Current through 2024-38, September 18, 2024
7.1
Use of
safe and acceptable procedures. The administrator shall ensure that all
persons administering medications and treatments (except residents who
self-administer) use safe and acceptable methods and procedures for ordering,
receiving, storing, administering, documentation, packaging, discontinuing,
returning for credit and/or destroying of medications and biologicals. All
employees must practice proper hand washing and aseptic techniques. A
hand-washing sink shall be available for staff administering medications.
[Classes I/II/III]
7.1.1
Residents shall receive only the medications ordered by his/her duly authorized
licensed practitioner in the correct dose, at the correct time, and by the
correct route of administration consistent with pharmaceutical standards.
[Classes I/II/III]
7.1.2 No injectable medications may be
administered by an unlicensed person, with the exception of bee sting kits and
insulin.
7.1.3 Before using a bee
sting kit, unlicensed persons must be trained by a registered professional
nurse in regard to safe and proper use. Documentation of training shall be
included in the employee record.
7.1.4 Unlicensed assistive personnel must be
trained by a registered professional nurse in regard to the management of
persons with diabetes. The registered professional nurse must provide
in-service training and documentation to include:
[Class III]
7.1.4.1 Dietary requirements;
7.1.4.2 Anti-Diabetic Oral Medications -
inclusive of adverse reactions and interventions, hyper and hypo glycemic
reactions;
7.1.4.3 Insulin mixing
including insulin action;
7.1.4.4
Insulin storage;
7.1.4.5 Injection
techniques and site rotation;
7.1.4.6 Treatment and prevention of insulin
reaction including signs/symptoms;
7.1.4.7 Foot care;
7.1.4.8 Lab testing, urine testing and blood
glucose monitoring; and
7.1.4.9
Standard Precautions.
Documentation of training shall be included in the employee
record.
Review of this training shall be on an annual basis.
7.1.5 Urine testing
shall not be done around medication or areas where food is stored or prepared.
Proper Standard Precautions relative to body fluids shall be implemented.
Toilets shall be used for the disposal of urine and test sample waste. Toxic
urine testing chemicals (tablets, solutions) shall be stored in a locked area
totally apart from oral medications.
7.1.6 For those residents whom the facility
is responsible for assistance with medication administration, no medications,
including those brought into the facility by the resident, family or friends,
shall be administered or discontinued without a written order signed by a duly
authorized licensed practitioner or other person licensed to prescribe
medications. [Class III]
7.1.7 Orders for medications and treatments
shall be in writing, signed and dated by a duly authorized licensed
practitioner and shall be in effect for the time specified by the duly
authorized licensed practitioner, but in no case to exceed twelve (12) months,
unless there is a written reorder. Orders for psychotropic medications shall be
reissued every three (3) months, unless otherwise indicated by the duly
authorized licensed practitioner. Standing orders for individual residents are
acceptable when signed and dated by the duly authorized licensed practitioner.
7.1.7.1 Upon admission to another facility,
all existing orders are no longer in effect. Upon return to the facility, all
orders must be reviewed and approved by the resident's duly authorized licensed
practitioner within 72 hours. During that timeframe, orders that are signed and
dated by the discharging duly authorized licensed practitioner are the current
acceptable orders. Prior to admission to another facility all medications must
be removed from service and placed in a locked area in accordance with Section
7.7.
7.2
Administration of medications.
7.2.1
Self-administration. Upon
admission, each individual's ability to self-administer medications will be
determined by an assessment of his/her ability or need for assistance, unless
the resident/legal representative elects (in writing) to have the facility
administer his/her medications. A final decision will be reached between the
resident, his/her legal representative, his/her duly authorized licensed
practitioner and a facility representative.
7.2.2
Medications administered by
facility. For those medications and/or associated treatments for which
the facility is responsible, the following apply:
7.2.2.1 Telephone orders shall be accepted
only by a registered or licensed nurse or pharmacist. Written dated orders for
telephone orders must be signed by the duly authorized licensed practitioner
within five (5) working days.
[Class III]
7.2.2.2 Facsimile orders are acceptable legal
orders as long as they are in compliance with the Commission on Pharmacy
regulations.
7.2.3
Unlicensed assistive personnel. Unlicensed assistive personnel
administering medications and/or treatments must successfully complete training
approved by the Department. There shall be evidence available in the facility
that such training has been successfully completed. Whenever the standards or
guidelines of the medication administration course are substantially revised,
unlicensed personnel must be re-certified within one (1) year of the revision,
by a method approved by the Department. An additional exception will be made on
a case-by-case basis for persons who only administer dietary supplements and/or
minor medicated treatments, shampoos, lotions and creams that could be obtained
over the counter without a physician's order.
A person qualified to administer medications must be on
site at the facility whenever a resident(s) have medications prescribed "as
needed" (PRN) if this medication is not self-administered.
All unlicensed assistive personnel administering
medications and/or treatments must complete a Department-approved eight (8)
hour refresher course biennially for re-certification within two (2) years of
the original certification. [Class III]
7.2.4
PRN Medications.
7.2.4.1
PRN Psychotropic medications.
Psychotropic medications ordered "as needed" by the duly authorized
licensed practitioner, shall not be administered unless the duly authorized
licensed practitioner has provided detailed behavior-specific written
instructions, including symptoms that might require use of medication, exact
dosage, exact time frames between dosages and the maximum dosage to be given in
a twenty-four (24) hour period. Facility staff shall notify the duly authorized
licensed practitioner within twenty-four (24) hours when such a medication has
been administered, unless otherwise instructed in writing by the duly
authorized licensed practitioner.
7.2.4.2 A person qualified to administer
medications must be on site at the assisted living program or residential care
facility whenever a resident(s) have medications prescribed "as needed" (PRN)
if this medication is not self-administered.
In no event, however, shall antipsychotic-type
psychotropic medications be prescribed on a PRN basis only, having no routinely
scheduled and administered doses.
7.3
Medication storage.
7.3.1 Residents who self-administer
medications and who handle their own medical regime may keep medications in
their own room. To ensure the safety of the other residents, the facility will
provide a locked area/container, if necessary. [Class
III]
7.3.2 Medications
administered by the assisted living program or residential care facility shall
be kept in their original containers in a locked storage cabinet. The cabinet
shall be equipped with separate cubicles, plainly labeled, or with other
physical separation for the storage of each resident's medications. It shall be
locked when not in use and the key carried by the person on duty in charge of
medication administration. [Class III]
7.3.3 Medications/treatments administered by
the assisted living program or residential care facility for external use only
shall be kept separate from any medications to be taken internally.
[Class III]
7.3.4
Medications administered by the assisted living program or residential care
facility, which require refrigeration, shall be kept safely stored and separate
from food by placement in a special tray or container, except vaccines, which
must be stored in a separate refrigeration unit that is not used to store food.
Refrigeration shall not exceed forty-one (41) degrees Fahrenheit. A thermometer
shall be used to ensure proper refrigeration. [Class
III]
7.4
Temporary absences. When a temporary absence from the facility is
expected to be greater than seventy-two (72) hours, medications leaving the
facility (except those for resident's who self-administer) must be in a form
packaged and labeled by a pharmacist. For medications leaving the facility for
seventy-two (72) hours or less, the medication shall be packaged in such a way
as to facilitate self-administration or administration by a responsible party
of the correct medication at the appropriate time. Properly certified or
licensed staff will use acceptable methods and procedures for preparing
medications for leaving the facility. Staff will follow the same policies used
in the facility for administering medications. The name of the resident and the
name and strength of each drug, as well as the directions from the original
prescription package, should be conveyed to the resident or their responsible
party along with all cautionary information in writing, either directly on an
envelope containing the appropriate dose or on a separate instruction sheet. If
the medication is sent in original container, pills must be counted and
documented upon leaving and returning to the facility. [Class
III]
7.5
Medication
labeling. Each prescription dispensed by a pharmacy shall be clearly
labeled in compliance with requirements of the Commission on Pharmacy and shall
include at least the following:
7.5.1
Prescription number;
7.5.2
Resident's full name;
7.5.3 Name,
strength and dosage of the drug;
7.5.4 Directions for use;
7.5.5 Name of prescribing duly authorized
licensed practitioner;
7.5.6 Name
and address of issuing pharmacy;
7.5.7 Date of issue of latest
refill;
7.5.8 Expiration date;
and
7.5.9 Appropriate accessory and
cautionary instructions.
7.6
Improperly labeled
medications. For medications administered by the residential care
facility, all pharmaceutical containers having soiled, damaged, incomplete,
incorrect, illegible or makeshift labels shall be returned to the original
dispensing pharmacy for relabeling within two (2) working days or shall be
disposed of in accordance with the requirements contained in Section 7.9.
[Class III]
7.7
Expired and discontinued medications. For all medications
administered by the residential care facility, medications shall be removed
from use and properly destroyed after the expiration date and when
discontinued, according to procedures contained in Section 7.9. They shall be
taken out of service and locked separately from other medications until
reordered or destroyed. [Class III]
7.8
Medication owned by
residents. Prescribed medicines are the property of the resident and
shall not be given to or taken by other residents or any other
person.
7.9
Destroying medications. For medications administered by the residential
care facility, all discontinued medications, expired medications or medications
prescribed for a deceased resident, except controlled substances and individual
doses, shall be destroyed by the administrator or the administrator's designee
and witnessed by one (1) competent person who is not a resident. The
destruction shall be conducted so that no person can use, administer, sell or
give away the medication. Individual unit doses may be returned to the
pharmacist and a credit or rebate made to the person(s) who originally paid for
the medication. Amounts destroyed or returned shall be recorded on the
resident's record, with the signature of the administrator or the
administrator's designee and witness(es). Destruction or return to the pharmacy
shall take place within sixty (60) calendar days of expiration or
discontinuation of a medication or following the death of the resident.
7.10
Schedule II controlled
substances. All Schedule II controlled substances administered by the
residential care facility listed in the Comprehensive Drug Abuse Act of 1970,
Public Law 91-513, Section 202 and as amended pursuant to Section 202 are
subject to the following standards. [Class II]
7.10.1 For all Schedule II controlled
substances, there shall be an individual record in which shall be recorded the
name of the resident, prescription number, the date, drug name, dosage,
frequency and method of administration, the signature of the person
administering it and verification of the balance on hand. [Class
II]
7.10.2 There shall be
a recorded and signed count of all Schedule II controlled substances at least
once a day, if such substances have been used in the facility that day.
[Class II]
7.10.3
All Schedule II controlled substances on hand shall be counted at least weekly
and records kept of the inventory in a bound book with numbered pages, from
which no pages shall be removed. [Class II]
7.10.4 All Schedule II controlled substances
shall be stored under double lock in a separate locked box or cabinet within
the medication cabinet or in an approved double-locked cabinet attached to the
wall. [Class II]
7.10.5 All excess and undesired Schedule II
controlled substances in the possession of a licensed facility that are no
longer required for a resident, shall be disposed of in the following manner.
The Administrator or a licensed or registered nurse shall list all such unused
substances and keep the same in a securely locked area apart from all other
drugs. Disposal shall be in the form of incineration or flushing into the
sewage system only in the presence of an authorized representative of the
Department, a licensed pharmacist, a member of the Commission on Pharmacy or an
authorized representative of the Drug Enforcement Agency. At least one (1) of
the persons must be a person who did not dispense the drug or who was the last
person to inventory the drug. Documentation of such destruction shall be made
on the resident's record and in the inventory record required in Section
7.10.3, signed by the individual authorized to dispose of the drug.
[Class II]
7.11
Bulk supplies. Facilities
may stock in bulk supply those items regularly available without prescription
at a pharmacy.
7.12
Medication/treatment administration records (MAR) for medications administered
by the residential care facility.
7.12.1 Individual medication/treatment
administration records shall be maintained for each resident and shall include
all treatments and medications ordered by the duly authorized licensed
practitioner. The name of the medication, dosage, route and time to be given
shall be recorded in the medication/treatment administration record.
Documentation of treatments ordered and time to be done shall be maintained in
the same manner. These rules apply only to treatments ordered by licensed
health care professionals. [Class III]
7.12.2 Whenever a medication or treatment is
started, given, refused or discontinued, including those ordered to be
administered as needed (PRN), the medication or treatment shall be documented
on the medication/treatment administration record. It shall be initialed by the
administering individual, with the full signature of the individual written on
the first page of each month's MAR. A medication or treatment shall not be
discontinued without evidence of a stop order signed and dated by the duly
authorized licensed practitioner. [Class III]
7.12.3 Medication errors and reactions shall
be recorded in an incident report in the resident's record. Medication errors
include errors of omission, as well as errors of commission. Errors in
documentation or charting are errors of omission. [Class
II]
7.12.4 Administration
of medications ordered as needed (PRN) shall be documented and shall include
date, time given, medication and dosage, route, reason given, results or
response and initials or signature of administering individual. Treatments
ordered PRN shall be documented in the same manner.
7.13
Medication containers.
Graduated medicine containers, for the accurate measurement of liquid
medications, shall be used. If not disposable, medicine containers shall be
returned to the facility's dishwashing unit for sanitization after each use.
Only sterile disposable syringes and needles shall be used for insulin
injection. Disposable medicine containers shall not be reused. [Class
III]
7.14
Breathing
apparatus. When the facility assists a resident with a hand-held
bronchodilator, metered dose nebulizers, intermittent positive pressure
breathing machine or oxygen machine, there shall be documentation of the
following:
7.14.1 The names of staff who are
qualified or trained to use the equipment and/or to mix medications, the nature
of their training, the date and who provided it;
7.14.2 The name of the distributing agency
and the frequency and specific directions for cleaning the equipment;
and
7.14.3 The resident's record
shall contain a copy of the duly authorized licensed practitioner's order,
possible side effects to be monitored, specific instructions as to when the
duly authorized licensed practitioner must be notified regarding side effects
and instructions to the resident on the use of the breathing
apparatus.
7.15 Whenever
a Registered Nurse teaches or provides in-service training to unlicensed
personnel on medical issues, treatments and/or use of medical equipment not
specifically outlined in these regulations, there must be documentation in the
employee file.
7.16 Whenever
employees are in serviced or taught procedures, the use of equipment or
anything else which impacts resident care, there must be documentation in the
employee file. This in service training could be taught by other professionals
including a Physician, Registered Nurse, Practitioner, Dietician, Physical
Therapist, Occupation Therapist, Speech Therapist, product company
representative, or other experts in their field.
