| (ii) TB screening of residents shall be completed within
seven calendar days of admission into the residential facility and
repeated annually thereafter. If a resident was confined in a jail
or other correctional facility immediately prior to admission to a
CCF, a TB screening test that was completed no more than 30 days prior
to transfer to a residential facility may be accepted, provided that
a TB questionnaire is completed and filed with the TB screening test
results.
(iii) Medical examinations shall be conducted for any
employee or resident suspected of having a communicable disease.
(4) Serious and Infectious Diseases.
(A) The facility shall provide for the management of
serious and infectious diseases.
(B) The CCFs 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 a 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.
(5) Dental Care. Access to dental care shall be made
available to each resident.
(6) Medications--General Guidelines.
(A) Staff who dispense medication shall have the proper
training and credentials. Staff who 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.
(7) Medication Storage.
(A) Prescription and OTC medications shall be kept
in locked storage and accessible only by staff who are authorized
to provide medication. Syringes, needles, and other medical supplies
shall also be kept in locked storage.
(B) All controlled/scheduled medications 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 use
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) The facility shall have a written policy approved
by the local medical authority that states the acceptable temperature
range for the medication refrigerator, and a written policy for what
actions shall be taken by staff in the event the refrigerator temperature
is above or below the approved temperature range.
(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;
Cont'd... |
