Section R9-10-421. Medication Services

A.      An administrator shall ensure that policies and procedures for medication services:

1.        Include:

a.         A process for providing information to a resident about medication prescribed for the resident 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:

i.         A medication error,

ii.        An adverse response to a medication, or

iii.      A medication overdose;

c.         Procedures to ensure that a pharmacist reviews a res- ident's medications at least once every three months and provides documentation to the resident's attend- ing physician and the director of nursing indicating potential medication problems such as incompatible or duplicative medications;

d.        Procedures for documenting medication services; and

e.         Procedures for assisting a resident in obtaining med- ication; and

2.        Specify a process for review through the quality manage- ment program of:

a.         A medication administration error, and

b.        An adverse reaction to a medication.

B.       An administrator shall ensure that:

1.        Policies and procedures for medication administration:

a.         Are reviewed and approved by the director of nurs- ing;

b.        Specify the individuals who may:

i.         Order medication, and

ii.        Administer medication;

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

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

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

3.        A medication administered to a resident:

a.         Is administered in compliance with an order, and

b.        Is documented in the resident’s medical record; and

4.        If a psychotropic medication is administered to a resident, the psychotropic medication:

a.         Is only administered to a resident for a diagnosed medical condition; and

b.        Unless clinically contraindicated or otherwise ordered by an attending physician or the attending physician's designee, is gradually reduced in dosage while the resident is simultaneously provided with interventions such as behavior and environment modification in an effort to discontinue the psycho- tropic medication, unless a dose reduction is attempted and the resident displays behavior justify- ing the need for the psychotropic medication, and the attending physician documents the necessity for the continued use and dosage.

C.      An administrator shall ensure that:

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

2.        If pharmaceutical services are provided:

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

b.        The pharmaceutical services comply with ARS Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4

A.A.C. 23; and

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

D.      When medication is stored at a nursing 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 resident for:

a.         Receiving, storing, inventorying, tracking, dispens- ing, and discarding medication  including expired medication;

b.        Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

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

d.        Storing, inventorying, and dispensing controlled substances.

E.       An administrator shall ensure that a personnel member imme- diately reports a medication error or a resident’s adverse reac- tion to a medication to the medical practitioner who ordered the medication and the nursing care institution’s director of nursing.

Historical Note

Adopted effective January 28, 1980 (Supp. 80-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-421 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt

rulemaking at 19 A.A.R. 3334, effective October 1, 2013 (Supp. 13-4). Amended by exempt rulemaking at 20

A.A.R. 1409, pursuant to Laws 2013, Ch. 10, § 13; effec- tive July 1, 2014 (Supp. 14-2).