Current through Reg. 50, No. 187; September 24, 2024
(1) The provider shall develop, implement and
maintain written policies and procedures governing the administration of
medication and the supervision of and assistance with self-administered
medication. These policies and procedures shall include, but not be limited to,
management of the medication administration program, training, inventory
control, accounting, and disposal of medications. In addition, these policies
and procedures shall be consistent with the Comprehensive Drug Abuse Prevention
and Control Act of 1970, 21 U.S.C.; Chapter 893, F.S., the Drug Abuse and
Prevention and Control Act; DEA compliance policy guidelines on disposal of
controlled substances, C.F.R. 21, Title 21, Section 1307.21, Disposal of
Controlled Substances, and related department rules and regulations.
(2) Children shall never be permitted to have
medication in their possession or to take any medication without direct
supervision of an authorized person.
(3) Psychotropic medication shall not be used
as a substitute for treatment, for the convenience of staff, or in quantities
that interfere with the child's treatment progress.
(4) The use of psychotropic medication shall
be described in the child's treatment plan and shall include the desired goals
and outcomes of the medication.
(5)
Informed consent for the administration of psychotropic medication.
(a) Informed consent from the parents or
legal guardian of any child must be obtained by the provider, in accordance
with Section 394.459, F.S., when the dosage
of current approved medications are changed and when the type of medication is
changed.
(b) The requirements for
obtaining express and informed consent for a child in the care and custody of
the state are governed by Section
39.407, F.S.
(6) If the circumstances requiring the
administration of the medication constitute an emergency, such administration
shall be governed by the provisions of Section
743.064 or
394.463(2)(f),
F.S., as applicable.
(7) There
shall be no pro re nata (PRN) orders for psychotropic medications.
(8) There shall be no standing orders for
psychotropic medications.
(9)
Children receiving antipsychotic medications shall be assessed for abnormal
involuntary movements by a physician or registered nurse using a recognized
standardized rating scale upon admission and quarterly thereafter.
(10) Refills for medications shall be ordered
only by a physician or nurse licensed in the state of Florida. Prescriptions
shall be timely refilled to prevent missed dosages.
(11) Administration of medication by
unlicensed staff.
(a) For therapeutic group
homes or residential treatment centers with 12 beds or less, where services are
rendered in a smaller home-like setting, unlicensed staff employed by the
facility, who have satisfactorily completed a competency-based training for
administration of unit dose medication, shall administer prescribed
prepackaged, pre-measured, oral medications, prescribed topical, otic, nasal
and ophthalmic medications in accordance with Section
464.022(1),
F.S.
(b) Medications requiring
subcutaneous or intra-muscular administration and rectal and vaginal
suppository medications will be administered, at a minimum, by a Florida
licensed nurse.
(c) The medication
administration course used to train unlicensed staff shall be eight hours, at a
minimum, in length and must meet the following criteria:
1. The course must consist of at least the
following topics:
a. Basic knowledge and
skills necessary for safe and accurate medication administration and
charting.
b. Roles of the
physician, nurse, pharmacist, and direct care staff in medication ordering,
dispensing, and administration.
c.
Procedures for recording/charting medications.
d. Interpretation of common abbreviations
used in administration and charting of medications.
e. Knowledge of facility medication
system.
f. Safety precautions used
in medication administration and charting.
g. Methods and techniques of medication
administration.
h. Problems and
intervention in the administration of medication.
i. Observation and reporting of medication
side effects and adverse effects.
j. Observation and reporting of effects of
medications including outcomes of psychotropic medication treatment.
k. Documenting and reporting of medication
errors.
l. Appropriate storage of
medications.
2. The
content must be taught by a Florida licensed physician, consulting pharmacist,
physician assistant, advanced registered nurse practitioner, or registered
nurse.
3. Training must be
competency-based and shall consist of lecture and a clinical practicum. This
training shall be documented and such documentation filed in the staff member's
personnel file.
4. During the
practicum, the trainee must be observed twice administering medications error
free during their regularly scheduled medication time. The observation must
include error free charting completed by the trainee after the medication(s)
has been administered. The practicum observations must be made by a Florida
licensed physician, consulting pharmacist, physician assistant, advanced
registered nurse practitioner, or registered nurse.
5. Training regarding the administration of
prescribed topical, otic, nasal and ophthalmic medications will only be
completed by unlicensed staff authorized to do so following competency-based
training and observation of proficiency by a licensed practitioner.
6. Monitoring of medication administration
shall be performed, at a minimum, quarterly by the supervising registered nurse
for each facility. In addition, a Florida registered nurse must be available to
facility staff via telephone or paging device 24 hours per day.
7. At a minimum, four (4) hours of continuing
education is required on an annual basis.
8. When a psychotropic medication is
initiated, a registered nurse or pharmacist will assure or make provisions for
the instruction of the facility staff regarding side effects and adverse
effects of the prescribed medication, including when to notify the physician if
undesirable side effects or adverse effects are observed.
9. All staff identified to receive training
in medication administration must be high school graduates or have passed an
equivalency exam (GED).
(12) Self administration of medication.
(a) For therapeutic group homes or
residential treatment centers with 12 beds or less unlicensed staff employed by
the facility, who have satisfactorily completed competency-based training in
administering medication and supervising children with self administration of
unit dose medication, shall be authorized to supervise with self administration
of prescription and over-the-counter medications.
(b) Only children who have been assessed by a
physician and determined to be capable of self-administering their medications
shall be permitted to do so under the supervision of an authorized person.
Documentation of such assessment and determination shall be filed in the
child's medical records.
(c) Staff
involved with supervising and assisting with the self-administration of
medications shall complete competency-based training of a minimum of four hours
annually by a registered nurse or licensed pharmacist. This training shall be
documented and filed in the staff member's personnel file.
(d) The course shall consist of at least the
following topics:
1. Basic knowledge and
skills necessary for providing supervision for self-administration of
medication;
2. Understanding a
prescription label;
3. Procedures
for recording/charting medications in the medication log;
4. Interpretation of common abbreviations
used in administration and charting of medications;
5. Observation and reporting of side effects,
adverse effects and outcomes of psychotropic medication treatment;
and
6. Recognizing, documenting and
reporting of medication errors.
(e) Upon completion of the course, the
trainee shall be able to demonstrate the ability to:
1. Measure liquid medications, break scored
tablets, and crush tablets in accordance with prescription
directions;
2. Recognize the need
to obtain clarification of an "as needed" prescription order;
3. Recognize a medication order which
requires judgment or discretion, and advise the child, child's health care
provider or facility employer of the inability to assist in the administration
of such orders;
4. Complete a
medication observation record;
5.
Retrieve and store medication; and
6. Recognize the general signs of adverse
reactions to medications and report such
reactions.
(13)
Storage of medications.
(a) All drugs,
including nonprescription drugs, shall be stored under double lock (e.g., a
locked cabinet within a locked room or in a locked container within a locked
cabinet).
(b) External and internal
medications and ophthalmic preparations shall be stored separately from each
other.
(c) Each child's medications
shall be stored separately from each other.
(d) Poisons and other toxic chemicals shall
not be stored in a medication storage area.
(e) No medication shall be repackaged by
facility staff.
(14)
Telephone physician orders for medication may only be accepted by another
physician, a licensed practical nurse, a registered nurse, a physician's
assistant, ARNP or a licensed pharmacist. Telephone orders shall be immediately
recorded in the child's medical record. Faxed physician orders are acceptable
with a physician's signature. The original physician's order must be obtained
within 72 hours of receipt of the faxed order.
Specific Authority
39.407,
394.875(10) FS.
Law Implemented 394.875
FS.
New 7-25-06.
