| (iv) Signs and symptoms of mental illness, retardation and chemical dependency; and (v) Procedures for patient transfers to appropriate medical facilities or health-care providers. (C) First aid kits shall be available in designated areas of the facility. Contents and locations shall be approved by the health authority. (3) Serious and Infectious Diseases. (A) The facility shall provide for the management of serious and infectious diseases. (B) The CRFs shall have policies and procedures to direct actions to be taken by employees concerning residents who have been diagnosed with human immunodeficiency virus (HIV), including, at minimum, the following: (i) When and where residents shall be tested; (ii) Appropriate safeguards for staff and residents; (iii) Staff and resident training; (iv) Issues of confidentiality; and (v) Counseling and support services. (4) Dental Care. Access to dental care shall be made available to each resident. (5) Medications--General Guidelines. (A) Staff who dispense medication shall be properly credentialed and trained. Staff that supervise self-administration of medication shall be appropriately trained to perform the task. (B) Policy and procedure shall direct the possession and use of controlled substances, prescribed medications, supplies and over-the-counter (OTC) drugs. Prescribed medications shall be dispensed according to the directions of the prescribing physician, advanced practice nurse or physician assistant. (C) Each residential facility shall have a written policy in place that sets forth required procedural guidelines for the administration, documentation, storage, management, accountability of all resident medication, inventory, disposal of medications, handling medication errors and adverse reactions. (D) If medications are distributed by facility staff, records shall be maintained and audited monthly and shall include, but not be limited to the date, time, name of the resident receiving the medication and the name of the staff distributing the medication. (E) Each facility shall ensure that the phone number of a pharmacy and a comprehensive drug reference source is readily available to the staff. (6) Medication Storage. (A) Prescription and OTC medications shall be kept in locked storage and accessible only to staff who are authorized to provide medication. Syringes, needles and other medical supplies shall also be kept in locked storage. (B) All controlled/scheduled drugs shall be stored under double lock and key. (C) Each facility shall ensure that all medications, syringes and needles are stored in the original container. (D) Medications labeled as internal and external only shall not be stored together in the same medication box or medication drawer. (E) Sample prescription medications provided by physicians shall be stored with proper labeling information that includes the name of the medication; name of the prescribing physician, advanced practice nurse or physician assistant; date prescribed; and dosage instructions. (F) Medications that require refrigeration shall be stored in a refrigerator designated for medications only. A thermometer shall be maintained inside the refrigerator with the temperature checked and recorded daily on a temperature log. (G) 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. (H) Facilities that allow residents to keep medications in the resident's possession shall have written guidelines specific for keep-on-person (KOP) medications. Staff shall ensure that authorized residents keep medication on their person or safely stored and inaccessible to other residents. (7) Medication Inventory and Disposal. (A) Facility staff shall conduct an inventory count of all controlled/scheduled prescription medications daily (at a minimum, once per 24-hour period). The count shall be conducted and witnessed by one (1) other staff member. Documentation of inventory counts shall be maintained for a minimum period of three (3) 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 person 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 person 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 (3) times daily (after each shift). The summary report shall be maintained for a minimum period of three (3) 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 (g) 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 (1) 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 (2) staff members that witnessed the disposal. (8) 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 person 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; Cont'd... |
