New state law mandates guidance on prescribed medications
January 3, 2019 (published)
By: Christy Corp-Minamiji, DVM
For The VIN News Service – (article: http://vin.com/doc/?id=8880635)
The death of one small dog sparked a big change in the part of the California Business and Professions Code pertaining to veterinary practice. Under a new law that took effect Tuesday, veterinarians in the state must provide information to their clients on all drugs they prescribe in a counseling discussion similar to a human pharmacy consultation.
In 2016, a Yorkshire terrier named Lizzie, like hundreds of pets every day across the United States, received a shot of a long-acting antibiotic for an infection. The story probably would have ended there had Lizzie not been afflicted with kidney disease. Lizzie had an adverse reaction to the drug, and due to the long-duration nature of the antibiotic and her own damaged kidneys prolonging the effect, Lizzie suffered irreversible complications and died.
Her owner, Solomon Stupp, said he was not told until later that the drug should not be given to dogs with kidney disease, according to a news report. His experience spurred him to form The Lizzie Initiative for Pet Protection to advocate for a legal requirement that veterinarians consistently provide their clients with information about medications, including potential risks, side effects and drug interactions.
In testimony before the California Veterinary Medical Board, Stupp said some veterinarians already do that, but “the problem is that it is not a consistent practice. It is like an option.”
He said providing drug counseling is not a radical idea, but something already done routinely in human medicine. “I am not inventing hot water here,” Stupp said.
State Sen. Jerry Hill, a Democrat from San Mateo, took up the cause in the California legislature, first sponsoring Senate Bill 546 in 2017 then SB 1480 in 2018, which passed and was signed into law on Sept. 19.
The law made several changes to the Business and Professions Code. The Lizzie-inspired addition (section 4829.5) requires veterinarians to provide verbal counseling on every drug prescribed to an outpatient. Veterinarians may offer written information as a supplement and must provide it upon request, but written information cannot substitute for verbal counseling.
Practitioners may delegate the counseling to a registered veterinary technician or to a veterinary assistant and must document whether the client received or declined the counseling.
What’s subject to the counseling requirement are “dangerous drugs,” which include all prescription drugs, according to the state definition.
As specified in the text of the law, the counseling must include:
(1) The name and description of the dangerous drug.
(2) Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3) Any special directions for proper use and storage.
(4) Actions to be taken in the event of a missed dose.
(5) If available, precautions and relevant warnings provided by the drug’s manufacturer, including common severe adverse effects of the drug.
In addition, the law states that:
(b) If requested, a veterinarian shall provide drug documentation, if available.
(c) A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d) It shall be noted in the medical record of the animal patient if the consultation … is provided or declined by the client or his or her agent.
Dr. Lauren Eichstadt, a pharmacist at the University of California, Davis, School of Veterinary Medicine, doesn’t think the counseling provisions will be onerous once veterinarians establish a routine for complying.
She pointed out that language in the law is modeled after human pharmacy law, and that much of the information clinics need to convey is already included on prescription labels.
“The trickiest bit to get used to,” she said, “will likely be the requirement for documenting receipt or decline of counsel.” For this part, Eichstadt suggests using a log or form to list all drugs being prescribed in a visit, and having the client sign it.
As for the requirement to provide written documentation if available, Eichstadt said it “doesn’t mean you need to provide every single available reference.” She added, “Plumb’s is writing medication guidelines that will conform [to the requirement],” referring to Plumb’s Veterinary Drugs, a well-known resource in the profession.
Ultimately, Eichstadt believes the drug-counseling requirement will benefit veterinary practitioners and their patients alike. “This law came from a veterinarian not doing what we are supposed to do,” she said.
Drug counseling: What to cover
Here is an example of the type of information to provide, using carprofen for illustration.
Carprofen – nonsteroidal anti-inflammatory drug (NSAID). This drug helps reduce joint pain due to arthritis.
25 mg tablets
Give one tablet orally (by mouth) one time daily for 10 days.
This drug will last in the system for a day or two after the last dose. The effects may last longer if your pet has liver or kidney disease.
Possible adverse effects include:
gastrointestinal problems such as vomiting, diarrhea and ulcer formation
bleeding due to platelet loss
Risks of adverse effects increase if pet:
is receiving other NSAIDs
is receiving corticosteroids
has a history of stomach ulcers or other gastrointestinal diseases
is receiving drugs that may damage the liver or kidneys
Store at room temperature. Keep out of reach of children and other pets.
In case of a missed dose:
If fewer than eight hours have passed since the dose was due, give the dose and return to the usual schedule.
If more than eight hours have passed since the dose was due, skip and return to the normal schedule with the next scheduled dose.