Compliance with 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 state of Virginia Department of Social Services takes the following regulation so seriously. Check it out and see how you can keep your facility compliant with DOSS:

22VAC40-73-640. Medication management plan and reference materials.

  1. The facility shall have, keep current, and implement a written plan for medication management. The facility’s medication plan shall address procedures for administering medication and shall include:
  2. Methods to ensure an understanding of the responsibilities associated with medication management;
  3. Standard operating procedures, including the facility’s standard dosing schedule and any general restrictions specific to the facility;
  4. Methods to prevent the use of outdated, damaged, or contaminated medications;
  5. Methods to ensure that each resident’s prescription medications and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages;
  6. Methods for verifying that medication orders have been accurately transcribed to medication administration records (MARs) within 24 hours of receipt of a new order or change in an order;
  7. Methods for monitoring medication administration and the effective use of the MARs for documentation;
  8. Methods to ensure that MARs are maintained as part of the resident’s record;
  9. Methods to ensure accurate counts of all controlled substances whenever assigned medication administration staff changes; 9. Methods to ensure that staff who are responsible for administering medications meet the qualification requirements of 22VAC40-73-670;
  10. Methods to ensure that staff who are responsible for administering medications are adequately supervised, including periodic direct observation of medication administration;
  11. A plan for proper disposal of medication;
  12. Methods to ensure that residents do not receive medications or dietary supplements to which they have known allergies;
  13. Identification of the medication aide or the person licensed to administer drugs responsible for routinely communicating issues or observations related to medication administration to the prescribing physician or another prescriber;
  14. Methods to ensure that staff who are responsible for administering medications are trained on the facility’s medication management plan; and
  15. Procedures for internal monitoring of the facility’s conformance to the medication management plan.
  16. The facility’s written medication management plan requires approval by the department.
  17. Subsequent changes shall be reviewed as part of the department’s regular inspection process.
  18. In addition to the facility’s written medication management plan, the facility shall have readily accessible at least one pharmacy reference book, drug guide, or medication handbook for nurses that is no more than two years old as reference materials for staff who administer medications.

22VAC40-73-650. Physician’s or other prescriber’s order.

  1. No medication, dietary supplement, diet, medical procedure, or treatment shall be started, changed, or discontinued by the facility without a valid order from a physician or other prescriber. Medications include prescription, over-the-counter, and sample medications.
  2. A physician or other prescriber orders, both written and oral, for the administration of all prescription and over-the-counter medications and dietary supplements shall include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given and identify the diagnosis, condition, or specific indications for administering each drug.
  3. Physician’s or other prescriber’s oral orders shall:
  4. Be charted by the individual who takes the order. That individual must be one of the following:
  5. A licensed health care professional practicing within the scope of his profession; or
  6. A medication aide.
  7. Be reviewed and signed by a physician or other prescriber within 14 days.
  8. Medication aides may not transmit an oral order to a pharmacy.
  9. The resident’s record shall contain the physician’s or another prescriber’s signed written order or a dated notation of the physician’s or other prescriber’s oral order. Orders shall be organized chronologically in the resident’s record.
  10. Whenever a resident is admitted to a hospital for treatment of any condition, the facility shall obtain new orders for all medications and treatments prior to or at the time of the resident’s return to the facility. The facility shall ensure that the primary physician is aware of all medication orders and has documented any contact with the physician regarding the new orders.

 22VAC40-73-660. Storage of medications.

  1. A medicine cabinet, container, or compartment shall be used for the storage of medications and dietary supplements prescribed for residents when such medications and dietary supplements are administered by the facility. Medications shall be stored in a manner consistent with current standards of practice.
  2. The storage area shall be locked.
  3. Schedule II drugs and any other drugs subject to abuse must be kept in a separate locked storage compartment (e.g., a locked cabinet within a locked storage area or a locked container within a locked cabinet or cart).
  4. The individual responsible for medication administration shall keep the keys to the storage area on his person.
  5. When in use, the storage area shall have adequate illumination in order to read container labels.
  6. The storage area shall not be located in the kitchen or bathroom, but in an area free of dampness or abnormal temperatures unless the medication requires refrigeration.
  7. When required, medications shall be refrigerated.
  8. It is permissible to store dietary supplements and foods and liquids used for medication administration in a refrigerator that is dedicated to medication storage if the refrigerator is in a locked storage area.
  9. When it is necessary to store medications in a refrigerator that is routinely used for food storage, the medications shall be stored together in a locked container in a clearly defined area.
  10. Single-use and dedicated medical supplies and equipment shall be appropriately labeled and stored. Medical equipment suitable for multi-use shall be stored to prevent cross-contamination.
  11. A resident may be permitted to keep his own medication in an out-of-sight place in his room if the UAI has indicated that the resident is capable of self-administering medication. The medication and any dietary supplements shall be stored so that they are not accessible to other residents. This does not prohibit the facility from storing or administering all medication and dietary supplements.

EXCEPTION: If the facility has no resident with a serious cognitive impairment or substance abuse problem, the facility may determine that the out-of-sight and inaccessibility safeguards specified in this subsection do not apply. If the facility determines that these safeguards do not apply, the facility shall maintain documentation of such, including the date and the names of residents at the time the determination is made. No such determination shall be valid for longer than six months. Such determinations may be renewed under the same conditions and with the same documentation requirements.

Top Takeaways:

  • The facility shall have, keep current, and implement a written plan for medication management. The facility’s medication plan shall address procedures for administering medication and shall include: 1-15

There is an omnipresent theme in my articles- and that is EVERYTHING BOILS DOWN TO POLICY. It goes without saying, but you must have a policy for everything related to meds. Have it written down and easily accessible for staff as well as any potential surveyors.

  • Physician’s or other prescriber’s oral orders shall:
  1. Be charted by the individual who takes the order. That individual must be one of the following:
  2. A licensed health care professional practicing within the scope of his profession; or
  3. A medication aide.
  4. Be reviewed and signed by a physician or other prescriber within 14 days.

While the approved staff is able to take a verbal order from a physician it must be charted in the resident’s medical file and sign by the physician within 14 days. You will be tagged for a deficiency if you are noted to be giving residents medication without a signed prescription.

  • A resident may be permitted to keep his own medication in an out-of-sight place in his room if the UAI has indicated that the resident is capable of self-administering medication. The medication and any dietary supplements shall be stored so that they are not accessible to other residents. This does not prohibit the facility from storing or administering all medication and dietary supplements.

Any procedures due to a specific resident’s med management must be reflected in their assessment. For example, if a resident is requesting their meds to be stored in their own room, you must have the fact that they are able to understand and comprehend the medications they are insisting on keeping.

 

 

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