Effective medication management
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 District of Columbia Community Residence Facilities Branch, Child and Residential Care Facilities Division, Health Regulation Administration (CRF/CRCFD/HRA) takes the following regulation so seriously. Check it out and see how you can keep your facility compliant:
10121 PRE-ADMISSION MEDICATION MANAGEMENT ASSESSMENT
10121.1 In addition to the consultations required by § 902 of the Act (D.C. Official Code § 44-109.02), the ALR shall consult with the prospective resident’s healthcare practitioner regarding the prospective resident’s ability to self-administer medication within thirty (30) days prior to admission.
10122 ON-SITE MEDICATION REVIEW
10122.1 The on-site medication review by a registered nurse that is arranged to occur every forty-five (45) days, pursuant to § 903 of the Act (D.C. Official Code § 44-109.03), shall include documentation of any changes to the resident’s medication profile, including changes in dosing and any medications that have been added or discontinued.
10123 MEDICATION STORAGE
10123.1 Medication that is entrusted to the ALR for storage shall be stored in accordance with the requirements of § 904 of the Act (D.C. Official Code § 44-109.04) and the following:
(a) Each medication shall be stored under proper conditions of light and temperature as indicated on its label; and
(b) Medication requiring refrigeration shall be maintained in a refrigerator that is secured and used exclusively for the storage of medication. The key to the refrigerator shall be kept on the person of the employee on duty who is responsible for administering the medications within.
10123.2 Medication taken from the ALR’s storage space for delivery to a resident or elsewhere shall not leave the immediate control of the employee delivering it unless the medication is secured with a locking mechanism or the delivery has been completed. The key to the lock must be kept on the person of the employee who is responsible for delivering the medication for the duration of the delivery.
10123.3 An ALR shall keep a current record of each prescription and non-prescription medication and dietary supplement kept by a resident in his or her living unit 33 pursuant to § 904(e)(8) of the Act (D.C. Official Code § 44-109.04(e)(8)), which shall be retained in the resident’s healthcare record and include:
(a) Name of the medication;
(b) Strength of medication and quantity;
(c) Lot number; and
(d) If a prescribed medication:
(1) Name of prescriber;
(2) Name and phone number of the pharmacy that filled the prescription;
(3) Date the prescription was filled; and
(4) The frequency and directions for use provided by the prescriber.
10123.4 In the event of voluntary or involuntary discharge, the ALR shall notify and attempt to return all medications to the resident (or surrogate) or a caregiver at the time of discharge, unless return of the medication is prohibited by federal or other District law. If the resident’s medications can’t be returned or remains unclaimed for more than thirty (30) days after the resident has been discharged, the medication shall be considered abandoned and destroyed. Witness and documentation of the destruction shall be in accordance with the § 904 of the Act (D.C. Official Code § 44-109.04) and applicable District law.
10124 MEDICATION ADMINISTRATION
10124.1 A resident shall be permitted to self-administer his or her medications, provided that the resident has been determined capable of self-administering his or her own medication as defined in paragraphs (a) or (b) of § 10124.2 by the most recent onsite medication review required under the Act or, if he or she is a new resident, by the initial assessment conducted during the ALR’s admission process.
10124.2 The initial assessment and periodic medication review performed pursuant to §§ 901 and 903 of the Act (D.C. Official Code §§ 44-109.01 and 44-109.03) for the purpose of determining whether a resident is capable of self-administering medication shall make one the following findings based on an assessment of the associated tasks below:
(a) A resident is capable of self-administering his or her own medication, provided that the resident can:
(1) Correctly read the label on the medication’s container;
(2) Correctly interpret the label;
(3) Correctly follow instructions as to route, dosage, and frequency of administration;
(4) Correctly ingest, inject, or otherwise apply the medication;
(5) Correctly measure or prepare the medication, including mixing, shaking, and filling syringes;
(6) Safely store the medication;
(7) Correctly follow instructions as to the time the medication must be administered; and
(8) Open the medication container, remove the medication from the container, and close the container;
(b) A resident is capable of self-administering his or her own medication, but requires a reminder to take medications or requires physical assistance with opening and removing medications from the container, or both, provided that the resident can:
(1) Correctly read the label on the medication’s container;
(2) Correctly interpret the label;
(3) Correctly follow instructions as to route, dosage, and frequency of administration;
(4) Correctly ingest, inject, or otherwise apply the medication;
(5) Correctly measure or prepare the medication, including mixing, shaking, and filling syringes; and
(6) Safely store the medication; or
(c) A resident is not capable of self-administering his or her own medication, provided that the resident needs the assistance of another person to properly carry out one or more of the tasks enumerated in paragraph (b) of this subsection.
10124.3 A resident who has been determined not capable of self-administering medication pursuant to paragraph (c) of § 10124.2, or has elected not to self-administer his or her own medications, or his or her surrogate, may arrange with a third-party for a licensed practical nurse, registered nurse, advanced practice registered nurse, physician, physician assistant, or certified medication aide to administer medication to the resident or assist the resident with taking his or her medications to the extent of the healthcare professional’s authority to do so under District and federal laws or regulations. A healthcare professional arranged to administer or assist in the self-administering of medication to a resident in accordance with this subsection shall be required to conform to the requirements of private duty healthcare professionals provided in § 10118 of this chapter.
10124.4 A resident who has been determined to be capable of self-administering his or her own medication but requires a reminder or physical assistance as defined in paragraph (b) of § 10124.02, shall be permitted to utilize a device or a third-party other than those who are listed in § 10124.3 in order to be reminded to take a medication, to open a medication container, or to remove a medication from its container, only. Under no circumstance shall this subsection be construed to authorize a person, other than a healthcare professional employed as described in § 10124.3, to assist a resident with an activity related to the administration of medication other than reminding that resident to take a medication, opening a medication container at the explicit direction of that resident, or removing a medication from its container at the explicit direction of that resident; nor shall any activity other than reminding a resident to take a medication, opening a medication container at the explicit direction of the resident, or removing a medication from its container at the explicit direction of the resident be construed as permissible for the purpose of this subsection. Activities that are not authorized by this subsection include, but are not limited to, the following: administering a medication, preparing a medication for administration or self-administration, advising or assisting in the administration of a medication, sorting medications, relabeling a medication, transferring medications from one container to another, removing a medication from its container for a purpose other than for the resident to self-administer independently promptly thereafter, or any other activity not expressly authorized by this subsection.
10124.5 An ALR shall provide or arrange for a licensed practical nurse, registered nurse, advanced practice registered nurse, physician, physician assistant, trained medication employee (“TME”), or certified medication aide to administer, or assist in the self-administering of, medication to a resident, provided that:
(a) The resident has been determined not capable of self-administering medication pursuant to paragraph (c) of § 10124.2 or has elected not to selfadminister his or her own medications, and he or she has not arranged with a third-party to administer, or assist in the self-administering of, his or her medication in accordance with § 10124.3;
(b) The healthcare professional holds the requisite certificate, registration, or license to practice issued by the District;
(c) The healthcare professional does not exceed his or her authority to administer or assist in the administration of medication to the resident under District and federal laws or regulations;
(d) The ALR discloses, orally and in writing, any fees, rates, or charges associated with providing assistance with or the administration of a medication that are additional to the resident’s existing bill, in accordance with § 10111 of this chapter;
(e) Prior to the provision of the medication administration or assistance, the resident (or surrogate) provides in writing:
(1) Acceptance of the medication administration or assistance offered by the ALR; and
(2) Acknowledgment of receiving the ALR’s medication administration policy and the disclosure of fees required in paragraph (c) of this subsection; and
(f) The ALR has in place education, remediation, and discipline procedures by which to address recurring medication errors perpetrated by the licensed practical nurse, registered nurse, advanced practice registered nurse, physician, physician assistant, TME, or certified medication aide.
10124.6 An ALR shall require that administration or assistance in the administration of medication to a resident by a healthcare professional pursuant to §§ 10124.3 and 10124.5 be in accordance with the prevailing standard of acceptable medication administration rights in the healthcare professional’s field.
10124.7 An ALR shall ensure that all medication administered to a resident by a licensed practical nurse, registered nurse, advanced practice registered nurse, physician, physician assistant, TME, or certified medication aide on its premises shall be recorded on a written or electronic medication administration record that is kept as part of the resident’s healthcare records.
10124.8 An ALR shall ensure that all employees and all licensed practical nurses, registered nurses, advanced practice registered nurses, physicians, physician assistants, or certified medication aides responsible for administering or assisting in the administration of medication to a resident while on the ALR’s premises, immediately report any medication error or adverse drug reactions to the ALR’s available registered nurse and ALA upon discovery. The ALR shall require the ALA or Acting Administrator to report the medication error or adverse drug reaction, to the resident’s healthcare practitioner, prescriber, pharmacist, and the resident (or surrogate), as appropriate.
10124.9 An ALR shall require all medication errors and adverse drug reactions be documented in the resident’s record.
10124.10 An ALR shall initiate an investigation of any reported medication error or adverse drug reaction within twenty-four (24) hours of discovery. Upon the completion of the investigation, the ALR shall compose a report documenting the findings and conclusion of the investigation, which shall be kept as part of the ALR’s records for no less than five (5) years. A report required under this subsection shall also be made available to the Director or the Director’s designee upon request during an inspection authorized by the Act or this chapter.
10124.11 An ALR shall submit to the Director a copy of any report of an adverse drug reaction required by § 10124.10 within thirty (30) days of the discovery of the adverse drug reaction, in addition to the requirements of § 10124.10 and the notification requirements of § 10125.4(a) of this chapter.
10124.12 Nothing in this section authorizes a healthcare professional to practice outside the scope of their authority to practice their profession in the District.
Top Takeaways:
- 1 In addition to the consultations required by § 902 of the Act (D.C. Official Code § 44-109.02), the ALR shall consult with the prospective resident’s healthcare practitioner regarding the prospective resident’s ability to self-administer medication within thirty (30) days prior to admission
Prior to the resident admitting to the facility, they must undergo an evaluation by their physician to determine if they are able to self-administer medication in the facility. This must be reflected on the resident’s care plan and available for the inspector’s review.
- 10 An ALR shall initiate an investigation of any reported medication error or adverse drug reaction within twenty-four (24) hours of discovery. Upon the completion of the investigation, the ALR shall compose a report documenting the findings and conclusion of the investigation, which shall be kept as part of the ALR’s records for no less than five (5) years. A report required under this subsection shall also be made available to the Director or the Director’s designee upon request during an inspection authorized by the Act or this chapter.
Even the most capable and diligent medication aides will eventually make a med error for one reason or another. When this happens, you must take the necessary steps listed above to ensure you avoid further issues.
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.