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(2)Services.
(a) Each facility shall provide for obtaining medications for the residents directly from licensed pharmacies.
(b) The facility shall establish, maintain, and implement such policies and procedures as are necessary to comply with this section and assure that resident needs are met.
(4)Emergency medication kit.
(a) A facility may have one or more emergency medication kits. All emergency medication kits shall be under the control of a pharmacist.
(b) The emergency kit shall be sealed and stored in a locked area.
(5)Contingency supply of medications.
(a) Maintenance. A facility may have a contingency supply of medications not to exceed 10 units of any medication. Any contingency supply of medications must be under the control of a pharmacist.
(b) Storage. Contingency drugs shall be stored at a nursing unit, except that those medications requiring refrigeration shall be stored in a refrigerator.
(c) Single units. Contingency medications shall be stored in single unit containers, a unit being a single capsule, tablet, ampule, tubex, or suppository.
(d) Committee authorization. The quality assessment and assurance committee shall determine which medications and strengths of medications are to be stocked in the contingency storage unit and the procedures for use and re-stocking of the medications.
(e) Control. Unless controlled by a “proof-of-use” system, as provided by sub. (6) (e), a copy of the pharmacy communication order shall be placed in the contingency storage unit when any medication is removed.
(6)Requirements for all medication systems.
(b) Storing and labeling medications. Unless exempted under par. (f), all medications shall be handled in accordance with the following provisions:
1. ‘Storage.’ Medications shall be stored near nurse’s stations, in locked cabinets, closets or rooms, conveniently located, well lighted, and kept at a temperature of no more than 85° F. (29° C.).
2. ‘Transfer between containers.’ Medications shall be stored in their original containers, and not transferred between containers, except by a physician or pharmacist.
3. ‘Controlled substances.’ Separately locked and securely fastened boxes or drawers, or permanently affixed compartments, within the locked medication area shall be provided for storage of schedule II drugs, subject to 21 USC ch. 13, and Wisconsin’s uniform controlled substance act, ch. 961, Stats.
4. ‘Separation of medications.’ Medications packaged for individual residents shall be kept physically separated.
5. ‘Refrigeration.’ Medications requiring refrigeration shall be kept in a separate covered container and locked, unless the refrigeration is available in a locked drug room.
6. ‘External use of medications.’ Poisons and medications for external use only shall be kept in a locked cabinet and separate from other medications, except that time-released transdermal drug delivery systems, including nitroglycerin ointments, may be kept with internal medications.
7. ‘Accessibility to drugs.’ Medications shall be accessible only to the registered nurse or designee. In facilities where no registered nurse is required, the medications shall be accessible only to the administrator or designee. The key shall be in the possession of the person who is on duty and assigned to administer the medications.
8. ‘Labeling medications.’ Prescription medications shall be labeled with the expiration date and as required by s. 450.11 (4), Stats. Non-prescription medications shall be labeled with the name of the medication, directions for use, the expiration date and the name of the resident taking the medication.
(c) Destruction of medications.
1. ‘Time limit.’ Unless otherwise ordered by a physician, a resident’s medication not returned to the pharmacy for credit shall be destroyed within 72 hours of a physician’s order discontinuing its use, the resident’s discharge, the resident’s death or passage of its expiration date. No resident’s medication may be held in the facility for more than 30 days unless an order is written every 30 days to hold the medication.
2. ‘Procedure.’ Records shall be kept of all medication returned for credit. Any medication not returned for credit shall be destroyed in the facility and a record of the destruction shall be witnessed, signed and dated by 2 or more personnel licensed or registered in the health field.
(d) Control of medications.
1. ‘Receipt of medications.’ The administrator or a physician, nurse, pharmacist, or the designee of any of these may be an agent of the resident for the receipt of medications.
2. ‘Signatures.’ When the medication is received by the facility, the person completing the control record shall sign the record indicating the amount received.
3. ‘Discontinuance of schedule II drugs.’ The use of schedule II drugs shall be discontinued after 72 hours unless the original order specifies a greater period of time not to exceed 60 days.
(e) Proof-of-use record.
1. For schedule II drugs, a proof-of-use record shall be maintained which lists, on separate proof-of-use sheets for each type and strength of schedule II drug, the date and time administered, resident’s name, physician’s name, dose, signature of the person administering dose, and balance.
2. Proof-of-use records shall be audited daily by the registered nurse or designee, except that in facilities in which a registered nurse is not required, the administrator or designee shall perform the audit of proof-of-use records daily.
(f) Resident control and use of medications. Medications which, if ingested or brought into contact with the nasal or eye mucosa, would produce toxic or irritant effects shall be stored and used only in accordance with the health, safety, and welfare of all residents.
(7)Additional requirements for unit dose systems.
(a) Scope. When a unit dose drug delivery system is used, the requirements of this subsection shall apply in addition to those of sub. (6).
(b) General procedures.
1. The individual medication shall be labeled with the drug name, strength, expiration date, and lot or control number.
2. A resident’s medication tray or drawer shall be labeled with the resident’s name and room number.
3. Each medication shall be dispensed separately in single unit dose packaging exactly as ordered by the physician, and in a manner to ensure the stability of the medication.
4. An individual resident’s supply of drugs shall be placed in a separate, individually labeled container and transferred to the nursing station and placed in a locked cabinet or cart. This supply shall not exceed 4 days for any one resident.
5. If not delivered from the pharmacy to the facility by the pharmacist, the pharmacist’s agent shall transport unit dose drugs in locked containers.
6. The individual medication shall remain in the identifiable unit dose package until directly administered to the resident. Transferring between containers is prohibited.
7. Unit dose carts or cassettes shall be kept in a locked area when not in use.
History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (3) (b), am. (6) (a), (b) 6. and (c), Register, January, 1987, No. 373, eff. 2-1-87; am. (3) (b) 2., (6) (b) 8. and (c) 1. and 3., Register, February, 1989, No. 398, eff. 3-1-89; correction in (1) (c) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; correction made to (6) (d) 1. under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; CR 04-053: am. (2) and (5) (d), r. (3) (a), renum. and am. (3) (b) 1. and 2., r. (6) (c) 3. Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (3) and (6) (a) and (f) 1. and 2., renum. (6) (f) 2. to be (6) (f), Register August 2007 No. 620, eff. 9-1-07.
DHS 132.67Dental services.
(1)Advisory dentist. The facility shall retain an advisory dentist to participate in the staff development program for nursing and other appropriate personnel and to recommend oral hygiene policies and practices for the care of residents.
(3)Dental examination of residents. Every resident shall have a dental examination by a licensed dentist within 6 months after admission unless a dental examination has been performed within 6 months before admission. Subsequent dental health care shall be provided or arranged for the resident as needed.
Note: For record requirements, see s. DHS 132.45; for dentists’ orders, see s. DHS 132.60 (5); for staff development programs about dental practices, see s. DHS 132.44 (2).
History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (3), Register, January, 1987, No. 373, eff. 2-1-87; CR 06-053: r. (2) and (4), Register August 2007 No. 620, eff. 9-1-07.
DHS 132.68Social services.
(1)Provision of services. Each facility shall provide for social services in conformance with this section.
(2)Staff. Social worker. Each facility shall employ or retain a person full-time or part-time to coordinate the social services, to review the social needs of residents, and to make referrals.
(3)Admission history. The facility shall prepare a social history of each resident.
(4)Care planning. A social services component of the plan of care, including potential for discharge, if appropriate, shall be developed and included in the plan of care required by s. DHS 132.60 (8) (a).
(5)Services. Social services staff shall provide the following:
(a) Referrals. If necessary, referrals for guardianship proceedings, or to appropriate agencies in cases of financial, psychiatric, rehabilitative or social problems which the facility cannot serve;
(b) Adjustment assistance. Assistance with adjustment to the facility, and continuing assistance to and communication with the resident, guardian, family, or other responsible persons;
(c) Discharge planning. Assistance to other facility staff and the resident in discharge planning at the time of admission and prior to removal under this chapter; and
(d) Training. Participation in inservice training for direct care staff on the emotional and social problems and needs of the aged and ill and on methods for fulfilling these needs.
Note: For record requirements, see s. DHS 132.45 (5) (d).
History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (3) (a), (4) (a) and (5) (a), Register, January, 1987, No. 373, eff. 2-1-87; CR 04-053: r. and recr. (3) and (4) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (2) (b) and (4) (b), renum. (2) (a) to be (2), renum. (4) (a) to be (4) and am., Register August 2007 No. 620, eff. 9-1-07.
DHS 132.69Activities. Each facility shall have an activity program designed to meet the needs and interests of each resident.
History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (2) (a), r. and recr. (2) (c), r. (2) (d) and (f), renum. (2) (e) to be (2) (d), Register, January, 1987, No. 373, eff. 2-1-87; CR 04-053: r. (2) (a) 1. a. Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. and recr. (1) to be DHS 132.69, r. (2), Register August 2007 No. 620. eff. 9-1-07.
DHS 132.695Special requirements for facilities serving persons who are developmentally disabled.
(1)Scope. The requirements in this section apply to all facilities that serve persons who are developmentally disabled.
(2)Definitions. In this section:
(a) “Active treatment” means an ongoing, organized effort to help each resident attain or maintain his or her developmental capacity through the resident’s regular participation, in accordance with an individualized plan, in a program of activities designed to enable the resident to attain or maintain the optimal physical, intellectual, social and vocational levels of functioning of which he or she is capable.
(b) “Interdisciplinary team” means the persons employed by a facility or under contract to a facility who are responsible for planning the program and delivering the services relevant to a developmentally disabled resident’s care needs.
(c) “IPP” or “individual program plan” means a written statement of the services which are to be provided to a resident based on an interdisciplinary assessment of the individual’s developmental needs, expressed in behavioral terms, the primary purpose of which is to provide a framework for the integration of all the programs, services and activities received by the resident and to serve as a comprehensive written record of the resident’s developmental progress.
(d) “QIDP” or “qualified intellectual disabilities professional” means a person who has specialized training in intellectual disabilities or at least one year of experience in treating or working with individuals with intellectual disabilities and is one of the following:
1. A psychologist licensed under ch. 455, Stats.;
2. A physician;
3. A social worker with a graduate degree from a school of social work accredited or approved by the council on social work education or with a bachelor’s degree in social work from a college or university accredited or approved by the council on social work education.
4. A physical or occupational therapist who meets the requirements of s. DHS 105.27 or 105.28;
5. A speech pathologist or audiologist who meets the requirements of s. DHS 105.30 or 105.31;
6. A registered nurse;
7. A therapeutic recreation specialist who is a graduate of an accredited program or who has a bachelor’s degree in a specialty area such as art, dance, music, physical education or recreation therapy; or
8. A human services professional who has a bachelor’s degree in a human services field other than a field under subds. 1. to 7., such as rehabilitation counseling, special education or sociology.
(3)Active treatment programming. All residents who are developmentally disabled shall receive active treatment. Active treatment shall include the resident’s regular participation, in accordance with the IPP, in professionally developed and supervised activities, experiences and therapies.
(4)Resident care planning.
(b) Development and content of the individual program plan.
1. Except in the case of a person admitted for short-term care, within 30 days following the date of admission, the interdisciplinary team, with the participation of the staff providing resident care, shall review the preadmission evaluation and physician’s plan of care and shall develop an IPP based on the new resident’s history and an assessment of the resident’s needs by all relevant disciplines, including any physician’s evaluations or orders.
2. The IPP shall include:
a. Evaluation procedures for determining whether the methods or strategies are accomplishing the care objectives; and
b. A written interpretation of the preadmission evaluation in terms of any specific supportive actions, if appropriate, to be undertaken by the resident’s family or legal guardian and by appropriate community resources.
(c) Reassessment of individual program plan.
1. The care provided by staff from each of the disciplines involved in the resident’s treatment shall be reviewed by the professional responsible for monitoring delivery of the specific service.
2. Individual care plans shall be reassessed and updated at least quarterly by the interdisciplinary team, with more frequent updates if an individual’s needs warrant it, and at least every 30 days by the QIDP to review goals.
3. Reassessment results and other necessary information obtained through the specialists’ assessments shall be disseminated to other resident care staff as part of the IPP process.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.