Ariz. Admin. Code § 4-23-402

Current through Register Vol. 30, No. 38, September 20, 2024

Section R4-23-402 - Pharmacist, Graduate Intern, and Pharmacy Intern

A. A pharmacist or a graduate intern or pharmacy intern under the supervision of a pharmacist shall perform the following professional practices in dispensing a prescription medication from a prescription order:

1. Receive, reduce to written form, and manually initial oral prescription orders;

2. Obtain and record the name of the individual who communicates an oral prescription order;

3. Obtain, or assume responsibility to obtain, from the patient, patient's agent, or medical practitioner and record, or assume responsibility to record, in the patient's profile, the following information:

a. Name, address, telephone number, date of birth (or age), and gender;

b. Individual history including known diseases and medical conditions, known drug allergies or drug reactions, and if available a comprehensive list of medications currently taken and medical devices currently used;

4. Record, or assume responsibility to record, in the patient's profile, a pharmacist's, graduate intern's, or pharmacy intern's comments relevant to the patient's drug therapy, including other information specific to the patient or drug;

5. Verify the legality and pharmaceutical feasibility of dispensing a drug based upon:

a. The patient's allergies,

b. Incompatibilities with medications the patient currently takes,

c. The patient's use of unusual quantities of dangerous drugs or narcotics,

d. A medical practitioner's signature, and

e. The frequency of refills;

6. Verify that a dosage is within proper limits;

7. Interpret the prescription order, which includes exercising professional judgment in determining whether to dispense a particular prescription;

8. Compound, mix, combine, or otherwise prepare and package the prescription medication needed to dispense individual prescription orders;

9. Prepackage or supervise the prepackaging of drugs by a pharmacy technician or pharmacy technician trainee under R4-23-1104. For drugs prepackaged by a pharmacy technician or pharmacy technician trainee, a pharmacist shall:

a. Verify the drug to be prepackaged;

b. Verify that the label meets the official compendium's standards;

c. Check the completed prepackaging procedure and product; and

d. Manually initial the completed label; or

e. For automated packaging systems, manually initial the completed label or a written log or initial a computer-stored log;

10. Check prescription order data entry to ensure that the data input:

a. Is for the correct patient by verifying the patient's name, address, telephone number, gender, and date of birth or age;

b. Is for the correct drug by verifying the drug name, strength, and dosage form;

c. Communicates the prescriber's directions precisely by verifying dose, dosage form, route of administration, dosing frequency, and quantity; and

d. Is for the correct medical practitioner by verifying the medical practitioner's name, address, and telephone number;

11. Except as provided in subsection (A)(12), make a final accuracy check of the completed prescription label including verification of medication, accuracy of patient's name, consistency with prescription order, and drug utilization review and initial in handwriting or by another method approved by the Board or its designee the finished label;

12. If a technology-assisted verification of product program is used, make a final accuracy check of the completed prescription label including accuracy of patient's name, consistency with prescription order, and drug utilization review and initial in handwriting or by another method approved by the Board or its designee the finished label. If a technology-assisted verification of product program is used, verification of product is not required.

13. Record, or assume responsibility to record, a prescription serial number and date dispensed on the original prescription order;

14. Obtain, or assume responsibility to obtain, permission to refill a prescription order and record, or assume responsibility to record on the original prescription order:

a. Date dispensed,

b. Quantity dispensed, and

c. Name of medical practitioner or medical practitioner's agent who communicates permission to refill the prescription order;

15. Reduce to written or printed form, or assume responsibility to reduce to written or printed form, a new prescription order received by:

a. Fax

b. E-mail, or

c. Other means of communication;

16. Verify, or assume responsibility to verify, that a completed prescription medication is sold only to the correct patient, patient's care-giver, or authorized agent;

17. Record on the original prescription order the name or initials of the pharmacist, graduate intern, or pharmacy intern who originally dispenses the prescription order; and

18. Record on the original prescription order the name or initials of the pharmacist, graduate intern, or pharmacy intern who dispenses each refill.

B. Only a pharmacist, graduate intern, or pharmacy intern shall provide oral consultation about a prescription medication to a patient or patient's care-giver in an outpatient setting, including a patient discharged from a hospital. The oral consultation is required whenever the following occurs:

1. The prescription medication has not been previously dispensed to the patient in the same strength or dosage form or with the same directions;

2. The pharmacist, through the exercise of professional judgment, determines that oral consultation is warranted; or

3. The patient or patient's care-giver requests oral consultation.

C. Oral consultation shall include:

1. Reviewing the name and strength of a prescription medication or name of a prescription-only device and the labeled indication of use for the prescription medication or prescription-only device;

2. Reviewing the prescription's directions for use;

3. Reviewing the route of administration; and

4. Providing oral information regarding special instructions and written information regarding side effects, procedure for missed doses, or storage requirements.

D. When, in the professional judgment of the pharmacist or graduate intern or pharmacy intern under the supervision of a pharmacist, or when circumstance precludes it, oral consultation may be omitted if the pharmacist, graduate intern, or pharmacy intern:

1. Personally provides written information to the patient or patient's care-giver that summarizes the information that would normally be orally communicated;

2. Documents, or assumes responsibility to document, both the circumstance and reason for not providing oral consultation by a method approved by the Board or its designee; and

3. Offers the patient or patient's care-giver the opportunity to communicate with a pharmacist, graduate intern, or pharmacy intern at a later time and provides a method for the patient or patient's care-giver to contact a pharmacist, graduate intern, or pharmacy intern at the pharmacy.

E. The pharmacist or graduate intern or pharmacy intern under the supervision of a pharmacist, through the exercise of professional judgment, may provide oral consultation that includes:

1. Common severe adverse effects, interactions, or therapeutic contraindications, and the action required if they occur;

2. Techniques of self-monitoring drug therapy;

3. The duration of the drug therapy; and

4. Prescription refill information.

F. Nothing in subsection (B) requires a pharmacist, graduate intern, or pharmacy intern to provide oral consultation if a patient or patient's care-giver refuses the consultation.

G. Using a method approved by the Board or its designee, a pharmacist, graduate intern, or pharmacy intern shall document, or assume responsibility to document, that oral consultation is or is not provided.

H. Oral consultation documentation. When oral consultation is required as specified in subsection (B), a pharmacist, graduate intern, or pharmacy intern shall:

1. Document, or assume responsibility to document, that oral consultation is provided; or

2. When a patient refuses oral consultation or a person other than the patient or patient's care-giver picks up a prescription and oral consultation is not provided, document, or assume responsibility to document, that oral consultation is not provided; or

3. When a pharmacist, graduate intern, or pharmacy intern determines to omit oral consultation under subsection (D) and oral consultation is not provided, document, or assume responsibility to document, both the circumstance and reason that oral consultation is not provided; and

4. Document, or assume responsibility to document, the name, initials, or identification code of the pharmacist, graduate intern, or pharmacy intern who did or did not provide oral consultation.

I. When a prescription is delivered to the patient or patient's care-giver outside the immediate area of a pharmacy and a pharmacist is not present, the prescription shall be accompanied by written or printed patient medication information that, in addition to the requirements in subsection (C), includes:

1. Approved use for the prescription medication;

2. Possible adverse reactions;

3. Drug-drug, food-drug, or disease-drug interactions;

4. Missed dose information; and

5. Telephone number of the dispensing pharmacy or another method approved by the Board or its designee that allows a patient or patient's care-giver to consult with a pharmacist.

J. A prescription medication or prescription-only device, delivered to a patient at a location where a licensed health care professional is responsible for administering the prescription medication to the patient, is exempt from the requirement of subsection (C).

K. A pharmacist, graduate intern, or pharmacy intern shall wear a badge indicating name and title while on duty.

L. Nothing in this Section prevents a hospital pharmacist from accepting a prescription order according to rules pertaining specifically to hospital pharmacies.

Ariz. Admin. Code § R4-23-402

Former Rule 4.1100; Amended effective August 10, 1978 (Supp. 78-4). Amended effective August 9, 1983 (Supp. 83-4). Amended effective May 16, 1990 (Supp. 90-2). Amended effective July 7, 1998 (Supp. 98-3). Amended by final rulemaking at 6 A.A.R. 4656, effective November 14, 2000 (Supp. 00-4). Amended by final rulemaking at 9 A.A.R. 5030, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 10 A.A.R. 1192, effective May 1, 2004 (Supp. 04-1). Amended by final rulemaking at 11 A.A.R. 2258, effective August 6, 2005 (Supp. 05-2). Amended by final rulemaking at 12 A.A.R. 274, effective March 11, 2006 (Supp. 06-1). Amended by final rulemaking at 12 A.A.R. 4691, effective February 3, 2007 (Supp. 06-4). Amended by final rulemaking at 23 A.A.R. 3257, effective 1/8/2018.