Bill Text: NC S246 | 2011-2012 | Regular Session | Amended
Bill Title: Expand Pharmacists' Immunizing Authority
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2011-06-09 - Ref To Com On Health and Human Services [S246 Detail]
Download: North_Carolina-2011-S246-Amended.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2011
S 2
SENATE BILL 246
Health Care Committee Substitute Adopted 6/8/11
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Short Title: Expand Pharmacists' Immunizing Authority. |
(Public) |
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Sponsors: |
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Referred to: |
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March 8, 2011
A BILL TO BE ENTITLED
AN ACT to protect the public's HEALTH by increasing access to immunizations and vaccines through the expanded role of immunizing pharmacists.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 90‑85.3 is amended by adding the following new subsection to read:
"(i1) "Immunizing pharmacist" means a licensed pharmacist who meets all of the following qualifications:
(1) Holds a current provider level cardiopulmonary resuscitation certification issued by the American Heart Association or the American Red Cross, or an equivalent certification.
(2) Has successfully completed a certificate program in vaccine administration accredited by the Centers for Disease Control and Prevention, the Accreditation Council for Pharmacy Education, or a similar health authority or professional body approved by the Board.
(3) Maintains documentation of three hours of continuing education every two years, designed to maintain competency in the disease states, drugs, and vaccine administration.
(4) Has successfully completed training approved by the Division of Public Health's Immunization Branch for participation in the North Carolina Immunization Registry.
(5) Enrolls with a local supervising health department and pays an annual enrollment fee.
(6) Registers with the North Carolina Board of Pharmacists as an immunizing pharmacist.
(7) Administers vaccines or immunizations in accordance with G.S. 90‑18.15B."
SECTION 2. G.S. 90‑85.3(r) reads as rewritten:
"(r) "Practice of pharmacy" means the
responsibility for: interpreting and evaluating drug orders, including
prescription orders; compounding, dispensing and labeling prescription drugs
and devices; properly and safely storing drugs and devices; maintaining proper
records; and controlling pharmacy goods and services. A pharmacist may advise
and educate patients and health care providers concerning therapeutic values,
content, uses and significant problems of drugs and devices; assess, record and
report adverse drug and device reactions; take and record patient histories
relating to drug and device therapy; monitor, record and report drug therapy
and device usage; perform drug utilization reviews; and participate in drug and
drug source selection and device and device source selection as provided in G.S. 90‑85.27
through G.S. 90‑85.31. A pharmacist who has received special
training may be authorized and permitted to administer drugs pursuant to a
specific prescription order in accordance with rules adopted by each of the
Boards of Pharmacy, the Board of Nursing, and the North Carolina Medical Board.
The rules shall be designed to ensure the safety and health of the patients for
whom such drugs are administered. An approved clinical pharmacist practitioner
may collaborate with physicians in determining the appropriate health care for
a patient, subject to the provisions of G.S. 90‑18.4.is as
specified in G.S. 90‑85.3A."
SECTION 3. Article 4A of Chapter 90 of the General Statutes is amended by adding a new section to read:
"§ 90‑85.3A. Practice of pharmacy.
(a) A pharmacist is responsible for interpreting and evaluating drug orders, including prescription orders; compounding, dispensing, and labeling prescription drugs and devices; properly and safely storing drugs and devices; maintaining proper records; and controlling pharmacy goods and services.
(b) A pharmacist may advise and educate patients and health care providers concerning therapeutic values, content, uses, and significant problems of drugs and devices; assess, record, and report adverse drug and device reactions; take and record patient histories relating to drug and device therapy; monitor, record, and report drug therapy and device usage; perform drug utilization reviews; and participate in drug and drug source selection and device and device source selection as provided in G.S. 90‑85.27 through G.S. 90‑85.31.
(c) An immunizing pharmacist may be authorized and permitted to administer drugs as provided in G.S. 90‑85.15B.
(d) A pharmacist who has received special training may be authorized and permitted to administer drugs pursuant to a specific prescription order in accordance with rules adopted by each of the Boards of Pharmacy, the Board of Nursing, and the North Carolina Medical Board. The rules shall be designed to ensure the safety and health of the patients for whom such drugs are administered.(e) An approved clinical pharmacist practitioner may collaborate with physicians in determining the appropriate health care for a patient, subject to the provisions of G.S. 90‑18.4."SECTION 4. Article 4A of Chapter 90 of the General Statutes is amended by adding a new section to read:
"§ 90‑85.15B. Immunizing pharmacists.
(a) An immunizing pharmacist may administer vaccines or immunizations recommended or required by the Centers for Disease Control and Prevention, including vaccines recommended or required for travel outside the United States, with the following limitations:
(1) Vaccines or immunizations shall not be administered to patients under the age of 14.
(2) For patients at least 14 years of age, but less than 18 years of age, vaccines or immunizations shall be administered (i) with a specific prescription order, and (ii) at the request of the patient's parent, guardian, or person standing in loco parentis to the minor.
(3) For patients at least 14 years of age, influenza vaccines shall be administered only pursuant to protocol as provided in 21 NCAC 46 .2507 and, if the patient is less than 18 years of age, at the request of the minor's parent, guardian, or person standing in loco parentis to the minor.
(4) For patients at least 18 years of age, vaccines or immunizations shall be administered with a specific prescription order, with a standing order, or pursuant to protocols developed by the State Health Director, in consultation with the Commission for Public Health, and implemented by rules adopted by the North Carolina Board of Pharmacy and the North Carolina Medical Board.
(b) An immunizing pharmacist who administers a vaccine or immunization to any patient pursuant to this section shall do all of the following:
(1) Maintain a record of any vaccine or immunization administered to the patient in a patient profile.
(2) Notify within 24 hours after administration the patient's primary care provider, if the patient has identified a primary care provider and, dependent upon the authority under which the vaccine or immunization was administered, (i) the prescribing physician, (ii) the physician who issued the standing order, or (iii) the local health department.
(3) Access the North Carolina Immunization Registry prior to administering the vaccine or immunization and record any vaccine or immunization administered to the patient in the registry within 24 hours after administration."
SECTION 5. G.S. 130A‑39(g) reads as rewritten:
"(g) A local board of health may impose a fee for services to be rendered by a local health department, except where the imposition of a fee is prohibited by statute or where an employee of the local health department is performing the services as an agent of the State. Notwithstanding any other provisions of law, a local board of health may impose cost‑related fees for services performed pursuant to Article 11 of this Chapter, "Wastewater Systems," for services performed pursuant to Part 10, Article 8 of this Chapter, "Public Swimming Pools", for services performed pursuant to Part 11, Article 8 of this Chapter, "Tattooing", for services performed pursuant to G.S. 90‑85.15B, and for services performed pursuant to G.S. 87‑97. Fees shall be based upon a plan recommended by the local health director and approved by the local board of health and the appropriate county board or boards of commissioners. The fees collected under the authority of this subsection are to be deposited to the account of the local health department so that they may be expended for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act."
SECTION 6. G.S. 130A‑153 reads as rewritten:
"(a) The required immunization may be obtained
from a physician licensed to practice medicine or from medicine;
a local health department. department; or an immunizing pharmacist,
in accordance with the provisions of G.S. 90‑85.15B. Local
health departments shall administer required and State‑supplied
immunizations at no cost to uninsured or underinsured patients with family
incomes below two hundred percent (200%) of the federal poverty level. A local
health department may redistribute these vaccines only in accordance with the
rules of the Commission.
(b) Local health departments shall file monthly immunization reports with the Department. The report shall be filed on forms prepared by the Department and shall state, at a minimum, each patient's age and the number of doses of each type of vaccine administered.
(c) Immunization certificates and information concerning immunizations contained in medical or other records shall, upon request, be shared with the Department, local health departments, immunizing pharmacist, and the patient's attending physician. In addition, an insurance institution, agent, or insurance support organization, as those terms are defined in G.S. 58‑39‑15, may share immunization information with the Department. The Commission may, for the purpose of assisting the Department in enforcing this Part, provide by rule that other persons may have access to immunization information, in whole or in part.
(d) A physician physician, immunizing pharmacist,
or local health department may immunize a minor with the consent of a parent,
guardian, or person standing in loco parentis to the minor. A physician physician,
immunizing pharmacist, or local health department may also immunize a minor
who is presented for immunization by an adult who signs a statement that he or
she is authorized by a parent, guardian, or person standing in loco parentis to
the minor to obtain the immunization for the minor. Notwithstanding any
other provision of this Chapter, an immunizing pharmacist's authority to
administer vaccines or immunizations to a minor is limited to the authority
specified in G.S. 90‑85.15B."
SECTION 7. G.S. 130A‑154(a) reads as rewritten:
"(a) A physician physician, immunizing pharmacist,
or local health department administering a required vaccine shall give a
certificate of immunization to the person who presented the child for
immunization. The certificate shall state the name of the child, the name of
the child's parent, guardian, or person responsible for the child obtaining the
required immunization, the address of the child and the parent, guardian or
responsible person, the date of birth of the child, the sex of the child, the
number of doses of the vaccine given, the date the doses were given, the name
and address of the physician physician, immunizing pharmacist, or
local health department administering the required immunization and other
relevant information required by the Commission."
SECTION 8. 21 NCAC 46 .2507 shall govern the administration of influenza, pneumococcal, and zoster vaccines by an immunizing pharmacist; provided, however, an immunizing pharmacist shall be granted the authority to administer influenza vaccine to patients aged 14 years and older.
SECTION 9. Not later than January 1, 2012, the State Health Director, in consultation with the Commission for Public Health, shall establish standards for the administration of immunizations by pharmacists in accordance with G.S. 90‑85.15. The standards shall include the following:
(1) Record-keeping procedures for all vaccines or immunizations administered by an immunizing pharmacist.
(2) Physician accessibility to the immunizing pharmacist.
(3) A protocol establishing the oversight of the immunizing pharmacist by the local health department and the process for the administration of any vaccine or immunization to an individual at least 18 years of age when that vaccine or immunization is administered without a specific prescription order and without a standing order.
(4) A uniform protocol specific to each vaccine or immunization recommended or required by the Centers for Disease Control and Prevention. The protocol shall include, but not be limited to, the following:
a. Any contraindications of the specific vaccine.
b. Emergency procedures associated with the administration of the specific vaccine.
c. Information to be disclosed to patients regarding the specific vaccine.
d. A procedure for annual updates on vaccine administration.
The North Carolina Board of Pharmacy and the North Carolina Medical Board shall adopt rules to implement the standards under this section by the State Health Director in consultation with the Commission for Public Health.
SECTION 10. This act becomes effective October 1, 2011.
