21 NCAC 46 .1417. REMOTE MEDICATION ORDER PROCESSING SERVICES

(a)  Purpose.  The purpose of this Rule is to set out requirements under which health care facility pharmacies that are not open 24 hours a day, seven days a week, may contract for the provision of remote medication order processing services when no pharmacist is present. 

(b)  Definitions of terms in this Rule:

(1)           "Remote medication order processing services" consists of the following:

(A)          receiving, interpreting, or clarifying medication orders;

(B)          entering data and transferring medication order information;

(C)          performing drug regimen review;

(D)          interpreting clinical data;

(E)           performing therapeutic interventions; and

(F)           providing drug information concerning medication orders or drugs.

(2)           "Remote medication order processing pharmacy" is a pharmacy permitted by the Board that provides remote medication order processing services. 

(3)           "Remote site" is a site located within the United States that is electronically linked to a health care facility licensed by the State of North Carolina for the purpose of providing remote medication order processing services.

(c)  Outsourcing.  A health care facility pharmacy may outsource medication order processing services to a remote medication order processing pharmacy provided the pharmacies have the same owner or the pharmacy has entered into a written contract or agreement with a remote medication order processing pharmacy that outlines the services to be provided and the responsibilities and accountabilities of each pharmacy in compliance with federal and state laws and regulations.  The pharmacy providing the remote processing of medication orders must notify the Board of Pharmacy prior to providing such services.

(d)  Training.  A pharmacy providing remote medication order processing must ensure that all pharmacists providing such services have been trained on each pharmacy's policies and procedures relating to medication order processing.  The training of each pharmacist shall be documented by the pharmacist-manager to ensure competency and to ensure that performance is at least at the same level of performance as pharmacists in the outsourcing pharmacy. The training shall include policies on drug and food allergy documentation, abbreviations, administration times, automatic stop orders, substitution, and formulary compliance.  The pharmacies shall jointly develop a procedure to communicate changes in the formulary and changes in policies and procedures related to medication order processing.

(e)  Access.

(1)           The pharmacies must share common electronic files or have technology to allow secure access to the pharmacy's information system and to provide the remote pharmacy with access to the information necessary or required to process a medication order.

(2)           Pharmacists employed by or otherwise acting as an agent for a remote medication order processing pharmacy may provide those services from a remote site.  Both the pharmacist providing those services from a remote site and the remote medication order processing pharmacy on whose behalf the pharmacist is providing such services are responsible for compliance with all statutes, rules, policies, and procedures governing the provision of remote mediation order processing services.

(f)  Communication.  The pharmacies must jointly define the procedures for resolving problems detected during the medication order review and communicating these problems to the prescriber and the nursing staff providing direct care.

(g)  Recordkeeping.  A pharmacy using remote order entry processing services shall maintain records of all orders entered into their information system including orders entered from a remote location.  The system shall have the ability to audit the activities of the individuals remotely processing medication orders.

(h)  Licensure.  All remote medication order processing pharmacies must be permitted by the Board.  An out-of-state remote medication order processing pharmacy must be registered with the Board as an out-of-state pharmacy.  All pharmacists located in this State or employed by an out-of-state remote medication order processing pharmacy providing services in this State shall be licensed by the Board.

(i)  Policy and Procedure Manual.  All remote medication order processing pharmacies shall maintain a policy and procedure manual.  Each remote medication order processing pharmacy, remote site, and health care facility pharmacy shall maintain those portions of the policy and procedure manual that relate to that pharmacy's or site's operations.  The manual shall:

(1)           outline the responsibilities of each of the pharmacies;

(2)           include a list of the name, address, telephone numbers, and all permit numbers of the pharmacies involved in remote order processing; and

(3)           include policies and procedures for:

(A)          protecting the confidentiality and integrity of patient information;

(B)          maintaining records to identify the name(s), initials, or identification code(s) and specific activity(ies) of each pharmacist who performed any processing;

(C)          complying with federal and state laws and regulations;

(D)          operating a continuous quality improvement program for pharmacy services designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care, pursue opportunities to improve patient care, and resolve identified problems;

(E)           annually reviewing the written policies and procedures and documenting such review; and

(F)           annually reviewing the competencies of pharmacists providing the remote order review service.

(j)  Nothing in this rule shall be construed to relieve a health care facility pharmacy of the need to provide on-site pharmacy services required for licensure as specified in the Pharmacy Practice Act and rules promulgated thereunder. 

 

History Note:        Authority G.S. 90-85.6; 90-85.21; 90-85.21A; 90-85.26; 90-85.32; 90-85.34;

Eff. February 1, 2006;

Amended Eff. March 1, 2013.