Programs To Treat Allergic Response Or Hypoglycemia


Published: 2015

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The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

PUBLIC HEALTH DIVISION

 


DIVISION 55
PROGRAMS TO TREAT ALLERGIC RESPONSE OR HYPOGLYCEMIA

333-055-0000

Purpose
(1) The purpose
of OAR 333-055-0000 through 333-055-0035 is to define the procedures for authorizing
certain individuals, when a licensed health care professional is not immediately
available, to administer epinephrine to a person who has a severe allergic response
to an allergen, and glucagon to a person who is experiencing severe hypoglycemia
when other treatment has failed or cannot be initiated, and to define the circumstances
under which these rules shall apply.
(2) Severe
allergic reactions requiring epinephrine will occur in a wide variety of circumstances.
Severe hypoglycemia requiring glucagon, in settings where children prone to severe
hypoglycemia are known to lay providers and arrangements for the availability of
glucagon have been made, will occur primarily in, but not limited to, school settings,
sports activities, and camps.
Stat. Auth.: ORS
433.800 & 433.830

Stats. Implemented:
ORS 433.800 - 433.830

Hist.: HD
10-1982, f. & ef. 5-25-82; HD 23-1990(Temp), f. & cert. ef. 8-15-90; OHD
7-1998, f. & cert. ef. 7-28-98; OSHA 4-2012, f. 9-19-12, cert. ef. 1-1-13;
PH 14-2012, f. & cert. ef. 9-19-12
333-055-0006
Definitions
(1) “Allergen”
means a substance, usually a protein, which evokes a particular adverse response
in a sensitive individual.
(2) “Allergic
response” means a medical condition caused by exposure to an allergen, with
physical symptoms that may be life threatening, ranging from localized itching to
severe anaphylactic shock and death.
(3) “Emergency
Medical Services Provider (EMS Provider)" means a person who has received formal
training in pre-hospital and emergency care and is state-licensed to attend to any
ill, injured or disabled person. Police officers, fire fighters, funeral home employees
and other personnel serving in a dual capacity, one of which meets the definition
of "emergency medical services provider" are "emergency medical services providers"
within the meaning of ORS chapter 682.
(4) “Hypoglycemia”
means a condition in which a person experiences low blood sugar, producing symptoms
that may range from drowsiness to loss of muscle control so that chewing or swallowing
is impaired, to irrational behavior in which food intake is resisted, or to convulsions,
fainting or coma.
(5) “Other
treatment” means oral administration of food containing glucose or other forms
of carbohydrate, such as jelly or candy.
(6) “Other
treatment has failed” means the hypoglycemic student’s symptoms have
worsened or the student has become incoherent, unconscious or unresponsive.
(7) “Paramedic”
means a person who is licensed by the Oregon Health Authority as a Paramedic.
(8) “Supervising
professional” means a physician licensed under ORS chapter 677, or a nurse
practitioner licensed under ORS chapter 678 to practice in this state and who has
prescription writing authority.
Stat. Auth.: ORS
433.810

Stats. Implemented:
ORS 433.800 & ORS 433.810

Hist: PH
14-2012, f. & cert. ef. 9-19-12
333-055-0015
Educational
Training
(1) Individuals
to be trained to administer glucagon shall be trained under the supervision of a
physician licensed under ORS chapter 677, or a nurse practitioner licensed under
ORS chapter 678 to practice in this state. The training may be conducted by a registered
nurse licensed under ORS chapter 678 as delegated by a supervising professional.
(2) Individuals
to be trained to administer epinephrine shall be trained under the supervision of
a physician licensed under ORS chapter 677, or a nurse practitioner licensed under
ORS chapter 678 to practice in this state. The training may be conducted by a registered
nurse licensed under ORS chapter 678 as delegated by a supervising professional,
or a paramedic as delegated by an EMS medical director defined in OAR chapter 333,
division 265.
(3) The training
shall be conducted following an Oregon Health Authority, Public Health Division
training protocol (or approved equivalent). The Public Health Division approved
training protocol for emergency glucagon providers is available on the Internet
at http://healthoregon.org/diabetes. The training protocol for the treatment of
severe allergic reaction is available on the Internet at http://healthoregon.org/ems.
Stat. Auth.: ORS
433.810

Stats. Implemented:
ORS 433.800 - 433.830

Hist.: HD
10-1982, f. & ef. 5-25-82; HD 23-1990(Temp), f. & cert. ef. 8-15-90; OHD
7-1998, f. & cert. ef. 7-28-98; PH 10-2004, f. & cert. ef. 3-23-04; PH 14-2012,
f. & cert. ef. 9-19-12
333-055-0021
Eligibility
for Training
In order to be eligible
for training, a person must:
(1) Be 18
years of age or older; and
(2) Have,
or reasonably expect to have, responsibility for or contact with at least one other
person as a result of the eligible person’s occupational or volunteer status,
such as, but not limited to, a camp counselor, scout leader, forest ranger, school
employee, tour guide or chaperone.
Stat. Auth.: ORS
433.810

Stats. Implemented:
ORS 433.820

Hist: PH
14-2012, f. & cert. ef. 9-19-12
333-055-0030
Certificates of Completion of Training
(1) Persons who
successfully complete educational training under OAR 333-055-0000 through 333-055-0035
shall be given a Public Health Division statement of completion signed by the individual
conducting the training. The statement of completion for the treatment of allergic
response training may also be used as an authorization to obtain epinephrine if
fully completed and personally signed by a nurse practitioner or a physician responsible
for the training program. Statements of completion for the treatment of allergic
response training may be obtained from the Oregon Health Authority, Public Health
Division, 800 NE Oregon Street, Suite 290, Portland, Oregon 97232, Phone: (971)
673-1230. A statement of completion for emergency glucagon providers is included
in the training protocol available at http://healthoregon.org/diabetes.
(2) The statement
of completion and authorization to obtain epinephrine form allows a pharmacist to
generate a prescription and dispense an emergency supply of epinephrine for not
more than one child and one adult in an automatic injection device if signed by
a nurse practitioner or physician. Whenever such a statement of completion form
for an emergency supply of epinephrine is presented, the pharmacist shall write
upon the back of the statement of completion form in non-erasable ink the date that
the prescription was filled, returning the statement of completion to the holder.
The prescription may be filled up to 4 times. The pharmacist who dispenses an emergency
supply of epinephrine under this rule shall also reduce the prescription to writing
for his files, as in the case of an oral prescription for a non-controlled substance,
and file the same in the pharmacy.
(3) A person
who has successfully competed educational training in the administration of glucagon
may receive, from the parent or guardian of a student, doses of glucagon prescribed
by a health care professional with appropriate prescriptive privileges licensed
under ORS chapters 677 or 678, and the necessary paraphernalia for administration.
(4) Completion
of a training program and receipt of a statement of completion does not guarantee
the competency of the individual trained.
(5) A statement
of completion and authorization to obtain epinephrine shall expire three years after
the date of training identified on the statement of completion. Individuals trained
to administer epinephrine or glucagon must be trained every three years in accordance
with OAR 333-055-0015 in order to obtain a new statement of completion.
(6) Individuals
trained to administer epinephrine or glucagon may be asked to provide copies of
a current statement of completion to their employers or to organizations or entities
to which they volunteer.
[ED. NOTE: Figures
referenced are available from the agency.]
Stat. Auth.:
ORS 433.810

Stats. Implemented:
ORS 433.800 & 433.830

Hist.: HD
10-1982, f. & ef. 5-25-82; HD 23-1990(Temp), f. & cert. ef. 8-15-90; OHD
7-1998, f. & cert. ef. 7-28-98; PH 10-2004, f. & cert. ef. 3-23-04; PH 14-2012,
f. & cert. ef. 9-19-12
333-055-0035
Circumstances
in Which Trained Persons May Administer Epinephrine or Glucagon
(1) A person who
holds a current statement of completion pursuant to OAR 333-055-0030 may administer,
in an emergency situation when a licensed health care professional is not immediately
available, epinephrine to any person suffering a severe allergic response to an
insect sting or other allergen. The decision to give epinephrine should be based
upon recognition of the signs of a systemic allergic reaction and need not be postponed
for purposes of identifying the specific antigen which caused the reaction.
(2) A person
who holds a current statement of completion pursuant to OAR 333-055-0030 may administer,
in an emergency situation involving an individual who is experiencing hypoglycemia
and when a licensed health care professional is not immediately available, physician-prescribed
glucagon to a person for whom glucagon is prescribed, when other treatment has failed
or cannot be initiated. The decision to give glucagon should be based upon recognition
of the signs of severe hypoglycemia and the inability to correct it with oral intake
of food or drink.
Stat. Auth.: ORS
433.810

Stats. Implemented:
ORS 433.800 - 433.830

Hist.: HD
10-1982, f. & ef. 5-25-82; OHD 7-1998, f. & cert. ef. 7-28-98; PH 10-2004,
f. & cert. ef. 3-23-04; PH 14-2012, f. & cert. ef. 9-19-12
Opiate Overdose
333-055-0100
Purpose
(1) The purpose of OAR 333-055-0100
through 333-055-0110 is to define the protocols and criteria for training on lifesaving
treatments for opiate overdose.
(2) Nothing in these rules
is meant to require training for health care professionals that are otherwise authorized
to administer naloxone within their scope of practice.
(3) Opiate overdose requiring
lifesaving treatment occurs in a wide variety of settings and circumstances, creating
a need for training a variety of overdose responders. In recognition of this need,
Oregon law authorizes a wide range of organizations to provide training on lifesaving
treatments for opiate overdose including public health authorities, and organizations
and other appropriate entities that provide services to individuals who take opiates.
The Oregon Public Health Division interprets providing services to opiate users
broadly and includes but is not limited to clinical, substance abuse, social services,
public health, law enforcement and criminal justice, and other providers.
Stat. Auth: ORS 689.681
Stats. Implemented: ORS 689.681
Hist.: PH 8-2013(Temp), f.
& cert. ef. 7-1-13 thru 12-27-13; PH 12-2013, f. & cert. ef. 11-19-13
333-055-0105
Definitions
Unless otherwise stated in OAR 333-055-0100
through 333-055-0110, or the context of 333-055-0100 through 333-055-0110 requires
otherwise, the following definitions apply to OAR 333-055-0100 through 333-055-0110:
(1) “Certified nurse
practitioner” means a nurse practitioner licensed under ORS chapter 678.
(2) “Licensed physician”
means a physician licensed under ORS chapter 677.
(3) “Opiate”
has the same meaning given that term in Oregon Laws 2013, chapter 340.
(4) “Opiate overdose”
has the same meaning given that term in Oregon Laws 2013, chapter 340.
(5) “Oversight”
means ensuring, through periodic review, that the training on lifesaving treatments
for opiate overdose is consistent with the scope and intent of the protocols and
criteria established by the Oregon Health Authority. ’Oversight’ does
not require the licensed physician or certified nurse practitioner to be present
during the training.
Stat. Auth: ORS 689.681
Stats. Implemented: ORS 689.681
Hist.: PH 8-2013(Temp), f.
& cert. ef. 7-1-13 thru 12-27-13; PH 12-2013, f. & cert. ef. 11-19-13
333-055-0110
Educational Training
(1) Training to administer naloxone
is subject to oversight by a licensed physician or certified nurse practitioner
with prescriptive privileges.
(2) Subject to the oversight
required in section (1) of this rule, training may be conducted by a public health
authority, an organization or other entity that provides services to individuals
who take opiates.
(3) Individuals trained to
respond to opiate overdose must be retrained at least every three years.
(4) The training must meet
the protocols and criteria established by the Oregon Health Authority, Public Health
Division. The approved training protocol and criteria for the treatment of opiate
overdose is available on the Internet at https://public.health.oregon.gov/ProviderPartnerResources/EMSTraumaSystems/Pages/Naloxone-Training-Protocol.aspx
and is incorporated by reference.
Stat. Auth: ORS 689.681
Stats. Implemented: ORS 689.681
Hist.: PH 8-2013(Temp), f.
& cert. ef. 7-1-13 thru 12-27-13; PH 12-2013, f. & cert. ef. 11-19-13
333-055-0115
Certificate of Completion of Training
(1) Persons who successfully complete
opiate overdose response training under OAR 333-055-0000 through 333-055-0115 shall
be given a statement of completion signed by the individual conducting the training.
The statement of completion may be used as an authorization to obtain naloxone from
a licensed pharmacy if fully completed and signed by a nurse practitioner or physician
overseeing the training. The statement of completion for the treatment of opiate
overdose response training is available on the Internet at https://public.health.oregon.gov/ProviderPartnerResources/EMSTraumaSystems/Pages/Naloxone-Training-Protocol.aspx
and is incorporated by reference.
(2) The statement of completion
authorizes a pharmacist to generate a prescription and dispense to the trained individual
doses of naloxone if the statement of completion is signed by a nurse practitioner
or physician. Whenever such a statement of completion is presented, the pharmacist
may generate a prescription and dispense naloxone to the trained individual as specified
under OAR 855-041-2330.
(3) A statement of completion
and authorization to obtain naloxone shall expire three years after the date of
training identified on the statement of completion. Individuals trained to respond
to opiate overdose must be trained every three years in accordance with OAR 333-055-0110
to obtain a new statement of completion.
Stat. Auth: ORS 689.681
Stats. Implemented: ORS 689.681
Hist.: PH 12-2013, f. &
cert. ef. 11-19-13

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