Library: Policy

340:100-5-32. Medication administration

Revised 7-1-11

(a) Purpose. OAC 340:100-5-32 sets forth requirements that enable service recipients to receive medication in the safest possible manner.

(b) Applicability. OAC 340:100-5-32 applies to Developmental Disabilities Services Division (DDSD) staff and service providers who are contracted, licensed, or funded through a Home and Community-Based Services Waiver or DDSD state funds and their employees who administer medication or assist with a medication support plan for a service recipient receiving community services, including employment service providers.

(c) General requirements. Administration of medication is managed in accordance with applicable Oklahoma Department of Human Services (OKDHS) rules and federal and state laws.

(1) Every service recipient is free from unnecessary use of medication.
(2) No medication is used for the convenience of staff or as a substitute for positive supports or program.
(3) Use of psychotropic medications and associated medication reviews must follow requirements per OAC 340:100-5-26.1.
(4) Form 06MP046E, Incident Report, and follow-up must be completed when a medication event occurs, per OAC 340:100-3-34. The service recipient's Personal Support Team (Team) reviews all medication incident reports and revises the service recipient's medication support plan when needed.

(d) Individual medication support plan. Each service recipient's Team may develop an individual medication support plan to identify participation by the service recipient in his or her medication administration and specify supports needed by the service recipient for administering, storing, and monitoring medication.

(1) The Team completes an assessment that identifies the service recipient's demonstrated ability to:

(A) understand and follow medication label directions;
(B) properly identify the medication;
(C) remember to take the medication at the correct time;
(D) take the correct dosage;
(E) administer his or her medication without supervision; and
(F) demonstrate ability to address problems, including asking staff for help.

(2) The Team may develop a medication support plan if the service recipient desires training in administering his or her medication, individualization of the medication support program, or both.

(A) The service recipient's medication support plan ensures the service recipient's involvement, together with the designed supports implemented by staff, result in a safe program of medication administration.
(B) The Team revises the medication support plan to provide safety and meet the service recipient's medication support needs if a medication change or monitoring by the DDSD case manager, program coordinator, nurse or quality assurance staff, or other person reveals a concern with the service recipient's medication supports.
(C) The provider is responsible to ensure:

(i) the medication support plan clearly specifies staff responsibilities in the administration of medication; and
(ii) staff implements the medication support plan as developed by the Team.

(D) The service recipient's medication support plan may address either or both of:

(i) the service recipient's administration of his or her medication. If the service recipient is not independent per OAC 340:100-5-32(d)(1), and he or she desires to achieve greater independence in medication administration, the medication support plan documents:
(I) service recipient's ability to administer medication;
(II) staff assistance that must be provided;
(III) any adaptations or reminder systems used;
(IV) documentation requirements to ensure accountability;
(V) monitoring requirements, including compliance with requirements of the medication review process per OAC 340:100-5-26; and
(VI) staff responsible for implementation and monitoring of the medication training program; or
(ii) modifications to the medication administration responsibilities of staff, per OAC 340:100-5-32(e).

(E) Each medication support plan must address medication safety issues affecting each household member.

(e) Medication administration. Items (1) through (9) must be implemented unless the service recipient's medication support plan identifies a specific alternative. The service recipient's medication support plan may modify only those rules that state the plan may address an exception.

(1) Prescription medication. Prescription medication, per OAC 340:100-1-2, is administered or used only with a written order by a licensed physician, dentist, advanced practice nurse, physician assistant, or optometrist.

(A) Prescription medication must only be administered to or used by the service recipient for whom the medication is ordered.
(B) All prescription medication is clearly labeled with:

(i) first and last name of the service recipient for whom the medication is prescribed;
(ii) prescribing physician's name;
(iii) prescription number;
(iv) name of medication;
(v) strength of medication;
(vi) dosage;
(vii) directions for use;
(viii) date of issue;
(ix) quantity; and
(x) name, address, and phone number of pharmacy or physician who dispensed the medication.

(C) All labels on containers must be legible and firmly affixed by the pharmacy or ordering physician.
(D) No one is permitted to alter the label on a prescription container.

(i) If a medication dosage change is made by the physician:

(I) the container must be flagged or prominently identified; and
(II) a label change must be made by the dispensing pharmacy or doctor within three business days of receiving the prescription change. If the service recipient uses a system of medication supply that precludes meeting the three-day requirement, that requirement may be modified in the service recipient's medication support plan.

(ii) The container may be marked or otherwise adapted to support a service recipient's independence as described in the medication support plan.

(E) Sample medications must be:

(i) accompanied by a physician's written order including the length of time the medication is to be taken;
(ii) labeled with the service recipient's name; and
(iii) used for no longer than 30 days, unless reviewed prior to the end of the 30 days by the DDSD nurse and case manager, per OAC 340:100-5-26.

(F) Prior to the initial administration, if the medication name on the doctor's order and the generic or trade name of the medication on the label are different, staff responsible for medication administration documents on the medication administration record the reason for the difference and source of the information.
(G) At an employment site, the labeled pharmacy container is considered the written order for a prescription medication.

(2) Medication count. Each prescription medication must be documented upon receipt from the pharmacy, and an inventory record maintained.

(A) All new or refilled prescription medication must be:

(i) counted upon receipt, following infection control procedures, unless the service recipient's medication support plan defines another method of inventorying new medication; and
(ii) documented in the service recipient's medication record noting the reason for which the medication is prescribed.

(B) Each prescription medication is counted, following infection control procedures, and documented at least weekly. The service recipient's medication support plan may provide for counting at least monthly. Specialized foster care (SFC) and agency companion services (ACS) providers count and document prescription medications at least monthly.
(C) Any staff responsible for administering, storing, monitoring or documenting controlled medications, listed in Schedule II of the current Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) schedule, is required to count and document controlled medications each time the responsibility for medication administration is transferred to another person, but at least monthly.
(D) Any discrepancy in the medication count must be reported immediately to the program coordinator, and then followed up with an incident report per OAC 340:100‑3-34. A SFC provider reports the discrepancy to the DDSD case manager and completes Form 06MP046E.

(3) Non-prescription medication. Approval for a service recipient to use or be administered a non-prescription medication, per OAC 340:100-1-2, is received in writing at least annually from the service recipient's primary care physician.

(A) Items used for personal care or hygiene are not considered medications.
(B) The service recipient's medication record must document:

(i) condition for which the non-prescription medication is used;
(ii) dosage;
(iii) frequency with which the non-prescription medication may be administered; and
(iv) any specific instructions related to the medication.

(C) Each non-prescription medication must have the service recipient's name clearly marked on the container when more than one service recipient lives in the home or works at the employment site.
(D) Administration of a non-prescription medication does not differ from the recommended dosage as noted by package directions, unless ordered in writing by a licensed physician, dentist, advanced practice nurse, physician assistant, or optometrist.

(4) Medication storage.

(A) All medications must be:

(i) secured under proper conditions of temperature and light; and
(ii) kept in a locked medication area, unless the service recipient's medication support plan specifies other storage arrangements.

(B) Each provider agency is responsible for developing and enforcing written policies that ensure medication security in the absence of a service recipient medication support plan.
(C) Schedule II medications, per current OBNDD schedule, must be secured separate from other medications.
(D) Medication requiring refrigeration must be:

(i) secured, unless this requirement is modified in the service recipient's medication support plan;
(ii) kept in the temperature range according to label directions; and
(iii) separated from food and other non-drug items.

(E) Hazardous or dangerous materials must not be kept in the secured medication area.
(F) Each service recipient's medication must be stored separately from the medication of other persons.
(G) Externally applied medications must be stored separately from medications taken internally.

(5) Medication administration. Only staff who complete an approved training program in medication administration per OAC 340:100-3-38 are permitted to administer medications.

(A) Staff responsible for medication administration must personally:

(i) read the medication label;
(ii) prepare the dosage;
(iii) give the medication as ordered;
(iv) observe the person using the medication as ordered; and
(v) document the medication administration immediately, but no longer than 30 minutes after administration.

(B) The person responsible for medication administration must know the purpose for each medication administered.
(C) All medications must be administered according to label directions unless flagged, prominently identified, for change in accordance with OAC 340:100‑5‑32(e)(1)(D). A medication with a flagged container is administered according to the change made on the medication sheet in accordance with the physician's orders.
(D) No contract provider or DDSD staff is permitted to transfer medications from the original container to any other container. The service recipient's medication support plan cannot modify this requirement.
(E) The ultimate user may transfer medication from one container to another container that clearly identifies the medication, in accordance with criteria established in the service recipient's medication support plan. The ultimate user is:

(i) the service recipient for whom the medication is prescribed, if assessed by the Team as able to carry out each step in OAC 340:100-5-32(d)(1);
(ii) an adult member of the service recipient's family, as identified in the medication support plan;
(iii) the service recipient's SFC provider; or
(iv) the service recipient's ACS provider.

(F) No one, other than the ultimate user who transferred the medication to the new container, is allowed to administer medications transferred from the original container. The service recipient's medication support plan cannot modify this requirement.
(G) Each medication must be administered at the specified time.

(i) When circumstances prevent administration at the specified time, the medication must be administered no more than one hour before or after the specified administration time.
(ii) Any time medication is administered more than one hour before or after the scheduled administration time, Form 06MP046E is completed according to OAC 340:100-3-34.
(iii) Orders requiring medication administration two, three, or four times a day, unless specific times are ordered by the physician, must be evenly spaced through the day and are required to accommodate the service recipient's schedule.

(H) The person administering medication must be able to access information to identify common side effects of the medication administered.
(I) If there is an adverse reaction, a significant change in behavior, or any other significant indication of a problem that may be related to medication currently administered to or by a service recipient, immediate action and notification is required according to written provider agency protocols.

(6) p.r.n. medication. Medication prescribed on a p.r.n. basis must have a physician's order identifying the medication, amount, route, time requirements, and under what circumstances the medication is administered.

(A) The decision to actually administer a p.r.n. medication, except per OAC 340:100-5-32(e)(6)(C), must be made by the service recipient's health care coordinator unless another person is designated by the Team in the medication support plan.
(B) The results or the service recipient's responses to p.r.n. medications must be documented for the physician to determine whether continuation of the medication is required.
(C) DDSD defines the use of p.r.n. medication for behavioral control to be a highly restrictive procedure per OAC 340:100-3-34. In cases where a medication is ordered to be administered p.r.n. for behavioral control, the service recipient's Team ensures there is a written protocol for the administration of the p.r.n. medication from the prescribing physician as part of the protective intervention planning per OAC 340:100-5-57, and contract provider agency staff will follow critical incident reporting requirements per OAC 340:100-3-34.
(D) Service recipients receiving Hospice services are exempt from the requirements for p.r.n. medications per OAC 340:100-5-32.

(7) Medication documentation. An accurate written record of the administration of the service recipient's medication or implementation of the service recipient's medication support plan must be maintained.

(A) Unless the service recipient is independent in medication administration per OAC 340:100-5-32(d)(2)(D)(i), the service recipient's medication administration record must specify:

(i) service recipient's first and last name;
(ii) name and strength of the medication as written on the label;
(iii) dosage and frequency to be administered;
(iv) date and time medication is administered, including a.m. or p.m. for each entry;
(v) service recipient's medication allergies and other known allergies;
(vi) results or the service recipient's response to p.r.n. medications and other treatment;
(vii) name of person administering the medication or implementing the medication support plan, or initials supported by signature;
(viii) route of administration, if specified on the label;
(ix) any special orders about the timing of the medication administration, if specified on the label; and
(x) reason for the medication's use, if specified on the label.

(B) If the service recipient is independent in medication administration per OAC 340:100-5-32(d)(2)(B)(i), the medication support plan documents monitoring and documentation needs.

(8) Medication away from home. When a service recipient goes on an outing, vacation, home with family, or otherwise leaves the location where he or she typically takes medication, accountability for the medication is maintained.

(A) When medication is taken from the location:

(i) the documented medication count confirms the amount of medication taken and returned, with signatures of the responsible party receiving the medication and staff responsible for medication administration who releases the medication;
(ii) any discrepancy in the count is documented on Form 06MP046E, and any necessary action is taken; and
(iii) medication is sent from the home and returned to the home only in the original container.

(B) The ultimate user, per OAC 340:100-5-32(e)(5)(E), may remove medication from the location in the original container or another container that fully identifies the medication, if the ultimate user also administers the medication.
(C) Although the medication administration record is not removed, medication administration or implementation of the medication support plan is documented while away from the home.

(9) Discontinued medication, expired medication, and medication destruction.

(A) Discontinued medication:

(i) may be kept up to 90 days, unless the time period is adjusted in the service recipient's medication support plan; and
(ii) must be secured separately from current medications.

(B) Expired or discontinued medications are safely disposed of in compliance with provider agency policy, Environmental Protection Agency recommendations, local, state, and applicable federal requirements.
(C) Scheduled medication are disposed of in compliance with OBNDD and Oklahoma State Bureau of Investigation requirements.
(D) When a service recipient dies, unused medication is kept for at least 30 days or longer if part of an ongoing investigation.
(E) The provider agency develops and enforces written policy regarding the disposal of any medication without an expiration date.