PURPOSE: This rule sets forth the procedures for health care, emergency medical care, psychiatric and psychological care, and psychotropic medication.

1. (1) Health Care Procedure.

   1. (A) The agency shall have a written health care program plan which shall address preventive medical, eye, hearing and dental care.
   2. (B) The agency’s health care program shall include admission examinations, subsequent examinations, nursing care, first-aid procedures, dispensing of medicine, basic remedial treatment and the training and implementation of the use of the Universal Health Care Precautions and the other basic principles of communicable disease prevention. The agency shall make provisions for the services of a licensed physician to be responsible for medical care, including on-site or office visits.
   3. (C) At admission, the agency shall obtain written authorization for each child from the parent(s), guardian or legal custodian for emergency medical care, necessary immunizations and for routine medical examinations and care.
   4. (D) A complete physical examination by a licensed physician certified nurse practitioner, advanced practice nurse in a collaborative practice agreement with a licensed physician, or a registered nurse who is under the supervision of a licensed physician shall be given to each child within thirty (30) days prior to admission, or within seventy-two (72) hours after admission. The findings of the examination shall be recorded on a form prescribed by the division, or one containing the equivalent information. Children shall receive physical examinations in accordance to the periodicity of the Missouri Medicaid Healthy Children and Youth Schedule for physical and developmental examinations.
   5. (E) If a child shows overt signs of highly infectious disease or other evidence of ill health, the agency shall make arrangements for an immediate examination by a licensed physician.
   6. (F) Any child who has not received primary immunization prior to admission shall be immunized according to the Department of Health’s current guidelines.
   7. (G) A current immunization history shall be maintained for each child.
   8. (H) Booster shots shall be administered to children as needed, and at time intervals recommended by the agency physician or by the Department of Health’s current guidelines.
   9. (I) Each child under twelve (12) years of age shall be given an annual eye examination. Children twelve (12) years of age and older shall be given an eye examination on an asneeded basis and corrective treatment shall be provided as prescribed.
   10. (J) Upon discharge, a copy or summary of the child’s health and dental records shall be provided to the child’s parent(s), guardian or legal custodian.

2. (2) Emergency Medical Procedure.

   1. (A) At least one (1) staff member shall be qualified/certified to administer first aid, including cardiopulmonary resuscitation (CPR), and shall be available within the agency at all times.
   2. (B) A first-aid kit shall be readily available.
   3. (C) An agency shall contact a child’s parent(s), guardian or legal custodian when a serious illness, a serious injury or hospitalization of the child occurs.
   4. (D) In the event of the death of a child, the parent(s), guardian, legal custodian and the division shall be notified immediately.
3. (3) Isolation for Illness. Provision shall be made for the medical isolation of any child with a highly communicable disease or other evidence of ill health which poses a serious threat to other children.
4. (4) Psychiatric and Psychological Care. When the agency’s service plan for a child indicates a need for professional care by a psychiatrist or a psychologist, the specialized treatment shall be provided, or arranged for, by the agency.

5. (5) Medicine and Drugs.

   1. (A) All medication shall be prescribed by a licensed physician, and administered by a licensed nurse or staff who successfully have completed, at a minimum, the Level 1, Medication Aide Training Program or a certified Medication Training Program, approved by the division for children in residential care.
   2. (B) All medicine and drugs shall be kept in a locked unit and shall only be accessible to and dispensed by the agency nurse or qualified/certified staff.
   3. (C) All medication shall be labeled to indicate the name of the child, the type and dosage of medication and shall be dated.
   4. (D) Medication prescribed for one (1) child shall not be administered to another.
   5. (E) No child shall self-administer medication unless the practice is approved by a licensed physician, or a registered nurse with approval of a licensed physician, and the executive director. The approval shall be documented in the child’s medication record and social service plan.
   6. (F) Either a licensed physician, licensed nurse or a qualified pharmacist shall be responsible for developing, coordinating and supervising all pharmaceutical services, including psychotropic medications.
   7. (G) When medications which are approved by a physician’s order are prescribed, continued, discontinued or changed, an entry shall be made in the child’s record. Entries shall be evaluated at least every sixty (60) days to determine if medication shall be continued, discontinued or changed.
   8. (H) When medications are discontinued, they shall be destroyed by staff as directed by a licensed physician or qualified pharmacist or a registered nurse.

6. (6) Psychotropic Medication.

   1. (A) Prescribing Psychotropic Medication.

      1. 1. An agency shall have written policies,

which upon request shall be made available to the child’s parent(s), or guardian or legal custodian, or both, to staff and to the child, governing the use of psychotropic medication.

1. 2. The prescribing physician shall pro-

vide a written medication order reflecting the reasons for prescribing the medication, the dosages and the frequency of administration.

1. 3. When a written order for psychotrop-

ic medication is provided by a physician to be administered in an emergency situation in his/her absence, staff shall document all dosages of medication given. The physician shall fully document the justification for, and the expected results of, the medication order.

1. 4. Psychotropic medication shall not be

administered as a form of punishment, as a substitute for a program or due to lack of staff.

1. 5. Unless there is a court order to the

contrary, the parent(s), guardian or legal custodian of a child shall give prior, informed, written consent to the use of medication. Consent may be given at the time of admission.

1. 6. The parent(s), guardian or legal cus-

todian shall be informed regarding any possible side-effects of medications to be administered. This shall be documented in the child’s record.

1. (B) Administering and Monitoring Psychotropic Medication.

   1. 1. The following information shall be

maintained in the case record of each child receiving psychotropic medication:

1. A. The medication history of the

child;

1. B. Documentation of all medication

administered;

1. C. A description of any significant

changes in the child’s appearance or behavior that may be related to the use of medication;

1. D. Any medication errors; and
2. E. A record of each refusal of medi-

cation including the child’s name, the date, the time, the staff administering medication and the child’s reason for refusal.

1. (C) Staff Training Relating to Psychotropic Medication. An agency shall provide training for all staff who work directly with children to enable them to recognize changes in a child’s appearance or behavior that may be related to the use of psychotropic medication.

AUTHORITY: sections 210.481, RSMo (1986), 210.486 and 210.506, RSMo (Cum. Supp. 1993).* This rule originally filed as 13 CSR 40-71.075. Emergency rule filed Nov. 1, 1993, effective Nov. 12, 1993, expired March 11, 1994. Emergency rule filed March 2, 1994, effective March 12, 1994, expired July 9, 1994. Original rule filed Nov. 1, 1993, effective June 6, 1994. Moved to 13 CSR 35- 71.075, effective Oct. 30, 2008. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.