Chapter DCF 57

DCF 57.25(3) (3) Medication Administration documentation.

DCF 57.25(3)(a) (a) Immediately upon administering medication to a resident or a resident self-administering medication, the staff member administering or supervising the administration of medication shall write all of the following in the resident’s record:

DCF 57.25(3)(a)1. 1. Full name of the resident to whom the medication was administered.

DCF 57.25(3)(a)2. 2. Date and time the medication was administered.

DCF 57.25(3)(a)3. 3. Name and dosage of the medication administered or medical treatments received.

DCF 57.25(3)(a)4. 4. Signature of the staff member who administered or supervised the administration of medication.

DCF 57.25(3)(a)5. 5. Any refusal of medication.

DCF 57.25(3)(a)6. 6. Any adverse reaction to the medication and steps taken to notify the resident’s health care provider, parent, guardian, or legal custodian.

DCF 57.25(3)(a)7. 7. Any error in medication administration and the steps taken to notify the resident’s physician as required in sub. (5).

DCF 57.25(3)(b) (b) Each entry made under this subsection shall be written in ink.

DCF 57.25(4) (4) Adverse reaction to medication. In the event of an adverse reaction to any medication, a staff member shall immediately notify the resident’s parent or guardian and the attending physician.

DCF 57.25(5) (5) Medication errors. The attending physician shall be notified in the event of a medication error. The department and placing agency shall be notified as required in ss. DCF 57.13 (1) (e) and 57.135.

DCF 57.25(6) (6) Medication storage and disposal. The licensee shall comply with all of the following requirements for storing medication:

DCF 57.25(6)(a) (a) Medication including over-the-counter medication, shall be kept in the container in which it was purchased or prescribed. No person may transfer medication that has been prescribed or purchased over-the-counter to another container or change the label on any medication, unless the person is a pharmacist as defined in s. 450.01 (15), Stats.

DCF 57.25(6)(b) (b) Medication shall be locked and stored in a location that is inaccessible to children. Only staff members who are designated in writing by the program director shall have access to keys to the medication. Prescription and over-the-counter medication shall not be stored next to chemicals or other contaminants.

DCF 57.25(6)(c) (c) Medication shall be kept under acceptable conditions of sanitation, temperature, light, moisture, and ventilation according to the requirements of each medication. Medication that requires refrigeration shall be stored in a separate locked compartment or container that is properly labeled, stored separately from food items, and kept inaccessible to children.

DCF 57.25(6)(d) (d) Medication for internal consumption shall be stored separately from medication for external application.

DCF 57.25(6)(e) (e) Within 72 hours of the medication’s expiration date, the date the medication is no longer in use by the resident for whom the medication was prescribed or purchased, or the date the resident is discharged, unused medication shall be returned to a parent, guardian, or legal custodian of the resident, for removal from the group home or shall be destroyed by the group home manager or returned to the prescribing pharmacy to be destroyed.

DCF 57.25(6)(f) (f) The group home shall maintain a log of medication destroyed. The information logged shall be written in ink and shall include the amount of medication destroyed, the name of the staff member who destroyed the medication, and the name of the resident to whom the medication belongs. Whenever medication is released to a resident’s parent, guardian or legal custodian, that information, including the name of the person receiving the medication, shall be documented in the resident’s record.

DCF 57.25(6)(g) (g) The group home shall contact the local police to destroy the medications or contact the Division Officer at the U.S. Drug Enforcement Agency (DEA) for instructions for destroying controlled substances.

DCF 57.25 Note Note: The address and phone number for the U.S. Drug Enforcement Agency is 1000 North Water Street, Milwaukee, WI 53202, or call [phone], extension 5300.

DCF 57.25(7) (7) Psychotropic medication.

DCF 57.25(7)(a) (a) Definitions. In this subsection, “psychotropic medication” means any drug that affects the mind and is used to manage inappropriate resident behavior or psychiatric symptoms and may include an anti-psychotic, an antidepressant, lithium carbonate or a tranquilizer.

DCF 57.25(7)(b) (b) Rights of patients. A group home shall comply with the provisions of s. 51.61 (1) (g) and (h), Stats., for each resident who is prescribed psychotropic medication.

DCF 57.25(7)(c) (c) Non-emergency procedures. A group home serving a resident for whom psychotropic medication is newly prescribed shall ensure that all of the following requirements are met:

DCF 57.25(7)(c)1. 1. A medical evaluation of the resident is completed by a physician detailing the reason for the type of psychotropic medication prescribed. The evaluation or screening shall be documented in the resident’s record within the first 45 days after the resident has first received a psychotropic medication. Subsequent evaluations of the resident related to the administration of psychotropic medications shall be completed as recommended by the prescribing physician and the results documented in the resident’s record.

DCF 57.25(7)(c)2. 2. The resident, if 14 years of age or older, and a parent, or guardian of the resident, have signed written consent forms as required under s. DHS 94.03, unless psychotropic medications are administered per court order. If the medication is administered per court order, there shall be a copy of the order in the resident’s record.

DCF 57.25(7)(c)3. 3. All group home staff understand the potential benefits and side effects of the medication and have received information relating to contraindicated medications.

DCF 57.25(7)(d) (d) Emergency procedures. For emergency administration of a psychotropic medication to a resident, a group home shall do all of the following:

DCF 57.25(7)(d)1. 1. Have authorization from a physician.

DCF 57.25(7)(d)2. 2. Whenever feasible, obtain written informed consent from a parent, or guardian, and the resident, if the resident is 14 years old or older, before using the medication unless the medication is administered per court order

DCF 57.25(7)(d)3. 3. Comply with the group home’s emergency medical procedures.

DCF 57.25(7)(d)4. 4. If written informed consent of a parent or guardian of a the resident was not obtained before administration of the medication notify the parent or guardian by phone as soon as possible following emergency administration and document the dates, times, and persons notified in the resident’s treatment record.

DCF 57.25(7)(d)5. 5. Document the physician’s reasons for ordering emergency administration of psychotropic medication in the resident’s treatment record.

DCF 57.25(7)(e) (e) Revocation of consent or refusal to take.

DCF 57.25(7)(e)1. 1. A resident’s parent or guardian may revoke consent for non-emergency use of psychotropic medications at any time, as provided under s. DHS 94.03.

DCF 57.25(7)(e)2. 2. When a consent is revoked, the group home shall do all of the following:

DCF 57.25(7)(e)2.a. a. Administer the medication pursuant to a court order or as prescribed by a physician to avoid serious physical harm to the resident or others.

DCF 57.25(7)(e)2.b. b. Inform the prescribing physician and the placing person or agency of the consent revocation and document the revocation in the resident’s treatment record.

DCF 57.25(7)(e)3. 3. When a resident refuses to take a prescribed psychotropic medication, the group home shall do all of the following:

DCF 57.25(7)(e)3.a. a. Document the resident’s reasons for refusal in the resident’s treatment record.

DCF 57.25(7)(e)3.b. b. Notify the resident’s physician, the parent or guardian or legal custodian and the resident’s placing person or agency. Notification shall be immediate if the resident’s refusal threatens the resident’s well-being and safety.

DCF 57.25(7)(f) (f) Administration standards. In administering psychotropic medication, a group home shall comply with requirements for administration of prescription medication in this section and clinically acceptable standards for good medical practice. Conformance to guidelines of the department’s division of disability and elder services for use and monitoring of the effects of psychotropic medications satisfies the requirement for clinically acceptable standards and for good medical practice.

DCF 57.25 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06; corrections in (2) (a), (5), (7) (c) 2. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DCF 57.26 DCF 57.26 Dental care. Within 30 days after admission to a group home, each resident over the age of 3 years old who is admitted to the group home for other than respite care shall receive a dental examination unless an examination has been performed within 6 months before the resident’s admission. Subsequent dental examinations shall occur at intervals not exceeding 6 months after the last examination or completion of treatment.

DCF 57.26 History History: CR 04-067: cr. Register September 2005 No. 597, eff. 1-1-06.

DCF 57.27 DCF 57.27 Behavior intervention.

DCF 57.27(1) (1) Prohibited measures. No licensee, staff member, or volunteer may do any of the following:

DCF 57.27(1)(a) (a) Hit, shake, pinch, push, twist or use any other means that the staff member or volunteer knows or should know may inflict mental or physical harm or actions that may be psychologically, emotionally or physically painful to a resident.

DCF 57.27(1)(b) (b) Verbally abuse a resident or use profanity, or any language that the staff member or volunteer knows or should know may ridicule a resident.

DCF 57.27(1)(c) (c) Lock a resident in a room or any other place.

DCF 57.27(1)(d) (d) Use any item to cover a resident’s head or face or wrap the resident’s body with sheets, blankets, or any other material.

DCF 57.27(1)(e) (e) Require a resident to march, stand, kneel, or assume and remain in any fixed position or assign work that is not therapeutic and not a part of the resident’s treatment plan.

DCF 57.27(1)(f) (f) Release any noxious, toxic or otherwise unpleasant substances near the eyes or face of a resident.

DCF 57.27(1)(g) (g) Authorize, direct or ask a resident to discipline another resident.

DCF 57.27(1)(h) (h) Discipline one resident for the behavior or action of another resident.

DCF 57.27(1)(i) (i) Employ any measure that the staff member or volunteer knows or should know is aversive, cruel, humiliating or that may be psychologically, emotionally, or physically painful, discomforting, dangerous, or potentially injurious to a resident.

DCF 57.27(1)(j) (j) Use any mechanical restraint or equipment that restricts the movement of an resident or a portion of the resident’s body as behavior intervention.

DCF 57.27(1)(k) (k) Use a prone restraint that places a resident in a face down position as behavior intervention.

DCF 57.27(2) (2) Time-outs.

DCF 57.27(2)(a) (a) As used in this subsection, “time-out” means a behavior intervention technique that involves brief periods of physical separation of a resident from others.

DCF 57.27(2)(b) (b) A time-out may not be used for the convenience of staff members or volunteers, as a substitute for supervision of a resident, or for a child under 3 years old.

DCF 57.27(2)(c) (c) Areas used for time-outs shall be free of objects with which a resident could self-inflict bodily harm, shall provide a staff view of the resident at all times and shall be equipped with adequate ventilation and lighting.

DCF 57.27(2)(d) (d) The use of time-outs shall be appropriate to the developmental level and the age of the resident and may not be for a period longer than the period of time necessary for the resident to regain control. The maximum length of time that a resident may be in a time-out on each occurrence of a time-out is as follows:

DCF 57.27(2)(d)1. 1. For a child 3 through 6 years of age, a time-out may not exceed 10 minutes.

DCF 57.27(2)(d)2. 2. For a child 7 through 10 years of age, a time-out may not exceed 15 minutes.

DCF 57.27(2)(d)3. 3. For a child over 11 years of age, a time-out may not exceed 30 minutes. The need for continued use of a time-out shall be reviewed at least every 10 minutes and documented in the resident’s record.

DCF 57.27(2)(e) (e) A resident that is in a time-out shall be permitted use of the toilet if requested.

DCF 57.27(2)(f) (f) Any resident that is in a time-out shall be within hearing of a staff member.

DCF 57.27(2)(g) (g) Within 12 hours of occurrence, there shall be documentation in the resident’s record of each time-out, including the name of each staff member involved, the length of the time-out, and rationale for use.

DCF 57.27(3) (3) Emergency safety intervention.

DCF 57.27(3)(a) (a) A staff member may not use any type of physical restraint on a resident unless the resident’s behavior presents an imminent danger of harm to self or others and physical restraint is necessary to contain the risk and keep the resident and others safe.

DCF 57.27(3)(b) (b) A staff member shall attempt other feasible alternatives to de-escalate a resident and situation before using physical restraint.

DCF 57.27(3)(c) (c) A staff member may not use physical restraint as disciplinary action, for the convenience of the staff member, or for therapeutic purposes.

DCF 57.27(3)(d) (d) If physical restraint is necessary under par. (a), a staff member may only use the physical restraint in the following manner:

DCF 57.27(3)(d)1. 1. With the least amount of force necessary and in the least restrictive manner to manage the imminent danger of harm to self or others.

DCF 57.27(3)(d)2. 2. That lasts only for the duration of time that there is an imminent danger of harm to self or others.

DCF 57.27(3)(d)3. 3. That does not include any of the following:

DCF 57.27(3)(d)3.a. a. Any maneuver or technique that does not give adequate attention and care to protection of the resident’s head.

DCF 57.27(3)(d)3.b. b. Any maneuver that places pressure or weight on the resident’s chest, lungs, sternum, diaphragm, back, or abdomen causing chest compression.

DCF 57.27(3)(d)3.c. c. Any maneuver that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the resident’s head or neck, or that otherwise obstructs or restricts the circulation or blood or obstructs an airway, such as straddling or sitting on the resident’s torso.

DCF 57.27(3)(d)3.d. d. Any type of choke hold.

DCF 57.27(3)(d)3.e. e. Any technique that uses pain inducement to obtain compliance or control, including punching, hitting, hyperextension of joints, or extended use of pressure points for pain compliance.

DCF 57.27(3)(d)3.f. f. Any technique that involves pushing on or into a resident’s mouth, nose, or eyes, or covering the resident’s face or body with anything, including soft objects, such as pillows, washcloths, blankets, and bedding.

DCF 57.27(3)(d)4. 4. Notwithstanding subd. 3. f., if a resident is biting himself or herself or other persons, a staff member may use a finger in a vibrating motion to stimulate the resident’s upper lip and cause the resident’s mouth to open and may lean into the bite with the least amount of force necessary to open the resident’s jaw.

DCF 57.27(3)(e) (e) After an episode of physical restraint, a debriefing shall take place with the resident and staff that were involved in the physical restraint.

DCF 57.27(3)(f) (f) Each staff member who uses a physical restraint or who witnesses the use of a physical restraint shall, within 24 hours of each incident, give the group home manager a written description of the incident. The group home manager shall document each incident, including date, time, and a description of the circumstances of the incident, and report the incident to the field office that serves the group home and the placing agency as required under s. DCF 57.13 (1) (c) and (5). Each description shall include all of the following:

DCF 57.27(3)(f)1. 1. The name, age, and sex of each resident involved.

DCF 57.27(3)(f)2. 2. The date, time, and location of the incident.