Rule 111-8-2-.12. Medication

1. (1) Self-Administration of Medications. Subject to discretion of the Medical Director, Clients who have the capacity to self-administer medications safely and independently without staff assistance or supervision must be allowed to store their own medications securely and self-administer medications if they so desire. Notwithstanding the foregoing, all controlled substances must be administered and stored by the program.
2. (2) Program's Administration of Medications. Where the clients are not capable of self-administration of medications, the program must provide medication administration services to the clients in accordance with physicians' orders, the needs of the clients and these rules. Such medications must be dispensed in accordance with Georgia law.

3. (3) Maintaining Records on Medication Assistance and Administration. Where the program administers medications to clients, the program must maintain a daily Medication Assistance Record (MAR) for each client receiving such service.

   1. (a) The MAR must include the name of the specific client, any known allergies, the name and telephone number of the client's health care provider, the name, strength, route of administration and specific directions, including a summary of severe side effects and adverse reactions for use of each medication, and a chart for staff who provide assistance or administration to record initials, time and date when medications are taken, refused or a medication error is identified (e.g. missed dosage).
   2. (b) The staff providing the assistance or administration of medications must update the MAR each time the medication is offered or taken.
   3. (c) The program must make medication information concerning the descriptions of medication, dosing, side effects, adverse reactions and contraindications for each medication being administered to the clients immediately available for reference by staff providing medication assistance or administration.
   4. (d) Staff providing assistance with or administration of medications must document in the client's record any unusual reactions to the medications and provide such information to the client, the client's representative and the health care provider as appropriate.
   5. (e) Refills of prescribed medications must be obtained timely so that there is no interruption in the routine dosing. Where the program is provided with a new medication for the client, the MAR must be modified to reflect the addition of the new medication within 48 hours or sooner if the prescribing physician, advance practice registered nurse or physician assistant indicates that the medication change must be made immediately. In ARMHPs, where unit or multi-dose packaging is not available for immediate changes in medications, unit or multi-dose packaging of the medication must be obtained when the prescription is refilled.
4. (4) Orders Required for All Medications. A program must not allow its staff to administer medications, including over-the-counter medications, unless there is a physician, advance practice registered nurse or physician assistant's order or individualized prescription bottle, specifying clear instructions for its use on file for the client.
5. (5) Timely Management of Medication Procurement. The program must obtain new prescriptions within 48 hours of receipt of notice of the prescription or sooner if the prescribing physician indicates that a medication change must be made immediately. If the pharmacy does not have the medication needed for the immediate change available and has not obtained further directions from the physician, the program must notify the physician of the unavailability of the prescription and request direction.

6. (6) Storage of Medications.

   1. (a) Storage of medications must be maintained in accordance with guidelines established by the United States Drug Enforcement Administration and the Georgia Board of Pharmacy.
   2. (b) The program is responsible for having an effective system to manage the medications it receives including storing medications under lock and key, or other secure system to prevent unauthorized access, at all times, whether kept by a client or kept by the program for the client, except when required to be kept by a client on his or her person due to need for frequent or emergency use, as determined by the client's physician, advance practice registered nurse or physician assistant, or when closely attended by a staff member. Additionally, for controlled substances, the secure storage must be a locked cabinet or box of substantial construction and a log must be maintained and updated daily by the program to account for all inventory.
   3. (c) Medication kept by a client may be stored in the client's bedroom, in a locked cabinet or other locked storage container. Single occupancy bedrooms which are kept locked at all times are acceptable. Duplicate keys for the client's locked storage container and room must be available to the client and the administrator, on-site manager or designated staff.
   4. (d) Medications must be kept in original containers with original labels intact.
   5. (e) A program may stock over-the-counter medications such as aspirin or acetaminophen for the convenience of clients who have PRN (as needed) orders for the specific medication and dosage. However, where the client takes an over-the-counter medication daily as prescribed in a written order by a licensed physician, nurse practitioner or physician assistant, such as vitamins or low-dose aspirins, the client must have a client bottle of the prescribed medication that is kept for the client's usage.
   6. (f) Unused or expired medications must be properly disposed of using the current U.S. Food and Drug Administration or U.S. Environmental Protection Agency guidelines for the specific medications.

Authority: O.C.G.A. §§ 37-3-204, 37-3-205, 31-2-4, 31-2-7, 31-2-8, 31-7-2.1.

History. Original Rule entitled "Medication" adopted. F. Dec. 10, 2024; eff. Dec. 30, 2024.