<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".17" citation="COMAR 10.12.04.17" title_num="10" subtitle_num="12" chapter_num="04" heading="Medication Services and Policies.">
  <paragraph num="A.">
    <text>Written policies for the center shall specify that the RN, LPN, or CMT is authorized to procure, receive, control, and manage the administration of medications at the center.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Medications.</text>
    <paragraph num="(1)">
      <text>Medicine or drugs shall be restricted to those prescribed for the participant by the authorized prescriber.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>All medications shall be accurately and plainly labeled and kept in the original container issued by the prescriber or pharmacist except as provided in §F(3) of this regulation.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Containers shall be labeled with the:</text>
      <paragraph num="(a)">
        <text>Participant's full name;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Authorized prescriber;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Prescription number;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Name of the medication and dosage;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Date of issuance;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Expiration date;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Refill limits;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Directions for use; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Name, address, and telephone number of the pharmacy issuing the drug.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Nurses may not package, repackage, bottle, or label, in whole or in part, any medication in any way by tampering or defacing any labeled medication, except that a nurse may take medications from pharmacy dispensed containers and place the medication in a pill box for the cognitively intact participant who lives independently to self-administer.</text>
  </paragraph>
  <paragraph num="D.">
    <text>When a RN or LPN observes an adverse reaction to a medication, the nurse shall immediately call the:</text>
    <paragraph num="(1)">
      <text>Participant's health care provider;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Designee of the participant's health care provider; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The health care provider that is on call for the center.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Drug Administration and Recording.</text>
    <paragraph num="(1)">
      <text>The center shall maintain records of all Schedule II drugs.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Written Order.</text>
      <paragraph num="(a)">
        <text>Except as provided in §E(2)(b) of this regulation, medications may not be administered without a written order that has been signed by the authorized health care provider.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Medication may only be given based upon a verbal order when the verbal order has been recorded and signed by the RN or the LPN.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Verbal orders shall be signed by the authorized health care provider within 30 days.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Except as provided in Regulation .14B(2)(c)(iii), only an RN, LPN, or authorized health care provider shall give injectable medication.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>For those participants who are not capable of self-medicating, the individual assigned the responsibility of administering medications shall:</text>
      <paragraph num="(a)">
        <text>Prepare the dosage;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Observe the participant swallowing the oral medication; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Document that the participant has taken the medication.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Staff members who are licensed and certified to administer medications shall make a written record of the medications and treatments that are administered.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Orders shall be reviewed and updated in a timely manner, consistent with nursing practice standards, when there is a change in the participant's condition.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Drug Storage.</text>
    <paragraph num="(1)">
      <text>The center shall:</text>
      <paragraph num="(a)">
        <text>Provide a safe, secure, locked place for medicines or drugs, and for making medications available to a participant according to the instructions of his or her health care provider;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Store Schedule II drugs in a locked box within the medicine cabinet;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Keep medications requiring refrigeration in a separate locked refrigerator or a locked box within a medication refrigerator; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Store medications and medical supplies in a manner that is secured and apart from participant activity areas, food storage areas, and chemical storage areas.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A licensed nurse shall inspect the drug storage conditions at least every 3 months and document his or her findings.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The center may keep over-the-counter type medications or supplements that can be purchased without prescription, such as aspirin or antacids, for administration as ordered by the participant's practitioner.</text>
    </paragraph>
  </paragraph>
</regulation>