BROCKTON AREA MULTI-SERVICES, INC. ORGANIZATION AND POLICY GUIDE

Transcription

1 Page 1 f 12 PURPOSE: T ensure cmpliance with 105 CMR regulatins regarding strage and dispensing f medicatins in cmmunity residences; t ensure the health and safety f individuals served; and t prvide a standardized and cmprehensive system t address medicatin issues. PROCEDURES: Strage: 1. All medicatins which are t be administered t persns served are t be stred in a lcked area (cabinet r drawer). All cuntable medicatins fr persn served administratin are t be kept under duble lck. (Schedule II-V) 2. N materials r articles ther than medicatins are t be stred in the medicatin cabinet r drawer. 3. Access t the medicatin cabinet is t be by medicatin key. The medicatin key is t be retained by the persn assigned t medicatin duties fr a particular shift. Only that persn assigned t medicatin duties fr a particular shift shall have access t the lcked medicatin cabinet. 4. The medicatin cabinet is t be kept lcked at all times except when medicatin duties are being perfrmed by the assigned staff persn (i.e., administering medicatin). The assigned staff persn must secure and relck all medicatins in the event that it is necessary t leave the immediate medicatin wrk space.

2 Page 2 f All prescriptin and nn-prescriptin (ver-the-cunter) medicatins shall be stred in their riginal cntainer and prperly labeled by the pharmacy. All pharmacy labels must be legible and cincide with the current physician s rder fr such medicatin. 6. Internal medicatin is t be stred separately frm medicatins intended fr external use. 7. Medicatins are t be stred in quantities f n mre than a 37-day supply. 8. Medicatins which require refrigeratin are t be kept in a lcked bx within the refrigeratr, separate frm ther items in the refrigeratr. 9. Discntinued r utdated medicatins are dispsed f in a manner cnsistent with the sectin titled Dispsal. The prgram will maintain a system t identify discntinued r expired medicatins. 10. It is advisable that medicatin be btained in blister packs; hwever, it is acceptable fr nn-cuntable substances t be available in pharmacy bttles. Blister packs are required fr all cuntable medicatins and are preferred fr individuals wh are self-medicating. 11. The prgram will maintain a recrd f when a prescriptin is filled and the quantity f medicatin dispensed by the pharmacy. Cuntable Substances: 1. All Schedule II-V drugs (cuntable substances) will be stred under duble lck.

3 Page 3 f All drugs classified as cuntable substances (Schedule II-V) will be cunted upn receipts frm the pharmacy and a cunt entry made in the Department f Public Health (DPH) Apprved Cntrlled Substance Bk. 3. An nging cunt f all cuntable substances, including pre-filled syringes if the syringe cntains a cuntable substance, shall be maintained in the inventry sectin f the Cntrlled Substance Bk; this inventry is t be recrded each time a cuntable medicatin is administered. 4. All Schedule II-V medicatins (cuntable substances), including pre-filled syringes if the syringe cntains a cuntable substance, are t be cunted by medicatin-certified individuals at the beginning and cnclusin f each shift. When there is an ncming and ff-ging staff at the shift change, the cunt will be cnducted jintly by the tw medicatin-certified staff. When a shift ends and there is n staff n duty fr the shift fllwing, the cunt will be dne by a single persn. When medicatin-assigned staff begins a shift when there has been n previus wrk shift, a cntrlled substance cunt will be cnducted at the beginning f the wrk shift and repeated at the cnclusin f the shift. Dcumentatin f this cunt will be entered in the cunt verificatin sectin f the Cntrlled Substance Bk. 5. At a minimum f nce in each 24-hur perid, a cunting f all Schedule II-V medicatins and pre-filled syringes if the syringe cntains a cuntable substance must be perfrmed by tw medicatin-certified individuals and dcumented. 6. Any discrepancy in the number f cuntable substances shuld be reprted immediately t the Prgram Manager and Prgram Supervisr wh shall investigate the discrepancy and dcument the same as a medicatin incident.

4 Page 4 f Any lss r suspected theft f a cuntable substance r any prescriptin medicatin will be reprted t Department f Public Health/Fd and Drug Divisin at (617) n later than the next business day fllwing the discvery f the discrepancy. A written reprt f the incident shall fllw within seven days. 8. Only cuntable substances are lgged in the Cntrlled Substance Bk. A pre-filled syringe cntaining a cuntable medicatin with needle attached is cunted as ne unit. Pharmacy Cntainers, Blister Packs, and Labels: 1. In the event that a pharmacy label is illegible (trn, stained, etc.), the Prgram Manager/Site Supervisr r designee is t be ntified. 2. The bttle r blister pack must be returned t the pharmacy fr relabeling. 3. In the event that an rder is changed and it is apprpriate t use medicatin frm the riginal pharmacy cntainer (e.g., frequency changed frm t.i.d. t b.i.d. fr the same strength medicatin), the Prgram Manager/Site Supervisr r designee is t be ntified. 4. If, upn the change in a medicatin rder, it is apprpriate t use the current medicatin supply, an agency sticker will be applied t the blister pack r bttle alerting staff t the change in rder and directing them t verify directins accrding t the new dctr s rder. 5. In the event that a pharmacy label des nt match the current physician rder, the Prgram Manager/Site Supervisr r designee is t be ntified. 6. The medicatin bttle r blister pack is t be returned t the pharmacy fr relabeling.

5 Page 5 f Medicatin is t be administered t persns served nly frm pharmacy cntainers that are crrectly labeled and legible. Prescriptin bttle and blister pack labels are t be changed nly by the pharmacy. 8. A pharmacy label which reads Take as directed is prhibited, with the exceptin f cumadin and insulin. 9. A pharmacy label must specify a particular dse and time interval. Ranges are nt permitted. 10. The splitting f pills by Medicatin Administratin Prgram (MAP)-certified staff is frbidden. If it is necessary t administer a prtin f a pill t achieve the rdered dse, the pharmacy must split the pill and package the rder in blister packs in rder t maintain the integrity f the split pills. Dcumentatin and Reference Materials: 1. A Medicatin Administratin Lg will be maintained fr each prgram. This lg will cntain the fllwing: Individually labeled sectins fr each resident wh receives medicatin Current physician s rders (within 1 year) fr each medicatin t be administered, as well as discntinued physician s rders. Fr Department f Mental Health (DMH) funded prgrams, psychiatrist s rders are valid fr 30 days unless a frmal waiver applies.

6 Page 6 f 12 Medicatin and Treatments Charts fr the current mnth A ntatin f all residents knwn allergies t medicatins A Medicatin Infrmatin Sheet fr each medicatin being received which includes the actins, side effects, warning statements r special instructins, typical dsage ranges, etc. Medicatin Infrmatin Sheets may be drawn frm: (a) current drug resurce bk; r (b) infrmatin prvided by the pharmacist r physician s ffice. A current drug reference bk will be available at each prgram site. 2. The Prgram Manager r designee will be respnsible fr maintaining mnthly Medicatin and Treatment Charts, infrming ther staff f medicatin changes (thrugh the staff lg, daily prgress ntes, and medicatin charts), dispsal f discntinued/expired medicatins, mnthly filing f Medicatin and Treatment Charts in the resident s cnfidential recrd, and rerdering medicatins. 3. The Prgram Manager is respnsible fr ensuring cmpliance with the agency s medicatin plicy. 4. Out-f-date dcumentatin must be remved frm the Medicatin Administratin Lg n a regular basis and placed in the client s cnfidential recrd. 5. There must exist a written physician s rder fr all medicatins including ver-the-cunter medicatins. A dcument dated and signed by the physician will suffice as a physician s rder. A phtcpy f a prescriptin is nt permitted as a physician s rder. Any change in a physician s rder r discntinuance f an rder will be signed by the physician.

7 Page 7 f If the physician rders r changes medicatins ver the telephne, such rders will be dcumented in the Medicatin Administratin Lg and daily prgress ntes, as well as n the telephne rder frm, as a verbal physician s rder. The Prgram Manager r designee will btain a written rder frm the physician within three business days. Faxed physician s rders are legal rders and are preferred ver telephne rders when available. 7. Each resident s Emergency Fact Sheet must cntain up-t-date infrmatin regarding current medicatins, knwn allergies, and the name, address, and telephne number f the primary care physician. It is recmmended that the Prgram Manager r designee review the Emergency Fact Sheet mnthly. 8. Each resident must have a Medicatin and Treatment Chart identifying each medicatin received. The prcedures fr cmpleting the chart are as fllws: Medicatin and Treatment Charts must be filled ut each mnth fr each persn served and kept in the prgram s Medicatin Administratin Lg. Past mnths medicatin charts are remved frm the Medicatin Administratin Lg and filed in the individual s cnfidential recrd, in the rear f the medical sectin. All prescribed medicatins are entered n an individual s medicatin chart. The chart is cmpleted as fllws: Mnth and year Name f medicatin as written n prescriptin and physician s rder, as well as the generic interchange if applicable. (Tegretl 200 mg; Carbamazepine); the numerical value f the medicatin indicates the strength r milligrams per tablet r pill.

8 Page 8 f 12 Amunt and number f pills, tablets, etc. given f medicatin at each administratin (2 tabs; 1 tab; 1 pill) Dse: Strength times amunt (i.e., 200 mg. strength x 2 pills = 400 mg.) Frequency: Number f times per day medicatin is administered (3x/day) Rute: Hw medicatin is taken (ral, tpical, etc.) Date the medicatin is first taken during the current mnth and day Date the medicatin is discntinued, if applicable (mnth, day, year) Hur f the day medicatin is t be taken (8:00 p.m.) If the resident takes tw different dsages per day f the same medicatin, use the next blck t indicate this (i.e., resident is t take Ativan.5mg., 1 tab in the mrning fr ten (10) days and Ativan 1mg., 1 tab twice a day fr the entire mnth). Draw lines thrugh spaces indicating any days that medicatin is nt t be taken. Fr each day/time a medicatin is t be given, the crrespnding blck is filled in with a staff s initials indicating that the medicatin was given. N blck shuld be left blank. Fr medicatins nt given, staff s initials are placed within a circle in the apprpriate bx. A nte shuld be made n the back f the medicatin chart indicating the reasn why the medicatin was given (i.e., leave f absence, hspitalized, refused). Medicatin infrmatin written n the medicatin chart must match the prescriptin label and the physician s rder. Any change in a physician s rder fr medicatin requires that the previus entry n the Medicatin Administratin Lg be discntinued and the new physician s rder

9 Page 9 f 12 transcribed nt the Medicatin Administratin Lg. Medicatin shuld be returned t the pharmacy fr relabeling r dispsed f if a new prescriptin is btained. All staff wh supervise r administer medicatin must sign legal name and indicate initials they will use when signing ff fr each dsage. Be certain t fill in resident s name. 9. Over-the-cunter medicatins (as defined by MAP plicy) may be administered by staff nly when a physician s rder is present. 10. Medicatins prescribed fr rutinely recurring cnditins n a PRN r as-needed basis will be administered fr specific target symptms r behavirs as identified and specified by the prescribing physician. If an rder exists that des nt clearly indicate in measurable terms the exact cnditins under which PRN medicatins are t be given, then such an rder will be clarified with the physician and dcumented prir t medicatins being administered by staff. 11. Medicatins prescribed fr the purpse f mdifying maladaptive behavirs shuld be prescribed by a specialist in that area. Any behavir-altering medicatins will be used in cnjunctin with a written medicatin plan. 12. All rders fr PRN r as-needed medicatins shall include specific target symptms fr which these medicatins are t be given and shuld include the time interval between dses as well as dsage maximums (e.g., may be given up t 4 times in 24 hurs). The effectiveness f PRN medicatins shall be entered in the individual s permanent recrd.

10 Page 10 f 12 Preparatin and Administratin f Medicatins: 1. Prescribed medicatins fr nn-self-medicating individuals are prepared and administered in the manner utlined in the MAP Administratin Certificatin training prgram. 2. Individuals wh are learning t self-medicate are cnsidered nn-self-medicating and regulatins 105 CMR apply. 3. Individuals wh meet all applicable criteria are cnsidered self-medicating and regulatins 105 CMR d nt apply. Dispsal: All permanently discntinued medicatins, as well as utdated r n lnger needed medicatins, are t be dispsed f by tw medicatin-certified staff persns, ne f whm is a supervisr. After cunting, ne staff persn will crush r bil pills/capsules, then bag with kitty litter r cffee grunds, while the ther bserves. Bth staff will cmplete and sign dispsal dcumentatin, including the name f the resident, name f medicatin, date, number f pills, and reasn fr dispsal. Cntrlled substances are remved frm the Cntrlled Substance Cunt bk. External medicatins are duble bagged (plastic) and placed in the general trash. Nn-prescriptin drugs d nt require cunting r dcumentatin. Dcumentatin f the dispsal f all prescriptin medicatins is entered n the DPH-apprved dispsal frm.

11 Page 11 f 12 Medicatin Cnsultant: A MAP cnsultant is available t ffer guidance and/r advice t prgram staff when questins arise regarding apprpriate administratin practices r ther medicatin-related questins. Fr the purpses f the Medicatin Administratin Prgram, the cnsultant is prfessinal, knwledgeable, skilled in medicatin administratin systems, and prvides technical assistance and advice t certified staff. Regulatins at 105 CMR (F)(1)(g) require that the prfessinal cnsultant be a registered nurse, registered pharmacist, r practitiner. Cnsultants prvide advice, assistance, and recmmendatins and answer questins n medicatins and n issues regarding medicatin administratin systems. This may include, but is nt limited t: 1. interpreting a practitiner s prescriptin fr the staff 2. prviding infrmatin n a medicatin s indicatins fr use and side effects 3. recmmending apprpriate actins t fllw a medicatin ccurrence (errr invlving the wrng medicatin, individual, dse, time, r rute f administratin) Additinal infrmatin regarding the MAP Cnsultant is cntained in the Medicatin Occurrence Plicy. Additinal Cnsideratins: 1. All staff administering medicatins and perfrming medicatin-related duties must be medicatin-certified.

12 Page 12 f A visiting nurse may be utilized as needed fr medicatin administratin r treatments beynd the scpe f practice f medicatin-certified staff (e.g., insulin injectin, prefilling insulin syringes, etc.). 3. It is the respnsibility f the Prgram Manager t ensure that all rdered medicatins are available at the prgram. 4. A current drug reference bk will be kept n site, listing indicatins, side effects, and ther precautinary infrmatin. It is the respnsibility f each staff persn t be infrmed f medicatins used at the prgram. 5. Medicatins nt cvered by the resident s insurance will be paid fr by the resident, unless ther arrangements can be made.