Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 83 - Community-Based Residential Facilities › Subchapter VII - Resident Care and Services › Section DHS 83.37 - Medications

Current through June 24, 2024
(1) GENERAL REQUIREMENTS.
(a)
Practitioner's order.
There shall be a written practitioner's order in the resident's record for any
				  prescription medication, over-the-counter medication or dietary supplements
				  administered to a resident.
(b)
Medications.
Prescription medications shall come from a
				  licensed pharmacy or a physician and shall have a label permanently attached to
				  the outside of the container. Over-the-counter medications maintained in the
				  manufacturer's container shall be labeled with the resident's name.
				  Over-the-counter medications not maintained in the manufacturer's container
				  shall be labeled by a pharmacist.
(c)
Packaging.
The CBRF
				  shall develop and implement a policy that identifies the medication packaging
				  system used by the CBRF. Any pharmacy selected by the resident whose
				  medications are administered by CBRF employees shall meet the medication
				  packaging system chosen by the CBRF. This does not apply to residents who self
				  administer medications.
(d)
Documentation.
As required in s.
				  DHS
				  83.42(1) (m), when a resident is
				  taking prescription or over-the-counter medications or dietary supplements, the
				  resident's record shall include a current list of the type and dosage of
				  medications or supplements, directions for use, and any change in the
				  resident's condition.
(e)
Medication Regimen Review.
1. If residents' medications are administered
				  by a CBRF employee, the CBRF shall arrange for a pharmacist or a physician to
				  review each resident's medication regimen. This review shall occur within 30
				  days before or 30 days after the resident's admission, whenever there is a
				  significant change in medication, and at least every 12 months.
2. At least annually, the CBRF shall have a
				  physician, pharmacist, or registered nurse conduct an on-site review of the
				  CBRF's medication administration and medication storage systems.
3. The CBRF shall obtain a written report of
				  findings under subds. 1. and 2., and address any irregularities for appropriate
				  action. When the review is done by someone other than the prescribing
				  practitioner, the prescribing practitioner shall receive a copy of the report
				  when there are irregularities identified with the resident's medication
				  regimen, which may need physician involvement to address.
(f)
More than one
				  practitioner.
1. When an employee of
				  the CBRF administers a resident's medication, the CBRF shall provide a list of
				  the resident's current medications to all practitioners. If this information is
				  not provided before a prescription is written, the CBRF shall update the
				  resident's primary practitioner or pharmacist before the administration of any
				  new medication.
2. When a resident
				  self administers medications, the CBRF shall provide a list of the resident's
				  current medications for the resident to provide to all practitioners.
(g)
Disposition of
				  medications.
1. When a resident is
				  discharged, the resident's medications shall be sent with the
				  resident.
2. If a resident's
				  medication has been changed or discontinued, the CBRF may retain a resident's
				  medication for no more than 30 days unless an order by a physician or a request
				  by a pharmacist is written every 30 days to retain the medication.
3. The CBRF shall develop and implement a
				  policy for disposing unused, discontinued, outdated, or recalled medications in
				  compliance with federal, state and local standards or laws. The CBRF shall
				  arrange for the stored medications to be destroyed in compliance with standard
				  practices. Medications that cannot be returned to the pharmacy shall be
				  separated from other medication in current use in the facility and stored in a
				  locked area, with access limited to the administrator or designee. The
				  administrator or designee and one other employee shall witness, sign, and date
				  the record of destruction. The record shall include the medication name,
				  strength and amount.
(h)
Scheduled psychotropic medications.
When a psychotropic
				  medication is prescribed for a resident, the CBRF shall do all of the
				  following:
1. Ensure the resident is
				  reassessed by a pharmacist, practitioner or registered nurse, as needed, but at
				  least quarterly for the desired responses and possible side effects of the
				  medication. The results of the assessments shall be documented in the
				  resident's record as required under s.
				  DHS
				  83.42(1) (q).
2. Ensure all resident care staff understands
				  the potential benefits and side effects of the medication.
(i)
As needed (PRN) psychotropic
				  medication.
When a psychotropic medication is prescribed on an as
				  needed basis for a resident, the CBRF shall do all of the following:
1. The resident's individual service plan
				  shall include the rationale for use and a detailed description of the behaviors
				  which indicate the need for administration of PRN psychotropic
				  medication.
2. The administrator or
				  qualified designee shall monitor at least monthly for the inappropriate use of
				  PRN psychotropic medication, including but not limited to, use contrary to the
				  individual service plan, presence of significant adverse side effects, use for
				  discipline or staff convenience, or contrary to the intended use.
3. Documentation in the resident's record
				  shall include the rationale for use, description of behaviors requiring the PRN
				  psychotropic medication, the effectiveness of the medication, the presence of
				  any side effects, and monitoring for inappropriate use for each PRN
				  psychotropic medication given.
(j)
Proof-of-use record.
The
				  CBRF shall maintain a proof-of-use record for schedule II drugs, subject to
				  21 USC
				  812(c), and Wisconsin's
				  uniform controlled substances act, ch. 961, Stats., that contains the date and
				  time administered, the resident's name, the practitioner's name, dose,
				  signature of the person administering the dose, and the remaining balance of
				  the drug. The administrator or designee shall audit, sign and date the
				  proof-of-use records on a daily basis.
(k)
Medication error or adverse
				  reaction.
1. The CBRF shall document
				  in the resident's record any error in the administration of prescription or
				  over-the-counter medication, known adverse drug reaction or resident refusal to
				  take medication.
2. The CBRF shall
				  report all errors in the administration of medication and any adverse drug
				  reactions to a licensed practitioner, supervising nurse or pharmacist
				  immediately. Unless otherwise directed by the prescribing practitioner, the
				  CBRF shall report to the prescribing practitioner, supervising nurse or
				  pharmacist as soon as possible after the resident refuses a medication for 2
				  consecutive days.
(L)
Medication information.
The CBRF shall make available written
				  information to resident care staff on the purpose and side effects of
				  medications taken by residents.