9 CSR 10-7.070 - Medications
(1)
General Guidelines, Policies and Practices. The following requirements apply to
all programs, where applicable.
(A) The
organization shall assure that staff authorized by the organization and by law
to conduct medical, nursing and pharmaceutical services do so using sound
clinical practices and following all applicable state and federal laws and
regulations.
(B) The organization
shall have written policies and procedures on how medications are prescribed,
obtained, stored, administered and disposed.
(C) The organization shall implement policies
that prevent the use of medications as punishment, for the convenience of
staff, as a substitute for services or other treatment, or in quantities that
interfere with the individual's participation in treatment and rehabilitation
services.
(D) The organization
shall allow individuals to take prescribed medication as directed.
1. Individuals cannot be denied service due
to taking prescribed medication as directed. If the organization believes that
a prescribed medication is subject to abuse or could be an obstacle to other
treatment goals, then the organization's treatment staff shall attempt to
engage the prescribing physician in a collaborative discussion and treatment
planning process. If the prescribing physician is nonresponsive, a second
opinion by another physician may be used.
2. Individuals shall not be denied service
solely due to not taking prescribed medication as directed. However, a person
may be denied service if he or she is unable to adequately participate in and
benefit from the service offered due to not taking medication as
directed.
(2)
Medication Profile. Where applicable, the individual's record shall include a
medication profile that includes name, age, weight, current diagnosis, current
medication and dosage, prescribing physician, allergies to medication,
non-prescription medication and supplements, medication compliance; and other
pertinent information related to the individual's medication regimen.
(3) Prescription of Medication. If a program
prescribes medications, there shall be documentation of each medication service
episode including description of the individual's presenting condition and
symptoms, pertinent medical and psychiatric findings, other observations,
response to medication, and action taken.
(4) Medication Administration and Related
Requirements. The following requirements apply to programs that prescribe or
administer medication and to those programs where individuals self-administer
medication under staff observation.
(A) Staff
Training and Competence. The organization shall ensure the training and
competence of staff in the administration of medication and observation for
adverse drug reactions and medication errors, consistent with each staff
individual's job duties.
1. Staff whose duties
include the administration of medication shall complete Level I medication aide
training in accordance with
19 CSR
30-84.030. This requirement shall not apply to those
staff who-
A. Have prior education and
training which meets or exceeds the Level I medication aide training hours and
skill objectives; or
B. Work in
settings where clients self-administer their own medication under staff
observation.
2. Staff
whose duties are limited to observing clients self-administer their own
medication or to documenting that medication is taken as prescribed shall have
available to them a physician, pharmacist, registered nurse or reference
material for consultation regarding medications and their actions, possible
side effects, and potential adverse reactions.
3. Staff whose duties are limited to
observing clients self-administer their own medication or to documenting that
medication is taken as prescribed shall receive education on general actions,
possible side effects, and potential adverse reactions to
medications.
(B)
Education. If medication is part of the treatment plan, the organization shall
document that the individual and family member, if appropriate, understands the
purpose and side effects of the medication.
(C) Compliance. The program shall take steps
to ensure that each individual takes medication as prescribed and the program
shall document any refusal of medications. A licensed physician shall be
informed of any ongoing refusal of medication.
(D) Medication Errors. The program shall
establish and implement policies defining the types of medication errors that
must be reported to a licensed physician.
(E) Adverse Drug Reactions. A licensed
physician shall be immediately notified of any adverse reaction. The type of
reaction, physician recommendation and subsequent action taken by the program
shall be documented in the individual's record.
(F) Records and Documentation. The
organization shall maintain records to track and account for all prescribed
medications in residential programs and, where applicable, in nonresidential
programs.
1. Each individual receiving
medication shall have a medication intake sheet which includes the individual's
name, known allergies, type and amount of medication, dose and frequency of
administration, date and time of intake, and name of staff who administered or
observed the medication intake. If medication is self-administered, the
individual shall sign or initial the medication intake sheet.
2. The amount of medication originally
present and the amount remaining can be validated by the medication intake
sheet.
3. Documentation of
medication intake shall include over-the-counter products.
4. Medication shall be administered in single
doses to the extent possible.
5.
The organization shall establish a mechanism for the positive identification of
individuals at the time medication is dispensed, administered or
self-administered under staff observation.
(G) Emergency Situations. The organization's
policies shall address the administration of medication in emergency
situations.
1. Medical/nursing staff shall
accept telephone medication orders only from physicians who are included in the
organization's list of authorized physicians and who are known to the staff
receiving the orders. A physician's signature shall authenticate verbal orders
within five (5) working days of the receipt of the initial telephone
order.
2. The organization may
prohibit telephone medication orders, if warranted by staffing patterns and
staff credentials.
(H)
Periodic Review. The organization shall document that individuals' medications
are evaluated by qualified staff at least every six (6) months to determine
their continued effectiveness.
(I)
Individuals Bringing Their Own Medication. Any medication brought to the
program by an individual served is allowed to be administered or
self-administered only when the medication is appropriately labeled.
(J) Labeling. All medication shall be
properly labeled. Labeling for each medication shall include drug name,
strength, dispense date, amount dispensed, directions for administration,
expiration date, name of individual being served, and name of the prescribing
physician.
(K) Storage. The
organization shall implement written policies and procedures on how medications
are to be stored.
1. The organization shall
establish a locked storage area for all medications that provides suitable
conditions regarding sanitation, ventilation, lighting and moisture.
2. The organization shall store ingestible
medications separately from noningestible medications and other
substances.
3. The organization
shall maintain a list of personnel who have been authorized access to the
locked medication area and who are qualified to administer
medications.
(L)
Inventory. Where applicable, the organization shall implement written policies
and procedures for:
1. Receipt and disposition
of stock pharmaceuticals must be accurately documented;
2. A log shall be maintained for each stock
pharmaceutical that documents receipts and disposition;
3. At least quarterly, each stock
pharmaceutical shall be reconciled as to the amount received and the amount
dispensed; and
4. A stock supply of
a controlled substance must be registered with the Drug Enforcement
Administration and the Missouri Department of Health, Bureau of Narcotics and
Dangerous Drugs.
(M)
Disposal. The organization shall implement written procedures and policies for
the disposal of medication.
1. Medication must
be removed on or before the expiration date and destroyed.
2. Any medication left by an individual at
discharge shall be destroyed within thirty (30) days.
3. The disposal of all medications shall be
witnessed and documented by two (2) staff members.
Notes
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No prior version found.