BILL ANALYSIS
AB 931
Page 1
ASSEMBLY THIRD READING
AB 931 (Fletcher)
As Amended March 26, 2009
Majority vote
HEALTH 19-0
-------------------------------------
|Ayes:|Jones, Fletcher, Adams, |
| |Ammiano, Block, Carter, |
| |Conway, De La Torre, De Leon, |
| |Emmerson, Gaines, Hall, |
| |Hayashi, Hernandez, Bonnie |
| |Lowenthal, Nava, |
| |V. Manuel Perez, Salas, Audra |
| |Strickland |
| | |
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SUMMARY : Increases from 24 to 48 the number of oral and
suppository drugs permitted to be stored in emergency drug
supply kits at long-term care facilities.
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 the Department of
Public Health to limit the number of doses of each drug to
four.
FISCAL EFFECT : None
COMMENTS : According to the California Pharmacists Association
(CPhA), emergency drug supply kits, or "e-kits," are containers
of prescription drugs maintained to treat long term care
residents who require urgent care, particularly elderly patients
or patients rehabilitating from major medical events. The drugs
in the kit may also be used to start new medication orders for
patients, in a natural disaster, or at other times when drugs
AB 931
Page 2
cannot be readily accessed from a pharmacy. 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.
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 four in order to reduce the
risk of diversion.
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 provide drugs for multiple drug regimens if the
available stock is limited to 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.
Analysis Prepared by : John D. Miller / HEALTH / (916)
319-2097
FN: 0000589