R432-270-19. Medication Administration

  (1) A licensed health care professional must assess each resident to determine what level and type of assistance is required for medication administration. The level and type of assistance provided shall be documented on each resident's assessment.

  (2) Each resident's medication program must be administered by means of one of the methods described in (a) through (f) in this section:

  (a) The resident is able to self-administer medications.

  (i) Residents who have been assessed to be able to self- administer medications may keep prescription medications in their rooms.

  (ii) If more than one resident resides in a unit, the facility must assess each person's ability to safely have medications in the unit. If safety is a factor, a resident shall keep his medication in a locked container in the unit.

  (b) The resident is able to self-direct medication administration. Facility staff may assist residents who self-direct medication administration by:

  (i) reminding the resident to take the medication;

  (ii) opening medication containers; and

  (iii) reminding the resident or the resident's responsible person when the prescription needs to be refilled.

  (c) Family members or a designated responsible person may administer medications. If a family member or designated responsible person assists with medication administration, they shall sign a waiver indicating that they agree to assume the responsibility to fill prescriptions, administer medication, and document that the medication has been administered. Facility staff may not serve as the designated responsible person.

  (d) For residents who are unable to self-administer or self-direct medications, facility staff may administer medications only after delegation by a licensed health care professional under the scope of their practice.

  (i) If a licensed health care professional delegates the task of medication administration to unlicensed assistive personnel, the delegation shall be in accordance with the Nurse Practice Act and R156-31B-701.

  (ii) The medications must be administered according to the prescribing order.

  (iii) The delegating authority must provide and document supervision, evaluation, and training of unlicensed assistive personnel assisting with medication administration.

  (iv) The delegating authority or another registered nurse shall be readily available either in person or by telecommunication.

  (e) Residents may independently administer their own personal injections if they have been assessed to be independent in that process. This may be done in conjunction with the administration of medication in methods (a) through (d) of this section.

  (f) home health or hospice agency staff may provide medication administration to facility residents exclusively, or in conjunction with (a) through (e) of this section.

  (3) The facility must have a licensed health care professional or licensed pharmacist review all resident medications at least every six months.

  (4) Medication records shall include the following:

  (a) the resident's name;

  (b) the name of the prescribing practitioner;

  (c) medication name including prescribed dosage;

  (d) the time, dose and dates administered;

  (e) the method of administration;

  (f) signatures of personnel administering the medication; and

  (g) the review date.

  (5) The licensed health care professional or licensed pharmacist should document any change in the dosage or schedule of medication in the medication record. When changes in the medication are documented by the facility staff the licensed health care professional must co-sign within 72 hours. The licensed health care professional must notify all unlicensed assistive personnel who administer medications of the medication change.

  (6) The facility must have access to a reference for possible reactions and precautions for all prescribed medications in the facility.

  (7) The facility must notify the licensed health care professional when medication errors occur.

  (8) Medication error incident reports shall be completed when a medication error occurs or is identified.

  (9) Medication errors must be incorporated into the facility quality improvement process.

  (10) Medications stored in a central storage area shall be:

  (a) locked to prevent unauthorized access; and

  (b) available for the resident to have timely access to the medication.

  (11) Medications that require refrigeration shall be stored separately from food items and at temperatures between 36 - 46 degrees Fahrenheit.

  (12) The facility must develop and implement policies governing the;

  (a) security and disposal of controlled substances by the licensee or facility staff which shall be consistent with the provisions of 21 CFR 1307.21; and

  (b) destruction and disposal of unused, outdated, or recalled medications.

  (13) The facility shall document the return of resident's medication to the resident or to the resident's responsible person upon discharge.