Section 670. Administration of medications and related provisions

A. Staff who are licensed, registered, or acting as a medication aide on a provisional basis as specified in 22VAC40-72-660 shall administer drugs to those residents who are dependent in medication administration as documented on the UAI.

B. All medications shall be removed from the pharmacy container by a staff person licensed, registered, or acting as a medication aide on a provisional basis as specified in 22VAC40-72-660 and administered by the same staff person not earlier than one hour before and not later than one hour after the facility's standard dosing schedules, except those drugs that are ordered for specific times, such as before, after or with meals. Pre-pouring for later administration is not permitted.

C. All medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing.

D. All medications shall remain in the pharmacy issued container, with the legible prescription label or direction label attached, until administered.

E. Sample medications shall remain in the original packaging, labeled by a physician or other prescriber or pharmacist with the resident's name, the name of the medication, the strength, dosage, route and frequency of administration, until administered.

F. Over-the-counter medication shall remain in the original container, labeled with the resident's name, or in a pharmacy-issued container, until administered.

G. In the event of an adverse drug reaction or a medication error:

1. First aid shall be administered as directed by a physician, pharmacist or the Virginia Poison Control Center.

2. The resident's physician of record shall be notified as soon as possible.

3. The direct care staff person shall document actions taken in the resident's record.

H. The facility shall document on a medication administration record (MAR) all medications administered to residents, including over-the-counter medications, and dietary supplements. The MAR shall include:

1. Name of the resident;

2. Date prescribed;

3. Drug product name;

4. Strength of the drug;

5. Dosage;

6. Diagnosis, condition, or specific indications for administering the drug or supplement;

7. Route (for example, by mouth);

8. How often medication is to be taken;

9. Date and time given and initials of direct care staff administering the medication;

10. Dates the medication is discontinued or changed;

11. Any medication errors or omissions;

12. Description of significant adverse effects suffered by the resident;

13. For PRN medications:

a. Symptoms for which medication was given;

b. Exact dosage given; and

c. Effectiveness; and

14. The name, signature and initials of all staff administering medications.

I. The performance of all medical procedures and treatments ordered by a physician or other prescriber shall be documented and the documentation shall be retained in the resident's record.

J. The use of PRN (as needed) medications is prohibited, unless one or more of the following conditions exist:

1. The resident is capable of determining when the medication is needed;

2. Licensed health care professionals are responsible for medication administration and management; or

3. The facility has obtained from the resident's physician or other prescriber detailed written instructions or a staff person as allowed in 22VAC40-72-640 D has telephoned the physician or other prescriber prior to administering the medication, explained the symptoms and received a documented oral order to assist the resident in self-administration. The physician's or other prescriber's instructions shall include symptoms that might indicate the use of the medication, exact dosage, the exact time frames the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist.

K. Medications ordered for PRN administration shall be available, properly labeled for the specific resident and properly stored at the facility.

L. Stat-drug boxes may only be used when the following conditions are met:

1. There is an order from the prescriber for any drug removed from the stat-drug box; and

2. The drug is removed from the stat-drug box and administered by a nurse, pharmacist or prescriber licensed to administer medications.

A stat-drug box may be prepared by a pharmacy prior to the receipt of ordered drugs from the pharmacy. Stat-drug boxes are subject to the conditions specified in 18VAC110-20-550 of the Virginia Board of Pharmacy.

Historical Notes

Derived from Volume 23, Issue 06, eff. December 28, 2006; amended, Virginia Register Volume 25, Issue 08, eff. February 5, 2009; Volume 25, Issue 19, eff. August 1, 2009.

Statutory Authority

§§ 63.2-217 and 63.2-1732 of the Code of Virginia.