| (a) Administration.
(1) A facility must ensure that a person who administers
medications to clients who choose not to or who cannot self-administer
his or her medications holds a current license under applicable state
law that authorizes the licensee to administer medications.
(2) A facility must ensure that all medication prescribed
to a client that is administered at the facility is dispensed through
a pharmacy or by the client's prescribing practitioner.
(3) A facility may administer sample medications at
the facility if the medication has been prescribed to the client and
includes specific dosage instructions for the client.
(4) A facility must record a client's medications on
the client's medication profile record. The recorded information must
be obtained from the prescription label and must include the medication
name, strength, dosage, amount received, directions for use, route
of administration, prescription number, pharmacy name, and date each
medication was issued by the pharmacy.
(b) Assistance with self-administration. A nurse may
assist with self-administration of a client's medication if the client
is unable to administer the medication without assistance. Assistance
with self-administration of medication is limited to:
(1) reminding the client to take medications at the
prescribed time;
(2) opening and closing containers or packages;
(3) pouring prescribed dosage according to the client's
medication profile record;
(4) returning medications to the proper locked areas;
(5) obtaining medications from a pharmacy; and
(6) listing on the client's medication profile record
the medication name, strength, dosage, amount received, directions
for use, route of administration, prescription number, pharmacy name,
and the date each medication was issued by the pharmacy.
(c) Self-administration.
(1) A nurse must counsel a client who self-administers
medication or treatment at least once per month to ascertain if the
client continues to be able to self-administer the medication or treatment.
The facility must keep a written record of the counseling.
(2) A facility may permit a client who chooses to keep
the client's medication locked in the facility's central medication
storage area to enter or have access to the area for the purpose of
self-administering medication or treatment. A facility staff member
must remain in or at the storage area the entire time the client is
present in the area.
(d) General.
(1) A facility director, an activities director, or
a facility nurse must immediately report to a client's prescribing
practitioner and responsible party any unusual reactions to a medication
or treatment.
(2) When a facility supervises or administers medications,
the facility must document in writing if a client does not receive
or take the medication and treatment as prescribed. The documentation
must include the date and time the dose should have been taken and
the name and strength of medication missed.
(e) Storage.
(1) A facility must provide a locked area for all medications,
which may include:
(A) a central storage area; or
(B) a medication cart.
(2) A facility must store a client's medication separately
from other clients' medications within the storage area.
(3) A facility must store medication requiring refrigeration
in a locked refrigerator that is used only for medication storage
or in a separate, permanently attached, locked medication storage
box in a refrigerator.
(4) A facility must store poisonous substances and
medications labeled for "external use only" separately from other
substances within the locked area.
(5) A facility must store drugs covered by Schedule
II of the Controlled Substances Act of 1970 in a locked, permanently
attached cabinet, box, or drawer that is separate from the locked
storage area for other medications.
(f) Disposal.
(1) In accordance with applicable federal and state
laws, a facility must dispose of medication that:
(A) has been discontinued by order of the client's
prescribing practitioner;
(B) remains after the client no longer attends the
DAHS; or
(C) has passed the medication expiration date.
(2) A facility must ensure the medication identified
in paragraph (1) of this subsection is disposed by:
(A) a registered pharmacist licensed in the State of
Texas;
(B) a local pharmacy on-site medication drop-off box;
or
(C) a local law enforcement or community drug take-back
program.
(3) A facility must inventory and store medications
awaiting disposal separate from current client medications.
(4) A facility must dispose of needles and hypodermic
syringes with needles attached as required by 25 TAC Chapter 1, Subchapter
K (relating to the Definition, Treatment, and Disposition of Special
Waste from Health Care-Related Facilities).
(5) A facility must obtain a signed receipt from the
client or the client's responsible party if the facility releases
medication to the client or responsible party.
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