Ga. Comp. R. & Regs. R. 111-8-62-.20 - Medications

(1) Self-Administration of Medications. Residents who have the capacity to self-administer medications safely and independently without staff assistance or supervision must be allowed to store their own medications securely and self-administer medications if they so desire.

(2) Assistance with Self-Administration. A resident who is not capable of independent self-administration of medication may be assisted and supervised in self-administration by staff to the following extent;

(a) Staff providing such assistance or supervision may perform the following:

1. Take the medication, in its previously dispensed, properly labeled container, from where it is stored, and bring the medication to the resident.

2. Read the label, open the container, remove a prescribed amount of medication from the container, and close the container, in the presence of the resident.

3. Place an oral dosage in the resident's hand or in another container where the resident requests assistance.

4. Apply topical medications.

5. Assist with self-administration of drops, inhalers, nasal sprays and patches.

6. Return the medication container to proper secured storage.

7. Assist the resident's use of an EPI pen where the resident has known severe allergies for which an EPI pen has been prescribed on condition that there is an established written protocol detailing how it is to be used and when. The protocol must include immediately calling Emergency Services, 911, after any use of the EPI pen.

(b) Staff assisting with or supervising self-administration of medications must be proficient in English and able to read, write and follow written instructions in English.

(3) Basic Medication Training for Staff Assisting with Self-Administration. The home must provide and document medication training for the unlicensed staff that are providing assistance with or supervision of self-administration of medications to capable residents. The medication training must be conducted with an appropriate curriculum for providing medication assistance and include at least the following topics:

(a) The home's medication policy and procedures, including actions to take if concerns regarding resident's capacity to self-administer medications are identified.

(b) How to read prescription labels including common abbreviations.

(c) Providing the right medication to the right resident at the right time in the right amount and the right way including how to measure various medications.

(d) Actions to take when concerns regarding medications are identified.

(e) Infection control procedures relative to providing assistance with medications.

(f) Proper medication storage and disposal.

(g) Recognition of side effects and adverse reactions for the specific medications.

(h) Understanding the common classifications of medications, typical side effects and adverse reactions and medications for which unlicensed staff may never provide assistance with or supervision of self-administration.

(i) Proper documentation and record keeping using the Medication Assistance Record.

(4) Medication Skills Competency Determinations. Unlicensed staff in homes providing assistance with or supervision of self-administered medications must demonstrate to a qualified supervisor when hired and at least, annually thereafter, the necessary skills to perform the medication tasks assigned competently.

(5) Memory Care Medication Administration. Medications for residents living in the memory care center must be provided to the residents by a proxy caregiver trained in accordance with the requirements of Chapter 111-8-100; a licensed registered nurse; a licensed practical nurse working under the supervision of a physician or registered nurse; or a certified medication aide subject to the requirements set forth below.

(6) Certified Medication Aide Requirements. A home using certified medication aides must meet the requirements below. CMAs working in the memory care center may also assist non-memory care residents in the same building.

(a) Check the Registry. The home must check to ensure that the medication aides employed in the home are listed in good standing on the Georgia Certified Medication Aide Registry and have no record of being terminated for cause relating to the performance of medication aide tasks before permitting the aides to administer medications.

(b) Administer Skills Competency Checks. The home must administer skills competency checks to determine and document that the medication aides who have been certified for more than one year upon hiring continue to have the knowledge and skills necessary to administer medications properly for the residents in care. The home must use a skills competency checklist which meets the requirements contained in the standardized clinical skills competency checklist used to certify medication aides.

(c) Quarterly Observations. The home must use a licensed registered professional nurse or a pharmacist to conduct quarterly random medication administration observations to determine that the aides are administering medications correctly and in compliance with these rules and report any issues to the home's administration for resolution.

(d) Quarterly Drug Regimen Reviews. The home must secure the services of a licensed pharmacist to perform all of the following duties:

(i) conduct quarterly reviews of the drug regimen for each resident of the assisted living community and report any irregularities to the assisted living community administration;

(ii) remove for proper disposal any drugs that are expired, discontinued or in a deteriorated condition or where the resident for whom such drugs were ordered is no longer a resident;

(iii) establish or review policies and procedures for safe and effective drug therapy, distribution, use and control; and

(iv) monitor compliance with established policies and procedures for medication handling and storage.

(e) Authorized Tasks for Certified Medication Aides. A home may allow a certified medication aide to do only the following tasks related the administration of medications utilizing only unit or multidose packaging of medications:

(i) Administer physician ordered oral, via a feeding tube, ophthalmic, topical, otic, nasal, vaginal and rectal medications;

(ii) Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol;

(iii) Administer medications via a metered dose inhaler;

(iv) Conduct finger stick blood glucose testing following established protocol;

(v) Administer a commercially prepared disposable enema ordered by a physician;

(vi) Assist residents in the supervision of self-administration of medications; and

(vii) Administer liquid morphine to a resident of the community who is the patient of a licensed hospice, pursuant to a hospice physician's written order that contains specific instructions for indication, dosage, frequency and route of administration.

(f) Annual Competency Reviews. Complete comprehensive clinical skills competency reviews for each certified medication aide utilizing the skills competency checklist at least, annually after hiring to determine that the aides continue to have the necessary skills to perform the medication tasks assigned competently. Such skills competency checklists must be administered by Georgia-licensed registered nurses, pharmacists or physicians, who indicate in writing that the tasks observed are being performed competently.

(g) Proper Notice of Separation for Cause. Ensure that where a medication aide is terminated for cause relating to the performance of medication aide tasks, the aide is provided with the following:

(i) a separation notice that clearly describes the facts that support the termination for cause;

(ii) written notice that being terminated for cause related to the administration of medications, if not successfully appealed through a hearing on right to unemployment benefits will result in the loss of good standing on the Georgia Certified Medication Aide Registry; and

(iii) the loss of good standing on the Certified Medication Aide Registry will make the aide ineligible for hiring as a certified medication aide by another assisted living community.

(h) Registry Notification. Submit to the Georgia Certified Medication Aide Registry a copy of the Separation Notice for the certified medication aide only if the separation related specifically to the performance of medication aide tasks and the termination for cause has either been finally upheld by the Department of Labor or the time for appealing the Separation Notice has expired.

(7) Homes Conducting Certified Medication Aide Training. A home choosing to provide a certified medication aide training program must do all of the following:

(a) Utilize the state-approved medication aide training program ensuring that the training is administered by a Georgia licensed registered nurse, pharmacist, or physician;

(b) Require the aide to demonstrate the requisite clinical skills to serve as a medication aide before a Georgia-licensed registered nurse, pharmacist or physician utilizing the standardized medication administration checklist developed by the Department;

(c) Prepare the aide to take the written competency examination to become a certified medication aide;

(d) Verify that the aide is in good standing on the Georgia certified nurse aide registry;

(e) Provide information to the aide on the registration and locations for taking the written competency examination;

(f) Provide the documentation to the Georgia Certified Medication Aide Registry that is necessary to complete the application for placement of the aide's name on the Georgia Certified Medication Aide Registry; and

(g) Not permit the aide to administer medications independently unless the aide is listed on the Georgia certified medication aide registry in good standing.

(8) Maintaining Records on Medication Assistance and Administration. Where the home either provides assistance with, or supervision of self-administered medications, or administers medications to residents, the home must maintain a daily Medication Assistance Record (MAR) for each resident receiving such service.

(a) The MAR must include the name of the specific resident, any known allergies, the name and telephone number of the resident's health care provider, the name, strength and specific directions including a summary of severe side effects and adverse reactions for use of each medication and a chart for staff who provide assistance or administration to record initials, time and date when medications are taken, refused or a medication error is identified (e.g. missed dosage).

(b) The staff providing the assistance or administration of medications must update the MAR each time the medication is offered or taken.

(c) The home must make medication information concerning the descriptions of medication, dosing, side effects, adverse reactions and contraindications for each medication being administered to the residents immediately available for reference by staff providing medication assistance or administration.

(d) Staff providing assistance with or administration of medications must document in the resident's record any unusual reactions to the medications and provide such information to the resident, the resident's representative and the health care provider as appropriate.

(e) Refills of prescribed medications must be obtained timely so that there is no interruption in the routine dosing. Where the home is provided with a new medication for the resident, the MAR must be modified to reflect the addition of the new medication within 48 hours or sooner if the prescribing physician, advance practice registered nurse or physician assistant indicates that the medication change must be made immediately. In homes, where unit or multi-dose packaging is not available for immediate changes in medications, unit or multi-dose packaging of the medication must be obtained when the prescription is refilled.

(f) For any administration of liquid morphine by a certified medication aide, staff shall observe and document the following in the resident's record:

(i) the resident's need for PRN liquid morphine, including but not limited to verbalizations of pain, groaning, grimacing or restlessness;

(ii) the date, time and location of the initial dose administered by a licensed hospice health care professional;

(iii) the dosage, time and route of administration for the morphine administered in the community;

(iv) the training provided by the licensed hospice; and

(v) information regarding the special circumstances under which the hospice was unavailable to administer the medication.

(9) Orders Required for All Medications. A home must not allow its staff to assist with, provide supervision of self-administered medications, including over-the-counter medications, unless there is a physician, advance practice registered nurse or physician assistant's order or individualized prescription bottle, specifying clear instructions for its use on file for the resident.

(10) Timely Management of Medication Procurement. The home must obtain new prescriptions within 48 hours of receipt of notice of the prescription or sooner if the prescribing physician indicates that a medication change must be made immediately. If the pharmacy does not have the medication needed for the immediate change, available and has not obtained further directions from the physician, the home must notify the physician of the unavailability of the prescription and request direction.

(11) Storage of Medications.

(a) The home is accountable for having an effective system to manage the medications it receives including storing medications under lock and key, or other secure system to prevent unauthorized access, at all times, whether kept by a resident or kept by the home for the resident, except when required to be kept by a resident on his or her person due to need for frequent or emergency use, as determined by the resident's physician, advance practice registered nurse or physician assistant, or when closely attended by a staff member. Additionally, for controlled substances, the secure storage must be a locked cabinet or box of substantial construction and a log must be maintained and updated daily by the home to account for all inventory.

(b) Medication kept by a resident may be stored in the resident's bedroom, in a locked cabinet or other locked storage container. Single occupancy bedrooms which are kept locked at all times are acceptable. Duplicate keys for the resident's locked storage container and room must be available to the resident and the administrator, on-site manager or designated staff.

(c) Medications must be kept in original containers with original labels intact.

(d) A home may stock over-the-counter medications such as aspirin or acetaminophen for the convenience of residents who have PRN (as needed) orders for the specific medication and dosage. However, where the resident takes an over-the-counter medication daily as prescribed in a written order by a licensed physician, nurse practitioner or physicians assistant, such as vitamins or low-dose aspirins, the resident must have an individual bottle of the prescribed medication that is kept for the resident's individual usage.

(e) Unused or expired medications must be properly disposed of using the current U.S. Food and Drug Administration or U.S. Environmental Protection Agency guidelines for the specific medications.

(f) The supply of liquid morphine on site shall be limited to 50 ml for each hospice patient in the home for which there is a physician's order for such medication.

Notes

Ga. Comp. R. & Regs. R. 111-8-62-.20

O.C.G.A. §§ 31-2-7, 31-2-9, 31-7-1, 31-7-2, 31-7-2.1, 31-7-12, 31-8-180 et seq., 43-26-32.

Original Rule entitled "Additional Requirements for Specialized Memory Care Units or Homes" adopted. F. Nov. 19, 2009; eff. Dec. 9, 2009. Amended: New Title "Medications". F. Dec. 19, 2012; eff. Jan. 8, 2013. Amended: F. Aug. 24, 2021; eff. Sept. 13, 2021.