Compliance with Licensed Prescriber's Orders

Section 390 Section 390.1420  Compliance with Licensed Prescriber's Orders a)         All medications shall be given only upon the written, facsimile or electronic order of a licensed prescriber.  The facsimile or electronic order of a licensed prescriber shall be authenticated by the licensed prescriber within 10 calendar days, in accordance with Section 390.1610.  All such orders shall have the handwritten or electronic signature of the licensed prescriber.  (Rubber stamp signatures are not acceptable.)  These medications shall be administered as ordered by the licensed prescriber and at the designated time. b)         Telephone orders may be taken by a registered professional nurse, licensed practical nurse or licensed pharmacist.  All such orders shall be immediately written on the resident's clinical record or a telephone order form and signed by the nurse or pharmacist taking the order.  These orders shall be countersigned by the licensed prescriber within 10 calendar days. c)         The staff pharmacist or consultant pharmacist shall review the medical record, including licensed prescriber orders and laboratory test results, at least monthly and, based on  their clinical experience and judgment, and Section 390.Appendix C, determine if there are irregularities that would cause adverse reactions, allergies, interactions, contraindications, medication errors or ineffectiveness.  This review shall be documented in the clinical record.  Portions of this review may be done outside the facility.  Any irregularities noted shall be reported to the attending physician, the advisory physician, the director of nursing and the administrator, and shall be acted upon. d)         A medication order not specifically limiting the time or number of doses shall be automatically stopped in accordance with written policy approved by the pharmaceutical advisory committee. e)         The resident's licensed prescriber shall be notified of medications about to be stopped so that the licensed prescriber may promptly renew such orders to avoid interruption of the resident's therapeutic regimen. f)         The licensed prescriber shall approve the release of any medications to the resident, or person responsible for the resident's care, at the time of discharge or when the resident is going to be temporarily out of the facility at medication time.  Disposition of the medications shall be noted in the resident's clinical record.