§ 2800.181. Self-administration.
(a) A residence shall provide residents with assistance, as needed, with medication prescribed for the resident’s self-administration. This assistance includes
helping the resident to remember the schedule for taking the medication, storing the medication in a secure place and offering the resident the medication at the
(b) If assistance includes helping the resident to remember the schedule for taking the medication, the resident shall be reminded of the prescribed schedule.
Appropriate cueing shall be used to remind residents to take their medication.
(c) The resident’s assessment shall identify if the resident is able to selfadminister medications as specified in § 2800.227(e) (relating to development
of the final support plan). A resident who desires to self-administer medications shall be assessed by a physician, physician’s assistant or certified registered nurse
practitioner regarding the ability to self-administer and the need for medication reminders.
(d) If the resident does not need assistance with medication, medication may be stored in a resident’s living unit for self-administration. Medications stored in
the resident’s living unit shall be kept in a safe and secure location to protect against contamination, spillage and theft. The residence shall provide a lockable
storage unit for this purpose.
(e) To be considered capable to self-administer medications, a resident shall:
(1) Be able to recognize and distinguish his medication.
(2) Know how much medication is to be taken.
(3) Know when medication is to be taken.
(f) The resident’s record shall include a current list of prescription, CAM and OTC medications for each resident who is self-administering his medication.
§ 2800.182. Medication administration.
(a) A residence shall provide medication administration services for a resident who is assessed to need medication administration services in accordance
with § 2800.181 (relating to self-administration) and for a resident who chooses not to self-administer medications.
(b) Prescription medication that is not self-administered by a resident shall be
administered by one of the following:
(1) A physician, licensed dentist, licensed physician’s assistant, RN, certified registered nurse practitioner, LPN or licensed paramedic.
(2) A graduate of an approved nursing program functioning under the
direct supervision of a professional nurse who is present in the residence.
(3) A student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the residence.
(4) A staff person who has completed the medication administration training as specified
in § 2800.190 (relating to medication administration training) for the administration of oral; topical; eye, nose and ear drop prescription
medications; insulin injections and epinephrine injections for insect bites or other allergies.
(c) Medication administration includes the following activities, based on the needs of the resident:
(1) Identify the correct resident.
(2) If indicated by the prescriber’s orders, measure vital signs and administer medications accordingly.
(3) Remove the medication from the original container.
(4) Crush or split the medication as ordered by the prescriber.
(5) Place the medication in a medication cup or other appropriate container, or in the resident’s hand.
(6) Place the medication in the resident’s hand, mouth or other route as
ordered by the prescriber, in accordance with the limitations specified in subsection (b)(4).
(7) Complete documentation in accordance with § 2800.187 (relating to medication records).
Cross References This section cited in 55 Pa. code § 2800.220 (relating to service provision).
§ 2800.183. Storage and disposal of medications and medical supplies.
(a) Prescription medications, OTC medications and CAM shall be kept in their original labeled containers and may not be removed more than 2 hours in
the advance of the scheduled administration. Assistance with insulin and epinephrine injections and sterile liquids shall be provided immediately upon removal of the
medication from its container.
(b) Prescription medications, OTC medications, CAM and syringes shall be kept in an area or container that is locked. This includes medications and syringes
unless kept in the resident’s living unit.
(c) Prescription medications, OTC medications and CAM stored in a refrigerator shall be kept in an area or container that is locked unless the resident has
the capacity to store the medications in the resident’s own refrigerator in the resident’s living unit.
(d) Only current prescription, OTC medications, sample and CAM for individuals living in the residence may be kept in the residence.
(e) Prescription medications, OTC medications and CAM shall be stored in
an organized manner under proper conditions of sanitation, temperature, moisture
and light and in accordance with the manufacturer’s instructions.
(f) Prescription medications, OTC medications and CAM that are discontinued, expired or for residents who are no longer served at the residence shall be
destroyed in a safe manner according to the Department of Environmental Protection and Federal and State regulations. When a resident permanently leaves the
residence, the resident’s medications shall be given to the resident, the designated
person, if any, or the person or entity taking responsibility for the new placement
on the day of departure from the residence.
(g) Subsections (a) and (e) do not apply to a resident who self-administers medication and stores the medication in his living unit.
§ 2800.184. Labeling of medications.
(a) The original container for prescription medications must be labeled with a pharmacy label that includes the following:
(1) The resident’s name.
(2) The name of the medication.
(3) The date the prescription was issued.
(4) The prescribed dosage and instructions for administration.
(5) The name and title of the prescriber.
(b) If the OTC medications and CAM belong to the resident, they must be
identified with the resident’s name.
(c) Sample prescription medications must have written instructions from the
prescriber that include the components specified in subsection (a).
§ 2800.185. Accountability of medication and controlled substances.
(a) The residence shall develop and implement procedures for the safe storage, access, security, distribution and use of medications and medical equipment
by trained staff persons.
(b) At a minimum, the procedures must include:
(1) Documentation of the receipt of controlled substances and prescription medications.
(2) A process to investigate and account for missing medications and medication errors.
(3) Limited access to medication storage areas.
(4) Documentation of the administration of prescription medications, OTC
medications and CAM for residents who receive medication administration
services or assistance with self-administration. This requirement does not apply
to a resident who self-administers medication without the assistance of a staff
person and stores the medication in his living unit.
(5) To the extent indicated in the resident’s support plan, the residence
shall obtain prescribed medication for residents and keep an adequate supply of resident medication on hand at all times.
§ 2800.186. Prescription medications.
(a) Each prescription medication must be prescribed in writing by an authorized prescriber. Prescription orders shall be kept current.
(b) Prescription medications shall be used only by the resident for whom the the prescription was prescribed.
(c) Changes in medication may only be made in writing by the prescriber, or in the case of an emergency, an alternate prescriber, except for circumstances in
which oral orders may be accepted by nurses in accordance with regulations of the Department of State. The resident’s medication record shall be updated as
soon as the residence receives written notice of the change.
§ 2800.187. Medication records.
(a) A medication record shall be kept to include the following for each resident for whom medications are administered:
(1) Resident’s name.
(2) Drug allergies.
(3) Name of medication.
(5) Dosage form.
(7) Route of administration.
(8) Frequency of administration.
(9) Administration times.
(10) Duration of therapy, if applicable.
(11) Special precautions, if applicable.
(12) Diagnosis or purpose for the medication, including pro re nata (PRN).
(13) Date and time of medication administration.
(14) Name and initials of the staff person administering the medication.
(b) The information in subsections (a)(13) and (14) shall be recorded at the
time the medication is administered.
(c) If a resident refuses to take prescribed medication, the refusal shall be
documented in the resident’s record and on the medication record. The refusal
shall be reported to the prescriber within 24 hours unless otherwise instructed by
the prescriber. Subsequent refusals to take a prescribed medication shall be
reported as required by the prescriber.
(d) The residence shall follow the directions of the prescriber.
§ 2800.188. Medication errors.
(a) Medication errors include the following:
(1) Failure to administer a medication.
(2) Administration of the wrong medication.
(3) Administration of the wrong amount of medication.
(4) Failure to administer a medication at the prescribed time.
(5) Administration to the wrong resident.
(6) Administration through the wrong route.
(b) A medication error shall be immediately reported to the resident, the resident’s designated person and the prescriber.
(c) Documentation of medication errors and the prescriber’s response shall be
kept in the resident’s record.
(d) There shall be a system in place to identify and document medication
errors and the residence’s pattern of error.
(e) There shall be documentation of the follow-up action that was taken to
prevent future medication errors.
This section cited in 55 Pa. Code § 2800.16 (relating to reportable incidents and conditions).
§ 2800.189. Adverse reaction.
(a) If a resident has a suspected adverse reaction to a medication, the residence shall immediately consult a physician or seek emergency
medical treatment. The resident’s designated person shall be notified, if applicable.
(b) The residence shall document adverse reactions, the prescriber’s response
and any action taken in the resident’s record.
§ 2800.190. Medication administration training.
(a) A staff person who has successfully completed a Department-approved
medications administration course that includes the passing of the Department’s
performance-based competency test within the past 2 years may administer oral;
topical; eye, nose and ear drop prescription medications and epinephrine injections for insect bites or other allergies.
(b) A staff person is permitted to administer insulin injections following successful completion of a Department-approved medications administration course
that includes the passing of a written performance-based competency test within
the past 2 years, as well as successful completion of a Department-approved diabetes patient education program within the past 12 months.
(c) A record of the training shall be kept including the staff person trained,
the date, source, name of trainer and documentation that the course was successfully completed.
Cross References This section cited in 55 Pa. Code § 2800.182 (relating to medication administration).
§ 2800.191. Resident education.
The residence shall educate the resident of the right to question or refuse a
medication if the resident believes there may be a medication error. Documentation of this resident education shall be kept.