Ariz. Admin. Code § R9-10-520 - Medication Services

A. An administrator shall ensure that policies and procedures for medication services:

1. Include:

a. A process for providing information to a resident about medication prescribed for the resident including:

i. The prescribed medication's anticipated results,

ii. The prescribed medication's potential adverse reactions,

iii. The prescribed medication's potential side effects, and

iv. Potential adverse reactions that could result from not taking the medication as prescribed;

b. Procedures for preventing, responding to, and reporting:

i. A medication error,

ii. An adverse response to a medication, or iii. A medication overdose;

c. Procedures to ensure that a pharmacist reviews a resident's medications at least once every three months and provides documentation to the resident's attending physician and the director of nursing indicating potential medication problems such as incompatible or duplicative medications;

d. Procedures for documenting medication services; and

e. Procedures for assisting a resident in obtaining medication; and

2. Specify a process for review through the quality management program of:

a. A medication administration error, and

b. An adverse reaction to a medication.

B. An administrator shall ensure that:

1. Policies and procedures for medication administration:

a. Are reviewed and approved by a pharmacist;

b. Specify the individuals who may:

i. Order medication, and

ii. Administer medication;

c. Ensure that medication is administered to a resident only as prescribed; and

d. Cover the documentation of a resident's refusal to take prescribed medication in the resident's medical record;

2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law;

3. A medication administered to a resident:

a. Is administered in compliance with an order, and

b. Is documented in the resident's medical record; and

4. If a psychotropic medication is administered to a resident, the psychotropic medication:

a. Is only administered to a resident for a diagnosed medical condition; and

b. Unless clinically contraindicated or otherwise ordered by an attending physician or the attending physician's designee, is gradually reduced in dosage while the resident is simultaneously provided with interventions such as behavior and environment modification in an effort to discontinue the psychotropic medication, unless a dose reduction is attempted and the resident displays behavior justifying the need for the psychotropic medication, and the attending physician documents the necessity for the continued use and dosage.

C. If an ICF/IID provides assistance in the self-administration of medication, an administrator shall ensure that:

1. A resident's medication is stored by the ICF/IID;

2. The following assistance is provided to a resident:

a. A reminder when it is time to take the medication;

b. Opening the medication container for the resident;

c. Observing the resident while the resident removes the medication from the container;

d. Verifying that the medication is taken as ordered by the resident's attending physician by confirming that:

i. The resident taking the medication is the individual stated on the medication container label,

ii. The resident is taking the dosage of the medication stated on the medication container label or according to an order from the resident's attending physician dated later than the date on the medication container label, and

iii. The resident is taking the medication at the time stated on the medication container label or according to an order from the resident's attending physician dated later than the date on the medication container label; or

e. Observing the resident while the resident takes the medication;

3. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by the resident's attending physician or registered nurse;

4. Training for a personnel member, other than a physician, physician assistant, or registered nurse, in assistance in the self-administration of medication:

a. Is provided by the resident's attending physician, another physician, a physician assistant, or a registered nurse or an individual trained by a physician, physician assistant, or registered nurse; and

b. Includes:

i. A demonstration of the personnel member's skills and knowledge necessary to provide assistance in the self-administration of medication,

ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

iii. The process for notifying the appropriate entities when an emergency medical intervention is needed;

5. A personnel member, other than a physician, physician assistant, or registered nurse, completes the training in subsection (C)(4) before the personnel member provides assistance in the self-administration of medication; and

6. Assistance in the self-administration of medication provided to a resident:

a. Is in compliance with an order, and

b. Is documented in the resident's medical record.

D. An administrator shall ensure that:

1. A current drug reference guide is available for use by personnel members; and

2. If pharmaceutical services are provided:

a. The pharmaceutical services are provided under the direction of a pharmacist;

b. The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

c. A copy of the pharmacy license is provided to the Department upon request.

E. When medication is stored at an ICF/IID, an administrator shall ensure that:

1. Medication is stored in a separate locked room, closet, or self-contained unit used only for medication storage;

2. Medication is stored according to the instructions on the medication container; and

3. Policies and procedures are established, documented, and implemented to protect the health and safety of a resident for:

a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication;

b. Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

c. A medication recall and notification of residents who received recalled medication; and

d. Storing, inventorying, and dispensing controlled substances.

F. An administrator shall ensure that a personnel member immediately reports a medication error or a resident's adverse reaction to a medication to the resident's attending physician or the physician who ordered the medication and the ICF/IID's director of nursing.

Notes

Ariz. Admin. Code § R9-10-520

Adopted by final rulemaking at 25 A.A.R. 1222, effective 4/25/2019