Medication Administration and all the variables involved with providing medication in an ARCP 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 Louisiana Department of Health and Hospitals:
- 6843. Medication Administration
- The ARCP shall have written policies and procedures on medication administration including self-administration, assistance with self-administration, gratuitous administration or third-party administration, and staff administration of medications. There shall also be policies regarding obtaining and refilling medications, storing and controlling medications, disposing of medications, and documentation of medication administration.
- The ARCP shall record in the resident’s PCSP whether the resident can self-administer medication, needs assistance with self-administration, has gratuitous administration, or third party administration or requires staff administration of medication. The determination of the need for staff administration of medication will be made by the resident’s physician after assessment of the resident, and after consultation with the resident, resident’s legal representative if applicable, and the ARCP staff. The PCSP shall also include how the medication will be obtained and stored.
- Levels of Administration
- Self-Administration. Unless otherwise indicated in the PCSP, residents shall have the option to self-administer their own medications. Residents who are appropriate for this service will be aware of what the medication is, what it is for, and the need for the medication. Self-medication means residents can maintain possession and control of their medications. However, the ARCP shall require the resident to undertake reasonable precautions to ensure the safety of other residents.
- Assistance with Self-Administration. Unless otherwise indicated in the PCSP, residents may elect assistance with self-medication if it is a service offered by the ARCP. Residents who are appropriate for this service will be aware of what the medication is, what it is for, and the need for the medication.
- Assistance with self-administration may be provided by staff members who hold no professional licensure, as long as that employee has documented training on the policies and procedures for medication assistance, including the limitations of assistance. This training must be repeated at least annually.
- Assistance with self-administration of medication shall be limited to the following:
- reminding residents that it is time to take medication(s), where such medications have been prescribed for a specific time of day, a specific number of times per day, specific intervals of time or for a specific time in relation to mealtimes or other activities such as arising from bed or retiring to bed;
- reading the medication regimen as indicated on the container to the resident;
iii. physically assisting residents who are familiar with their medications by opening a medication container and/or providing assistance with pouring medications;
- offering liquids to residents who are familiar with their medications to assist that resident in ingesting oral medications, and v. physically bringing a container of oral medications to residents.
- Assistance with self-administration of medications shall not include:
- administering injections of any kind; ii. administering any prescription medications including, but not limited to, eye drops, ear drops, nose drops, liquid medications, inhalers, suppositories, or enemas;
iii. prompting or reminding a resident that it is time to take a PRN or as-needed medication;
- crushing or splitting medications;
- placing medications in a feeding tube; or
- mixing medications with foods or liquids.
- Staff Administration of Medication
- The ARCP shall administer medications to ARCP residents in accordance with their PCSP. Staff administration of medications may be provided by all levels of ARCPs.
- Medications shall be administered only by an individual who is currently licensed to practice medicine or osteopathy by the appropriate licensing agency for the state, or by an individual who is currently licensed as an RN or LPN by the appropriate state agency.
- In level 4 ARCPs only, staff administration of medication may include intravenous therapy. Intravenous therapy is permitted on a time-limited basis and must be under the supervision of a licensed RN, physician, or advanced practice nurse.
- The ARCP shall require pharmacists to perform a monthly review of all ordered medication regimens for possible adverse drug interactions and to advise the ARCP and the prescribing health care provider when adverse drug interactions are detected. The ARCP shall notify the prescribing health care provider of the pharmacist’s review related to possible adverse drug interactions, and shall have documentation of this review and notification in the resident’s record.
- Medication Orders and Records
- Medications, including over-the-counter medications, may be administered to a resident of an ARCP only after the medications have been prescribed specifically for the resident by an individual currently licensed to prescribe medications. All orders for medications shall be documented, signed, and dated by the resident’s licensed practitioner.
- Only an authorized licensed medical professional shall accept telephone orders for medications from a physician or other authorized practitioner. All telephone orders shall be documented in the resident’s record. The telephone order shall be signed by the prescriber within 14 days of the issuance of the order.
iii. The ARCP is responsible for: (a). complying with the physician orders, associated with medication administration; (b). clarifying orders as necessary; (c). notifying the physician of resident refusal of the medication or treatment, and (d). notifying the physician of any adverse reactions to medications or treatments.
- All medications administered by staff to residents in an ARCP, including over-the-counter medications, shall be recorded on a medication administration record at the same time or immediately after the medications are administered.
- The medication administration record shall include at least the following:
(a). the name of the resident to whom the medication was administered;
(b). the name of the medication administered (generic, brand or both);
(c). the dosage of the medication administered;
(d). the method of administration, including route;
(e). the site of injection or application, if the medication was injected or applied;
(f). the date and time of the medication administration;
(g). any adverse reaction to the medication; and
(h). the printed name and written or electronic signature of the individual administering the medication.
- Medication administration records and written physician orders for all over-the-counter medications, legend drugs, and controlled substances shall be retained for a period of not less than five years. They shall be available for inspection and copying on demand by the state regulatory agency. vii. The most current edition of drug reference materials shall be available.
viii. All medication regimes and administration charting shall be reviewed by a licensed RN at least monthly to:
(a). determine the appropriateness of the medication regime;
(b). evaluate contraindications;
(c). evaluate the need for lab monitoring;
(d). make referrals to the primary care physician for needed monitoring tests;
(e). report the efficacy of the medications prescribed; and
(f). determine if medications are properly being administered in the ARCP.
- Contracted Third Party Administration
- The ARCP or the resident or the resident’s representative, if applicable, may contract with an individual or agency to administer the resident’s prescribed medications. The ARCP shall ensure that medications shall be administered by an individual who is currently professionally licensed in Louisiana to administer medications.
- A copy of such a third-party contract shall be verifiable in writing and retained in the resident’s record. The ARCP retains responsibility for notifying the resident or resident’s legal representative, if applicable, if services are not delivered or if the resident’s conditions change.
- Storage of Medications
- An ARCP shall not stock or dispense resident medications. Where medications are kept under the control or custody of an ARCP, the medications shall be packaged by the pharmacy and shall be maintained by the ARCP as dispensed by the pharmacist.
- Medication stored by the ARCP shall be stored in an area inaccessible to residents and accessible only to authorized personnel. This area must be kept locked. Any other staff (e.g., housekeeping, maintenance, etc.) needing access to storage areas must be under the direct visual supervision of authorized personnel.
- All medications must be stored in accordance with industry standards or according to the manufacturer’s recommendations.
- If controlled substances prescribed for residents are kept in the custody of the ARCP, they shall be stored in a manner that is compliant with local, state, and federal laws. At a minimum, controlled substances in the custody of the ARCP shall be stored using a double lock system, and the ARCP shall maintain a system to account for the intake, distribution, and disposal of all controlled substances in its possession and maintain a written policy and procedure regarding such.
- All other medications in the ARCP shall be stored using at least a single lock mechanism. This shall include medications stored in a resident’s room whereby the staff and the resident have access to the medications. When residents self-administer their medications, the medications shall be stored in a locked area or container accessible only to the resident, resident’s family, and staff or may be stored in the resident’s living quarters, if the room is single occupancy and has a locking entrance.
- Any medication stored by the ARCP requiring refrigeration shall be kept separate from foods in separate containers within a refrigerator and shall be stored at appropriate temperatures according to the medication specifications. A daily temperature log must be maintained at all times for the refrigerator. No lab solutions or lab specimens may be stored in refrigerators used for the storage of medications or food.
- The medication preparation area shall have an operable hand washing sink with hot and cold water, paper towels, and soap or an alternative method for hand sanitization.
- Medications shall be under the direct observation of the person administering the medications or locked in a storage area.
- Labeling of Medications
- All containers of medications shall be labeled in accordance with the rules of the Board of Pharmacy and any local, state, and federal laws.
- Medication labels shall include appropriate cautionary labels (e.g., shake well, take with food, or for external use only).
- Medications maintained in storage must contain the original manufacturer’s label with expiration date or must be appropriately labeled by the pharmacy supplying the medications.
- Any medications labeled for single resident use may not be used for more than one resident. One resident’s medications cannot be used for another resident.
- Any medication container with an unreadable label shall be returned to the issuing pharmacy for relabeling. Conditions that might affect readability include but are not limited to detachment, double labeling, excessive soiling, wear, or damage.
- Disposal of Medications
- All medications and biologicals disposed of by the ARCP shall be according to ARCP policy and subject to all local, state, and federal laws.
- Expired medications shall not be available for resident or staff use. They shall be destroyed no later than 30 days from their expiration/discontinuation date.
- Medications awaiting disposition must be stored in a locked storage area.
- Medications of residents who no longer reside in the ARCP shall be returned to the resident or the resident’s representative, if applicable. The resident or the resident’s representative shall sign a statement that these medications have been received. The statement shall include the pharmacy, prescription number, date, resident’s name, name and strength of the medication, and the amount returned. This statement shall be maintained in the resident’s termination of services record.
- When medication is destroyed on the premises of the ARCP, a record shall be made and filed at the ARCP according to ARCP policy.
- This record shall include, but is not limited to:
- name of ARCP;
- name of the medication;
iii. method of disposal;
- pharmacy; v. prescription number;
- name of the resident;
vii. strength of medication;
viii. dosage of medication;
- amount destroyed; and
- reason for disposition.
- This record shall be signed and dated by the individual performing the destruction and by at least one witness.
- The medication must be destroyed by a licensed pharmacist, RN, or physician.
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. It is also suggested to audit your med passes at the very minimum on a quarterly basis as well as including med pass training for the clinical team upon orientation.