(a) The caregiver
shall, in coordination with the case manager, arrange for resident access to
medical services at all times, including emergency services.
The facility shall have a written policy which specifies the
procedures to be followed in medical emergencies.
(b) Basic first aid supplies and equipment
shall be available at the facility.
(c) In the event of an emergency concerning a
resident such as hospitalization, serious illness, serious bodily harm or
injury, or imminent death or death, the caregiver shall inform the case
manager, who in turn, shall promptly notify the resident's next of kin,
guardian or significant others. The wishes of the resident and the parent or
guardian regarding religious matters shall be considered, and the resident's
wishes shall be followed as closely as possible.
(1) Staff observing an emergency shall
complete a written incident report within twenty-four hours of the emergency
and shall submit it to the case manager within seventy-two hours.
(2) In cases of known or suspected neglect or
abuse, the staff person aware of the situation shall notify the adult
protective services (APS) which is mandated to have the authority to
investigate such incidents, and/or for elderly persons at least sixty-five
years of age, follow procedures as outlined in chapter 349C, HRS.
(d) The caregiver shall develop an
emergency evacuation plan to ensure rapid evacuation of the facility in the
event of fire or other life-threatening situations. The plan shall be posted
and shall include a provision for evacuation drills as follows:
(1) Evacuation drills shall be held at least
monthly and at varied times during the twenty-four hour period. Instruction in
the evacuation procedures shall be given to each new resident upon admission to
the facility.
(2) A written record
of each drill shall be kept on file.
(3) Each resident of the facility shall be
certified annually by a physician that the resident is capable of
self-preservation. A maximum of two residents not so certified may reside in
the facility provided that a staff ratio of one-to-one is maintained, at all
times, for each of these residents and there are no stairways which must be
negotiated by such noncertified residents. As an alternative, the facility
shall install an automatic sprinkler system, as defined in the national fire
protection association's 101 life safety code.
(e) Medications:
(1) All medicines shall be properly and
clearly labeled. The storage shall be in a staff-controlled
workcabinet/workcounter apart from either residents' bathrooms or
bedrooms.
(2) Drugs shall be stored
under proper conditions of sanitation, temperature, light, moisture,
ventilation, segregation, and security. Medications that require storage in a
refrigerator shall be properly labeled and kept in a separate locked
container.
(3) Compartments shall
be provided, for each resident's medications and separated as to:
(A) External use only; and
(B) Internal use only.
(4) All poisons shall be plainly labeled and
stored separately in a locked' cabinet.
(5) All medications and supplements, such as
vitamins, minerals, and formulas shall be made available by written physician
order and shall be based upon current evaluation of the resident's
condition.
(6) All physician orders
shall be reevaluated and signed by the physician every three months or at the
next physician's visit, whichever comes first.
(7) All verbal orders for medication shall be
recorded on the physician's order sheet by the certified caregiver receiving
the verbal orders. Written confirmation from the attending physician shall be
obtained within seventy-two hours.
(8) Only an appropriately trained caregiver
shall be allowed to make available prescribed medications to
residents.
(9) Medications shall
not be offered to any resident other than the one for whom they were
ordered.
(10) Medication errors and
drug reactions shall be reported immediately to the physician responsible for
the medical care of the resident and the case manager. An incident report shall
be prepared within twenty-four hours from the time of the incident and shall be
properly documented in the resident's record.
(11) Discontinued or outdated medications
shall be disposed of by flushing down the toilet.
(12) All medications and supplements, such as
vitamins, minerals, and formulas, shall have written physician's orders and
shall be labeled according to pharmaceutical practices for prescribed items.
When taken by the resident, the date, time, name of drug, and dosage shall be
recorded on the resident's medication record and initialed by the certified
caregiver.
(13) Only oral,
suppository and topical medications shall be made available to the resident for
administration or application. Any injections or intravenous medication shall
be administered by a licensed nurse.
