Current through Register Vol. 39, No. 6, September 16, 2024
(a) The
facility shall ensure that medications are administered in accordance with
applicable occupational licensure regulations and manufacturer's
recommendations.
(b) The facility
shall ensure that each patient's drug regimen is free from drugs used in
excessive dose or duplicative therapy, for excessive duration or without
indications for the prescription of the drug. Drugs shall not be used without
monitoring or in the presence of adverse conditions that indicate the drugs'
usage should be modified or discontinued. As used in this Paragraph:
(1) "Excessive dose" means the total amount
of any medication (including duplicate therapy) given at one time or over a
period of time that is greater than the amount recommended by the manufacturer
for a resident's age and condition.
(2) "Excessive Duration" means the medication
is administered beyond the manufacturer's recommended time frames or
facility-established stop order policies or without either evidence of
additional therapeutic benefit for the resident or clinical evidence that would
warrant the continued use of the medication.
(3) "Duplicative Therapy" means multiple
medications of the same pharmacological class or category or any medication
therapy that replicates a particular effect of another medication that the
individual is taking.
(4)
"Indications for the prescription" means a documented clinical rationale for
administering a medication that is based upon an assessment of the resident's
condition and therapeutic goals and is consistent with manufacturer's
recommendations.
(5) "Monitoring"
means ongoing collection and analysis of information (such as observations and
diagnostic test results) and comparison to baseline data in order to:
(A) Ascertain the individual's response to
treatment and care, including progress or lack of progress toward a therapeutic
goal;
(B) Detect any complications
or adverse consequences of the condition or of the treatments; and
(C) Support decisions about modifying,
discontinuing, or continuing any interventions.
(c) Antipsychotic therapy shall not be
initiated on any patient unless necessary to treat a clinically diagnosed and
clinically documented condition. When antipsychotic therapy is prescribed,
unless clinically contraindicated, gradual dose reductions and behavioral
interventions shall be employed in an effort to discontinue these drugs.
"Gradual dose reduction" means the stepwise tapering of a dose to determine if
symptoms, conditions or risks can be managed by a lower dose or if the dose or
the medication can be discontinued.
(d) The facility shall ensure that procedures
aimed at minimizing medication error rates include the following:
(1) All medications or drugs and treatments
shall be administered and discontinued in accordance with signed medical orders
which are recorded in the patient's medical record. Such orders shall be
complete and include drug name, strength, quantity to be administered, route of
administration, frequency and, if ordered on an as-needed basis, a stated
indication for use.
(2) The
requirements for self-administration of medication shall include the following:
(A) determination by the interdisciplinary
team that this practice is safe;
(B) administration ordered by the physician
or other person legally authorized to prescribe medications;
(C) instructions for administration printed
on the medication label; and
(D)
administration of medication monitored by the nursing staff and consultant
pharmacist.
(3) The
administration of one patient's medications to another patient is prohibited
except in the case of an emergency. In the event of such emergency, the
facility shall ensure that the borrowed medications are replaced and so
documented.
(4) Omission of
medications and the reason for omission shall be indicated in the patient's
medical record.
(5) Medication
administration records shall provide time of administration, identification of
the drug and strength of drug, quantity of drug administered, route of
administration, frequency, documentation sufficient to determine the staff who
administered the drugs. Medication administration records shall indicate
documentation of injection sites and topical medication sites requiring
rotation of transdermal medication.
(6) The pharmacy shall receive an exact copy
of each physician's order for medications and treatments.
(7) When medication orders do not state the
number of doses or days to administer the medication, the facility shall
implement automatic stop orders according to manufacturer's
recommendations.
(8) The facility
shall maintain an accountability of controlled substances as defined by the
North Carolina Controlled Substances Act, G.S. 90, Article 5.
Authority
G.S.
131E-104;
Eff. January 1,
1996;
Amended Eff. January 1, 2013;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. March 22,
2015.
