Current through Register Vol. 41, No. 3, September 23, 2024
A. The center
shall have, keep current, and implement a plan for medication management. The
center's medication management plan shall address procedures for administering
medication and shall include:
1. Standard
operating procedures and any general restrictions specific to the
center;
2. Methods to ensure an
understanding of the responsibilities associated with medication management,
including the following:
a. Determining that
staff who are responsible for administering medications meet the qualification
requirements of subdivisions E 7 a and E 7 b of this section;
b. Ensuring that staff who are responsible
for administering medications are trained on requirements of the center's
medication management plan; and
c.
Ensuring that staff who are responsible for administering medications are
adequately supervised, including periodic direct observation of medication
administration. Supervision shall be provided by (i) an individual employed by
the center who is licensed by the Commonwealth of Virginia to administer
medications or (ii) the director who has successfully completed a training
program as required in subdivisions E 7 a and E 7 b of this section.
3. Methods to ensure that
authorizations for the administration of medications are current;
4. Methods to secure and maintain supplies of
each participant's prescription medications and any over-the-counter drugs and
supplements in a timely manner to avoid missed dosages;
5. Methods for verifying that medication
orders have been accurately transcribed to medication administration records
(MARs), including within 24 hours of receipt of a new order or a change in an
order;
6. Methods for monitoring
medication administration and the effective use of the MARs for
documentation;
7. Methods to ensure
that participants do not receive medications or dietary supplements to which
they have known allergies;
8.
Methods to ensure accurate accounting for all controlled substances whenever
received by center staff, returned to participant, or whenever assigned
medication administration staff changes;
9. Procedures for proper disposal of
medication; and
10. Procedures for
preventing, detecting, and investigating suspected or reported drug
diversion.
B. The center
shall have readily accessible as reference materials for medication aides at
least one pharmacy reference book, drug guide, or medication handbook for
nurses that is no more than two years old.
C. Prescription and nonprescription
medications, including sample medications, shall be given to a participant
according to the center's medication policies and only with written or verbal
authorization from the physician or prescriber or the physician's authorized
agent. For the purposes of this section, an "authorized agent" means an
employee of the physician who is under the physician's immediate and personal
supervision. Verbal orders shall be reviewed and signed by the physician or
prescriber within 10 working days.
D. The center shall maintain a list of all
medications, including those taken at home and at the center, for each
participant. The center shall attempt to verify and update the list of
center-administered medications with the prescribing health care professional
at least twice a year. Unsuccessful attempts to verify shall be
documented.
E. The following
standards shall apply when medications are administered to participants at the
adult day center:
1. All medication shall be
in the original container with the prescription label or direction label
attached and legible. Sample medications shall remain in the original
packaging, labeled by a physician or other prescriber or pharmacist with the
participant's name, the name of the medication, the strength, dosage, and route
and frequency of administration, until administered.
2. All medication shall be labeled with the
participant's name, the name of the medication, the strength and dosage amount,
the route of administration, and the frequency of administration.
3. The medication shall be kept in a locked
compartment or area, not accessible to participants. The locked compartment or
area shall be free from direct sunlight and high temperatures and free from
dampness and shall remain darkened when closed.
4. The area in which the medication is
prepared shall have sufficient light so that the labels can be read accurately
and the correct dosage can be clearly determined.
5. Medication shall be refrigerated, if
required. When medication is stored in a refrigerator used for food, the
medications shall be stored together in a locked container in a clearly defined
area. If a refrigerator is used for medication only, it is permissible to store
dietary supplements and foods and liquids used for medication
administration.
6. Unless it is
contrary to the center's policy, a participant may take the participant's own
medication, provided that:
a. A physician has
deemed the participant capable of self-administering medication;
b. The physician has given written
authorization for the participant to self-administer the participant's
medication; and
c. Medications are
kept in a safe manner inaccessible to other participants.
7. When the center staff administers
medications to participants, the following standards shall apply:
a. Each staff person who administers
medication shall be authorized by §
54.1-3408 of the Code of
Virginia. All staff responsible for medication administration shall:
(1) Be licensed by the Commonwealth of
Virginia to administer medications;
(2) Be a registered medication
aide;
(3) Successfully complete a
training program approved by the Board of Nursing and accepted for use in adult
day centers; or
(4) Successfully
complete a training program approved by the Board of Nursing for the
registration of medication aides that consists of 68 hours of student
instruction and training.
b. All staff who administer medications,
except those licensed by the Commonwealth, shall complete, on an annual basis,
four hours of medication management refresher training on topics specific to
the administration of medications in the adult day center setting.
c. Medications shall remain in the original
or pharmacy issued container until administered to the participant by the
qualified medication staff. All medications shall be removed from the pharmacy
container and be administered by the same qualified person within one hour of
the individual's scheduled dosing time.
d. Documentation shall be maintained on the
MAR of all medications, including prescription, nonprescription, and sample
medication, administered to a participant while at the center. This
documentation shall become part of the participant's permanent record and shall
include:
(1) Name of participant;
(2) All known allergies;
(3) Diagnosis, condition, or specific
indications for which the medication is prescribed;
(4) Date medication prescribed;
(5) Drug product name;
(6) Dosage and strength of
medication;
(7) Route of
administration;
(8) Frequency of
administration;
(9) Date and time
given and initials of staff administering the medication;
(10) Date the medication is discontinued or
changed;
(11) Any medication errors
or omissions;
(12) Notation of any
adverse effects or unusual reactions that occur; and
(13) The name, signature, and initials of all
staff administering medications. A master list may be used in lieu of this
documentation on individual MARs.
F. In the event of an adverse drug reaction
or a medication error, the following applies:
1. Action shall be taken as directed by a
physician, pharmacist, or a poison control center;
2. The participant's physician and family
member or other legal representative shall be notified as soon as possible. If
not contrary to immediate medical needs of the participant, the participant
shall also be notified of the error; and
3. Medication administration staff shall
document actions taken in the participant's record.
G. The use of PRN (as needed) medications is
prohibited unless one or more of the following conditions exist:
1. The participant is capable of determining
when medication is needed;
2. A
licensed health care professional administers the medication;
3. The participant's physician has provided
detailed written instructions, including symptoms that might indicate the need
for the medication, exact dosage, exact timeframes the medication is to be
given in a 24-hour period, and directions for what to do if symptoms persist;
or
4. The center staff has
telephoned the participant's physician prior to administering the medication
and explained the symptoms and received a documented verbal order that includes
the information in subdivision 3 of this subsection.
H. Any physician-ordered treatment provided
by staff shall be documented and shall be within the staff's scope of
practice.
Statutory Authority: §§
63.2-217 and 63.2-1733 of the Code of
Virginia.
