| (H) Medications that are discontinued, have expired
dates, or are no longer in use shall be stored in a separate locked
container or drawer until destroyed.
(I) Facilities that allow residents to keep medications
in the resident's possession shall have written guidelines specific
for keep-on-person medications. Staff shall ensure that authorized
residents keep medication on their person or safely stored and inaccessible
to other residents.
(8) Medication Inventory and Disposal.
(A) Facility staff shall conduct an inventory count
of all controlled/scheduled medications daily, at a minimum, once
per 24-hour period. The count shall be conducted and witnessed by
one other staff member. Documentation of inventory counts shall be
maintained for a minimum of three years.
(B) The facility shall conduct a monthly inventory
of all prescription and OTC drugs provided to or purchased by the
resident. The monthly audit shall be conducted by a staff member who
is not responsible for conducting the daily inventory counts.
(C) A monthly audit shall be conducted of all medication
administration records to verify the accuracy of recorded information.
The monthly audit of medication administration records shall be conducted
by a staff member who is not responsible for the documentation of
medication administration records.
(D) When a discrepancy is noted between the medication
administration record and the monthly inventory count, documentation
explaining the reason for the discrepancy and action taken to correct
it shall be recorded. In the event an inventory count reveals unaccounted
for controlled/scheduled medication, an investigation shall be conducted
and a summary report written detailing the steps taken to resolve
the matter. Until the discrepancy is resolved, an inventory count
shall be conducted three times daily, after each shift. The summary
report shall be maintained for a minimum of three years. If misapplication,
misuse, or misappropriation of controlled/scheduled medication leads
to an investigation by law enforcement, such information shall be
reported pursuant to subsection (i) of this rule.
(E) Discontinued and outdated medications shall be
removed from the current medication storage, stored in a separate
locked container, and disposed of within 30 days. The drugs designated
for disposal shall be recorded on a drug disposal form.
(F) Methods used for drug disposal shall prevent medication
from being retrieved, salvaged, or used in any way. The disposal of
drugs shall be conducted, documented, and the process witnessed by
one other staff member. The documentation shall include:
(i) Name of the resident and date of disposal;
(ii) Name and strength of the medication;
(iii) Prescription number, sample, or OTC lot numbers;
(iv) Amount disposed, reason for disposal, and the
method of disposal; and
(v) Signatures of the two staff members who disposed
of the drug and witnessed the disposal.
(9) Administration of Medication for Non-Medical Model
Facilities.
(A) Prescription medications shall be dispensed only
by licensed nurses or other staff who are trained and have the appropriate
documented medication certification to dispense medications while
under the supervision of a physician or registered nurse. Facilities
that do not have licensed nurses or other credentialed staff to dispense
medications, non-medical model facilities, shall implement the practice
of self-administration of medications.
(B) If medications are dispensed through the practice
of self-administration in a non-medical model program, staff trained
by a qualified health professional to supervise residents in the self-administration
of medications shall monitor the residents during the self-administration
process.
(C) Each dose of prescription medication received by
the resident shall be documented on the prescription medication administration
record and maintained in the resident's medical file. The prescription
medication record shall include:
(i) Name of the resident receiving the medication;
(ii) Drug allergies or the absence of known drug allergies;
(iii) Name, strength of medication, and route of administration;
(iv) Instructions for taking the medication, the amount
taken, and the route of administration;
(v) Date and time the medication was provided;
(vi) Prescription number, or lot number for sample
drugs, and the initial amount of medication received;
(vii) Prescribing physician, advanced practice nurse
or physician assistant, and the name of the pharmacy;
(viii) Signature of the resident receiving the medication
and the staff member supervising the self-administration of medication;
(ix) The remaining amount of medication after each
dose dispensed; and
(x) Comment section for recording a variance, discrepancy,
or change.
(D) Each dose of OTC medication received by the resident
shall be documented on the OTC medication administration record and
maintained in the resident's medical file. The OTC drugs purchased
by the resident or supplied for the resident in quantities larger
than single dose packages shall be recorded on the OTC drug record.
The OTC drug record shall include:
(i) The resident's name;
(ii) The name and strength of the medication dispensed;
(iii) Drug allergies or the absence of known drug allergies;
(iv) The dosage instructions and route of administration;
(v) The initial amount received, OTC lot number, and
the expiration date;
(vi) The date and time the medication was dispensed;
(vii) The amount dispensed and the ending count after
each dose;
(viii) Comment section for recording reason for OTC
drug or other notations; and
(ix) The signature of the resident and the employee
who supervised each dose dispensed.
(E) Facility Stock OTC Drugs. Multiple OTC stock drugs
supplied in single dose packaging may be recorded on the same form.
The medication drug record for facility stock OTC drugs shall include:
(i) The resident's name;
(ii) The name, strength, and route of administration;
(iii) Drug allergies or the absence of known drug allergies;
(iv) The date, time, amount dispensed, and the lot
number on the container;
(v) Comment section to record the reason the OTC drug
was requested; and
(vi) The signature of the resident and the employee
who supervised each dose dispensed.
(10) Training for Monitoring Self-Administration of
Medications. All residential employees responsible for supervising
residents in self-administration of medication, who do not have credentials
to dispense medication, shall complete required training before performing
this task.
(A) The initial training for new employees shall be
four hours in length.
(B) Employees shall complete a minimum of two hours
of review training annually thereafter.
(C) The training shall be provided by a physician,
pharmacist, physician assistant, or registered nurse before supervising
self-administration of medications. A licensed vocational nurse or
paramedic, under supervision, may teach the course from an established
curriculum. Topics to be covered shall include:
(i) Prescription labels;
(ii) Medical abbreviations;
(iii) Routes of administration;
(iv) Use of drug reference materials;
(v) Monitoring and observing insulin preparation and
administration;
(vi) Storage, maintenance, handling, and destruction
of medication;
(vii) Transferring information from prescription labels
to the medication administration record and documentation requirements,
including sample medications; and
(viii) Procedures for medication errors, adverse reactions,
and side effects.
(11) Female Residents. If female residents are housed,
access to pregnancy management services shall be available.
(12) Mental Health. Access to mental health services
shall be available to residents.
(13) Suicide Prevention. Each facility shall have a
written suicide prevention and intervention program reviewed and approved
by a qualified medical or mental health professional. All staff with
resident supervision responsibilities shall be trained in the implementation
of the suicide prevention program.
(14) Personnel.
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