Or. Admin. Code § 411-325-0120 - Medical Services
(1) A provider
must have and implement written policies and procedures that maintain and
protect individuals' physical health. The policies and procedures must address
the following:
(a) Individual health
care;
(b) Medication
administration;
(c) Medication
storage;
(d) Response to emergency
medical situations;
(e) Nursing
services, if provided;
(f) Disposal
of medications; and
(g) Early
detection and prevention of infectious disease.
(2) INDIVIDUAL HEALTH CARE.
(a) A provider must ensure an individual
receives care that promotes the health and well-being of the individual as
follows:
(A) The provider must ensure the
individual has a primary physician or health care provider whom the individual
has chosen from among qualified providers. Provisions must be made for a
secondary physician or clinic in the event of an emergency.
(B) The provider must ensure the individual
receives a medical evaluation by a qualified health care provider no fewer than
every two years or as recommended by a physician.
(C) The provider must monitor the health
status and physical conditions of the individual and take action in a timely
manner in response to identified changes or conditions that may lead to
deterioration or harm.
(b) A written, signed order from a physician
or qualified health care provider is required prior to the usage or
implementation of all of the following:
(A)
Prescription medications;
(B)
Non-prescription medications except over the counter topical;
(C) Treatments other than basic first
aid;
(D) Modified or special
diets;
(E) Adaptive equipment;
and
(F) Aids to physical
functioning.
(c) A
provider must implement the order of a physician or qualified health care
provider.
(d) A provider must
maintain records on each individual to aid physicians, licensed health
professionals, and the provider in understanding the medical history of the
individual. The record must include:
(A) A
list of known health conditions, medical diagnoses, known allergies, and
immunizations;
(B) A record of
visits to licensed health professionals that include documentation of the
consultation and any therapy provided; and
(C) A record of known hospitalizations and
surgeries.
(3) MEDICATION.
(a) All medications must be:
(A) Kept in their original
containers;
(B) Labeled by the
dispensing pharmacy, product manufacturer, or physician, as specified per the
written order of a physician or qualified health care provider; and
(C) Kept in a secured locked container and
stored as indicated by the product manufacturer.
(b) All medications and treatments must be
recorded on an individualized medication administration record (MAR). The MAR
must include:
(A) The name of the
individual;
(B) A transcription of
the written order of a physician or qualified health care provider, including
the brand or generic name of the medication, prescribed dosage, frequency, and
method of administration;
(C) For
topical medications and treatments without the order of a physician or
qualified health care provider, a transcription of the printed instructions
from the package;
(D) Times and
dates of administration or self-administration of the medication;
(E) Signature of the person administering the
medication or the person monitoring the self-administration of the
medication;
(F) Method of
administration;
(G) An explanation
of why a PRN (i.e., as needed) medication was administered;
(H) Documented effectiveness of any PRN
(i.e., as needed) medication administration;
(I) An explanation of any medication
administration irregularity; and
(J) Documentation of any known allergy or
adverse drug reaction.
(c) Self-administration of medication.
(A) The ISP for individuals who independently
self-administer medications must include a plan for the periodic monitoring and
review of the self-administration of medications.
(B) A provider must ensure that individuals
able to self-administer medications keep the medications in a secure locked
container unavailable to other individuals residing in the same home and store
the medications as recommended by the product manufacturer.
(d) PRN (i.e., as needed) orders
are not allowed for psychotropic medication.
(e) Safeguards to prevent adverse effects or
medication reactions must be utilized and include:
(A) Whenever possible, obtaining all
prescription medication for an individual, except samples provided by a health
care provider, from a single pharmacy which maintains a medication profile for
the individual;
(B) Maintaining
information about the desired effects and side effects of each
medication;
(C) Ensuring that
medications prescribed for one individual are not administered to, or
self-administered by, another individual or staff member; and
(D) Documentation in the record for an
individual of the reason all medications are not provided through a single
pharmacy.
(f) All
expired, discontinued, recalled, or contaminated medications, including
over-the-counter medications, may not be kept in a home and must be disposed of
within 10 calendar days of expiration, discontinuation, or a provider's
knowledge of a recall or contamination. A provider must dispose of the
prescription medications for an individual who has died within 10 calendar days
of the individual's death.
(A) A provider
must dispose of medications according to the provider's policy. The provider's
policy must reflect the medication disposal guidelines issued by the Department
of Environmental Quality.
(B) A
provider must maintain a written record of the disposal of a medication. The
record must include documentation of the following:
(i) Date of disposal;
(ii) Description of the medication, including
dosage, strength, and amount being disposed;
(iii) Name of the individual for whom the
medication was prescribed;
(iv)
Reason for disposal;
(v) Method of
disposal;
(vi) Signature of the
person disposing of the medication; and
(vii) For controlled medications, the
signature of a witness to the disposal.
(4) NURSING SERVICES. When nursing
services are provided to an individual, a provider must:
(a) Coordinate with a registered nurse and
the individual's ISP team to ensure the nursing services being provided are
sufficient to meet the health needs of the individual; and
(b) Implement the Nursing Service Plan, or
appropriate portions therein, as agreed upon by the individual's ISP team and
the registered nurse.
(5) DELEGATION AND SUPERVISION OF NURSING
TASKS. Nursing tasks must be delegated by a registered nurse to a provider in
accordance with the rules of the Oregon State Board of Nursing in OAR chapter
851, division 047.
(6) DIRECT
NURSING SERVICES. Upon official approval from the Centers for Medicare and
Medicaid Services, direct nursing services may be provided to individuals 21
years of age and older in accordance with OAR chapter
411,
division 380.
(a) A provider of a 24-hour
residential setting may deliver direct nursing services to an individual in the
24-hour residential setting under the following conditions:
(A) The provider must be endorsed to OAR
chapter 411, division 380 in accordance with OAR chapter 411, division 323, and
the staff delivering the direct nursing services must meet the qualifications
described in OAR 411-380-0060;
(B) More than one individual who receives
Department-funded services must reside in the 24-hour residential
setting;
(C) The provider must be
the individual's, or as applicable the individual's legal representative's,
provider of choice for direct nursing services;
(D) Direct nursing services are not delivered
at the 24-hour residential setting for the convenience of the provider or
24-hour residential program; and
(E) The provider meets the requirements as an
enrolled Medicaid Provider as described in OAR
411-380-0060 and has a separate
and distinct Medicaid provider number for the provision of direct nursing
services.
(b) A Nursing
Service Plan must be present when Department funds are used for direct nursing
services. The provision of direct nursing services must be authorized by a case
manager as identified in an ISP.
(c) When direct nursing services are provided
to an eligible individual by a provider, the provider must:
(A) Coordinate with the registered nurse and
the individual's ISP team to ensure the direct nursing services being provided
are sufficient to meet the individual's health needs;
(B) Implement the Nursing Service Plan, or
appropriate portions therein, as agreed upon by the individual's ISP team and
the registered nurse; and
(C) While
delivering direct nursing services exclusively to the individual, assure the
needs of other individuals in the home are met.
(7) A provider must immediately notify an
individual's case manager, and document the notification, when the individual's
medical, behavioral, or physical needs change to a point that they may not be
met by the provider.
Notes
Statutory/Other Authority:ORS 409.050, 441.715, 443.450 & 443.455
Statutes/Other Implemented:ORS 441.705-441.720, 441.740, 441.745, 443.384, 443.392, 443.400-443.445, 443.450, 443.455, 443.880, 443.881 & 443.991
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