Current through Register Vol. 51, No. 19, September 20, 2024
A. All staff who administer medications to
residents shall have completed the medication administration course that is
taught by a registered nurse who is approved by the Maryland Board of
Nursing.
B. The assisted living
manager shall document completion of the medication technician training in the
personnel file or other readily available record of each unlicensed staff
member who administers medications.
C. All medications shall be administered
consistent with applicable requirements of COMAR 10.27.11.
D. An assisted living manager shall ensure
that the resident's initial assessment process identifies whether a resident:
(1) Is capable of self-administration of
medication;
(2) Is capable of
self-administration of medication, but requires a reminder to take medications
or physical assistance with opening and removing medications from the
container, or both; or
(3) Requires
that medications be administered by the assisted living program staff or by a
spouse or domestic partner of the resident in accordance with §F of this
regulation.
E. For a
resident who is capable of self-administration or, although capable, requires a
reminder or physical assistance, as stated in §D(2) of this regulation,
the assisted living manager shall ensure that the resident is reassessed by the
delegating nurse quarterly for the ability to safely self-administer
medications with or without assistance.
F. While residing in the same assisted living
facility as their spouse or domestic partner, a resident may administer
medications to their spouse or domestic partner providing the following
documentation is maintained in the resident's record:
(1) An initial assessment by their health
care provider documenting the resident's competency and ability to safely
administer medications to their spouse or domestic partner;
(2) Quarterly assessments by the delegating
nurse documenting the resident's continued ability to safely administer
medications to their spouse or domestic partner; and
(3) Current signed medical orders.
G. Medication Review Upon
Admission.
(1) The assisted living manager
shall consult within 14 days of a resident's admission with the individuals set
forth in §G(2) of this regulation to review a new resident's medication
regime.
(2) The medication review
may be conducted by a:
(a) Primary care
physician;
(b) Certified registered
nurse practitioner;
(c) Certified
registered nurse midwife;
(d)
Registered nurse, who may be the delegating nurse; or
(e) Licensed pharmacist.
H. The purpose of the review
required by §G of this regulation is to review with the assisted living
manager or designee:
(1) A resident's current
medication profile, including all prescription and nonprescription medications
and tube feedings;
(2) The
potential that current medications have to act as chemical
restraints;
(3) The potential for
any adverse drug interactions, including potential side effects from the
medications; and
(4) Any medication
errors that have occurred since admission.
I. The assisted living manager, or designee,
shall ensure that the review required by §G of this regulation is
documented in the resident's records, including any recommendations given by
the reviewer.
J. Pharmacy Review.
(1) The assisted living manager of a program
shall arrange for a licensed pharmacist to conduct an on-site review of
physician prescriptions, physician orders, and resident records at least every
6 months for any resident receiving nine or more medications, including over
the counter and PRN (as needed) medications.
(2) The pharmacist's review shall include,
but is not limited to, whether:
(a) The
program is in compliance with Board of Pharmacy's requirements for packaging of
medications;
(b) Each resident's
medications are properly stored and maintained;
(c) Each resident receives the medications
that have been specifically prescribed for that resident in the manner that has
been ordered;
(d) Based on
available information, the desired effectiveness of each medication is
achieved, and, if not, that the appropriate authorized prescriber is so
informed;
(e) Any undesired side
effects, potential and actual adverse drug reactions, and medication errors are
identified and reported to the appropriate authorized prescriber;
(f) The resident has a medical condition as
documented in the resident's records that is not currently being treated by
medication;
(g) There is drug use
without current indication in the resident's records of a medical condition
that warrants the use of the drug;
(h) There is drug overuse that is causing
side effects as documented in the resident records;
(i) Current medication selections result in
inappropriate drug dosage;
(j) The
resident may be experiencing drug interactions;
(k) The resident is receiving medication,
either prescribed or over-the-counter medications, as well as herbal remedies
that could result in drug-drug, drug-food, or drug-laboratory test
interactions;
(l) Administration
times of medication need to be modified to address drug interactions or meal
times, or both;
(m) The resident
records need to be reviewed to assure that periodic diagnostic monitoring
required by certain medications have been performed; and
(n) The resident's medication regimens need
to be reviewed to determine if more cost-effective medications are available to
treat current medical conditions.
(3) The pharmacist shall document the
pharmacy review as required under this section in each resident's chart and
this documentation shall be reviewed every 6 months as part of the assisted
living program's quality assurance activities as required in Regulation .13 of
this chapter.
K. The
person conducting the on-site review under §G or J of this regulation
shall recommend changes, as appropriate, to the appropriate authorized
prescriber and the assisted living manager or designee.
L. If a resident requires that staff
administer medications as defined in Regulation .02B(3) of this chapter, and
the administration of medications has been delegated to an unlicensed staff
person pursuant to COMAR 10.27.11, the assisted living manager shall comply
with COMAR 10.27.11 by arranging for an on-site review by the delegating
registered nurse at least every 45 days. The delegating nurse shall make
appropriate recommendations to the appropriate authorized prescriber, and the
assisted living manager or designee.
M. Safe Storage of Medication. The assisted
living manager, or designee, shall ensure that:
(1) Medications are stored in the original
dispensed container;
(2)
Medications are stored in a secure location, at the proper temperature;
and
(3) The following documentation
is maintained for all residents:
(a) Name of
the resident;
(b) Name of the
medication;
(c) Reason for the
medication;
(d) Dose;
(e) Physician's or authorized prescriber's
name;
(f) Date of
issuance;
(g) Expiration
date;
(h) Refill limits;
and
(i) Directions for
use.
N.
Medications and treatments shall be administered consistent with current signed
medical orders and using professional standards of practice.
O. Required Documentation.
(1) A staff member shall record the
documentation required under §M of this regulation for all residents for
whom medications are administered, or who receive assistance in taking their
medications, as defined by Regulation .02B(3)(b) of this chapter, at the time
that the resident takes or receives medications.
(2) A staff member shall record the
documentation required under §M of this regulation for residents who
self-administer:
(a) Upon admission;
or
(b) When changes in the
resident's medication regimen are ordered by a physician or other authorized
health care practitioner.
P. Accounting for Narcotic and Controlled
Drugs.
(1) Staff shall count and record
controlled drugs, such as narcotics, before the close of every shift.
(2) The daily record shall account for all
controlled drugs documented as administered on the medication administration
record.
(3) All Schedule II and III
narcotics shall be maintained under a double lock system.
