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RULE §98.62Program Requirements

      (iv) identification and reporting of abuse, neglect, or exploitation.

  (2) Ongoing training.

    (A) A facility must provide at least three hours of ongoing training to direct service staff quarterly. The facility must ensure that direct delivery staff maintain current certification in CPR.

    (B) A facility must practice evacuation procedures with staff and individuals at least once a month. The facility must document evacuation results in the facility records.

  (3) Policy for individuals with Alzheimer's disease or a related disorder. A facility must adopt, implement, and enforce a written policy that:

    (A) requires a facility employee who provides direct care at the facility to an individual with Alzheimer's disease or a related disorder to successfully complete training in the provision of care to individuals with Alzheimer's disease or related disorders; and

    (B) ensures the care and services provided by a facility employee to an individual with Alzheimer's disease or a related disorder meet the specific identified needs of the individual relating to the diagnosis of Alzheimer's disease or a related disorder.

    (C) The training required for facility employees under paragraph (3)(A) of this subsection must include information about:

      (i) symptoms and treatment of dementia;

      (ii) stages of Alzheimer's disease;

      (iii) person-centered behavioral interventions; and

      (iv) communication with an individual with Alzheimer's disease or a related disorder.

(f) Medications.

  (1) Administration.

    (A) A facility must ensure that a person who holds a current license under state law that authorizes the licensee to administer medications to individuals who choose not to or cannot self-administer their medications.

    (B) A facility must ensure that all medication prescribed to an individual that is administered at the facility is dispensed through a pharmacy or by the individual's treating physician or dentist.

    (C) A facility may administer physician sample medications at the facility if the medication has specific dosage instructions for the individual.

    (D) A facility must record an individual's medications on the individual'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 the date each medication was issued by the pharmacy.

  (2) Assistance with self-administration. A nurse may assist with self-administration of an individual's medication if the individual is unable to administer the medication without assistance. Assistance with self-administration of medication is limited to the following activities:

    (A) reminding an individual to take medications at the prescribed time;

    (B) opening and closing containers or packages;

    (C) pouring prescribed dosage according to the individual's medication profile record;

    (D) returning medications to the proper locked areas;

    (E) obtaining medications from a pharmacy; and

    (F) listing on an individual'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.

  (3) Self-administration.

    (A) A nurse must counsel an individual who self-administers medication or treatment at least once per month to ascertain if the individual continues to be able to self-administer the medication or treatment. The facility must keep a written record of the counseling.

    (B) A facility may permit an individual who chooses to keep the individual'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 individual is present.

  (4) General.

    (A) A facility director, an activities director, or a facility nurse must immediately report to an individual's physician and responsible party any unusual reactions to a medication or treatment.

    (B) When a facility supervises or administers medications, the facility must document in writing if an individual 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.

  (5) Storage.

    (A) A facility must provide a locked area for all medications, which may include:

      (i) a central storage area; and

      (ii) a medication cart.

    (B) A facility must store an individual's medication separately from other individuals' medications within the storage area.

    (C) 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.

    (D) A facility must store poisonous substances and medications labeled for "external use only" separately within the locked area.

    (E) 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.

  (6) Disposal.

    (A) A facility must keep medication that is no longer being used by an individual for the following reasons separate from current medications and ensure the medication is disposed of by a registered pharmacist licensed in the State of Texas:

      (i) the medication has been discontinued by order of the physician;

      (ii) the individual is deceased; or

      (iii) the expiration date of the medications has passed.

    (B) 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).

    (C) A facility must obtain a signed receipt from an individual or the individual's responsible party if the facility releases medication to the individual or responsible party.

(g) Accident, injury, or acute illness.

  (1) A facility must stock and maintain in a single location first aid supplies to treat burns, cuts, and poisoning.

  (2) In the event of accident or injury to an individual requiring emergency medical, dental, or nursing care, or in the event of death of an individual, a facility must:

    (A) make arrangements for emergency care or transfer to an appropriate place for treatment, including:

      (i) a physician's office;

      (ii) a clinic; or

      (iii) a hospital;

    (B) immediately notify an individual's physician and responsible party, or agency who admitted the individual to the facility; and

    (C) describe and document the accident, injury, or illness on a separate report. The report must contain a statement of final disposition and be maintained on file.

(h) Menus.

  (1) A facility must plan, date, and post a menu at least two weeks in advance and maintain a copy of the menu. A facility must serve meals according to approved menus.

  (2) A facility must ensure that a special diet meal ordered by an individual's physician and developed by the dietician consultant is labeled with the individual's name and type of diet.

Source Note: The provisions of this §98.62 adopted to be effective May 1, 1999, 24 TexReg 3100; amended to be effective November 1, 2000, 25 TexReg 10753; amended to be effective December 1, 2016, 41 TexReg 9327; amended to be effective October 28, 2018, 43 TexReg 7210

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