Pharmacy Practice FAQs
Q: What is the scope of an immunizing pharmacist’s vaccination administration authority?
A: This guidance details state-law pharmacist vaccination authority, including training requirements and the authority of pharmacy technicians and pharmacy interns to administer vaccines under the supervision of an immunizing pharmacist.
Q: Where can I find more information about using the NC Vaccination / Immunization Registry?
A: The NC Department of Health and Human Services has information and training for the NC Immunization Registry available here.
Q: Are pharmacists required to report influenza vaccine administration to the North Carolina Immunization Registry?
A: No. GS § § 90-85.15B(d)(3) exempts influenza vaccines from the requirement to report pharmacist-administered vaccines to the Immunization Registry.
Q: What authority do pharmacists have to initiate drug therapy for hormonal contraception, prenatal vitamin needs, smoking cessation, post-HIV-exposure prophylaxis, and glucagon to treat severe hypoglycemia?
A: GS § 90-85.15B(c2) grants “immunizing pharmacists” authority to dispense, deliver, and administer drug therapy for these conditions.
This guidance document details this grant of authority and links to the statewide protocols that pharmacists must follow when exercising the authority.
*NOTE* Immunizing pharmacists who wish to exercise the authority to provide oral or transdermal hormonal contraceptive therapy are required by the protocol to complete the North Carolina Hormonal Contraceptive Training Program. Additional detail on the program and how to report completion to the Board is found in the guidance document.
Q: What authority do immunizing pharmacists have to administer long-acting injectable drugs?
Q: What guidance does the Board offer on the intersection of professional practice and individual conscience decisions?
Q: What guidance do the health occupation licensing bodies offer on end-of-life care?
A: Through dialogue with members of the healthcare community and consumers, a number of perceived regulatory barriers to adequate pain management in end-of-life care have been expressed to the Boards of Medicine, Nursing, and Pharmacy. The following statement attempts to address these misperceptions by outlining practice expectations for physicians and other health care professionals authorized to prescribe medications, as well as nurses and pharmacists involved in this aspect of end-of-life care. The statement is based on: the legal scope of practice for each of these licensed health professionals; professional collaboration and communication among health professionals providing palliative care; and a standard of care that assures on-going pain assessment, a therapeutic plan for pain management interventions; and evidence of adequate symptom management for the dying patient.
It is the position of all three Boards that patients and their families should be assured of competent, comprehensive palliative care at the end of their lives. Physicians, nurses and pharmacists should be knowledgeable regarding effective and compassionate pain relief, and patients and their families should be assured such relief will be provided.
Because of the overwhelming concern of patients about pain relief, the physician needs to give special attention to the effective assessment of pain. It is particularly important that the physician frankly but sensitively discuss with the patient and the family their concerns and choices at the end of life. As part of this discussion, the physician should make clear that, in some end-of-life care situations, there are inherent risks associated with effective pain relief. The Medical Board will assume opioid use in such patients is appropriate if the responsible physician is familiar with and abides by acceptable medical guidelines regarding such use, is knowledgeable about effective and compassionate pain relief, and maintains an appropriate medical record that details a pain management plan. Because the Board is aware of the inherent risks associated with effective pain relief in such situations, it will not interpret their occurrence as subject to discipline by the Board.
With regard to pharmacy practice, North Carolina has no quantity restrictions on dispensing controlled substances including those in Schedule II. This is significant when utilizing the federal rule that allows the partial filling of Schedule II prescriptions. In these situations, it would minimize expenses and unnecessary waste of drugs if the prescriber would note on the prescription that the patient is terminally ill and specify the largest anticipated quantity that could be needed for the next two months. The pharmacist could then dispense smaller quantities of the prescription to meet the patient’s needs up to the total quantity authorized.
Government-approved labeling for dosage level and frequency can be useful as guidance for patient care. Health professionals may, on occasion, determine that higher levels are justified in specific cases. However, these occasions would be exceptions to general practice and would need to be properly documented to establish informed consent of the patient and family. Federal and state rules also allow the fax transmittal of an original prescription for Schedule II drugs for hospice patients. If the prescriber notes the hospice status of the patient on the faxed document, it serves as the original. Pharmacy rules also allow the emergency refilling of prescriptions in Schedules III, IV, and V. While this does not apply to Schedule II drugs, it can be useful in situations where the patient is using Xanax for anxiety.
The nurse is often the health professional most involved in on-going pain assessment, implementing the prescribed pain management plan, evaluating the patient’s response to such interventions and adjusting medication levels based on patient status. In order to achieve adequate pain management, the prescription must provide dosage ranges and frequency parameters within which the nurse may adjust (titrate) medication in order to achieve adequate pain control. Consistent with the licensee’s scope of practice, the RN or LPN is accountable for implementing the pain management plan utilizing his/her knowledge base and documented assessment of the patient’s needs. The nurse has the authority to adjust medication levels within the dosage and frequency ranges stipulated by the prescriber and according to the agency’s established protocols.
Within this interdisciplinary framework for end-of-life care, effective pain management should include:
It is important to remind health professionals that licensing boards hold each licensee accountable for providing safe, effective care. Exercising this standard of care requires the application of knowledge, skills, as well as ethical principles focused on optimum patient care while taking all appropriate measures to relieve suffering. The healthcare team should give primary importance to the expressed desires of the patient tempered by the judgment and legal responsibilities of each licensed health professional as to what is in the patient’s best interest.
Q: What resources are available to pharmacists, pharmacy personnel, and pharmacy students who have, or are concerned they might have a substance use disorder?
A: The North Carolina Professionals Health Program ("NCPHP") works with the Board to provide clinical resources and support to pharmacists, pharmacy technicians, and pharmacy students struggling with substance abuse and misuse. NCPHP can be reached at (919)870-4480.
Q: Are there financial resources to assist pharmacists and pharmacy personnel in need of substance use assessment treatment and monitoring?
A: Yes. The Board and NCPHP established the L. Stanley Haywood Recovery Fund in April 2018. The Fund provides financial support to qualifying pharmacists and pharmacy personnel in need of substance use assessment, treatment, and monitoring services. NCPHP works with pharmacy personnel to determine their eligibility for Haywood Recovery Fund assistance.
Q: May pharmacists or others contribute to the L. Stanley Haywood Fund?
A: Yes. In coordination with NCPHP, Board staff have created a way for individuals licensed or registered with the NC Board of Pharmacy to contribute to this Fund at any time and in any amount. Simply log in to the Board’s Licensure Gateway and select the blue tile labeled Donate to Stan Haywood Recovery Fund to be taken directly to NCPHP’s donation site.
Members of the public who wish to contribute may do so by visiting this link: L. Stan Haywood Recovery Fund Donation Page.