Department of Pharmacy Policies & Procedures
Number: 5:21
Effective Date: May, 1990
Revisions: 3/99; 10/08
Reviewed: 11/09
Approval: March, 1999
Subject: EMERGENCY ROOM PRESCRIPTIONS
A. POLICY
The hospital pharmacy can fill and dispense prescriptions written in the UAMS Medical Center Emergency Department during the hours that the Outpatient Pharmacy is closed with prior approval from the Director of Pharmacy. Quantities will be limited to the amounts allowed by applicable laws and regulations. These are contained in the State Health Department Regulations, the State Board of Pharmacy Laws and Regulations and the DEA Regulations.
Normally, emergency department patients are given 3 doses by the physician in the Emergency Department. An entry is made in the patient's medical record. The charge for this medication is made on the Emergency Room charge. If more medication is needed to continue the therapy, the patient is given a prescription that can be taken to a community pharmacy or brought back to the Out-Patient Pharmacy when it is open.
B. PROCEDURE
1. The physician should write a separate set of prescriptions for filling and dispensing by the inpatient pharmacy. Since the inpatient pharmacy can only dispense limited quantities, the patient will have another set of prescriptions to be filled by a pharmacy near the patient's home or by the Outpatient Pharmacy.2. The separate discharge prescriptions are filled in accordance with the procedures for the dispensing of outpatient prescriptions.
3. Access to the inpatient pharmacy is limited. Emergency department personnel must send the prescriptions to the inpatient pharmacy by pneumatic tube.
4. The prescriptions are priced. The bill is returned to the Emergency Department where the patient must pay cash for the prescriptions or by prior approval charge it on the bill. When the receipt for payment is received, prescriptions are given to the nurse who in turn delivers them to the patient with an ER drug counseling sheet.
5. Prescriptions are priced by using the usual outpatient pricing schedule in the computer.
6. There will be "NO REFILLS" authorized on an Emergency Department prescription.
C. QUANTITIES ON EMERGENCY ROOM PRESCRIPTIONS
1. Generally, the quantity of medications dispensed will be limited to an adequate quantity which allows the patient enough time to obtain the remainder of the course of therapy. This is to be calculated on the dosage regimen stated on the prescription which usually should cover up to 48 hours. However, in certain instances such as "long" weekends, up to a 72 hour supply may be dispensed .
2. Approval for longer periods of time may be obtained from the Director of Pharmacy or their designee.
3. Medications that are packaged in a dispensing package, such as oral antibiotic suspensions in 150ml. or 200 ml. containers, will be dispensed in total since the remaining quantities would usually be discarded.
4. Up to a 10 day supply of anti-infectives can be dispensed when the situation warrants it.
D "CODE R" PRESCRIPTIONS
1. There is a standardized drug protocol for all "Code R" patients. Unless extenuating circumstances occur the following drugs are used:
Ovral 0.5mg - #4 - Take two tablets now and two in 12 hours. These tablets are packaged and labeled and available in the Pyxis Medstation. The ED physician will counsel the patient on use of this.
Doxycycline 100mg - #20 - Take twice daily for 10 days The patient may be given the first dose and then is given a prescription for the remainder which should be filled at the patient’s pharmacy.