Some local health departments have licensed pharmacies staffed by pharmacists on a full or part-time basis to provide their pharmacy services. However, for most health departments, the dispensing of prescription drugs must be handled by other methods.
Health department personnel must understand the differences between dispensing, administering and delivering drugs to patients, as there are legal requirements that must be followed to be in compliance with Virginia laws and regulations.
Physicians, dentists, and nurse practitioners with prescriptive authority are the only individuals, other than pharmacists, that are permitted to dispense prescription drugs (providing patients with prescription drugs for take home - self administration) in health departments. Dentists may only dispense prescription drugs for their dental patients. Nurse practitioners may only dispense those prescription drugs that they are authorized to prescribe.
Nursing personnel may administer a dose (orally, by injection, etc.) of a prescription drug to a patient after receiving a written or verbal order from the prescriber for that patient.
Prescription drugs that have been dispensed by an individual who is legally authorized to dispense may be delivered to (handed to/taken to) the patient by a responsible, authorized staff member who has been instructed to refer questions related to patients' medications to appropriate individuals.
When prescription drugs that have not been dispensed by a licensed pharmacy must be provided to patients for take home - self administration, they must be dispensed by a physician, nurse practitioner (only those drugs that he/she is authorized to prescribe) or a dentist (only for his/her own dental patients).
(1) To be in compliance with pharmacy laws and regulations, the physician, nurse practitioner, or dentist must supervise the dispensing of all prescription drugs. The labels, charts, containers, etc, may be prepared by the staff at any convenient time without one of these individuals being on the premises. However, the physician, nurse practitioner or dentist must be present when prescription drugs are obtained from the secure bulk storage area and placed in the proper containers and labeled. This work may be done by a designated staff person, but the physician, nurse practitioner or dentist must be in the building supervising the dispensing, must review the final labeled product, assure himself/herself of its accuracy and initial the prescription blank or the section of the chart in which the prescription is recorded to verify responsibility for dispensing. This is in addition to signing the order, which only verifies responsibility for prescribing the drug.
The prescription record must include the patient's name, date prescribed, drug name, strength and dosage form (capsule, tablet, etc) quantity prescribed, directions for use and refill instructions if applicable.
For the initial dispensing of a prescription, if the individual prescribing the drug is always the individual who dispenses the drug, the health department may have each prescriber sign a statement indicating that for those drugs that must be prescribed and dispensed at the health department, by signing the prescription order, he/she verifies that he/she is also the individual who dispensed the drug.
If the original prescription is refilled, the prescriber must document in the record the date of the refill, quantity dispensed (if different than quantity prescribed), and initial the record to verify responsibility for dispensing the refill.
(2) All drugs must be dispensed in tight, light resistant containers with approved child resistant safety closures. If the patient requests that his/her drugs not be placed in a child resistant container, the patient should sign the back of the prescription blank or some other document indicating such. This documentation should be retained in the patient's record.
(3) The label on a patient's prescription medication should include the name, address and telephone number of the health department; the date of dispensing; the name of the prescriber; patient's name; directions for use; the
drug's name, strength and dosage form (capsule, tablet, etc); and the quantity dispensed. If the drug is not a combination product, the label also should include the generic name of the drug. Where appropriate, cautionary statements (take with food-avoid sunlight-etc) should be included on the container. Blank prescription labels can be ordered from Central Services. Ancillary labels (shake well, take with food, refrigerate, etc.) can be ordered from the central pharmacy. Patient drug information sheets can be obtained from the central pharmacy.
(4) Once dispensed, patients' medications must be stored in a secure area. These properly dispensed medications may be delivered to the patient by a responsible staff member. Individuals delivering medication to patients should be instructed to refer the patients to the prescriber or nursing personnel when patients have questions concerning their medications.
(5) Treatment of Sexually Transmitted Diseases with Tetracycline: The Virginia Board of Pharmacy has approved the dispensing of tetracycline by registered nurses under the following conditions which may be considered only when a physician, nurse practitioner or pharmacist is not on the premises:
In those situations where patients with chlamydia trachomatis must be treated with a multiple dose tetracycline regimen due to drug allergies or specific treatment indications, nursing personnel may be permitted to dispense tetracycline 500mg capsules to the patient when a physician, nurse practitioner or pharmacist is not present to initiate treatment. The tetracycline must be supplied to the health department from the central pharmacy in a ready to dispense container which would be labeled in the following manner:
Name, address and telephone number of health department
Blank line for patient's name
Blank line for prescriber's name
Blank line for date dispensed
Take one capsule four times a day until all medication is taken.
Appropriate accessory labels or patient information will be included with the product when it is shipped to the health department.
The nurse, after obtaining the prescriber's verbal order for an individual patient, would provide the patient with a supply of tetracycline after writing the patient's name, date dispensed, and prescriber's name on the label. The nurse would then note in the patient's record the drug name,
strength and quantity that had been dispensed and initial the record to verify responsibility for dispensing.