Standard Protocol and Procedures for Initiating and Dispensing Emergency Contraception by Pharmacists
(a) 26 V.S.A. Chapter 36, Subchapter 7 authorizes licensed pharmacists who have entered a Collaborative Practice Agreement with a physician or other prescriber to initiate and dispense emergency contraception. They may do so pursuant to the protocol set forth below. These rules, forms, and documents adopted herein implement that legislative directive.
(b) Copies of all documents required as part of the emergency contraception protocol and procedures may be obtained from the Department of Health through its website (http://healthvermont.gov) or the Board of Pharmacy through its website (http://vtprofessionals.org)
(c) Adopted as part of these rules are the following forms:
- Form A (pdf) – Vermont Prescriber/Pharmacist Collaborative Practice Agreement and Protocol for Dispensing Emergency Contraception
- Form B (pdf) – Emergency Contraception: Client Informed Consent and Referral
- Form C (pdf) – Emergency Contraception: Key Facts and Instructions for Use in Vermont
1.2 Emergency Contraception Pharmacist Education Program
Prior to initiating emergency contraception drug therapy, a pharmacist must complete an emergency contraception therapy training and education program which is specifically approved by the Vermont Board of Pharmacy as a precondition to entering a Vermont Collaborative Practice Agreement. Only then may the pharmacist enter into a Collaborative Practice Agreement with a physician or other prescriber.
1.3 Collaborative Practice Agreements: Requirements
A pharmacist and physician or other prescriber may enter into a Collaborative Practice Agreement as set forth in Form A. The Agreement sets forth the purpose, limits, and intent of the collaboration.
1.4 Emergency Contraception Collaborative Practice Agreement
(a) The Emergency Contraception Collaborative Practice Agreement must be signed and dated by the prescriber and the pharmacist to be valid.
(b) By executing the Collaborative Practice Agreement, both the pharmacist and the authorized prescriber agree and acknowledge that:
- The licensed pharmacist shall provide the client with drug information concerning dosage, potential adverse side effects, and follow-up contraceptive care as set forth in the forms and documents adopted as part of these rules.
- The Collaborative Practice Agreement shall remain in effect for up to two years and may be renewed for two year periods thereafter, unless terminated prior to that time in writing by either the pharmacist or authorized prescriber.
- Termination must be by written notice to the other.
- Two copies of the Collaborative Practice Agreement will be sent to the Board of Pharmacy who will keep a copy on file and send a copy to the Vermont Department of Health.
- The pharmacist will notify both the Board of Pharmacy and the prescriber if the pharmacist moves to a different practice site during the period of the Collaborative Practice Agreement.
(c) When the Collaborative Practice Agreement expires or is rescinded, the licensed pharmacist shall not have authority to initiate and dispense emergency contraceptives until another Collaborative Practice Agreement is executed.
1.5 Emergency Contraception: Client Informed Consent and Referral
For each client seeking emergency contraception, the pharmacist shall complete a Client Informed Consent and Referral (Form B). The Informed Consent and Referral shall be signed by both the client and the licensed pharmacist.
1.6 Labels for Emergency Contraception
In addition to information required by law, the prescription label placed on the drug therapy product shall identify: 1) the collaborating physician or other prescriber and 2) the pharmacist authorized to initiate and dispense emergency contraception.
1.7 Documents to be Provided by Pharmacist
For each emergency contraception drug therapy initiated pursuant to this protocol, the pharmacist shall provide the client receiving the emergency contraceptive drug with the following original/photocopy:
(a) “Emergency Contraception: Client Informed Consent and Referral” (Form B)
(b) “Emergency Contraception: Key Facts and Instructions for Use” (Form C)
1.8 Client Records
(a) Each emergency contraception therapy prescription authorized herein shall be documented in a client profile.
(b) The Client Informed Consent and Referral (Form B) is considered a “client record” and is subject to client record retention requirements prescribed by law.
(c) Nothing in these rules shall affect the requirements of existing law relating to maintaining the confidentiality of medical records.
1.9 Duties of Collaborating Pharmacists
In addition to the other requirements set forth in these rules, the collaborating pharmacist shall be sensitive to the privacy and emotional needs of those seeking emergency contraception. The collaborating pharmacist shall be aware of Vermont state law reporting requirements relating to vulnerable individuals.