PURPOSE: This rule prescribes general medical and health care requirements for day programs as required by section 630.710, RSMo.

1. (1) The head of the program shall require each client’s record to contain an annual statement from a physician indicating that the client is free of symptoms and signs of communicable diseases and is capable of participating in the activities offered by the program. The record shall contain results of the client’s annual tuberculin control test. Any medical conditions that would restrict a client’s activity, such as high blood pressure, diabetes, and the like shall be noted.
2. (2) The head of the day program shall immediately report any unusual occurrences of infectious or contagious diseases, epidemic outbreaks, poisoning or other occurrences which threaten the welfare, safety or health of any client, to the licensing office, local health authorities and the client’s family or community residential facility, regional center and placement office, if applicable. The program shall furnish other information relative to the occurrences as required by the department.
3. (3) The program shall have a written policy regarding whether or not it will administer drugs and medications.

4. (4) If medications are administered at the day program, the head of the program shall manage client’s medications in one (1) or a combination of the following ways and shall thoroughly describe the process in a policy and procedure:

   1. (A) Clients may self-administer medications if the following conditions are met:

      1. 1. Self-administration is provided for in

the clients’ individualized habilitation plans;

1. 2. Medication and its self-administration

is authorized by a physician’s order retained in the clients’ records;

1. 3. The head of the day program is aware

of which clients self-administer and the type and dosage of the medication taken; and

1. 4. At least one (1) staff person on duty

at the program has completed a course in medications approved by the regional center; and

1. (B) If clients do not self-administer, the head of the day program shall regulate the receipt and storage of medication administered by day program staff in one (1), or a combination, of the following ways:

   1. 1. A supply of medication may be main-

tained at the day program. All prescription drugs shall be in containers prepared for the day program by a pharmacist;

1. 2. Medications may be transported daily

from the client’s residence in containers prepared by the pharmacist.

1. A. The medication must be transport-

ed in a hand-carried box which is key-locked in the client’s residence and is not unlocked until it reaches the day program.

1. B. At the end of the day, the medica-

tion shall be returned to the client’s residence in a hand-carried box which is key-locked at the day program and not unlocked until it reaches the client’s residence.

1. C. If the transporter is someone other

than a staff person from the client’s residence or the parent/guardian, s/he will not have a key to the locked box.

1. D. If the natural parent or guardian

transports only his/her child/ward to the day program, the locked box is not required; and

1. 3. A unit-dose system may be used, in

which the medication has been dispensed in blister cards by a pharmacist so that the blister card, or, if a single dose is sent daily, each dose of the medication is labeled with the client’s name, the medication dose and schedule of administration. Unit-dose medication shall be transported to the day program as set out previously in paragraph (4)(B)2.

1. (5) The head of the program shall regulate the administration of the medication by day program staff in the following ways:

   1. (A) All prescription drugs administered at the day program shall be in containers or blister cards dispensed by the pharmacist; medications shall be labeled with the client’s name, instructions and physician’s name as required by law. A dated copy of the physician’s orders for medication shall be kept at the day program;
   2. (B) 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;
   3. (C) All medicine shall be kept in a locked container;
   4. (D) Medicine needing refrigeration shall be kept in the refrigerator in a locked container separate from food;
   5. (E) Discontinued, outdated or deteriorated drugs shall immediately be disposed of by Are Mentally Retarded and Developmentally Disabled

destruction at the program, returned to the pharmacist or returned to the client’s residence. Destruction of drugs shall be recorded on a medication sheet by two (2) persons, one (1) of whom is a pharmacist, a physician or a licensed nurse;

1. (F) All nonprescription medicine, except topical medication, shall be labeled with the client’s name; a copy of the physician’s order for that medicine shall be kept at the day program;
2. (G) Physician’s orders for nonprescription medications, except nonprescription topical medication, shall be reviewed at least every ninety (90) days;

3. (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.

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 residents if the order indicates specific drugs and specific drug dosage or specific treatments, for specific indications.

1. 4. Only 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. 5. 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 paragraphs 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 medications 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 client’s residence, physician and regional center case manager;

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 facility.

1. (6) The head of the day program may permit a client’s natural or adoptive parent to administer medication to his/her own child while at the day program if the head of the day program is aware of the type and dosage of medication being administered.
2. (7) If a program takes possession of the medications of self-administering clients, the program shall meet all rules for programs which administer medications.
3. (8) If a program has both clients who selfadminister medications and clients who do not self-administer, the program must take safeguards to ensure that clients who cannot self-administer are protected.
4. (9) Errors in dispensing or in self-administration of medications shall be reported immediately to the appropriate physician, the head of the program and the individuals who are to be notified in case of emergency as identified in the client’s record.
5. (10) 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.
6. (11) The day program shall maintain first-aid supplies sufficient to care for minor injuries.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Aug. 4, 1987, effective Nov. 15, 1987. 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.