Current through Register Vol. 30, No. 38, September 20, 2024
A. An
administrator shall ensure that policies and procedures for medication
services:
1. Include:
a. A process for providing information to a
patient about medication prescribed for the patient including:
i. The prescribed medication's anticipated
results,
ii. The prescribed
medication's potential adverse reactions,
iii. The prescribed medication's potential
side effects, and
iv. Potential
adverse reactions that could result from not taking the medication as
prescribed;
b.
Procedures for preventing, responding to, and reporting:
i. A medication error,
ii. An adverse reaction to a medication,
or
iii. A medication
overdose;
c. Procedures
to ensure that a patient's medication regimen is reviewed by a medical
practitioner to ensure the medication regimen meets the patient's
needs;
d. Procedures for
documenting medication administration and assistance in the self-administration
of medication;
e. Procedures for
assisting a patient in obtaining medication; and
f. If applicable, procedures for providing
medication administration or assistance in the self-administration of
medication off the premises; and
2. Specify a process for review through the
quality management program of:
a. A
medication administration error, and
b. An adverse reaction to a
medication.
B. If a behavioral health inpatient facility
provides medication administration, an administrator shall ensure that:
1. Policies and procedures for medication
administration:
a. Are reviewed and approved
by a medical practitioner;
b.
Specify the individuals who may:
i. Order
medication, and
ii. Administer
medication;
c. Ensure
that medication is administered to a patient only as prescribed; and
d. Cover the documentation of a patient's
refusal to take prescribed medication in the patient's medical
record;
2. Verbal orders
for medication services are taken by a nurse, unless otherwise provided by law;
and
3. A medication administered to
a patient is:
a. Administered in compliance
with an order, and
b. Documented in
the patient's medical record.
C. If a behavioral health inpatient facility
provides assistance in the self-administration of medication, an administrator
shall ensure that:
1. A patient's medication
is stored by the behavioral health inpatient facility;
2. The following assistance is provided to a
patient:
a. A reminder when it is time to
take the medication;
b. Opening the
medication container for the patient;
c. Observing the patient while the patient
removes the medication from the container;
d. Verifying that the medication is taken as
ordered by the patient's medical practitioner by confirming that:
i. The patient taking the medication is the
individual stated on the medication container label,
ii. The patient is taking the dosage of the
medication stated on the medication container label or according to an order
from a medical practitioner dated later than the date on the medication
container label, and
iii. The
patient is taking the medication at the time stated on the medication container
label or according to an order from a medical practitioner dated later than the
date on the medication container label; or
e. Observing the patient while the patient
takes the medication;
3.
Policies and procedures for assistance in the self-administration of medication
are reviewed and approved by a medical practitioner or registered
nurse;
4. Training for a personnel
member, other than a medical practitioner or registered nurse, in assistance in
the self-administration of medication:
a. Is
provided by a medical practitioner or registered nurse or an individual trained
by a medical practitioner or registered nurse; and
b. Includes:
i. A demonstration of the personnel member's
skills and knowledge necessary to provide assistance in the self-administration
of medication,
ii. Identification
of medication errors and medical emergencies related to medication that require
emergency medical intervention, and
iii. The process for notifying the
appropriate entities when an emergency medical intervention is
needed;
5. A
personnel member, other than a medical practitioner or registered nurse,
completes the training in subsection (C)(4) before the personnel member
provides assistance in the self-administration of medication; and
6. Assistance in the self-administration of
medication provided to a patient:
a. Is in
compliance with an order, and
b. Is
documented in the patient's medical record.
D. An administrator shall ensure that:
1. A current drug reference guide is
available for use by personnel members;
2. A current toxicology reference guide is
available for use by personnel members; and
3. If pharmaceutical services are provided on
the premises:
a. A committee, composed of at
least one physician, one pharmacist, and other personnel members as determined
by policies and procedures, is established to:
i. Develop a drug formulary,
ii. Update the drug formulary at least once
every 12 months,
iii. Develop
medication usage and medication substitution policies and procedures,
and
iv. Specify which medications
and medication classifications are required to be stopped automatically after a
specific time period unless the ordering medical practitioner specifically
orders otherwise;
b. The
pharmaceutical services are provided under the direction of a
pharmacist;
c. The pharmaceutical
services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18;
and 4 A.A.C. 23; and
d. A copy of
the pharmacy license is provided to the Department upon request.
E. When medication is
stored at a behavioral health inpatient facility, an administrator shall ensure
that:
1. Medication is stored in a separate
locked room, closet, or self-contained unit used only for medication storage ;
2. Medication is stored
according to the instructions on the medication container; and
3.
Policies and procedures are established, documented, and implemented for:
a. Receiving, storing, inventorying,
tracking, dispensing, and discarding medication, including expired
medication;
b. Discarding or
returning prepackaged and sample medication to the manufacturer if the
manufacturer requests the discard or return of the medication;
c. A medication recall and notification of
patients who received recalled medication; and
d. Storing, inventorying, and dispensing
controlled substances.
F. An administrator shall ensure that a
personnel member immediately reports a medication error or a patient's adverse
reaction to a medication to the medical practitioner who ordered the medication
and, if applicable, the behavioral health inpa-tient facility's clinical
director.