Guidelines For The Administration Of Medications
In Michigan Assisted Living Facilities
III. POLICY RECOMMENDATIONS
The following recommendations for facility policies are based
on statutory requirements, such as the Pharmacy Administrative
Rules, Public Act 368 as amended and on current standards of
practice. Each facility is accountable for providing safe and
sound medication administration practices that include delineating
who is responsible for monitoring medications and how the reporting
of changes and untoward drug effects or reactions should be
handled. These practices should be described in user-friendly
terms in the facility policy manual. The manual should be readily
accessible and include the following:
A. Self-Administration of Medications
If a facility chooses to allow some or all of its' residents
to self-administer medications, their policy should outline
the resident criteria that must be met in order to self administer
(knowledge, skills, & abilities), who will evaluate the
resident for continued competency and how medications will be
obtained and stored. Facility, resident and resident responsible
party roles should be clearly defined. Residents who self-medicate
should safeguard their medication(s) in their original container(s)
in a locked cabinet or drawer or out of reach from others to
ensure the safety of all residents.
B. Use of Unlicensed Staff to Administer Medications
If a facility chooses to allow unlicensed staff to administer
medications, the policy should require each staff to have successfully
completed a medication training program including periodic demonstrations
of safe practice. Evidence of such training should be documented
and retained in the employee's personnel file.
C. Physician Orders in Facilities Where Staff Administer Medications
If facility staff are administering medications, the facility
should have a written prescription in the resident's record
signed by an authorized prescriber i.e., a physician, nurse
practitioner, podiatrist, or dentist for all medications being
administered, including over the counter medications. Verbal
or telephone order(s) may only be taken by a pharmacist(s) or
registered nurse, but must be countersigned by the ordering
professional in a timely manner (e.g. 48 to 72 hours). If medication
prescriptions are phoned directly to the pharmacist, the pharmacist
could reduce the order to writing and then forward a copy to
the facility to obtain the physician's signature for the resident's
chart. Written prescriptions (including faxed copies) are preferable
to verbal orders or pharmacy-forwarded orders. The facility
must have a policy that outlines procedures for medication renewals,
discontinuations and changes of medication(s).
All orders, including over-the-counter medication(s), must
be written for specific individuals. Facility Standing Orders
are not appropriate and must not be used.
Medication(s) must only be given to the person for whom it
was prescribed and cannot be borrowed or used for or by another
resident.
D. Packaging and labeling
- Medication(s) must be filled according to the authorized
prescription, properly labeled and packaged by the pharmacy.
All prescriptions dispensed by the pharmacy shall have, affixed
to the container, a label showing the dispenser's name and
address, the serial number, date, full name of the resident,
the name of the prescriber, the name of the medication, the
directions for use including the dosage, route and frequency,
any cautionary statements necessary for the proper administration
or storage of the medication and number of refills except
when unit dose or multi dose packaging is used. Medications
are to be kept in the container supplied by the pharmacy.
Facility staff must not alter the medication label.
- Unit dose or multi-dose medication packaging systems may
be used by a facility since they streamline the medication
administration process. Multi-dose medication packaging is
acceptable under the following conditions:
- Each packet has the resident's name, room and bed number,
and prescription number.
- The name of the drug, dosage, date, and time to be given,
as well as, the exact physical description of each drug
printed on the packet (includes tablet description of
each dose), lot number for each drug and expiration date.
- The 60-day medication expiration date, per USP guidelines,
is to be followed.
- Prohibition of unauthorized persons accessing or changing
the medication(s) or the label.Look-alike medication(s)
and/or incompatible medication(s) are not to be packaged
in multi-dose packaging.
E. Medication Back-Up Boxes
Such boxes must not be used in assisted living facilities.
(Note: These drug boxes are only allowed in medical institutions,
such as hospitals or nursing homes, where the acuity of individuals
require immediate medication treatment or time is of the essence
in receiving the first dose of medication, and licensed staff
are mandated).
F. Emergency Medication System
Procedures for obtaining medications in urgent or emergency
situations must be outlined.
G. Medication Storage
All medications must be stored in their original container
or package, separate from food and caustic items, at the appropriate
temperature or storage condition specified by the manufacturer,
and in a secured area such as a medication room, where only
authorized persons have access to the medications. All expired
medications must be discarded appropriately.
H. Medication Administration
Each facility must define how medications are to be given and
delineate which staff members may give oral, eye, ear, inhalant,
topical, patch, vaginal, and rectal medications. Except for
residents who self-administer medications, only RNs and LPNs
can be responsible for injections.
All medications are to be administered in accordance with the
instructions on the written prescription order and as recommended
by the manufacturer (examples: with food, before meals, not
crushed). Checking or verifying the 5 Rights (Right Resident,
Right Medication, Right Dosage, Right Route, & Right Frequency/Time)
when preparing, administering, and documenting medications given
is essential.
Medications are to be given in a timely manner within one hour
of the scheduled time and must not be prepared in advance. The
person preparing the medication must also be the person who
administers the medication, except for a special situation such
as when licensed nurses pre fill insulin syringes and properly
label the syringes for resident's self administration at a later
time.
The medication administration system needs to have a means
of correctly identifying each resident. Using photographic identification
is acceptable.
I. Leave of Absence
The facility must have a policy that provides a system for
the facility to prepare and give ordered medication(s) to the
resident or the responsible party if the resident is leaving
the facility for a short period of time and would otherwise
miss a dose or doses of medication(s).
J. Documentation of Administration
Medications must be charted by the person administering the
medication and documented directly following the administration.
Charting is to include: medication name, dosage, route, time
of administration, and person administering the medication.
The identity of the person administering the medication may
be an initial in the designated area on the Medication Administration/Observation
Record (MAR/MOR), as long as there is a specific master signature
log for identification of all initials used in the charting.
All as needed or PRN medication(s) must be charted on the MAR,
and must also specify the time and reason given and the whether
the medication was effective or not.
When a resident refuses to take medications, notification of
the physician and responsible party of the situation, and follow-up
must also be documented.
K. Medication References
Current references containing medication information in language
staff can understand are to be available for staff use. The
facility Pharmacy should also be utilized as a resource to staff.
L. Medication Errors
Medication errors occur when a medication is erroneously omitted
or a medication is not given according to the prescription order
or there is any deviation from the 5 Rights of medication administration.
The error is to be immediately reported to the supervisor, physician,
and resident responsible party and corrective actions taken.
M. Discontinued Medications
Medications that are no longer required shall be properly disposed
of per consultation and direction from a pharmacist or physician
and resident responsible party as indicated. Facility policy/procedures
for unused or discontinued medications should be available and
followed by the staff.
N. Staff Training
Staff training must be completed by a qualified professional
(Registered Nurse and/or Pharmacist). The staff member must
demonstrate safe practice under supervision before being given
the responsibility for medication administration in the facility.
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Guidelines Index
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