Medical care

The facility shall institute policies and procedures to address the medical care for each child during placement at the facility, including: 1. Medical examination. Each child must have a medical examination within thirty days prior to admission or within seventy-two hours of admission. 2. Immunizations. Each child must have current immunizations as required by North Dakota Century Code section 23-07-17.1. 3. Medical care arrangements. A facility shall make arrangements with a physician for medical care of each child. 4. Annual medical examination. Each child shall have a medical examination at least annually. 5. Employee instruction. The facility shall train employees what medical care, including first aid, may be given by employees without specific orders from a physician. The facility shall instruct employees how to obtain further medical care and how to handle emergency cases. 6. Hospital admission. Each facility shall institute policies and procedures regarding transfers and discharges from an admission to the hospital. A facility's policies and procedures must include arrangements made with a hospital for the admission of children from the facility in the event of serious illness or an emergency. 7. Hospitalization or death reports. A facility shall report all hospitalizations immediately to an individual who lawfully may act on behalf of the involved child. The facility shall report any death immediately to the department, an individual who lawfully may act on behalf of the child, a law enforcement agency, and the county coroner. The facility shall document these contacts in the involved child's case file. 8. Prescription labels. The facility shall obtain prescribed medications on an individual prescription basis and labeled according to state and federal rules. 9. Administration of medications. a. The facility shall institute policies and procedures for guidance in the administration of all medications. Medications must be administered by a designated employee who is medication-certified. All medications must be labeled and stored in a locked cabinet, with the keys for the cabinet kept under the supervision of the designated employee assigned to administer the medications. The medication cabinet must be equipped with separate cubicles, plainly labeled with each child's name. b. The facility shall return medications belonging to a child to the person who lawfully may act on behalf of the child upon discharge, or the designated individual in charge of medication storage shall dispose of the medications according to the facility's policies and procedures for the disposal of medications. The facility's policies and procedures for the disposal of medications must be in accordance with state and federal requirements for the disposal of medications. c. The facility may possess a limited quantity of nonprescription medications. The medications must be ordered by a physician and administered under the supervision of medication-certified employee. d. (1) The facility shall obtain written consent, including via electronic mail, or shall obtain verbal consent witnessed by another individual, from a person who lawfully may act on behalf of the child prior to administering: (a) A newly prescribed medication to the child except in an emergency situation; (b) A psychotropic medication; or (c) A medication dosage or dosage range change. A person who lawfully may act on behalf of the child who receives medication must be informed of benefits, risks, and the potential side effects of all prescribed medication. The facility shall obtain written consent within fourteen days verifying verbal consent received. The facility shall document and file all consents in the child's case file. (2) The facility shall institute policies and procedures governing the use of psychotropic medications, which require documentation in the case file justifying the necessity and therapeutic advantages for the child receiving psychotropic medication. Documentation must reflect that a trauma screening has been completed and that the symptomology that the psychotropic medication is attempting to treat is not more effectively treated through therapeutic interventions that specifically address symptomology related to trauma. e. Upon admission, when a new psychotropic medication is prescribed, and when a psychotropic medication is discontinued, a child's psychotropic medication regime must be reviewed by the attending psychiatrist every seven days for the first thirty days and every thirty days thereafter. Additionally, the facility's nursing staff shall complete an involuntary movement assessment prior to the start of, or a change in the dose of, a psychotropic medication. An involuntary movement assessment must be repeated every three months, or sooner if determined necessary, following completion of the initial involuntary movement assessment to monitor the child for side effects of the psychotropic medication.