New Jersey Administrative Code › Title 8 - HEALTH › Chapter 111 - FOOD AND DRUGS › Subchapter 14 - CLIENT CARE POLICIES AND SERVICES › Section 8:111-14.2 - Standards for drug administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				facility's policies and procedures shall ensure that medication(s), in the correct
				strength and dosage and at the correct time intervals, are administered to the
				correct client through the prescribed route of administration. The facility's
				policies and procedures shall ensure a method of tracking the line of possession of
				the medications while in the facility and shall describe the facility's plan to
				ensure the adequate maintenance of supplies, including at least the following:
1. Methods for procuring medications on a routine
				basis, in emergencies and in the event of disaster;
2. Stocking and maintenance of emergency kits and
				carts, including:
i. Assuring the contents thereof
				are appropriate for the type of clients served in the facility;
ii. Verification and approval by the medical
				director of the contents of emergency kits and carts, and review thereof by the
				director of nursing;
iii. The location
				and contents of emergency kits and carts;
iv. Frequency of reviewing contents and expiration
				dates of medications;
v. Assignment of
				responsibility for reviewing contents; and
vi. Emergency kits should have a breakable seal to
				indicate use of the kit, since they are not to be kept under lock and
				key;
3. Acceptable methods for
				ordering medications shall be consistent with the following:
i. Orders shall be in writing and shall specify
				the name and strength of the medication, dose, frequency and route of
				administration;
ii. Orders shall be
				signed and dated by the prescriber;
iii.
				Verbal orders and telephone orders shall be written and countersigned by authorized
				medical personnel issuing the verbal order or telephone within 72 hours of the
				original order and provide the information required in (a)3i and ii above;
				and
iv. Special requirements for
				prescribing or dispensing controlled drugs shall be noted on the prescription and in
				the client's clinical record;
4. Administration of medication, including
				establishment of the times for administration of medication prescribed;
5. When self-administration is permitted at the
				facility, the self-administration process shall include:
i. A prohibition on self-administration of
				medication, except upon a written order of the prescriber;
ii. Storage and labeling of medications, including
				directions for use and appropriate cautionary and/or warning messages;
iii. Methods for documenting self-administration
				of medication in the client's clinical record and medication administration record
				along with signature and date of staff observing self-administration;
iv. Individualized client medication
				administration record;
v. Training and
				education of clients and staff in self-administration and the safe use of
				medications including procedures for self-administration off-site (examples include
				field trips, outings away from the facility, etc.);
vi. Identification of staff trained and authorized
				to observe self-administration; and
vii.
				Establishment of precautions against clients sharing their medications with one
				another;
6. Procedures for
				documenting and reporting adverse medication reactions, medication errors and
				medication defects, subject to the following:
i.
				Allergies shall be documented in the client's clinical and medical record and on
				their outside front covers; and
ii.
				Medication product defects shall be reported in accordance with the USP-NF
				Online;
7. Procedures for
				ensuring the immediate delivery of emergency (STAT) doses from the pharmacy even
				during off hours;
8. If permitted at the
				facility, over-the-counter floor stock medications approved as set forth on a list
				maintained at the facility and the amounts that may be and are stored throughout the
				facility.
i. A limited quantity of prescription
				(legend) medications that are approved by the medical director, properly labeled
				according to the manufacturer and State law, may be stocked for STAT doses. The
				number of doses stocked for each medication shall be that number that would last one
				client approximately three days;
9. Discontinuation of medication orders,
				including:
i. The length of time medication orders
				may be in effect, for medications that are not specifically limited as to duration
				of use or number of doses when ordered, including intravenous infusion
				solutions;
ii. A process for notifying
				the prescriber prior to the expiration of a medication order in accordance with the
				written policy of the facility, to ensure that the medication for the specific
				client is discontinued if no specific renewal is ordered; and
iii. Removal of discontinued medications within 30
				days of the discharge of the client;
10. Standards for the purchase, storage,
				safeguarding, accountability, use and disposal of medications consistent with
				N.J.A.C. 13:39 and 24:21-1 et seq.;
11.
				Standards for the procurement, storage, use and disposal of needles and syringes in
				accordance with State laws and a system of accountability therefor, which shall not
				require counting of individual needles and syringes after they are placed in a
				container for disposal;
12. Standards
				for the control of medications subject to 24:21-1 et seq., consistent with N.J.A.C.
				13:39, and other applicable Federal and State laws, including:
i. Provisions for a verifiable record system for
				controlled medication;
ii. Procedures to
				be followed when inventories of controlled medications cannot be verified,
				medications are lost, contaminated, unintentionally wasted or destroyed, which
				procedures shall include a written report of the incident signed and dated by the
				individuals involved and any witnesses; and
iii. Procedures for the intentional wasting of
				controlled medications, including the disposal of partial doses, which shall include
				written documentation of the event signed by the individual responsible for the
				intentional wasting of the medication and an individual assigned to witness the
				event;
13. Maintenance of a
				record of each onsite prescriber's Federal Drug Enforcement Administration numbers
				and State CDS numbers;
14. Data to be
				maintained on each medical unit, including:
i. A
				list of abbreviations, metric conversion charts and chemical symbols, subject to
				approval by the medication staff;
ii.
				Specific information on medications and other drugs, including indications,
				contraindications, actions, reactions, interactions, cautions, precautions that
				should be taken, toxicity and dosages that is, Physician's Desk Reference (PDR),
				USP-NF Online; and
iii. Antidote
				information and the telephone number of the State Poison Information and Education
				System Center 1 (800) 222-1222.
15. In no instance shall the facility permit drug
				or medication samples to be accepted, stocked, distributed or otherwise used for any
				client or staff at the facility unless specifically approved in writing by the
				Pharmacy and Therapeutics Committee in writing.
i.
				If the facility utilizes drugs marked "samples," the Pharmacy and Therapeutics
				Committee or client care committee shall develop a mechanism for the control and
				limitations of these drugs in accordance with 13:35-6.6; and
16. If the facility permits it, use of
				over-the-counter floor stock medications approved as set forth on a list maintained
				at the facility, and the amounts that may be administered, are stored in the
				facility.