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A BILL TO BE ENTITLED
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AN ACT
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relating to the performance of pharmacy services in certain rural |
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areas. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter C, Chapter 562, Occupations Code, is |
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amended by adding Section 562.1011 to read as follows: |
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Sec. 562.1011. OPERATION OF CLASS C PHARMACY IN CERTAIN |
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RURAL HOSPITALS. (a) In this section: |
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(1) "Nurse" has the meaning assigned by Section |
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301.002. The term includes a nurse who is also registered as a |
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pharmacy technician. |
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(2) "Rural hospital" means a licensed hospital with 75 |
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beds or fewer that: |
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(A) is located in a county with a population of |
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50,000 or less; or |
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(B) has been designated by the Centers for |
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Medicare and Medicaid Services as a critical access hospital, rural |
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referral center, or sole community hospital. |
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(b) If a practitioner orders a prescription drug or device |
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for a patient in a rural hospital when the hospital pharmacist is |
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not on duty or when the institutional pharmacy is closed, a nurse or |
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practitioner may withdraw the drug or device from the pharmacy in |
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sufficient quantity to fill the order. |
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(c) The hospital pharmacist shall verify the withdrawal of a |
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drug or device under Subsection (b) and perform a drug regimen |
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review not later than the seventh day after the date of the |
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withdrawal. |
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(d) In a rural hospital that uses a floor stock method of |
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drug distribution, a nurse or practitioner may withdraw a |
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prescription drug or device from the institutional pharmacy in the |
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original manufacturer's container or a prepackaged container. |
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(e) The hospital pharmacist shall verify the withdrawal of a |
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drug or device under Subsection (d) and perform a drug regimen |
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review not later than the seventh day after the date of the |
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withdrawal. |
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(f) A rural hospital may allow a pharmacy technician to |
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perform the duties specified in Subsection (g) if: |
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(1) the pharmacy technician is registered and meets |
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the training requirements specified by the board; |
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(2) a pharmacist is accessible at all times to respond |
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to any questions and needs of the pharmacy technician or other |
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hospital employees, by telephone, answering or paging service, |
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e-mail, or any other system that makes a pharmacist accessible; and |
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(3) a nurse or practitioner or a pharmacist by remote |
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access verifies the accuracy of the actions of the pharmacy |
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technician. |
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(g) If the requirements of Subsection (f) are met, the |
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pharmacy technician may, during the hours that the institutional |
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pharmacy in the hospital is open, perform the following duties in |
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the pharmacy without the direct supervision of a pharmacist: |
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(1) enter medication order and drug distribution |
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information into a data processing system; |
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(2) prepare, package, or label a prescription drug |
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according to a medication order if a licensed nurse or practitioner |
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verifies the accuracy of the order before administration of the |
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drug to the patient; |
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(3) fill a medication cart used in the rural hospital; |
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(4) distribute routine orders for stock supplies to |
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patient care areas; |
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(5) access and restock automated medication supply |
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cabinets; and |
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(6) perform any other duty specified by the board by |
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rule. |
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(h) The pharmacist-in-charge of an institutional pharmacy |
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in a rural hospital shall develop and implement policies and |
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procedures for the operation of the pharmacy when a pharmacist is |
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not on-site. |
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(i) On or after September 1, 2011, the board may establish, |
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by rule, a requirement for prospective and retrospective drug use |
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review by a pharmacist for each new drug order. A drug use review is |
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not required when a delay in administration of the drug would harm |
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the patient in an urgent or emergency situation, including sudden |
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changes in a patient's clinical status. |
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(j) Rural hospitals may establish standing orders and |
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protocols, to be developed jointly by the pharmacist and medical |
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staff, that may include additional exceptions to instances in which |
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prospective drug use review is required. |
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(k) This section does not restrict or prohibit the board |
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from adopting a rule related to authorizing the withdrawal of a drug |
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or device by a nurse or practitioner from, or the supervision of a |
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pharmacy technician in, an institutional pharmacy not located in a |
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rural hospital. As part of the rulemaking process, the board shall |
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consider the effect that a proposed rule, if adopted, would have on |
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access to pharmacy services in hospitals that are not rural |
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hospitals. |
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(l) The board shall adopt rules to implement this section, |
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including rules specifying: |
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(1) the records that must be maintained under this |
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section; |
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(2) the requirements for policies and procedures for |
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operation of a pharmacy when a pharmacist is not on-site; and |
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(3) the training requirements for pharmacy |
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technicians. |
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SECTION 2. Chapter 568, Occupations Code, is amended by |
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adding Section 568.008 to read as follows: |
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Sec. 568.008. TECHNICIANS IN HOSPITALS WITH CLINICAL |
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PHARMACY PROGRAM. (a) In this section, "clinical pharmacy program" |
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means a program that provides pharmaceutical care services as |
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specified by board rule. |
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(b) A Class C pharmacy that has an ongoing clinical pharmacy |
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program may allow a pharmacy technician to verify the accuracy of |
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work performed by another pharmacy technician relating to the |
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filling of floor stock and unit dose distribution systems for a |
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patient admitted to the hospital if the patient's orders have |
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previously been reviewed and approved by a pharmacist. |
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(c) The pharmacist-in-charge of the clinical pharmacy |
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program shall adopt policies and procedures for the verification |
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process authorized by this section. |
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(d) A hospital must notify the board before implementing the |
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verification process authorized by this section. |
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(e) The board shall adopt rules to implement this section, |
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including rules specifying: |
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(1) the duties that may be verified by another |
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pharmacy technician; |
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(2) the records that must be maintained for the |
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verification process; and |
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(3) the training requirements for pharmacy |
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technicians who verify the accuracy of the work of other pharmacy |
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technicians. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2009. |
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