Pre-Hospital Emergency Medication Policy Statement

BACKGROUND: From the beginning of paramedic systems in this state, pre-hospital care providers have used prescription and non-prescription drugs to provide lifesaving care. In spite of the widespread use of drugs by prehospital care providers, no rule has ever been written specifically devoted to the distribution, possession, storage, security, administration and replacement of these drugs and controlled substances. As a result, important policy questions have arisen from time to time concerning the supply and resupply of drugs in prehospital care. This policy guide is based on the Arizona Board of Pharmacy interpretation of existing statutes and rules related to drug distribution by Arizona hospital pharmacies.

Provide drugs necessary for pre-hospital treatment, timely availability of drugs, flexibility for regional/local needs, and pharmacy control and accountability of all drugs distributed within and from a given hospital. It is the hospital "pharmacist-in-charge" responsibility to meet this goal.

PROPOSAL: Hospital pharmacies may use either the traditional "box for box" exchange method or an "item for item" exchange method for pre-hospital care drug distribution. The pharmacist-in-charge of a hospital pharmacy should prepare a detailed policy and procedure covering the distribution of drugs used by prehospital care providers. At a minimum the policy and procedure will include the following:

• 1. DISTRIBUTION ACCOUNTABILITY RECORDS FOR ALL DRUGS SUPPLIED TO PRE-HOSPITAL CARE PROVIDERS.
• 2. "IN AND OUT" INVENTORY CONTROL AND SECURITY PROVISIONS FOR PRE-HOSPITAL CARE DRUGS STORED OUTSIDE THE PHARMACY BUT WITHIN THE HOSPITAL AND UNDER THE SUPERVISION/CONTROL OF THE PHARMACY.
• 3. MONTHLY EXPIRATION DATE REVIEW OF EMS DRUG BOX ITEMS, AND
• 4. "ITEM FOR ITEM" EXCHANGE OF ALL CONTROLLED SUBSTANCES DIRECTLY FROM THE PHARMACY OR IN A HOSPITAL WITHOUT 24 HOUR PHARMACY SERVICES, THE HOSPITAL PIC MAY REQUEST BOARD APPROVAL OF AN ALTERNATIVE METHOD OF EXCHANGE BASED ON POLICIES & PROCEDURES DEVELOPED IN CONJUNCTION WITH THE BOARD'S COMPLIANCE STAFF. ANYTHING OTHER THAN "ITEM FOR ITEM" EXCHANGES MAY BE APPROVED BY THE BOARD OR ITS DESIGNEE ON A CASE BY CASE BASIS.

This substantive policy statement is advisory only. A substantive policy statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on regulated parties or include confidential information or rules made in accordance with the Arizona Administrative Procedure Act. If you believe that this substantive policy statement does impose additional requirements or penalties on regulated parties you may petition the agency under A.R.S. § 41-1033 for a review of the statement. REV. 08/2002