Current through Register Vol. 50, No. 9, September 20, 2024
A. The
CRCC facility shall ensure that pharmaceutical services are provided under the
directions of a pharmacist licensed to practice in the state of Louisiana. The
facility shall ensure that pharmaceutical services are provided in accordance
with appropriate methods and procedures for the storage, dispensing and
administering of drugs and biologicals. The CRCC facility is responsible for
ensuring that pharmaceutical services are provided in accordance with accepted
professional principles and appropriate federal, state, and local laws, whether
drugs and biologicals are obtained from community or institutional pharmacists
or stocked by the facility. The CRCC shall ensure the appropriate monitoring
and supervision of the pharmaceutical needs of the patient, and have written
policies governing prescribing, administering, controlling, storing and
disposing of all biologicals and drugs.
B. The CRCC shall provide for the
pharmaceutical needs of the patient, consistent with the Board of Pharmacy
regulations.
C. The CRCC shall
institute procedures which protect the patient from medication
errors.
D. CRCC procedures shall
provide verbal and written instructions to patient and family as
indicated.
E. CRCC policies and
procedures shall describe which drugs and treatments are administered by the
agency. All drugs shall be administered in compliance with the needs of the
client and applicable laws and regulations.
F. The CRCC pharmacy shall have a pharmacy
permit issued by the Louisiana Board of Pharmacy to allow ordering, storage,
dispensing, and delivering of legend prescriptive orders. The CRCC shall have a
current controlled dangerous substance license and a DEA registration. Pharmacy
services shall be directed by a registered pharmacist licensed to practice in
Louisiana.
G. A physician must
order all medications for the patient.
1. If
the medication order is verbal, the physician shall give it only to a licensed
nurse, pharmacist, or another physician; and the individual receiving the order
shall record and sign it immediately.
2. All orders (to include telephone and/or
verbal) shall be signed by the prescribing physician in a timely manner, not to
exceed 30 days.
H.
Patients shall be accurately identified prior to administration of a
medication.
1. Medications shall be
administered only by a physician, a licensed nurse, the patient, or the parent
or guardian, if his or her attending physician has approved.
2. Physicians' orders shall be checked at
least daily to assure that changes are noted.
3. Drugs and biologicals shall be
administered as soon as possible after dose is prepared for distribution, not
to exceed two hours.
4. Each
patient shall have an individual medication record (MAR) on which the dose of
each drug administered shall be properly recorded by the person administering
the drug to include:
a. name, strength, and
dosage of the medication;
b. method
of administration to include site, if applicable;
c. times of administration;
d. the initials of persons administering the
medication (the initials shall be identified on the MAR to identify the
individual by name);
e. medications
administered on a "PRN" or as needed basis shall be recorded in a manner as to
explain the reason for administration and the results obtained. The CRCC shall
have a procedure to define its methods of recording these
medications.
f. medications brought
to the CRCC facility by the patient or other individuals for use by that
patient shall be accurately identified as to name and strength, properly
labeled, stored in accordance with facility policy and shall be administered to
the patient only upon the written orders of the attending physician;
g. medications shall not be retained at the
patient's bedside nor shall self-administration be permitted except when
ordered by the physician. These medications shall be appropriately labeled and
safety precautions taken to prevent unauthorized usage;
h. medication errors and drug reactions shall
be immediately reported to the director of nurses, pharmacist and physician and
an entry made in the patients' medical record and/or an incident report. This
procedure shall include recording and reporting to the physician the failure to
administer a drug, for any reason other than refusal of a patient to take a
drug. The refusal of a patient to take a drug shall be reported to the DON and
the physician and an entry made in the patients' medical record;
i. the nurses station or medicine room for
all CRCC facilities shall have readily available items necessary for the proper
administration and accounting of medications;
j. each CRCC facility shall have available
current reference materials that provide information on the use of drugs, side
effects and adverse reactions to drugs and the interactions between
drugs.
I.
Each CRCC facility shall have a procedure for at least quarterly monitoring of
medication administration. This monitoring shall be accomplished by a
registered nurse or a pharmacist, to assure accurate administration and
recording of all medications.
J.
Procedures for storing and disposing of drugs and biologicals shall be
established and implemented by the CRCC facility.
1. In accordance with state and federal laws,
all drugs and biologicals shall be stored in locked compartments under proper
temperature controls and only authorized personnel shall have access to the
keys. A separately locked compartment shall be provided for storage of all
controlled drugs and other drugs subject to abuse.
2. Controlled drugs no longer needed by the
patient shall be disposed of in compliance with state requirements. In the
absence of state requirements, the pharmacist and a registered nurse shall
dispose of the drugs and prepare a record of the disposal. Each CRCC shall
establish procedures for release of patient's own medications upon discharge or
transfer of the patient. An entry of such release shall be entered in the
medical record to include drugs released, amounts, who received the drugs and
signature of the person carrying out the release.
3. There shall be a medicine room or drug
preparation area at each nurses' station of sufficient size for the orderly
storage of drugs, both liquid and solid dosage forms and for the preparation of
medications for patient administration within the unit. In the event that a
drug cart is used for storage and administration of drugs, the room shall be of
sufficient size to accommodate placement of the cart.
4. There shall be a sink provided with hot
and cold water in or near the medicine room or medication preparation area for
washing hands or cleaning containers used in medicine preparation. Paper towels
and soap dispensers shall be provided.
5. Sufficient lighting shall be provided and
the temperature of the medicine storage area shall not be lower than 48°F or
above 85°F and the room shall have adequate ventilation.
6. Drugs and biologicals, including those
requiring refrigeration, shall be stored within the medicine room or shall have
separate locks if outside the medicine room. The refrigeration shall have a
thermometer and be capable of maintaining drugs at the temperature recommended
by the manufacturer of the drug.
7.
No laboratory solutions or materials awaiting laboratory pickup or foods shall
be stored in the same storage area (i.e., cupboard, refrigerator, or drawer)
with drugs and biologicals. The areas designated for drug and biological
storage shall be clearly marked.
8.
The drug or medicine rooms shall be provided with safeguards, including locks
on doors and bars on accessible windows, to prevent entrance by unauthorized
persons.
a. Only authorized, designated
personnel shall have access to the medicine storage area.
b. External use only drugs shall be plainly
labeled and stored separate from drugs and biologicals. No poisonous substance
shall be kept in the kitchen, dining area, or any public spaces or rooms.
Storage within the drug or medicine room of approved poisonous substances
intended for legitimate medical use, provided that such substances are properly
labeled and stored in accordance with applicable federal and state law, shall
not be prohibited.
9.
The CRCC shall develop policies and procedures for maintaining an emergency
medicine cabinet for the purpose of keeping a minimum amount of stock
medications that may be needed quickly or after regular duty hours. The
following rules shall apply to such a cabinet.
a. The contents of the emergency medicine
cabinet shall be approved by the CRCC pharmacist and members of the medical and
clinical staff responsible for the development of policies and
procedures.
b. There shall be a
minimum number of doses of any medication in the emergency medicine cabinet
based upon the established needs of the CRCC facility.
c. There shall be records available to show
amount received, name of patient and amount used, prescribing physician, time
of administration, name of individual removing and using the medication, and
the balance on hand.
d. There shall
be written procedures for utilization of the emergency medicine cabinet with
provisions for prompt replacement of used items.
e. The emergency medicine cabinet shall be
inspected at least monthly replacing outdated drugs and reconciliation of its
prior usage. Information obtained shall be included in a monthly
report.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
40:2175.14(B).
