Properly abiding by the rules and regulations for Medication in an Assisted Living Facility can be the biggest headache (no pun intended) that you come in contact with- that is if you don’t have a system in place for adhering to the following regulation provided by the Minnesota ALLHRD:
144G.71 MEDICATION MANAGEMENT.
Subdivision 1. Medication management services.
(a) This section applies only to assisted living facilities that provide medication management services.
(b) An assisted living facility that provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines.
(c) The written policies and procedures must address requesting and receiving prescriptions for medications; preparing and giving medications; verifying that prescription drugs are administered as prescribed; documenting medication management activities; controlling and storing medications; monitoring and evaluating medication use; resolving medication errors; communicating with the prescriber, pharmacist, and resident and legal and designated representatives; disposing of unused medications; and educating residents and legal and designated representatives about medications. When controlled substances are being managed, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 23.
Subd. 2.Provision of medication management services.
(a) For each resident who requests medication management services, the facility shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the resident. The assessment must include an identification and review of all medications the resident is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues.
(b) The assessment must identify interventions needed in management of medications to prevent diversion of medication by the resident or others who may have access to the medications and provide instructions to the resident and legal or designated representatives on interventions to manage the resident’s medications and prevent diversion of medications. For purposes of this section, “diversion of medication” means misuse, theft, or illegal or improper disposition of medications.
Subd. 3.Individualized medication monitoring and reassessment.
The assisted living facility must monitor and reassess the resident’s medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually.
Subd. 4.Resident refusal.
The assisted living facility must document in the resident’s record any refusal for an assessment for medication management by the resident. The facility must discuss with the resident the possible consequences of the resident’s refusal and document the discussion in the resident’s record.
Subd. 5.Individualized medication management plan.
(a) For each resident receiving medication management services, the assisted living facility must prepare and include in the service plan a written statement of the medication management services that will be provided to the resident. The facility must develop and maintain a current individualized medication management record for each resident based on the resident’s assessment that must contain the following:
(1) a statement describing the medication management services that will be provided;
(2) a description of storage of medications based on the resident’s needs and preferences, risk of diversion, and consistent with the manufacturer’s directions;
(3) documentation of specific resident instructions relating to the administration of medications;
(4) identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis;
(5) identification of medication management tasks that may be delegated to unlicensed personnel;
(6) procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; and
(7) any resident-specific requirements relating to documenting medication administration, verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions.
(b) The medication management record must be current and updated when there are any changes.
(c) Medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management.
Subd. 6.Administration of medication.
Medications may be administered by a nurse, physician, or other licensed health practitioner authorized to administer medications or by unlicensed personnel who have been delegated medication administration tasks by a registered nurse.
Subd. 7.Delegation of medication administration.
When administration of medications is delegated to unlicensed personnel, the assisted living facility must ensure that the registered nurse has:
(1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed personnel has demonstrated the ability to competently follow the procedures;
(2) specified, in writing, specific instructions for each resident and documented those instructions in the resident’s records; and
(3) communicated with the unlicensed personnel about the individual needs of the resident.
Subd. 8.Documentation of administration of medications.
Each medication administered by the assisted living facility staff must be documented in the resident’s record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the resident’s needs when medication was not administered as prescribed and in compliance with the resident’s medication management plan.
Subd. 9.Documentation of medication setup.
Documentation of dates of medication setup, name of the medication, the quantity of dose, times to be administered, route of administration, and name of person completing medication setup must be done at the time of setup.
Subd. 10.Medication management for residents who will be away from home.
(a) An assisted living facility that is providing medication management services to the resident must develop and implement policies and procedures for giving accurate and current medications to residents for planned or unplanned times away from home according to the resident’s individualized medication management plan. The policies and procedures must state that:
(1) for planned time away, the medications must be obtained from the pharmacy or set up by the licensed nurse according to appropriate state and federal laws and nursing standards of practice;
(2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall provide medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar days;
(3) the resident must be provided written information on medications, including any special instructions for administering or handling the medications, including controlled substances; and
(4) the medications must be placed in a medication container or containers appropriate to the provider’s medication system and must be labeled with the resident’s name and the dates and times that the medications are scheduled.
(b) For unplanned time away when the licensed nurse is not available, the registered nurse may delegate this task to unlicensed personnel if:
(1) the registered nurse has trained the unlicensed staff and determined the unlicensed staff is competent to follow the procedures for giving medications to residents; and
(2) the registered nurse has developed written procedures for the unlicensed personnel, including any special instructions or procedures regarding controlled substances that are prescribed for the resident. The procedures must address:
(i) the type of container or containers to be used for the medications appropriate to the provider’s medication system;
(ii) how the container or containers must be labeled;
(iii) written information about the medications to be provided;
(iv) how the unlicensed staff must document in the resident’s record that medications have been provided, including documenting the date the medications were provided and who received the medications, the person who provided the medications to the resident, the number of medications that were provided to the resident, and other required information;
(v) how the registered nurse shall be notified that medications have been provided and whether the registered nurse needs to be contacted before the medications are given to the resident or the designated representative;
(vi) a review by the registered nurse of the completion of this task to verify that this task was completed accurately by the unlicensed personnel; and
(vii) how the unlicensed personnel must document in the resident’s record any unused medications that are returned to the facility, including the name of each medication and the doses of each returned medication.
Subd. 11.Prescribed and nonprescribed medication.
The assisted living facility must determine whether the facility shall require a prescription for all medications the provider manages. The facility must inform the resident whether the facility requires a prescription for all over-the-counter and dietary supplements before the facility agrees to manage those medications.
Subd. 12.Medications; over-the-counter drugs; dietary supplements not prescribed.
An assisted living facility providing medication management services for over-the-counter drugs or dietary supplements must retain those items in the original labeled container with directions for use prior to setting up for immediate or later administration. The facility must verify that the medications are up to date and stored as appropriate.
There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the assisted living facility is managing for the resident.
Subd. 14.Renewal of prescriptions.
Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152.
Subd. 15.Verbal prescription orders.
Verbal prescription orders from an authorized prescriber must be received by a nurse or pharmacist. The order must be handled according to Minnesota Rules, part 6800.6200.
Subd. 16.Written or electronic prescription.
When a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the resident’s record.
Subd. 17.Records confidential.
A prescription or order received verbally, in writing, or electronically must be kept confidential according to sections 144.291 to 144.298 and 144A.44.
Subd. 18.Medications provided by resident or family members.
When the assisted living facility is aware of any medications or dietary supplements that are being used by the resident and are not included in the assessment for medication management services, the staff must advise the registered nurse and document that in the resident record.
Subd. 19.Storage of medications.
An assisted living facility must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer’s directions and permit only authorized personnel to have access.
Subd. 20.Prescription drugs.
A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or beyond-use date of a time-dated drug.
No prescription drug supply for one resident may be used or saved for use by anyone other than the resident.
Subd. 22.Disposition of medications.
(a) Any current medications being managed by the assisted living facility must be provided to the resident when the resident’s service plan ends or medication management services are no longer part of the service plan. Medications for a resident who is deceased or that have been discontinued or have expired may be provided for disposal.
(b) The facility shall dispose of any medications remaining with the facility that are discontinued or expired or upon the termination of the service contract or the resident’s death according to state and federal regulations for disposal of medications and controlled substances.
(c) Upon disposition, the facility must document in the resident’s record the disposition of the medication including the medication’s name, strength, prescription number as applicable, quantity, to whom the medications were given, date of disposition, and names of staff and other individuals involved in the disposition.
Subd. 23.Loss or spillage.
(a) Assisted living facilities providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must require that when a spillage of a controlled substance occurs, a notation must be made in the resident’s record explaining the spillage and the actions taken. The notation must be signed by the person responsible for the spillage and include verification that any contaminated substance was disposed of according to state or federal regulations.
(b) The procedures must require that the facility providing medication management investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state or federal regulations and document the investigation in required records.
- (b) An assisted living facility that provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines.
Staying in compliance with ALLHRD regulations often boils down to having a proper policy in place for managing each aspect of your operation. This is no different when providing medication assistance for your residents. You must ensure this med policy has the buy-in of all care professionals who are handling medication. It is suggested to audit the med pass on a frequent basis and consistently coach your employees on how they have improved their practice.
- 3.Individualized medication monitoring and reassessment.
The assisted living facility must monitor and reassess the resident’s medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually
Due to the ever-changing needs of residents in an ALF setting, it is important to update their needs on a regular basis, especially when speaking on medication services. This should be completed on a minimum of annually or when residents are showing symptoms that could be related to medication issues.
- (b) The procedures must require that the facility providing medication management investigate any known loss or unaccounted for prescription drugs and take the appropriate action required under state or federal regulations and document the investigation in required records.
If medication is deemed to be missing you must take the appropriate steps to investigate the situation. Interview the staff that was responsible for the medication and be thorough with your search to find the meds.