| (a) While a client is under hospice care, a hospice
must provide drugs and biologicals related to the palliation and management
of the terminal illness and related conditions, as identified in the
hospice plan of care.
(b) A hospice must ensure that the interdisciplinary
team (IDT) confers with a person with education and training in drug
management, as defined in hospice policies and procedures and State
law, who is an employee of or under contract with the hospice to ensure
that drugs and biologicals meet a client's needs. The hospice must
be able to demonstrate that the person has specific education and
training in drug management. Persons with education and training in
drug management include:
(1) a licensed pharmacist, a physician who is board
certified in hospice and palliative medicine, or an RN who is certified
in palliative nursing; or
(2) a physician, an RN, or an advanced practice nurse
who completes a specific drug management course for hospice or palliation.
(c) Only a physician or an advanced practice nurse,
in accordance with the plan of care, may order drugs for a client.
(d) If the drug order is verbal or given by or through
electronic transmission:
(1) it must be given only to a licensed nurse, pharmacist,
or physician; and
(2) the person receiving the order must record and
sign it immediately and have the prescribing person sign it in accordance
with the agency's policies and applicable State and federal regulations.
(e) A hospice must obtain drugs and biologicals from
community or institutional pharmacists or stock drugs and biologicals
itself. A hospice that dispenses, stores, and transports drugs must
do so in accordance with federal, State, and local laws and regulations,
as well as the hospice's own policies and procedures. A hospice that
operates its own pharmacy must comply with the Texas Occupations Code,
Subtitle J, and applicable pharmacy and pharmacists' regulations adopted
by the Texas Board of Pharmacy under that subtitle.
(f) The IDT, as part of the review of the plan of care,
must determine the ability of the client or the client's family to
safely administer drugs and biologicals to the client in the client's
home.
(g) Drugs and biologicals must be labeled in accordance
with currently accepted professional practice and must include appropriate
usage and cautionary instructions, as well as an expiration date,
if applicable.
(h) A hospice must have written policies and procedures
for the safe use and storage of drugs and biologicals in a client's
home.
(i) A hospice must have written policies and procedures
that address management of controlled substance prescription drugs
in a client's home, including:
(1) at the time when controlled substance prescription
drugs are first ordered;
(2) when controlled substance prescription drugs are
discontinued;
(3) when a new controlled substance prescription drug
is ordered; and
(4) when the client dies.
(j) At the time when controlled substance prescription
drugs are first ordered for use in a client's home, the hospice must:
(1) provide a copy of the hospice's written policies
and procedures on the management of controlled substance prescription
drugs in a client's home to the client or client representative and
family;
(2) discuss the hospice policies and procedures for
managing the safe use of controlled substance prescription drugs with
the client or LAR and the family in a language and manner that they
understand, to ensure that these parties are educated regarding the
safe use, storage, and disposal of controlled substance prescription
drugs in the client's home; and
(3) document in the client record that the hospice
provided and discussed its written policies and procedures for managing
the safe use and storage of controlled substance prescription drugs
in the client's home, as described in subsection (m) of this section.
(k) A hospice must have a written policy describing
whether the agency will dispose of a client's unused controlled substance
prescription drugs on the client's death or in other circumstances
in which disposal is appropriate, as described in subsection (m) of
this section.
(l) If a hospice agency's policy under subsection (k)
of this section provides that the agency will dispose of a client's
unused controlled substance prescription drugs as described in that
subsection, the written policies and procedures which the hospice
must implement and enforce, must:
(1) identify disposal methods that are consistent with
recommendations by the United States Food and Drug Administration
and the laws of the State of Texas;
(2) permit disposal described in subsection (k) of
this section only by a hospice employee or contractor who is a health
care practitioner licensed to perform medical or nursing services
who meets the conditions of this section;
(3) require each health care practitioner responsible
for disposal of an unused controlled substance of a client under this
section to receive training regarding the secure and responsible disposal
of controlled substance prescription drugs in accordance with paragraph
(1) of this subsection and in a manner that discourages abuse, misuse,
or diversion;
(4) require that hospice agency staff:
(A) provide a copy of the disposal policies and procedures
to a licensed facility in which the client is residing or receiving
short-term in-patient hospice services;
(B) provide a copy of the disposal policies and procedures
to the client and the client's family;
(C) discuss the policies and procedures with the patient
and the client's family in a language and manner the client and client's
family understand;
(D) document in the client's clinical record that the
policies and procedures were provided and discussed as required by
subsections (b) and (c) of this section; and
(E) document the client's agreement to the disposal
of the client's unused controlled substance prescription drugs under
circumstances described in subsection (m) of this section by a qualified
health practitioner employed or contracted by the agency; and
(5) otherwise comply with state, federal, and local
laws applicable to the disposal of drugs and biologicals in a facility.
(m) A health care practitioner qualified under subsection
(l) of this section may confiscate and dispose of a client's unused
controlled substance prescription drug if:
(1) the client has died;
(2) the drug has expired; or
(3) the client's physician has given written instructions
that the patient should no longer use the drug.
(n) A hospice agency may not dispose of controlled
prescription drugs not prescribed to the client.
(o) A health care practitioner qualified under subsection
(l) of this section, confiscating the controlled substance prescription
drug, must dispose of the drug in a manner consistent with recommendations
of the United States Food and Drug Administration and the laws of
the State of Texas.
(p) A health care practitioner qualified under subsection
(l) of this section must dispose of a client's unused controlled substance
prescription drugs as described in this section only at the location
at which practitioner confiscated the drug.
(q) A health care practitioner disposal of a client's
unused controlled substance prescription drugs as described in this
section must be witnessed by another person 18 years of age or older.
The witness does not have to be a hospice employee.
(r) After disposing of the client's unused controlled
substance prescription drug, the health care practitioner shall document
in the client's record:
(1) the name of the drug;
(2) the dosage of the drug the client was receiving;
(3) the route of controlled substance prescription
drug administration;
(4) the quantity of the controlled substance prescription
drug originally dispensed and the quantity of the drug remaining;
(5) the time, date, and manner of disposal; and
(6) name and relationship of the witness to the client.
(s) A health care practitioner shall document in the
client's file if a family member of the client prevented the confiscation
and disposal of a controlled substance prescription drug authorized
under this section.
(t) A health care practitioner shall document in the
client's file if an employee of a licensed facility where the client
is receiving in-patient hospice services prevented the confiscation
and disposal of a controlled substance prescription drug otherwise
authorized under this section.
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