The policies and procedures shall:

1. A. Be congruent with State regulations and standards of care from accrediting bodies and professional organizations; and

2. B. Address:

   1. (1) Personnel:

      1. (a) Training and Orientation;
      2. (b) Duties; and
      3. (c) Qualifications;
   2. (2) Security of the facility;
   3. (3) Standards of patient care;
   4. (4) Infection control;
   5. (5) Initial and ongoing home safety assessments;

   6. (6) The provision of patient or caregiver education including, but not limited to:

      1. (a) Drug and therapy administration-specific information and precautions;
      2. (b) Reporting adverse drug reactions;
      3. (c) Reporting side effects;
      4. (d) Infusion pharmacy contact information;

      5. (e) Emergency measures related to:

         1. (i) Changes in patient condition requiring medical intervention; and
         2. (ii) Events which may delay or prevent delivery of pharmaceuticals or nursing care; and
      6. (f) Equipment use and safety.

   7. (7) Patient care operations, including but not limited to:

      1. (a) If applicable, pharmacist checking procedures related to order entry and compounding accuracy;

      2. (b) Therapy-specific monitoring parameters for:

         1. (i) Laboratory testing;
         2. (ii) Appropriate frequency of testing; and
         3. (iii) Patient follow-up; and

      3. (c) Pump, or other patient-use equipment, between-patient cleaning, testing, and preventive maintenance, which include specific:

         1. (i) Procedures and documentation of cleaning, testing and preventive maintenance for patient equipment according to manufacturer’s guidelines; and
         2. (ii) Frequencies for all equipment maintenance activities;
   8. (8) Delivery arrangements;
   9. (9) Patient confidentiality and the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; and

   10. (10) Availability of a pharmacist on call after-hours to respond to:

       1. (a) Pharmacy related patient or caregiver inquiries; and
       2. (b) Medication or supply needs.

Authority: Health-Occupations Article, §12-205, Annotated Code of Maryland

Effective date: March 1, 2012 (38:23 Md. R. 1421)