Article XXXV - INSTITUTIONAL EMERGENCY MEDICATION KIT PERMITS (FIRST DOSE KITS) FOR LONG TERM CARE FACILITIES AND OTHER APPROVED INSTITUTIONAL FACILITIES1. Institutions, excluding hospitals, that desire to maintain a stock of prescription drugs provided by a supplying pharmacy for emergency use by patients who are confined to the institution, shall obtain an Institutional Emergency Medication Kit (IEMK) permit from the Mississippi Board of Pharmacy. Emergency use is the procurement of non-patient assigned medications from a stock supply for the purpose of initiating medication therapy or supplying non-routine medications to provide for optimal patient care. Emergency kits as described in this article are not crash carts that are maintained by the institution for resuscitative care A. Permit. The IEMK permit shall be classified as either a Manual IEMK or an Automated IEMK. The manual IEMK permit is required if the dispensing method is such that the release of each individual dose is not electronically integrated to the documentation required for each such release. An Automated IEMK permit shall be required if the dispensing method is such that the release of each individual dose is electronically integrated to the documentation required for each such releases. Only one (1) type of permit, either Manual or Automated, shall be issued per facility.B. Application for an IEMK permit shall be on a form supplied by the Board. The Application for a Manual IEMK permit shall be accompanied by a fee of One Hundred Dollars ($100.00) and the Application for an Automated IEMK permit shall be accompanied by a fee of Three Hundred Dollars ($300.00). A separate permit shall be required for each IEMK and shall be renewed biennially. The Administrator (if a nursing home or other long-term care facility) or business manager of the institution shall make application for the IEMK permit. In the event of a change of the administrator or business manager, a new permit must be obtained. Any IEMK permit renewal application postmarked after December 31 of the renewal period shall be returned and a Fifty Dollar ($50.00) late renewal fee shall be assessed prior to renewal.C. IEMK Inventory and Accountability(1) The contents of the IEMK are supplied by a pharmacy permitted by the Board. Only one supplying pharmacy may be utilized per facility;(2) The contents of the IEMK are jointly determined by the consultant pharmacist, medical director, director of nurses and the pharmacist supplying the IEMK;(3) The IEMK shall have a "par value" for each prepackaged product that is stored in the IEMK;(4) A copy of the inventory of the IEMK is on file in the institution and at the provider pharmacy and a physical inventory shall be taken at least annually;(5) A Manual IEMK permit authorizes an inventory up to sixty (60) medication items with a limit on the quantity (or par value) to no more than fifteen (15) units each of the sixty (60) medication items. A facility may choose to increase six (6) of the medication items to a maximum of thirty (30) units for those six (6) items. A maximum of ten (10) medication items may be controlled substances with a maximum limit of ten (10) units each. A facility that requires more than one manual IEMK based on facility design or divergent patient populations may request consideration for an additional manual permit. Without multiple permits, manual IEMK's are globally restricted to the total quantity and drug counts for all kits combined. An Automated IEMK permit shall not have any limits on the quantity of the inventory, except controlled substances shall be limited to a maximum of twenty (20) medication items with a maximum limit of twenty (20) units each; each automated IEMK location requires an additional permit for the facility. (6) An IEMK withdrawal log shall be maintained at the institution and all withdrawals of medications from the IEMK shall be documented as follows: (a) name and room number of resident/patient;(b) drug name, strength, and number of units withdrawn;(c) date and time of withdrawal; and(d) name of person withdrawing the medication.2. Use. Emergency kit medications shall be administered to patients only for emergencies and when medications are otherwise unavailable pursuant to a valid medication order or prescription. Providing a patient starting dose(s) of a new medication regimen would be considered a valid emergency. Controlled substances may only be administered by licensed healthcare professionals.3. Storage and Security. The IEMK shall be maintained in a securely locked room or cabinet at the institution. Access to the contents of the IEMK shall be limited to those licensed personnel designated by the director of nurses and the provider pharmacist.4. Controlled Substances. An IEMK that contains controlled substances as allowed per 45 FR24128 (Schedule II, III, IV and V) shall be subject to the following:A. The institution has been issued a controlled substance registration by the Mississippi Board of Pharmacy;B. Controlled substances are stored in a separate locked container; andC. The withdrawal of controlled substances shall comply with the Mississippi Pharmacy Practice Regulations and the Drug Enforcement Administration Regulations which includes a signed prescription by the provider. Miss. Code. tit. 30, pt. 3001, art. XXXV