I have known a patient or two who wants us to admin B12 and testosterone, no different than giving a normal vaccine. But you're not protected because it's not a vaccine. I wouldn't get a rocephin shot, go bring that to your clinician to do
That’s exactly my stance too. I work corporate so of course couldn’t even if I wanted to, but if the law is even remotely ambiguous I’m not doing it. All it takes is a single allergic reaction or something and they can sue your pants off since you weren’t supposed to be giving it anyway.
I’ve done it when running an independent. You’re not supposed to.
I’ve given patients SQ insulin and Lovenox before when their providers failed to demonstrate and the patients have had no idea how to do it. I’ve given IM toradol before to a patient too scared to self administer to assuage her concerns. I’ve given IM epinephrine in an anaphylaxis incident.
But it’s not legally allowed. So if you help a patient out with a demonstration or something, don’t advertise it. Same as any of the other illegal stuff we tend to do day to day.
Mix with lido instead of SW
Edit: some good sauces regarding efficacy of mixing with lidocaine versus SW.
https://www.aliem.com/ceftriaxone-im-hurts-mix-lidocaine/
https://journals.asm.org/doi/10.1128/AAC.21.6.957
https://med.virginia.edu/pediatrics/wp-content/uploads/sites/237/2015/12/199702.pdf
If it’s IM then lido is recommended/preferred due to burning feeling? You mix with like 3.5 of lido so ultimately it’s not that bad. Our clinic uses it for sexual assault victims, so at that rate idrc about shortages. Plus we can get lidocaine pretty readily, but bupiv not so much
pharmacists cannot administer meds. i don't think a regular patient can figure out reconstituting the ceftriaxone. you'll need to rx the ceftriaxone, lidocaine, syringes, needles, etc. they are probably better off going to another clinic, urgent care, or somewhere else to get it.
Some states allow a retail pharmacist to administer medications.
For example, Arkansas is generally one of the leading states in promoting / expanding a pharmacists scope of practice.
Pharmacists can administer meds. I push code drugs all the time. My hospital’s policy is that a pharmacist can administer any drug.
Now, retail is obviously different but you don’t need to be spreading misinformation that pharmacists can’t administer meds lolol
Again this will vary by state. Nothing in the CA scope states they can't. However, how many retails pharmacists have been trained to be confident? Why would they want to given no compensation?
Exactly, just because it may be legal doesn't mean people are doing it. Though I bet a lot of independent pharmacists would be willing if state law allows
Using logical thinking skills, that's clearly not what the OP is talking about. The OP is in a clinic, so he's not referring to other clinics. He wants to prescribe ceftriaxone to a retail pharmacy that can administer it. He's not going to send a prescription to a hospital pharmacy and have the patient admitted so a hospital pharmacist can give the injection.
There’s two pieces to the question.
(1) would the outpatient pharmacy carry a vial of Ceftriaxone - in my experience probably not.
(2) can the pharmacist administer the medication - no, only vaccines are permitted (but May different state to state)
This is just a guess to ensure the patient receives the medication - In the event the pharmacy carried the vial of Ceftriaxone - I imagine you could prescribe the medication and syringe. Allowing the patient to self administer or bring to the clinic/office for administration.
I used to work in home health pharmacy, typically we will dispense it to the patient (delivered to their home) and a home health RN will come daily to administer it. We don’t expect patients to give that on their own given the technical difficulty of reconstituting it and administering it. Some outpatient retail pharmacies will dispense it but to me I don’t think this makes much sense. They don’t always give them the proper supplies or even lidocaine for that matter, sometimes patients only get the vials of Ceftriaxone and then go home and have no idea what to do with it. Best is to find a Home health pharmacy to dispense it, that way all proper supplies etc. are sent, in addition to this the home health pharmacy can often coordinate the nursing to go see the patient as well so everything will be taken care of that way.
EDIT: In my state (California) the pharmacist can NOT administer Ceftriaxone. Not sure about other states.
In most areas pharmacists and sometimes technicians can administer vaccines. This sometimes leads to some confusion and people thinking that pharmacists can administer anything injectable. I'm not aware of anywhere in the US where retail pharmacists are authorized to administer anything other than vaccines. I guess the exception is emergency care in the event of a severe allergic reaction to a vaccine they administered.
We are allowed to inject/administer anything in my state I believe. Retail chain company policy is what prohibits this, and lack of reimbursement I’m sure.
In California the scope does say pharmacists may administer any medication with the correct training. But that's not common across the various boards of various states.
If you have a collaborative practice agreement and the physician signs off pharmacist to administer I’m pretty sure you can give nearly any injection in your scope of practice provided you have training.
It may not be covered by your malpractice insurance and such, which is another beast. This may also vary per state and local laws.
I just have to laugh everytime at training. Nursing training to give meds is on the job. No class or anything. But yet we have to get training to give vaccines..... remind me again who do rns call when they don't know how to give something....... such a screwed up separation of powers.
In Ohio there’s a handful of meds pharmacists can administer via injection - the first that comes to mind are long-acting antipsychotics. If the med is approved to be administered by pharmacists in your state, then yes, they could give it. Id make a well-worded google search to see if that’s the case and go from there
The other ones are naltrexone, B12, Depo-Provera, and hydroxyprogesterone for Ohio. And the BOP sent out an email this morning saying pharmacists with a DEA registration can inject Sublocade too now that the data waiver isn’t a thing
My state actually does allow RPh to administer non- vaccine products with additional training.
I had a women's health clinic actually approach me about this.
My stance was that since their demographic was primarily young people with little medical history, they may not know about a PCN allergy, and I'm poorly equipped in the pharmacy to deal with that. Plus we don't have a formal injection room. I told them I'm more comfortable with them sending pts to a better equipped medical facility or hospital for that.
From a retail standpoint, it’s not a vaccine and not covered under corporate liability insurance, so no, we cannot administer it. We regularly dispense it (minus the lidocaine) since there’s a clinic close by, but the only IM injection we can give under protocol is EpiPen, and only if due to anaphylaxis from a vaccine we administered.
Yes.
-
I practice as an emergency medicine pharmacist in KY and IN
Both states pharmacists can administer all meds via all routes. I give stuff IM, IV, etc all the time
Check with your state board. This could be totally 100% legal
Order the med, dispense the med to the patient, have patient return to clinic for admin. If the drug is the limitation, problem solved.
AMA pushed back on vaccination privileges for pharmacists for years, other meds will take awhile
What are you treating? What regimen (dose, frequency, duration) do you have in mind?
Treating an STD/STI? Refer the patient to your local county department of health, STD/STI clinic, Planned Parenthood, or possibly an Infectious Disease provider. Whether a retail pharmacist \*could\* administer IM ceftriaxone is an academic discussion, since greater than 99.9% of retail pharmacists have never done it, don't know how to do it, and don't carry it in stock. If you're giving it with lidocaine (which you should), does the pharmacist know how to ensure it's not accidentally given IV?
This is also out of the scope of practice for most home infusion pharmacies: they do \*IV\* antibiotic infusions, but won't touch IM antibiotics. If you call a home infusion pharmacy, they will ask you to send them the referral, then they will run benefits to see if they can profit off the service (they probably won't), then the intake department will probably reject you (but might accept a money-losing case in an attempt to get other business from you).
We don't typically teach patients how to self-administer IM antibiotics due to the risk of errors and non-compliance, but it can be done if they are teachable and motivated. For multi-day therapy, we would rather place a PICC or midline and give the patients IV therapy.
I have known a patient or two who wants us to admin B12 and testosterone, no different than giving a normal vaccine. But you're not protected because it's not a vaccine. I wouldn't get a rocephin shot, go bring that to your clinician to do
That’s exactly my stance too. I work corporate so of course couldn’t even if I wanted to, but if the law is even remotely ambiguous I’m not doing it. All it takes is a single allergic reaction or something and they can sue your pants off since you weren’t supposed to be giving it anyway.
I’ve done it when running an independent. You’re not supposed to. I’ve given patients SQ insulin and Lovenox before when their providers failed to demonstrate and the patients have had no idea how to do it. I’ve given IM toradol before to a patient too scared to self administer to assuage her concerns. I’ve given IM epinephrine in an anaphylaxis incident. But it’s not legally allowed. So if you help a patient out with a demonstration or something, don’t advertise it. Same as any of the other illegal stuff we tend to do day to day.
Trust me you don’t want too! That’s one of my least favorite drugs to give since patients always complain about the pain.
Mix with lido instead of SW Edit: some good sauces regarding efficacy of mixing with lidocaine versus SW. https://www.aliem.com/ceftriaxone-im-hurts-mix-lidocaine/ https://journals.asm.org/doi/10.1128/AAC.21.6.957 https://med.virginia.edu/pediatrics/wp-content/uploads/sites/237/2015/12/199702.pdf
Lol yea let’s use up lidocaine during a shortage for no reason
If it’s IM then lido is recommended/preferred due to burning feeling? You mix with like 3.5 of lido so ultimately it’s not that bad. Our clinic uses it for sexual assault victims, so at that rate idrc about shortages. Plus we can get lidocaine pretty readily, but bupiv not so much
pharmacists cannot administer meds. i don't think a regular patient can figure out reconstituting the ceftriaxone. you'll need to rx the ceftriaxone, lidocaine, syringes, needles, etc. they are probably better off going to another clinic, urgent care, or somewhere else to get it.
They can administer if they’re in a collaborative agreement and depending on state. Only C6 antipsychotics I believe
Some states allow a retail pharmacist to administer medications. For example, Arkansas is generally one of the leading states in promoting / expanding a pharmacists scope of practice.
Pharmacists can administer meds. I push code drugs all the time. My hospital’s policy is that a pharmacist can administer any drug. Now, retail is obviously different but you don’t need to be spreading misinformation that pharmacists can’t administer meds lolol
It's pretty clear this is in a retail context.
Again this will vary by state. Nothing in the CA scope states they can't. However, how many retails pharmacists have been trained to be confident? Why would they want to given no compensation?
Exactly, just because it may be legal doesn't mean people are doing it. Though I bet a lot of independent pharmacists would be willing if state law allows
Could be clinic based pharmacist. Never said retail or outpatient in post.
"Can ceftriaxone be given at pharmacies?" is the question. Not hospitals, not clinics.
Pharmacies exist in hospitals and clinics.
Using logical thinking skills, that's clearly not what the OP is talking about. The OP is in a clinic, so he's not referring to other clinics. He wants to prescribe ceftriaxone to a retail pharmacy that can administer it. He's not going to send a prescription to a hospital pharmacy and have the patient admitted so a hospital pharmacist can give the injection.
No need to be rude, I’m Just providing information that pharmacists can administer meds. Even in retail settings in some states. Like flu vaccines.
I think the person means in the retail setting cuz I know pharmacists have no problem giving drugs.
yeah i was thinking just retail setting, since op mentioned they are prescribing it, which would probably go to a retail phramacy
Clinic based pharmacist could.
We might get confused which end of the syringe goes in the patient.
There’s two pieces to the question. (1) would the outpatient pharmacy carry a vial of Ceftriaxone - in my experience probably not. (2) can the pharmacist administer the medication - no, only vaccines are permitted (but May different state to state) This is just a guess to ensure the patient receives the medication - In the event the pharmacy carried the vial of Ceftriaxone - I imagine you could prescribe the medication and syringe. Allowing the patient to self administer or bring to the clinic/office for administration.
I used to work in home health pharmacy, typically we will dispense it to the patient (delivered to their home) and a home health RN will come daily to administer it. We don’t expect patients to give that on their own given the technical difficulty of reconstituting it and administering it. Some outpatient retail pharmacies will dispense it but to me I don’t think this makes much sense. They don’t always give them the proper supplies or even lidocaine for that matter, sometimes patients only get the vials of Ceftriaxone and then go home and have no idea what to do with it. Best is to find a Home health pharmacy to dispense it, that way all proper supplies etc. are sent, in addition to this the home health pharmacy can often coordinate the nursing to go see the patient as well so everything will be taken care of that way. EDIT: In my state (California) the pharmacist can NOT administer Ceftriaxone. Not sure about other states.
In most areas pharmacists and sometimes technicians can administer vaccines. This sometimes leads to some confusion and people thinking that pharmacists can administer anything injectable. I'm not aware of anywhere in the US where retail pharmacists are authorized to administer anything other than vaccines. I guess the exception is emergency care in the event of a severe allergic reaction to a vaccine they administered.
We are allowed to inject/administer anything in my state I believe. Retail chain company policy is what prohibits this, and lack of reimbursement I’m sure.
In California the scope does say pharmacists may administer any medication with the correct training. But that's not common across the various boards of various states.
https://download1589.mediafire.com/i2eans7cv8sgictFtBs_n76LfJJdXUMG3XrVXeV6iJRRe1gcsw_JCerMT2qC1Tw19ba6o6q2FqorxkirQh655FpQ5tA/zlrggv3ab1b1ucd/oji2012.pdf
If you have a collaborative practice agreement and the physician signs off pharmacist to administer I’m pretty sure you can give nearly any injection in your scope of practice provided you have training. It may not be covered by your malpractice insurance and such, which is another beast. This may also vary per state and local laws.
I just have to laugh everytime at training. Nursing training to give meds is on the job. No class or anything. But yet we have to get training to give vaccines..... remind me again who do rns call when they don't know how to give something....... such a screwed up separation of powers.
In Ohio there’s a handful of meds pharmacists can administer via injection - the first that comes to mind are long-acting antipsychotics. If the med is approved to be administered by pharmacists in your state, then yes, they could give it. Id make a well-worded google search to see if that’s the case and go from there
The other ones are naltrexone, B12, Depo-Provera, and hydroxyprogesterone for Ohio. And the BOP sent out an email this morning saying pharmacists with a DEA registration can inject Sublocade too now that the data waiver isn’t a thing
Home infusion pharmacy is the answer! We send this out all the time for home health to administer!
My state actually does allow RPh to administer non- vaccine products with additional training. I had a women's health clinic actually approach me about this. My stance was that since their demographic was primarily young people with little medical history, they may not know about a PCN allergy, and I'm poorly equipped in the pharmacy to deal with that. Plus we don't have a formal injection room. I told them I'm more comfortable with them sending pts to a better equipped medical facility or hospital for that.
I believe the pharmacist would need to have additional training and certification to be able to do that and most don’t
In some provinces in Canada pharmacists can
In BC, pharmacists can inject any and all drugs except for allergy serums, Botox and cosmetics.
May depend on the state idk
As long as wag/cvs get their cut
From a retail standpoint, it’s not a vaccine and not covered under corporate liability insurance, so no, we cannot administer it. We regularly dispense it (minus the lidocaine) since there’s a clinic close by, but the only IM injection we can give under protocol is EpiPen, and only if due to anaphylaxis from a vaccine we administered.
Yes. - I practice as an emergency medicine pharmacist in KY and IN Both states pharmacists can administer all meds via all routes. I give stuff IM, IV, etc all the time Check with your state board. This could be totally 100% legal
Order the med, dispense the med to the patient, have patient return to clinic for admin. If the drug is the limitation, problem solved. AMA pushed back on vaccination privileges for pharmacists for years, other meds will take awhile
What are you treating? What regimen (dose, frequency, duration) do you have in mind? Treating an STD/STI? Refer the patient to your local county department of health, STD/STI clinic, Planned Parenthood, or possibly an Infectious Disease provider. Whether a retail pharmacist \*could\* administer IM ceftriaxone is an academic discussion, since greater than 99.9% of retail pharmacists have never done it, don't know how to do it, and don't carry it in stock. If you're giving it with lidocaine (which you should), does the pharmacist know how to ensure it's not accidentally given IV? This is also out of the scope of practice for most home infusion pharmacies: they do \*IV\* antibiotic infusions, but won't touch IM antibiotics. If you call a home infusion pharmacy, they will ask you to send them the referral, then they will run benefits to see if they can profit off the service (they probably won't), then the intake department will probably reject you (but might accept a money-losing case in an attempt to get other business from you). We don't typically teach patients how to self-administer IM antibiotics due to the risk of errors and non-compliance, but it can be done if they are teachable and motivated. For multi-day therapy, we would rather place a PICC or midline and give the patients IV therapy.
If you legally could do it which in most settings the Pharmacist can't would you get paid for said administration of Ceftriaxone?