| (a) Physician services.
(1) Each resident shall have an attending physician
who is charge of the resident's medical care.
(2) The facility shall make a reasonable effort to
contact the resident's physician within 72 hours after admission to
obtain any information relating to the care of the resident. Any relevant
information obtained from the physician will be recorded in the resident's
care document.
(3) In the event of an acute illness, condition, or
accident requiring medical and/or nursing care beyond the capabilities
of the facility, the resident shall be transferred, in a medically
appropriate manner, to a hospital or other health care facility as
appropriate where needed services and facilities are available.
(b) Nursing services.
(1) Licensed nurses shall function consistent with
the nursing practices recognized and authorized by Texas Board of
Nurse Examiners.
(2) When nursing services are provided, nursing personnel
are responsible for ensuring that residents receive treatments, medications,
and diets as prescribed; receive preventive care to prevent and minimize
the incidence of skin breakdown; are kept comfortable with personal
hygiene needs met; are protected from accident and injury through
the initiation of appropriate safety measures; and are treated with
kindness and respect.
(3) Nursing or attendant personnel on duty shall be
responsible for obtaining emergency medical care when a resident's
condition so requires and shall be responsible for notifying the attending
physician.
(c) Medications.
(1) Medications shall be provided as required for those
residents on a physician or practitioner-ordered medication therapy
regimen.
(2) Upon admission, and as part of the plan of care,
the admitting physician shall determine whether a resident can self-administer
his or her medications or will require administration by qualified
personnel in accordance with paragraph (7) of this subsection.
(3) Each resident's health status shall be reviewed
at least quarterly, or more often if indicated, to determine if any
changes are necessary in the medication administration procedures.
(A) The appropriateness for a resident to self-administer
medications shall be reviewed by facility staff and the attending
physician or an advanced practice nurse working in collaboration with
the attending physician.
(B) A resident's drug regimen review shall be incorporated
into the individual's plan of care.
(4) Medications must be kept secured at all times.
Only the resident and authorized facility staff shall have access
to the secured medications. Residents self-administering their medications
may:
(A) keep medications in their possession at all times;
(B) secure their medications within their locked room
if the room is not shared with others, or in a locked cabinet in
their room; or
(C) allow the facility to keep residents' medications
in a central medication storage area under control of facility staff.
(5) The central medication storage shall be kept locked
when facility staff is not actually in or at the storage area.
(6) Residents may be permitted entrance or access to
the storage area for the purpose of self-administering their medications
or treatments or receiving assistance with their medication or treatment
regimen. A facility staff member shall remain in or at the storage
area the entire time any resident is in the storage area.
(7) Medications that are administered to a resident
shall be administered only by a registered professional nurse, licensed
vocational nurse, or an individual under direct delegation orders
by a physician and in conformance with all laws, rules, and recognized
professional standards of practice. A home health agency who is providing
services within a special care facility may use a home health medication
aide in accordance with 40 Texas Administrative Code, §95.128
(relating to Home Health Medication Aides).
(A) The person administering medications shall properly
record the medications administered. This record will be retained
in the resident file.
(B) Medications classified as dangerous drugs or controlled
substances may not be taken by or administered to residents unless
the medication was obtained directly from or under a valid prescription
or order of a physician or practitioner. If facility staff administer
the medications, they shall only be administered under written orders,
or verbal orders which are subsequently verified in writing by the
treating physician or practitioner.
(C) All injectable medication, intravenous solutions,
or medications administered by way of a tube inserted in a cavity
of the body shall be administered under physician's or practitioner's
orders by a physician, registered professional nurse, licensed vocational
nurse, or other individual qualified under state law.
(D) If administration of medications to residents is
performed by a registered professional nurse or licensed vocational
nurse the following shall apply.
(i) There shall be a specific area designated for medication
that is:
(I) sufficient in size and/or space for the storage
of all medications that are being administered to residents and for
the preparation of medications for administration to residents;
(II) lockable and shall be maintained locked at all
times when not occupied;
(III) accessible only to persons authorized to administer
medications to residents;
(IV) equipped with a sink having hot and cold water
available at all times; and
(V) adequately ventilated and temperature controlled.
(ii) A medication storage cart may be used in addition
to the medication room for the storage of residents' medications.
When not in use, the medication storage cart must be kept locked in
the locked medication room or in the designated locked storage room
that shall be used only for the storage of the cart.
(8) When a resident needs assistance with taking oral
medication, only those individuals approved in writing by the director
of the facility may provide that assistance.
(A) A mechanism will be developed, implemented and
monitored by the facility director to insure that the resident is
given only those medications that have been prescribed by the resident's
physician or practitioner at the intervals detailed on the resident's
medication container.
(B) When assistance with taking oral medication is
provided, the facility will maintain a medication record which documents
the medication, date, and time taken. The name of the individual who
assisted the resident taking the oral medication shall also be documented.
(C) The facility director or designee will monitor
the medication records daily to insure accuracy.
(9) Medication requiring refrigeration shall be stored
in a separate refrigerator designated for medications which is kept
in the secured medication storage area. Medications may be stored
in an area within the common refrigerator if they are stored in a
manner that prevents contamination of the medications, and allows
for the security of the medication to be maintained.
(10) Medication under storage control of the facility
shall be returned to the resident upon dismissal from the facility,
or as directed by the physician.
(11) Medications of a resident shall not be used for
another resident. When a resident is dismissed from or otherwise leaves
the facility for a period of time greater than 48 hours, medications
which had been under the control of the resident and left in the facility
shall be secured under locked storage control of the facility until
reclaimed by the resident and no longer than 90 days. Medications
of deceased residents shall not remain in the facility for more than
7 days after the resident's death. Medications of deceased residents
and medications which have been left unclaimed in the facility for
more than 90 days shall be handled in one of the following manners.
(A) Medications may be returned to any licensed pharmacy
for destruction in accordance with regulations of the Texas Board
of Pharmacy governing the destruction of dangerous drugs or controlled
substances. A record shall be maintained by the facility which itemizes
the quantity and strength of each medication returned to a pharmacy
for destruction. Such record shall be signed by the director of the
facility and the pharmacist accepting the drugs for destruction and
shall be retained in the resident's file.
Cont'd... |
