Compliance with medication management

Medication in the CBRF

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 Wisconsin Department of Health and Family Services takes the following regulation so seriously. Check it out and see how you can keep your facility compliant:

DHS 83.37Medications.

(1)  General requirements.

(a) Practitioner’s order. There shall be a written practitioner’s order in the resident’s record for any prescription medication, over-the-counter medication or dietary supplements administered to a resident.

(b) Medications. Prescription medications shall come from a licensed pharmacy or a physician and shall have a label permanently attached to the outside of the container. Over-the-counter medications maintained in the manufacturer’s container shall be labeled with the resident’s name. Over-the-counter medications not maintained in the manufacturer’s container shall be labeled by a pharmacist.

(c) Packaging. The CBRF shall develop and implement a policy that identifies the medication packaging system used by the CBRF. Any pharmacy selected by the resident whose medications are administered by CBRF employees shall meet the medication packaging system chosen by the CBRF. This does not apply to residents who self administer medications.

(d) Documentation. As required in s. DHS 83.42 (1) (m), when a resident is taking prescription or over-the-counter medications or dietary supplements, the resident’s record shall include a current list of the type and dosage of medications or supplements, directions for use, and any change in the resident’s condition.

(e) Medication Regimen Review.

  1. If residents’ medications are administered by a CBRF employee, the CBRF shall arrange for a pharmacist or a physician to review each resident’s medication regimen. This review shall occur within 30 days before or 30 days after the resident’s admission, whenever there is a significant change in medication, and at least every 12 months.
  2. At least annually, the CBRF shall have a physician, pharmacist, or registered nurse conduct an on-site review of the CBRF’s medication administration and medication storage systems.
  3. The CBRF shall obtain a written report of findings under subds. 1.and 2., and address any irregularities for appropriate action. When the review is done by someone other than the prescribing practitioner, the prescribing practitioner shall receive a copy of the report when there are irregularities identified with the resident’s medication regimen, which may need physician involvement to address.

(f) More than one practitioner.

  1. When an employee of the CBRF administers a resident’s medication, the CBRF shall provide a list of the resident’s current medications to all practitioners. If this information is not provided before a prescription is written, the CBRF shall update the resident’s primary practitioner or pharmacist before the administration of any new medication.
  2. When a resident self administers medications, the CBRF shall provide a list of the resident’s current medications for the resident to provide to all practitioners.

(g) Disposition of medications.

  1. When a resident is discharged, the resident’s medications shall be sent with the resident.
  2. If a resident’s medication has been changed or discontinued, the CBRF may retain a resident’s medication for no more than 30 days unless an order by a physician or a request by a pharmacist is written every 30 days to retain the medication.
  3. The CBRF shall develop and implement a policy for disposing unused, discontinued, outdated, or recalled medications in compliance with federal, state and local standards or laws. The CBRF shall arrange for the stored medications to be destroyed in compliance with standard practices. Medications that cannot be returned to the pharmacy shall be separated from other medication in current use in the facility and stored in a locked area, with access limited to the administrator or designee. The administrator or designee and one other employee shall witness, sign, and date the record of destruction. The record shall include the medication name, strength and amount.

(h) Scheduled psychotropic medications. When a psychotropic medication is prescribed for a resident, the CBRF shall do all of the following:

  1. Ensure the resident is reassessed by a pharmacist, practitioner or registered nurse, as needed, but at least quarterly for the desired responses and possible side effects of the medication. The results of the assessments shall be documented in the resident’s record as required under s. DHS 83.42 (1) (q).
  2. Ensure all resident care staff understands the potential benefits and side effects of the medication.

(i) As needed (PRN) psychotropic medication. When a psychotropic medication is prescribed on an as needed basis for a resident, the CBRF shall do all of the following:

  1. The resident’s individual service plan shall include the rationale for use and a detailed description of the behaviors which indicate the need for administration of PRN psychotropic medication.
  2. The administrator or qualified designee shall monitor at least monthly for the inappropriate use of PRN psychotropic medication, including but not limited to, use contrary to the individual service plan, presence of significant adverse side effects, use for discipline or staff convenience, or contrary to the intended use.
  3. Documentation in the resident’s record shall include the rationale for use, description of behaviors requiring the PRN psychotropic medication, the effectiveness of the medication, the presence of any side effects, and monitoring for inappropriate use for each PRN psychotropic medication given.

(j) Proof-of-use record. The CBRF shall maintain a proof-of-use record for schedule II drugs, subject to 21 USC 812 (c), and Wisconsin’s uniform controlled substances act, ch. 961, Stats., that contains the date and time administered, the resident’s name, the practitioner’s name, dose, signature of the person administering the dose, and the remaining balance of the drug. The administrator or designee shall audit, sign and date the proof-of-use records on a daily basis.

(k) Medication error or adverse reaction.

  1. The CBRF shall document in the resident’s record any error in the administration of prescription or over-the-counter medication, known adverse drug reaction or resident refusal to take medication.
  2. The CBRF shall report all errors in the administration of medication and any adverse drug reactions to a licensed practitioner, supervising nurse or pharmacist immediately. Unless otherwise directed by the prescribing practitioner, the CBRF shall report to the prescribing practitioner, supervising nurse or pharmacist as soon as possible after the resident refuses a medication for 2 consecutive days.

(L) Medication information. The CBRF shall make available written information to resident care staff on the purpose and side effects of medications taken by residents.

(2) Medication administration.

(a) Self-administered by resident.

  1. The resident shall self-administer prescribed and over-the-counter medications and dietary supplements, unless the resident has been found incompetent under ch. 54, Stats., or does not have the physical or mental capacity to self-administer as determined by the resident’s physician, or the resident requests in writing that CBRF employees manage and administer medication.
  2. Except as specified under sub. (4), when a resident self-administers medications, prescribed and over-the-counter medications and dietary supplements shall remain under the control of the resident. The CBRF shall provide a secure place for the storage of medications in the resident’s room.
  3. A resident with the mental and physical capacity to develop increased independence in medication administration shall receive self-administration instruction.

(b) Medication administration supervised by a registered nurse, practitioner or pharmacist. When medication administration is supervised by a registered nurse, practitioner or pharmacist, the CBRF shall ensure all of the following:

  1. The registered nurse, practitioner or pharmacist coordinates, directs and inspects the administration of medications and the medication administration system.
  2. The registered nurse, practitioner or pharmacist participates in the resident’s assessment under s. DHS 83.35 (1)and development and review of the individual service plan under s. DHS 83.35 (3) regarding the resident’s medical condition and the goals of the medication regimen.

(c) Medication administration not supervised by a registered nurse, practitioner or pharmacist. When medication administration is not supervised by a registered nurse, practitioner or pharmacist, the CBRF shall arrange for a pharmacist to package and label a resident’s prescription medications in unit dose. Medications available over-the-counter may be excluded from unit dose packaging requirements, unless the physician specifies unit dose.

(d) Documentation of medication administration. As required under s. DHS 83.42 (1) (o), at the time of medication administration, the person administering the medication or treatment shall document in the resident record the name, dosage, date and time of medication taken or treatments performed and initial the medication administration record. Any side effects observed by the employee or symptoms reported by the resident shall be documented. The need for any PRN medication and the resident’s response shall be documented.

(e) Other administration. Injectables, nebulizers, stomal and enteral medications, and medications, treatments or preparations delivered vaginally or rectally shall be administered by a registered nurse or by a licensed practical nurse within the scope of their license. Medication administration described under sub. (2) (e) may be delegated to non-licensed employees pursuant to s. N 6.03 (3).

(3) Medication storage.

(a) Original containers. The CBRF shall keep medications in the original containers and not transfer medications to another container, unless the CBRF complies with all of the following:

  1. Transfer of medications from the original container to another container shall be done by a practitioner, registered nurse, or pharmacist. Transfer of medication to another container may be delegated to other personnel by a practitioner, registered nurse or pharmacist.
  2. If a medication is administered by CBRF employees and the medication is transferred from the original container by a registered nurse, or practitioner or other personnel who were delegated the task, the CBRF shall have a legible label on the new container that includes, at a minimum, the resident’s name, medication name, dose and instructions for use. The CBRF shall maintain the original pharmacy container until the transferred medication is gone.

(b) Unit dose packaging. For use during unplanned or non-routine events or activities, employees who have completed medication administration training as required in s. DHS 83.20 (2) (d) may transfer unit doses of medications into packages for the resident.

(c) Administered by facility. The CBRF shall keep medicine cabinets locked and the key available only to personnel identified by the CBRF.

(d) Refrigeration. Medications stored in a common refrigerator shall be properly labeled and stored in a locked box.

(e) Proximity to chemicals. The CBRF may not store prescription and over-the-counter medications or dietary supplements next to chemicals or other contaminants.

(f) Internal and external application. The CBRF shall physically separate medications for internal consumption from medications for external application.

(g) Controlled substances. The CBRF shall provide separately locked and securely fastened boxes or drawers or permanently fixed compartments within the locked medications area for storage of schedule II drugs subject to 21 USC 812 (c), and Wisconsin’s uniform controlled substances act, ch. 961, Stats.

(4) Exemptions. Any CBRF that exclusively serves residents in the custody of a government correctional agency or who is alcohol or drug dependent is exempt from the requirements in sub. (2) (a) 2. These facilities may store medications in a central, secure area and employees may observe and record the self administration of medication as described in the resident’s individual service plan.

Top Takeaways:

  • (e)Medication Regimen Review.
  1. If residents’ medications are administered by a CBRF employee, the CBRF shall arrange for a pharmacist or a physician to review each resident’s medication regimen. This review shall occur within 30 days before or 30 days after the resident’s admission, whenever there is a significant change in medication, and at least every 12 months.
  2. At least annually, the CBRF shall have a physician, pharmacist, or registered nurse conduct an on-site review of the CBRF’s medication administration and medication storage systems.

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, inappropriate 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.

  • (a) Practitioner’s order. There shall be a written practitioner’s order in the resident’s record for any prescription medication, over-the-counter medication or dietary supplements administered to a resident.

(b) Medications. Prescription medications shall come from a licensed pharmacy or a physician and shall have a label permanently attached to the outside of the container. Over-the-counter medications maintained in the manufacturer’s container shall be labeled with the resident’s name. Over-the-counter medications not maintained in the manufacturer’s container shall be labeled by a pharmacist.

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 Wisconsin Department of Health and Family Services audits your medication administration records and recognizes a medication without an order you will be cited as deficient.

 

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