.27 Pharmaceutical Management.

A. Administration Procedures.

(1) Medications, legend and non-legend, administered to residents shall be ordered in writing by the residentís physician.

(2) Medications shall be administered by:

(a) Appropriately licensed personnel in accordance with laws and regulations governing these acts; or

(b) Certified graduates of a State-approved medicine aide course.

(3) The individual who prepares medications shall give and record them.

(4) Medicine may not be returned to the container. If the resident refuses the drug or if a mistake occurs:

(a) The drug shall be discarded; and

(b) The occurrence shall be documented in the residentís chart.

(5) Before invoking stop order policies, the residentís attending physician shall be contacted for instructions so that continuity of the residentís therapeutic regimen is not interrupted. If the attending physician cannot be reached, the medical director shall be contacted for instructions.

B. Pharmaceutical Services.

(1) The nursing home shall arrange for pharmacies that provide medications for residents in the nursing home. The pharmacy shall agree in writing to maintain at the pharmacy a resident profile record system for each resident in the nursing home for whom prescriptions are dispensed.

(2) If the nursing home does not employ a licensed pharmacist, the nursing home shall arrange by written contract for a pharmacy to provide consultation on administering the pharmacy services in accordance with the policies and procedures established by the pharmaceutical services committee. Pharmaceutical services shall be under the general supervision of a licensed pharmacist who shall:

(a) With the advice of the pharmaceutical services committee, be responsible for developing, coordinating, and supervising pharmaceutical services and provide in-service training at least twice yearly;

(b) Visit the nursing home frequently enough to ensure that policies and procedures established by the pharmaceutical services committee are enforced;

(c) Notify the attending physician of any potential drug problems found during the drug regimen review; and

(d) At least quarterly, submit a report to the pharmaceutical services committee on the status of the nursing homeís pharmaceutical services and staff adherence to policies and procedures.

C. Resident-Designated Pharmacy.

(1) The nursing home shall inform a residentís designated pharmacy about the nursing homeís written policies concerning the provision of drugs.

(2) To provide services to the resident, a designated pharmacy shall agree to comply with the nursing homeís policies.

(3) If the pharmacy fails to comply with the policies, a representative of the nursing home shall discuss the situation with the pharmacy and the resident, and if the pharmacy subsequently refuses to follow the policies, the resident shall select another pharmacy that agrees to comply.

(4) The pharmacy shall have access to a copy of the written pharmaceutical care policies.

(5) The pharmacy shall be responsible for delivering medications to the nursing home. Members of the residentís family or the responsible party for the resident may not deliver medications to the resident or to the nursing home.

D. Medication Return and Disposal.

(1) The nursing home shall return all prescribed medications, for residents who have been discharged or otherwise departed, to the pharmacy in accordance with the nursing homeís policy.

(2) The nursing home shall destroy adulterated, deteriorated, or outdated medications in the following manner:

(a) Disposal shall occur in the presence of two witnesses who are authorized by the nursing home; and

(b) The witnesses shall document the disposal in the residentís chart.

(3) The nursing home shall only release prescribed medications to residents at the time of discharge based on the written authorization of the residentís authorized prescriber.

(4) Each month, the nursing home shall perform a drug regimen review on each residentís records at the nursing home and document the findings in the residentís medical record.

E. Administration of Medications for Leave of Absence of 24 Hours or Less.

(1) A nursing home shall develop policies and procedures to ensure that a resident or, if the resident lacks the capacity, the residentís family or other individual accompanying the resident is informed, both orally and in writing, on how the resident shall safely and correctly take the residentís medications during a short-term leave of absence of 24 hours or less.

(2) In accordance with a nursing home-developed procedure, a licensed nurse shall prepare medications to be sent with a resident during a short-term leave of absence of 24 hours or less.