411-348-0120 Medical Services (1) POLICY AND PROCEDURE. A program provider must have and implement written policies and procedures that maintain and protect a child’s physical health. The policies and procedures must address the following: (a) Child health care needs; (b) Medication administration; (c) Medication storage and disposal; (d) Response to emergency medical situations; (e) Medical care coordination with the child’s health insurance, health care plan coverage, or health care team as applicable; (f) Nursing services, if provided; and (g) Early detection and prevention of infectious disease. (2) HEALTH CARE. (a) A program provider must ensure a child receives care that promotes the health and well-being of the child by ensuring the following: (A) The child has a primary physician or health care provider whom the child’s parent or guardian has chosen from among qualified providers. Provisions must be made for a secondary physician or clinic in the event of an emergency. (B) The child receives a medical evaluation by a qualified health care provider no less frequently than annually or as recommended by a physician. (C) The child receives a dental screening exam and oral hygiene care from a dental clinic annually, or as recommended by a dentist. If the program provider is not able to identify an available dentist for routine dental care, the program provider must document ongoing efforts to locate a dentist for the child. (D) Coordination with the in-residence caregiver to monitor the health status and physical conditions of the child and action in a timely manner in response to identified changes or conditions that may lead to deterioration or harm. (E) The child’s parent or guardian is notified as timely as possible when medical attention is sought for the child. The notification must include the following: (i) Condition for which medical care was sought; (ii) Health care provider’s diagnosis of the child’s condition; and (iii) Treatment and recommended follow up prescribed by the health care provider. (b) A written, signed order from a prescribing physician or qualified health care provider is required prior to the usage or implementation of all of the following: (A) Prescription medications; (B) Non-prescription medications except over-the-counter topicals; (C) Treatment other than basic first aid; (D) Modified or special diets; (E) Adaptive equipment; and (F) Aids to physical functioning. (c) A program provider, in-residence caregiver, staff, and alternate caregivers must implement the order of a physician or qualified health care provider as written. (d) A program provider must coordinate with the in-residence caregiver to maintain a medical history on each child to aid physicians, licensed health professionals, staff, and alternate caregivers in understanding the medical history of each child. The medical history must include: (A) A list of known health conditions, medical diagnoses, known allergies, and immunizations; (B) A record of visits to licensed health professionals that include documentation of the consultation and any therapy provided; and (C) A record of known hospitalizations and surgeries. (3) MEDICATION. (a) All medications must be: (A) Kept in their original containers; (B) Labeled by the dispensing pharmacy, product manufacturer, or physician, as specified per the written order of a physician or qualified health care provider; and (C) Kept in a secured, locked container or stored in a manner that prevents access by children, and stored as indicated by the product manufacturer. (b) All medications and treatments must be recorded on an individualized medication administration record (MAR). The MAR must include: (A) The name of the child; (B) A transcription of the written order of a physician or qualified health care provider, including the brand or generic name of the medication, prescribed dosage, frequency, and method of administration; (C) For topical medications and treatments without the order of a physician or qualified health care provider, a transcription of the printed instructions from the package; (D) Times and dates of administration or self-administration of the medication; (E) Signature of the person administering the medication or the person monitoring the self-administration of the medication; (F) Method of administration; (G) An explanation of why a PRN (i.e., as needed) medication was administered; (H) Documented effectiveness of any PRN (i.e., as needed) medication administration; (I) An explanation of any medication administration irregularity; and (J) Documentation of any known allergy or adverse drug reaction. (c) A program provider must document when a treatment, medication, therapy, or special diet is not implemented in accordance with an order from a health care provider, including why the ordered care was not implemented. (d) A program provider, in-residence caregiver, or staff may not use alternative medications intended to alter or affect a child’s mood or behavior, such as herbals or homeopathic remedies without direction and supervision of a licensed health care provider. (e) Any medication used with the intent to alter a child’s behavior must be documented in the child’s ISP and meet the standards set forth in OAR 411-348-0360. (f) PRN (i.e., as needed) orders are not allowed for psychotropic medication. (g) SELF-ADMINISTRATION OF MEDICATION. (A) The ISP for children who independently self-administer medications must include a plan for the periodic monitoring and review of the self-administration of medications. (B) An in-residence caregiver must ensure that children able to self-administer medications keep the medications in a secure, locked container unavailable to other children residing in the Host Home and store the medications as recommended by the product manufacturer. (h) Safeguards to prevent adverse effects or medication reactions must be utilized and include: (A) Whenever possible, obtaining all prescription medication for a child, except samples provided by a health care provider, from a single pharmacy which maintains a medication profile for the child; (B) Maintaining information about the desired effects and side effects of each medication; (C) Ensuring that medications prescribed for one child are not administered to, or self-administered by, another child or staff member; and (D) Documentation in the child's record of the reason all medications are not provided through a single pharmacy if multiple pharmacies are utilized for the same child. (i) All expired, discontinues, recalled, or contaminated medications, including over-the-counter medications, may not be kept in a Host Home and must be disposed of within 10 calendar days of expiration, discontinuation, or a program provider or in-residence caregiver’s knowledge of a recall or contamination. A program provider must dispose of the prescription medications for a child who has died within 10 calendar days of the child’s death. (A) A program provider must dispose of medications according to the program provider’s policy. The program provider’s policy must reflect the medication disposal guidelines issued by the Department of Environmental Quality. (B) A program provider must maintain a written record of the disposal of a medication. The record must include documentation of the following: (i) Date of disposal; (ii) Description of the medication, including dosage, strength, and amount being disposed; (iii) Name of the child for whom the medication was prescribed; (iv) Reason for disposal; (v) Method of disposal; (vi) Signature of the person disposing of the medication; and (vii) For controlled medications, the signature of a witness to the disposal. (4) NURSING SERVICES. When nursing services are provided to a child, a program provider must: (a) Coordinate with a registered nurse and the child's ISP team to ensure the nursing services being provided are sufficient to meet the health needs of the child; and (b) Implement the Nursing Service Plan, or appropriate portions therein, as agreed upon by the child's ISP team and the registered nurse. (5) DELEGATION AND SUPERVISION OF NURSING TASKS. Nursing tasks must be delegated by a registered nurse to a program provider, in-residence caregiver, and staff in accordance with the rules of the Oregon State Board of Nursing in OAR chapter 851, division 047. (6) A program provider must immediately notify a child's services coordinator, and document the notification, when the child's medical, behavioral, or physical needs change to a point that they may not be met by the program provider. Statutory/Other Authority: ORS 409.050, 427.104, 441.715, 443.450 & 443.455 Statutes/Other Implemented: ORS 427.104, 441.705-441.720, 441.740, 441.745, 443.384, 443.392, 443.400-443.445, 443.450, 443.455, 443.880, 443.881 & 443.991 History: APD 36-2019, adopt filed 10/29/2019, effective 11/01/2019