DHS 83.37 Medications.
(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
Agenda Item X.A – WI Chapter DHS 83 Regulations
161 DEPARTMENT OF HEALTH SERVICES DHS 83.37
Published under s. 35.93, Wis. Stats., by the Legislative Reference Bureau.
Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page
is the date the chapter was last published. Register December 2011 No. 672
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.