Or. Admin. Code § 411-054-0055 - Medications and Treatments
(1)
MEDICATION AND TREATMENT ADMINISTRATION SYSTEMS. The facility must have safe
medication and treatment administration systems in place that are approved by a
pharmacist consultant, registered nurse, or physician.
(a) The administrator is responsible for
ensuring adequate professional oversight of the medication and treatment
administration system.
(b)
Medications administered by the facility must be set-up or poured and
documented by the same person who administers the medications.
(c) The staff person who administers the
medication must visually observe the resident take (e.g., ingest, inhale,
apply) the medication unless the prescriber's order for that specific
medication states otherwise.
(d)
Medications must be kept secure between set-up and administration of
medications.
(e) The facility must
have a system approved by a pharmacist consultant or registered nurse for
tracking controlled substances and for disposal of all unused, outdated or
discontinued medications administered by the facility.
(f) Medication and treatment orders must be
carried out as prescribed.
(g)
Written, signed physician or other legally recognized practitioner orders must
be documented in the resident's facility record for all medications and
treatments that the facility is responsible to administer.
(h) Only a physician or other legally
recognized prescribing practitioner is authorized to make changes in a
medication or treatment order.
(i)
A registered pharmacist or registered nurse must review all medications and
treatments administered by the facility to a resident at least every 90 days.
The facility must provide documentation related to the recommendations made by
the reviewer.
(j) The resident or
the person legally authorized to make health care decisions for the resident
has the right to consent to, or refuse, medications and treatments.
(k) The physician or other practitioner must
be notified if a resident refuses consent to an order. Subsequent refusals to
consent to an order will be reported as requested by the prescriber.
(2) MEDICATION ADMINISTRATION. An
accurate Medication Administration Record (MAR) must be kept of all
medications, including over-the-counter medications that are ordered by a
legally recognized prescriber and are administered by the facility.
(a) Documentation of the MAR must be
completed using one of the following processes. An alternative process may be
used only with a written exception from the Department.
(A) The MAR may be signed as the medications
are set-up or poured. Medications must not be set-up in advance for more than
one administration time. If a medicine cup or other individual container is
used to set-up the medications, it must be placed in a closed compartment
labeled with the resident's name. Changes to the MAR that occur after the
medication is delivered, must be documented by the same staff person who
administered the medication.
(B)
The facility may choose to sign the MAR after the medication is administered to
a specific resident and prior to the next resident-specific medication or
treatment.
(b) MEDICATION
RECORD. At minimum, the medication record for each resident that the facility
administers medications to, must include:
(A)
Current month, day and year.
(B)
Name of medications, reason for use, dosage, route and date and time
given.
(C) Any medication specific
instructions, if applicable (e.g., significant side effects, time sensitive
dosage, when to call the prescriber or nurse).
(D) Resident allergies and sensitivities, if
any.
(E) Resident specific
parameters and instructions for p.r.n. medications.
(F) Initials of the person administering the
medication.
(3)
TREATMENT ADMINISTRATION.
(a) An accurate
treatment record for each resident must be kept of all treatments ordered by a
legally recognized practitioner and administered by the facility to that
resident.
(b) The treatment record
must include:
(A) Current month, day and
year.
(B) Type of treatment (e.g.,
dressing change, ointment application), treatment instructions and if
applicable, significant side effects or when to call the prescriber or
nurse.
(C) Date and time
administered.
(D) Resident
allergies and sensitivities, applicable to treatments.
(E) Instructions for p.r.n. treatments,
including resident specific parameters.
(F) Initials of person administering the
treatments.
(G) Any deviation from
instructions or refusal of treatment must be documented.
(4) MEDICATION AND
TREATMENT GENERAL. The facility must maintain legible signatures of staff that
administer medications and treatments, either on the MAR or on a separate
signature page, filed with the MAR.
(a) If
the facility administers or assists a resident with medication, all medication
obtained through a pharmacy must be clearly labeled with the pharmacist's
label, in the original container, in accordance with the facility's established
medication delivery system.
(b) The
facility shall ensure that prescription drugs dispensed to residents are
packaged in a manner that reduces errors in the tracking and administration of
the drugs, including, but not limited to, the use of unit dose systems or
blister packs.
(A) The facility shall have as
its primary goal dispensing prescription drugs in unit dose systems, blister
packs or similar packaging.
(B)
When unit dose packaging cannot be reasonably achieved, the facility shall have
a written policy describing how prescription drugs that are not prepared as
unit dose or blister packs shall be dispensed. Written policies shall be in
effect not later than October 1, 2018.
(C) Subsection (b) of this rule does not
apply to residents receiving pharmacy benefits through the United States
Department of Veterans Affairs, if the pharmacy benefits do not reimburse cost
of such packaging.
(c)
Over-the-counter medication or samples of medications must have the original
manufacturer's labels if the facility administers or assists a resident with
medication.
(d) All medications
administered by the facility must be stored in locked containers in a secured
environment such as a medication room or medication cart.
(e) Medications that have to be refrigerated
must be stored at the appropriate temperature in a locked, secure
location.
(f) Order changes
obtained by telephone must be documented in the resident's record and the MAR
must be updated prior to administering the new medication stated on the order.
Telephone orders must be followed-up with written, signed orders.
(g) The facility must not require residents
to purchase prescriptions from a pharmacy that contracts with the
facility.
(5) SELF
ADMINISTRATION OF MEDICATION.
(a) Residents
who choose to self-administer their medications must be evaluated upon move-in
and at least quarterly thereafter, to assure ability to safely self-administer
medications.
(b) Residents must
have a physician's or other legally recognized practitioner's written order of
approval for self-administration of prescription medications.
(c) Residents able to administer their own
medication regimen may keep prescription medications in their unit.
(d) If more than one resident resides in the
unit, an evaluation must be made of each person and the resident's ability to
safely have medications in the unit. If safety is a factor, the medications
must be kept in a locked container in the unit.
(e) Unless contraindicated by a physician or
resident evaluation, residents may keep and use over-the-counter medications in
their unit without a written order.
(6) PSYCHOTROPIC MEDICATION. Psychotropic
medications may be used only pursuant to a prescription that specifies the
circumstances, dosage and duration of use.
(a)
Facility administered psychotropic medications may be used only when required
to treat a resident's medical symptoms or to maximize a resident's
functioning.
(b) The facility must
not request psychotropic medication to treat a resident's behavioral symptoms
without a consultation from a physician, nurse practitioner, registered nurse,
or mental health professional. This does not apply when a resident is enrolled
in a hospice program as defined in OAR
333-035-0050.
(c) Prior to requesting a psychotropic
medication, the facility must demonstrate through the evaluation and service
planning process that non-pharmacological interventions have been
attempted.
(d) Prior to
administering any psychotropic medications to treat a resident's behavior, all
direct care staff administering medications for the resident must know:
(A) The specific reasons for the use of the
psychotropic medication for that resident.
(B) The common side effects of the
medications.
(C) When to contact a
health professional regarding side effects.
(e) When a psychotropic medication is ordered
by a health care practitioner other than the resident's primary care provider,
the facility is responsible for notifying the resident's primary care provider
of that medication order within 72 hours of when the facility was notified of
the order. This includes weekends and holidays. Notification may be either by
telephone or electronic submission and should be documented by the
facility.
(f) Medications that are
administered p.r.n. that are given to treat a resident's behavior must have
written, resident-specific parameters.
(A)
These p.r.n. medications may be used only after documented; non-pharmacological
interventions have been tried with ineffective results.
(B) All direct care staff must have knowledge
of non-pharmacological interventions.
(g) Psychotropic medications must not be
given to discipline a resident, or for the convenience of the
facility.
Notes
Statutory/Other Authority: ORS 410.070 & 443.450
Statutes/Other Implemented: ORS 443.400 - 443.455 & 443.991
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