DHS 132.65(2)(b)(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. DHS 132.65(4)(a)(a) A facility may have one or more emergency medication kits. All emergency medication kits shall be under the control of a pharmacist. DHS 132.65(4)(b)(b) The emergency kit shall be sealed and stored in a locked area. DHS 132.65(5)(a)(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. DHS 132.65(5)(b)(b) Storage. Contingency drugs shall be stored at a nursing unit, except that those medications requiring refrigeration shall be stored in a refrigerator. DHS 132.65(5)(c)(c) Single units. Contingency medications shall be stored in single unit containers, a unit being a single capsule, tablet, ampule, tubex, or suppository. DHS 132.65(5)(d)(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. DHS 132.65(5)(e)(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. DHS 132.65(6)(b)(b) Storing and labeling medications. Unless exempted under par. (f), all medications shall be handled in accordance with the following provisions: DHS 132.65(6)(b)1.1. ‘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.). DHS 132.65(6)(b)2.2. ‘Transfer between containers.’ Medications shall be stored in their original containers, and not transferred between containers, except by a physician or pharmacist. DHS 132.65(6)(b)3.3. ‘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. DHS 132.65(6)(b)4.4. ‘Separation of medications.’ Medications packaged for individual residents shall be kept physically separated. DHS 132.65(6)(b)5.5. ‘Refrigeration.’ Medications requiring refrigeration shall be kept in a separate covered container and locked, unless the refrigeration is available in a locked drug room. DHS 132.65(6)(b)6.6. ‘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. DHS 132.65(6)(b)7.7. ‘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. DHS 132.65(6)(b)8.8. ‘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. DHS 132.65(6)(c)1.1. ‘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. DHS 132.65(6)(c)2.2. ‘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. DHS 132.65(6)(d)1.1. ‘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. DHS 132.65(6)(d)2.2. ‘Signatures.’ When the medication is received by the facility, the person completing the control record shall sign the record indicating the amount received. DHS 132.65(6)(d)3.3. ‘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. DHS 132.65(6)(e)1.1. 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. DHS 132.65(6)(e)2.2. 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. DHS 132.65(6)(f)(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. DHS 132.65(7)(a)(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). DHS 132.65(7)(b)1.1. The individual medication shall be labeled with the drug name, strength, expiration date, and lot or control number. DHS 132.65(7)(b)2.2. A resident’s medication tray or drawer shall be labeled with the resident’s name and room number. DHS 132.65(7)(b)3.3. 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. DHS 132.65(7)(b)4.4. 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. DHS 132.65(7)(b)5.5. If not delivered from the pharmacy to the facility by the pharmacist, the pharmacist’s agent shall transport unit dose drugs in locked containers. DHS 132.65(7)(b)6.6. The individual medication shall remain in the identifiable unit dose package until directly administered to the resident. Transferring between containers is prohibited. DHS 132.65(7)(b)7.7. Unit dose carts or cassettes shall be kept in a locked area when not in use. DHS 132.65 HistoryHistory: 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 132.67(1)(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. DHS 132.67(3)(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. DHS 132.67 HistoryHistory: 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 132.68(1)(1) Provision of services. Each facility shall provide for social services in conformance with this section. DHS 132.68(2)(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. DHS 132.68(3)(3) Admission history. The facility shall prepare a social history of each resident. DHS 132.68(4)(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). DHS 132.68(5)(5) Services. Social services staff shall provide the following: DHS 132.68(5)(a)(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; DHS 132.68(5)(b)(b) Adjustment assistance. Assistance with adjustment to the facility, and continuing assistance to and communication with the resident, guardian, family, or other responsible persons; DHS 132.68(5)(c)(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 DHS 132.68(5)(d)(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. DHS 132.68 HistoryHistory: 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 132.69DHS 132.69 Activities. Each facility shall have an activity program designed to meet the needs and interests of each resident. DHS 132.69 HistoryHistory: 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 132.695DHS 132.695 Special requirements for facilities serving persons who are developmentally disabled. DHS 132.695(1)(1) Scope. The requirements in this section apply to all facilities that serve persons who are developmentally disabled. DHS 132.695(2)(a)(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. DHS 132.695(2)(b)(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. DHS 132.695(2)(c)(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. DHS 132.695(2)(d)(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: DHS 132.695(2)(d)3.3. 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. DHS 132.695(2)(d)7.7. 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 DHS 132.695(2)(d)8.8. 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. DHS 132.695(3)(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. DHS 132.695(4)(b)1.1. 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. DHS 132.695(4)(b)2.a.a. Evaluation procedures for determining whether the methods or strategies are accomplishing the care objectives; and DHS 132.695(4)(b)2.b.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. DHS 132.695(4)(c)1.1. 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. DHS 132.695(4)(c)2.2. 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. DHS 132.695(4)(c)3.3. 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. DHS 132.695(4)(c)4.4. Documentation of the reassessment results, treatment objectives, plans and procedures, and continuing treatment progress reports shall be recorded in the resident’s record. DHS 132.695(4)(d)(d) Implementation. Progress notes shall reflect the treatment and services provided to meet the goals stated in the IPP.
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