La. Admin. Code tit. 48 § I-8071

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-8071 - Pharmaceutical Services

A. The CRCC facility shall ensure that pharmaceutical services are provided under the directions of a pharmacist licensed to practice in the state of Louisiana. The facility shall ensure that pharmaceutical services are provided in accordance with appropriate methods and procedures for the storage, dispensing and administering of drugs and biologicals. The CRCC facility is responsible for ensuring that pharmaceutical services are provided in accordance with accepted professional principles and appropriate federal, state, and local laws, whether drugs and biologicals are obtained from community or institutional pharmacists or stocked by the facility. The CRCC shall ensure the appropriate monitoring and supervision of the pharmaceutical needs of the patient, and have written policies governing prescribing, administering, controlling, storing and disposing of all biologicals and drugs.

B. The CRCC shall provide for the pharmaceutical needs of the patient, consistent with the Board of Pharmacy regulations.

C. The CRCC shall institute procedures which protect the patient from medication errors.

D. CRCC procedures shall provide verbal and written instructions to patient and family as indicated.

E. CRCC policies and procedures shall describe which drugs and treatments are administered by the agency. All drugs shall be administered in compliance with the needs of the client and applicable laws and regulations.

F. The CRCC pharmacy shall have a pharmacy permit issued by the Louisiana Board of Pharmacy to allow ordering, storage, dispensing, and delivering of legend prescriptive orders. The CRCC shall have a current controlled dangerous substance license and a DEA registration. Pharmacy services shall be directed by a registered pharmacist licensed to practice in Louisiana.

G. A physician must order all medications for the patient.

1. If the medication order is verbal, the physician shall give it only to a licensed nurse, pharmacist, or another physician; and the individual receiving the order shall record and sign it immediately.

2. All orders (to include telephone and/or verbal) shall be signed by the prescribing physician in a timely manner, not to exceed 30 days.

H. Patients shall be accurately identified prior to administration of a medication.

1. Medications shall be administered only by a physician, a licensed nurse, the patient, or the parent or guardian, if his or her attending physician has approved.

2. Physicians' orders shall be checked at least daily to assure that changes are noted.

3. Drugs and biologicals shall be administered as soon as possible after dose is prepared for distribution, not to exceed two hours.

4. Each patient shall have an individual medication record (MAR) on which the dose of each drug administered shall be properly recorded by the person administering the drug to include:

a. name, strength, and dosage of the medication;

b. method of administration to include site, if applicable;

c. times of administration;

d. the initials of persons administering the medication (the initials shall be identified on the MAR to identify the individual by name);

e. medications administered on a "PRN" or as needed basis shall be recorded in a manner as to explain the reason for administration and the results obtained. The CRCC shall have a procedure to define its methods of recording these medications.

f. medications brought to the CRCC facility by the patient or other individuals for use by that patient shall be accurately identified as to name and strength, properly labeled, stored in accordance with facility policy and shall be administered to the patient only upon the written orders of the attending physician;

g. medications shall not be retained at the patient's bedside nor shall self-administration be permitted except when ordered by the physician. These medications shall be appropriately labeled and safety precautions taken to prevent unauthorized usage;

h. medication errors and drug reactions shall be immediately reported to the director of nurses, pharmacist and physician and an entry made in the patients' medical record and/or an incident report. This procedure shall include recording and reporting to the physician the failure to administer a drug, for any reason other than refusal of a patient to take a drug. The refusal of a patient to take a drug shall be reported to the DON and the physician and an entry made in the patients' medical record;

i. the nurses station or medicine room for all CRCC facilities shall have readily available items necessary for the proper administration and accounting of medications;

j. each CRCC facility shall have available current reference materials that provide information on the use of drugs, side effects and adverse reactions to drugs and the interactions between drugs.

I. Each CRCC facility shall have a procedure for at least quarterly monitoring of medication administration. This monitoring shall be accomplished by a registered nurse or a pharmacist, to assure accurate administration and recording of all medications.

J. Procedures for storing and disposing of drugs and biologicals shall be established and implemented by the CRCC facility.

1. In accordance with state and federal laws, all drugs and biologicals shall be stored in locked compartments under proper temperature controls and only authorized personnel shall have access to the keys. A separately locked compartment shall be provided for storage of all controlled drugs and other drugs subject to abuse.

2. Controlled drugs no longer needed by the patient shall be disposed of in compliance with state requirements. In the absence of state requirements, the pharmacist and a registered nurse shall dispose of the drugs and prepare a record of the disposal. Each CRCC shall establish procedures for release of patient's own medications upon discharge or transfer of the patient. An entry of such release shall be entered in the medical record to include drugs released, amounts, who received the drugs and signature of the person carrying out the release.

3. There shall be a medicine room or drug preparation area at each nurses' station of sufficient size for the orderly storage of drugs, both liquid and solid dosage forms and for the preparation of medications for patient administration within the unit. In the event that a drug cart is used for storage and administration of drugs, the room shall be of sufficient size to accommodate placement of the cart.

4. There shall be a sink provided with hot and cold water in or near the medicine room or medication preparation area for washing hands or cleaning containers used in medicine preparation. Paper towels and soap dispensers shall be provided.

5. Sufficient lighting shall be provided and the temperature of the medicine storage area shall not be lower than 48°F or above 85°F and the room shall have adequate ventilation.

6. Drugs and biologicals, including those requiring refrigeration, shall be stored within the medicine room or shall have separate locks if outside the medicine room. The refrigeration shall have a thermometer and be capable of maintaining drugs at the temperature recommended by the manufacturer of the drug.

7. No laboratory solutions or materials awaiting laboratory pickup or foods shall be stored in the same storage area (i.e., cupboard, refrigerator, or drawer) with drugs and biologicals. The areas designated for drug and biological storage shall be clearly marked.

8. The drug or medicine rooms shall be provided with safeguards, including locks on doors and bars on accessible windows, to prevent entrance by unauthorized persons.

a. Only authorized, designated personnel shall have access to the medicine storage area.

b. External use only drugs shall be plainly labeled and stored separate from drugs and biologicals. No poisonous substance shall be kept in the kitchen, dining area, or any public spaces or rooms. Storage within the drug or medicine room of approved poisonous substances intended for legitimate medical use, provided that such substances are properly labeled and stored in accordance with applicable federal and state law, shall not be prohibited.

9. The CRCC shall develop policies and procedures for maintaining an emergency medicine cabinet for the purpose of keeping a minimum amount of stock medications that may be needed quickly or after regular duty hours. The following rules shall apply to such a cabinet.

a. The contents of the emergency medicine cabinet shall be approved by the CRCC pharmacist and members of the medical and clinical staff responsible for the development of policies and procedures.

b. There shall be a minimum number of doses of any medication in the emergency medicine cabinet based upon the established needs of the CRCC facility.

c. There shall be records available to show amount received, name of patient and amount used, prescribing physician, time of administration, name of individual removing and using the medication, and the balance on hand.

d. There shall be written procedures for utilization of the emergency medicine cabinet with provisions for prompt replacement of used items.

e. The emergency medicine cabinet shall be inspected at least monthly replacing outdated drugs and reconciliation of its prior usage. Information obtained shall be included in a monthly report.

La. Admin. Code tit. 48, § I-8071

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:455 (February 2005).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2175.14(B).