NAC639.468. Establishment of policies, procedures and systems.

The managing pharmacist of a pharmacy shall establish policies, procedures and systems related to the following matters, without limitation:

     1. Preparation of parenteral medications compounded within the pharmacy.

     2. Supervision of the admixture of parenteral products and training of personnel in incompatible admixtures if they are not performed within the pharmacy.

     3. Supervision of the bulk compounding of drugs.

     4. Procurement and storage of all materials in the pharmacy, including drugs, chemicals and biologicals.

     5. Participation in the development of a formulary for the medical facility or correctional institution in which the pharmacy is located, subject to the approval of the appropriate committee at the facility or institution.

     6. Distribution of drugs to be administered to patients, pursuant to an original or a direct copy of a practitioner’s order for medication.

     7. Filling and labeling of all containers from which drugs are to be distributed or dispensed.

     8. Maintenance and availability in the pharmacy, and in areas where care is provided to inpatients, of:

     (a) A sufficient inventory of emergency drugs;

     (b) The telephone numbers of poison control centers and other organizations for emergency assistance; and

     (c) Such other materials and information as are considered necessary by the appropriate committee.

     9. Recording of all transactions of the pharmacy required by applicable state and federal laws.

     10. Participation in those aspects of the medical facility’s program to evaluate care provided to patients that relate to the use and effectiveness of pharmaceutical materials.

     11. Participation in teaching and research programs at the medical facility.

     12. Carrying out the policies and decisions of the appropriate committee relating to pharmaceutical services of the medical facility.

     13. Labeling, storage and distribution of investigational drugs, and maintenance of information in the pharmacy and nursing stations where such drugs are being administered concerning the dosage form, route of administration, strength, uses, side effects, interactions and symptoms of toxicity of those drugs.

     (Added to NAC by Bd. of Pharmacy, eff. 3-27-90; A 9-12-91)