Wyo. Code R. 059-0001-15
Pharmacy, Board of
Chapter 15: Long Term Care Pharmacy Services
Effective Date: 05/16/2017 to Current
Rule Type: Current Rules & Regulations
Reference Number: 059.0001.15.05162017
These rules are promulgated as authorized by the Wyoming Pharmacy Act W.S. § 33-24-101 through -301.
To regulate pharmacies who provide services to residents of long term care facilities.
Applies to any pharmacy or pharmacist providing services to a long term care facility.
(a) 'Long Term Care Facility' (LTCF) means any skilled or intermediate care nursing home, board and care home, or any resident behavioral health facility subject to regulation and licensure by the department of health. For the purpose of this Chapter, long term care facility does not include adult day care facilities, home health agencies, or assisted living facilities.
(b) 'Consultant Pharmacist' in a long-term facility means a pharmacist licensed to engage in the practice of pharmacy in this State who is responsible for developing, coordinating, and supervising pharmacy services in a long-term care facility on a regularly scheduled basis.
(c) 'Medication Order,' as used in this rule means a written, verbal, facsimile or electronic order from a practitioner or the practitioner's authorized agent to a licensed nurse in the LTCF for a resident of that facility for administration of a drug or device. For purposes of this Chapter, a 'medication order' is considered a prescription, with the exception of controlled substances which require a prescription from the practitioner.
(d) 'Provider Pharmacy' means any pharmacy licensed by the Board that provides medications to residents of any long-term care facility pursuant to a medication order or prescription. A provider pharmacy must have a written agreement with the long-term care facility in order to provide services to the residents.
(e) 'First Dose Pharmacy' means a pharmacy contracting with a provider pharmacy to ensure that drugs or devices are attainable to meet the immediate needs of the resident or if the provider pharmacy cannot provide services on an ongoing basis.
No consultant pharmacist or provider pharmacy shall participate in any agreement or plan that infringes on any resident's right to freedom of choice as to the provider of pharmacy services. A resident in a long-term care facility shall have a choice of a provider pharmacy provided the provider pharmacy complies with this Chapter.
A provider pharmacy shall be responsible for:
(a) Dispensing drugs pursuant to a medication order for an individual resident, properly labeled for that resident, as addressed in Chapter 2 of these rules, including the manufacturer's expiration date. If prepackaged or repackaged by the pharmacy, the expiration date shall be the lesser of the manufacturer's expiration date or twelve (12) months from the date of prepackaging or repackaging;
(b) Dispensing drugs for residents of long-term care facilities in packaging consistent with the drug distribution system required by the facility's policies and procedures;
(c) Developing a drug recall procedure that protects the health and safety of residents including immediate discontinuation of any recalled drug or device and subsequent notification of the prescriber and director of nursing of the facility. The drug recall policy must be readily retrievable at the provider pharmacy and the facility;
(d) Providing service twenty-four (24) hours a day, seven (7) days per week, either directly or by contract with another pharmacy. All 'on-call' services shall be verifiable by the board and its inspectors. Ancillary boxes or automated dispensing devices may be used as outlined in Chapter 2 of these rules;
(e) Performing prospective drug usage reviews for all new and refill medication orders as described in Chapter 9 of these rules;
(f) Providing sufficient and accurate information to facility staff regarding the appropriate administration and use of all dispensed drugs and devices;
(g) Providing intravenous (IV) services or contracting with another pharmacy to provide IV services, if the long term care facility is a skilled unit providing such services;
(h) Communicating with the consultant pharmacist and the facility regarding concerns and resolution thereof, including, but not limited to 'on-call' services and IV services; and
(i) Returning non-controlled substance prescriptions dispensed to residents in long term care facilities for re-dispensing under specific conditions listed in Chapter 2. Controlled substance prescriptions dispensed to residents in long term care facilities cannot be returned to a pharmacy.
(a) The consultant pharmacist shall assist the long-term care facility in developing policy and procedures for the following:
(i) The manner of issuance of prescription drugs provided by a provider pharmacy to residents of the long-term care facility;
(ii) Storage, administration and record-keeping for all medications administered to residents of the long-term care facility;
(iii) Inspection of drug storage areas;
(iv) Destruction or recycling of unused or discontinued resident medications; and
(v) Continuing education for nursing personnel regarding medication administration.
(b) Resident Drug Regimen Review.
(i) The primary duty of the consultant pharmacist is to apply his/her expertise on drugs to the resident’s specific situation.
(ii) The consultant pharmacist shall review each resident’s medical record at least monthly. State and federal regulations shall be the minimum standards for an adequate drug regimen review.
(iii) The consultant pharmacist shall communicate with provider pharmacies to enhance resident care.
(a) No drug shall be distributed or issued by the use of any automated dispensing device unless the device and method of operation have been found to ensure the purity, potency and integrity of the drug, and to protect the drug from diversion, and provide that:
(i) The device shall be stocked with drugs only by a pharmacist licensed by the Board or a registered pharmacy technician or pharmacy intern under his supervision;
(ii) The device shall be used only for the furnishing of drugs for administration to residents of that facility; and (iii) At the time of removal of any drug from the device, it shall automatically make a written or electronic record to be retained by the pharmacist for at least one (1) year, indicating:
(A) The date of removal of the drug; (B) The name, strength, dosage form and quantity of the drug removed; (C) The name of the resident for whom the drug was ordered; and (D) The name or identification code of the nurse removing the drug from the device.
Section 9. First Dose Pharmacy Services.
Provider pharmacy may contract with another pharmacy (first dose pharmacy) for first dose services if in compliance as follows:
(a) Limited Purpose - Services are for the limited purpose of ensuring that drugs or devices are attainable to meet the needs of residents or if the provider pharmacy cannot provide services for the LTCF on an ongoing basis;
(b) Long Term Care Facility Approval - The provider pharmacy obtains approval from the LTCF to obtain first dose services for its residents;
(c) Written Contract - The provider pharmacy has a written contract with the first dose pharmacy outlining the services to be provided and the responsibilities and accountabilities of each party in fulfilling the terms of the contract; and
(d) Medication Orders - The provider pharmacy provides a valid verbal, electronic or paper medication order to the first dose pharmacy. A single medication order may be shared by a provider pharmacy and a first dose pharmacy with no transfer required.