BILL ANALYSIS
AB 931
Page 1
Date of Hearing: May 5, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 931 (Fletcher) - As Amended: March 26, 2009
SUBJECT : Emergency supplies.
SUMMARY : Increases the number of oral and suppository drugs
stored in emergency drug supply kits at long-term care
facilities from 24 to 48 and authorizes the Department of Public
Health (DPH) to reduce the number of doses of each drug from six
to four.
EXISTING LAW :
1)Authorizes a pharmacy to furnish a dangerous drug or device to
a licensed health care facility for storage in a secure
emergency pharmaceutical supply container maintained in the
facility under specified conditions.
2)Limits the number of oral and suppository drugs provided to a
health facility for storage in a secured emergency container
to 24 different drugs, and authorizes DPH to limit the number
of doses of each drug to six.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the current
limitation on the number of drugs permitted in long-term care
facilities diminishes the availability and ultimately, the
quality of care available to elderly residents who experience
medical emergencies. The author argues this bill will improve
access to critical prescription medications for a vulnerable
population.
2)BACKGROUND . According to the California Pharmacists
Association (CPhA), emergency drug supply kits, or "e-kits",
are containers of prescription drugs maintained to treat
individuals in long term care facilities, according to the
California Pharmacists Association (CPhA), that require
unanticipated urgent care, specifically elderly patients or
patients rehabilitating from major medical events. The drugs
AB 931
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in the kit may also be used to start new medication orders for
patients and may be used in a natural disaster or other times
when drugs cannot be readily accessed by a facility. E-kits
typically include pain medications, antibiotics, and
anti-anxiety medications. The drugs included in each e-kit
vary based on a facility's census and are determined and
approved by a pharmacy and therapeutics committee, comprised
of the director of nurses, the medical director, and the
consultant pharmacist.
3)DRUG SECURITY . E-kits are required by regulation to be
located on each floor of skilled nursing facilities and
intermediate care facilities, or at each nursing station on
each floor. The distribution of the boxes is intended to
maintain a ratio of roughly one box for every 50 patients.
Security measures include coded locking mechanisms and direct
monitoring of each kit by the pharmacist. After any drug is
dispensed, a written record must be entered in the e-kit, and
the supervising pharmacist is required to replace the
dispensed drug within 72 hours. The doses of each drug in the
e-kit are now limited by law to six and under this bill, may
be reduced to four in order to further reduce the risk of
diversion.
4)SUPPORT . According to CPhA, sponsor of this bill, the current
limit of 24 different drugs in each kit means that prescribed
medications are frequently unavailable. More than one
physician often prescribes for patients in the same facility,
which makes it difficult to accommodate multiple physicians
with different drug orders if the available stock is limited
to only 24 drugs. It has been 15 years, notes CPhA, since the
number of drugs in the e-kits has been increased, and many new
and effective medications are now available to treat specific
ailments. Further, CPhA argues that in a catastrophic event,
the selection and level of antibiotics, which averages
approximately 50% of the drugs in e-kits, would not be
adequate to treat frail elderly patients. If specific
medications are not available in the e-kit, the facility is
required by regulation to obtain the drug on a rush order
basis from its contracting pharmacy. The California
Association of Health Facilities, in support of this bill,
believes the measure will protect vulnerable populations like
the elderly and individuals recuperating from major medical
events, and particularly those who reside rural facilities.
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5)PREVIOUS LEGISLATION : AB 3388, Chapter 1060, Statutes of 1994
creates the pharmacy and therapeutics committees and specifies
the dosage limits and limits on the number of drugs in the
e-kits.
REGISTERED SUPPORT / OPPOSITION :
Support
California Pharmacists Association (sponsor)
California Association of Health Facilities
Opposition
None on file.
Analysis Prepared by : John D. Miller / HEALTH / (916)
319-2097