N.D. Admin. Code 75-03-40-43

Current through Supplement No. 395, January, 2025

Section 75-03-40-43 - Medication management

1. For purposes of this section:

a. "General supervision" means regular coordination, direction, and inspection of the exercise of delegation of medication administration by a physician or nurse of an employee not licensed to administer medications.

b. "Medication administration" means proper administration of medication to a resident by an employee designated and trained for the administration of medications.

c. "Monitoring of resident self-administration" means distributing the medication to the resident by a designated and trained employee according to physician and medication label instructions and observing and ensuring the proper ingestion, injection, application, or inhalation of the medication by the resident.

2. The facility shall adopt comprehensive written policies and procedures for medication administration and monitoring of resident self-administration. Each employee responsible for administering medication or monitoring of resident self-administration shall receive a copy of the facility policies and procedures for medication administration and monitoring of resident self-administration and shall be knowledgeable of them. The policies and procedures must include:

a. Medications administration:

(1) Having written informed consent on file;

(2) Having information in each resident's health record about any health allergies or health-related restrictions;

(3) Having on file written authorization from a physician or nurse for each employee permitted to administer medications or to monitoring of resident self-administration;

(4) Instructions for employees concerning administration of medications and monitoring of resident self-administration of medications, secure storage of medications, and recording medication administration information in the resident's health record;

(5) Immediate notification to the facility nurse of all medication errors;

(6) Immediate notification of a physician in the event of a resident's adverse drug reaction; and

(7) Medications distributed onsite may only occur when an employee authorized by the facility is present;

b. For prescription medications, all of the following apply:

(1) Require the medication be administered by employees certified to distribute medication to a resident only when:

(a) The resident's attending physician or medical consultant provides employees with clear written instructions for administering the medication and authorizes the facility to administer the medication;

(b) The administration takes place under the general supervision of a physician or nurse. Employees certified to distribute medication are supervised by the facility nurse; and

(c) The label on the medication container gives clear instruction for administration of the medication and, if not clear, the facility shall contact the physician or pharmacy for clarification before administration of the medication; and

(2) Allowing a medication to be self-administered onsite by a resident only while the resident is under direct supervision of an employee and if self-administration is authorized in writing from the prescribing physician or facility medical consultant;

c. Information to employees, a resident, and the custodian and parent or guardian about any medication prescribed for the resident and when a physician orders any changes to the resident's medication. Information must include expected benefits and potential adverse side effects that may affect the resident's overall treatment. Employees also shall be informed on procedures of what to do if the resident refuses medication;

d. Instructions for employees on what to look for in monitoring physical or mental changes to a resident that may occur from a medication, what to do if physical or mental changes are observed, and documentation needed in the resident's health record;

e. Arrangement for a second medical consultation when a resident or the custodian and parent or guardian has concerns about any medication received by the resident or the resident's medication plan;

f. The resident's physician or facility medical consultant review a resident's prescription when there are noted adverse effects from the medication. Documentation showing the date of review and reviewer's name must appear in the resident's health record;

g. The use of any nonprescription medication is based on an assessment by a physician or nurse and is approved by either a physician or nurse;

h. Arrangement for administration of prescribed medications to a resident when the resident is away from the facility. A resident may not be given access to medications if there is reason to believe the resident may harm themself through abuse or overdose;

i. Medications storage. A facility shall comply with all the following requirements for storage of medications:

(1) Medications must be kept in locked cabinets or containers and under proper conditions of sanitation, temperature, light, moisture, and ventilation to prevent deterioration;

(2) A facility immediately shall dispose properly of all outdated prescriptions, over-the-counter medication, and all prescription medication no longer in use; and

(3) The facility shall maintain a log of the medication properly disposed, which employee disposed of it, and what and how much was disposed;

j. Medication administration record. A facility shall have in each resident's health record a written medications administration record which lists each prescribed and over-the-counter medication the resident receives. The record must contain the following information:

(1) For an over-the-counter medication, the resident's name, type of medicine, reason for use, times and day of administration, and employee authorizing its use; and

(2) For a prescription medication, all of the following apply:

(a) The name of the resident;

(b) The generic or commercial name of the medication;

(c) The date the medication was prescribed;

(d) The name and telephone number of the prescriber to call in case of a medical emergency;

(e) The reason the medication was prescribed; (f) The dosage;

(g) The time or times of day for administering the medication;

(h) Documentation of all medication administered with the date and time of administration or, if not administered, with the date and time of resident refusal to take it;

(i) The method of administration, such as orally or by injection;

(j) The name of the employee who administered or monitored resident self-administration of the medication;

(k) Any adverse effects observed; and

(l) Any medication administration errors and corrective or other action taken; and

k. Psychotropic medications. In this subdivision, "psychotropic medication" means any drug that affects the mind and is used to manage behavior or psychiatric symptoms.

(1) Nonemergency procedures. A facility serving a resident for whom psychotropic medications are prescribed shall ensure all of the following requirements are met:

(a) Arrangements have been made for a physician or medical consultant to complete a medical screening of the resident for the type of psychotropic medication to be prescribed;

(b) The resident, if fourteen years of age or older, and the custodian have signed written consent forms agreeing to the use of the psychotropic medication. The facility shall pursue consent from a parent or guardian with the final consent made by the custodian; and

(c) The facility has obtained from the prescribing physician or medical consultant a written report within the first forty-five days after the resident has first received a psychotropic medication and at least every sixty days thereafter. The report must state in detail all of the following:

[1] Reasons for the initial use of the medication;

[2] Reasons for continuing, discontinuing, or changing the medication;

[3] Any recommended change in treatment goals or program; and

[4] The method and procedures for administering or monitoring of resident self-administration of a psychotropic medication must have been approved by the prescribing physician or medical consultant.

(2) Emergency procedures. For emergency administration of a psychotropic medication to a resident, a facility shall:

(a) Have authorization from a physician;

(b) Notify the custodian and parent or guardian as soon as possible following emergency administration. The facility shall document the dates, times, and individuals notified in the resident's record; and

(c) Document the physician's reasons for ordering the emergency administration of psychotropic medication.

(3) Revocation of consent or refusal. A resident or custodianmay at any time revoke consent for nonemergency use of psychotropic medications. The facility shall consider the consent or refusal of the resident's parent or guardian. When a consent is revoked, the facility shall do all of the following:

(a) Document the reasons for refusal;

(b) Employee who personally witnessed the refusal shall sign a written statement indicating the event and place it in the file;

(c) Notify the resident's physician or medical consultant; and

(d) Notify the custodian and parent or guardian. Notification must be provided immediately if the resident's refusal threatens the resident's well-being and safety.

N.D. Admin Code 75-03-40-43

Adopted by Administrative Rules Supplement 374, October 2019, effective 10/1/2019.

Amended by Administrative Rules Supplement 2021-382, October 2021, effective 10/1/2021.

General Authority: NDCC 50-11-03

Law Implemented: NDCC 12-66, 14-13