PURPOSE: This rule prescribes general medical and health care requirements for day programs serving people who are mentally ill or mentally disordered as required by section 630.710, RSMo.

1. (1) The head of the day program shall immediately report to the licensing office, local health authorities and the affected client, parent/guardian, if applicable, or combination of these, any unusual occurrences of infections or contagious diseases, epidemic outbreaks, poisoning or other occurrences which threaten the welfare, safety or health of any client. The program shall furnish other information relative to the occurrences as required by the department.
2. (2) The program shall have a written policy regarding whether or not it will administer drugs and medications.

3. (3) If medications are administered at the day program, the head of the program shall regulate their use as follows:

   1. (A) All prescription drugs administered at the day program shall be in containers prepared for day program use by the pharmacist and shall be kept at the day program; medications shall be labeled with the client’s name, instructions and the physician’s name as required by law. A dated copy of the physician’s orders for medication shall be kept with the medication;
   2. (B) The same person shall prepare, administer and chart medication at the time it is given. If a unit dosage system is used, the same person who removes the medication from the unit dose blister card also shall administer and chart the medication;
   3. (C) All nonprescription medicine shall be labeled with the client’s name; a copy of the physician’s order for this medicine shall be kept with the medication;
   4. (D) Medicines shall be kept in a locked container;
   5. (E) Medicine needing refrigeration shall be kept in the refrigerator in a container separate from food;
   6. (F) Medicine shall be properly disposed of when no longer needed;
   7. (G) The date and time(s) of administration, the name of the person giving the medication and the quantity of any medication given shall be recorded in the client’s permanent record;

   8. (H) The head of the program shall not permit any client to be provided medical treatment, drugs or topical medications other than by written order of a licensed physician. This rule does not apply to nonprescription topical applications.

      1. 1. Physician’s orders shall be limited to

ninety (90) days for prescription drugs. Pro re nata (PRN) orders for prescription drugs shall be reviewed every thirty (30) days. It is not necessary that the physician’s orders be rewritten each time if there are no changes. The physician’s signature and date is sufficient.

1. 2. Standing orders for the entire facility

shall not be allowed.

1. 3. PRN orders for nonprescription drugs

and treatment may be utilized for individual clients if the order indicates specific drugs and dosages, or specific treatments, for specific indications.

1. 4. Physicians’ orders for nonprescrip-

tion medication, except nonprescription topical medication, shall be reviewed at least every ninety (90) days.

1. 5. In an emergency, the physician may

give or change an order by telephone, but the order must be signed within forty-eight (48) hours.

1. 6. Stock supplies of nonprescription

medications are permitted. Nonprescription medication shall not be used after the expiration date on the medication container and shall be disposed of properly; and

1. (I) The following regulations shall regulate the storage and administration of drugs and medications:

   1. 1. Medications shall be properly and

clearly labeled in accordance with Missouri statutes and shall be stored under lock and key. Schedule II controlled substances as defined under section 195.017, RSMo shall be stored under double lock. Internal and external medication shall be kept separate;

1. 2. The head of the program shall assume

responsibility for the proper administration of medications in a well-lighted area;

1. 3. Errors in administering or in self-

administration of medication shall be reported immediately to the physician and regional center;

1. 4. Medical treatment and medications

shall be administered in accordance with the physician’s orders and directions on the label of medication containers; and

1. 5. First-aid supplies needed to treat sim-

ple medical emergencies shall be available at the day program.

1. (4) If a program takes possession of the medications of self-administering clients, the program shall meet all rules for programs which administer medications.
2. (5) If a program has both clients who selfadminister and clients who do not self-administer, the program must take safeguards to insure that clients who cannot administer are protected.
3. (6) Information regarding any illness, accident or injury, and action taken, which occurs while the client is attending the day program shall be noted in the client’s record.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Emergency rule filed June 17, 1986, effective July 1, 1986, expired Oct. 29, 1986. Original rule filed June 17, 1986, effective Nov. 13, 1986. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Amended: Filed July 17, 1995, effective March 30, 1996. *Original authority: 630.050, RSMo (1980), amended 1993, 1995 and 630.705, RSMo (1980), amended 1982, 1984, 1985, 1990.