Best medication administration practices
Perhaps one of the most important elements of a resident’s care is the proper distribution of their medication. Think about it- these people are entrusting us with their life. The medication that often keeps them functioning and at times even alive rests in our care. That is why the Nevada Department of Health and Human Services takes the following regulation so seriously. Check it out and see how you can keep your facility compliant:
NAC 449.2742 Administration of medication: Responsibilities of administrator, caregivers and employees of facility. (NRS 449.0302)
1. The administrator of a residential facility that provides assistance to residents in the administration of medications shall:
(a) Ensure that a physician, pharmacist or registered nurse who does not have a financial interest in the facility:
(1) Reviews for accuracy and appropriateness, at least once every 6 months, the regimen of drugs taken by each resident of the facility, including, without limitation, any over-the-counter medications and dietary supplements taken by a resident; and
(2) Provides a written report of that review to the administrator of the facility.
(b) Include a copy of each report submitted to the administrator pursuant to paragraph (a) in the file maintained pursuant to NAC 449.2749 for the resident who is the subject of the report.
(c) Make and maintain a report of any actions that are taken by the caregivers employed by the facility in response to a report submitted pursuant to paragraph (a).
(d) Develop and maintain a plan for managing the administration of medications at the residential facility, including, without limitation:
(1) Preventing the use of outdated, damaged or contaminated medications;
(2) Managing the medications for each resident in a manner which ensures that any prescription medications, over-the-counter medications and nutritional supplements are ordered, filled and refilled in a timely manner to avoid missed dosages;
(3) Verifying that orders for medications have been accurately transcribed in the record of the medication administered to each resident in accordance with NAC 449.2744;
(4) Monitoring the administration of medications and the effective use of the records of the medication administered to each resident;
(5) Ensuring that each caregiver who administers a medication is in compliance with the requirements of subsection 6 of NRS 449.0302 and NAC 449.196;
(6) Ensuring that each caregiver who administers a medication is adequately supervised;
(7) Communicating routinely with the prescribing physician or other physician of the resident concerning issues or observations relating to the administration of the medication; and
(8) Maintaining reference materials relating to medications at the residential facility, including, without limitation, a current drug guide or medication handbook, which must not be more than 2 years old or providing access to websites on the Internet which provide reliable information concerning medications.
(e) Develop and maintain a training program for caregivers of the residential facility who administer medication to residents, including, without limitation, an initial orientation on the plan for managing medications at the facility for each new caregiver and an annual training update on the plan. The administrator shall maintain documentation concerning the provision of the training program and the attendance of caregivers.
(f) In his or her first year of employment as an administrator of the residential facility, receive, from a program approved by the Bureau, at least 16 hours of training in the management of medication consisting of not less than 12 hours of classroom training and not less than 4 hours of practical training and obtain a certificate acknowledging completion of such training.
(g) After receiving the initial training required by paragraph (f), receive annually at least 8 hours of training in the management of medication and provide the residential facility with satisfactory evidence of the content of the training and his or her attendance at the training.
(h) Annually pass an examination relating to the management of medication approved by the Bureau.
2. Within 72 hours after the administrator of the facility receives a report submitted pursuant to paragraph (a) of subsection 1, a member of the staff of the facility shall notify the resident’s physician of any concerns noted by the person who submitted the report. The report must be reviewed and initialed by the administrator.
3. Before assisting a resident in the administration of any medication, including, without limitation, any over-the-counter medication or dietary supplement, a caregiver must obtain written information describing the side effects, possible adverse reactions, contraindications and toxicity of the medication.
4. Except as otherwise provided in this subsection, a caregiver shall assist in the administration of medication to a resident if the resident needs the caregiver’s assistance. A caregiver may assist the ultimate user of controlled substances or dangerous drugs only if the conditions prescribed in subsection 6 of NRS 449.0302 are met.
5. An over-the-counter medication or a dietary supplement may be given to a resident only if the resident’s physician has approved the administration of the medication or supplement in writing or the facility is ordered to do so by another physician. The over-the-counter medication or dietary supplement must be administered in accordance with the written instructions of the physician. The administration of over-the-counter medications and dietary supplements must be included in the record required pursuant to paragraph (b) of subsection 1 of NAC 449.2744.
6. Except as otherwise provided in this subsection, a medication prescribed by a physician must be administered as prescribed by the physician. If a physician orders a change in the amount or times medication is to be administered to a resident:
(a) The caregiver responsible for assisting in the administration of the medication shall:
(1) Comply with the order;
(2) Indicate on the container of the medication that a change has occurred; and
(3) Note the change in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744;
(b) Within 5 days after the change is ordered, a copy of the order or prescription signed by the physician must be included in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744; and
(c) If the label prepared by a pharmacist does not match the order or prescription written by a physician, the physician, registered nurse or pharmacist must interpret that order or prescription and, within 5 days after the change is ordered, the interpretation must be included in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744.
7. If a resident refuses, or otherwise misses, an administration of medication, a physician must be notified within 12 hours after the dose is refused or missed.
8. An employee of a residential facility shall not draw medication into a syringe or administer an injection unless authorized by law to do so.
9. If the medication of a resident is discontinued, the expiration date of the medication of a resident has passed, or a resident who has been discharged from the facility does not claim the medication, an employee of a residential facility shall destroy the medication, by an acceptable method of destruction, in the presence of a witness and note the destruction of the medication in the record maintained pursuant to NAC 449.2744.
10. The administrator of a facility is responsible for any assistance provided to a resident of the residential facility in the administration of medication, including, without limitation, ensuring that all medication is administered in accordance with the provisions of this section.
(Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R204-99, 2-10-2000; R073-03, 1-22-2004; R119-10, 1-13-2011)
NAC 449.2744 Administration of medication: Maintenance and contents of logs and records. (NRS 449.0302)
1. The administrator of a residential facility that provides assistance to residents in the administration of medications shall maintain:
(a) A log for each medication received by the facility for use by a resident of the facility. The log must include:
(1) The type and quantity of medication received by the facility;
(2) The date of its delivery;
(3) The name of the person who accepted the delivery;
(4) The name of the resident for whom the medication is prescribed; and
(5) The date on which any unused medication is removed from the facility or destroyed.
(b) A record of the medication administered to each resident. The record must include:
(1) The type of medication administered;
(2) The date and time that the medication was administered;
(3) The date and time that a resident refuses, or otherwise misses, an administration of medication; and
(4) Instructions for administering the medication to the resident that reflect each current order or prescription of the resident’s physician.
2. The administrator of the facility shall keep a log of caregivers assigned to administer medications that indicates the shifts during which each caregiver was responsible for assisting in the administration of medication to a resident. This requirement may be met by including on a resident’s medication sheet an indication of who assisted the resident in the administration of the medication, if the caregiver can be identified from this indication.
(Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)
NAC 449.2746 Administration of medication: Restrictions concerning medication taken as needed by resident; written records. (NRS 449.0302)
1. A caregiver employed by a residential facility shall not assist a resident in the administration of a medication that is taken as needed unless:
(a) The resident is able to determine his or her need for the medication;
(b) The determination of the resident’s need for the medication is made by a medical professional qualified to make that determination; or
(c) The caregiver has received written instructions indicating the specific symptoms for which the medication is to be given, the exact amount of medication that may be given and the frequency with which the medication may be given.
2. A caregiver who administers medication to a resident as needed shall record the following information concerning the administration of the medication:
(a) The reason for the administration;
(b) The date and time of the administration;
(c) The dose administered;
(d) The results of the administration of the medication;
(e) The initials of the caregiver; and
(f) Instructions for administering the medication to the resident that reflect each current order or prescription of the resident’s physician.
(Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)
NAC 449.2748 Medication: Storage; duties upon discharge, transfer and return of resident. (NRS 449.0302)
1. Medication, including, without limitation, any over-the-counter medication, stored at a residential facility must be stored in a locked area that is cool and dry. The caregivers employed by the facility shall ensure that any medication or medical or diagnostic equipment that may be misused or appropriated by a resident or any other unauthorized person is protected. Medications for external use only must be kept in a locked area separate from other medications. A resident who is capable of administering medication to himself or herself without supervision may keep the resident’s medication in his or her room if the medication is kept in a locked container for which the facility has been provided a key.
2. Medication stored in a refrigerator, including, without limitation, any over-the-counter medication, must be kept in a locked box unless the refrigerator is locked or is located in a locked room.
3. Medication, including, without limitation, any over-the-counter medication or dietary supplement, must be:
(a) Plainly labeled as to its contents, the name of the resident for whom it is prescribed and the name of the prescribing physician; and
(b) Kept in its original container until it is administered.
4. Except as otherwise provided in subsection 5, when a resident is discharged or transferred from a residential facility, all medications prescribed for the resident must be provided to the resident or to the facility to which he or she is transferred.
5. If a resident is transferred to a hospital or skilled nursing facility, the residential facility shall hold the resident’s medications until the resident returns or for 30 days after the transfer, whichever is less, unless the hospital or skilled nursing facility requests the residential facility to provide the hospital or skilled nursing facility with the medications. If the resident does not return within 30 days after the transfer, the residential facility shall promptly dispose of any remaining medications. Upon the return of the resident from the hospital or skilled nursing facility, the residential facility shall, if there has been any change in the resident’s medication regimen:
(a) Contact a physician, within 24 hours after the resident returns, to clarify the change; and
(b) Document the physician contact in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744.
Top Takeaways:
- (a) Ensure that a physician, pharmacist or registered nurse who does not have a financial interest in the facility:
(1) Reviews for accuracy and appropriateness, at least once every 6 months, the regimen of drugs taken by each resident of the facility, including, without limitation, any over-the-counter medications and dietary supplements taken by a resident
Having a process in place for reviewing the medication residents in your facility are being prescribed has been shown to reduce drug related problems by cutting down on inappropriate medication, incorrect dosages and adverse drug to drug reactions. By effectively reviewing a residents medication regiment you may be able to reduce hospitalizations and mortality by identifying issues before they arise.
- An over-the-counter medication or a dietary supplement may be given to a resident only if the resident’s physician has approved the administration of the medication or supplement in writing or the facility is ordered to do so by another physician. The over-the-counter medication or dietary supplement must be administered in accordance with the written instructions of the physician. The administration of over-the-counter medications and dietary supplements must be included in the record required pursuant to paragraph (b) of subsection 1 of NAC 449.2744
Any medication that is being given to residents in the facility must be issued by a prescribing physician. If any medication is administered to residents without an order by a physician. If the DHHS audits your medication administration records and recognizes a medication without an order you will be cited as deficient.
- Pro Tip:
It is necessary for your entire clinical team to be well versed in the regulations that is applicable to their position. The Nursing Director or their designee should hold frequent refresher trainings 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.