Current through Register Vol. 50, No. 9, September 20, 2024
A. The hospice shall provide pharmaceutical
services that meets the needs of the patients.
B. The hospice shall ensure that
pharmaceutical services are provided by appropriate methods and procedures for
the storage, dispensing and administering of drugs and biologicals. Whether
drugs and biologicals are obtained from community or institutional pharmacists
or stocked by the facility, the hospice facility is responsible for ensuring
that pharmaceutical services are provided in accordance with accepted
professional principles and appropriate federal, state, and local
laws.
C. If a pharmacy is to be
constructed within the hospice inpatient facility, plans shall be submitted to
the Board of Pharmacy for Licensing and Registration. The 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 hospice
inpatient facility pharmacy shall have a current controlled dangerous substance
license to dispense controlled substances to patients in the facility. The
pharmacy shall be directed by a registered pharmacist licensed to practice in
Louisiana.
D. Licensed Pharmacist.
The hospice shall employ a licensed pharmacist or have a formal agreement with
a licensed pharmacist to advise the hospice on ordering, storage,
administration, disposal, and record keeping of drugs and
biologicals.
E. Orders for
Medications. A licensed medical practitioners order shall be obtained for all
medication administered to the patient.
1. If
the medication order is verbal, the licensed medical practitioner 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) are to be signed by the prescribing licensed medical practitioner in a
timely manner, not to exceed 30 days.
F. Administering Medications. Patients shall
be accurately identified prior to administration of a medication.
1. Medications are administered only by a
physician, a licensed nurse; or the patient, if his/her attending licensed
medical practitioner has approved self-administration.
2. Orders shall be checked at least daily to
assure that changes are noted.
3.
Drugs and biologicals are administered as soon as possible after dose is
prepared for distribution, not to exceed 2 hours.
4. Each patient has an individual medication
administration record (MAR) on which the dose of each medication administered
shall be properly recorded by the person administering the medication 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, except that 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 Hospice shall have a procedure to define its methods of recording these
medications;
f. medications brought
to the hospice 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 licensed medical
practitioner;
g. medications shall
not be retained at the patients bedside nor shall self-administration be
permitted except when ordered by the licensed medical practitioner. These
medications shall be appropriately labeled and safety precautions taken to
prevent unauthorized usage;
h.
medication errors and drug reactions are immediately reported to the director
of nurses, pharmacist and the licensed medical practitioner, and an entry made
in the patients' medical record and on an incident report in accordance with
facility policy. This procedure shall include recording and reporting to the
licensed medical practitioner the failure to administer a medication, for any
other reason than refusal of a patient to take a medication. The refusal of a
patient to take a medication should be reported during IDT conferences. If
there is adverse consequence resulting from the refusal, this is to be
immediately reported to the director of nurses, pharmacist and licensed medical
practitioner, and an entry made in the patients' medical record and on an
incident report in accordance with facility policy;
i. the nurses station or medicine room for
all hospice inpatient facilities shall have readily available items necessary
for the proper administration and accounting of medications;
j. each hospice shall have available current
reference materials that provide information on the use of medications, side
effects and adverse reactions to drugs and the interactions between
drugs.
G.
Conformance with Medication Orders. Each hospice inpatient facility shall have
a procedure for at least quarterly monitoring of medication administration.
This monitoring may be accomplished by a registered nurse or a pharmacist, to
assure accurate administration and recording of all medications.
1. Each hospice shall establish procedures
for release of patient's own medications upon discharge or transfer of the
patient.
2. Medications shall be
released upon discharge or transfer only upon written authorization of the
attending licensed medical practitioner.
3. An entry of such release shall be entered
in the medical record to include medications released, amounts, who received
the medications and signature of the person carrying out the release.
H. Storage of Drugs and
Biologicals. Procedures for storing and disposing of drugs and biologicals
shall be established and implemented by the inpatient hospice facility.
1. In accordance with state and federal laws,
all drugs and biologicals are stored in locked compartments under proper
temperature controls and only authorized personnel have access to the keys.
Separately locked compartments are provided for storage of controlled drugs
listed in schedule II of the Comprehensive Drug Abuse Prevention and Control
Act of 1970 and other drugs subject to abuse, except under single unit package
drug distribution systems in which the quantity stored is minimal and a missing
dose can be readily detected.
2.
Controlled drugs no longer needed by the patient are disposed of in compliance
with state requirements.
3. There
shall be a secure drug or medicine room/drug preparation area at each nurses'
station of sufficient size for the orderly storage of medications, 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 medication, the room shall be of sufficient size
to accommodate placement of the cart.
4. There shall be a separate area or cubicle
for the storage of each patient's medication, except where a cart is used for
the administration of drugs and biologicals.
5. There shall be an operable 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 dispenser shall be provided.
6. Sufficient artificial lighting shall be
provided and the temperature of the medicine storage area shall not be lower
than 48 degrees Fahrenheit or above 85 degrees Fahrenheit and the room shall be
provided with adequate ventilation.
7. 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.
8.
No foods may 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 should be clearly marked.
9. Medication refrigerators shall not be used
to store laboratory solutions or materials awaiting laboratory
pickup.
10. The drug or medicine
rooms shall be provided with safeguards to prevent entrance of unauthorized
persons including locks on doors and bars on accessible windows.
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. This
Section shall not prohibit storage within the drug or medicine room of approved
poisonous substances intended for legitimate medicinal use, provided that such
substances are properly labeled in accordance with applicable federal and state
law.
11. First aid
supplies shall be kept in a place readily accessible to the person or persons
providing care in the inpatient hospice.
12. Each hospice may maintain one "STAT"
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 apply to such a cabinet.
a.
The contents of the "STAT" medicine cabinet shall be approved by the hospice
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 "STAT" cabinet based upon the established needs of the
hospice.
c. There shall be a list
of the contents of the "STAT" medicine cabinet, including the name and strength
of the drug and the quantity of each.
d. There shall be records available to show
amount received, name of patient and amount used, prescribing licensed medical
practitioner, time of administration, name of individual removing and using the
medication, and the balance on hand.
e. There shall be written procedures for
utilization of the "STAT" medicine cabinet with provisions for prompt
replacement of used items.
f. The
pharmacist shall inspect the "STAT" medicine cabinet 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.
40:2181-2191.
