Wis. Admin. Code Department of Health Services § DHS 132.65 - Pharmaceutical services
(1) DEFINITIONS. As
used in this section:
(a) "Medication" has
the same meaning as the term "drug" defined in s.
450.06,
Stats.
(b) "Prescription
medication" has the same meaning as the term "prescription drug" defined in s.
450.07,
Stats.
(c) "Schedule II drug" means
any medication listed in s.
961.16,
Stats.
(2) SERVICES.
(a) Each facility shall provide for obtaining
medications for the residents directly from licensed pharmacies.
(b) The facility shall establish, maintain,
and implement such policies and procedures as are necessary to comply with this
section and assure that resident needs are met.
(4) EMERGENCY MEDICATION KIT.
(a) A facility may have one or more emergency
medication kits. All emergency medication kits shall be under the control of a
pharmacist.
(b) The emergency kit
shall be sealed and stored in a locked area.
(5) CONTINGENCY SUPPLY OF MEDICATIONS.
(a)
Maintenance. A facility
may have a contingency supply of medications not to exceed 10 units of any
medication. Any contingency supply of medications must be under the control of
a pharmacist.
(b)
Storage. Contingency drugs shall be stored at a nursing unit,
except that those medications requiring refrigeration shall be stored in a
refrigerator.
(c)
Single
units. Contingency medications shall be stored in single unit
containers, a unit being a single capsule, tablet, ampule, tubex, or
suppository.
(d)
Committee
authorization. The quality assessment and assurance committee shall
determine which medications and strengths of medications are to be stocked in
the contingency storage unit and the procedures for use and re-stocking of the
medications.
(e)
Control. Unless controlled by a "proof-of-use" system, as
provided by sub. (6) (e), a copy of the pharmacy communication order shall be
placed in the contingency storage unit when any medication is
removed.
(6)
REQUIREMENTS FOR ALL MEDICATION SYSTEMS.
(b)
Storing and labeling medications. Unless exempted under par.
(f), all medications shall be handled in accordance with the following
provisions:
1. `Storage.' Medications shall
be stored near nurse's stations, in locked cabinets, closets or rooms,
conveniently located, well lighted, and kept at a temperature of no more than
85º F. (29º C.).
2.
`Transfer between containers.' Medications shall be stored in their original
containers, and not transferred between containers, except by a physician or
pharmacist.
3. `Controlled
substances.' Separately locked and securely fastened boxes or drawers, or
permanently affixed compartments, within the locked medication area shall be
provided for storage of schedule II drugs, subject to 21 USC ch. 13, and
Wisconsin's uniform controlled substance act, ch. 961, Stats.
4. `Separation of medications.' Medications
packaged for individual residents shall be kept physically separated.
5. `Refrigeration.' Medications requiring
refrigeration shall be kept in a separate covered container and locked, unless
the refrigeration is available in a locked drug room.
6. `External use of medications.' Poisons and
medications for external use only shall be kept in a locked cabinet and
separate from other medications, except that time-released transdermal drug
delivery systems, including nitroglycerin ointments, may be kept with internal
medications.
7. `Accessibility to
drugs.' Medications shall be accessible only to the registered nurse or
designee. In facilities where no registered nurse is required, the medications
shall be accessible only to the administrator or designee. The key shall be in
the possession of the person who is on duty and assigned to administer the
medications.
8. `Labeling
medications.' Prescription medications shall be labeled with the expiration
date and as required by s.
450.11(4),
Stats. Non-prescription medications shall be labeled with the name of the
medication, directions for use, the expiration date and the name of the
resident taking the medication.
(c)
Destruction of
medications.
1. `Time limit.' Unless
otherwise ordered by a physician, a resident's medication not returned to the
pharmacy for credit shall be destroyed within 72 hours of a physician's order
discontinuing its use, the resident's discharge, the resident's death or
passage of its expiration date. No resident's medication may be held in the
facility for more than 30 days unless an order is written every 30 days to hold
the medication.
2. `Procedure.'
Records shall be kept of all medication returned for credit. Any medication not
returned for credit shall be destroyed in the facility and a record of the
destruction shall be witnessed, signed and dated by 2 or more personnel
licensed or registered in the health field.
(d)
Control of medications.
1. `Receipt of medications.' The
administrator or a physician, nurse, pharmacist, or the designee of any of
these may be an agent of the resident for the receipt of medications.
2. `Signatures.' When the medication is
received by the facility, the person completing the control record shall sign
the record indicating the amount received.
3. `Discontinuance of schedule II drugs.' The
use of schedule II drugs shall be discontinued after 72 hours unless the
original order specifies a greater period of time not to exceed 60
days.
(e)
Proof-of-use record.
1. For
schedule II drugs, a proof-of-use record shall be maintained which lists, on
separate proof-of-use sheets for each type and strength of schedule II drug,
the date and time administered, resident's name, physician's name, dose,
signature of the person administering dose, and balance.
2. Proof-of-use records shall be audited
daily by the registered nurse or designee, except that in facilities in which a
registered nurse is not required, the administrator or designee shall perform
the audit of proof-of-use records daily.
(f)
Resident control and use of
medications. Medications which, if ingested or brought into contact
with the nasal or eye mucosa, would produce toxic or irritant effects shall be
stored and used only in accordance with the health, safety, and welfare of all
residents.
(7)
ADDITIONAL REQUIREMENTS FOR UNIT DOSE SYSTEMS.
(a)
Scope. When a unit dose
drug delivery system is used, the requirements of this subsection shall apply
in addition to those of sub. (6).
(b)
General procedures.
1. The individual medication shall be labeled
with the drug name, strength, expiration date, and lot or control
number.
2. A resident's medication
tray or drawer shall be labeled with the resident's name and room
number.
3. Each medication shall be
dispensed separately in single unit dose packaging exactly as ordered by the
physician, and in a manner to ensure the stability of the medication.
4. An individual resident's supply of drugs
shall be placed in a separate, individually labeled container and transferred
to the nursing station and placed in a locked cabinet or cart. This supply
shall not exceed 4 days for any one resident.
5. If not delivered from the pharmacy to the
facility by the pharmacist, the pharmacist's agent shall transport unit dose
drugs in locked containers.
6. The
individual medication shall remain in the identifiable unit dose package until
directly administered to the resident. Transferring between containers is
prohibited.
7. Unit dose carts or
cassettes shall be kept in a locked area when not in use.
Notes
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