Section R9-10-1709. Medication Services

A.      An administrator shall ensure that:

1.        Policies and procedures for medication services include:

a.         A process for providing information to a patient about medication prescribed for the patient includ- ing:

i.         The prescribed medication’s anticipated results,

ii.        The prescribed medication’s potential adverse reactions,

iii.      The prescribed medication’s potential side effects, and

iv.       Potential adverse reactions that could result from not taking the medication as prescribed;

b.        Procedures for preventing, responding to, and reporting a medication error;

c.         Procedures for responding to and reporting an unex- pected reaction to a medication;

d.        Procedures to ensure that a patient’s medication reg- imen and method of administration is reviewed by a medical practitioner and to ensure the medication regimen meets the patient’s needs;

e.         Procedures for:

i.         Documenting, as applicable, medication administration and assistance in the self-admin- istration of medication; and

ii.        Monitoring a patient who self-administers med- ication;

f.         Procedures for assisting a patient in obtaining medi- cation; and

g.        If applicable, procedures for providing medication administration or assistance in the self-administra- tion of medication off the premises; and

2.        A process is specified for review through the quality management program of:

a.         A medication administration error, and

b.        An adverse reaction to a medication.

B.       If a health care institution provides medication administration, an administrator shall ensure that:

1.        Medication is stored by the health care institution;

2.        Policies and procedures for medication administration:

a.         Are reviewed and approved by a medical practi- tioner;

b.        Specify the individuals who may:

i.         Order medication, and

ii.        Administer medication;

c.         Ensure that medication is administered to a patient only as prescribed; and

d.        Cover the documentation of a patient’s refusal to take prescribed medication in the patient’s medical record;

3.        Verbal  orders  for  medication  services  are  taken   by  a nurse, unless otherwise provided by law; and

4.        A medication administered to a patient:

a.         Is administered in compliance with an order, and

b.        Is documented in the patient’s medical record.

C.      If a health care institution provides assistance in the self- administration of medication, an administrator shall ensure that:

1.        A patient’s medication is stored by the health care institu- tion;

2.        The following assistance is provided to a patient:

a.         A reminder when it is time to take the medication;

b.        Opening the medication container for the patient;

c.         Observing the patient while the patient removes the medication from the container;

d.        Verifying that the medication is taken as ordered by the patient’s medical practitioner by confirming that:

i.         The patient taking the medication is the indi- vidual stated on the medication container label,

ii.        The patient is taking the dosage of the medica- tion as stated on the medication container label, and

iii.      The patient is taking the medication at the time stated on the medication container label; or

e.         Observing the patient while the patient takes the medication;

3.        Policies and procedures for assistance in the self-adminis- tration of medication are reviewed and approved by a medical practitioner or registered nurse;

4.        Training for a personnel member, other than a medical practitioner or registered nurse, in assistance in the self- administration of medication:

a.         Is provided by a medical practitioner or registered nurse or an individual trained by a medical practi- tioner or registered nurse; and

b.        Includes:

i.         A demonstration of the personnel member’s skills and knowledge necessary to provide assistance in the self-administration of medica- tion,

ii.        Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

iii.      Process for notifying the appropriate entities when an emergency medical intervention is needed;

5.        A personnel member, other than a medical practitioner or registered nurse, completes the training in subsection (C)(4) before the personnel member provides assistance in the self-administration of medication; and

6.        Assistance in the self-administration of medication pro- vided to a patient:

a.         Is in compliance with an order, and

b.        Is documented in the patient’s medical record.

D.      An administrator shall ensure that:

1.        A current drug reference guide is available for use by per- sonnel members;

2.        A current toxicology reference guide is available for use by personnel members; and

3.        If pharmaceutical services are provided on the premises:

a.         A committee, composed of at least one physician, one pharmacist, and other personnel members as determined by policies and procedures, is estab- lished to:

i.         Develop a drug formulary,

ii.        Update the drug formulary at least once every 12 months,

iii.      Develop medication usage and medication sub- stitution policies and procedures, and

iv.       Specify which medications and medication classifications are required to be automatically stopped after a specific time period unless the ordering medical practitioner  specifically orders otherwise;

b.        The pharmaceutical services are provided under the direction of a pharmacist;

c.         The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

d.        A copy of the pharmacy license is provided to the Department upon request.

E.       When medication is stored at a health care institution, an administrator shall ensure that:

1.        Medication is stored in a separate locked room, closet, or self-contained unit used only for medication storage;

2.        Medication is stored according to the instructions on the medication container; and

3.        Policies and procedures are established, documented, and implemented to protect the health and safety of a patient for:

a.         Receiving, storing, inventorying, tracking, dis- pensing, and discarding medication including expired medication;

b.        Discarding or returning prepackaged and sam- ple medication to the manufacturer if the manu- facturer requests the discard or return of the medication;

c.         A medication recall and notification of patients who received recalled medication; and

d.        Storing, inventorying, and dispensing con- trolled substances.

F.       An administrator shall ensure that a personnel member imme- diately reports a medication error or a patient’s adverse reac- tion to a medication to the medical practitioner who ordered the medication and, if applicable, the health care institution’s clinical director.

Historical Note

Adopted effective July 6, 1994 (Supp. 94-3). Section repealed; new Section made by exempt rulemaking at 19

A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 20 A.A.R. 1409, pur- suant to Laws 2013, Ch. 10, § 13; effective July 1, 2014

(Supp. 14-2).