1. (1) The birthing center shall develop, implement, and enforce written policies and procedures governing the provision of pharmaceutical services.

2. (2) Administering Drugs and Medicines.

   1. (a) Drugs and medicines shall not be administered to patients unless ordered by a physician duly licensed to prescribe such drugs, or, by a licensed CNM, as authorized by the CNM's collaborative practice protocol or formulary pursuant to the rules of the Alabama Board of Nursing and the Alabama State Board of Medical Examiners, as applicable, and approved protocols. Such orders shall be in writing and signed personally by the prescriber.
   2. (b) All verbal or telephone orders for medication shall be received by an RN, LPN, CNM, physician, or registered pharmacist and shall be placed in writing into the patient's permanent medical record. The order shall include the name of the prescribing physician or CNM, accompanied by the time, date, name, and title of the person making the entry into the record. All verbal or telephone orders shall be countersigned by the prescriber within 48 hours of the order.
   3. (c) All treatments and medications provided to patients shall be recorded in the medical record by the nurse administering the treatment or medication. CPMs may not administer drugs and medicines to patients or handle drugs or medicines for administration to patients, other than anti-hemorrhagic medication and oxygen in an emergency.
   4. (d) Preparation and administration of medications shall be under the supervision of a physician or CNM. Pain control should depend primarily on close emotional support and adequate preparation for the birth experience.
   5. (e) The birthing center shall not dispense any medications to outpatients. The birthing center may procure medications for its patients from community pharmacists through contractual agreements with those pharmacies. Individual medication containers shall be properly stored in individual patient bins/trays within a lockable area, room or cabinet; or the birthing center may procure medications via the staff physician's or CNM's registration. Medical staff shall administer or order medications to be administered to patients solely while in the birthing center. Medications for patients to take home shall be provided only via written prescription by the attending physician or CNM.
   6. (f) An individual qualified by licensure and experience to meet the requirements of subsections (d) and (g) of this section shall be responsible for the overall supervision of the handling, administration, storage, record-keeping, and final disposition of medications and controlled substances stocked within the birthing center.
   7. (g) Prescribing, dispensing, and administration of medications shall meet all standards required by law and by regulations of the Alabama State Board of Medical Examiners, the Alabama State Board of Pharmacy, and the Alabama Board of Nursing.

3. (3) Medical Storage.

   1. (a) Medicines and drugs maintained in the birthing center shall be stored in a drug room of sufficient size for orderly storage and accurate identification. The room shall be adequately illuminated and maintained at a temperature for safe storage of drugs.
   2. (b) Safety. Drug rooms shall be provided with safeguards to prevent entrance of unauthorized persons, including bars on accessible windows and locks on doors. Controlled drugs and ethyl alcohol, if stocked, shall be stored under double locks and in accordance with applicable federal and state laws.
   3. (c) Only authorized personnel shall have access to the drug/medicine room, as defined by the birthing center.
   4. (d) The drug/medicine room shall be provided with a counter and sink.
4. (4) Emergency Kit. The birthing center, upon the written advice and written approval of its staff physician or consultant physician, shall provide an emergency kit or stock supply of drugs and medicines for the exclusive use of the physician or CNM in treating the emergency needs of patients.

Author: Dana Billingsley, Diane Milledge

Statutory Authority: Code of Ala. 1975, §22-2-2(6), et seq.; §22-21-20, et seq.

History: Filed November 19, 1987. Repealed: Filed April 16, 2010; effective May 21, 2010. New Rule: Published August 31, 2023; effective October 15, 2023.