Long Term Care Regulations

Question 1

Disposition of meds in LTCF

Answer 1

-outdated, deteriorated or recalled meds: return to pharmacy for quarterly disposal
-the disposition of d/c and unused meds or discharged or dead pts:
–> method of disposition and the quantity of drugs documented in chart (kept for 7 yrs*)
–> disposition shall be done at least quarterly

Question 2

Regulations for pharmaceutical services for LTCF: (title 28, chapter 211.9)

Answer 2

-staff should be knowledgeable in P&P regarding pharmacy services
-only licensed rphs can dispense meds for residents (physicians can dispense meds for those in their care)
-meds shall be dispensed by same person who prepared the dose
-meds shall be admins under the written orders of the attending physician
-if OTCs are kept at facility, bear the original label and have the name of the resident on the label

Question 3

Purchase of Medications from Pharmacy of Choice for LTCF

Answer 3

-set up procedures for receipt of meds from outside pharmacy
-pharmacist shall receive a monthly medication profile from the residents selected pharmacy provider
-policay shall be established regarding procuring meds in urgent situations (ex: may order 7 ds from LTFC contracted pharmacy)

Question 4

Who has oversight of LTCF pharmaceutical services?

Answer 4

Quality Assurance Committee

Question 5

LTCF Emergency Kits

Answer 5

*must have at least one

-written policies and procedures pertaining to the use, content, storage and refill
-be under the control of a practitioner authorized to dispense or prescribe meds under the pharmacy act
-kits shall be readily available to staff and shall have a breakaway lock which shall be replaced after each use

Question 6

Physicians orders in LTCFs

Answer 6

-physicians telephone and oral orders: shall be dated and countersigned by the prescribing practitioner within 48 hours
-oral order for CII are permitted in a bona fide emergency
-Oral orders for medications shall be accepted only under circumstances where it is impractical for the orders to be given a written manner by the responsible practitioner.
-Initial written orders as well as a countersignature may be received by fax which includes the practitioner’s signature

Question 7

Policies for Oral Orders in LTCF

Answer 7

facility must have policy for:
-identification of all medications and txs which may NOT be prescribed and dispensed pursuant to an oral order
-a req that all orders be stated clearly, repeated by the issuing practitioner, and be read back in their entirety by personnel authorized to take the order
-policy on fax transmissions

Question 8

PA and CRNP oral prescribing in LTCFs

Answer 8

-physicians have to countersign and date their verbal orders to PAs or CRNPS within 7 days
-documentation on a pts chart by PA shall be countersigned by the supervising physician within 7 days with an original sig date by the licensed physician