A. Written policies for the center shall specify that the RN, LPN, or CMT is authorized to procure, receive, control, and manage the administration of medications at the center.
(1) Medicine or drugs shall be restricted to those prescribed for the participant by the authorized prescriber.
(2) All medications shall be accurately and plainly labeled and kept in the original container issued by the prescriber or pharmacist except as provided in §F(3) of this regulation.
(3) Containers shall be labeled with the:
(a) Participant's full name;
(b) Authorized prescriber;
(c) Prescription number;
(d) Name of the medication and dosage;
(e) Date of issuance;
(f) Expiration date;
(g) Refill limits;
(h) Directions for use; and
(i) Name, address, and telephone number of the pharmacy issuing the drug.
C. Nurses may not package, repackage, bottle, or label, in whole or in part, any medication in any way by tampering or defacing any labeled medication, except that a nurse may take medications from pharmacy dispensed containers and place the medication in a pill box for the cognitively intact participant who lives independently to self-administer.
D. When a RN or LPN observes an adverse reaction to a medication, the nurse shall immediately call the:
(1) Participant's health care provider;
(2) Designee of the participant's health care provider; or
(3) The health care provider that is on call for the center.
E. Drug Administration and Recording.
(1) The center shall maintain records of all Schedule II drugs.
(2) Written Order.
(a) Except as provided in §E(2)(b) of this regulation, medications may not be administered without a written order that has been signed by the authorized health care provider.
(b) Medication may only be given based upon a verbal order when the verbal order has been recorded and signed by the RN or the LPN.
(c) Verbal orders shall be signed by the authorized health care provider within 30 days.
(3) Except as provided in Regulation .14B(2)(c)(iii), only an RN, LPN, or authorized health care provider shall give injectable medication.
(4) For those participants who are not capable of self-medicating, the individual assigned the responsibility of administering medications shall:
(a) Prepare the dosage;
(b) Observe the participant swallowing the oral medication; and
(c) Document that the participant has taken the medication.
(5) Staff members who are licensed and certified to administer medications shall make a written record of the medications and treatments that are administered.
(6) Orders shall be reviewed and updated in a timely manner, consistent with nursing practice standards, when there is a change in the participant's condition.
F. Drug Storage.
(1) The center shall:
(a) Provide a safe, secure, locked place for medicines or drugs, and for making medications available to a participant according to the instructions of his or her health care provider;
(b) Store Schedule II drugs in a locked box within the medicine cabinet;
(c) Keep medications requiring refrigeration in a separate locked refrigerator or a locked box within a medication refrigerator; and
(d) Store medications and medical supplies in a manner that is secured and apart from participant activity areas, food storage areas, and chemical storage areas.
(2) A licensed nurse shall inspect the drug storage conditions at least every 3 months and document his or her findings.
(3) The center may keep over-the-counter type medications or supplements that can be purchased without prescription, such as aspirin or antacids, for administration as ordered by the participant's practitioner.