Nursing Homes

Question 1

The drug regimen of each resident shall be reviewed by a consultant registered pharmacist at least…

Answer 1

once a month

Question 2

The facility shall permit access only to authorized personnel and store all drugs and biologicals in…

Answer 2

locked compartments under proper temperature controls

Question 3

The facility shall provide separately locked, permanently affixed, compartments for storage of controlled drugs and other drugs subject to abuse, except when…

Answer 3

the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected

Question 4

When can drug products be returned to the vendor pharmacy for re-dispensing?

Answer 4

Provided such medication is sealed in unopened, individually packaged, units and within the recommended period of shelf life

Question 5

Drug products that may be returned can show no obvious signs of deterioration and are limited to…

Answer 5

oral and parenteral medication in single-dose hermetically sealed containers and parenteral medication in multiple-dose hermetically sealed containers. Must be unused (no doses have been withdrawn)

Question 6

Drug products packaged in manufacturer’s unit-dose packages may be returned for re-dispensing provided that they are re-dispensed in time for…

Answer 6

use before the expiration date, if any, indicated on the package

Question 7

Drugs may be returned from a nursing home and repackaged into blister packs for redispensing as long as…

Answer 7

it has not been more than 90 days since the repackaging, the expiration, repackaging dates, and the lot # are clearly marked on the package

Question 8

Partially used blister packs may be re-dispensed only as returned and…

Answer 8

may not be emptied and repackaged. additional units of medication may not be added to partially used blister packs

Question 9

Which products cannot be returned?

Answer 9

Drug product dispensed in bulk and controlled substances

Question 10

The contents of emergency kits must be approved by…

Answer 10

the Medical Director, Pharmacist, and Director of Nursing

Question 11

Each such kit may contain up to a 24-hour supply of…

Answer 11

a max of 10 different controlled substances in unit dose packaging (3 of which may be injectable drugs)

Question 12

If unusual circumstances justify a verbal order, the verbal order shall be given to a licensed nurse, or to a licensed pharmacist, immediately reduced to writing, and then…

Answer 12

authenticated by the nurse or registered pharmacist and countersigned by the prescriber within 48 hours

Question 13

In the event a verbal order is not signed by the prescriber or a legally designated alternate practitioner within 48 hours, the order shall…

Answer 13

be terminated and the facility shall ensure that the resident’s medication needs are promptly evaluated

Question 14

Controlled substances contained in emergency medication kits may be administered by authorized personnel pursuant to…

Answer 14

an order of an authorized practitioner to meet the immediate need of a resident.

Question 15

For medications other than controlled substances the medication contents of each kit shall be limited to injectables except that the kit may also include:

Answer 15

(i) sublingual nitroglycerin
(ii) up to 5 non-controlled, noninjectable, prepackaged medications (not to exceed a 24-hour supply) **The total number of non-injectables may not exceed 25 medications for the entire facility

Question 16

Each emergency kit shall be kept and secured…

Answer 16

within or near the nurses’ station

Question 17

Drug products repackaged by the pharmacy into unit-dose or multiple-dose “blister packs” may be returned for redispensing provided that:

Answer 17

(a) the date on which the drug product was repackaged, its lot number and expiration date are indicated clearly on the package
(b) not more than 90 days have elapsed from the date of the repackaging
(c) a repackaging log is maintained by the pharmacy in the case of drug products repackaged in advance of immediate needs

Question 18

Which laws apply to partially used “blister packs”?

Answer 18

(a) Partially used “blister packs” may be redispensed only as returned
(b) Partially used “blister packs” may not be emptied and repackaged
(c) Additional units of medication may not be added to partially used “blister packs” (no comingling)

Question 19

No drug product dispensed in bulk in a dispensing container may be returned.

Answer 19

True

Question 20

No medication or drug product defined as a controlled substance may be returned.

Answer 20

True

Question 21

In a nursing home, controlled substances in emergency medication kits may be administered to patients as follows:

Answer 21

In an emergency situation, a controlled substance from a sealed emergency medication kit may be administered to a patient by an order of an authorized practitioner.

Question 22

In a nursing home, an oral order for controlled substances must be immediately…

Answer 22

reduced to writing and a notation made of the condition which required the administration of the drug. Such an oral order must be signed by the practitioner within 48 hours.

Question 23

A separate record must be maintained of the administration of controlled substances from an emergency medication kit. Such record must indicate:

Answer 23

(i) the date and hour of administration
(ii) name and quantity of controlled substances
(iii) name of the practitioner ordering the administration of the controlled substance
(iv) patient name
(v) signature of the person administering
(vi) the balance of the controlled substances in the emergency medication kit after such administration

Question 24

Each time the emergency kit is unsealed, opened, or shows evidence of tampering, the nursing home must notify the pharmacy…

Answer 24

within 24 hours

Question 25

A nursing home may administer controlled substances to patients only pursuant to a prescription…

Answer 25

issued by an authorized physician or other authorized practitioner and filled by a registered pharmacy

Question 26

How should emergency kits be secured in a nursing home?

Answer 26

Each kit shall be secured in a stationary double-locked system or other secure method approved by the department.

Question 27

Psychotropic drug regimens of nursing home residents must be reviewed by an independent external consultant at least:

Answer 27

once every year

Question 28

Repacking of a medication shall include records of all of the following information:

Answer 28

(i) drug name and strength
(ii) drug quantity
(iii) lot #
(iv) date of repacking
(v) # of packages prepared,
(vi) # of dosage units in each package
(vii) name of manufacturer and/or distributor
(viii) signatures of the person repacking and the supervising pharmacist (SP).