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Physician delegation to pharmacists under a drug therapy management prot. (00094603).docx

Policies of the University of North Texas Health Science Center 14.315 Physician Delegation to Pharmacists under a Drug Therapy
Management Protocol

Policy Statement.
UNTHSC shall require pharmacists and physicians to sign a delegated drug therapy management protocol before pharmacists may provide drug therapy management to patients in a UNT Health practice site. Application of Policy.
This policy shall apply to all employed or contracted UNT Health physicians and pharmacists who are providing patient care under a Delegated Drug Therapy Management Protocol. Definitions
1. "Supervising Physician" means an employed or contracted UNT Health credentialed physician who is authorized to prescribe drugs and who is responsible for the delegation of drug therapy management to a Pharmacist pursuant to a Protocol. 2. "Pharmacist" means an employed or contracted UNT Health credentialed pharmacist who is authorized to dispense drugs and to engage in Drug Therapy Management as delegated by the Supervising Physician under a Delegated Drug Therapy Management Protocol. 3. "Dangerous Drug" means a drug or device that is unsafe for self medication and is not included in Chapter 481 of Texas Health and Safety Code's Schedules I-V or Penalty Groups I-IV. It includes a drug or device that bears or is required to bear the legend: "Caution: federal law prohibits dispensing without prescription" or "Rx only" or another legend that complies with federal law. 4. "Drug Therapy Management" means the performance of specific acts, including the authority to sign a prescription drug order for dangerous drugs, by a Pharmacist as authorized by the Supervising Physician through a Protocol. It does not include the selection of drug products not prescribed by the Supervising Physician unless the drug product is named in the Protocol or the Supervising Physician initiated a written record allowing a deviation from the Protocol. 5. "Delegated Drug Therapy Management Protocol" or "Protocol" means the document in which the Supervising Physician delegates Drug Therapy Management to a Pharmacist and which meets the requirements of a "written protocol" under the Texas Medical Practice Act and the Texas Pharmacy Act. Procedures and Responsibilities.
A. Protocol
1. A Pharmacist may provide Drug Therapy Management under the supervision of a Supervising Physician pursuant to a Protocol. The Supervising Physician shall formulate or approve the Protocol and any patient deviation from the Protocol. Responsible Party: Supervising Physician and Pharmacist 2. The Protocol shall contain, at a minimum, the following information: a. A statement identifying the Supervising Physician authorized to prescribe drugs and responsible for the delegation of Drug Therapy Management. b. A statement identifying the Pharmacist authorized to dispense drugs and to engage in Drug Therapy Management as delegated by the Supervising Physician. c. A statement identifying the types of drug therapy management decisions that the Pharmacist is authorized to make which shall include: A statement of the ailments or diseases involved, drugs, and types of drug therapy management authorized, and A specific statement of the procedures, decision criteria or plan the Pharmacist shall follow when exercising drug management therapy authority. A statement of the activities the Pharmacist shall follow in the course of exercising Drug Therapy Management authority including the method for documenting decisions made and a plan for communication of feedback to the Supervising Physician concerning specific decisions made. A statement that documentation shall be recorded in the patient's medical record within a reasonable time of each intervention. A statement that describes appropriate mechanisms and time schedule for the Pharmacist to report to the Supervising Physician and the results of Drug Therapy Management. The expiration date of the Protocol. Responsible Party: Supervising Physician and Pharmacist 3. The Credentialing Office shall maintain a copy of the Protocol in the Pharmacist's and Supervising Physician's credentialing files. Responsible Party: Credentialing Office B. Responsibilities of Supervising Physician
1. The Supervising Physician shall: a. Establish and maintain a physician-patient relationship with each patient provided Drug Therapy Management by a Pharmacist and inform the patient that drug therapy will be managed by a Pharmacist under a written Protocol. b. Verify that the Pharmacist establishes and maintains a pharmacist-patient relationship with each patient provided Drug Therapy Management. c. Diagnose and perform an initial assessment of the patient and initiate drug therapy orders for the patient. d. Provide a summary to the Pharmacist of the patient's medical condition, medication needs and any other information or specific instructions necessary to assist the Pharmacist in making decisions. e. Be geographically located so as to be able to be physically present daily to provide medical care and supervision and be available through direct telecommunication for consultation, assistance, direction and feedback about the patient's condition. f. Receive, as specified in the Protocol, periodic status reports from the Pharmacist on patients including any services provided to a patient or problems or complications encountered. g. On a monthly basis, review the medical record documentation of all services provided to patients by the Pharmacist. h. At least annually, review the Protocol, services provided to the patient under the Protocol or any patient specific deviations from the Protocol with the Pharmacist and revise the Protocol as necessary. Responsible Party: Supervising Physician C. Responsibilities of Pharmacist
1. The Pharmacist shall: a. Prior to signing a prescription for a Dangerous Drug or instituting Drug Therapy Management, sign a Protocol, and notify the Texas State Board of Pharmacy, on an application provided by the Texas State Board of Pharmacy, that the Supervising Physician has delegated the authority to sign a prescription for Dangerous Drugs. The Pharmacist shall provide the Texas State Board of Pharmacy with a copy of the Protocol. b. Include the name, address and telephone number of the Pharmacist and Supervising Physician on each prescription signed by the Pharmacist. c. Complete required continuing education related to Drug Therapy Management by a provider approved by the Accreditation Council for Pharmacy Education or have engaged in Drug Therapy Management as allowed under previous laws or rules. Thereafter, the Pharmacist shall annually complete required hours of continuing education in Drug Therapy Management as required by the Texas State Board of Pharmacy. d. Establish and maintain a pharmacist-patient relationship with each patient. e. Document patient care activities in the patient's medical record within a reasonable time frame of each activity or intervention. f. As required by the Protocol, provide a status report of the patient to the Supervising Physician including any problem or complication encountered, results of Drug Therapy Management and decisions made. g. Maintain a copy of the Protocol and any deviations from the Protocol ordered by the Supervising Physician for at least 2 years from the date of the record(s). h. At least annually, review the Protocol, services provided to the patient under the Protocol or any patient specific deviations from the Protocol with the Supervising Physician and provide the Texas State Board of Pharmacy with an updated Protocol. Such review shall be documented by the Pharmacist and maintained by the Pharmacist for at least 2 years from the date of the review. Responsible Party: Pharmacist References and Cross-references
Texas Occupations Code, The Texas Medical Practice Act, Chapter 157 Texas Occupations Code, The Texas Pharmacy Act, Chapters 551 and 554 Texas Administrative Code, Title 22, Chapter 193 – "Standing Delegation Orders" Texas Administrative Code, Title 22, Chapter 295 – "Drug Therapy Management by a Pharmacist under Written Protocol of a Physician" Forms and Tools
Delegated Drug Therapy Management Protocol for Pharmacists Approved: May 13, 2014 Effective: May 13, 2014 DELEGATED DRUG THERAPY MANAGEMENT PROTOCOL FOR PHARMACISTS
A. PURPOSE
The purpose of the Delegated Drug Therapy Management Protocol ("Protocol") is to describe the delegation of drug therapy management by the physician to the pharmacist pursuant to the Texas Medical Practice Act and the Texas Medical Board rules. The following physician is authorized to prescribe drugs and is responsible for the delegation of drug therapy management under this Protocol: Name of supervising physician: . The following pharmacist is authorized to dispense drugs and to engage in drug therapy management as delegated by the supervising physician under this Protocol: Name of pharmacist: . B. SCOPE OF DELEGATION
The pharmacist may provide the following drug therapy management in the supervising physician's UNTHealth Practice site: 1. collecting and reviewing patient drug histories, 2. ordering or performing routine drug therapy related patient assessment procedures i ncluding temperature, pulse and respiration, 3. ordering drug therapy related laboratory tests, 4. implementing or modifying drug therapy, including the authority to sign a prescription drug order for the dangerous drugs listed in this Protocol following the di agnosis, initial patient assessment and ordering of drug therapy by a physician, 5. generically equivalent drug selection if the physician's signature does not clearly indicate that the prescription be dispensed as written, or 6. any other drug therapy related act delegated in this Protocol. Referrals to the pharmacist may be made by providers at any UNT Health practice site who recognize a patient meeting the following criteria: 1. Has multiple medications, disease states, or healthcare providers in numerous locations 2. Has difficulty in self-management of medications 3. Has difficulty in adherence to chronic medications or use of devices 4. Has difficulty with access to medications 5. Has significant lack of understanding or knowledge of chronic drug therapy or disease states 6. Is not able to attain goals of therapy (i.e. HgA1c or lipid levels) 7. Other– Assess medication therapy management issues including potential drug – drug & drug -food The pharmacist may provide drug therapy management for the following diseas es and ailments and is authorized to prescribe or modify the following medications: PLEASE CROSS OUT ANY (DISEASES/AILMENTS AND LAB TESTS) THAT DO NOT APPLY
Medications and Devices
Thiazolidinediones Gestational Diabetes alpha-Glucosidase Inhibitors DPP-4 Inhibitors GLP-1 Agonists and SGLT2 Insulins and Insulin Syringes Glucometers and Supplies Metered Dose Inhalers Inhaled Beta Agonists Inhaled/PO Corticosteroids Leukotriene Modifiers HMG-CoA Reductase Inhibitors Bile Acid Resins ARB's and ACE inhibitors, Antiadrenergic Agents Beta Blockers and Diuretics Calcium Channel Blockers Direct Renin Inhibitors Phentermine-Topiramate 5HT2C Receptor Agonists Thyroid USP, Levothyroxine Cardiovascular Disorders Digoxin and Oral Direct Thrombin Inhibitors Wafarin and Other Anticoagulants LMWHs and Factor Xa Inhibitors Nicotine Addiction Bupropion and OTC Products The pharmacist is authorized to order the following tests for drug therapy management:
Lab Tests:
Chem 14
Urine Microalbumin/Creatinine Ratio Urine Microalbumin CBC with differential Triiodothryronine (T3) Thyroxine (T4) Total International Normalized Ratio (INR) Prothrombin Time (PT) Thyroid Stimulating Hormone (TSH) C. PHYSICIAN SUPERVISION, DECISION-MAKING AND DOCUMENTATION
The supervising physician must have a patient physician relationship with all patients before delegating drug therapy management and shall inform the patient that drug therapy will be managed by a pharmacist under a Protocol. Before the pharmacist may initiate any drug therapy management on any patient, the supervising physician shall provide a summary of the patient's medical condition and medication needs to the pharmacist and any other information or specific instructions the physician deems appropriate to assist the pharmacist in making decisions. The supervising physician shall be geographically located so as to be able to be physically present daily to provide medical care and supervision and shall be available through direct telecommunication for consultation, assistance, direction and feedback about the patient's condition. Every 6 months, or more frequently as required by a patient's medical status, the pharmacist shall provide a status report of the patients to the supervising physician including any problem or complications encountered, results of drug therapy management and decisions made by the pharmacist under this Protocol. The supervising physician and pharmacist shall document patient care activities in the UNT Health EMR within a reasonable time of each intervention. D. EMERGENCIES

In the event of an emergency, the pharmacist or supervising physician will provide appropriate care for persons
commensurate with their training, experience and level of expertise and resource s available at the site. 911
emergency services will be utilized as appropriate.

E. QUALITY IMPROVEMENT:
This protocol will be reviewed yearly by the pharmacist and the supervising physician, and revised as necessary. The supervising physician shall review the medical record documentation of all services provided to patients by the pharmacist on a monthly basis. F. EXPIRATION DATE

This protocol shall expire on (DATE). _ Signature of supervising physician Signature of pharmacist _ Date Date

Source: https://app.unthsc.edu/policies/PoliciesPDF/Physician%20Delegation%20to%20Pharmacists%20under%20a%20Drug%20Therapy%20Management%20Protocol.pdf

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Journal of Animal Ecology 2010, 79, 82–87 Differential effects of moving versus stationary territorialintruders on territory defence in a songbird Valentin Amrhein* and Sabine Lerch Research Station Petite Camargue Alsacienne, Rue de la Pisciculture, 68300 Saint-Louis, France, and University of Basel,Zoological Institute, Vesalgasse 1, 4051 Basel, Switzerland 1. In territorial contests, not only acoustic or other signals, but also the movements of a territorialintruder are likely to influence the response of a resident.2. We tested this movement hypothesis by simulating moving vs. stationary intruders into the ter-ritories of winter wrens Troglodytes troglodytes, using the same non-interactive song playbacks inboth treatments.3. Male winter wrens showed a different long-term singing reaction in response to a moving thanto a stationary intruder.4. One day after experiencing an intruder that was switching between three locations, residentsstarted to sing earlier before sunrise, and they sang more and longer songs at dawn than before theintrusion.5. Residents receiving the same playback from one location only reacted by starting to sing laterrelative to sunrise, and by singing fewer and shorter songs than before the intrusion.6. We could not discriminate between the treatments when examining the short-term singing reac-tions during and immediately after the playbacks. However, our results clearly demonstrate aneffect of the spatial behaviour of territorial intruders on the long-term territory defence of residentsat dawn, about 24 h after an intrusion.7. We argue that spatial behaviour of territorial intruders should be an integral part of the studyof animal territory defence behaviour. Investigating long-term changes in territory defence at dawnis a sensitive tool for discriminating between different types of intruders.

Microsoft word - 3d best practice resource guide-jan. 2007 _final_.doc

Developed by: Toronto Best Practice in LTC Initiative January 2007 This resource guide was developed by a sub-committee of the Toronto Best Practice Implementation Steering Committee: Helen Ferley, Co-Chair Administrator Seniors' Health Centre – North York General Hospital Patty Carnegy, Co-Chair Staff Education Coordinator Toronto Homes for the Aged