for any reason. The auxiliary system shall insure that all renewals are authorized by the original prescription and that the maximum number of renewals are not exceeded. When the ADP is restored to operation, the information regarding prescriptions dispensed and renewed during the inoperative period shall be entered into the automated data processing system.
5.98.6 Common Data Base. Two or more pharmacies may establish and use a common data file or base to maintain required or pertinent dispensing information. Pharmacies using such a common file are not required to transfer prescriptions or information for dispensing purposes between or among pharmacies participating in the same common prescription file or data base; provided however, any such common file must contain complete and adequate records of such prescription and renewals dispensed. Where common data base is used, this shall not be considered a transfer under Board Regulation 5.0 for non-controlled substances.
5.98.7 Transfer of Prescriptions via ADP. A pharmacist may transfer a prescription electronically (ADP) for Schedule III, IV, or V controlled substances to another pharmacy for renewal purposes in accordance with Title 21, Code of Federal Regulations Section 1306.26. A pharmacist may transfer a prescription electronically (ADP) for non-controlled drug for renewal purposes in accordance with current State Regulations.
5.98.7.1 Any pharmacy using ADP must comply with all applicable State and Federal regulations.
5.98.7.2 A pharmacy shall make arrangements with the supplier of data processing services or materials to assure that the pharmacy continues to have adequate and complete prescription and dispensing records if the relationship with such supplier terminates for any reason. A pharmacy shall assure continuity in maintenance of records.
5.98.7.3 The computer record shall reflect the fact that the prescription order has been transferred, the name of the pharmacy to which it was transferred, the date of transfer, the name of the pharmacist transferring information, and any remaining refill information, if applicable.
5.98.7.4 The pharmacist receiving the transferred prescription drug order shall reduce it to writing with the following information:
5.98.7.4.1 Write the word "TRANSFER" on the face of the transferred prescription.
5.98.7.4.2 Provide all information required to be on the prescription drug order pursuant to State and Federal laws and regulations.
5.98.7.5 To maintain the confidentiality of patient's prescriptions (drug orders) or other pertinent records, there must exist adequate safeguards of security. This shall also pertain to prevent non-user access.
5.109 Electronic Transmission of Prescriptions
5.109.1 All Prescription Drug Orders communicated by way of Electronic Transmission shall:
5.109.1.1 be transmitted directly to a Pharmacist in a licensed Pharmacy of the patient’s choice with no intervening Person having access to the Prescription Drug Order;
5.109.1.2 identify the transmitter’s phone number for verbal confirmation, the time and date of transmission, and the identity of the Pharmacy intended to receive the transmission, as well as any other information required by Federal or State law;
5.109.1.3 be transmitted by an authorized Practitioner or his designated agent; and
5.109.1.4 be deemed the original Prescription Drug Order provided it meets the requirements of this subsection.
5.109.2 The prescribing Practitioner may authorize his agent to communicate a Prescription Drug Order orally or by way of Electronic Transmission to a Pharmacist in a licensed Pharmacy, provided that the identity of the transmitting agent is included in the order.
5.109.3 The Pharmacist shall exercise professional judgment regarding the accuracy, validity, and authenticity of the Prescription Drug Order communicated by way of Electronic Transmission consistent with existing Federal or State laws and rules.
5.109.4 All electronic equipment for receipt of Prescription Drug Orders communicated by way of Electronic Transmission shall be maintained so as to ensure against unauthorized access.
5.109.5 Persons other than those bound by a confidentiality agreement pursuant to Section 2.A. (2)(k) shall not have access to Pharmacy records containing Confidential Information or personally identifiable information concerning the Pharmacy’s patients.
5.109.6 Controlled substance prescriptions may only be electronically transmitted via a facsimile.
5.109.7 Facsimile prescriptions must meet the following requirements in addition to the above listed electronic Transmission requirements.
5.109.7.1 The prescription order shall include the fax number of the transmitter, the number of transmitted pages, the name, phone number, and electronic number of the pharmacy intended to receive the transmission, and a confidentiality statement in bold type stating the electronic transmission should not be seen by unauthorized persons.
5.109.7.2 Unless the prescription is written for a schedule II controlled substance, the prescriber should not issue the written prescription to the patient.
5.109.7.3 A facsimile transmitted prescription order must be reduced to writing, unless received as a non-fading document, with a notation that the order was received by facsimile.
5.109.7.4 The receiving facsimile machine must be in the prescription department to protect patient-pharmacist-authorized prescriber confidentiality and security.
5.109.7.5 Both non-controlled and controlled substance prescriptions may be transmitted via facsimile following state and federal requirements. All prescription orders for controlled substances shall be hand-signed by the practitioner.
5.1110 Return of Medications and Supply
5.1110.1 Prescriptions and items of personal hygiene shall not be accepted for return or exchange by any pharmacist or pharmacy after such prescription or items of personal hygiene have been taken from the premises where sold, distributed or dispensed.
5.1110.2 Products under the direct control of a health care professional which are packaged in manufacturer unit dose or tamper-proof unopened bulk containers, tamper proof seal in tact, including unused multi-dose punch cards, may be redispensed in accordance with expiration dating in customized patient medication package. Partially used products may not be redispensed. Nothing in this regulation precludes the Federal laws and regulations.
5.1211 Centralized Prescription Processing
5.1211.1 A Pharmacy may perform or outsource centralized prescription processing, services provided the parties:
5.1211.1.1 have the same owner; or
5.1211.1.2 have a written contract outlining the services to be provided and the responsibilities and accountabilities of each party in fulfilling the terms of said contract in compliance with federal and state laws and regulations; and
5.1211.1.3 share a common electronic file or have appropriate technology to allow access to sufficient information necessary or required to fill or refill a prescription drug order.
5.1211.2 The parties performing or contracting for centralized prescription processing services shall maintain a policy and procedures manual and documentation that implementation is occurring in a manner that shall be made available to the Board for review upon request and that includes, but is not limited to, the following:
5.1211.2.1 A description of how the parties will comply with federal and state laws and regulations;
5.1211.2.2 The maintenance of appropriate records to identify the responsible pharmacist(s) in the dispensing and counseling processes;
5.1211.2.3 The maintenance of a mechanism for tracking the prescription drug order during each step in the dispensing process;
5.1211.2.4 The maintenance of a mechanism to identify on the prescription label all pharmacies involved in dispensing the prescription drug, order;
5.1211.2.5 The provision of adequate security to protect the confidentiality and integrity of patient information;
5.1211.2.6 The maintenance of a quality assurance program for pharmacy services designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care, pursue opportunities to improve patient care, and resolve identified problems.
5.1211.3 In addition to the requirements of 24 Del.C. §2536, all drugs dispensed to a patient that have been filled via a centralized prescription processing system shall bear a label containing an identifiable code that provides a complete audit trail of the dispensing of the drug and pharmaceutical care activities.
5.1312 Compounded medications for office use.
5.1312.1 On the order of a practitioner, compounded products may be sold to the practitioner for use in his or her office to administer to individual patients, but not for resale.
9.2.1.12 The pharmacist shall be involved with the utilization review process as it pertains to drug therapy.
9.2.3 Supportive Personnel. Supportive personnel may be utilized in assisting the pharmacist. These persons must be supervised by a registered pharmacist who is present within the hospital and is responsible for the activities of those persons.
9.6.4 Notification - Whenever an emergency drug supply is accessed, the pharmacy or its designee shall be notified within 24 hours, and the pharmacy or its designee shall restock and reseal or replace the kit or cart within forty-eight hours.
9.9.1 The drug dispensed for inpatient use shall contain a label, shall show the brand or established name and the strength of the medication. If the medication is prepacked, it must also show the source, lot number and expiration date, in compliance with the Board's prepacking regulation.
10.2.1.4.6 References: In addition to compliance with the reference requirements as set forth in Delaware Board Regulation 3.0, the pharmacy must have the following texts if chemotherapy agents are prepared:
10.3.3 Supportive Personnel: The pharmacist managing the section of the pharmacy providing sterile/anti-neoplastic product pharmacy services may be assisted by supportive personnel. These personnel must have specialized training in this field, and shall work under the supervision of a licensed pharmacist. The training provided to these personnel must be described in writing in a training manual. The duties and responsibilities of these personnel must be consistent with their training and experience.
10.6.5 If antineoplastic agents are compounded in the pharmacy, protection shall be provided for its personnel by utilizing the proper equipment and protective garb and having a Policy and Procedures Manual for said antineoplastic agents. The Manual shall include, among the other requirements, the following special requirements outlined in sections 10.2 - 10.5 the following special requirements:
11.3.1 Emergency use medications are for the purposes of this Regulation shall be those injectable medications which may be required to meet the immediate therapeutic needs of patients, as determined by the prescriber, and which are not available from any other authorized source in sufficient time to prevent risk or harm to patients by delay resulting from obtaining such drugs from other sources.
11.3.23 It is the responsibility of the facility and provider pharmacy to determine the supply of emergency use medication and interim use medication that are to be stocked as well as documenting their the number of boxes and location(s) within the facility. Stock supply of interim use medication shall not exceed sixty (60) medications without the prior review and approval of the Board or its designee. A list Emergency use and interim use medications lists of current contents must be attached to the medication supply.
11.3.34 Accountability for emergency use medications and interim use medications.
11.3.34.1 The pharmacy provider must be contacted within 24 hours after medication is used from the supply and the pharmacy must restock the supply within a reasonable time to prevent harm to patients.
11.3.34.2 The provider pharmacy is responsible for the accuracy of all emergency use and interim use medications at the time of the filling of the medication. This check must also include any medication that became available when the medication is accessed. Records documenting use of an emergency medication or interim medication must be kept for a minimum of 2 years at the provider pharmacy with a copy at the facility and must be readily available for inspection by the Board.
11.3.34.3 Failure to comply with these procedures can result in the suspension or denial of the use of emergency use and/or interim use medications.
11.3.34.4 Violations of accountability procedures for emergency use and/or interim use medications may result in review proceedings before the Board.
15.2.2 Automated Pharmacy Systems under the jurisdiction of the Board of Pharmacy can be utilized in licensed pharmacies, remote locations under the jurisdiction of the Board of Pharmacy, and licensed health care facilities when legally permissible. Automated Pharmacy Systems shall be used only in settings where there is an established program of pharmaceutical care that ensures medication orders are reviewed by a pharmacist in accordance with established policies and procedures and good pharmacy practice.
15.3.4 To ensure that changes in automation technology are reflected the Board will be notified of any updates, a repeat presentation will shall be made to the Board if there is a substantive change in the technology.
15.3.5 A pharmacy wishing to install an Automated Pharmacy System previously approved by the Board will provide the Board will shall prior written notice of the installation or substantive changes of automated pharmacy systems. This written notification shall be readily retrieveable upon inspection. Such notice must include, but is not limited to:
15.3.5.4 Written policies and procedures for system operations that address at a minimum accessibility and quality assurance unless already on file with the Board.
15.3.5.4.1 System operation, including access to and limits on access (e.g., security levels) to the Automated Pharmacy System that comply with State and Federal regulations;
15.3.5.4.2 Prevention of unauthorized access;
15.3.5.4.3 Maintenance of patient confidentiality;
15.3.5.4.4 Quality assurance procedures;
15.3.5.4.5 Procedures that will be followed if the automated dispensing system is unavailable at any time; and
15.3.5.4.6 Record keeping procedures.
15.4.1.2 Assuring that the Automated Pharmacy System is in good working order and accurately dispenses the correct strength, dosage form, and quantity of the drug prescribed while maintaining appropriate record keeping and security safeguards.
15.4.1.32 Developing and implementing an ongoing quality assurance program that monitors performance of the Automated Pharmacy System.
15.4.1.4 Developing written policies and procedures for system operation, safety, security, accuracy, patient confidentiality, access, and malfunction or down time.
15.4.1.54 Maintaining documentation readily available at the location where the system is used of at least the following:
15.4.1.5.14.2 Name and address of the pharmacy and/or licensed health care facility where the automated pharmacy system is being used;
15.4.1.5.24.3 Manufacturer’s name and model;
15.4.1.4.3 Description of how the device is used;
15.4.1.4.4 Quality assurance procedures to determine continued appropriate use of the automated device; and
15.4.1.5.54 Policies and procedures for operation of the Automated Pharmacy System accessibility and quality assurance.
15.5.1.1 All events involving the contents filling/restocking, dispensing and maintenance of the Automated Pharmacy System must be recorded electronically; and
15.5.1.2 Records must be maintained by the pharmacy and must be readily available to the Board Such records must be maintained for a period of three(3) years and shall include:
15.5.1.2.1 Identity of the system accessed Type of transaction including filling/restocking, dispensing and maintenance;
15.5.1.2.3 Type of transaction;
15.5.1.2.43 Name, strength, dosage form, and quantity of the drug accessed removed or added;
15.5.1.2.54 Name of the patient for whom the drug was ordered; and
15.5.1.2.6 Such additional information as the pharmacist-in-charge may deem necessary.
15.6.2 Community/Outpatient Pharmacy. A final check by the pharmacist is required after the medication is placed in the final container prior to dispensing and administration to the patient.
15.6.3 Hospital/Institution. Unit based or centralized dispensing requires the same level of supervision required in Regulation 9.2.3 which states: "Supportive personnel pharmacy technicians may be utilized in assisting the pharmacist. These persons must be supervised by a registered pharmacist who is present within the hospital and is responsible for the activities of those persons”.
15.6.4 A record of medication filled/stocked into an Automated Pharmacy System shall be maintained and shall include identification of the persons filling/stocking and checking for accuracy. Long Term Care Pharmacy. The filling/restocking of automated pharmacy systems in long term care settings may be performed by a licensed pharmacist, physician, physician assistant, advanced practice nurse, and registered nurse who is authorized by their Act to handle such medications subject to accountability provisions of regulation 11.3.3.
19.1.1.1 The pharmacist-in-charge is responsible for ensuring proper training of all supportive personnel. The actual training may be delegated to a pharmacist or other trained supportive personnel.
19.1.1.5 Supervision. Supportive personnel must be supervised by a registered pharmacist who will be responsible for the activities of these persons.
19.1.2 Certified pharmacy technicians must be at least 18 years of age, successfully complete a certified training program approved by the Board of Pharmacy and successfully pass the PTCB Exam or other national technician certification exam approved by the Board of Pharmacy. Only certified pharmacy technicians may assist the pharmacist by reconstituting oral solutions and contacting the prescriber or their agent to obtain refill authorization or other patient or prescription information of a non-clinical nature, or assisting the pharmacist with compounding.
13 DE Reg. 57 (07/01/09) (Prop.)