Properly abiding by the rules and regulations for Medication in an Assisted Living Facility can be the biggest headache (no pun intended) that you come in contact with- that is if you don’t have a system in place for following the following regulation provided by the Georgia Department of Community Health:

(1) Self-Administration of Medications. Residents who have the cognitive and functional capacities to engage in the self-administration of medications safely and independently without staff assistance or supervision must be allowed to store their own medications securely and self-administer medications if they so desire.

(2) Assistance with Self-Administration. An assisted living community must provide assistance with or supervision of self-administered medications to those residents who have the cognitive capacity to engage in the self-administration of medications, but require or request staff assistance with or supervision of the self-administration of medications for safety or convenience.

Ensure the resident’s physical examination or care plan accurately depicts their needs for assistance with self-administration.

(a) Such staff assistance with or supervision of self-administered medications may only be provided for the unit or multidose packaged medications prescribed for the particular resident and may include only the following tasks:

  1. taking the medication, in its previously dispensed, properly labeled container, from where it is stored, and bringing the medication to the resident;
  2. reading the label, opening the container, removing a prescribed amount of medication from the container, and closing the container, in the presence of the resident;
  3. placing an oral dosage in the resident’s hand or placing the dosage in another container where the resident requests assistance;
  4. applying topical medications;
  5. returning the medication container to properly secured storage; and
  6. assisting the resident’s use of an EPI pen where the resident has known severe allergies for which an EPI pen has been prescribed on condition that there is an established written protocol detailing how it is to be used and when. The protocol must include immediately calling Emergency Services, 911, after any use of the EPI pen.

If your staff is placing the medication in the resident’s mouth it is not considered assistance with self-administration- that would be considered Administration of Medication which must be performed by specifically trained personnel.

(b) Staff assisting with or supervising self-administration of medications must be proficient in English and able to read, write and follow written instructions in English.

(3) Community Administration of Medications. Where the residents either are not capable of self-administration of medications or choose not to self-administer medications with assistance or supervision, the assisted living community must provide medication administration services to the residents in accordance with physicians’ orders, the needs of the residents, and these rules.

(4) Specialized Staffing for Medication Administration.

The assisted living community offering medication administration services must employ certified medication aides, at a minimum, to administer medications.

(5) Certified Medication Aide Requirements. An assisted living community using certified medication aides to administer specific medications must do all of the following:

(a) Check the Registry. Ensure that the medication aides employed in the community are listed in good standing on the Georgia Certified Medication Aide Registry and have no record of being terminated for cause relating to the performance of medication aide tasks before permitting the aides to administer medications.

(b) Administer Skills Competency Checks. Determine and document that the medication aides who have been certified for more than one year upon hiring, continue to have the knowledge and skills necessary to administer medications properly for the particular community. The community must use a skills competency checklist that meets the requirements contained in the standardized clinical skills competency checklist used to certify medication aides.

(c) Quarterly Observations. Use a licensed registered professional nurse or a pharmacist to conduct quarterly random medication administration observations to determine that the aides are administering medications correctly and in compliance with these rules and report any issues to the assisted living community administration for resolution.

(d) Quarterly Drug Regimen Reviews. Secure the services of a licensed pharmacist to perform all of the following duties:

  1. Conduct quarterly reviews of the drug regimen for each resident of the assisted living community and report any irregularities to the assisted living community administration.
  2. Remove for proper disposal any drugs that are expired, discontinued, or in a deteriorated condition or where the resident for whom such drugs were ordered is no longer a resident.
  3. Establish or review policies and procedures for safe and effective drug therapy, distribution, use, and control.
  4. Monitor compliance with established policies and procedures for medication handling and storage.

(e) Authorized Tasks for Certified Medication Aides. An assisted living community may allow a certified medication aide to do only the following tasks related to the administration of medications utilizing only unit or multidose packaging of medications:

  1. Administer physician ordered oral, via a feeding tube, ophthalmic, topical, otic, nasal, vaginal, and rectal medications.
  2. Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol.
  3. Administer medications via a metered-dose inhaler.
  4. Conduct finger sticks blood glucose testing following established protocol.
  5. Administer a commercially prepared disposable enema ordered by a physician.
  6. Assist residents in the supervision of self-administration of medications.
  7. Administer liquid morphine to a resident of the community who is the patient of a licensed hospice, pursuant to a hospice physician’s written order that contains specific instructions for indication, dosage, frequency, and route of administration.

(f) Annual Competency Reviews. Complete comprehensive clinical skills competency reviews for each

certified medication aide utilizing the skills competency checklist at least, annually after hiring to determine that the aides continue to have the necessary skills to perform the medication tasks assigned competently. Such skills competency checklists must be administered by Georgia-licensed registered nurses, pharmacists, or physicians, who indicate in writing that the tasks observed are being performed competently.

(g) Proper Notice of Separation for Cause. Ensure that where a medication aide is terminated for cause relating to the performance of medication aide tasks, the aide is provided with the following:

  1. a separation notice that clearly describes the facts that support the termination for cause;
  2. written notice that being terminated for cause related to the administration of medications, if not successfully appealed through a hearing on right to unemployment benefits will result in the loss of good standing on the Georgia Certified Medication Aide Registry; and
  3. the loss of good standing on the Certified Medication Aide Registry will make the aide ineligible for hiring as a certified medication aide by another assisted living community.

(h) Registry Notification. Submit to the Georgia Certified Medication Aide Registry a copy of the Separation Notice for the certified medication aide only if the separation-related specifically to the performance of medication aide tasks and the termination for the cause has either been finally upheld by the Department of Labor or the time for appealing the Separation Notice has expired.

(6) Communities Conducting Certified Medication Aide Training. A community choosing to provide a certified medication aide training program must do all of the following:

(a) Utilize the state-approved medication aide training program ensuring that the training is administered by a Georgia licensed registered nurse, pharmacist, or physician.

(b) Require the aide to demonstrate the requisite clinical skills to serve as a medication aide before a Georgia-licensed registered nurse, pharmacist or physician utilizing the standardized medication administration checklist developed by the Department.

(c) Prepare the aide to take the written competency examination to become a certified medication aide.

(d) Verify that the aide is in good standing on the Georgia certified nurse aide registry.

(e) Provide information to the aide on the registration and locations for taking the written competency examination.

(f) Provide the documentation to the Georgia Certified Medication Aide Registry that is necessary to complete the application for placement of the aide’s name on the Georgia Certified Medication Aide Registry.

(g) Not permit the aide to administer medications independently unless the aide is listed on Georgia certified medication aide registry in good standing.

(7) Basic Medication Training for Staff Assisting with Self-Administration. The assisted living community must provide and document medication training for the unlicensed staff who are not certified medication aides but who are providing assistance with or supervision of self-administration of medications to capable residents. The medication training must be conducted with an appropriate curriculum for providing medication assistance and include at least the following topics:

(a) the assisted living community’s medication policy and procedures, including actions to take if concerns regarding resident’s capacity to self-administer medications, are identified;

(b) how to read prescription labels including common abbreviations;

(c) providing the right medication to the right resident at the right time in the right amount and the right way including how to measure various medications;

(d) actions to take when concerns regarding medications are identified;

(e) infection control procedures relative to providing assistance with medications;

(f) proper medication storage and disposal;

(g) recognition of side effects and adverse reactions for the specific medications;

(h) understanding the common classifications of medications, typical side effects and adverse reactions, and medications for which unlicensed staff may never provide assistance with or supervision of self-administration; and

(i) proper documentation and record-keeping using the Medication Assistance Record.

(8) Medication Skills Competency Determinations. Unlicensed staff who are not certified as medication aides providing assistance with or supervision of self-administered medications must demonstrate when hired and at least, annually thereafter, the necessary skills to perform the medication tasks assigned competently by completing skills competency checklists before appropriately trained community staff.

(9) Maintaining Records on Medication Assistance and Administration. Where the assisted living community either provides assistance with or supervision of self-administered medications or administers medications to residents, the community must maintain a daily Medication Assistance Record (MAR) for each resident who receives assistance or administration. The MAR must include the name of the specific resident, any known allergies, the name and telephone number of the resident’s health care provider, the name, strength, and specific directions including key side effects and adverse reactions for use of each medication and a chart for staff who provide assistance or administration to record initials, time and date when medications are taken, refused or a medication error is identified (e.g. missed dosage). The staff providing the assistance or administration of medications must update the MAR each time the medication is offered or taken.

(a) The assisted living community must make medication information concerning the descriptions of medication, dosing, side effects, adverse reactions, and contraindications for each medication being administered to the residents immediately available for reference by staff providing medication assistance or administration.

(b) Staff of the assisted living community providing assistance with or administration of medications must document in the resident’s record any unusual reactions to the medications and provide such information to the resident, the resident’s representative, and the health care provider as appropriate.

(c) For any administration of liquid morphine by a certified medication aide, staff shall observe and document the following in the resident’s record:

  1. the resident’s need for PRN liquid morphine, including but not limited to verbalizations of pain, groaning, grimacing, or restlessness;
  2. the date, time, and location of the initial dose administered by a licensed hospice health care professional;
  3. the dosage, time, and route of administration for the morphine administered in the community;
  4. the training provided by the licensed hospice; and
  5. information regarding the special circumstances under which the hospice was unavailable to administer the medication.

(10) Orders Required for All Medications. An assisted living community must not allow its staff to assist with, provide supervision of self-administered medications or administer any medications, including over-the-counter medications unless there is a physician’s order specifying clear instructions for its use on file for the resident.

(11) Timely Management of Medication Procurement. Where the assisted living community procures medications on behalf of the residents, the community must obtain new prescriptions within 48 hours of receipt of notice of the prescription or sooner if the prescribing physician indicates that a medication

change must be made immediately. If the pharmacy does not have the medication needed for the immediate change, available and has not obtained further directions from the physician, the community must notify the physician of the unavailability of the prescription and request direction. Refills of prescribed medications must be obtained timely so that there is no interruption in the routine dosing. Where the assisted living community is provided with a new medication for the resident, the MAR must be modified to reflect the addition of the new medication within 48 hours or sooner if the prescribing physician indicates that the medication change must be made immediately.

(12) Storage and Disposal of Medications. Medications must be stored securely and inventoried appropriately to prevent loss and unauthorized use. Medications must be stored under lock and key at all times whether kept by a resident or kept by the assisted living community for the resident unless the medication is required to be kept by the resident on his or her person or staff member in close attendance due to the need for physician-prescribed frequent or emergency use. Additionally, for controlled substances, the secure storage must be a locked cabinet or box of substantial construction and a log must be maintained and updated daily by the community to account for all inventory.

It would be prudent to have a community policy for how often inventory is audited and be sure to account for any missing medication.

(a) Duplicate keys for all medication storage containers must be available on-site for appropriate use.

(b) Medications must be kept in original containers with original labels intact.

(c) Medications must be properly labeled in separate unit or multi-unit dose packaging and handled in accordance with physician’s instructions, and laws and regulations applicable to the medications.

(d) The assisted living community must ensure that it properly disposes of unused medications using the current U.S. Food and Drug Administration or U.S. Environmental Protection Agency guidelines for the specific medications.

(e) The supply of liquid morphine on site shall be limited to 50 ml for each hospice patient in the community for which there is a physician’s order for such medication.

It is necessary for your entire clinical team to be well versed in the regulations that are applicable to their position. The Nursing Director or their designee should hold frequent refresher training and have processes put into place for all matters related to medication administration, storage, procurement as well as the destruction of expired or discharged medication.