Chapter DCF 52

DCF 52.46(2)(b)7. 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.

DCF 52.46(2)(b)8. 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.

DCF 52.46(3) (3) Medications storage.

DCF 52.46(3)(a) (a) A center shall comply with all the following requirements for storage of medications:

DCF 52.46(3)(a)1. 1. All medications shall be kept in the original container or, when authorized in writing by a physician, in a dispensing container, and shall:

DCF 52.46(3)(a)1.a. a. If a prescription medication, be labeled with the expiration date and information required under s. 450.11 (4), Stats.

DCF 52.46(3)(a)1.b. 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.

DCF 52.46(3)(a)2. 2. Medications shall be kept in locked cabinets or containers and under proper conditions of sanitation, temperature, light, moisture and ventilation to prevent deterioration.

DCF 52.46(3)(a)3. 3. Medications used externally and medications taken internally shall be stored on separate shelves or in separate cabinets.

DCF 52.46(3)(a)4. 4. Medications stored in a refrigerator containing other items shall be stored in a separate locked compartment.

DCF 52.46(3)(a)5. 5. Medications may not be stored with disinfectants or poisons.

DCF 52.46(3)(b) (b) A center shall immediately destroy all outdated prescription and over-the-counter medications and all prescription medication no longer in use.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.

DCF 52.46(4) (4) Medications administration record.

DCF 52.46(4)(a) (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:

DCF 52.46(4)(a)1. 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.

DCF 52.46(4)(a)2. 2. For a prescription medication, all of the following:

DCF 52.46(4)(a)2.a. a. The name of the resident.

DCF 52.46(4)(a)2.b. b. The generic or commercial name of the medication.

DCF 52.46(4)(a)2.c. c. The date the medication was prescribed.

DCF 52.46(4)(a)2.d. d. The name and telephone number of the prescribing physician to call in case of a medical emergency.

DCF 52.46(4)(a)2.e. e. The reason the medication was prescribed.

DCF 52.46(4)(a)2.f. f. The dosage.

DCF 52.46(4)(a)2.g. 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.

DCF 52.46(4)(a)2.h. h. The method of administration, such as orally or by injection.

DCF 52.46(4)(a)2.i. i. The name of the center-authorized person who administered or monitored resident self-administration of the medication.

DCF 52.46(4)(a)2.j. j. Any adverse effects observed.

DCF 52.46(4)(a)2.k. k. Any medication administration errors and corrective or other action taken.

DCF 52.46(4)(b) (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.

DCF 52.46(5) (5) Psychotropic medications.

DCF 52.46(5)(a) (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.

DCF 52.46 Note 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.

DCF 52.46(5)(b) (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.

DCF 52.46(5)(c) (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:

DCF 52.46(5)(c)1. 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.

DCF 52.46(5)(c)2. 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.

DCF 52.46(5)(c)3. 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:

DCF 52.46(5)(c)3.a. a. Reasons for the initial use of the medication.

DCF 52.46(5)(c)3.b. b. Reasons for continuing, discontinuing or changing the medication.

DCF 52.46(5)(c)3.c. c. Any recommended change in treatment goals or program.

DCF 52.46(5)(c)3.d. d. The physician’s actual observation of the resident and reaction to staff reports on the resident.

DCF 52.46(5)(c)4. 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.

DCF 52.46(5)(d) (d) Emergency procedures. For emergency administration of a psychotropic medication to a resident, a center shall do all of the following:

DCF 52.46(5)(d)1. 1. Have authorization from a physician.

DCF 52.46(5)(d)2. 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.

DCF 52.46(5)(d)3. 3. Comply with the center’s emergency medical procedures under s. DCF 52.41 (1) (c) 10.

DCF 52.46(5)(d)4. 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.

DCF 52.46(5)(d)5. 5. Document in the resident’s treatment record the physician’s reasons for ordering emergency administration of psychotropic medication.

DCF 52.46(5)(e) (e) Revocation of consent or refusal to take.

DCF 52.46(5)(e)1. 1. A resident, if 14 years of age or older, or a resident’s parent or guardian or legal custodian, if any, may at any time revoke consent for non-emergency use of psychotropic medications, as provided under s. DHS 94.03.

DCF 52.46(5)(e)2. 2. When a consent is revoked, the center shall do all of the following:

DCF 52.46(5)(e)2.a. a. Stop administration of the medication in accordance with good medical practice for withdrawal of the specific medication.

DCF 52.46(5)(e)2.b. b. Inform the prescribing physician and the placing person or agency of consent revocation and document the revocation in the resident’s treatment record.

DCF 52.46(5)(e)3. 3. When a resident refuses to take a prescribed psychotropic medication, the center shall do all of the following:

DCF 52.46(5)(e)3.a. a. Document in the resident’s treatment record the resident’s reasons for refusal and have 2 staff members who personally witnessed the refusal sign a written statement to that effect.

DCF 52.46(5)(e)3.b. b. Notify the resident’s physician.

DCF 52.46(5)(e)3.c. c. Notify the parent or guardian and legal custodian, if any, and the resident’s placing person or agency, if different. Notification shall be immediate if the resident’s refusal threatens the resident’s well-being and safety.

DCF 52.46(5)(f) (f) Administration standards. In administering psychotropic medications, a center shall comply with requirements for administration of prescription medications in this section and clinically acceptable standards for good medical practice.

DCF 52.46 History History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (2) (intro.), (a) 1., (b) 2., (5) (c) 2., (d) 3. and (e) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; EmR1106: emerg. am. (5) (f), eff. 9-16-11; CR 11-026: am. (5) (f) Register December 2011 No. 672, eff. 1-1-12.

DCF 52.47 DCF 52.47 Transportation.

DCF 52.47(1) (1) Applicability. This section applies to transportation of residents by any of the following:

DCF 52.47(1)(a) (a) Center-owned or leased vehicles.

DCF 52.47(1)(b) (b) Vehicles driven by volunteers, student interns or center staff.

DCF 52.47(1)(c) (c) Center-contracted transportation.

DCF 52.47(2) (2) School buses. A school bus, as defined in s. 340.01 (56), Stats., that is used to transport residents shall be in compliance with ch. Trans 300.

DCF 52.47(3) (3) Driver information.

DCF 52.47(3)(a) (a) When a center provides transportation, the name of each driver, type of license held and the date of expiration of the license shall be on file at the center.

DCF 52.47(3)(b) (b) When a center contracts for transportation services, the center shall have on file the name, address and telephone number of the contracting firm and the name and home telephone number of a representative of the firm.

DCF 52.47(4) (4) Driver qualifications.

DCF 52.47(4)(a) (a) The driver of a center-operated or center-contracted vehicle shall hold a current valid operator’s license for the type of vehicle being driven, be at least 18 years of age and have one year of experience as a licensed driver.

DCF 52.47(4)(b) (b) A center shall obtain and keep on file before initial service and annually thereafter a copy of each center driver’s driving record.

DCF 52.47(4)(c) (c) Before a driver may transport residents, the center shall check the driver’s driving record for any reckless driving safety violation under s. 346.62, Stats., and for operation of a motor vehicle under the influence of an intoxicant or other drug under s. 346.63, Stats. A driver having a driving record with any of these violations in the last 12 months may not transport residents.

DCF 52.47 Note Note: For a copy of a driver’s driving record, contact the Bureau of Driver Services, Department of Transportation, P.O. Box 7918, Madison, Wisconsin 53707.

DCF 52.47(5) (5) Vehicle capacity and supervision.

DCF 52.47(5)(a) (a) A center shall provide one adult supervisor in a vehicle in addition to the driver in either of the following circumstances:

DCF 52.47(5)(a)1. 1. When transporting more than 2 residents unable to take independent action and having limited ability to respond to an emergency.

DCF 52.47(5)(a)2. 2. When transporting a resident with a recent history of physically aggressive or acting out behavior.

DCF 52.47(5)(b) (b) A center vehicle may only carry as many passengers as the vehicle is rated for by the manufacturer.

DCF 52.47(6) (6) Vehicle.

DCF 52.47(6)(a) (a) Operation. A vehicle used to transport residents shall meet all of the following conditions:

DCF 52.47(6)(a)1. 1. Be in safe operating condition and carry vehicle liability insurance with minimums no less than those provided in s. 121.53 (1), Stats. Once a year for a vehicle 2 years of age or older, the licensee shall place on file evidence of the vehicle’s safe operating condition on a form provided by the department.

DCF 52.47 Note Note: Form number CFS52, Vehicle Safety Inspection, is available in the forms section of the department website at http://dcf.wisconsin.gov or by writing or calling any field office listed in Appendix D.

DCF 52.47(6)(a)2. 2. Be registered in Wisconsin.

DCF 52.47(6)(a)3. 3. Carry emergency information such as local police and ambulance service phone numbers and phone numbers of center personnel to notify in case of accident.

DCF 52.47(6)(a)4. 4. Be clean, uncluttered and free of obstructions on the floors, aisles and seats.

DCF 52.47(6)(a)5. 5. Be enclosed.

DCF 52.47(6)(a)6. 6. Have a Red Cross-approved first aid kit.

DCF 52.47(6)(am) (am) Child safety seats. No licensee or person acting on behalf of a licensee may transport any resident under the age of 8 years or less than 80 pounds in weight in any private motor vehicle unless the following conditions are met, as required in s. 347.48 (4), Stats.:

DCF 52.47(6)(am)1. 1. Each resident who is less than one year old or who weighs less than 20 pounds being transported in a vehicle shall be properly seated and restrained in a rear-facing individual child car safety seat in the back seat of the vehicle.

DCF 52.47(6)(am)2. 2. Each resident who is at least one year old but less than 4 years old or who weighs at least 20 pounds but less than 40 pounds shall be properly restrained in a forward-facing individual child car safety seat in the back seat of the vehicle.