(a)

1. (1) The facility must ensure that:

   1. (A) It is free of medication error rates of five percent (5%) or greater; and
   2. (B) Residents are free of any significant medication errors.

2. (2) “Medication error” means the observed preparation or administration of drugs or biologicals which is not in accordance with:

   1. (A) Physician’s orders;
   2. (B) Manufacturer’s specifications (not recommendations) regarding the preparation and administration of the drug or biological; or
   3. (C)

(i) Accepted professional standards and principles which apply to professionals providing services.

1. (ii) Accepted professional standards and principles include the various practice rules in Arkansas and current commonly accepted health standards established by national organizations, boards, and councils.
2. (3) “Medication error rate” means the percentage of both significant and nonsignificant medication errors.
3. (4) “Nonsignificant medication error” means a medication error that does not meet the definition of a significant medication error.

4. (5)

   1. (A) “Significant medication error” means one which causes the resident discomfort or jeopardizes his or her health and safety.

   2. (B) Whether a medication error is significant is determined by consideration of the:

      1. (i) Resident’s condition;
      2. (ii) Drug category; and
      3. (iii) Frequency of the error.

(b) Determining medication error rate.

1. (1) The medication error rate is determined by dividing the number of errors by the opportunities for errors and multiplying the result by one hundred (100), and is expressed as: Medication Error Rate = (Number of Errors Observed / the Opportunities for Errors) x 100
2. (2) The “number of errors observed” is the total number of errors the survey team observes, both significant and nonsignificant.

3. (3) The “opportunities for errors” includes all the doses the survey team observes being administered plus the doses ordered but not administered.

   1. (c) The facility shall document in the resident’s record whether the resident or the facility is responsible for storing the resident’s medication.

      1. (d) The facility shall document in the resident’s record whether the resident will self-administer medication or the facility will administer medication to the resident.

(f)

1. (1) Facility staff shall provide assistance to enable residents to manage their medications.

2. (2) For clarification, examples of acceptable practices are listed below:

   1. (A) The medication regimen on the container label may be read to the resident;

   2. (B)

      1. (i) A larger sterile or disposable container may be provided to the resident if needed to prevent spillage.
      2. (ii) The containers shall not be shared by residents;
   3. (C) The resident may be reminded of the time to take the medication and be observed to ensure that the resident follows the directions on the container; and

   4. (D) Facility staff may assist residents in the management of their medications by:

      1. (i) Taking the medication in its container from the area where it is stored and handing the container with the medication in it to the resident;
      2. (ii)

(b) (b) If the resident is physically impaired but cognitively able (has awareness with perception, reasoning, intuition, and memory), facility staff, upon request by or with the consent of the resident, may assist the resident in removing oral medication from the container and in taking the medication; and

1. (iii) If the resident is physically unable to place a dose of oral medication into his or her mouth without spilling or dropping it, placing the dose of medication into another container and placing that container to the mouth of the resident.

(g)

1. (1) Changes in dosage or schedule of the medication shall be made only upon the authorization of the resident’s physician or advanced practice nurse.
2. (2) This section is not applicable to residents who manage their own medications.