Section 11-94.2-46 - Pharmaceutical services(a) Each facility shall employ a licensed pharmacist or shall have a written contractual arrangement with a licensed pharmacist, to provide consultation on methods and procedures for ordering, storing, administering, disposing, and recordkeeping of drugs and biologicals, and provisions for emergency service.(b) A facility shall have a current pharmacy policy manual consistent with current pharmaceutical practices developed and approved by the pharmacist, medical director/medical advisor, and director of nursing that:(1) Includes policies and procedures, and defines the functions and responsibilities relating to pharmacy services, including the safe administration and handling of all drugs and self-administration of drugs. Policies and procedures shall include pharmacy functions and responsibilities, formulary, storage, administration, documentation, verbal and telephone orders, authorized personnel, recordkeeping, and disposal of drugs;(2) Is reviewed at least every two years and revised as necessary to keep abreast of current developments in overall drug usage; and(3) Has a drug recall procedure that can be readily implemented.(c) As authorized by facility policy and state law, a physician, physician assistant, or APRN shall order medications, either in writing or verbally, to be administered to a resident.(d) A physician's, physician assistant's, or APRN's verbal orders for prescription drugs shall be given only to a licensed nurse, pharmacist, or another physician.(e) All verbal or telephone orders for medication shall be recorded and signed by the licensed person receiving them and shall be authenticated by the prescribing physician according to the policies and procedures of the facility.(f) The physician, physician assistant, or APRN shall review all orders at the time of the visit to the resident.(g) Each drug shall be rechecked and identified immediately prior to administration.(h) Prescription medication shall not be used for any resident other than the resident for whom it was issued. Stock supply items may be administered per facility protocol.(i) Appropriately licensed and trained staff shall be responsible for the entire act of medication administration, which entails removing an individual dose from a container properly labeled by a pharmacist or manufacturer (unit dose included), verifying the dosage with the physician's orders, giving the specified dose to the proper resident, and promptly recording the time, route, and dose given to the resident, and signing the record- Only a licensed nurse, physician, or other individual to whom the licensed professional has delegated the responsibility pursuant to chapter 16-89, subchapter 15, may administer medications.(j) Medication errors and drug reactions shall be recorded in the resident's chart and reported immediately to the physician, physician assistant, or APRN who ordered the drug, and a medication error report shall be prepared and given to the administrator of the facility or director of nursing for review and appropriate action, according to facility policy.(k) Drugs shall be stored under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security. (l) All drugs, including drugs that are stored in a refrigerator, shall be kept under lock and key, except when authorized personnel are in attendance. The facility shall be in compliance with all security requirements of federal and state laws as they relate to storerooms and pharmacies.(m) Drugs for external and internal use shall be kept separate and stored in locked, well-marked, separate cabinets.(n) Discontinued and outdated prescriptions and containers with worn, illegible, or missing labels shall be disposed of according to facility policy.(o) A pharmacist shall, on a monthly basis, review the record of all residents receiving medications to determine potential adverse reactions, interactions, and contraindications. The review and any concerns identified shall be documented in the resident's record.(p) When appropriateness of drugs or dosage of drugs as ordered are questioned by the pharmacist or licensed nurse, the licensed nurse or the pharmacist shall consult the physician, and a record of the consultation shall be made available to the administrator of the facility or director of nursing.Haw. Code R. § 11-94.2-46
[Eff 9/16/2022] (Auth: HRS §§ 321-9, 321-11) (Imp: HRS §§ 321-9, 321-11)