H.B. No. 1924
AN ACT
relating to the performance of pharmacy services in certain rural
areas.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 562, Occupations Code, is
amended by adding Section 562.1011 to read as follows:
Sec. 562.1011. OPERATION OF CLASS C PHARMACY IN CERTAIN
RURAL HOSPITALS. (a) In this section:
(1) "Nurse" has the meaning assigned by Section
301.002. The term includes a nurse who is also registered as a
pharmacy technician.
(2) "Rural hospital" means a licensed hospital with 75
beds or fewer that:
(A) is located in a county with a population of
50,000 or less; or
(B) has been designated by the Centers for
Medicare and Medicaid Services as a critical access hospital, rural
referral center, or sole community hospital.
(b) If a practitioner orders a prescription drug or device
for a patient in a rural hospital when the hospital pharmacist is
not on duty or when the institutional pharmacy is closed, a nurse or
practitioner may withdraw the drug or device from the pharmacy in
sufficient quantity to fill the order.
(c) The hospital pharmacist shall verify the withdrawal of a
drug or device under Subsection (b) and perform a drug regimen
review not later than the seventh day after the date of the
withdrawal.
(d) In a rural hospital that uses a floor stock method of
drug distribution, a nurse or practitioner may withdraw a
prescription drug or device from the institutional pharmacy in the
original manufacturer's container or a prepackaged container.
(e) The hospital pharmacist shall verify the withdrawal of a
drug or device under Subsection (d) and perform a drug regimen
review not later than the seventh day after the date of the
withdrawal.
(f) A rural hospital may allow a pharmacy technician to
perform the duties specified in Subsection (g) if:
(1) the pharmacy technician is registered and meets
the training requirements specified by the board;
(2) a pharmacist is accessible at all times to respond
to any questions and needs of the pharmacy technician or other
hospital employees, by telephone, answering or paging service,
e-mail, or any other system that makes a pharmacist accessible; and
(3) a nurse or practitioner or a pharmacist by remote
access verifies the accuracy of the actions of the pharmacy
technician.
(g) If the requirements of Subsection (f) are met, the
pharmacy technician may, during the hours that the institutional
pharmacy in the hospital is open, perform the following duties in
the pharmacy without the direct supervision of a pharmacist:
(1) enter medication order and drug distribution
information into a data processing system;
(2) prepare, package, or label a prescription drug
according to a medication order if a licensed nurse or practitioner
verifies the accuracy of the order before administration of the
drug to the patient;
(3) fill a medication cart used in the rural hospital;
(4) distribute routine orders for stock supplies to
patient care areas;
(5) access and restock automated medication supply
cabinets; and
(6) perform any other duty specified by the board by
rule.
(h) The pharmacist-in-charge of an institutional pharmacy
in a rural hospital shall develop and implement policies and
procedures for the operation of the pharmacy when a pharmacist is
not on-site.
(i) On or after September 1, 2011, the board may establish,
by rule, a requirement for prospective and retrospective drug use
review by a pharmacist for each new drug order. A drug use review is
not required when a delay in administration of the drug would harm
the patient in an urgent or emergency situation, including sudden
changes in a patient's clinical status.
(j) Rural hospitals may establish standing orders and
protocols, to be developed jointly by the pharmacist and medical
staff, that may include additional exceptions to instances in which
prospective drug use review is required.
(k) This section does not restrict or prohibit the board
from adopting a rule related to authorizing the withdrawal of a drug
or device by a nurse or practitioner from, or the supervision of a
pharmacy technician in, an institutional pharmacy not located in a
rural hospital. As part of the rulemaking process, the board shall
consider the effect that a proposed rule, if adopted, would have on
access to pharmacy services in hospitals that are not rural
hospitals.
(l) The board shall adopt rules to implement this section,
including rules specifying:
(1) the records that must be maintained under this
section;
(2) the requirements for policies and procedures for
operation of a pharmacy when a pharmacist is not on-site; and
(3) the training requirements for pharmacy
technicians.
SECTION 2. Chapter 568, Occupations Code, is amended by
adding Section 568.008 to read as follows:
Sec. 568.008. TECHNICIANS IN HOSPITALS WITH CLINICAL
PHARMACY PROGRAM. (a) In this section, "clinical pharmacy program"
means a program that provides pharmaceutical care services as
specified by board rule.
(b) A Class C pharmacy that has an ongoing clinical pharmacy
program may allow a pharmacy technician to verify the accuracy of
work performed by another pharmacy technician relating to the
filling of floor stock and unit dose distribution systems for a
patient admitted to the hospital if the patient's orders have
previously been reviewed and approved by a pharmacist.
(c) The pharmacist-in-charge of the clinical pharmacy
program shall adopt policies and procedures for the verification
process authorized by this section.
(d) A hospital must notify the board before implementing the
verification process authorized by this section.
(e) The board shall adopt rules to implement this section,
including rules specifying:
(1) the duties that may be verified by another
pharmacy technician;
(2) the records that must be maintained for the
verification process; and
(3) the training requirements for pharmacy
technicians who verify the accuracy of the work of other pharmacy
technicians.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1924 was passed by the House on April
24, 2009, by the following vote: Yeas 140, Nays 0, 1 present, not
voting; that the House refused to concur in Senate amendments to
H.B. No. 1924 on May 29, 2009, and requested the appointment of a
conference committee to consider the differences between the two
houses; and that the House adopted the conference committee report
on H.B. No. 1924 on May 31, 2009, by the following vote: Yeas 145,
Nays 0, 1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1924 was passed by the Senate, with
amendments, on May 25, 2009, by the following vote: Yeas 31, Nays
0; at the request of the House, the Senate appointed a conference
committee to consider the differences between the two houses; and
that the Senate adopted the conference committee report on H.B. No.
1924 on May 31, 2009, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor