Medications - ALF Boss

WAC 388-78A-2210 Medication services. (1) An assisted living facility providing medication service, either directly or indirectly, must:

Meet the requirements of chapter 69.41 RCW Legend drugs—Prescription drugs, and other applicable statutes and administrative rules; and
Develop and implement systems that support and promote safe medication service for each resident.

(2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250:

Each resident who requires medication assistance and his or her negotiated service agreement indicates the assisted living facility will provide medication assistance; and
If the assisted living facility provides medication adminis-tration services, each resident who requires medication administration and his or her negotiated service agreement indicates the assisted living facility will provide medication administration.

388-78A-2210, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2210, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2220 Prescribed medication authorizations. (1) Before the assisted living facility may provide medication assistance or medication administration to a resident for prescribed medications, the assisted living facility must have one of the following:

A prescription label completed by a licensed pharmacy;
A written order from the prescriber;
A facsimile or other electronic transmission of the order from the prescriber; or
Written documentation by a nurse of a telephone order from the prescriber.

(2) The documentation required above in subsection (1) of this section must include the following information:

The name of the resident;
The name of the medication;
The dosage and dosage frequency of the medication; and(d) The name of the prescriber.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2220, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2220, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2230 Medication refusal. (1) When a resident who is receiving medication assistance or medication administration services from the assisted living facility chooses to not take his or her medications, the assisted living facility must:

Respect the resident’s right to choose not to take medica-tion;
Document the time, date and medication the resident did not take;
Notify the physician of the refusal and follow any instruc-tions provided, unless there is a staff person available who, acting within his or her scope of practice, is able to evaluate the significance of the resident not getting his or her medication, and such staff person;
Conducts an evaluation; and
Takes the appropriate action, including notifying the pre-scriber or primary care practitioner when there is a consistent pattern of the resident choosing to not take his or her medications.

(2) The assisted living facility must comply with subsection (1) of this section, unless the prescriber or primary care practitioner has provided the assisted living facility with:

Specific directions for addressing the refusal of the identi-fied medication;
The assisted living facility documents such directions; and
The assisted living facility is able to fully comply with such directions.

388-78A-2230, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2230, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2240 Nonavailability of medications. When the assisted living facility has assumed responsibility for obtaining a resident’s prescribed medications, the assisted living facility must obtain them in a correct and timely manner.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2240, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2240, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2250 Alteration of medications. The assisted living facility must generally provide medications in the form they are prescribed when administering medications or providing medication assistance to a resident. The assisted living facility may provide medications in an altered form consistent with the following:

Alteration includes, but is not limited to, crushing tablets, cutting tablets in half, opening capsules, mixing powdered medications with foods or liquids, or mixing tablets or capsules with foods or liquids.
Residents must be aware that the medication is being altered or added to their food.
A pharmacist or other practitioner practicing within their scope of practice must determine that it is safe to alter a medication.
If the medication is altered, documentation of the appropri-ateness of the alteration must be on the prescription container, or in the resident’s record.
Alteration of medications for self-administration with assis-tance is provided in accordance with chapter 246-888 WAC.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2250, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2250, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2260 Storing, securing, and accounting for medications. (1) The assisted living facility must secure medications for residents who are not capable of safely storing their own medications.

(2) The assisted living facility must ensure all medications under the assisted living facility’s control are properly stored:

In containers with pharmacist-prepared label or original man-ufacturer’s label;
Together for each resident and physically separated from oth-er residents’ medications;
Separate from food or toxic chemicals;
In a locked compartment that is accessible only to designated responsible staff persons; and
In environments recommended on the medication label.

388-78A-2260, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2260, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2270 Resident controlled medications. (1) The assisted living facility must ensure all medications are stored in a manner that prevents each resident from gaining access to another resident’s medications.

(2) The assisted living facility must allow a resident to control and secure the medications that he or she self-administers or self-administers with assistance if the assisted living facility assesses the resident to be capable of safely and appropriately storing his or her own medications and the resident desires to do so.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2270, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090. WSR 06-01-047, § 388-78A-2270, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2270, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2280 Medication organizers. (1) The assisted living facility must ensure no staff person other than a nurse or licensed pharmacist fills medication organizers for residents.

(2) The assisted living facility must ensure that any nurse who fills a medication organizer for a resident labels the medication organizer with:

The name of the resident;
The name of the medications in the organizer; and(c) The frequency of the dosage.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2280, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090. WSR 06-01-047, § 388-78A-2280, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2280, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2290 Family assistance with medications and treatments. (1) An assisted living facility may permit a resident’s family member to administer medications or treatments or to provide medication or treatment assistance, including obtaining medications or treatment supplies, to the resident.

The assisted living facility must disclose to the department, residents, the residents’ legal representatives, if any, and if not the residents’ representative if any, and to interested consumers upon request, information describing whether the assisted living facility permits such family administration or assistance and, if so, the extent of any limitations or conditions.
If the assisted living facility allows family assistance with or administration of medications and treatments, and the resident and a family member(s) agree a family member will provide medication or

treatment assistance, or medication or treatment administration to the resident, the assisted living facility must request that the family member submit to the assisted living facility a written plan for such assistance or administration that includes at a minimum:

By name, the family member who will provide the medication or treatment assistance or administration;
A description of the medication or treatment assistance or administration that the family member will provide, to be referred to as the primary plan;
An alternate plan if the family member is unable to fulfill his or her duties as specified in the primary plan;
An emergency contact person and telephone number if the as-sisted living facility observes changes in the resident’s overall functioning or condition that may relate to the medication or treatment plan; and
Other information determined necessary by the assisted living facility.
The plan for family assistance with medications or treatments must be signed and dated by:
The resident, if able;
The resident’s representative, if any;
The resident’s family member responsible for implementing the plan; and
A representative of the assisted living facility authorized by the assisted living facility to sign on its behalf.
The assisted living facility may, through policy or proce-dure, require the resident’s family member to immediately notify the assisted living facility of any changes in the medication or treatment plans for family assistance or administration.
The assisted living facility must require that whenever a resident’s family provides medication assistance or medication administration services, the resident’s significant medications remain on the assisted living facility premises whenever the resident is on the assisted living facility premises.
The assisted living facility’s duty of care shall be limited to: Observation of the resident for changes in overall functioning consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident’s overall functioning or condition, or when the assisted living facility is aware that both the primary and alternate plan are not implemented; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident’s physical or mental functioning.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2290, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2290, filed 7/30/04, effective 9/1/04.]