657—7.12 (124,126,155A) Drugs dispensed to patients as a result of an emergency room visit. In those facilities with 24-hour pharmacy services, only a pharmacist or prescribing practitioner may dispense any drugs to an outpatient, including emergency department patients. In those facilities without 24-hour pharmacy services, or those facilities without outpatient pharmacy services or when the facility’s outpatient pharmacy is closed, the following procedures shall be observed in dispensing drugs:
	 7.12(1) Patients examined in emergency room. Drugs may be dispensed only to patients who have been examined in the emergency room.
	 7.12(2) Accountability. Drugs may be dispensed only in accordance with the system of control and accountability for drugs administered or dispensed from the emergency room.
	  a.   	 The system shall be developed and supervised by the pharmacist in charge and the facility’s emergency department committee, or a similar group or person responsible for policy in that department.
	  b.   	 The system shall identify drugs of the nature and type to meet the immediate needs of emergency room patients.
	  c.   	 Controlled substances maintained in the emergency room are kept for use by, or at the direction of, prescribers in the emergency room. In order to receive a controlled substance, a patient must be examined in the emergency room by a prescriber who shall determine the need for the drug. It is not permissible under state and federal requirements for a prescriber to see a patient outside the emergency room setting, or talk to the patient on the telephone, and then proceed to call the emergency room and order the administration of a stocked controlled substance upon the patient’s arrival at the emergency room.
	  d.   	 In an emergency situation when a health care practitioner authorized to prescribe controlled substances is not available on site and regardless of the provisions of paragraph “c,” the emergency room nurse may examine the patient in the emergency room and contact the on-call prescriber. The on-call prescriber may then authorize the nurse to administer a controlled substance to the patient pending the arrival of the prescriber. As soon as possible, the prescriber shall examine the patient in the emergency room and determine the patient’s further treatment needs.
	  e.   	 The pharmacist in charge is responsible for maintaining accurate records of dispensing of drugs from the emergency room.
	 7.12(3) Prepackaging. Drugs dispensed in greater than a 24-hour supply may be dispensed only in prepackaged quantities not to exceed a 72-hour supply or the minimum prepackaged quantity in suitable containers. Prepackaged drugs shall be prepared pursuant to the requirements of 657—22.3(126). Drugs dispensed pursuant to this subrule shall be appropriately labeled as required in subrule 7.12(4), including necessary auxiliary labels.
	 7.12(4) Labeling. At the time of delivery of the drug, the practitioner shall appropriately complete the label, such that the dispensing container bears a label with at least the following information:
	  a.   	 Name and address of the hospital;
	  b.   	 Date dispensed;
	  c.   	 Name of prescriber;
	  d.   	 Name of patient;
	  e.   	 Directions for use;
	  f.   	 Name and strength of drug.
	 7.12(5) Delivery of drug to patient. The practitioner, or a licensed nurse under the supervision of the practitioner, shall give the appropriately labeled, prepackaged drug to the patient or patient’s caregiver and shall explain the correct use of the drug.