R432-150-19. Pharmacy Services

  (1) The facility must provide or obtain by contract routine and emergency drugs, biologicals, and pharmaceutical services to meet resident needs.

  (2) The facility must employ or obtain the services of a licensed pharmacist who:

  (a) provides consultation on all aspects of pharmacy services in the facility;

  (b) establishes a system of records of receipt and disposition of all controlled substances which documents an accurate reconciliation; and

  (c) determines that drug records are in order and that an account of all controlled substances is maintained and reconciled monthly.

  (3) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.

  (a) The pharmacist must report any irregularities to the attending physician and the director of nursing or health services supervisor.

  (b) The physician and the director of Nursing or health services supervisor must indicate acceptance or rejection of the report and document any action taken.

  (4) Pharmacy personnel must ensure that labels on drugs and biologicals are in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date.

  (5) The facility must store all drugs and biologicals in locked compartments under proper temperature controls according to R432-150-19 (5)(e), and permit only authorized personnel to have access to the keys.

  (a) The facility must provide separately locked, permanently affixed compartments for storage of controlled substances listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit dose package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.

  (b) Non-medication materials that are poisonous or caustic may not be stored with medications.

  (c) Containers must be clearly labeled.

  (d) Medication intended for internal use shall be stored separately from medication intended for external use.

  (e) Medications stored at room temperature shall be maintained within 59 and 80 degrees F.

  (f) Refrigerated medications shall be maintained within 36 and 46 degrees F.

  (6) The facility must maintain an emergency drug supply.

  (a) Emergency drug containers shall be sealed to prevent unauthorized use.

  (b) Contents of the emergency drug supply must be listed on the outside of the container and the use of contents shall be documented by the nursing staff.

  (c) The emergency drug supply shall be stored and located for access by the nursing staff.

  (d) The pharmacist must inventory the emergency drug supply monthly.

  (e) Used or outdated items shall be replaced within 72 hours by the pharmacist.

  (7) The pharmacy must dispense and the facility must ensure that necessary drugs and biologicals are provided on a timely basis.

  (8) The facility must limit the duration of a drug order in the absence of the prescriber's specific instructions.

  (9) Drug references must be available for all drugs used in the facility. References shall include generic and brand names, available strength and dosage forms, indications and side effects, and other pharmacological data.

  (10) Drugs may be sent with the resident upon discharge if so ordered by the discharging physician provided that a record of the drugs sent with the resident is documented in the resident's health record.

  (11) Disposal of controlled substances must be in accordance with the Pharmacy Practice Act.