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(1) During times that an institutional pharmacy does not have a pharmacist in attendance, arrangements must be made in advance by the pharmacist-in-charge for provision of drugs to the medical staff and other authorized personnel by use of night cabinets, floor stock and, in emergency circumstances, by access to the pharmacy. A mechanism for providers and nursing to obtain pharmacy consultation must be available at all times in accordance with ARM 24.174.1101.

(2) If night cabinets are used to store drugs in the absence of a pharmacist, they must be locked and sufficiently secure to deny access to unauthorized persons, and must be located outside of the pharmacy area. Contents of night cabinets must be prepackaged. Only specifically authorized personnel may obtain access by key or combination, pursuant to a valid prescription order. The pharmacist-in-charge shall, in conjunction with the appropriate committee of the facility, develop inventory listings of drugs included in these cabinets and determine who may have access.

(3) A complete verification audit of all inpatient orders and activity concerning the night cabinet or after-hours pharmacy entry must be conducted by a pharmacist, pharmacy technician, or other licensed designee of that pharmacist within 72 hours of the drugs having been removed from the night cabinet or pharmacy.

(4) Whenever any drug is not available from floor stock or night cabinets, and that drug is required to treat the immediate needs of a patient whose health would otherwise be jeopardized, the drug may be obtained from the pharmacy by an authorized registered nurse or licensed practical nurse in accordance with established policies and procedures. The responsible nurse shall be designated by the appropriate committee of the institutional facility.

(a) Removal of any drug from the pharmacy, floor stock, or night cabinet by an authorized nurse must be recorded on a suitable form showing the following information:

(i) patient name;

(ii) the patient's room number if applicable;

(iii) the name, strength, and quantity of drug removed;

(iv) the date and time the drug was removed;

(v) the signature of the nurse removing the drug; and

(vi) documentation of pharmacy review.

(b) in cases of medication not unit-dosed, the NDC number of the drug removed must also be recorded.

(5) The pharmacist-in-charge shall ensure that:

(a) written policies and procedures are established to implement the requirements of this rule;

(b) all drugs are properly labeled; and

(c) only prepackaged drugs are available, in amounts sufficient for immediate therapeutic requirements.

(6) A copy of the original drug order with the NDC number or other identifying code of the drug(s) provided may be faxed to the pharmacist. If the patient is an inpatient, a patient profile containing the patient's name, location, allergies, current medication regimen, and relevant laboratory values must be reviewed by a pharmacist within 72 hours.

History: 37-7-201, MCA; IMP, 37-7-201, MCA; NEW, 2002 MAR p. 3605, Eff. 12/27/02; AMD, 2006 MAR p. 1615, Eff. 6/23/06.

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