Health Care

PURPOSE: This rule sets forth the procedures for health care, emergency medical care, psychiatric and psychological care, including psychotropic medication. (1) Health Care Procedure. (A) The agency shall have a written health care program plan which shall address preventive medical, eye, hearing, and dental care. (B) The agency’s health care program shall include admission examinations, subsequent examinations, nursing care, first-aid procedures, dispensing of medicine, basic remedial treatment and the training and implementation of the use of the universal health care precautions and the other basic principles of communicable disease prevention. The agency shall make provisions for the services of a licensed physician to be responsible for medical care, including on site or office visits. (C) At admission, the agency shall obtain written authorization for each child from the parent(s), guardian, or legal custodian for emergency medical care, necessary immunizations, and for routine medical examinations and care. (D) A complete medical examination by a licensed physician certified nurse practitioner, advanced practice nurse in a collaborative practice agreement with a licensed physician, or a registered nurse who is under the supervision of a licensed physician shall be given to each child within thirty (30) days prior to admission, or within ten (10) days after admission. The findings of the examination shall be recorded on a form prescribed by the division, or one containing the equivalent information. Children shall receive physical examinations in accordance to the periodicity of the Missouri medicaid healthy children and youth schedule for medical and developmental examinations. (E) If a child shows overt signs of highly infectious disease or other evidence of ill health, the agency shall make arrangements for an immediate examination by a licensed physician. (F) Any child who has not received primary immunization prior to admission shall be immunized according to the Department of Health and Senior Services’s current guidelines. (G) A current immunization history shall be maintained for each child. (H) Booster shots shall be administered to children as needed, and at time intervals recommended by the agency physician or by the Department of Health and Senior Services’s current guidelines. (I) Each child shall be given an annual eye examination and corrective treatment shall be provided as prescribed. (J) Children must be tested for communicable diseases including, but not limited to, tuberculosis and hepatitis according to the recommendations of a licensed physician. (K) Dental Care. 1. Children must have a dental examination by a licensed dentist within one (1) year before admission or within three (3) months after admission. A copy of the examination report and findings must be in the child’s record. 2. A child shall have a dental examination at least annually while in care. (L) Any treatment or corrective measures required by the licensed physician or dentist shall be arranged by the agency, as approved by a parent, guardian, or legal custodian. (M) Upon discharge, a copy or summary of the child’s health and dental records shall be provided to the child’s parent(s), guardian, or legal custodian. (2) Emergency Medical Procedure. (A) At least one (1) staff member shall be qualified/certified to administer first aid, including adult/child cardio pulmonary resuscitation, and shall be available within the agency at all times. (B) A first-aid kit shall be readily available. (C) An agency shall contact a child’s parent(s), guardian, or legal custodian immediately, but no longer than twelve (12) hours when a serious illness, a serious injury, or hospitalization of the child occurs. This includes any visit to an emergency medical facility. (D) In the event of the death of a child, the parent(s), guardian, legal custodian, and the division shall be notified immediately. (3) Isolation for Illness. Provision shall be made for the medical isolation of any child with a highly communicable disease or other evidence of ill health which poses a serious threat to other children. (4) Psychiatric and Psychological Care. When the agency’s treatment plan for a child indicates a need for professional care by a psychiatrist or a psychologist, the specialized treatment shall be provided, or arranged for, by the agency. (5) Medicine and Drugs. (A) All medication shall be prescribed by a licensed physician, and administered by a licensed nurse or staff who have successfully completed and maintained, at a minimum, the Level 1, Medication Aide Training Program or a recognized medication certification training program, approved by the division for children in residential treatment. (B) All medicine and drugs shall be kept in a locked unit and shall only be accessible to and dispensed by the agency nurse or qualified/certified staff. Medications requiring refrigeration shall also be stored in a locked unit. (C) All medication shall be labeled to indicate the name of the child, the type and dosage of medication, and shall be dated. All administered, transferred, and/or destroyed medications shall be documented on a medication administration record. (D) Medication prescribed for one (1) child shall not be administered to another. (E) No child shall self-administer medication unless the practice is approved by a licensed physician, or a registered nurse with approval of a licensed physician. The approval shall be documented in the child’s medication record and treatment plan. (F) When medications which are approved by a physician’s order are prescribed, continued, discontinued or changed, an entry shall be made in the child’s record. Entries shall be evaluated at least every thirty (30) days by a licensed nurse or staff that have successfully completed a recognized medication certification training program approved by the division for children in residential care. (G) When medications are discontinued, they shall be destroyed within forty-eight (48) hours by staff as directed by a licensed physician or qualified pharmacist or a registered nurse. (H) Upon discharge, all medication shall be transferred with the resident for whom it was prescribed. Medication must be given directly to a responsible adult/guardian/legal custodian or adult designee (such as a contracted transportation service) of the resident. (6) Psychotropic Medication. (A) Prescribing Psychotropic Medication. 1. An agency shall have written policies, which, upon request, shall be made available to the child’s parent(s), or guardian or legal custodian, or both, to staff and to the child, governing the use of psychotropic medication. 2. The prescribing physician shall provide a written medication order reflecting the reasons for prescribing the medication, the dosages and the frequency of administration. 3. When a written order for psychotropic medication is provided by a physician to be administered in an emergency situation in his/her absence, staff shall document all dosages of medication given. The physician shall fully document the justification for, and the expected results of, the medication order. 4. Psychotropic medication shall not be administered as a form of punishment, as a substitute for a program, or due to lack of staff. 5. Unless there is a court order to the contrary, the parent(s), guardian or legal custodian of a child shall give prior, informed, written consent to the use of medication. Consent may be given at the time of admission. 6. The parent(s), guardian or legal custodian shall be informed regarding any possible side-effects of medications to be administered. This shall be documented in the child’s record. (B) Administering and Monitoring of All Medications, Including Psychotropic Medication. 1. The following information shall be maintained in the case record of each child receiving medication: A. The medication history of the child; B. Documentation of all medication administered; C. A description of any significant changes in the child’s appearance or behavior that may be related to the use of medication; D. Any medication errors; and E. A record of each refusal of medication including the child’s name, the date, the time, the staff administering medication and the child’s reason for refusal. (C) Staff Training Relating to Medication Management. An agency shall provide training for all staff who work directly with children to enable them to recognize changes in a child’s appearance or behavior that may be related to the use of any medication, including psychotropic. AUTHORITY: sections 210.481, 210.486, and 210.506, RSMo 2000.* This rule originally filed as 13 CSR 40-71.075. Emergency rule filed Nov. 1, 1993, effective Nov. 12, 1993, expired March 11, 1994. Emergency rule filed March 2, 1994, effective March 12, 1994, expired July 9, 1994. Original rule filed Nov. 1, 1993, effective June 6, 1994. Moved to 13 CSR 35-71.075, effective Oct. 30, 2008. Amended: Filed Dec. 16, 2013, effective June 30, 2014. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.