Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part I - General Administration › Subpart 3 - Licensing and Certification › Chapter 68 - Adult Residential Care Providers › Subchapter D - Adult Residential Care Provider Services › Section I-6843 - Medication Administration

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 ARCP shall have written policies and procedures on medication administration
					 including self-administration, assistance with self-administration, gratuitous
					 administration or third party administration, and staff administration of
					 medications. There shall also be policies regarding obtaining and refilling
					 medications, storing and controlling medications, disposing of medications,
					 documentation of medication administration, and assistance with
					 selfadministration.
B. The ARCP
					 shall record in the residents PCSP whether the resident can self-administer
					 medication, needs assistance with self-administration, has gratuitous
					 administration, or third party administration or requires staff administration
					 of medication. The determination of the need for staff administration of
					 medication will be made by the residents physician after assessment of the
					 resident, and after consultation with the resident, residents legal
					 representative if applicable, and the ARCP staff. The PCSP shall also include
					 how the medication will be obtained and stored.
C. Levels of Administration
1. Self-Administration. Unless otherwise
					 indicated in the PCSP, residents shall have the option to self-administer their
					 own medications. Residents who are appropriate for this service will be aware
					 of what the medication is, what it is for and the need for the medication. The
					 ARCP shall require the resident to undertake reasonable precautions to ensure
					 the safety of other residents.
2.
					 Assistance with Self-Administration. Unless otherwise indicated in the PCSP,
					 residents may elect assistance with self-medication if it is a service offered
					 by the ARCP. Residents who are appropriate for this service will be aware of
					 what the medication is, what it is for and the need for the medication.
a. Assistance with self-administration may be
					 provided by staff members who hold no professional licensure, as long as that
					 employee has documented training on the policies and procedures for medication
					 assistance, including the limitations of assistance. This training must be
					 repeated at least annually.
b.
					 Assistance with self-administration of medication shall be limited to the
					 following:
i. reminding residents that it is
					 time to take medication(s), where such medications have been prescribed for a
					 specific time of day, a specific number of times per day, specific intervals of
					 time or for a specific time in relation to mealtimes or other activities such
					 as arising from bed or retiring to bed;
ii. reading the medication regimen as
					 indicated on the container to the resident;
iii. physically assisting residents who are
					 familiar with their medications by opening a medication container and/or
					 providing assistance with pouring medications;
iv. offering liquids to residents who are
					 familiar with their medications to assist that resident in ingesting oral
					 medications; and
v. physically
					 bringing a container of oral medications to residents.
c. Assistance with self-administration of
					 medications shall not include:
i.
					 administering injections of any kind;
ii. administering any prescription
					 medications including, but not limited to, eye drops, ear drops, nose drops,
					 liquid medications, inhalers, suppositories, or enemas;
iii. prompting or reminding a resident that
					 it is time to take a PRN, or as-needed medication;
iv. crushing or splitting
					 medications;
v. placing medications
					 in a feeding tube;
vi. mixing
					 medications with foods or liquids; or
vii. filling a single day or multi-day pill
					 organizer for the resident.
3. Staff Administration of Medication
a. The ARCP shall administer medications to
					 ARCP residents in accordance with their PCSP. Staff administration of
					 medications may be provided by all levels of ARCPs.
b. Drugs and biologicals shall be
					 administered only by medical personnel or licensed nurses authorized to
					 administer drugs and biologicals under their practice act or as allowed by
					 statutorily designated MACs.
c. In
					 level 4 ARCPs only, staff administration of medication may include intravenous
					 therapy. Intravenous therapy is permitted on a time limited basis and must be
					 under the supervision of a licensed RN, physician, or advanced practice
					 nurse.
d. The ARCP shall require
					 pharmacists to perform a monthly review of all ordered medication regimens for
					 possible adverse drug interactions and to advise the ARCP and the prescribing
					 health care provider when adverse drug interactions are detected. The ARCP
					 shall have documentation of this review and notification in the resident's
					 record.
e. Medication Orders and
					 Records
i. Medications, including
					 over-the-counter medications, may be administered to a resident of an ARCP only
					 after the medications have been prescribed specifically for the resident by an
					 individual currently licensed to prescribe medications. All orders for
					 medications shall be documented, signed and dated by the residents licensed
					 practitioner.
ii. Only an
					 authorized licensed medical professional shall accept telephone orders for
					 medications from a physician or other authorized practitioner. All telephone
					 orders shall be documented in the residents record. The telephone order shall
					 be signed by the prescriber within 14 days of the issuance of the
					 order.
iii. The ARCP is responsible
					 for:
(a). complying with the physician
					 orders, associated with medication administration;
(b). clarifying orders as
					 necessary;
(c). notifying the
					 physician of resident refusal of the medication or treatment; and
(d). notifying the physician of any adverse
					 reactions to medications or treatments.
iv. All medications administered by staff to
					 residents in an ARCP, including over the counter medications, shall be recorded
					 on a medication administration record at the same time or immediately after the
					 medications are administered.
v.
					 The medication administration record shall include at least the following:
(a). the name of the resident to whom the
					 medication was administered;
(b).
					 the name of the medication administered (generic, brand or both);
(c). the dosage of the medication
					 administered;
(d). the method of
					 administration, including route;
(e). the site of injection or application, if
					 the medication was injected or applied;
(f). the date and time of the medication
					 administration;
(g). any adverse
					 reaction to the medication; and
(h). the printed name and written or
					 electronic signature of the individual administering the medication.
vi. Medication administration
					 records and written physician orders for all over-the-counter medications,
					 legend drugs and controlled substances shall be retained for period of not less
					 than five years. They shall be available for inspection and copying on demand
					 by the state regulatory agency.
vii. The most current edition of drug
					 reference materials shall be available.
viii. All medication regimes and
					 administration charting shall be reviewed by a licensed RN at least monthly to:
(a). determine the appropriateness of the
					 medication regime;
(b). evaluate
					 contraindications;
(c). evaluate
					 the need for lab monitoring;
(d).
					 make referrals to the primary care physician for needed monitoring
					 tests;
(e). report the efficacy of
					 the medications prescribed; and
(f). determine if medications are properly
					 being administered in the ARCP.
f. Medication Errors
i. The ARCP shall ensure medication error
					 rates are not five percent or greater and residents are free from any
					 significant medication errors.
4. Contracted Third Party Administration
a. The ARCP or the resident or the residents
					 representative, if applicable, may contract with an individual or agency to
					 administer residents prescribed medications. The ARCP shall ensure that
					 medications shall be administered by an individual who is currently
					 professionally licensed in Louisiana to administer medications.
b. A copy of such third party contract shall
					 be verifiable in writing and retained in residents record. The ARCP retains
					 responsibility for notifying the resident or residents legal representative, if
					 applicable, if services are not delivered or if the residents conditions
					 changes.