Or. Admin. Code § 333-536-0075

Current through Register Vol. 63, No. 11, November 1, 2024

Section 333-536-0075 - Medication Services

(1) To provide non-injectable medication services, an agency must:

(a) Be classified as basic, intermediate or comprehensive;

(b) Provide medication assistance or medication administration by persons who meet the requirements of section (5) of this rule; and

(c) Provide medication services as requested by the client or client's representative in accordance with these rules, accepted standards of medication practice, and the service plan.

(d) Medication services does not include medication reminding.

(2) A client representative or family member may perform the task of filling secondary non-injectable medication containers from which an agency caregiver is to provide medication services. The agency shall obtain a signed agreement from the client representative or family member that identifies their obligation to:

(a) Provide a list of the client's medication and a physical description of each medication (a photograph may be used in lieu of a physical description), possible side effects, and any special instructions. The list must be updated when changes to the client's medication regimen are made;

(b) Keep the original labeled medication containers in the home for verification should the caregiver have questions; and

(c) Use closed non-injectable medication secondary containers designed and manufactured for that purpose that meet the labeling requirements of paragraph (4)(a)(D) of this rule.

(3) Medication administration is a medication service that allows a caregiver to administer non-injectable medications to the client. In order to provide medication administration, an agency must:

(a) Be classified as intermediate or comprehensive;

(b) Employ a registered nurse licensed under ORS chapter 678;

(c) Develop and implement safe and appropriate medication administration delivery systems and policies and procedures that include, but are not limited to, provisions to ensure:

(A) The right client receives the right medication, in the right amount, by the right route, and at the right time in accordance with the licensed independent practitioner's (LIP) order;

(B) Medication is administered by qualified and trained employees under the supervision of the agency's registered nurse;

(C) Sufficient number of registered nurses licensed under ORS chapter 678 are employed to meet the needs of medication administration services offered to clients and provide necessary oversight;

(D) Caregivers are informed about the potential adverse reactions, side effects, drug-to-drug interactions and food-to-drug interactions, and contraindications associated with each client's medication regimen;

(E) Caregivers promptly report problems or discrepancies related to each client's medication regimen to the caregivers' supervisor, agency registered nurse, administrator, administrator designee, or assigned agency representative. The report must be documented and maintained in a separate file from the client or caregiver records;

(F) Storage of medication at appropriate temperatures based on the manufacturer's recommendations while the caregiver is present and providing care; and

(G) The security and integrity of narcotics and controlled substances while the caregiver is present and providing care, and disposal of any such substances.

(d) Ensure agency staff obtain written or telephone orders from an LIP for all medications managed or administered by an agency under this rule and for any changes to those medications.

(A) Written orders shall be signed by an LIP. Electronic signatures are acceptable.

(B) Telephone orders shall be immediately recorded, dated, and signed by the agency's registered nurse, and transmitted within 72 hours to the LIP for signature. The orders that have been signed by the LIP shall be incorporated into the client's record within 30 days.

(e) Ensure that every 90 days, a registered nurse provides an evaluation of each client's medication regimen and of medication services provided by the agency to the client.

(A) A licensed practical nurse may collect data for the registered nurse's evaluation when the licensed practical nurse practice occurs under the clinical care of the registered nurse in accordance with OAR chapter 851, division 045.

(B) Documentation of the registered nurse's evaluation shall include the evaluation process, impact, outcome and summation.

(f) Ensure the medication tasks to be performed are documented in the service plan in accordance with OAR 333-536-0065.

(g) Maintain records for medication administration that include, but are not limited to, the name of each medication, physical description of the medication, the dosage to be administered, the route of administration, the frequency of administration, client medication allergies and sensitivities, client specific indicators for administration of as needed medications and other special instructions necessary for safe and appropriate administration.

(4) An agency that provides any form of medication service shall ensure:

(a) Medication packaging and labeling meet the following requirements:

(A) Prescription medications shall be in the original pharmacy containers and clearly labeled with the pharmacists' labels, unless in the secondary container as specified in this rule.

(B) Samples of medications received from the LIP shall be in the original containers and have the original manufacturers' labels.

(C) Over-the-counter medications shall be in the original containers and have the original manufacturers' labels.

(D) Secondary containers and all removable compartments must be labeled with the client's name, the specific time the medications in each compartment are to be administered, the date and time the secondary container was filled, and the name of the individual who filled the container.

(E) Liquid and non-pill medications that cannot be put in secondary containers shall be appropriately labeled.

(b) Medication tasks are documented by the individuals performing the tasks. The documentation shall include the tasks completed, the date and signature of the individual(s) performing the task(s), and shall be maintained in accordance with agency policies and procedures.

(5) Agency caregivers assigned to provide medication services must complete the necessary training described in OAR 333-536-0070 prior to providing medication services.

(6) Effective January 1, 2024, any order issued for the care or treatment of a client by a physician that is licensed in another state may be executed by an Oregon licensed registered nurse employed by an agency for no more than 90 days from the time the client was added to the agency's clientele.

Or. Admin. Code § 333-536-0075

OHD 19-2002, f. 12-4-02, cert. ef. 2-1-03; PH 3-2004(Temp), f. & cert. ef. 2-6-04 thru 7-30-04; PH 22-2004, f. & cert. ef. 6-25-04; PH 14-2007, f. 12-19-07, cert. ef. 1-1-08; PH 10-2012, f. 6-26-12, cert. ef. 7-1-12; PH 26-2021, amend filed 06/29/2021, effective 7/1/2021; PH 50-2023, amend filed 10/23/2023, effective 10/23/2023

Statutory/Other Authority: ORS 443.340 & ORS 443.011

Statutes/Other Implemented: ORS 443.340, ORS 443.315, ORS 443.011 & OL 2023, ch. 275