N.J. Admin. Code § 8:111-14.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:111-14.2 - Standards for drug administration

(a) The facility's policies and procedures shall ensure that medication(s), in the correct strength and dosage and at the correct time intervals, are administered to the correct client through the prescribed route of administration. The facility's policies and procedures shall ensure a method of tracking the line of possession of the medications while in the facility and shall describe the facility's plan to ensure the adequate maintenance of supplies, including at least the following:

1. Methods for procuring medications on a routine basis, in emergencies and in the event of disaster;

2. Stocking and maintenance of emergency kits and carts, including:

i. Assuring the contents thereof are appropriate for the type of clients served in the facility;

ii. Verification and approval by the medical director of the contents of emergency kits and carts, and review thereof by the director of nursing;

iii. The location and contents of emergency kits and carts;

iv. Frequency of reviewing contents and expiration dates of medications;

v. Assignment of responsibility for reviewing contents; and

vi. Emergency kits should have a breakable seal to indicate use of the kit, since they are not to be kept under lock and key;

3. Acceptable methods for ordering medications shall be consistent with the following:

i. Orders shall be in writing and shall specify the name and strength of the medication, dose, frequency and route of administration;

ii. Orders shall be signed and dated by the prescriber;

iii. Verbal orders and telephone orders shall be written and countersigned by authorized medical personnel issuing the verbal order or telephone within 72 hours of the original order and provide the information required in (a)3i and ii above; and

iv. Special requirements for prescribing or dispensing controlled drugs shall be noted on the prescription and in the client's clinical record;

4. Administration of medication, including establishment of the times for administration of medication prescribed;

5. When self-administration is permitted at the facility, the self-administration process shall include:

i. A prohibition on self-administration of medication, except upon a written order of the prescriber;

ii. Storage and labeling of medications, including directions for use and appropriate cautionary and/or warning messages;

iii. Methods for documenting self-administration of medication in the client's clinical record and medication administration record along with signature and date of staff observing self-administration;

iv. Individualized client medication administration record;

v. Training and education of clients and staff in self-administration and the safe use of medications including procedures for self-administration off-site (examples include field trips, outings away from the facility, etc.);

vi. Identification of staff trained and authorized to observe self-administration; and

vii. Establishment of precautions against clients sharing their medications with one another;

6. Procedures for documenting and reporting adverse medication reactions, medication errors and medication defects, subject to the following:

i. Allergies shall be documented in the client's clinical and medical record and on their outside front covers; and

ii. Medication product defects shall be reported in accordance with the USP-NF Online;

7. Procedures for ensuring the immediate delivery of emergency (STAT) doses from the pharmacy even during off hours;

8. If permitted at the facility, over-the-counter floor stock medications approved as set forth on a list maintained at the facility and the amounts that may be and are stored throughout the facility.

i. A limited quantity of prescription (legend) medications that are approved by the medical director, properly labeled according to the manufacturer and State law, may be stocked for STAT doses. The number of doses stocked for each medication shall be that number that would last one client approximately three days;

9. Discontinuation of medication orders, including:

i. The length of time medication orders may be in effect, for medications that are not specifically limited as to duration of use or number of doses when ordered, including intravenous infusion solutions;

ii. A process for notifying the prescriber prior to the expiration of a medication order in accordance with the written policy of the facility, to ensure that the medication for the specific client is discontinued if no specific renewal is ordered; and

iii. Removal of discontinued medications within 30 days of the discharge of the client;

10. Standards for the purchase, storage, safeguarding, accountability, use and disposal of medications consistent with N.J.A.C. 13:39 and 24:21-1 et seq.;

11. Standards for the procurement, storage, use and disposal of needles and syringes in accordance with State laws and a system of accountability therefor, which shall not require counting of individual needles and syringes after they are placed in a container for disposal;

12. Standards for the control of medications subject to 24:21-1 et seq., consistent with N.J.A.C. 13:39, and other applicable Federal and State laws, including:

i. Provisions for a verifiable record system for controlled medication;

ii. Procedures to be followed when inventories of controlled medications cannot be verified, medications are lost, contaminated, unintentionally wasted or destroyed, which procedures shall include a written report of the incident signed and dated by the individuals involved and any witnesses; and

iii. Procedures for the intentional wasting of controlled medications, including the disposal of partial doses, which shall include written documentation of the event signed by the individual responsible for the intentional wasting of the medication and an individual assigned to witness the event;

13. Maintenance of a record of each onsite prescriber's Federal Drug Enforcement Administration numbers and State CDS numbers;

14. Data to be maintained on each medical unit, including:

i. A list of abbreviations, metric conversion charts and chemical symbols, subject to approval by the medication staff;

ii. Specific information on medications and other drugs, including indications, contraindications, actions, reactions, interactions, cautions, precautions that should be taken, toxicity and dosages that is, Physician's Desk Reference (PDR), USP-NF Online; and

iii. Antidote information and the telephone number of the State Poison Information and Education System Center 1 (800) 222-1222.

15. In no instance shall the facility permit drug or medication samples to be accepted, stocked, distributed or otherwise used for any client or staff at the facility unless specifically approved in writing by the Pharmacy and Therapeutics Committee in writing.

i. If the facility utilizes drugs marked "samples," the Pharmacy and Therapeutics Committee or client care committee shall develop a mechanism for the control and limitations of these drugs in accordance with 13:35-6.6; and

16. If the facility permits it, use of over-the-counter floor stock medications approved as set forth on a list maintained at the facility, and the amounts that may be administered, are stored in the facility.

N.J. Admin. Code § 8:111-14.2

Amended and recodified from 10:161A-14.2 53 N.J.R. 2208(a), effective 12/20/2021