HAR §11-96-29. Pharmaceutical services

(a) The center shall consult with a licensed pharmacist on methods and procedures for storage, administration, disposal, and record keeping of drugs and biological substances. (b) A pharmacy policy manual shall be developed and kept current by the licensed nursing staff, consultant pharmacist or a licensed physician which: (1) Contains appropriate policies and procedures and defines the functions and responsibilities relating to pharmacy services; 96- (2) Is revised as necessary to keep up to date with development in overall drug usage; (3) Specifies the safe administration and handling of all drugs; and (4) Includes policies regarding self-administration of drugs. (c) Medications administered to a client shall be ordered by the attending physician in writing. (1) Where physicians' verbal orders are directed to the center, only the fa ci li ty ' s l i c e n s e d medical or nursing staff s h a l l receive such orders; and (2) Any verbal or telephone medication orders shall be recorded and signed by the person receiving them and must be verified in writing by the attending physician within four days. (d) Each drug shall be rechecked and identified prior to administration. (e) No medication shall be administered to a client by center personnel unless the name, dosage, and frequency of administration of the drug and the name of the prescribing physician are recorded in the client's record. (f) Only appropriately licensed and trained staff shall be allowed to administer drugs and shall be responsible for proper recording of the medication including the route of administration. Medication errors and drug reactions shall be recorded in the client's health record, reported immediately to the prescribing physician and an incident report prepared. All incident reports shall be kept available for inspection by the director for a period of three years. (g) Drugs shall be stored under proper 96- conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security when placed in the care of the center. (1)All drugs shall be kept under lock and key except when authorized personnel are in attendance; (2)Poisons, drugs used externally, and drugs taken internally shall be stored in locked, well marked separate cabinets, at all locations; (3)Medications that are stored in a refrigerator containing things other than drugs shall be kept apart and in a locked container; (4) Discontinued and out dated drugs,drugs left by clients who have expired or who have not visited the center for thirty days, containers with worn, illegible, or missing labels, shall be returned to the client's family or responsible party for proper disposition. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11) §11-96-30 Physical plant construction requirements. (a) The center shall be fully accessible to and functional for physically handicapped clients, personnel, and the public. (b) Each center shall comply with state and local building requirements. (c) Each center shall have a working, listed telephone on the premises. (d) Temperature and humidity shall be maintained within a normal comfort range. (e) There shall be provisions within the center for one or more areas for dining, social activities, secluded areas, and therapy areas. (1)The center shall be equipped with adequate natural and artificial lighting, tables, chairs, or their equivalent, for the use and comfort of the client; (2)Dining areas shall be equipped with tables and chairs. A sufficient number of tables shall be of proper height to accommodate wheelchair clients; (3)If a multi-purpose room is used for dining and recreational activities, there shall be 96- sufficient space to accommodate all activities; and (4)A secluded area shall be set aside for clients who require bed rest during the day; (A) The secluded area shall have chaise lounges or beds in the number necessary to meet the needs of the clients under written order of the staff or attending physician; and (B) Space around sleeping accommodations shall permit easy passage. (f) Total area for recreational and dining activities shall be not less than fifty square feet per client. (g) Activity, dining and service areas shall be accessible to all clients. (1) There shall be adequate space to allow free movement of clients using wheelchairs, walkers, canes, and crutches to bed, bathroom, closet, and common hallway areas; and (2) Areas used for cooking, storage, bathrooms, laundry, and other areas not suitable for sleeping shall not be used as rest or sleep areas. (h) There shall be one toilet room for every twelve clients. (1) The toilet room shall contain a toilet and lavatory; (2) Appropriately placed grab bars shall be provided in designated toilets, bathtubs, and shower enclosures; (3) Curtains or doors to ensure privacy shall be provided; (4) An adequate supply of hot and cold potable running water must be provided at all times. Temperatures of hot water at plumbing fixture used by clients shall be automatically regulated and shall be maintained at a level between 100_ to 110_F; (5) Each toilet and bath center shall have an auditory call system which permits the client to signal staff in an emergency; (6) There shall be at least one bathtub or shower available; and 96- (7) Separate toilet facilities shall be provided for the use of personnel. (i) Ramps must be designed to permit use by clients in wheelchairs. Ramps shall meet the provisions of the 1987 Uniform Building Code. (j) Walls and floors of rooms used by clients shall be made of materials which shall permit washing or cleaning. (k) Where appropriate, screening of doors and windows shall be provided, using screening having sixteen meshes per inch. (l) Double acting doors shall be provided with vision panels of sufficient height to permit use by walkers as well as wheelchair riders. (m) The minimum clear width of a corridor shall be thirty-six inches except that corridors serving one or more clients who require the use of a wheel chair or walking aids shall be not less than forty-four inches. Stationary handrails shall be installed at least along one side of corridors. (n) Locked storage space shall be provided for janitors' supplies and equipment. Storage space, conveniently located, for general and specialized equipment shall be provided. (o) The water supply shall be in accordance with Chapter 340E, Hawaii Revised Statutes. (p) Chapter 11-39 relating to air conditioning and ventilation, shall be followed. (q) Flashlights shall be in readiness and functional at all times. (r) Open flame types of light shall not be used. (s) Space for outdoor activities shall be easily accessible to all clients and protected from traffic. (t) Facilities shall be maintained in accordance with provisions of state and county fire safety, sanitat ion laws and ordinances. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11) §11-96-31 Physicians services. (a) All clients admitted to a center shall be under the care of a physician selected by the 96- client. (b) The physician shall authorize the client's initial individualized plan of care and major revisions thereafter. The plan of care shall be reviewed at least annually. (c) There shall be a statement from the physician as to the medical condition and functional status of the client, prescribed therapies, and any special care or observations which is required at least annually, with updates whenever there are changes which significantly alter the client's medical or functional status. (d) There shall be a statement from the physician that the client does not have active tuberculosis. (e) There shall be directions from the physician as to the procedures to be followed if the physician is not immediately available in the event of an emergency. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)