1. (a) With recognition of the Drug Enforcement Administration’s statement of policy regarding emergency kits for long-term care facilities and other law applicable to noncontrolled legend drugs, the following section is adopted to permit controlled substances and noncontrolled legend drugs to be stored in emergency kits in long-term care facilities in Arkansas.

2. (b) Requirements.

   1. (1)

      1. (A) All contents of the emergency kit will be provided by one (1) pharmacy designated by the long-term care facility.
      2. (B) This pharmacy must be properly registered with the Drug Enforcement Administration.

   2. (2) The emergency kit shall be:

      1. (A) Properly sealed and stored; and
      2. (B) Accessible only to authorized personnel.
   3. (3) The emergency kit contents shall only be administered by authorized personnel acting on order of a physician in compliance with 21 C.F.R. § 1306.11 and 21 C.F.R. § 1306.21.

   4. (4)

      1. (A) The categories of drugs that may be contained in an emergency kit are identified in 17 CAR § 160-1805.
      2. (B) The contents of the kit shall be determined by the medical director, director of nurses, and consultant pharmacist at the long-term care facility.
      3. (C) Any exceptions to the established standard categories must be approved by the Arkansas State Board of Pharmacy.
      4. (D) A list of contents shall be kept in the kit.
   5. (5) The facility’s licensed consultant pharmacist shall be responsible for maintaining the nursing home’s emergency kit contents in compliance with 17 CAR § 160-1805 and the facility’s licensed consultant pharmacist shall check the kit monthly for outdated drugs, etc.
   6. (6) All drugs administered from the kit will be replaced within seventy-two (72) hours by the designated provider pharmacy based on a prescription for the patient to whom the drugs were administered.
   7. (7) Violation of 17 CAR §§ 160-1801 – 160-1805 shall be just cause for the board to impose appropriate disciplinary action.
   8. (8) Emergency kit drugs shall be of such a nature that the absence of such drugs would detrimentally affect the health of the patient.

   9. (9)

      1. (A) Before an out-of-state pharmacy may supply an emergency kit to an Arkansas long-term care facility, it must provide an affidavit on a form supplied by the board that it will comply with Arkansas law regarding emergency kits.
      2. (B) If applicable, an out-of-state pharmacy will also be subject to reciprocal restrictions as are imposed by its home state on out-of-state pharmacies.

3. (c) Recognizing the emergency and or unanticipated need for certain legend (noncontrolled) drugs to be available to nurses employed by Arkansas-licensed home health agencies, an Arkansas-licensed pharmacy may provide certain medications under the following conditions:

   1. (1) A written contract must:

      1. (A) Exist between the Arkansas-licensed home health agency and the Arkansas-licensed pharmacy; and
      2. (B) Be available for review by the board upon request;
   2. (2) The legend drugs remain the property of, and under the responsibility of, the Arkansas-licensed pharmacy;
   3. (3) All medications shall be administered only on physician’s orders and any medication administered from the nurse’s supply must be recorded as a prescription by the pharmacy prior to the pharmacy’s replacement of the drug in the emergency supply;
   4. (4) All medication records must be maintained as required by law, and out-of-date drugs must be properly destroyed by the pharmacy;
   5. (5) The emergency supply may be carried by each nurse or an emergency kit may be provided for each patient’s home;

   6. (6) Careful patient planning shall be a cooperative effort between the pharmacy and the nursing agency to make all medications available, and this emergency supply:

      1. (A) Shall only be used for emergency or unanticipated needs; and
      2. (B) Shall not become a routine source or supply;

   7. (7)

      1. (A) Only the following medications can be supplied for emergency use by licensed home health agencies under this section by the pharmacy in sufficient but limited quantities:

4. (i) Heparin flush, pediatric (one (1) strength);

   1. (ii) Heparin flush, adult (one (1) strength);

      1. (iii) Sterile water for injection, small volume;

         1. (iv) Sodium chloride for injection, small volume;
         2. (v) Adrenalin (epinephrine) injection, single dose only; and
         3. (vi)
5. (a) (a) Benadryl (diphenhydramine) injection, single dose only.

6. (b) (b) Note. For heparin, adrenaline, and benadryl, all patients shall have a precalculated dose.

   1. (B) If a container is opened and partially used, the unused portion shall be immediately discarded;
   2. (8) The pharmacy is responsible for ensuring compliance with this part, and any abuse or misuse of the intent of this part shall be immediately reported to the board; and
   3. (9) The pharmacy and the agency shall develop policy and procedures to address storage conditions for medications.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: “(Amended 10/12/93, 10/14/97, 02/11/2003, 6/23/05, 7/10/2009 and 8/1/2018)" Subdivision (b)(9)(B) as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "(10/14/1981 and 7/27/2011)".