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Management of Athletes' Medications a Thesis Presented in Partial

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Management of Athletes' Medications a Thesis Presented in Partial Management of Athletes’ Medications A Thesis Presented in Partial Fulfillment of the Requirements for The Degree Masters of Science in the Graduate School of The Ohio State University By Alexis Gore, B.S. Graduate Program in Allied Medicine The Ohio State University 2009 Master’s Examination Committee: Laura Harris, PhD., Advisor Katherine Kelley, PhD Kay Wolf, PhD Jill Clutter, PhD Abstract State and federal violations of prescription (Rx) and over-the-counter (OTC) drug regulations by Athletic Trainers (ATs) and Physicians in all settings can have severe consequences. Anyone who is involved with handling medication must understand the limits of their authority. The penalties for individuals who fail to properly safeguard their actions can be severe and potentially career ending. Unfortunately, there have been many reports and allegations from across the country concerning professional teams, universities, and colleges in regard to inappropriate handling of Rx and OTC medications. Because of this, research has been conducted regarding ATs’ handling of medications with athletes. These studies have yielded controversial results in regards to dispensing medication. Commonly sited potential violations include ATs engaging in drug distribution practices and improperly packaging medication. Due to theses violations further research was needed to help assess to what level ATs in the state of Ohio, who work in a high school or collegiate setting, understand their state rules and regulations in regards to administering and dispensing over the counter drugs. This is significant because some practicing ATs may be unsure of or may disregard the rules of their state statues regarding this topic. This study is classified as a cross-sectional descriptive study that will describe Ohio employed ATs’ knowledge of drug administration and dispensing laws. A questionnaire was developed and electronically administered to a population of athletic ii trainers employed in Ohio colleges/universities and high schools. The demographic data were compiled and analyzed with The Statistical Package for Social Sciences (SPSS). Seven total demographic questions were analyzed by reporting frequencies. The four multiple choice scenarios and four true/false statements were graded to determine if the response was correct or incorrect. Further, test scores were compared by the following demographic variables, title, years of experience, and work setting. The results of the study revealed that one third of the respondents had poor knowledge on the topic and would have failed (scores equal to or less than 5/8) had this been an actual test. It was noticed that there was no difference between knowledge of Head ATs compared to Assistant ATs and that years of experience did not appear to have an impact on knowledge. And lastly, it was revealed that overall athletic trainers who work in the high school settings were least knowledgeable on the survey topic compared to ATs that work in the collegiate setting. Overall it appears that the respondents in this study struggled mostly with issues surrounding minors and being able to differentiate between dispensing versus administering medications. Continuing education in the area of drug dispensing and administration is necessary, as indicated by 96% of the respondents. iii Dedicated to my Mother Valerie and my Father Michael, a constant source of encouragement and strength. iv ACKNOWLEDGMENTS I wish to thank my advisor, Dr. Laura Harris, for inspiring me to become an athletic trainer. I want to thank her for her constant support through the research process as well as the hours of dedication to this thesis. I thank Kathy Kelley for her extensive assistance in instrumentation and feedback regarding the Management of Athletes Medications’ questionnaire. I thank Jill Clutter for her assistance with this research study. I also thank Kay Wolf for her insight into the research process and this thesis. v Vita April 13, 1982…………………..Born, Columbus, Ohio 2006…………………………….B.S. Allied Medicine, The Ohio State University 2007-Present……………………Certified Athletic Trainer, OhioHealth Sports Medicine Fields of Study Major Field: Allied Medicine vi Table of Contents Page Abstract……………………………………………………………………………………ii Dedication………………………………………………………………………………...iv Acknowledgments…………………………………………………………………………v Vita………………………………………………………………………………………..vi List of Tables……………………………………………………………………………..x Chapters: 1. Introduction………………………………………………………………………..1 1.1 Background of the Problem………………………………………….....1 1.2 Statement of the Problem……………………………………………....3 1.3 Purpose of the Study…………………………………………………...4 1.4 Research Objective...…………………………………………………..4 1.5 Significance of the Study……………………………………………...4 1.6 Limitations of the Study………………………………………………5 1.7 Definitions of Terms…………………………………………………..5 2. Literature Review…………………………………………………………………9 2.1 Legal Precedence of Adminstering and Dispensing………...……….11 2.2 Labeling Requirements for Non-Prescription Drugs………...............14 2.3 Medication and Record Keeping…………………………………….15 2.4 Ohio Law…………………………………………………………….16 2.5 Ohio High School Law………………………………………………18 2.6 Ohio Law for Collegiate Facilities…………………………………..20 2.7 Medication and Traveling in a Collegiate Setting…………………...21 3. Methodology…………………………………………………………………….22 3.1 Research Design……………………………………………………..22 3.2 Instrumentation………………………………………………………23 3.3 Data Collection………………………………………………………29 3.4 Data Analysis………………………………………………………...30 3.5 Ethical Issues………………………………………………………...30 vii 4. Results……………………………………………………………………………32 4.1 Questionnaire Results……………………………………………......32 4.2 Summary……………………………………………………………..41 5. Discussion………………………………………………......................................42 5.1 Demographics………………………………………………………..43 5.2 Summary……………………………………………………………..44 5.3 Implications………………………………………………………….46 5.4 Limitations…………………………………………………………...47 5.5 Questions for Future Research……………………………………….49 5.6 Conclusion…………………………………………………………...51 List of References………………………………………………………………………..52 Appendices…………………………………………………………………………….....55 Appendix A-Ohio Revises Codes & Ohio Administration Code……………......55 Appendix B-Federal Regulations Governing Pharmaceutical Care……………..59 Appendix C-Emergency Medical Authorization Form………………………….61 viii List of Tables Table Page 2.1 Federal 8-Point Label……………………………………………………………15 3.1 Percentage of Correct Answers on Test-Retest Administration………………...26 3.2 Changes Between Test Administrations………………………………………...27 3.3 Consistency Between Test Administrations…………………………………….28 4.1 Respondents’ Overall Test Performance………………………………………..35 4.2 Percentage of Correct Responses per Item……………………………………...36 4.3 Percentage of Correct Responses per Item by Position………………………...37 4.4 Percentage of Correct Responses per Years of Service………………………...39 4.5 Percentage of Correct Responses per Work Setting……………………............40 ix CHAPTER 1 INTRODUCTION 1.1 Background of the Problem: Athletic trainers (AT) routinely deal with both over-the-counter (OTC) and prescription (Rx) medications in the performance of their jobs. Some examples of ATs dealing with OTC medications include administering a single dose of Tylenol for a headache or Pepto-Bismol for an upset stomach. It is important to ensure that medical and legal guidelines are followed for the administering and dispensing of all drugs whether OTC or prescription.1 The methods by which drugs may be administered and dispensed vary according to individual state laws. Sports medicine settings are subject to those laws. An AT, unless specifically allowed by state licensure, is not permitted to dispense or administer a prescription drug. Failure to follow this regulation can be a violation of federal laws and state statutes. A violation of these laws could mean legal consequences for the physician, AT, school, school district, or even the league in which an AT’s patient participates.2 In most cases, the team physician is the individual ultimately responsible for prescribing medications. These prescription medications can then be dispensed by either the physician, the physician’s extender licensed to dispense, or the pharmacist. The AT may 1 not dispense medication. It is beyond the scope of practice for ATs.1 However, in most states they may legally administer a single dose of a non-prescription medication. After the Controlled Substances Act was passed, the act that established the authority of the Drug Enforcement Administration (DEA) to prepare rules regarding the proper handling of controlled substances, only individuals and institutions authorized by the state in which they are located can be registered by the DEA to administer, prescribe, or dispense controlled substances. Therefore, when working in a field like sports medicine it is important to make the central point of authority the registered practitioner who retains responsibility for all activities conducted under the DEA registration. Everyone who is involved with handling prescription and controlled substances must understand the limits of his/her practice. The penalties for individuals who fail to properly safeguard registration privileges can be severe.3 Appendix A lists and explains all Revised and Administrative Codes specific to Ohio. The conduct of ATs has both legal and ethical undertones. One would think that acting ethically means acting legally, and vice versa. This is not always the case. It is possible for an act to be ethical but not legal. An example of this could involve an AT providing OTC topical ointment
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