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managing medications in texas assisted living facilities

Texas Assisted Living Medication Management How an Assisted Living Facility Must
Manage Resident Medication.

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From the
Texas Department of Aging and Disability Services
Licensing Standards for Assisted Living Facilities Handbook.

(1) Administration

Medications must be administered according to physician's orders.

(A) Residents who choose not to or cannot self-administer their medications must have their medications administered by a person who:

    (i) holds a current license under state law that authorizes the licensee to administer medication; or

    (ii) holds a current medication aide permit and acts under the authority of a person who holds a current nursing license under state law that authorizes the licensee to administer medication. A medication aide must function under the direct supervision of a licensed nurse on duty or on call by the facility; or

    (iii) is an employee of the facility to whom the administration of medication has been delegated by a registered nurse, who has trained them to administer medications or verified their training. The delegation of the administration of medication is governed by 22 TAC Chapter 225 (concerning RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions), which implements the Nursing Practice Act.

(B) All resident's prescribed medication must be dispensed through a pharmacy or by the resident's treating physician or dentist.

(C) Physician sample medications may be given to a resident by the facility provided the medication has specific dosage instructions for the individual resident.

(D) Each resident's medications must be listed on an individual resident's medication profile record. The recorded information obtained from the prescription label must include, but is not limited to, the medication:

    (i) name;

    (ii) strength;

    (iii) dosage;

    (iv) amount received;

    (v) directions for use;

    (vi) route of administration;

    (vii) prescription number;

    (viii) pharmacy name; and

    (ix) the date each medication was issued by the pharmacy.

(2) Supervision

Supervision of a resident's medication regimen by facility staff may be provided to residents who are incapable of self-administering without assistance to include and limited to:

    (A) reminders to take their medications at the prescribed time;

    (B) opening containers or packages and replacing lids;

    (C) pouring prescribed dosage according to medication profile record;

    (D) returning medications to the proper locked areas;

    (E) obtaining medications from a pharmacy; and

    (F) listing on an individual resident's medication profile record the medication

      (i) name;

      (ii) strength;

      (iii) dosage;

      (iv) amount received;

      (v) directions for use;

      (vi) route of administration;

      (vii) prescription number;

      (viii) pharmacy name; and

      (ix) the date each medication was issued by the pharmacy

(3) Self-administration

(A) Residents who self-administer their own medications and keep them locked in their room must be counseled at least once a month by facility staff to ascertain if the residents continue to be capable of self-administering their medications/treatments and if security of medications can continue to be maintained. The facility must keep a written record of counseling.

(B) Residents who choose to keep their medications locked in the central medication storage area may be permitted entrance or access to the area for the purpose of self-administering their own medication/treatment regimen. A facility staff member shall remain in or at the storage area the entire time any resident is present.

(4) General

(A) Facility staff will immediately report to the resident's physician and responsible party any unusual reactions to medications or treatments.

(B) When the facility supervises or administers the medications, a written record must be kept when the resident does not receive or take his/her medications/treatments as prescribed. The documentation must include the date and time the dose should have been taken, and the name and strength of medication missed; however, the recording of missed doses of medication does not apply when the resident is away from the assisted living facility.

(5) Storage

(A) The facility must provide a locked area for all medications. Examples of areas include, but are not limited to:

    (i) central storage area;

    (ii) medication cart; and

    (iii) resident room.

(B) Each resident's medication must be stored separately from other resident's medications within the storage area.

(C) A refrigerator must have a designated and locked storage area for medications that require refrigeration, unless it is inside a locked medication room.

(D) Poisonous substances and medications labeled for "external use only" must be stored separately within the locked medication area.

(E) If facilities store controlled drugs, facility policies and procedures must address the prevention of the diversion of the controlled drugs.

(6) Disposal

(A) Medications no longer being used by the resident for the following reasons are to be kept separate from current medications and are to be disposed of by a registered pharmacist licensed in the State of Texas:

    (i) medications discontinued by order of the physician;

    (ii) medications that remain after a resident is deceased; or

    (iii) medications that have passed the expiration date.

(B) Needles and hypodermic syringes with needles attached must be disposed as required by 25 TAC 1.131-1.137 (Definition, Treatment, and Disposition of Special Waste from Health Care-Related Facilities).

(C) Medications kept in a central storage area are released to discharged residents when a receipt has been signed by the resident or responsible party.

SOURCE:
Texas Department of Aging and Disability Services (DADS) Licensing Standards for Assisted Living Facilities Subchapter A, 92.41

 
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