Section 441.24.40. Medication—administration, storage and documentation.

This rule sets forth medication requirements for 23-hour crisis observation and holding, crisis stabilization community-based services, and crisis stabilization residential services.

         24.40(1) Performance benchmark. Policies and procedures ensure prescription and over-the-counter drugs are administered or self-administered safely and properly in accordance with federal, state and local laws and regulations. Medication is administered by a qualified prescriber or an individual following the instructions of a qualified prescriber. Medication storage is maintained in accordance with the security requirements of federal, state and local laws. Case records include written policies and procedures regarding use of medication.

         24.40(2) Performance indicators.

            a.                Administration of medication.

             (1)             Medication administration dose schedules and standardization of abbreviations are documented.

             (2)             Throughout the CSRS specific methods for control and accountability of medication products are established.

             (3)             Prescription and over-the-counter drugs are administered or self-administered safely and properly in accordance with federal, state and local laws and regulations.

             (4)             Medications are prescribed by a qualified prescriber under Iowa law.

             (5)             Prescription drugs are not administered or self-administered without a written order signed by a qualified prescriber.

            b.                Staff-administered medication.

             (1)             Only qualified and authorized staff administers medication, and a current, accurate list of staff is maintained.

             (2)             Qualified prescribers instruct how medications are administered and documented. The type and amount of medication, time and date of medication administered, and the name of staff administering the medication are transcribed in the medication record.

            c.                Self-administered medication.

             (1)             Policies and procedures document which staff have completed department-approved training on self-administration of prescription medication.

             (2)             Self-administration of prescription and over-the-counter medications are permitted only when the medication label is clear and complete.

            d.                Medication storage. Medication storage policies under the care and control of the administration include:

             (1)             All medication is maintained in locked storage, and controlled substances are maintained in a locked box within locked storage.

             (2)             Medications requiring refrigeration are kept in a refrigerator separated from food and other edible items.

             (3)             Disinfectants and medication for external use are stored separately from internal and injectable medications.

             (4)             Each medication is stored in original containers and labeled with the name.

             (5)             All potent poisonous or caustic medications are clearly labeled; stored separately from other medication, in a specific well-illuminated cabinet, closet, or storeroom; and made accessible only to authorized staff.

             (6)             Medication provided is dispensed from a licensed pharmacy in the state of Iowa in accordance with the Iowa Code. It can also be provided by a qualified prescriber from a licensed pharmacy in another state according to the laws of the state.

             (7)             Prescription medications prescribed for one individual are not administered or allowed in the possession of another.

            e.                Medication labeling. All prescribed medications are clearly labeled with the full name; prescriber’s name; prescription number; name and strength of the medication; dosage; directions for use; date of issue; and name, address and telephone number of the pharmacy or prescriber issuing the medication. Medications are packaged and labeled according to state and federal guidelines.

            f.                 Monthly inspection. The staff member in charge of medication provides monthly inspection of all storage units.

            g.                Damaged labels. Medication containers having soiled, damaged, illegible, or makeshift labels are returned to the issuing pharmacist, pharmacy, or qualified prescriber for relabeling or disposal.

            h.                Unused medications. Unused prescription drugs are destroyed by staff with a witness present, when an individual leaves the crisis service without medication. A notation is documented in the record. When an individual is discharged or leaves the crisis service, medications currently being administered are sent in their original containers with the individual or with a designated person, with the approval of the qualified prescriber.

            i.                 Medication brought by individual. If the prescribed and over-the-counter medication the individual brings to the CSRS is not used, the medication is packaged, sealed and stored. The sealed packages of medications are returned to the individual or family at the time of discharge.

            j.                 Medication documentation.

             (1)             Written policies and procedures are in place for the review, approval, and implementation of ethical, safe, human and efficient behavioral intervention procedures.

             (2)             Written policies and procedures are in place to inform the individual and the individual’s legal guardian, when appropriate, about prohibitions on the use of medication as a restraint.

             (3)             Documentation is required in case records on adverse drug reactions when medications are administered and self-administered.

             (4)             All medication orders are documented in the case records and document the name of the medication, dose, route of administration, frequency of administration, name of the qualified prescriber prescribing the medication, and name of the staff administering or dispensing the medication.

             (5)             Medication records are documented by authorized staff administering the medication.

            k.                Medication rights and responsibilities.

             (1)             Medication is not used as a restraint. The use of psychopharmacological medication in excess of the standard plan of care is prohibited. Using medication as a restraint includes:

            1.      Drugs or medications used to control behavior or restrict freedom of movement.

            2.      Drugs or medications used in excessive amounts or in excessive frequency.

            3.      Neuroleptics, anxiolytics, antihistamines, and atypical neuroleptics, or other medication used for calming, rather than for the medication’s indicated treatment.

             (2)             Drugs or medications used for standard treatment of the individual’s medical or psychiatric condition are not considered to be used as a restraint.

These rules are intended to implement Iowa Code section 331.397 and 2014 Iowa Acts, House File 2379.

[ARC 1660C, IAB 10/15/14, effective 12/1/14]