Cal. Code Regs. Tit. 22, § 78317 - Nursing Services: Medications

(a) Each participant's health record shall include a drug history which lists all medications currently being taken by the participant and any medications to which the participant is allergic.

(b) Medications stored in the center or administered by center personnel shall be labeled in conformance with state and federal laws and regulations. Center personnel shall not alter prescription labels.

(c) Center personnel, except those lawfully authorized to do so, shall not dispense, repackage or label drugs or transfer drugs between containers.

(d) No medication shall be administered to a participant by center personnel unless the name, dosage and frequency of administration of the drug and the name of the prescriber is recorded in that participant's record. P.R.N. drug orders shall include an indication for use.

(e) Medications not self-administered shall be administered only by licensed medical or licensed nursing personnel.

(f) The self-administration of medications shall be permitted only under the following conditions:

(1) Center shall have approved policies permitting self-administration of medications when approved by the multidisciplinary team.

(2) Training in self-administration of medications shall be provided to all participants based on the recommendation of the multidisciplinary team.

(3) The health record of each participant who is capable of self-medication shall name all drugs which are to be self-administered.

(g) Medications shall be stored in the center under the following conditions:

(1) Medications shall be kept in clean, lockable cabinets, drawers or rooms. Such medications shall be accessible only to those licensed medical, nursing or pharmaceutical personnel designated by the center.

(2) Medications shall be stored in an orderly manner without overcrowding. External use drugs in liquid, tablet, capsule or powder form shall be stored separately from drugs for internal use.

(3) Test reagents, germicides, disinfectants and other household substances shall be stored separately from all drugs.

(4) Drugs shall not be stored after the expiration date on the label, and no contaminated or deteriorated drugs shall be available for use.

(5) The center shall keep a record of all prescription medications stored overnight. The record shall include the participant's name, the drug name and strength, the prescription number, if dispensed by a pharmacy and the date received. If the medication is returned to the participant, that shall be noted and dated on the record. The record shall be retained for at least one year.

(6) Medications requiring refrigeration shall be stored at a temperature between 2°C (36°F) and 8°C (46°F). If stored in the same refrigerator with foods, the drugs shall be in a closed container or compartment clearly marked "drugs" or "medication."

(h) Only disposable syringes and needles shall be used to administer drugs by injection. Such equipment shall be accessible only to licensed medical, nursing and pharmacy personnel and shall be destroyed so as to render it unfit for reuse in any manner.

(i) Those centers desiring to keep emergency drug supplies shall meet the following requirements:

(1) The drugs included in the emergency drug supply shall be determined by the pharmacist, the staff or attending physician and the registered nurse and shall be limited to a maximum of three doses in either sealed ampules or vials of any one emergency drug. If an emergency drug is not available in parenteral form, a supply of the drug in inhalation or sublingual form may be maintained in the smallest sealed manufacturer's package. No other oral legend drugs shall be stored.

(2) The emergency drug supply shall be stored in a portable container which is sealed in such a manner that the tamper-proof seal must be broken to gain access to the drugs. The registered nurse shall notify the pharmacist when drugs have been used from the emergency kit or when the seal has been broken. Drugs used from the kit shall be replaced within 72 hours and the supply resealed by the registered nurse.

(3) The contents of the supply shall be listed on the outside of the container.

(4) The supply shall be checked at least quarterly by the pharmacist.

(5) Separate records of use shall be maintained for drugs administered from the supply. Such records shall include the name and dose of the drug administered, name of the participant, the date and time of administration and signature of the person administering the dose.

(j) Drugs which have been left in the center by participants who have expired or have not visited the center for 30 days shall be destroyed in the center in the following manner:

(1) A registered nurse employed by the center and either another licensed nurse, the center administrator, a pharmacist or a physician shall witness the destruction.

(2) The method of destruction shall be recorded or indicated in the center's written procedures. Destruction shall be by flushing into the sewage system.

(3) Both witnesses required in (1) above shall sign a record which lists the date of destruction, the participant's name, the drug name and strength, the quantity destroyed and the prescription number, if any.

(k) There shall be written policies and procedures governing all aspects of medication storage, distribution, recording and disposal in the center.

(l) The center shall retain the services of a pharmacist who shall:

(1) Assist in the development and review of written policies and procedures.

(2) Monitor at least quarterly the implementation of policies and procedures related to medications at the center.

(3) Furnish to the center administrator at least quarterly a written report on the status of medication-related services.

(4) Communicate directly with participants, pharmacies, attending physician and center staff on matters pertaining to individual participant's drug therapy.

Notes

Cal. Code Regs. Tit. 22, § 78317

1. Amendment filed 9-22-79; effective thirtieth day thereafter (Register 79, No. 38).

Note: Authority cited: Section 208(a), Health and Safety Code. Reference: Section 1580, Health and Safety Code.

1. Amendment filed 9-22-79; effective thirtieth day thereafter (Register 79, No. 38).