Section 29-2360. SPECIALITY SERVICES -- MEDICATION MANAGEMENT STANDARDS

 

2360.1 Controlled substances shall be maintained in accordance with Chapter 10, Title 22 of the District of Columbia Municipal Regulations, and 21 C.F.R., Part 1300 of the Code of Federal Regulations.

 

2360.2 A substance abuse treatment facility or program shall implement written policies and procedures to govern the acquisition, safe storage, prescribing, dispensing, labeling, administration, and the self-administration of medication, including medications patients may bring into the program.

 

2360.3 For any medication that is administered or self-administered, the program shall have a record of the attending practitioner’s order or approval prior to the administration or self-administration of medication.

 

2360.4 Any medication brought into a facility or program by a patient shall not be administered or self-administered until the medication is identified and the attending practitioner’s written order or approval is documented in the patient record.

 

2360.5 Verbal orders may be given by the attending practitioner and received only by another practitioner, physician assistant, nurse, or pharmacist. Verbal orders shall be noted in the patient’s record as such and countersigned and dated by the prescribing practitioner within twenty-four (24) hours.

 

2360.6 All medication brought into a facility or program must be packaged and labeled in accordance with District and federal laws and regulations, including but not limited to the Poison Prevention Packaging Act of 1970, approved December 30, 1970 (15 U.S.C. §1471 et seq.).

 

2360.7 Medication brought into a facility or program by a patient that is not approved by the attending practitioner shall be packaged, sealed, stored and returned to the patient upon discharge.

 

2360.8 The administration of medications, excluding the self-administration, shall be permitted only by licensed individuals pursuant to the Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99, D.C. Code, 2001 Ed. §3-1201.01 et seq.).

 

2360.9 Medications shall be administered in single doses to the extent possible.

 

2360.10 A licensed nurse, practitioner or physician assistant shall administer controlled substances or injectable drugs, excluding insulin.

 

2360.11 Program staff responsible for supervision of the self-administration of medication shall document consultations with a practitioner, pharmacist, registered nurse, or referral to appropriate reference material regarding the action and possible side effects or adverse reactions of each medication under their supervision.

 

2360.12 The facility or program shall provide medication management training to the staff designated to supervise the self-administration of medication. The training shall include, but not be limited to, the expected action and adverse reaction of the self-administered medication.

 

2360.13 Only designated staff shall supervise the self-administration of medication.

 

2360.14 The facility or program shall ensure that medication is available to patients as prescribed for the required therapy.

 

2360.15 A facility or program shall maintain records that track and account for all prescribed medication, including the following:

 

(a) Each patient receiving medication shall have a medication administration record, which includes the individual’s name, name of medication, type of medication (classification), and amount of medication, dose and frequency of administration/self-administration, and name of staff who administered or observed the self-administration of medication;

 

(b) Documentation shall include omission and refusal of medication administration;

 

(c) The medication administration record shall validate the amount of medication originally present and the amount remaining;

 

(d) Documentation of medication administration shall include over-the-counter drugs administered or self-administered; and

 

(e) Narcotic treatment programs administering narcotics, including but not limited to methadone, shall follow the requirements in accordance with Chapter 10, Title 22 of the District of Columbia Municipal Regulations; 21 C.F.R., Part 1300; and 21 C.F.R., Part 291.

 

2360.16 An attending practitioner shall be notified immediately of any medication error or adverse reaction. The staff responsible for the medication error shall complete an incident report. The medication error, or adverse reaction, practitioner recommendations and subsequent actions taken by the program shall be documented in the patient record.

 

2360.17 The facility or program shall have written policies and procedures on how medications are obtained and stored.

 

2360.18 The facility or program shall ensure that all medications, including those that are self-administered, are secured in locked storage areas.

 

2360.19 The locked medication area shall provide for separation of internal and external medications.

 

2360.20 The facility or program shall maintain a list of personnel who have access to the locked medication area and, where applicable, who are qualified to administer medication.

 

2360.21 The facility or program shall comply with all District and federal laws concerning the acquisition and storage of pharmaceuticals.

 

2360.22 Each patient’s medication shall be properly labeled as required by District and federal laws and regulations, stored in its original container, and shall not be transferred to another container or taken by persons other than the person for whom it was originally prescribed.

 

2360.23 Medications requiring refrigeration shall be maintained in a separate and secure refrigerator, labeled “FOR MEDICATION ONLY”, and shall be maintained at a temperature between 36℃ F and 46℃ F. All refrigeration shall have thermometers, which are easily readable, in proper working condition, and accurate within a range of plus or minus two (2) degrees.

 

2360.24 The facility or program shall conspicuously post in the drug storage area the following information:

 

(a) Telephone number for the regional Poison Control Center;

 

(b) Antidote charts; and

 

(c) Metric-apothecaries weight and conversion measure charts.

 

2360.25 Inspections of all drug storage areas shall be conducted monthly to ensure that medications are stored in compliance with District and federal regulations. The facility shall maintain records of these inspections for verification.

 

2360.26 Where applicable, the facility shall implement written policies and procedures for the control of stock pharmaceuticals.

 

2360.27 The receipt and disposition of stock pharmaceuticals must be accurately documented as follows:

 

(a) Invoices from companies or pharmacies shall be maintained to document the receipt of stock pharmaceuticals;

 

(b) A log shall be maintained for each stock pharmaceutical that documents receipt and disposition; and

 

(c) At least quarterly, each stock pharmaceutical shall be reconciled as to the amount received and the amount dispensed.

 

2360.28 The facility or program shall implement written procedures and policies for the disposal of medication.

 

2360.29 The facility or program shall promptly dispose of all medications discontinued by the attending practitioner, outdated medications, and medications having illegible or missing labels.

 

2360.30 Any medication left by the patient at discharge shall be destroyed within thirty (30) calendar days.

 

2360.31 The disposal of all medications shall be witnessed and documented by two appropriate (2) staff members.

 

 

source

Final Rulemaking published at 47 DCR 9341 (November 24, 2000), adopting Emergency and Proposed Rulemaking published at 47 DCR 7708, 7794 (September 22, 2000).