Chapter 617 Oregon Laws 2003
AN ACT
SB 708
Relating to drug dispensing authority of certified nurse practitioners; creating new provisions; and amending ORS 678.390 and 689.605.
Be It Enacted by the People of the State of
Oregon:
SECTION 1. ORS 678.390 is amended to read:
678.390. (1) The Oregon State Board of Nursing may grant to a certified nurse practitioner the privilege of writing prescriptions described in the formulary under ORS 678.385.
[(2) The board shall establish by rule criteria for emergency drug dispensing authority. A certified nurse practitioner may make application to the Oregon State Board of Nursing for emergency drug dispensing authority, if the certified nurse practitioner’s practice is located in an area of the state where geographic conditions severely limit the ability of the certified nurse practitioner to meet emergency patient needs. Criteria to be used in reviewing the application shall include but not be limited to the proximity in road miles of the nearest community pharmacy, general road conditions and weather conditions. Such emergency dispensing shall be from prepackaged drugs, from the formulary authorized under ORS 678.385, prepared by a licensed pharmacist.]
[(3) The Oregon State Board of Nursing shall renew the privilege of writing and dispensing drugs for a nurse practitioner who reapplies for the privilege and satisfies the requirements of this section and applicable rules and statutes.]
(2)
A certified nurse practitioner may submit an application to the Oregon State
Board of Nursing to dispense prescription drugs. The Oregon State Board of
Nursing shall provide immediate notice to the State Board of Pharmacy upon
receipt and upon approval of an application from a certified nurse practitioner
for authority to dispense prescription drugs to the patients of the applicant.
(3)
An application for the authority to dispense prescription drugs as authorized
under subsection (1) of this section must include:
(a)
Evidence of completion of a prescription drug dispensing training program
jointly developed and adopted by rule by the Oregon State Board of Nursing and
the State Board of Pharmacy.
(b)
Demonstration of a lack of readily available access to pharmacy services in the
practice area of the applicant and that the lack of access would be corrected
by granting authority to dispense prescription drugs by the applicant. Lack of
readily available access to pharmacy services for patients may be established
by evidence:
(A)
That the patients of the applicant are located:
(i)
Outside the boundaries of a metropolitan statistical area;
(ii)
Thirty or more highway miles from the closest hospital within the major
population center in a metropolitan statistical area; or
(iii)
In a county with a population of less than 75,000; or
(B)
Of financial barrier to access, including but not limited to receiving services
from a health care safety net clinic or eligibility for participation in a
patient assistance program of a pharmaceutical company.
(c)
Any other information required by the Oregon State Board of Nursing.
(4)
The Oregon State Board of Nursing shall adopt rules requiring:
(a)
Drugs dispensed by certified nurse practitioners to be in the formulary
established under ORS 678.385 and be either prepackaged by a manufacturer registered
with the State Board of Pharmacy or repackaged by a pharmacist licensed by the
State Board of Pharmacy under ORS chapter 689.
(b)
Labeling requirements for drugs dispensed by certified nurse practitioners that
are the same as labeling requirements required of pharmacies licensed under ORS
chapter 689;
(c)
Record keeping requirements for prescriptions and drug dispensing by a
certified nurse practitioner that are the same as the record keeping
requirements required of pharmacies licensed under ORS chapter 689;
(d)
A dispensing certified nurse practitioner to have available at the dispensing
site a hard copy or electronic version of prescription drug reference works
commonly used by professionals authorized to dispense prescription medications;
and
(e)
A dispensing certified nurse practitioner to allow representatives of the State
Board of Pharmacy, upon receipt of a complaint, to inspect a dispensing site
after prior notice to the Oregon State Board of Nursing.
(5) The Oregon State Board of Nursing has sole disciplinary authority regarding certified nurse practitioners who have drug dispensing authority.
[(4)] (6) The privilege of writing prescriptions and dispensing drugs may be denied, suspended or revoked by the Oregon State Board of Nursing upon proof that the privilege has been abused. The procedure shall be a contested case under ORS 183.310 to 183.550. Disciplinary action under this subsection is grounds for discipline of the nurse practitioner in the same manner as a licensee may be disciplined under ORS 678.111.
SECTION 2. ORS 689.605 is amended to read:
689.605. (1) In a hospital or long term care facility having a pharmacy and employing a pharmacist, the pharmacy and pharmacist are subject to the requirements of this chapter, except that in a hospital when a pharmacist is not in attendance, pursuant to standing orders of the pharmacist, a registered nurse supervisor on the written order of a person authorized to prescribe a drug may withdraw such drug in such volume or amount as needed for administration to or treatment of an inpatient or outpatient until regular pharmacy services are available in accordance with the rules adopted by the board. However, the State Board of Pharmacy may grant an exception to the requirement for a written order by issuing a special permit authorizing the registered nurse supervisor in a hospital to dispense medication on the oral order of a person authorized to prescribe a drug. An inpatient care facility which does not have a pharmacy must have a drug room. In an inpatient care facility having a drug room as may be authorized by rule of the Department of Human Services, the drug room is not subject to the requirements of this chapter relating to pharmacies. However, a drug room must be supervised by a pharmacist and is subject to the rules of the State Board of Pharmacy. When a pharmacist is not in attendance, any person authorized by the prescriber or by the pharmacist on written order may withdraw such drug in such volume or amount as needed for administration to or treatment of a patient, entering such withdrawal in the record of the responsible pharmacist.
(2) In a hospital having a drug room, any drug may be withdrawn from storage in the drug room by a registered nurse supervisor on the written order of a licensed practitioner in such volume or amount as needed for administration to and treatment of an inpatient or outpatient in the manner set forth in subsection (1) of this section and within the authorized scope of practice.
(3) A hospital having a drug room shall cause accurate and complete records to be kept of the receipt, withdrawal from stock and use or other disposal of all legend drugs stored in the drug room. Such record shall be open to inspection by agents of the board and other qualified authorities.
(4) In an inpatient care facility other than a hospital, the drug room shall contain only prescribed drugs already prepared for patients therein and such emergency drug supply as may be authorized by rule by the Department of Human Services.
(5) The requirements of this section shall not apply to facilities described in ORS 441.065.
(6) A registered nurse who is an employee of a local health department established under the authority of a county or district board of health and registered by the board under ORS 689.305 may, pursuant to the order of a person authorized to prescribe a drug or device, dispense a drug or device to a client of the health department for purposes of caries prevention, birth control or prevention or treatment of a communicable disease. Such dispensing shall be subject to rules jointly adopted by the board and the Department of Human Services.
[(7) A nurse practitioner who is authorized to write prescriptions under ORS 678.390 and employed by a college or university student health center registered by the board under ORS 689.305 shall be authorized to dispense drugs to the practitioner’s patients if they are students of the college or university. Drugs dispensed shall be prepackaged by a pharmacy registered by the board or repackaged by a manufacturer registered with the board. The board and the Oregon State Board of Nursing shall jointly develop a list of classes of drugs to be dispensed, based on clinical appropriateness for the college student population. This list shall include, but not be limited to, oral contraceptives, contraceptive devices, antibiotics and anti-inflammatory medications. The list shall not include drugs not authorized for nurse practitioner prescription writing under ORS 678.385. Such dispensing is subject to rules jointly adopted by the board and the Oregon State Board of Nursing. The rules shall require that a pharmacist establish dispensing procedures and perform regular drug utilization reviews and that the pharmacist and nurse practitioner provide a means for patients to receive information on drugs dispensed to them.]
[(8)] (7) The board shall adopt rules authorizing a pharmacist to delegate to a registered nurse the authority to withdraw prescription drugs from a manufacturer’s labeled container for administration to persons confined in penal institutions including, but not limited to, adult and juvenile correctional facilities. A penal institution, in consultation with a pharmacist, shall develop policies and procedures regarding medication management, procurement and distribution. A pharmacist shall monitor a penal institution for compliance with the policies and procedures and shall perform drug utilization reviews. The penal institution shall submit to the board for approval a written agreement between the pharmacist and the penal institution regarding medication policies and procedures.
SECTION 3. The Oregon State Board of Nursing shall report to the Seventy-third Legislative Assembly in the manner provided in ORS 192.245 on the results of the implementation of drug dispensing authority for certified nurse practitioners authorized by the amendments to ORS 678.390 by section 1 of this 2003 Act. The report must include, but is not limited to, the number of applications submitted to and the number of applications approved by the board.
Approved by the Governor July 28, 2003
Filed in the office of Secretary of State July 28, 2003
Effective date January 1, 2004
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