Ala. Admin. Code r. 580-9-46-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 580-9-46-.01 - General Medical And Pharmacy

(1) The agency must demonstrate that all medical care aspects of the program are performed or supervised by a physician licensed to practice in the State of Alabama.

(2) The agency must have written medical procedures which describe the steps for the management of medical emergencies.

(3) All residential programs must demonstrate their client's accessibility to a local licensed hospital for the purpose of providing emergency hospital care.

(4) All substance abuse treatment programs must provide for, or be able to refer, clients for physical and/or laboratory examinations when clinically appropriate in accordance with the supervising physician's written medical procedures. However, programs are not required to provide uncompensated medical care.

(5) For those situations where drug screening by urinalysis is deemed appropriate and necessary by the program director, or supervising physician, the program must:

(a) Establish procedures which protect against the falsification and/or contamination of any urine sample;

(b) Provide assurance that no client will be discharged from treatment solely on the basis of a single positive urine analysis (not applicable to substance abuse residential programs).

(6) The agency must, at all times, meet applicable federal and state requirements regarding the storing and/or dispensing of "prescription legend" and/or "controlled substance" drugs (including, but not limited to: Code of Ala. 1975, Section 34-23-94, Code of Ala. 1975, Section 20-2-1 through 20-2-93; Federal Controlled Substance Act of 1970; Indigent Drug Program Manual for Mental Health Centers, where applicable).

(7) Any agency storing bulk quantities of "controlled substance" or "prescription legend" drugs must document that one of the following Drug Enforcement Administration (DEA) registration procedures has been met:

(a) The supervising or consulting physician for the program has registered the facility as one of his offices with the DEA Registration Branch, or;

(b) The program itself has been registered with the DEA Registration Branch when there is more than one physician involved with the program.

(8) The agency must demonstrate accurate accounting/ tracking procedures for all "controlled substance" and/or "prescription legend" drugs purchased/dispensed by the program. These procedures must additionally account for any client owned medication that is present in the facility. The following records must be kept on all such drugs received, and administered, or self-administered:

(a) A medication log/running inventory on which the following information is recorded:

1. Date on which drug(s) were placed in inventory;

2. Brand name/generic name;

3. Quantity/dosage of drug(s);

4. Date drug(s) were administered;

5. Initials/signature of nurse administering drug(s).

(b) A medication sheet for each individual client on which the following information is recorded each time drugs are administered:

1. Brand name/generic name;

2. Date/time drugs were administered;

3. Quantity/dosage;

4. Initials/signature of nurse administering drugs, or initial/signature of client when self medicating;

5. Client's name;

(c) Non-prescription medication allowed to be self-administered to a client in a substance abuse residential treatment program shall be recorded on the medication sheet.

(d) The agency must document that a reconciliation of the drug inventory, performed under the supervision of the program director or supervising physician, is performed according to the following:

1. At least semiannually;

2. Each time there is a change in the responsibilities among those individuals with designated access to the drug supplies.

(9) All "controlled substances" and/or "prescription legend" drugs kept in the facility must be stored in a locked cabinet or other substantially constructed storage that precludes surreptitious entry.

(10) All such storage units must be locked when not in use.

(11) Access to all "controlled substances" and/or prescription legend" drugs must be restricted to the absolute minimum number of employees needed to handle daily transactions of such drugs.

(12) A listing of those employees permitted access to the drugs will be on file at the agency. This listing should be displayed in the drug storage area.

(13) In the event of loss or the theft of controlled substances, the agency must perform the following:

(a) Notify local law enforcement personnel immediately upon the detection of the loss;

(b) Notify the supervising physician immediately upon the loss if the supervising or consulting physician has registered the program as one of his offices with the DEA Registration Branch;

(c) Notify the DEA Registration Branch directly if the program itself has been registered with the DEA Registration Branch;

(d) Notify the Director, Substance Abuse Services Division, Department of Mental Health within 24 hours of the detection of the loss;

(e) Provide a subsequent written description of the events and extent of the loss to the Director, Substance Abuse Services Division, Department of Mental Health. This written description must be mailed within 72 hours from loss detection.

(14) For residential services, there shall be a registered nurse or licensed practical nurse as a full-time or part-time employee or a consultant to the provider who is responsible for supervision of delegation of medication assistance to the unlicensed personnel. Access to an on-call nurse must be available 24 hours/day, 7 days/week. Providers will implement policies and procedures approved by their Boards of Directors requiring full compliance with the Alabama Board of Nursings regulation 610-X-6-.15 Alabama Department of Mental Health Residential Community Programs.

Ala. Admin. Code r. 580-9-46-.01

New Filed: July 22, 1992. Extended: September 30, 1992. Extended: December 31, 1992. Certified: March 30, 1993. Effective: May 5, 1993. Amended: Filed November 19, 2003; effective December 24, 2003. Amended: Filed September 5, 2007; effective October 10, 2007.

Author: Substance Abuse Services Division

Statutory Authority:Code of Ala. 1975, § 22-50-11.