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May 6, 1996
Civil Division-New Castle County
Mr. James Kaminski
Acting Drug Control Administrator
Delaware State Board of Pharmacy
P.O. Box 637
Dover, DE 19903
Dear Mr. Kaminski:
You asked whether 24 Del. C. 2502 (1)(7) gives pharmacists the authority to draw blood for glucose monitoring and to give immunizations? We conclude that the drawing of blood for glucose monitoring and giving immunizations is not within a pharmacist's practice as set forth in 24 Del. C. § 2502(l)(7).
Section 2502 provides:
(l) "Practice of pharmacy" means the interpretation and evaluation of an authorized prescriber's order. This process shall include, but not be limited to, the proper compounding, dispensing, labeling, packaging and administering of a drug to the patient or his/her agent. The practice shall include the application of the pharmacist's knowledge of pharmaceutics, pharmacology, pharmacokinetics, drug and food interactions, drug product selection and patient counseling. It shall also include:
(7) Monitoring drug therapy to determine if there is any potential problem with doses, combinations of medications ordered or noncompliance with the prescriber's orders.
The practice of pharmacy as legislated in Delaware clearly focuses on the application of pharmaceutical science which is authorized by a prescriber's order. The services of the pharmacist
are performed within the license of the "practice of pharmacy." Drawing blood for glucose testing and giving immunizations are not within the application of pharmaceutical science because such testing requires that the patient's skin be broken by a finger stick procedure to draw blood to complete the test. Likewise immunizations (other than oral vaccines) are given by shot therapy which requires an intramuscular injection. Neither procedure comes within the scope of activity by which pharmacists are licensed.
As stated above, the current law allows for the monitoring of drug therapy founded in the pharmacists knowledge of the product and its use as to the individual patient and the prescriber's order. It is clearly the legislature's intent to protect public safety "in the manufacture, production, sale and distribution of drugs, medication. . . used in the diagnosis and treatment of injury. . ." "The fundamental rule is to ascertain and give effect to the intent of the legislature." See Coastal Barge Corp. v. Coastal Zone Indus., Del. Supr., 492 A.2d 1242(1905): Further, pharmacists certificates are issued within the meaning of the law to retail, compound or dispense drugs, chemicals or poisons as per physician's prescription or as allowed by law. See 24 Del. C. 2521 and 2541.
It should be noted in answering your question that the services at issue fall within the provisions of the Medical Practice and the Nurse Practice Acts of Delaware. Specifically, 24 Del. C. 1703(b) includes the following within its definition of the practice of medicine:
(2) investigate or diagnose or offer to investigate or diagnose any physical or mental ailment, condition or disease of any person, living or dead;
(3) sell or give to suggest, prescribe or direct for the use of any person, any drug, surgery, medicine, appliance or other agent, for the prevention or cure or relief of any ailment or disease of the mind or body or any symptom thereof, or for the cure or relief of any wound, fracture, bodily injury or deformity.
As to the Delaware Nursing Act, 24 Del. C. § 1902(b) defines the practice of nursing as follows in part:
(6) Executing regimens, as prescribed by a licensed physician, dentist, podiatrist or advanced practice nurse, including the dispensing and/or administration of medications and treatments,
(f) "Administration of medications" means a process whereby a single dose of a prescribed drug or biological is given to a patient by an authorized licensed person by 1 of several routes, oral, inhalation, topical, or parenteral.
Accordingly, we conclude that pharmacists may not draw blood for glucose monitering nor give immunizations by injection.
Very truly yours,
Malcolm S. Cobin
Assistant State Solicitor
Loretta G. LeBar
Deputy Attorney General
_____________________________
Michael J. Rich
State Solicitor
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