Labeling and Storage of Medications

Section 390 Section 390.1440  Labeling and Storage of Medications a)         All medications for all residents shall be properly labeled and stored at or near the nurses' station in a locked cabinet, in a locked medication room, or in one or more locked mobile medication carts of satisfactory design for such storage.  (See subsections (f) and (g) of this Section.) 1)         These cabinets, rooms, and carts shall be well lighted and of sufficient size to permit storage without crowding. 2)         All mobile medication carts shall be under the visual control of the responsible nurse at all times when not stored safely and securely. b)         All medications for external use shall be kept in a separate area in the medicine cabinet, medicine room or mobile medication cart. c)         All poisonous substances and other hazardous compounds shall be kept in a separate locked container away from medications. d)         Biologicals or medications requiring refrigeration shall be kept in a separate , securely fastened and locked box within a refrigerator or a locked refrigerator, at or near the nurses' station or in a refrigerator within a locked medication room. e)         The key or access code to the medicine cabinet, medicine  room or mobile medication cart shall be the responsibility of, and in the possession of, the persons authorized to handle and administer medications at all times. f)         The label of each individual multidose medication container filled by a pharmacist shall clearly indicate the resident's full name; licensed prescriber's name; prescription number, name, strength and quantity of drug; date this container was last filled; the initials  of the pharmacist and, if applicable, the pharmacy technician filling the prescription; the identity of the pharmacy; the refill date; and any necessary special instructions.  If the individual multidose medication container is filled by a licensed prescriber from his or her own supply, the label shall clearly indicate all of the preceding information and the source of supply; it shall exclude identification of the pharmacy, pharmacist and prescription number. g)         Each single unit or unit dose package shall bear the proprietary and nonproprietary name of the drug, strength of dose and total contents delivered, lot or control number, and expiration date, if applicable.  The names of the resident and the licensed prescriber do not have to be on the label of the package, but they must be identified with the package in such a manner as to assure that the drug is administered to the right resident.  Appropriate accessory and cautionary statements and any necessary special instruction shall be included, as applicable.  Hardware for storing and delivering the medications shall be labeled with the identity of the dispensing pharmacy.  The pharmacist shall provide written verification of the date the medications were dispensed and the initials (or unique identifier) of the pharmacist who reviewed and verified the medications.  The pharmacist need not store such verification at the facility but shall readily make it available to the Department upon request.  The lot or control number need not appear on unit dose packages if the dispensing pharmacy has a system for identifying those doses recalled by the manufacturer/distributor or if the dispensing pharmacy will recall and destroy all dispensed doses of a recalled medication, irrespective of a manufacturer's/distributor's specifically recalled lot. h)         Medication in containers having soiled, damaged, incomplete, illegible, or makeshift labels shall be returned to the issuing pharmacist, pharmacy, or dispensing licensed prescriber for relabeling or disposal.  Medications whose directions for use have changed since the medication was originally dispensed and labeled may be retained for use at the facility in accordance with the licensed prescriber's current medication order.  Medications in containers having no labels shall be destroyed in accordance with federal and State laws. i)          The medications of each resident shall be kept and stored in their originally received containers.  Medications shall not be transferred between containers, except that a licensed nurse, acting as the agent of the resident, may remove previously dispensed medication from original containers and place it in other containers to be sent with a resident when the resident will be out of the facility at the time of scheduled administration of medication.  When medication is sent out of the facility with the resident, it shall be labeled by the nurse with the name of the resident, name and strength of the medication, instructions for administration and any other appropriate information.