1. (a) An infirmary shall be considered a facility established for the purpose of offering temporary medical care and/or treatment exclusively for persons residing on a designated premise, e.g., schools, reformatories, correctional institutions, etc.

2. (b) Compliance.

   1. (1) Infirmaries shall comply with applicable parts of 20 CAR §§ 41-109 – 41-112.

   2. (2) Infirmaries shall comply with all applicable parts of:

      1. (A)

3. (i) 20 CAR § 41-104, governing body, and 20 CAR § 41-105, medical staff.

   1. (ii) The infirmary shall have an organized governing body or in its absence, a person shall be legally responsible for:
4. (a) (a) Maintaining quality patient care;

5. (b) (b) Establishing policies for the infirmary; and

   1. (c) (c) The conduct of the infirmary;

      1. (B)

         1. (i) 20 CAR § 41-105, medical staff.
         2. (ii) The infirmary shall be under the direction of a qualified physician who shall be responsible for the medical care and treatment rendered;

      2. (C)

         1. (i) 20 CAR § 41-110(a), patient care service.
         2. (ii) The infirmary shall be under the supervision of a registered nurse on the day tour of duty.
         3. (iii) Evening and night tours shall be staffed with licensed nursing personnel.
         4. (iv) The medical record for each patient admitted to the infirmary during the day tour of duty shall document the admission and observation of patient acuity by a registered nurse.
         5. (v) The admission shall be performed by the director of nursing or the registered nurse on call when such admission occurs on a weekend day;
      3. (D) 20 CAR § 41-113, Health Information Services, and 20 CAR § 41-114, medical record requirements for outpatient services, emergency room, observation services, and psychiatric records;

      4. (E)

         1. (i) Applicable parts of 20 CAR § 41-118, laboratory, and 20 CAR § 41-119, radiological services.
         2. (ii) The infirmary need not comply unless the services are offered in the infirmary.
         3. (iii) Where laboratory and/or radiology services are not offered in the infirmary, the infirmary shall obtain a written agreement to provide any such services, as appropriate in the scope of the infirmary setting from a source approved by the Department of Health;

      5. (F)

         1. (i) 20 CAR § 41-116, food and nutrition services.
         2. (ii) Kitchen sanitation and food preparation areas shall meet the requirements for public eating establishments set forth by the Department of Health;
      6. (G) 20 CAR § 41-115, pharmacy;
      7. (H) 20 CAR § 41-182, physical facilities — infirmaries; and

      8. (I) 20 CAR § 41-117, infection prevention and control.

         1. (c) Pharmacy services.
   2. (1) All infirmaries shall have adequate provisions for pharmaceutical services regarding the procurement, storage, distribution, and control of all medications.
   3. (2) All federal and state regulations shall be followed.

   4. (3) See 20 CAR § 41-115, pharmacy.

      1. (d) Administration of pharmaceutical services.

   5. (1)

      1. (A) The infirmary shall provide policies and procedures for obtaining, dispensing, and administering of drugs and biologicals developed with the advice of a physician or pharmacist.

      2. (B) Definition of “dispensing”. A function restricted to licensed pharmacists that involves the issuance of:

         1. (i) One (1) or more doses of a medication in containers other than the original, with such new containers being properly labeled by the dispenser as to content and/or directions for use as directed by the prescriber;
         2. (ii) Medication in its original container with a pharmacy-prepared label that carries to the patient the directions of the prescriber as well as other vital information; and
         3. (iii)
6. (a) (a) A package carrying a label prepared for nursing station use.

7. (b) (b) The contents of the container may be for one (1) patient individual prescription or for several patients, such as a nursing station medication container.

   1. (C) Definition of “administering”.

      1. (i) An act restricted to nursing personnel as defined in the Nurse Practice Act, Arkansas Code § 17-87-101 et seq., in which a single dose of a prescribed drug or biological is given to a patient.

         1. (ii) This activity includes the removal of the dose from a previously dispensed, properly labeled container:
8. (a) (a) Verifying it with the prescriber’s orders;

9. (b) (b) Giving the individual dose to the proper patient; and

   1. (c) (c) Recording the time and dose given.

   2. (2) The infirmary shall provide for the procurement of drugs and pharmaceutical supplies as follows:

      1. (A) If the infirmary has a pharmacy department, a licensed pharmacist shall be employed to administer the pharmacy in accordance with all state and federal laws and regulations regarding drugs and drug control;
      2. (B) If the infirmary does not have a pharmacy department, the infirmary shall provide for prompt, convenient availability of prescribed drugs and biologicals from a community pharmacy;

      3. (C)

         1. (i) If the infirmary does not have a pharmacy department but does maintain a supply of medications, a licensed pharmacist shall:
10. (a) (a) Be responsible for the control of all bulk drugs; and

11. (b) (b) Maintain records of receipt and disposition.

    1. (ii) The pharmacist shall dispense medications from the drug supply, properly labeled and available to appropriate nursing personnel; and

       1. (D) If a physician maintains his or her own stock of drugs in the infirmary, he or she shall dispense all drugs and maintain control as required of a pharmacist.

12. (e) Medication orders.

    1. (1)

       1. (A) All medications administered to patients shall be ordered in writing by the physician.

       2. (B) Verbal orders shall be:

          1. (i) Given only to a licensed nurse or a licensed pharmacist; and
          2. (ii) Immediately reduced in writing signed by the nurse or pharmacist and countersigned by the physician within seventy-two (72) hours.
    2. (2) Medications are released to patients on discharge only on the written authorization of the physician.

13. (f) Administration of medication.

    1. (1) All medications administered by licensed personnel shall be in accordance with the Arkansas practice acts.
    2. (2) Medications prescribed for one (1) patient shall not be administered to any other patient.
    3. (3) Medication errors and adverse drug reactions shall be reported to the patient’s physician and the pharmacist.
    4. (4) All medications administered shall be recorded in the medical record.

14. (g) Labeling.

    1. (1) Medication kept as general floor stock in the facility shall be labeled with the:

       1. (A) Trade name or generic name with the name of the manufacturer;
       2. (B) Strength;
       3. (C) Lot number; and
       4. (D) Expiration date.

    2. (2) The label of each patient’s individual medication container shall clearly indicate the:

       1. (A) Patient’s full name;
       2. (B) Physician’s name;
       3. (C) Prescription number;
       4. (D) Name and strength of the medication;
       5. (E) Date of issue; and
       6. (F) Name, address, and telephone number of issuing pharmacy.
    3. (3) Medication containers having soiled, damaged, incomplete, illegible, or makeshift labels are returned to the issuing pharmacist or pharmacy for relabeling or disposal.

15. (h) Storage and security of medications.

    1. (1) All medications shall be locked to limit access to licensed personnel.

    2. (2)

       1. (A) Each patient medication shall be kept and stored in original containers.
       2. (B) There shall be no transferring between containers.
    3. (3) Medication cabinets shall be of sufficient size to permit storage of medication.

    4. (4)

       1. (A) Refrigeration shall be provided for the proper storage of biologicals and other medications.
       2. (B) Medications shall be stored in a separate compartment or area from food.
       3. (C) Employee foods and/or medications shall be stored in a separate refrigeration area.
       4. (D) An internal thermometer shall be provided and checked to ensure temperatures between thirty-six degrees and forty-six degrees Fahrenheit (36°F – 46°F) or two to eight degrees Celsius (2°C – 8°C).
       5. (E) Daily documentation of temperatures shall be maintained.
       6. (F) Refrigerated medications may be stored in a locked box inside the refrigerator.
    5. (5) Poisons and external medications shall be separated from other medications.

    6. (6) Applicable medications shall be removed from usage:

       1. (A) In the event of a drug recall; or

       2. (B) Upon expiration.

          1. (i) Pharmacy records.
    7. (1) The infirmary shall comply with all federal and state laws and regulations relating to the procurement, storage, dispensing, administering, and disposal of medications.

    8. (2) A controlled substance record is maintained that lists the following information on a separate sheet for each type and strength of controlled substance:

       1. (A) Date;
       2. (B) Time administered;
       3. (C) Name of patient;
       4. (D) Dose;
       5. (E) Prescriber’s name;
       6. (F) Signature of the person administering the dose; and
       7. (G) Remaining drug balance.

    9. (3) All controlled substances shall be counted by two (2) licensed personnel at the opening and closing of each staffed shift to ensure compliance between the:

       1. (A) Listed drug balances; and
       2. (B) Actual amounts in stock.
    10. (4) All pharmacy records shall be maintained for two (2) years.
    11. (5) The pharmacy shall either maintain copies of the order or a prescription for every medication dispensed.
    12. (6) Policies and procedures shall be provided.

    13. (7)

        1. (A) Clinically relevant educational programs shall be conducted on a regularly scheduled basis of not less than twelve (12) per year.

        2. (B) There shall be evidence of:

           1. (i) Program dates;
           2. (ii) Attendance; and
           3. (iii) Subject matter.
    14. (8) There shall be an ongoing QA/PI program that is specific to the patient care administered.
16. (j) Physical facilities. Infirmary shall comply with 20 CAR § 41-182, physical facilities — infirmaries.

Codification Notes: “QA/PI” means quality assurance/performance improvement.