Board Meeting Minutes
Board of Nursing Office
Sioux Falls, SD
Members present: President Arvid Liebe, Lisa Rave, Jeff Nielsen and Diane Dady
Staff present: Executive Director Randy Jones, PDMP Director Ron Huether, Inspectors Gary Karel and Paula Stotz, and Secretaries Melanie Houg and Jony Bruns.
Others present: Al Barber, Golden Living/Alixa Rx; Larry Johnson, Golden Living/Alixa Rx; Bernie Hendricks, SDPhA;
Scott Fjeldheim, P4; Quenton McEntee, Cigna Home Delivery Pharmacy; Chad Sherand, Cigna Home Delivery Pharmacy, Dennis Hedge, SDSU College of Pharmacy; Brian Lounsbery, Walgreens; Mark Gerdes, Omnicare of SD; Angela Johnson, Omnicare of SD
The meeting was called to order by Board President Arvid Liebe at 9:05 a.m. with introductions of board members and others in attendance.
Minutes from the September 16, 2011 were introduced. Rave moved to approve the minutes of the December 9th , 2011 meeting, seconded by Dade. Motion approved.
The financial reports through March 31, 2012 were reviewed. It was noted that approximately 25% of our budget remaining for the balance of the fiscal year. Randy Jones brought to the board’s attention that Incidentals – travel in-state was the use of a personal vehicle which now has been changed to use a state vehicle. A vehicle from the Board of Nursing is being used when our state vehicle is not available. The Board of Nursing then charges our Board for the use. The computer consultant (contractual services) is funds that are reimbursed from the PDMP grant fund. $18,000 went to the support of the electronic SDSU intern database. SDSU IT department will be training the Board of Pharmacy staff in the use of this database. On the second page, it was reported that computer services included the re-installation of servers when the office was relocated, equipment rental included signage for the new office and removal from the previous location, office supplies included promotional material for PDMP, and computer hardware was budgeted under a different code.
On the Revenue Reports by Month, the Federal Grant for the PDMP program was reviewed. President Liebe requested that the electronic fees for pharmacists renewal be summarized with the other pharmacist fees.
- The Board of Pharmacy welcomed Jony Bruns, PDMP secretary to the staff in April. This addition of staff brings the office up to being fully staffed.
- Announcement of Ron Huether’s retirement on July 16, 2012 was made. President Liebe expressed his appreciation for his years of services and the great progress he has made with the board and also noted this leaves a large footprint with the board.
- The Inspectors’ Activity Reports were reviewed. Paula Stotz reviewed two formal complaints. Stotz has also made several stops to promote the use of PDMP on-line access for prescribers and dispensers. Gary Karel reviewed the Sterile Products Guidelines for hood inspections to be done every 6 months (some are done at 1 year intervals), MDV Policy still finds some are at 30 days instead of 28 days and there is a lack of policy for immediate use. Karel pointed out that most PICs know that Carisoprodol is a CIV and baseline inventories are not always being completed. Karel also found a place where clinic staff was coming into hospital and signing out CII and should have filled out a DEA 222 Form. One facility was found to have Potassium Chloride in their KCI storage as stated in their policy but was also found in AMDD. Combat meth permits have been found to be outdated. One location had a change in PIC but did not do a count on CS. Also, one location where biennialinventory had not been done for 29 months. Karel also brought to the attention that a Reverse Distributor had not been licensed with the Board of Pharmacy.
- The 797 survey results-to-date were presented. Information on the report was reviewed. Once all the surveys are returned a copy will be sent out electronically for the board to review.
- A question regarding the advertising being done by Specialty Pharmacy in Sioux Falls was brought up with the concern that diagnosing was being performed at this facility. Randy Jones spoke with this facility and it was clarified that Neuro Science Labs gets UAs directly from the patient via Specialty Pharmacy advice, but the results are reviewed between Neuro Science Labs and the patient. There is no diagnosis being done by Specialty Pharmacy.
- The License Summary was reviewed and the numbers recapped. Noted was one new pharmacist (Courtney Conatser) that completed her licensure within the year of graduation and full time permits included SD Human Services in Custer.
- Applications have been submitted and the following sites have been approved:
- Sanford Chamberlain Hospital Pharmacy; AMDD
- SD Human Services Ctr. Pharmacy; AMDD / Remote Dispensing
- Remote Pick-Up Site; Bon Homme – Avon
- Sanford Aberdeen Hospital; AMDD
- Avera Compounding Pharmacy; Darrel Mutchler PIC
- SD Human Services Ctr. Pharmacy; Pierre; Jeff Heron PIC
- A variance was given to Scott Fjeldhiem, a registered nurse and P4 student. Scott will be allowed to use 130 hours of his nursing experience toward the 260 required internship hours needed to be licensed as a South Dakota pharmacist. President Liebe moved to approve, Jeff Nielson seconded the move. Motion approved.
- Cigna Home Delivery requested a technician variance asking that technicians working on the production floor be exempt from becoming a certified technician as the new guidelines require by July 1st, 2014. These technicians use an automatic filling system/tote system in a baker cell verifying labeled vials with a scanning method. In Cigna Home Delivery’s opinion this staff does not necessarily require the skill of a certified technician. The Board’s opinion was that these technicians would be technicians-in-training for two years which is the approximate time someone is in these positions and that it is important to have personnel registered as technicians as they have access to medications. Nielson refrained from a vote. A vote was deferred until either the July 2012 or September 2012 meeting as Jones will review policies in other states.
- Lewis Drug LTC was granted a one year continuation of their existing variance to supply emergency kits to the jail.
- Medicap Pharmacy in Rapid City had a complaint regarding the right drug for the wrong patient which review of the policies of how technicians bag drug (using clear bag system), person ringing order then verifies with birthdate or other defining characteristic are going to be used.
- Medicine Shoppe in Rapid City had a complaint where it was the correct patient but incorrect drug. The counseling is done after the patient makes the payment instead of before the patient pays which was an opportunity to prevent an error. Secondly two technicians consulted each other on the prescription instead of having the pharmacist verify which would have prevented an error. New procedures were put into place. In both cases the patients wanted apologies and to feel they were being taken care of.
SD Pharmacists Association Report
- Bernie Hendricks reported on behalf of the SDPhA .
- Reported was there are many position openings in South Dakota that have been received and the information has been forwarded to the SDSU P4 students/graduates. There has been a graduating P4 that accepted a position in the Williston, ND area that included sign on bonuses.
- Fiscally the Association remains in good condition.
- Financial and activity reports were provided to board members for their review.
- Dean Hedge, SDSU College of Pharmacy, reported that it is ‘banquet’ season. There is a white coat ceremony this evening for the end of the P1 year with Gary Karel being the keynote speaker. In two weeks is the P4 hooding ceremony in which Randy Jones will administer the pharmacist’s oath. The College of Pharmacy had 232 applications this year with an average 3.78 GPA and 21 ACT score. The pool of candidates has been stable. The admission process is changing slightly as acceptance letters and offers are now going out March 1st instead of April 1st as well as a rolling admission is being used. For a student to secure their spot in the College a $600 fee is needed which will be applied to their tuition. With offers being sent March 1st allows candidates to say yes to more colleges and make a final decision in April. A poll was conducted on the class of 2011, four graduates did not have a job. This year’s graduates have a tighter job market as 20 have not locked in a job upon graduation (this was about a month ago). South Dakota still maintains a 2 + 4 program where other areas are going to a 7 (3+4) or 8 (3+5) year program; this give South Dakota pharmacy students not only a fiscal advantage but also getting a great education. SDSU is #3 in the nation for the NAPLEX testing. The College is doing pre-testing of the NAPLEX to ensure areas that need more attention can be addressed. Residencies will make up about 25% of the graduating class. A community residency program has been set up with Liebe Drug for not only clinical base practice but will also include entrepreneurship training. There will be a dedication of the Lockery Lecture Hall A/B on Thursday, April 26th at 3:00 P.M.
- A letter from the South Dakota Society of Health-System Pharmacists was given to the Board. The letter included the President’s Annual Report 2011-2012 and noted that and annual award known as The Gary W. Karel Lecture Award has been established as the highest lifetime achievement honor in South Dakota health-system pharmacy practice.
- No report was given by the SD Association of Pharmacy Technicians. Their Annual Meeting will be in Pierre on October 6th.
Prescription Drug Monitoring Program (PDMP) – Ron Huether reported that the program has over 700,000 prescriptions in the database. Emphasized was the need to educate the public on the illegal use of medications (such as someone taking medications from a grandparent and the need to secure these medications in a lock box not in common accessible areas on the home. Online access sign up has begun. A packet of instructions to sign up for online access along with program information has been developed and distributed to prescribers and dispensers as opportunities arise. Profiles are also being sent via fax and/or encrypted e-mail to DCI agents and regional DEA agents. There are 20 DCI agents and 4 regional DEA agents who are approved to receive profile information. Our program information will be shared on with NABP’s national format called Inter-connect. This should begin in two to three months. IHS has begun to submit information. Currently the VA is not participating. Some states limit prescribers/dispensers from other states in the ability to receive information. South Dakota does not.
Interim Rules Committee Meeting, December 20, 2011 – Jones asked if there were any questions regarding this meeting. None were brought up.
Omnicare Emergency Kits – A temporary variance was given to Omnicare to allow Emergency Kits to be supplied to their nursing facilities however no letter of confirmation was received. Omnicare asked for an extension of this variance. Rave moved to approve until May 1, 2013. Nielson seconded. Motion carried.
USP / NF 797 Survey Results – previously reviewed in Activity Reports.
SB 24 Background Checks – as of 07/01/2012 any new license issued by DOH will require a background check (Pharmacists for Board of Pharmacy). Independent of SB 24, President Liebe posed a question related to new board staff hires or newly appointed board members and if we should require a background check. It was asked that this be put on the July meeting agenda.
HB 1009 – The governor of South Dakota requested that any law that is no longer necessary be repealed. Meeting these criteria was the poison and nonprescription permits. Both were repealed with the last legislative session. Effective date is 07/01/2012.
Golden Living Center, Remote AMDD – A discussion was held regarding the use of an AlixaRx machine (remotely operated dispensing machine) to provide just-in-time medications for patients at their facilities in South Dakota beginning in March 2013. Medications are dispensed into packets which are then put into a medicine cart for distribution to the patients. A registered Technician would fill the machines by being supervised remotely by a pharmacists and a nurse present at the facility. Topics covered included diversion, recalls, expired medications, cost effectiveness, patient choice of pharmacy, use of controlled substances, billing, the elimination of nurses counting the medications, and variances in other states. Golden Living Center will return for the Fall Meeting for more discussion of the use of an AlixaRx machine. This summer, Golden Living will also have available a video and other information that will be provided to the board.
Future Meetings – Board member and staff will participate in upcoming meetings:
- July 13, Aberdeen
- September 20, Deadwood (change to Thursday meeting instead of Friday)
- December 7, Sioux Falls
Recent Meetings – Board members and/or staff that attended recent meetings gave brief reports on those meetings:
- Various PDMP Presentations and Exhibits have been presented by Huether
- NABP MPJE Item Writing Workshop in Chicago, March 22-23 attended by Jones
- HID User’s Meeting (PDMP) will be held in Atlanta May 15-17 with Huether and Jill Vanderbush attending
- NABP 108th Annual Meeting will be in Philadelphia May 19-22; Jones, Liebe, and Dady will attend
The meeting was adjourned at 2:30 p.m. Nielson motioned, Dady seconded, motion carried.