Agency Medication Standards And Requirements

The agency must develop and implement written policy and procedures describing the program’s system for handlin g participant medications. (3-17-22) 01. Medication Policy. Each agency must develop written medication policies and procedures that outline in detail how the agency will ensure appropriate handling and safeguarding of medications. An agency tha t chooses to assist participants with medications to include PRN medications must also develop specific policies an d procedures to ensure this assistance is safe and is delivered by qualified, fully-trained staff. Documentation o f training must be maintained in the staff personnel record. (3-17-22) 02. Handling of Participant’s Medication. (3-17-22) a. The medication must be in the original pharmacy-dispensed container, or in an original over-the- counter container, or placed in a unit container by a licensed nurse and be appropriately labeled with the name of th e medication, dosage, time to be taken, route of administration, and any special instructions. Each medication must b e packaged separately, unless in a Mediset, blister pack, or similar system. (3-17-22) b. Evidence of the written order for the medication from the physician or other practitioner of th e healing arts must be maintained in the participant’s record. Medisets, blister pack, or similar system filled and labele d by a pharmacist or licensed nurse can serve as written evidence of the order. An original prescription bottle labeled b y a pharmacist describing the order and instructions for use can also serve as written evidence of an order from the physician or other practitioner of the healing arts. (3-17-22) c. The agency is responsible to safeguard the participant’s medications when assuming th e responsibility for assisting with medications. (3-17-22) d. Medications that are expired or no longer used by the participant must not be retained by th e agency or agency staff for longer than thirty (30) calendar days. (3-17-22) 03. Self-Administration of Medication. When the participant is responsible for administering thei r own medication without assistance, a written approval stating that the participant is capable of self-administratio n must be obtained from the participant’s primary physician or other practitioner of the healing arts. The participant’ s record must also include documentation that a physician or other practitioner of the healing arts, or a licensed nurs e has evaluated the participant’s ability to self-administer medication and has found that the participant: (3-17-22) a. Understands the purpose of the medication; (3-17-22) b. Knows the appropriate dosage and times to take the medication; (3-17-22) c. Understands expected effects, adverse reactions or side effects, and action to take in an emergency ; and (3-17-22) d. Is able to take the medication without assistance. (3-17-22) 04. Assistance with Medication. An agency may choose to assist participants with medications ; however, only a licensed nurse or other licensed health professional may administer medications. Prior to unlicense d agency staff assisting participants with medication, the following conditions must be in place: (3-17-22) a. Each staff person assisting with participant medications must successfully complete and follow th e “Assistance with Medications” course available through the Idaho Division of Career-Technical Education, or other Department-approved training; (3-17-22) b. The participant’s health condition is stable; (3-17-22) c. The participant’s health status does not require nursing assessment, as outlined in IDAPA 24.34.01, “Rules for the Idaho Board of Nursing,” before receiving the medication or nursing assessment of the therapeutic o r side effects after the medication is taken; (3-17-22) d. The medication is in the original pharmacy-dispensed container with proper label and directions, or in an original over-the-counter container, or the medication has been placed in a unit container by a licensed nurse . Proper measuring devices must be available for liquid medication that is poured from a pharmacy-dispense d container; (3-17-22) e. Written and oral instructions from a licensed physician or other practitioner of the healing arts , pharmacist, or nurse concerning the reason(s) for the medication, the dosage, expected effects, adverse reactions o r side effects, and action to take in an emergency have been reviewed by the staff person; (3-17-22) f. Written instructions are in place that outline required documentation of assistance and who to call i f any doses are not taken, overdoses occur, or actual or potential side effects are observed; (3-17-22) g. Procedures for disposal or destruction of medications must be documented and consistent wit h procedures outlined in the “Assistance with Medications” course or local medication destruction programs.(3-17-22) 05. Administration of Medications. Only a licensed nurse or another licensed health professiona l working within the scope of their license may administer medications. Administration of medications must compl y with IDAPA 24.34.01, “Rules of the Idaho Board of Nursing.” (3-17-22) 303. AGENCY POLICIES AND PROCEDURES REGARDING DEVELOPMENT OF SOCIAL SKILL S AND MANAGEMENT OF MALADAPTIVE BEHAVIOR. Each agency must develop and implement written policies and procedures that address the development o f participants’ social skills and management of maladaptive behavior. These policies and procedures must includ e statements that address: (3-17-22) 01. Adaptive and Maladaptive Behavior. The agency must address possible underlying causes o r function of a behavior and identify what the participant may be attempting to communicate by the behavior. (3-17-22) 02. Behavior Intervention. Positive behavior interventions must be used prior to and in conjunctio n with, the implementation of any restrictive intervention. Interventions must address the following: (3-17-22) a. Social Skills Development. Focus on developing or increasing participants’ social skills. (3-17-22) b. Prevention Strategies. Ensure and document the use of positive approaches to increase social skills and decrease maladaptive behavior while using least restrictive alternatives and consistent, proactive responses t o behaviors. (3-17-22) c. Behavior replacement. Ensure that programs to assist participants with managing maladaptiv e behavior include teaching of alternative adaptive skills to replace the maladaptive behavior. (3-17-22) d. Protected Rights. Ensure the safety, welfare, and human and civil rights of participants ar e adequately protected. (3-17-22) e. Objectives and Programs. Ensure that objectives and intervention techniques are developed o r obtained and implemented to address self-injurious behavior, aggressive behavior, inappropriate sexual behavior, and any other behaviors that significantly interfere with participants’ independence or ability to participate in th e community. Ensure that reinforcement selection is individualized and appropriate to the task and not contraindicate d for medical reasons. (3-17-22) f. Participant Involvement. Ensure programs developed by the agency involve the participants, to th e best of their ability, in developing the plan to increase social skills and to manage maladaptive behavior. (3-17-22) g. Written Informed Consent. Ensure programs developed by an agency to assist participants wit h managing maladaptive behaviors are conducted only with the written informed consent of the participant, or lega l guardian, where applicable. When programs used by the agency are developed by another service provider the agency must obtain a copy of the informed consent. (3-17-22) h. Review and Approval. Programs developed by an agency to manage maladaptive behavior ar e implemented after the review and written approval of the residential habilitation professional. If the program contain s restrictive or aversive components, an individual working within the scope of their license or certification must als o review and approve, in writing, the program prior to implementation. When programs implemented by the agency ar e developed by another service provider, the agency must obtain a copy of these reviews and approvals. (3-17-22) 03. Appropriate Use of Interventions. Employees of the agency must not use physical, verbal , sexual, or psychological abuse, or punishment. For the purposes of these rules, punishment is any procedure in which an adverse consequence is presented that is designed to produce a decrease in the rate, intensity, duration, o r probability of the occurrence of a behavior; or, the administration of any noxious or unpleasant stimulus o r deprivation of a participant’s rights or freedom for the purpose of reducing the rate, intensity, duration, or probabilit y of a particular behavior. Employees of the agency must not withhold food or hydration that contributes to a nutritionally adequate diet. The agency must ensure that interventions used to manage participants’ maladaptiv e behavior are never used: (3-17-22) a. For disciplinary purposes; (3-17-22) b. For the convenience of staff; (3-17-22) c. As a substitute for a needed training program; or (3-17-22) d. By untrained or unqualified staff. (3-17-22) 04. Use of Restraint on Participants. No restraints, other than physical restraint in an emergency , must be used on participants prior to the use of positive behavior interventions. The following requirements apply t o the use of physical restraint on participants: (3-17-22) a. Physical restraint. (3-17-22) i. Physical restraint may be used in an isolated emergency to prevent injury to the participant o r others and must be documented and reviewed in the participant’s record by the direct service staff and the residentia l habilitation professional. Documentation must include a debrief with the participant and staff involved focusing o n strategies to avoid the occurrence of future physical restraints. (3-17-22) ii. Physical restraint may be used in a non-emergency setting when a written behavior change plan i s developed by the participant and their guardian, if applicable, their team, and a qualified residential habilitatio n professional. Informed participant consent is required. (3-17-22) 304. -- 399. (RESERVED)