Wisconsin Legislature: DCF 52.46(2)(a)4.

(3) Pregnant residents or resident mothers.

(a) If a center serves pregnant residents or residents who are mothers who keep their babies at the center, the center shall do all of the following:

1. Refer those residents for enrollment to the women, infants and children (WIC) supplemental food and nutrition counseling program.

2. Ensure that pregnant residents receive prenatal health care.

3. Ensure that resident mothers and their infant or toddler children receive health care through a HealthCheck provider or, if through private insurance, a physician, according to the frequency recommended under medical assistance program HealthCheck guidelines or as described by the private insurance policy.

(b) A center which serves residents who are mothers with infants or toddlers shall comply with s. DCF 250.07, family day care standards for infant and toddler care. The center shall provide an additional 35 square feet of resident living space for each infant and toddler in addition to the resident living space required under s. DCF 52.52 (1).

(4) Health care record. A center shall maintain a separate health care record as part of each resident’s case record. The health care record shall include all of the following:

(a) The signed written consent required under s. DCF 52.21 (5).

(b) The dates and results of all physical health, mental health and dental examinations.

(c) The resident’s health history and, if applicable, medications history prior to admission and during the resident’s stay at the center.

(d) Information about any of the following medical procedures received while the young person was a resident of the center, including dates, person administering and results:

1. Immunizations.

2. Laboratory tests.

3. Routine health care examinations and treatment.

4. Emergency health care examinations and treatment.

5. Dental examinations and treatment.

(e) The medications administration record required under s. DCF 52.46 (4).

(f) If applicable, the nutritional care plan required under s. DCF 52.44 (2) (c).

History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (3) (b), (4) (a), (e) and (f) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DCF 52.46 Medications.

(1) Definitions. In this section:

(a) “General supervision” means regular coordination, direction and inspection of the exercise of delegation of medication administration by a physician or registered nurse of someone who is not licensed to administer medications.

(b) “Staff administration” means proper administration of medication to a resident by center nonmedically nonlicensed staff under a valid medical order from a medically licensed practitioner who specifically designates, trains and supervises center staff administration of medications.

(c) “Staff monitoring of self-administration” means handing the medication to the resident by center staff according to physician and medication label instructions and observing and ensuring the proper ingestion, injection, application or inhalation of the medication by the resident.

(2) Medications administration. Each staff person responsible for administering or monitoring resident use of medications shall receive a copy of the center policies and procedures required under s. DCF 52.41 (1) (c) 9. for medication administration and monitoring and shall be knowledgeable of them. The policies and procedures shall include:

(a) For all medications, all of the following:

1. Having written informed consent on file as required under s. DCF 52.21 (5).

2. Having information in each resident’s health record about any health allergies or health-related restrictions.

3. Having on file written authorization from a physician or registered nurse for each staff person permitted to administer medications or to monitor self-administration of medications.

4. Instructions for center staff concerning administration of medications and monitoring of resident self-administration of medications, secure storage of medications and recording medication administration information as required under sub. (4) (a) in the resident’s health record.

5. Immediate notification of the resident’s attending physician in the event of a medication error or adverse drug reaction.

6. Medications may only be made available when an individual authorized by the center is present.

(b) For prescription medications, all of the following:

1. Requiring that a medication be administered by center staff to a resident only when:

a. The resident’s attending physician or center medical consultant provides center staff with clear written instructions for administering the medication and authorizes specific center staff to administer the medication.

b. The administration takes place under the general supervision of a physician or registered nurse.

c. The label on the medication container gives clear instruction for administration of the medication and, if not clear, center staff contact the physician or pharmacy for clarification before administration of the medication.

2. Allowing a medication, including a self-injectable medication, to be self-administered by a resident only while the resident is under direct supervision of center staff and if self-administration is authorized in writing from the prescribing physician or center medical consultant under s. DCF 52.41 (1) (c) 4., and that authorization is confirmed by review of the authorization for self-administration by center staff before allowing self-administration by a resident.

3. Providing information to a resident and the resident’s resident care workers and resident services case manager about any medication prescribed for the resident and when a physician orders or changes the resident’s medication. Information provided shall include expected benefits and potential adverse side effects which may affect the resident’s overall treatment and, for staff, what to do if the resident refuses medication.

4. Instructions for center staff on what to look for in monitoring physical or mental changes to a resident that may occur from a medication, what to do if physical or mental changes are observed and recording them in the resident’s health record.

5. Arranging a second medical consultation when a resident or the resident’s parent or guardian or legal custodian, if any, has concerns about any medication received by the resident or the resident’s medication plan.

6. Having the resident’s physician or center medical consultant review a resident’s prescription medications when there are noted adverse effects from the medication. Documentation showing the date of review and reviewer’s name shall appear in the resident’s health record.

7. Ensuring that any use-as-needed medication is based on an assessment by a physician or registered nurse and is approved by either a physician or registered nurse.

8. Arranging for administration of prescribed medications to a resident when the resident is away from the center, for example, at school or on a home visit. A resident may not be given access to medications if there is a possibility that the resident may harm self through abuse or overdose.

(3) Medications storage.

(a) A center shall comply with all the following requirements for storage of medications:

1. All medications shall be kept in the original container or, when authorized in writing by a physician, in a dispensing container, and shall:

a. If a prescription medication, be labeled with the expiration date and information required under s. 450.11 (4), Stats.

b. If a non-prescription medication, be labeled with the name of the medication, directions for use, expiration date and the name of the resident taking the medication.

2. Medications shall be kept in locked cabinets or containers and under proper conditions of sanitation, temperature, light, moisture and ventilation to prevent deterioration.

3. Medications used externally and medications taken internally shall be stored on separate shelves or in separate cabinets.

4. Medications stored in a refrigerator containing other items shall be stored in a separate locked compartment.

5. Medications may not be stored with disinfectants or poisons.

(b) A center shall immediately destroy all outdated prescription and over-the-counter medications and all prescription medication no longer in use. The center shall maintain a log of the medication destroyed, who destroyed it and what amount was destroyed.

(4) Medications administration record.

(a) A center shall have in each resident’s health record a written medications administration record which lists each prescribed and over-the-counter medication the resident receives. The record shall contain the following information:

1. For an over-the-counter medication, the resident’s name, type of medicine, reason for use, time and day of administration and staff person authorizing its use.

2. For a prescription medication, all of the following:

a. The name of the resident.

b. The generic or commercial name of the medication.

c. The date the medication was prescribed.

d. The name and telephone number of the prescribing physician to call in case of a medical emergency.

e. The reason the medication was prescribed.

f. The dosage.

g. The time or times of day for administering the medication. Staff shall document all medication administered with the date and time of administration or, if not administered, with the date and time of resident refusal to take it.

h. The method of administration, such as orally or by injection.

i. The name of the center-authorized person who administered or monitored resident self-administration of the medication.

j. Any adverse effects observed.

k. Any medication administration errors and corrective or other action taken.

(b) The center shall have a copy of a resident’s medication administration record readily available for all center authorized personnel responsible for administering medications to the resident.

(5) Psychotropic medications.

(a) Definition. In this subsection, “psychotropic medication” means any drug that affects the mind and is used to manage inappropriate resident behavior or psychiatric symptoms, which may include an antipsychotic, an antidepressant, lithium carbonate or a tranquilizer.

Note: This definition does not include a drug that can be used to manage inappropriate symptoms when it is prescribed only for a different medical use, such as carbamazapine (Tegretol), which is usually used for control of seizures but may be used to control labile behavior, and propranolol (Inderal), which is usually used to control high blood pressure but may be used to control anxiety states or side effects from antipsychotic medication.

(b) Rights of patients. A center shall comply with the provisions of s. 51.61 (1) (g) and (h), Stats., for all residents who are prescribed psychotropic medications.

(c) Non-emergency procedures. A center serving a resident for whom psychotropic medications are prescribed shall ensure that all of the following requirements are met:

1. Arrangements have been made for a physician to perform an initial medical work up or conduct a medical screening of the resident for the type of psychotropic medication to be prescribed for the resident. If the prescribing physician is not a board-certified pediatrician or psychiatrist, consultation shall be obtained from a board-certified pediatrician or psychiatrist.

2. The resident, if 14 years of age or older, and the resident’s parent or guardian and legal custodian shall have signed written consent forms as required under s. DHS 94.03.

3. The center has obtained from the prescribing physician and filed in the resident’s treatment record a written report at least within the first 45 days after the resident has first received a psychotropic medication and at least every 60 days thereafter. The report shall state in detail all of the following:

a. Reasons for the initial use of the medication.

b. Reasons for continuing, discontinuing or changing the medication.

c. Any recommended change in treatment goals or program.

d. The physician’s actual observation of the resident and reaction to staff reports on the resident.

4. The method and procedures for administering or monitoring resident self-administration of a psychotropic medication shall have been approved by either the prescribing physician or a psychiatrist.

(d) Emergency procedures. For emergency administration of a psychotropic medication to a resident, a center shall do all of the following:

1. Have authorization from a physician.

2. Whenever feasible, obtain written informed consent before using the medication from the resident’s parent or guardian and legal custodian, if any, and from the resident if 14 years of age or older.

3. Comply with the center’s emergency medical procedures under s. DCF 52.41 (1) (c) 10.

4. If written informed consent of the resident’s parent or guardian and legal custodian, if any, was not obtained before administration of the medication, notify by phone the parent or guardian and legal custodian if any, as soon as possible following emergency administration, and document the dates, times and persons notified in the resident’s treatment record.

5. Document in the resident’s treatment record the physician’s reasons for ordering emergency administration of psychotropic medication.