411-054-0055 Medications and Treatments (1) MEDICATION AND TREATMENT ADMINISTRATION SYSTEMS. The facility must have safe medication and treatment administration systems in place that are approved by a pharmacist consultant, registered nurse, or physician. (a) The administrator is responsible for ensuring adequate professional oversight of the medication and treatment administration system. (b) Medications administered by the facility must be set-up or poured and documented by the same person who administers the medications. (c) The staff person who administers the medication must visually observe the resident take (e.g., ingest, inhale, apply) the medication unless the prescriber's order for that specific medication states otherwise. (d) Medications must be kept secure between set-up and administration of medications. (e) The facility must have a system approved by a pharmacist consultant or registered nurse for tracking controlled substances and for disposal of all unused, outdated or discontinued medications administered by the facility. (f) Medication and treatment orders must be carried out as prescribed. (g) Written, signed physician or other legally recognized practitioner orders must be documented in the resident's facility record for all medications and treatments that the facility is responsible to administer. (h) Only a physician or other legally recognized prescribing practitioner is authorized to make changes in a medication or treatment order. (i) A registered pharmacist or registered nurse must review all medications and treatments administered by the facility to a resident at least every 90 days. The facility must provide documentation related to the recommendations made by the reviewer. (j) The resident or the person legally authorized to make health care decisions for the resident has the right to consent to, or refuse, medications and treatments. (k) The physician or other practitioner must be notified if a resident refuses consent to an order. Subsequent refusals to consent to an order will be reported as requested by the prescriber. (2) MEDICATION ADMINISTRATION. An accurate Medication Administration Record (MAR) must be kept of all medications, including over-the-counter medications that are ordered by a legally recognized prescriber and are administered by the facility. (a) Documentation of the MAR must be completed using one of the following processes. An alternative process may be used only with a written exception from the Department. (A) The MAR may be signed as the medications are set-up or poured. Medications must not be set-up in advance for more than one administration time. If a medicine cup or other individual container is used to set-up the medications, it must be placed in a closed compartment labeled with the resident's name. Changes to the MAR that occur after the medication is delivered, must be documented by the same staff person who administered the medication. (B) The facility may choose to sign the MAR after the medication is administered to a specific resident and prior to the next resident-specific medication or treatment. (b) MEDICATION RECORD. At minimum, the medication record for each resident that the facility administers medications to, must include: (A) Current month, day and year. (B) Name of medications, reason for use, dosage, route and date and time given. (C) Any medication specific instructions, if applicable (e.g., significant side effects, time sensitive dosage, when to call the prescriber or nurse). (D) Resident allergies and sensitivities, if any. (E) Resident specific parameters and instructions for p.r.n. medications. (F) Initials of the person administering the medication. (3) TREATMENT ADMINISTRATION. (a) An accurate treatment record for each resident must be kept of all treatments ordered by a legally recognized practitioner and administered by the facility to that resident. (b) The treatment record must include: (A) Current month, day and year. (B) Type of treatment (e.g., dressing change, ointment application), treatment instructions and if applicable, significant side effects or when to call the prescriber or nurse. (C) Date and time administered. (D) Resident allergies and sensitivities, applicable to treatments. (E) Instructions for p.r.n. treatments, including resident specific parameters. (F) Initials of person administering the treatments. (G) Any deviation from instructions or refusal of treatment must be documented. (4) MEDICATION AND TREATMENT – GENERAL. The facility must maintain legible signatures of staff that administer medications and treatments, either on the MAR or on a separate signature page, filed with the MAR. (a) If the facility administers or assists a resident with medication, all medication obtained through a pharmacy must be clearly labeled with the pharmacist's label, in the original container, in accordance with the facility's established medication delivery system. (b) The facility shall ensure that prescription drugs dispensed to residents are packaged in a manner that reduces errors in the tracking and administration of the drugs, including, but not limited to, the use of unit dose systems or blister packs. (A) The facility shall have as its primary goal dispensing prescription drugs in unit dose systems, blister packs or similar packaging. (B) When unit dose packaging cannot be reasonably achieved, the facility shall have a written policy describing how prescription drugs that are not prepared as unit dose or blister packs shall be dispensed. Written policies shall be in effect not later than October 1, 2018. (C) Subsection (b) of this rule does not apply to residents receiving pharmacy benefits through the United States Department of Veterans Affairs, if the pharmacy benefits do not reimburse cost of such packaging. (c) Over-the-counter medication or samples of medications must have the original manufacturer's labels if the facility administers or assists a resident with medication. (d) All medications administered by the facility must be stored in locked containers in a secured environment such as a medication room or medication cart. (e) Medications that have to be refrigerated must be stored at the appropriate temperature in a locked, secure location. (f) Order changes obtained by telephone must be documented in the resident's record and the MAR must be updated prior to administering the new medication stated on the order. Telephone orders must be followed-up with written, signed orders. (g) The facility must not require residents to purchase prescriptions from a pharmacy that contracts with the facility. (5) SELF ADMINISTRATION OF MEDICATION. (a) Residents who choose to self-administer their medications must be evaluated upon move-in and at least quarterly thereafter, to assure ability to safely self-administer medications. (b) Residents must have a physician's or other legally recognized practitioner's written order of approval for self-administration of prescription medications. (c) Residents able to administer their own medication regimen may keep prescription medications in their unit. (d) If more than one resident resides in the unit, an evaluation must be made of each person and the resident's ability to safely have medications in the unit. If safety is a factor, the medications must be kept in a locked container in the unit. (e) Unless contraindicated by a physician or resident evaluation, residents may keep and use over-the-counter medications in their unit without a written order. (6) PSYCHOTROPIC MEDICATION. Psychotropic medications may be used only pursuant to a prescription that specifies the circumstances, dosage and duration of use. (a) Facility administered psychotropic medications may be used only when required to treat a resident's medical symptoms or to maximize a resident's functioning. (b) The facility must not request psychotropic medication to treat a resident's behavioral symptoms without a consultation from a physician, nurse practitioner, registered nurse, or mental health professional. This does not apply when a resident is enrolled in a hospice program as defined in OAR 333-035-0050. (c) Prior to requesting a psychotropic medication, the facility must demonstrate through the evaluation and service planning process that non-pharmacological interventions have been attempted. (d) Prior to administering any psychotropic medications to treat a resident's behavior, all direct care staff administering medications for the resident must know: (A) The specific reasons for the use of the psychotropic medication for that resident. (B) The common side effects of the medications. (C) When to contact a health professional regarding side effects. (e) When a psychotropic medication is ordered by a health care practitioner other than the resident's primary care provider, the facility is responsible for notifying the resident's primary care provider of that medication order within 72 hours of when the facility was notified of the order. This includes weekends and holidays. Notification may be either by telephone or electronic submission and should be documented by the facility. (f) Medications that are administered p.r.n. that are given to treat a resident's behavior must have written, resident-specific parameters. (A) These p.r.n. medications may be used only after documented; non-pharmacological interventions have been tried with ineffective results. (B) All direct care staff must have knowledge of non-pharmacological interventions. (g) Psychotropic medications must not be given to discipline a resident, or for the convenience of the facility. Statutory/Other Authority: ORS 410.070 & 443.450 Statutes/Other Implemented: ORS 443.400 - 443.455 & 443.991 History: APD 30-2019, amend filed 08/19/2019, effective 09/01/2019 APD 19-2018, amend filed 06/29/2018, effective 06/29/2018 APD 35-2017, temporary amend filed 12/30/2017, effective 01/01/2018 through 06/29/2018 SPD 14-2007, f. 8-31-07, cert. ef. 11-1-07