Alabama Administrative Code
Title 420 - ALABAMA STATE BOARD OF HEALTH
Chapter 420-5-10 - NURSING FACILITIES
Section 420-5-10-.16 - Pharmacy Services

1. Provides consultation on all aspects of the provision of pharmacy services in the facility;

2. Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and

3. Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.

1. The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.

2. The pharmacist must report any irregularities to the attending physician and the director of nursing, and these reports must be acted upon.

1. In accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys.

2. The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.

3. The facility must maintain readily traceable records of receipt and disposition of all controlled drugs.

1. The nursing facility develops policies and procedures for the destruction of drugs and biologicals.

2. Controlled substances and legend drugs dispensed to residents, that are unused because the medication is discontinued, or because the resident dies shall be destroyed within 30 days, except unused legend drugs may be donated to a charitable clinic pursuant to Alabama Administrative Code Chapter 420-11-11, et. seq.

3. Medications of residents transferred to a hospital may be retained until the resident is returned to the facility. Upon return of the resident to the facility, the physician's order will dictate whether or not the resident is to continue the same drug regimen as previously ordered. Medications not reordered by the physician must be destroyed.

4. Medications ordered to be used on an "as needed" basis shall be destroyed after 90 days if they have not been used during that period of time. Medications shall be destroyed upon expiration of the drug.

5. Both controlled substances and non-controlled substances may be destroyed on the premises or may be picked up by an environmental agency that provides such service. Drugs to be destroyed shall not be returned to the drug store for destruction.

6. Records must be completed and maintained by the facility that include:

7. The pharmacist will verity that the list of drugs to be destroyed is accurate and with a Registered Nurse, will carry out destruction. Both will sign the destruction form indicating amounts listed are correct and have been destroyed. For destruction of controlled substances there shall be a third witness who may be a law enforcement official, management or supervisory personnel, i.e., administrator, LPN charge nurse, etc. If medications are to be picked up and destroyed by an environmental agency, the RN should verify the list of drugs to be destroyed and should obtain a signed copy of the destruction form as a receipt.

8. If records of destruction are maintained in resident's medical record, they must be retained for as long as the medical record is kept. If a separate file of destruction records is to be maintained, they must be retained for a period of not less than two years.

1. All containers of medicines and drugs shall be properly and plainly labeled, including name and strength of drug, resident's name, ordering physician, date of filling, directions for administration, prescription number, expiration date, number of tablets or capsules sent and any necessary auxiliary labels. The prescription label shall conform with any additional federal, state and local requirements.

2. Use of and labeling of generic drugs shall comply with State Board of Pharmacy requirements.

3. When authorized substitution of a drug takes place, there will be established policies and procedures to provide accurate identification.

4. Over-the-counter (non-prescription) medicines shall be plainly labeled with the name and strength of the drug. Additional labeling information may be at the discretion of the facility as related in its policies and procedures except that manufacturer's labeling information must be present in the absence of prescription labeling.

5. The contents of all individual prescriptions shall be kept in the original dispensed container bearing the original prescription label.

6. Procedures shall be developed to assure proper control and labeling for medications provided a resident upon leaving the facility on a temporary absence.

7. Unit dose medications shall be packaged according to an acceptable format to include product name, strength, control number, and expiration date. Procedures for utilization of the system used are developed and approved by administration, nursing and pharmacy personnel and must comply with federal and state regulations.

1. Emergency kits may contain controlled substances utilizing the following conditions:

1. Each nursing facility may maintain one "stat" medicine cabinet for the purpose of keeping a minimum amount of stock medications that may be needed quickly or after regular duty hours. If a facility wants more than one "stat" medicine cabinet, it must be approved by the State Board of Health. The following rules apply to such a cabinet: