Or. Admin. Code § 309-035-0215 - Health Services

(1) The program administrator must ensure all residents are offered medical attention when needed. The provider must arrange for health services with the informed consent of the resident or the resident's representative. The program must arrange for physicians to be available in the event the resident's regular physician is unavailable. The provider must identify a hospital emergency room that may be used in case of emergency.

(2) The provider must ensure that each resident admitted to the program is screened by an LMP or a Registered Nurse to identify health problems and to screen for communicable disease. The provider must maintain documentation of the initial health screening in the resident service record:

(a) The health screening must include a brief history of health conditions, current physical condition, and a written record of current or recommended medications, treatments, dietary specifications, aids to physical functioning, and a statement of whether the resident must undergo testing for communicable illness prior to admission;

(b) For regular admissions, the health screening must be obtained no more than 90 days prior to the individual's admission;

(c) For emergency admissions, the health screening must be obtained as follows:

(A) For individuals experiencing psychiatric or medical distress, a health screening must be completed by an LMP prior to the individual's admission or within 24 hours of the emergency placement. The health screening must confirm that the individual does not have health conditions requiring continuous nursing care, hospital level of care, or immediate medical assistance.

(B) For residents who are admitted on an urgent basis due to a lack of alternative supportive housing, the health screening must be obtained within 72 hours after the resident's admission;

(3) The program must ensure that each resident has a primary physician who is responsible for monitoring their health care. Regular health examinations must be done in accordance with the recommendations of this primary health care professional but not less than once every three years. Newly admitted residents must be provided assistance with coordinating a health examination within three months after admission. Documentation of findings from each examination must be placed in the resident's service record.

(4) A transgender resident must be provided access to any assessments, therapies, and treatments that are recommended by the resident's health care provider, including but not limited to transgender-related medical care, hormone therapy, and supportive counseling.

(5) A written order signed by a prescribing practitioner is required for any medical treatment, special diet for health reasons, aid to physical functioning, and any limitation of physical activity.

(6) A written order signed by a prescribing practitioner is required for all medications administered or supervised by program staff including over-the-counter medications and prescribed supplements. This written order is required before any medication is administered to a resident. Signatures by a prescriber must be either ink, indelible pencil, or approved electronic equivalent:

(a) A written order must, at minimum, it includes the following information:

(A) The name of the medication to be provided;

(B) The form of the medication to be provided;

(C) The dosage of the medication to be provided;

(D) The frequency that the medication is to be provided;

(E) The route or method of administration for the medication to be provided; and

(F) Medication orders prescribed as P.R.N. must include the reason for administration of the medication.

(b) Medications for all residents must be labeled.

(c) Medications may not be used for the convenience of staff or as a substitute for supervision, care and treatment. Medications may not be withheld or used as reinforcement or punishment or in quantities that are excessive in relation to the amount needed to attain the resident's best possible functioning:

(d) Medications may be self-administered by the resident if the resident demonstrates the ability to self-administer medications in a safe and reliable manner, the facility has received written orders from the prescriber and the residential service plan documents that medications will be self-administered. The self-administration of medications may be supervised by program staff who may prompt the resident to administer the medication and observe the fact of administration and dosage taken. When supervision occurs, program staff must document information in the resident's record consistent with section (5)(h) below;

(e) Program staff who assist with administration of medication must be trained by a Licensed Medical Professional, Registered Nurse or Licensed Pharmacist on the use and effects of commonly used medications;

(f) Medications prescribed for one resident may not be administered to or self-administered by another resident;

(g) The program may not maintain stock supplies of prescription medications. The facility may maintain a stock supply of non-prescription medications including FDA-approved short-acting, non-injectable, opioid antagonist medications;

(h) The program must develop and implement a policy and procedure that ensures all orders for prescription drugs are reviewed by a prescribing practitioner at least every six months. When this review identifies a contra-indication or other concern, the resident's primary physician or LMP must be immediately notified. Each resident receiving psychotropic medications must be evaluated at least every three months by the LMP prescribing the medication, who must note for the resident's record the results of the evaluation and any changes in the form and dosage of medication, the condition for which it is prescribed, when and how the medication is to be administered, common side effects, including any signs of tardive dyskinesia, contraindications or possible allergic reactions, and what to do in case of a missed dose or other dosing error;

(i) The provider must dispose of all unused, discontinued, outdated, or recalled medications and any medication containers with worn, illegible or missing labels. The provider must dispose of medications in a safe method consistent with any applicable state and federal requirements and designed to prevent diversion of these substances to persons for whom they were not prescribed.

(j) The provider must maintain a written record of all disposals specifying the date of disposal, a description of the medication, its dosage potency, amount disposed, the name of the resident for whom the medication was prescribed, the reason for disposal, the method of disposal, and the signature of the program staff disposing of the medication. For any medication classified as a controlled substance in schedules 1 through 5 of the Federal Controlled Substance Act, the disposal must be witnessed by a second staff person who documents their observation by signing the disposal record;

(k) The provider must properly and securely store all medications in a locked space for medications only in accordance with the instructions provided by the prescriber or pharmacy except as otherwise permitted in OAR 309-035-0215(9).

(l) Medications requiring refrigeration must be stored in an enclosed, locked container within the refrigerator. The provider must ensure that residents have access to a locked, secure storage space for their self-administered medications. The program must note in its written policy and procedures which persons have access to this locked storage and under what conditions;

(m) For all residents taking prescribed medication, the provider must dispense and record medications as described in the prescriber's signed written order.

(n) The medication administration record must:

(A) Identify all medication and prescribed dietary supplements including the name, date, time, dosage and route;

(B) Identify any treatments and therapies provided including the type of treatment or therapy and the time the procedure must be performed;

(C) Be immediately signed or initialed or entered into the electronic health record system by the caregiver administering the medication, treatment, or therapy as it is completed. Each resident's MAR must contain a legible signature that identifies each set of initials or electronic equivalent;

(D) Document changed and discontinued orders immediately showing the date of the change or discontinued order. A changed order must be written on a new line with a line drawn to the start date and time or entered into the electronic health record system; and

(E) Document missed or refused medications, treatments or therapies by circling the initials of the caregiver administering the medication, treatment or therapy and documenting a brief explanation on the back of the MAR or entered into the electronic health record system.

(o) All effects, adverse reactions, and medication errors must be documented in the resident's service record. All errors, adverse reactions, or refusals of medication must be reported to the prescribing LMP within 48 hours;

(p) PRN medications, treatments and therapies must be documented on the resident's MAR with the time, dose (as applicable), the reason the medication treatment or therapy was given and the outcome.

(q) Prescription medication, treatment or therapies ordered to be given "as needed" or "PRN" must have specific parameters indicating what the medication, treatment or therapy is for and specifically when, how much, and how often the medication, treatment or therapy may be administered. Any additional instructions must be available for the caregiver to review before the medication is administered to the resident.

(r) A Registered Nurse may write parameters to clarify to an existing physician or nurse practitioner order in accordance with Oregon State Board of Nursing in OAR chapter 851, division 45.

(s) In the event a prescribed medication or therapy needs to be modified due to urgent concerns for the resident's safety or for administration of medication outside of prescribed medication window, and the prescribing physician is not available, program staff may follow the written advice of a practicing Pharmacist currently licensed by the State of Oregon to temporarily administer, modify, or hold a medication, medical treatment, or special diet. The prescribing physician must be notified in writing within 48 hours. Notification must be documented in the resident's record.

(7) Nursing tasks may be trained or delegated by a registered nurse to direct care staff within the limitations of their classification and only in accordance with the administrative rules of the Oregon State Board of Nursing, chapter 851, division 45 and division 47.

(8) The program must ensure at least one unexpired opioid overdose kit for emergency response to a suspected overdose is available in the facility at all times. Opioid overdose kits do not require a prescription and are not specific to a resident (see ORS 689.684).

(9) All opioid overdose kits must include an ultraviolet light-protected hard case and must contain, but not be limited to:

(a) Two doses of an FDA-approved short-acting, non-injectable, opioid antagonist medication;

(b) One pair non-latex gloves;

(c) One face mask;

(d) One disposable face shield for rescue breathing; and

(e) One short-acting, non-injectable, opioid antagonist medication administration instruction card.

(9) Opioid overdose kits must be:

(a) Installed in an easily accessible, highly visible, and unlocked location;

(b) At a height of no more than 48 inches from the floor;

(c) In a location without direct sunlight;

(d) In an area where temperatures are maintained between 59F and 77F; and

(e) Have a sign clearly indicating the location and content of the kit.

(10) Short-acting, non-injectable, opioid antagonist medication not within installed opioid overdose kits must be stored in a locked cabinet with other resident medications.

(11) Opioid overdose kits must be:

(a) Checked daily to ensure the required components have not been removed or damaged, with documentation of daily checks maintained for three years;

(b) Checked monthly to ensure the short-acting, non-injectable, opioid antagonist medication has not expired, with documentation of monthly checks maintained for three years; and

(c) Restocked immediately after use.

(12) Upon recognizing a person is likely experiencing an overdose, program staff must immediately respond based on the medical emergency procedures of the facility.

(13) A person who has reasonable cause to believe a resident is experiencing an overdose, and in good faith administers short-acting, non-injectable, opioid antagonist medication to the resident, is protected against civil liability or criminal prosecution unless the person, while rendering care, acts with gross negligence, willful misconduct, or intentional wrongdoing as described in Oregon Revised Statute (ORS) 689.681.

(14) Program staff must fully cooperate with emergency medical service (EMS) personnel. Program staff must not interfere with or impede the administration of emergency medical services.

(15) Administration of short-acting, non-injectable, opioid antagonist medication must be documented in a critical incident report by the program staff who administered the medication. Documentation must be submitted to the Authority within 48 hours of the incident and must include:

(a) Name of the resident;

(b) Description of the incident including date, time, and location;

(c) Time 9-1-1 contacted;

(d) Time of administration(s) of short-acting, non-injectable, opioid antagonist medication;

(e) Resident's response;

(f) Transfer of care to EMS; and

(g) Signature of program staff.

Notes

Or. Admin. Code § 309-035-0215

MHS 2-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8-30-17; MHS 5-2017, f. & cert. ef. 6/8/2017; BHS 1-2024, temporary amend filed 01/09/2024, effective 1/10/2024 through 4/11/2024; BHS 6-2024, amend filed 04/11/2024, effective 4/11/2024; BHS 4-2025, amend filed 02/28/2025, effective 3/1/2025

Statutory/Other Authority: ORS 413.042 & 443.450

Statutes/Other Implemented: ORS 413.032, 443.400 - 443.465 & 443.991