1. (a) Purpose. Oklahoma Administrative Code (OAC) 340:100-5-32 sets forth requirements that enable service recipients to receive medication in the safest possible manner.
2. (b) Applicability. OAC 340:100-5-32 applies to Developmental Disabilities Services (DDS) staff and service providers who are contracted, licensed, or funded through a Home and Community-Based Services Waiver or DDS state funds and their employees who administer medication or assist with an individualized medication support plan (IMSP) for a service recipient receiving community services, including employment service providers.
3. (c) General requirements. Administration of medication is managed in accordance with applicable Oklahoma Human Services rules and federal and state laws.
4. (1) Every service recipient is free from unnecessary use of medication.
5. (2) No medication is used for the convenience of staff or as a substitute for positive supports or program.
6. (3) Use of psychotropic medications and associated medication reviews must follow requirements per OAC 340:100-5-26.1.
7. (4) Incident reporting and follow-up must be completed when a medication event occurs, per OAC 340:100-3-34.
8. (d) Independent medication administration. When a service recipient wants to independently administer medication, the service recipient's Personal Support Team (Team) completes an assessment and documents the ability to independently administer medication in the Individual Plan (Plan). The ability to safely continue to self-administer medication is reviewed annually and if a concern is identified by a Team member, DDS Registered Nurse (RN), quality assurance staff, or other interested person. The assessment identifies the service recipient's demonstrated ability to:
9. (1) understand and follow medication label directions;
10. (2) properly identify medication;
11. (3) remember to take medication at the correct time;
12. (4) take the correct dosage;
13. (5) administer his or her medication without supervision; and
14. (6) address problems, including asking staff for help.
15. (e) IMSP. The Team develops an IMSP when a service recipient is not independent in medication administration and desires training on his or her medication, individualization of the medication support program or both. The IMSP identifies participation by the service recipient in medication administration and specifies supports needed for administering, storing, and monitoring medication.
16. (1) The service recipient's IMSP ensures the service recipient's involvement, with necessary supports, results in a safe program of medication administration.
17. (2) The Team revises the IMSP to meet the service recipient's medication support needs when the service recipient's medical status changes or a member of the service recipient's Team or other person reveals a concern with the service recipient's medication supports.
18. (3) The service provider and employer of record (EOR) ensure the IMSP is implemented as developed by the Team.
19. (4) The service recipient's IMSP addresses the following when applicable:
20. (A) the service recipient's ability to administer medication;
21. (B) staff assistance that must be provided;
22. (C) use of adaptations or reminder systems, including an automated medication dispenser. Self-directed services (SDS), DDS and service provider staff, except specialized foster care (SFC) and agency companion services (ACS) providers, cannot fill automated medication dispensers. A service recipient who is not an ultimate user may transfer his or her medications from the original container to an automated medication dispenser if the Team determines the individual is able to do so safely with any of the following specified staff supports:
23. (i) verbal assistance;
24. (ii) oversight to ensure accuracy; or
25. (iii) assistance with problem resolution.
26. (D) documentation requirements to ensure accountability;
27. (E) monitoring requirements, including compliance with requirements of the medication review process per OAC 340:100-5-26;
28. (F) staff responsible for implementation and monitoring of the medication training program; and
29. (G) modifications to the medication administration responsibilities of staff, per OAC 340:100-5-32(g).
30. (5) Each IMSP must address medication safety issues affecting each household member.
31. (f) Ultimate User. An ultimate user is:
32. (1) the service recipient for whom the medication is prescribed, if assessed by the Team as able to carry out each step in OAC 340:100-5-32(d);
33. (2) an adult member of the service recipient's family, as identified in the IMSP;
34. (3) the service recipient's SFC provider; or
35. (4) the service recipient's ACS provider
36. (g) Medication administration. Items (1) through (9) must be implemented unless the service recipient's IMSP identifies a specific alternative. The service recipient's IMSP may modify only those rules that state the plan may address an exception.
37. (1) Prescription medication. Prescription medication, per OAC 340:100-1-2, is administered only with an order by a licensed healthcare provider with prescriptive authority.
38. (A) Prescription medication must only be administered to or used by the service recipient for whom the medication is ordered.
39. (B) All prescription medication is clearly labeled with:
40. (i) first and last name of the service recipient for whom the medication is prescribed;
41. (ii) prescriber’s name;
42. (iii) prescription number;
43. (iv) trade or generic name of medication, except when otherwise directed by the prescriber;
44. (v) prescription strength of medication, except when otherwise directed by the prescriber;
45. (vi) directions for administration;
46. (vii) date of filling;
47. (viii) prescribed quantity, except when otherwise directed by the prescriber; and
48. (ix) name and address of pharmacy of origin or dispensing healthcare provider with prescriptive authority.
49. (C) Prescription labels must be legible. Containers may only be labeled by pharmacy staff or the dispensing healthcare provider with prescriptive authority.
50. (D) When an IMSP includes use of an automated medication dispenser and that device cannot be labeled, a copy of the medication administration record (MAR) which provides the information listed in OAC 340:100-5-32(e)(1)(B) must be kept with the device. When more than one service recipient lives in the home, the automated medication dispenser must be kept in a secured location separate from medications of other service recipients. SDS, DDS and service provider staff, except SFC and ACS providers, cannot fill automated medication dispensers. The service recipient's IMSP cannot modify this requirement.
51. (E) No one is permitted to alter the label on a prescription container.
52. (i) If a change in medication instructions is made by the prescriber:
53. (I) the container must be prominently identified to note that a change has occurred;
54. (II) the MAR must be updated when the change occurs noting date of the change and the authorizing prescriber; and
55. (III) the EOR or DDS provider ensures the prescription label matches the updated instructions when the medication is next filled. Medication is administered according to the updated change on the MAR while waiting on a prescription label change to occur. A copy of the updated order, which has been signed by the prescriber, must be kept with the medication container at the vocational site until the prescription label is updated with the current instructions by the pharmacy or prescriber.
56. (ii) The container may be adapted to support a service recipient's independence as described in the IMSP.
57. (F) Sample medications must be:
58. (i) accompanied by a prescribing healthcare provider’s order;
59. (ii) labeled with the service recipient's name; and
60. (iii) included on the MAR specifying SAMPLE MEDICATION.
61. (G) Prior to the initial administration, if the medication name on the prescriber’s order and the generic or trade name of the medication on the label are different, staff responsible for medication administration documents on the MAR the reason for the difference and source of the information.
62. (H) At an employment site, the labeled pharmacy container is considered the order for a prescription medication. If a change in directions has occurred since the prescription was last filled, the container must be prominently identified to note a change has occurred. A copy of the updated order, which has been signed by the prescribing healthcare provider, must be kept with the container until an updated label change occurs by the pharmacy or prescriber.
63. (2) Medication inventory. Each prescription medication must be documented upon receipt, and an inventory record maintained.
64. (A) All prescription medication must be:
65. (i) counted upon receipt, using procedures to prevent contamination, unless the service recipient's IMSP defines another method of inventorying medication; and
66. (ii) documented in the service recipient's medication inventory record noting the reason for which the medication is prescribed. The reason a medication is prescribed must be requested from the prescriber if not provided on the prescription label or documentation received from the prescriber.
67. (B) Prescription medication is counted using procedures to prevent contamination and documented at least monthly.
68. (C) Medications identified as controlled dangerous substances in the Oklahoma Uniform Controlled Dangerous Substance Act, Title 63, Chapter 2, Article 2, must be counted and the inventory documented monthly and each time the responsibility for medication administration is transferred to another person, but at least monthly.
69. (D) Staff identifying a discrepancy in the medication inventory must promptly report this information according to service provider policies or procedures. An SFC provider reports any discrepancy to the foster care specialist. SDS staff report any discrepancy to the EOR.
70. (3) Non-prescription medication. Approval for a service recipient to use or be administered a non-prescription medication, per OAC 340:100-1-2, is received and documented at least annually from the service recipient's primary healthcare provider with prescriptive authority.
71. (A) Items used for personal care or hygiene are not considered medications.
72. (B) The service recipient's MAR must document:
73. (i) condition for which the non-prescription medication is intended to treat; and
74. (ii) the directions for use if prescribed differently from the recommended package instructions
75. (C) Each non-prescription medication must have the service recipient's name clearly identified on the container when more than one service recipient lives in the home or works at the employment site.
76. (4) Medication storage.
77. (A) All medications must be:
78. (i) secured under proper conditions of temperature and light; and
79. (ii) kept in a locked medication area, or container unless the service recipient's IMSP specifies other storage arrangements.
80. (B) Each service provider is responsible for developing and enforcing policies or procedures that ensure medication security in the absence of a service recipient IMSP. SFC providers and EOR's adhere to established policy.
81. (C) Medication requiring refrigeration must be:
82. (i) secured, unless this requirement is modified in the service recipient's IMSP;
83. (ii) kept in the temperature range according to label directions; and
84. (iii) separated from food and other non-drug items.
85. (D) Hazardous or dangerous materials must not be kept in the secured medication area.
86. (E) Each service recipient's medication must be stored separately from the medication of other persons.
87. (F) Externally applied medications must be stored separately from medications taken internally.
88. (5) Administration of Medication. Only staff who complete an approved training program in medication administration per OAC 340:100-3-38, successfully complete the written test and lab competency, and are able to read, write, understand and communicate the English language are permitted to administer medications.
89. (A) Staff responsible for medication administration must personally:
90. (i) read the medication label;
91. (ii) prepare the dose;
92. (iii) give the medication as ordered;
93. (iv) observe the person using the medication; and
94. (v) document the medication administration immediately, but no longer than 30 minutes after administration.
95. (B) The person responsible for medication administration must know how to obtain information for each medication administered including possible adverse effects and both generic and trade names.
96. (C) All medications must be administered according to label directions unless prominently identified with a change in instructions in accordance with OAC 340:100‑5‑32(g)(1)(E)(i). The MAR must be updated with the change in instructions according to the prescriber’s orders at the time the change is made.
97. (D) No SDS, DDS or service provider staff, except SFC and ACS providers, is permitted to transfer medications from the original container to another container. The service recipient's IMSP cannot modify this requirement.
98. (E) The ultimate user may transfer medication from one container to another.
99. (F) Only the person who transferred the medication to the new container or automated medication dispenser, is allowed to administer transferred medications. The service recipient's IMSP cannot modify this requirement.
100. (G) Each medication must be administered at the specified time except when authorization has been obtained from the prescriber or pharmacist and documented on the MAR accordingly with the name, title, date, and time of person authorizing administration.
101. (i) When circumstances prevent administration at the specified time, the medication must be administered no more than one hour before or after the specified administration time.
102. (ii) Any time medication is administered more than one hour before or after the scheduled administration time, incident reporting is completed according to OAC 340:100-3-34 unless authorization has been obtained as identified in subsection (5)(G).
103. (iii) Administration of medication ordered multiple times daily must be evenly spaced through the day unless specific times are ordered by the prescriber. Administration times are required to accommodate the service recipient’s schedule.
104. (H) The person administering medication or implementing an IMSP must be able to access information to identify common side effects of the medication administered.
105. (I) If an adverse reaction, a significant change in behavior, or any other , potential medication-related concern occurs, immediate action and notification is required according to service provider policies or procedures. SFC providers and EOR's adhere to established policy.
106. (6) p.r.n. medication. Medication prescribed on a p.r.n. basis must have a prescribing healthcare provider’s order identifying the medication, amount, route, time requirements, and under what circumstances the medication is administered.
107. (A) The decision to administer a p.r.n. medication, except per OAC 340:100-5-32(e)(6)(C), is made after consulting with another staff person or Team member identified in the IMSP. When the same p.r.n. medication is administered an average of three times in one week or ten times in one month, the prescribing healthcare provider is contacted for further evaluation.
108. (B) The service recipient's response to p.r.n. medication must be documented on the MAR.
109. (C) DDS defines administration of p.r.n. medication for behavioral control to be a highly restrictive procedure per OAC 340:100-3-34. When a medication is ordered for p.r.n. administration for behavioral control, the service recipient's Team ensures there is a documented protocol for the administration from the prescribing healthcare provider as part of the protective intervention protocol per OAC 340:100-5-57. The service provider, SFC provider and EOR follow incident reporting requirements per OAC 340:100-3-34.
110. (D) Service recipients receiving hospice services are exempt from the requirements for p.r.n. medications per OAC 340:100-5-32.
111. (7) Medication documentation. An accurate record of medication administration or implementation of the service recipient's IMSP must be maintained.
112. (A) Unless the service recipient is independent in medication administration per OAC 340:100-5-32(d), the service recipient's MAR must specify:
113. (i) service recipient's first and last name;
114. (ii) name and strength of the medication as documented on the label;
115. (iii) directions for administration as documented on the label;
116. (iv) date and time medication is administered, including a.m. or p.m. for each entry;
117. (v) service recipient's allergies;
118. (vi) service recipient's response to p.r.n. medications and other treatment;
119. (vii) documentation of the person who administered the medication or implemented the IMSP;
120. (viii) route of administration, if specified on the label;
121. (ix) any special orders for timing of administration, if specified on the label;
122. (x) reason for the medication's use, when specified on the label;
123. (xi) all medications a service recipient receives including routine medications administered by a healthcare provider, notated accordingly; and
124. (xii) any special instructions applicable to the service recipient including but not limited to oral intake status, preferred food for administration of medication(s) as approved by the prescriber, any color coding or adaptation systems used.
125. (B) If the service recipient is independent in medication administration per OAC 340:100-5-32(d), the Plan documents monitoring and documentation needs.
126. (8) Medication away from home. When a service recipient leaves the location where he or she typically takes medication, accountability for the medication is maintained.
127. (A) When medication is taken from the location:
128. (i) the medication inventory record documents the amount of medication taken and returned for the leave of absence, the responsible party receiving the medication, and staff responsible for medication administration who releases the medication;
129. (ii) any discrepancy in medication inventory is documented with action taken by the service provider, EOR, or SFC provider to prevent recurrence; and
130. (iii) medication is sent from the home and returned in the original container unless the service recipient uses an automated medication dispenser or has been identified as an ultimate user.
131. (B) Service recipients who use an automated medication dispenser can take the device to assist with medication administration while away from home if the Team has determined supports necessary to promote safe medication administration will be available. The IMSP must identify supports needed for verbal assistance, oversight, and problem resolution to safely use the automated medication dispenser away from home. Automated medication dispensers must be accompanied with a copy of the MAR or another document which provides the information listed in OAC 340:100-5-32(g(1)(B).
132. (C) Ultimate users that travel with an automated medication dispenser are encouraged to keep a document verifying authorization to possess a controlled dangerous substances if this applies to any medications contained in the device.
133. (D) Medication administration or implementation of the IMSP is documented while away from the home.
134. (9) Discontinued medication, expired medication, and medication destruction.
135. (A) Discontinued medication:
136. (i) must be removed from current medications, secured separately from current medications, and discontinued on the MAR; and
137. (ii) may be kept up to 60-calendar days unless otherwise directed by the prescriber or the time period is adjusted in the service recipient's IMSP.
138. (B) Expired or discontinued medications are safely disposed of in compliance with service provider policies or procedures, Environmental Protection Agency recommendations, local, state, and applicable federal requirements. SFC providers and EOR's adhere to established policy.
139. (C) Controlled dangerous substance medications are disposed of in compliance with Oklahoma Bureau of Narcotics and Dangerous Drugs and Oklahoma State Bureau of Investigation requirements and the medication inventory record is updated accordingly.
140. (D) When a service recipient dies, unused medication is safely disposed of in compliance with service provider agency policies or procedures. If death:
141. (i) is unexpected or unanticipated, unused medication is kept for at least 30-calendar days.
142. (ii) results in an investigation, medication is kept the length of time determined relevant by the investigative authority.
143. (iii) is due to a terminal illness, unused medication is safely disposed of according to the service recipients end of life plan.
144. (E) The service provider develops and enforces written policy or procedures regarding the disposal of any medication without an expiration date. SFC providers and EOR's adhere to established policy.

Added at 19 Ok Reg 2948, eff 8-1-02 (emergency)

Added at 20 Ok Reg 936, eff 6-1-03

Amended at 25 Ok Reg 986, eff 5-15-08

Amended at 28 Ok Reg 897, eff 6-1-11

Amended at 42 Ok Reg, Number 20, effective 9-15-25