Current through August 31, 2023
The following requirements must be met: (3-17-22)
01.
Pharmacy Service. That each
SNF has a written agreement with a pharmacist licensed by the state of Idaho to
direct, supervise, and be responsible for pharmacy service in the facility and
for coordinating services when more than one (1) supplier of medications is
utilized by the facility. (3-17-22)
02.
Care of General Medications.
That the care and handling of medications is conducted in the following manner:
(3-17-22)
a. Medications are administered to
residents of the SNF only on the order of a person authorized by law in Idaho
to prescribe medications. This order is recorded on the resident's medical
record, dated and signed by the ordering physician, dentist or nurse
practitioner. (3-17-22)
b. All
telephone and verbal orders are taken by licensed nurses, pharmacists and
physicians only, and recorded on the resident's clinical record, dated and
signed by the person taking the order. Telephone and verbal orders are
countersigned by the ordering physician, dentist or nurse practitioner within
seven (7) days. (3-17-22)
c. No
person other than licensed nursing personnel and physicians administer
medications. This does not include execution of duties of inhalation therapists
as ordered by the attending physician. (3-17-22)
d. Nursing service personnel do not package
or repackage, bottle or label any medication, in whole or in part.
(3-17-22)
e. Prescription
medication is administered only to the resident whose name appears on the
prescription legend. (3-17-22)
f.
All medications are labeled with the original prescription legend including the
name and address of the pharmacy, resident's name, physician's name,
prescription number, original date and refill date, dosage unit, number of
dosage units, and instructions for use and drug name. (Exception: See Unit Dose
System.) (3-17-22)
g. No alteration
or replacement of original prescription legend is allowed. (3-17-22)
h. Prescription renewal or refill is made
only under physician's, dentist's, or nurse practitioner's authorization.
(3-17-22)
i. Drugs dispensed meet
the standards established by the United States Pharmacopeia, the National
Formulary, New Drugs, the Idaho Board of Pharmacy, and the U.S. Food and Drug
Administration. (3-17-22)
j. All
medications in the facility are maintained in a locked cabinet with the key for
the lock carried only by licensed nursing personnel and/or the pharmacist.
(3-17-22)
k. Poisons and toxic
chemicals are stored in separate locked areas apart from medications.
(3-17-22)
03.
Record of Medications. (3-17-22)
a. An accurate and complete record of all
medication given, both prescription and nonprescription, is recorded in the
resident's chart. The record includes the time given, the medication given,
date, dosage, method of administration, and the name and professional
designation (R.N., L.P.N.) of the person preparing and administering the
medication. The first and last name initials may be used if identified fully
elsewhere in the medical record. (3-17-22)
b. Entries are made on the resident's
medication record whenever medications are started or discontinued.
(3-17-22)
c. Reasons for
administration of a PRN medication and the resident's response to the
medication are documented in the nurse's notes. (3-17-22)
04.
Unit Dose Pharmacy. That a
unit dose pharmacy system may be provided in a SNF as the drug distribution
system under the following rules and regulations. (3-17-22)
a. All residents of the facility are served
by the unit dose system. (3-17-22)
b. All medications distributed to the
residents are under the unit dose system, if they are prepared and available in
unit dose. (3-17-22)
c. The unit
dose system is on a signed, written agreement basis between the facility and
the pharmacist. If the facility employs a pharmacist to operate its own
in-house pharmacy, a signed, written agreement is not necessary.
(3-17-22)
d. All medications are
packaged by individual unit dose, and labeled with drug (proprietary and/or
generic) name, unit of dose, and lot identification number or date packaged,
and such other rules that may be promulgated by the Board of Pharmacy. The
pharmacist maintains a log identifying the drug lot number by date packaged.
(3-17-22)
e. The pharmacist (or the
facility) provides suitable drug-distribution cabinets that can be locked, or
in lieu of a locked cabinet, medications are stored in a room that can be
locked. Safe, orderly transport of the drug distribution cabinets are assured
by the pharmacist. (3-17-22)
f. A
direct copy of all medication orders from the resident's chart are supplied to
the pharmacist in a timely manner so that they can maintain each individual
resident's medication profile in the pharmacy from which they fill each
resident's twenty-four (24) hour medication orders. (3-17-22)
g. The pharmacist is responsible to see that
each individual resident's medication drawer is filled from the drug
distribution cabinet each twenty-four (24) hours from the resident's medication
profile; records individual doses not administered from returned sets of
drawers; indicates the reason the medication was not administered; and records
medications supplied for the next twenty-four (24) hour period.
(3-17-22)
h. Designated nursing
staff check each resident's medication drawer contents against their medication
profile prior to distribution to the resident. (3-17-22)
i. The unit dose system is an alternate to
packaging and labeling requirements and does not preclude the facility from
meeting all other requirements of Section
201. (3-17-22)
05.
Customized Medication
Packaging. That the packaging of medications commonly referred to as
"blister paks," "punch cards" and "bingo cards" may be utilized by the facility
provided that measures of accountability, safety and sanitation are employed.
Customized packaging is not to be interpreted to mean a unit dose system. All
other requirements of Section
201 applies except for alternate
packaging systems. (3-17-22)