Request By:
Sandra Frommeyer, R.N.
Assistant Nursing Staff Education
Coordinator
Wm. Booth Memorial Hospital
The Salvation Army
Box 472
Covington, Kentucky 41012
Opinion
Opinion By: Robert F. Stephens, Attorney General; By: Martin Glazer, Assistant Attorney General
You advise that the Wm. Booth Memorial Hospital has a pharmacy department, that its procedures permit a nursing supervisor or other authorized person to obtain "emergency" drugs in the absence of the pharmacist.
You state that the entire pharmacy with the exception of Schedule II and III drugs is considered an "emergency box" or an "approved night cabinet" and is available to this "authorized person" from the hours of 9:00 p.m. to 8:00 a.m. You point out that a pharmacist is on 24-hour call though he may not be present.
You specifically ask the following questions:
"How broadly can the term 'emergency drugs' be interpreted?
"Would that include any drugs needed by a new admission between 9:00 p.m. and 8:00 a.m.?
"Would that cover any drug needed by any patient between these hours?
"Is the Registered Nurse under the above circumstances, legally covered?
"What could occur if she refuses to accept this responsibility when it is written Hospital Policy?"
Your request concerns not so much nursing law as it concerns the pharmacy law.
KRS 315.020(1) provides in part:
". . . No person except a registered pharmacist shall himself . . . compound or dispense any drug, medicine, chemical, poison or pharmaceutical preparation for medical use, or compound and dispense practitioners' prescriptions.
(2) No owner of a pharmacy . . . who is not a registered pharmacist shall fail to place a registered pharmacist in charge of his place of business or shall permit any person to compound or dispense prescriptions . . . except in the presence and under the immediate supervision of a registered pharmacist. "
In OAG 73-443, this office advised: "It is our feeling that a physician prescribes, a pharmacist dispenses, and a nurse administers." In that same opinion, we advised that a nurse may not dispense medications in the absence of a hospital pharmacist.
We recognize that some hospitals do not have a pharmacist on actual duty 24 hours, but keep them "on call". In such cases, emergency boxes are set apart in which the pharmacist places certain medications for use in "emergencies" by the nursing staff upon standing orders of physicians.
But, the entire pharmacy, itself, cannot be used as an emergency box or approved night cabinet.
Board of Pharmacy Regulation 201 KAR 2:100, Section 1 provides:
"A pharmacy must provide adequate security and control of its controlled substances and prescription legend drugs and in the absence of a pharmacist the pharmacy must be closed. If a pharmacy is located within a larger establishment which is open to the public for business at times when a pharmacist is not present then the pharmacy must be enclosed by a floor to ceiling partition which may be either solid or solid transparent secured by lock from other departments of the store. In the absence of a pharmacist such pharmacies must be locked and secured. Employees of the establishment cannot be authorized to enter the closed pharmacy during those hours when a pharmacist is not present. Owners of prescription departments, which are to be closed at times the merchandise area of the same establishment remains open, must request permission from the Kentucky Board of Pharmacy, submit a detailed plan of the prescription department barrier and obtain written approval before enclosing the prescription department." (Emphasis supplied)
What are "emergency drugs" would depend upon the institution and their necessary use. We view emergency drugs as those needed in a strict emergency. If the patient must have the drugs during the hours the pharmacy is closed, and cannot wait its opening, they should be set aside for the patient's use. Drugs needed at regular intervals by patients as prescribed by a physician should be set aside in special cabinets for administration by nursing staff. The pharmacist will have to dispense the drugs in advance if one cannot be on duty 24 hours. If a question should arise concerning a particular drug for a particular patient that has not been anticipated, the pharmacist should be called (since he is on 24 hour call).
All of your questions cannot be answered with specificity, because the answers (such as liability) will depend upon specific fact situations.
but, generally, the entire pharmacy cannot be open, when the pharmacist is absent. A nurse who goes into a closed pharmacy in the absence of the pharmacist violates that regulation, may be in violation of the pharmacy law itself, and could be subject to criminal penalties. If a pharmacist cannot be on duty 24 hours, drugs should be set aside to cover true emergencies and to cover specific doses for specific patients which have previously been prescribed by a physician, dispensed by a pharmacist, for administration by a nurse.