NMBOP: 16.19.11 NURSING HOME DRUG CONTROL Flashcards
Licensed Facility
Any facility, skilled nursing facility, intermediate care or any other upper level of care facility as defined by Health and Human Services Department that is required to maintain custody of patients drugs in a drug room, and such drugs are administered by the facilities’ designated personnel.
Licensed Custodial Care Facility
Any facility or business, including non-profit entity which provides retirement care, mental care or other facility that provides extended health care to patients.
Consultant Pharmacist
means a pharmacist who is responsible to the administrator of the facility and the Board of Pharmacy for the development of the drug storage and distribution and record keeping requirements of a licensed nursing home facility
Designated Agent
A licensed nurse, certified nurse practitioner, physician assistant, pharmacist or pharmacist clinician authorized by a practitioner and employed in a facility to whom the practitioner communicates a prescription drug order.
Q: What is the primary purpose of organizing and maintaining the pharmaceutical service?
A: The pharmaceutical service shall be organized and maintained primarily for the benefit and safety of the patient.
Q: Who can administer medications to patients?
A: All medications administered to patients shall be by direct order of a physician, or other licensed practitioner, as defined in the Pharmacy Act, 61-11-2P.
Q: Who is responsible for directing the pharmaceutical service?
A: The pharmaceutical service shall be under the direction of a registered pharmacist, who may be on a part-time or consultant basis.
Q: Who is responsible for developing policies related to the control, distribution, and administration of medications?
A: Policies relating to the control, distribution, and administration of medications shall be developed by the pharmacist. Preparation of a written procedures manual shall be the responsibility of the pharmacist.
Q: What policy must be adopted regarding medications that are not specifically limited in terms of time or number of doses?
A: An automatic stop-order policy shall be adopted to provide guidance in these instances where medications ordered are not specifically limited as to time or number of doses.
Q: What are the requirements for medication storage facilities?
A: Adequate facilities to be provided for storage of medications. Proper labeling is required on each patient’s medication container.
Q: What records must be maintained regarding medications?
A: In addition to those records specifically required by federal and state laws, records shall be maintained of the receipt, use, or disposition of medications. The receipt and destruction journal shall show:
- Date;
- Patient’s name;
- Pharmacy’s name;
- Name of drug;
- Strength and dosage form;
- Prescription number;
- Quantity;
- Initials of person accepting delivery; and
- Inventory of drugs to be destroyed.
Q: What should be provided at the facility to ensure proper drug information?
A: Appropriate current drug reference sources shall be provided at the facility.
Q: What are the requirements for an emergency drug supply in licensed nursing homes and custodial care facilities?
A: In licensed nursing homes, an emergency drug supply shall be maintained to be used in a medical emergency situation, with contents and quantity determined by a physician, nursing director, and the pharmacist of each institution. In licensed custodial care facilities, an emergency drug supply may be used. The emergency drug supply shall be accessed only when licensed personnel are on duty. In licensed custodial care facilities without a 24-hour/365 day per year on-site nurse, the emergency drug tray shall not contain any controlled substances. Licensed custodial care facilities with a 24-hour/365 day per year on-site nurse may use an emergency drug tray containing controlled substances. A list of the contents of the emergency drug supply shall be attached to the outside of the tray.
Q: How should medication errors and drug reactions be handled?
A: Medication errors and drug reactions should be documented and a method of reporting shall be addressed in the pharmacy procedure manual.
Q: What are the aims of the written procedures manual prepared by the pharmacist?
A: The aim of the written procedures manual shall be:
- To improve communications with the facility;
- To improve patient care;
- To aid in personnel training;
- To increase legal protection;
- To aid in evaluating performance; and
- To promote consistency and continuity.
Q: Where must a copy of the policy and procedure manual be kept?
A: There shall be a copy of the policy and procedure manual at each facility location. This copy must be read and initialed by all personnel responsible for the procurement, administration, or control of the patient’s medication.
Q: How often should the procedures manual be reviewed?
A: The consultant pharmacist shall make an annual review of the procedures manual. Findings of which shall be reported to the facility administration.
Q: What should the pharmaceutical procedures manual include?
A: Guidelines for developing a pharmaceutical procedures manual include:
- Drug Policy: A written policy concerning methods and procedures for the pharmaceutical services stating the appropriate methods and procedures for obtaining, dispensing, and administering drugs and biologicals.
- Prescription Drug Orders: The designated agent of the facility may transcribe prescription drug orders from a licensed practitioner and transmit those orders via telephone or facsimile to the pharmacy.
- Identification of Designated Agents: Licensed practitioners will identify the designated agents of a facility by written authorization according to the facility’s policy and procedures manual.
- Medication Administration Record (MAR): The facility shall have a MAR documenting medications administered to residents, including over-the-counter medications. This documentation shall include:
- Name of resident;
- Date given;
- Drug product name;
- Dosage and form;
- Strength of drug;
- Route of administration;
- How often medication is to be taken;
- Time taken and staff initials;
- Dates when the medication is discontinued or changed;
- The name and initials of all staff administering medications.
- Medications Removed from Containers: Any medications removed from the pharmacy container or blister pack must be given immediately and documented by the person assisting.
- PRN Medications: All PRN medications shall have complete detail instructions regarding the administering of the medication, including:
- Symptoms that indicate the use of the medication;
- Exact dosage to be used;
- The exact amount to be used in a 24-hour period.
- Medication Storage: Describe medication storage, procedures, and function at the nursing stations.
- Medication Administration System: Describe the medication administration system used with means of verifying accuracy of delivered dosage. Describe the procedure for recording missed or refused doses and the procedure followed for missed or refused doses.
- Medication Administration Policy: State that medications prescribed for one patient shall not be administered to any other patient.
- Self-Administration of Medications: Describe policy concerning self-administration of medications by patients. A physician’s order shall be required before any resident is allowed to self-administer medications.
- Documentation of Medication Errors and Drug Reactions: State procedures for documenting medication errors and drug reactions, including:
- Should a staff member of the facility notice an error, possible overdose, or any discrepancy in any of the prescriptions filled by the pharmacy, they will immediately contact the pharmacy. If necessary, the pharmacy will contact the physician.
- In the event of an adverse drug reaction, the facility will immediately contact the physician.
- Labeling and Storage Requirements: List labeling and storage requirements of medications in conformity with the official compendium (USP/NF).
