Current through Register Vol. 63, No. 12, December 1, 2024
(1) The
program administrator shall ensure that all individuals are offered medical
attention when needed. The provider shall arrange for health services with the
informed consent of the individual or the individual's representative. The
program shall arrange for physicians to be available in the event the
individual's regular physician is unavailable. The provider shall identify a
hospital emergency room that may be used in case of emergency.
(2) The provider shall ensure that each
individual admitted to the program shall be screened by an LMP or other
qualified health care professional to identify health problems and to screen
for communicable disease. The provider shall maintain documentation of the
initial health screening in the individual service record:
(a) The health screening shall include a
brief history of health conditions, current physical condition, and a written
record of current or recommended medications, treatments, dietary
specifications, and aids to physical functioning;
(b) For regular admissions, the health
screening shall be obtained prior to the individual's admission and include the
results of testing for tuberculosis;
(c) For emergency admissions including
crisis-respite admissions, the health screening shall be obtained as follows:
(A) For individuals experiencing psychiatric
or medical distress, a health screening shall be completed by an LMP prior to
the individual's admission or within 24 hours of the emergency placement. The
health screening shall confirm that the individual does not have health
conditions requiring continuous nursing care, a hospital level of care, or
immediate medical assistance. For each crisis-respite individual who continues
in the program for more than seven consecutive days, a complete health
examination shall be arranged if any symptoms of a health concern
exist;
(B) For other individuals
who are admitted on an urgent basis due to a lack of alternative supportive
housing, the health screening shall be obtained within 72 hours after the
individual's admission;
(C) The
health screening criteria may be waived for individuals admitted for
crisis-respite services who are under the active care of an LMP if it is the
opinion of the attending health care professional that the crisis-respite
placement presents no health risk to the individual or other individuals in the
program. Such a waiver shall be provided in writing and be signed and dated by
the attending health care professional within 24 hours of the individual's
admission.
(3)
Except for crisis-respite individuals, the program shall ensure that each
individual has a primary physician who is responsible for monitoring their
health care. Regular health examinations shall be done in accordance with the
recommendations of this primary health care professional but not less than once
every three years. Newly admitted individuals shall have a health examination
completed within one year prior to admission or within three months after
admission. Documentation of findings from each examination shall be placed in
the individual's service record.
(4) A written order signed by a physician is
required for any medical treatment, special diet for health reasons, aid to
physical functioning, or limitation of activity.
(5) A written order signed by a physician is
required for all medications administered or supervised by program staff. This
written order is required before any medication is provided to an individual.
Medications may not be used for the convenience of staff or as a substitute for
programming. Medications may not be withheld or used as reinforcement or
punishment or in quantities that are excessive in relation to the amount needed
to attain the client's best possible functioning:
(a) Medications shall be self-administered by
the individual if the individual demonstrates the ability to self-administer
medications in a safe and reliable manner. In the case of self-administration,
both the written orders of the prescriber and the residential service plan
shall document that medications shall be self-administered. The
self-administration of medications may be supervised by program staff who may
prompt the individual to administer the medication and observe the fact of
administration and dosage taken. When supervision occurs, program staff shall
enter information in the individual's record consistent with section (5) (h)
below;
(b) Program staff who assist
with administration of medication shall be trained by a Licensed Medical
Professional on the use and effects of commonly used medications;
(c) Medications prescribed for one individual
may not be administered to or self-administered by another
individual;
(d) The program may not
maintain stock supplies of prescription medications. The facility may maintain
a stock supply of non-prescription medications including FDA-approved
short-acting, non-injectable, opioid antagonist medications;
(e) The program shall develop and implement a
policy and procedure that ensures all orders for prescription drugs are
reviewed by an LMP, as specified by a physician, at least every six months.
When this review identifies a contra-indication or other concern, the
individual's primary physician or LMP shall be immediately notified. Each
individual receiving psychotropic medications shall be evaluated at least every
three months by the LMP prescribing the medication, who shall note for the
individual's record the results of the evaluation and any changes in the type
and dosage of medication, the condition for which it is prescribed, when and
how the medication is to be administered, common side effects, including any
signs of tardive dyskinesia, contraindications or possible allergic reactions,
and what to do in case of a missed dose or other dosing error;
(f) The provider shall dispose of all unused,
discontinued, outdated, or recalled medications and any medication containers
with worn, illegible or missing labels. The provider shall dispose of
medications in a safe method consistent with any applicable federal statutes
and designed to prevent diversion of these substances to persons for whom they
were not prescribed. The provider shall maintain a written record of all
disposals specifying the date of disposal, a description of the medication, its
dosage potency, amount disposed, the name of the individual for whom the
medication was prescribed, the reason for disposal, the method of disposal, and
the signature of the program staff disposing of the medication. For any
medication classified as a controlled substance in schedules 1 through 5 of the
Federal Controlled Substance Act, the disposal shall be witnessed by a second
staff person who documents their observation by signing the disposal
record;
(g) The provider shall
properly and securely store all medications in a locked space for medications
only in accordance with the instructions provided by the prescriber or pharmacy
except as otherwise permitted in OAR
309-035-0215
(9). Medications for all individuals shall be
labeled. Medications requiring refrigeration shall be stored in an enclosed,
locked container within the refrigerator. The provider shall ensure that
individuals have access to a locked, secure storage space for their
self-administered medications. The program shall note in its written policy and
procedures which persons have access to this locked storage and under what
conditions;
(h) For all individuals
taking prescribed medication, the provider shall record in the medical record
each type, date, time, and dose of medication provided. All effects, adverse
reactions, and medication errors shall be documented in the individual's
service record. All errors, adverse reactions, or refusals of medication shall
be reported to the prescribing LMP within 48 hours;
(i) P.R.N. medications and treatments shall
only be administered in accordance with administrative rules of the Board of
Nursing, chapter 851, division 47.
(6) Nursing tasks may be delegated by a
registered nurse to direct care staff within the limitations of their
classification and only in accordance with administrative rules of the Board of
Nursing, chapter 851, division 47 immediately respond based on the medical
emergency procedures of the facility.
(7) The program must ensure at least one
unexpired opioid overdose kit for emergency response to suspected overdose is
available in the facility at all times. Opioid overdose kits do not require a
prescription and are not specific to an individual (see ORS
689.684).
(8) All opioid overdose kits must include an
ultraviolet light-protected hard case and must contain, but not be limited to:
(a) Two doses of an FDA-approved
short-acting, non-injectable, opioid antagonist medication;
(b) One pair non-latex gloves;
(d) One disposable face shield for rescue
breathing; and
(e) One
short-acting, non-injectable, opioid antagonist medication administration
instruction card.
(9)
Opioid overdose kits must be:
(a) Installed in
an easily accessible, highly visible, and unlocked location;
(b) At a height of no more than 48 inches
from the floor;
(c) In a location
without direct sunlight;
(d) In an
area where temperatures are maintained between 59F and 77F; and
(e) Have a sign clearly indicating the
location and content of the kit.
(10) Short-acting, non-injectable, opioid
antagonist medication not within installed opioid overdose kits must be stored
in a locked cabinet with other resident medications.
(11) Opioid overdose kits must be:
(a) Checked daily to ensure the required
components have not been removed or damaged;
(b) Checked monthly to ensure the
short-acting, non-injectable, opioid antagonist medication has not expired; and
(c) Restocked immediately after
use.
(12) Upon recognizing
a person is likely experiencing an overdose, program staff must immediately
respond based on the medical emergency procedures of the facility.
(13) A person who has reasonable cause to
believe an individual is experiencing an overdose, and in good faith
administers short-acting, non-injectable, opioid antagonist medication to the
individual, is protected against civil liability or criminal prosecution unless
the person, while rendering care, acts with gross negligence, willful
misconduct, or intentional wrongdoing as described in Oregon Revised Statute
(ORS) 689.681.
(14) Program staff
must fully cooperate with emergency medical service (EMS) personnel. Program
staff must not interfere with or impede the administration of emergency medical
services.
(15) Administration of
short-acting, non-injectable, opioid antagonist medication must be documented
by the caregiver who administered the medication. Documentation must be
submitted to the Authority within 48 hours of the incident and must include:
(a) Name of the individual;
(b) Description of the incident including
date, time, and location;
(c) Time
9-1-1 contacted;
(d) Time of
administration(s) of short-acting, non-injectable, opioid antagonist
medication;
(e) Individual's
response;
(f) Transfer of care to
EMS; and
(g) Signature of
caregiver.
Statutory/Other Authority: ORS
413.042 &
443.450
Statutes/Other Implemented: ORS
413.032,
443.400 -
443.465 &
443.991