(a) Supervision and Administration of Medication. The organization shall develop, adopt, follow and maintain on file written policies and procedures governing the supervision, the administration and monitoring of medication to children. - (i) These policies shall include prescription medications, non-prescription medications and vitamins;
- (ii) Prescription medication shall only be administered under the order of a physician, a nurse practitioner, physician's assistant or dentist;
- (iii) All medications shall be administered by the appropriately trained personnel in the facility;
- (iv) A medication consent form must be completed by the child's parent or legal guardian for all medications given within agreed upon dosage range;
- (v) Before the recommended dosage for over the counter medication is exceeded, written permission must be given to the facility by the parent(s) or legal guardian and a health care professional;
- (vi) The effects of medication must be documented in the child's health record and the prescribing physician should regularly review the child's response to medication;
- (vii) If prescribed medications are used, daily monitoring and documentation is required; and
- (viii) There shall be written policy, procedures and controls governing the destruction of out-of-date medication, unused medication or medication prescribed for former children and disposal of syringes and medical waste in accordance with state and local law.
(b) Storage of Medications. The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that all medications (over-the-counter and prescribed) are stored in a locked area that is inaccessible to children.
(c) Labeling of Medications. The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that all medications are accurately labeled. - (i) Medications must bear their original prescription label or a manufacturer's label; and
- (ii) Any deviation from the recommend dosage on the label must be accompanied by a physician's written instructions.
(d) Repackaging of Medication. If medication repackaging (e.g., the placing of a limited supply of medication in a separate container for use during an absence/excursion from the facility) is to occur, it must be done in accordance with the following guidelines: - (i) The individual having the responsibility of repackaging the medication must have training and experience in all aspects of medication administration;
- (ii) All medication that is repackaged must be labeled with the following information:
- (C) Correct dosage instructions;
- (E) Prescription number; and
- (iii) Repackaging may occur as often as needed; and
- (iv) If there is medication left over from repackaging:
- (A) It shall be documented in the child's record. Said documentation shall state why there was medication left over and a description of what the medication is for; and
- (B) Medication left over from repackaging shall not be returned to the original bottle/container due to changes in potency and contamination.
(e) Medication Logs. The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that medication logs are maintained for each child. The organization shall maintain a cumulative record of all medication dispensed to children, a copy of which shall be placed in the child's case record. This record shall include: - (ii) Name of physician prescribing medication;
- (iii) The name of the medication;
- (iv) Date and time the medication was administered;
- (v) Amount of medication given;
- (vi) Signature/initial of person monitoring medication;
- (vii) Any medication errors and reason for the errors; and
- (viii) A statement must be signed and documented by the staff member who witnessed medication refusal.
(f) Medication Errors. Documentation of medication errors shall be kept in the medication log. - (i) Medication errors may include:
- (A) The failure to administer medication;
- (B) Administering the incorrect medication;
- (C) Administering the correct medication in an incorrect dosage; or
- (D) Administering the correct medication at the incorrect time.
- (ii) After each medication error:
- (A) Medical personnel (e.g., physician, registered nurse, nurse practitioner, licensed practical nurse, physician's assistant) shall be contacted as soon as possible for instructions;
- (B) Immediate actions shall be taken to prevent future medication errors and actions shall be documented; and
- (C) An incident report shall be submitted to the DFS Caseworker and the DFS Certifying Authority within two (2) working days.
(g) Adverse Reactions. The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that all staff members are aware of the side effects of medication prescribed for the child.
(h) Medication Administration Training. The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that medication administration training has been provided.
(i) Psychotropic Medication - (i) The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that psychotropic medications shall be prescribed and administered only as a component of a comprehensive treatment plan;
- (ii) If psychotropic medications are used, the organization must have a written policy governing the use of such medications that shall include the following:
- (A) Criteria for the use and review of psychotropic medications as a part of the ITPC and/or ISPC;
- (B) Procedures for monitoring and reviewing use of psychotropic medication by a physician, nurse practitioner, or physician's assistant; and
- (C) Procedures for reporting the suspected presence of side effects.
- (iii) Special training shall be given to all staff and foster parents to enable them to recognize changes in a child's appearance or behavior that may be related to the use of the psychotropic medication.
(j) Revocation of consent. If a parent or guardian revokes consent for the use of medication, the organization has the option of continuing to provide services to the child without the use of medications. The organization also has the option of not continuing to serve the child and DFS shall be notified immediately if the child is in DFS custody. In addition, the organization shall immediately file a statement describing the circumstances under which consent has been revoked. - (i) This statement shall be provided to all organization staff;
- (ii) The child's prescriber shall be notified; and
- (iii) The child's DFS caseworker shall be notified.
(k) Incident reporting. Any unscheduled use of medications, excluding any PRN orders, used to target psychiatric symptoms or behaviors shall be reported to the DFS Caseworker and the DFS Certifying Authority within two (2) working days.
049-3 Wyo. Code R. § 3-16