Dr. Eric Fuchs, LAT, ATC, NRAEMT, SMTC
As the revised CAATE 2020 Educational standards are being implemented, athletic trainers are being taught how to administer a wide variety of prescription and over-the-counter (OTC) medications under upon the order of a physician. The medications specifically identified in the new standards include: Oxygen, Insulin, Glucagon, Epinephrine, Albuterol, Naloxone, Glucose Tabs, and Aspirin. (1) Specifically, standard 75 states, “Administer medications or other therapeutic agents by the appropriate route of administration upon the order of a physician or other provider with legal prescribing authority.”(1) As always, educational standards may or may not align with individual state practice acts. The Board of Certification’s (BOC’s) Professional practice Standard 1 states “The athletic trainer renders service or treatment under the direction of or in collaboration with a physician, in accordance with their training and states statutes, rules and regulations.”(3) Furthermore, ambiguity exists when travelling across state lines or country borders, requiring athletic trainers to possess a comprehensive understanding of current state practice act, pharmacy state laws, and federal laws on transportation and administration of medications. The National Athletic Trainers’ Association published a consensus statement in 2009 on athletic trainers handing of medications, and though guidelines and recommendations are introduced, the currency of the information should also be taken into account.(2)
Athletic trainers regulated in a state where one’s practice act allows for medication administration must consider multiple factors to reduce or mitigate liability exposure. Athletic trainers’ function in various types of administrative roles and will need to consider what professional development requirements as well as policies and procedures are to be established so that current staff possess the knowledge and competence to provide medication to patients while adhering to all guidelines. As an example the current Kentucky AT practice act 311.903 effective through December 31, 2020 states athletic trainers “ May dispense, but shall not prescribe, over-the-counter or prescription medications only to an adult athlete and with the supervision of a physician licensed under K.R.S (Kentucky Revised Statutes) Chapter 311.903, and shall maintain accurate records identifying the medication, dose, amount, directions, condition for which the medication is being used, identity of the supervising physician, lot number and expiration date; (3) Shall not dispense over-the-counter or prescription medications to a minor athlete; (4) shall not perform invasive procedures” This creates multiple dilemmas to consider. Can an athletic trainer use an epi-pen or glucagon pen? As (4) clearly states shall not perform invasive procedures but (2) states an athletic trainer can “Dispense” and according to KRS 217.015(9) “Dispense” means to deliver a drug or device to an ultimate user … by or pursuant to the lawful order of a practitioner”. Guidance from one’s directing physician is essential in answering these questions.
Kentucky’s new athletic training practice act SB 125, effective January 1, 2021 requires the establishment of rules and regulations in one section for medications and invasive procedures in KRS 311.903. The regulations for the new KRS 311.903 are in draft and currently posted for public comment at the time of writing. The new draft regulations include the creation of legend medications, which may be obtained, transported, provided and administered by. This proposed language allows an athletic trainer licensed in Kentucky in coordination with a supervising physician, obtain, transport, provide and administer the following legend drugs, which currently includes Albuterol, Atrovent, Oxygen; Nitroglycerin Epinephrine 1:1000 for administration via IM or Epi-Pen; IV Fluids including Normal Saline and Lactated Ringers; Naloxone for IM or nasal; Glucagon IM; D50-Dextrose 50% and D25- Dextrose 25% for IV administration; Flu Vaccine; Lidocaine (1% or 2%) injectable; Bupivacaine (.5%) injectable; Xylocaine (1% or 2%) injectable; Topical Lidocaine; and Dermabond tissue adhesive. The draft language when approved would allow an athletic trainer licensed in Kentucky in coordination with a supervising physician to obtain, transport, provide and administer OTC medications in accordance with the manufacturer’s recommendations or upon physician order.
While Kentucky is used here as an example, athletic trainers and program administrators need to be aware of current state practice act and any pending updates, which may require updates to existing policies, procedures and practices to reduce liability exposure. Failure to provide educational training and operate under contemporary standard of practice for a new state defined scope of practice could create a liability exposure. Understanding what your state practice act and applicable federal laws is critical to decrease liability exposure.
Sources
1. Commission on Accreditation of Athletic Training Education- CAATE (2020), 2020 Standards for Accreditation of Professional Athletic Training Programs - Master’s Degree Programs Adoption date: January 9, 2018 effective July 1, 2020; Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjn3qK59ZjtAhUSQTABHUlGB1EQFjAAegQIBhAC&url=https%3A%2F%2Fcaate.net%2Fwp-content%2Fuploads%2F2018%2F09%2F2020-Standards-for-Professional-Programs-copyedited-clean.pdf&usg=AOvVaw0EPGU621vJKWN8U8lSmbJa
2. National Athletic Trainers’ Association (2009) Consensus Statement: Managing prescriptions and Non-Prescription Medication in the Athletic Training Facility. Retrieved: https://www.nata.org/sites/default/files/managingmedication.pdf
3. Board of Certification (2018) BOC Standards of Professional Practice Version 3.2 Implemented January 2019. Retrieved 11/29/2020 from: https://7f6907b2.flowpaper.com/SOPP012019/#page=1
This blog was written by Dr. Eric Fuchs, LAT, ATC, NRAEMT, SMTC