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What are the rules and regulations for athletic trainers regarding dispensing, acquiring, and storing drugs in the athletic setting? To answer these questions, each athletic trainer must first contact his or her state attorney general or state licensing board to determine what, if any, laws regulate medications in the athletic training setting. In addition, the athletic trainer should be aware of federal laws and regulations (promulgated primarily by the United States Drug Enforcement Agency [DEA] and the FDA) that govern controlled substances that may be found in the athletic training room.
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There are literally hundreds of federal laws governing the prescription, storage, distribution, and administration of medications. However, athletic trainers should be particularly aware of specific laws that may be applicable in the athletic training setting. For example, any controlled substance in schedules II through V must be securely locked in a structurally sound location to avert theft. All controlled substances found in the athletic training setting must have a complete and accurate written inventory, including the date. If controlled substances are kept in multiple locations, a separate inventory must be on file at each location. Inventory of all controlled substances must be taken at least every 2 years.
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If controlled substances are stored in the athletic training setting and dispensed to athletes, it is suggested the athletic trainer contact the state attorney general (for state law guidance) and the DEA (for federal law information) to determine whether special procedures, registrations, or certificates are required. Usually, the team physician solicits this information, because he or she is ultimately responsible for dispensing controlled substances.
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To avoid legal liability, the athletic trainer should follow some simple procedures. The athletic trainer should document the following information about each drug administered, whether prescription or OTC, in a logbook (Fig. 1–7):
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Name of the athlete/patient
Sport
Age of athlete/patient
Name of drug
Dose given
Quantity prescribed
Indication (why the drug was given)
Manufacturer
Lot number
Drug expiration date
Name of person who dispensed the drug
Date drug was given
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In order to properly monitor drug therapy, all drugs should be in single-dose packages with expiration dates stamped on them. If drugs are purchased in bulk, only a 1-day supply should be dispensed. Drugs so dispensed should be placed in a small, secured envelope labeled with the athlete's name and appropriate directions for use.
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Many athletes self-administer their medications. They may need assistance with this process. To properly assist the athlete in the drug administration process, the athletic trainer should read all package inserts with the athlete and make sure that the athlete understands the directions for use. OTC and prescription medications should never be made freely available for use or distribution without proper supervision. All medications should be kept in locked offices or storage cabinets and should only be dispensed with physician approval and supervision. Failure to follow these guidelines can predispose athletic trainers to undue legal liability.
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Scenario from the Field
An athlete was seen by the team physician for an infected foot. The physician prescribed an antibiotic. An athletic training student was sent to the local pharmacy to pick up the prescription. The athletic training student then delivered the prescription and told the athlete to read the directions on the bottle and take all the pills. Approximately 24 hours later, the athlete developed an allergic reaction to the medication and sought medical attention in a hospital emergency room. How could have this situation been prevented? Who is financially responsible for the emergency room visit? Who is at fault?
Ideally, athletes should pick up their own prescriptions so that they can talk to the pharmacist. The pharmacist should ask the above questions, make sure that the athlete understands how and when to take the medication, and explain possible side effects. If an athlete cannot pick up his or her own prescription, the prescription should be brought to the athletic training setting and be handed to the athlete in the presence of a physician or other qualified medical professional.
At no time should an athletic training student or staff member deliver or dispense medications to an athlete without proper medical supervision. Athletic trainers should encourage their athletes to pick up their own prescriptions so that they can talk directly to a pharmacist, who will make sure that the athlete understands all aspects of the medication. These policies will ensure that all athletes are given proper medical care and decrease the possible legal or ethical responsibility of the athletic training student, staff, or program.
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Scenario from the Field
In your job as an athletic trainer, you often dispense Tylenol No. 3 to athletes who have pain and inflammation associated with athletic injuries. Tylenol No. 3 is a prescription medication, and the team physician regularly brings samples of it to the athletic training setting. However, the team physician does not supervise the dispensing of any medication on a regular basis. If an athlete develops dependence or abuses the medication, who is at fault?
State and federal laws mandate that only a physician is allowed to prescribe drugs. Either a physician or a pharmacist may dispense prescription medications. In this case, the athletic trainer should not dispense any prescription medication without written orders and supervision from the team physician. The head athletic trainer, therefore, can be held liable for any allergic reaction, addiction, or other condition associated with the medication that an athlete subsequently suffers.
To help avoid legal liability, it is recommended that the physician develop a document stating that the athletic trainer is an agent of the physician. This document must include the official name and address of the setting, the name of the physician, his or her license number, and a list of individuals who will be allowed to act as agents under the supervision of the physician. At the discretion of the physician, this document may allow athletic trainers some responsibility to store drugs, keep records, call a local pharmacy for restocking purposes, and perform other duties as appropriate. However, it still will not allow athletic trainers to dispense prescription or controlled medications.
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Implications for Athletic Trainers
In settings where athletes are under the age of 18, it is recommended that the athletic trainer not administer any drug, even an OTC drug. Instead, in this situation, it is recommended that the athletic trainer discuss all medication issues with the athlete's legal guardian. Referrals can then be made to the appropriate medical personnel or pharmacist for specific drug information.
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In the foregoing scenario, an athletic training student was given the task of delivering the medication to the athlete without:
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Determining if the athlete had medical allergies.
Instructing the athlete on the proper administration of the prescription.
Determining if the athlete was currently taking other medications.
Providing information about possible complications from the prescription.
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What to Tell the Athlete
As an athletic trainer, you may encounter athletes who regularly obtain OTC products for care of their injuries. Because OTC products can be purchased without a prescription, many athletes do not know the differences among the various products they can consume to treat their injuries. If you were to become aware that an athlete was consistently or stubbornly taking the wrong OTC medication for an anti-inflammatory effect, what would you tell the athlete?
Let the athlete know which OTC drugs will produce the desired effect and which ones will not.
Explain the need for taking medication only as directed.
Explain how to recognize the symptoms of side effects and how to reduce them, such as by ingesting medication with meals.
Have the athlete consult with his or her physician or pharmacist.
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Internet Resource Box
A variety of Websites can be useful in researching medications and their actions. However, not all Websites are reliable. It is your responsibility to select credible sources about drugs and medicines. The following sites are among the most reliable and accurate sources of online information about medicines.
http://www.fda.gov—United States Food and Drug Administration
http://www.cdc.gov—Centers for Disease Control and Prevention
http://www.nih.gov—National Institutes of Health
http://www.dea.gov—United States Drug Enforcement Agency
http://www.hhs.gov—United States Department of Health and Human Services
http://www.safemedication.com—American Society of Health-System Pharmacists
http://www.pharmacyandyou.org—American Pharmacists Association
http://www.aapcc.org—American Association of Poison Control Centers
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Discussion Topics
Is it the employer's responsibility to provide practicing athletic trainers with all state and national drug laws that pertain to the athletic training profession?
Should controlled substances be kept in the athletic training room?
Should athletic training students be responsible for distributing medications to athletes?
What are some of the advantages and disadvantages of having individual dose packages versus bulk containers of medications?
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Chapter Review
The origins of pharmacy date back to ancient civilizations in which botanicals were used to treat illnesses and injuries.
Pharmacists are educated about all aspects of drugs, injuries, and illnesses.
The FDA, originally established to govern drug uses and abuses, now regulates the approval processes for thousands of medicines.
The Poison Prevention Packaging Act and the Anti- Tampering Act require drugs to have child-resistant and tamper-proof containers.
OTC products are considered safe for the general public; however, not following directions for their use can produce undesired side effects.
All drugs are given one of three derived names—chemical, brand, and generic. The generic name is the one most commonly used, and is preferred by the United States Pharmacopeia.
Brand and generic products of the same drug have the same active ingredients and produce the same desired effects, but may differ in the content of inert ingredients.
When researching information about drugs, there are many valuable sources one can consult, including pharmacists, physicians, and reference texts such as "Drug Facts and Comparisons and the Physician's Desk Reference."
Poison control centers are available 24 hours a day, 7 days a week in case of emergencies.
The athletic trainer should be aware of state and federal laws governing the use, distribution, and storing of medicines in the athletic training setting.
It is the responsibility of the athletic trainer to communicate with athletes and patients about the proper use of medications to alleviate symptoms of athletic injuries.