DHS 83.37(1)(e)3. 3. The CBRF shall obtain a written report of findings under subds. 1. and 2., and address any irregularities for appropriate action. When the review is done by someone other than the prescribing practitioner, the prescribing practitioner shall receive a copy of the report when there are irregularities identified with the resident’s medication regimen, which may need physician involvement to address.

DHS 83.37(1)(f) (f) More than one practitioner.

DHS 83.37(1)(f)1. 1. When an employee of the CBRF administers a resident’s medication, the CBRF shall provide a list of the resident’s current medications to all practitioners. If this information is not provided before a prescription is written, the CBRF shall update the resident’s primary practitioner or pharmacist before the administration of any new medication.

DHS 83.37(1)(f)2. 2. When a resident self administers medications, the CBRF shall provide a list of the resident’s current medications for the resident to provide to all practitioners.

DHS 83.37(1)(g) (g) Disposition of medications.

DHS 83.37(1)(g)1. 1. When a resident is discharged, the resident’s medications shall be sent with the resident.

DHS 83.37(1)(g)2. 2. If a resident’s medication has been changed or discontinued, the CBRF may retain a resident’s medication for no more than 30 days unless an order by a physician or a request by a pharmacist is written every 30 days to retain the medication.

DHS 83.37(1)(g)3. 3. The CBRF shall develop and implement a policy for disposing unused, discontinued, outdated, or recalled medications in compliance with federal, state and local standards or laws. The CBRF shall arrange for the stored medications to be destroyed in compliance with standard practices. Medications that cannot be returned to the pharmacy shall be separated from other medication in current use in the facility and stored in a locked area, with access limited to the administrator or designee. The administrator or designee and one other employee shall witness, sign, and date the record of destruction. The record shall include the medication name, strength and amount.

DHS 83.37(1)(h) (h) Scheduled psychotropic medications. When a psychotropic medication is prescribed for a resident, the CBRF shall do all of the following:

DHS 83.37(1)(h)1. 1. Ensure the resident is reassessed by a pharmacist, practitioner or registered nurse, as needed, but at least quarterly for the desired responses and possible side effects of the medication. The results of the assessments shall be documented in the resident’s record as required under s. DHS 83.42 (1) (q).

DHS 83.37(1)(h)2. 2. Ensure all resident care staff understands the potential benefits and side effects of the medication.

DHS 83.37(1)(i) (i) As needed (PRN) psychotropic medication. When a psychotropic medication is prescribed on an as needed basis for a resident, the CBRF shall do all of the following:

DHS 83.37(1)(i)1. 1. The resident’s individual service plan shall include the rationale for use and a detailed description of the behaviors which indicate the need for administration of PRN psychotropic medication.

DHS 83.37(1)(i)2. 2. The administrator or qualified designee shall monitor at least monthly for the inappropriate use of PRN psychotropic medication, including but not limited to, use contrary to the individual service plan, presence of significant adverse side effects, use for discipline or staff convenience, or contrary to the intended use.

DHS 83.37(1)(i)3. 3. Documentation in the resident’s record shall include the rationale for use, description of behaviors requiring the PRN psychotropic medication, the effectiveness of the medication, the presence of any side effects, and monitoring for inappropriate use for each PRN psychotropic medication given.

DHS 83.37(1)(j) (j) Proof-of-use record. The CBRF shall maintain a proof-of-use record for schedule II drugs, subject to 21 USC 812 (c), and Wisconsin’s uniform controlled substances act, ch. 961, Stats., that contains the date and time administered, the resident’s name, the practitioner’s name, dose, signature of the person administering the dose, and the remaining balance of the drug. The administrator or designee shall audit, sign and date the proof-of-use records on a daily basis.

DHS 83.37(1)(k) (k) Medication error or adverse reaction.

DHS 83.37(1)(k)1. 1. The CBRF shall document in the resident’s record any error in the administration of prescription or over-the-counter medication, known adverse drug reaction or resident refusal to take medication.

DHS 83.37(1)(k)2. 2. The CBRF shall report all errors in the administration of medication and any adverse drug reactions to a licensed practitioner, supervising nurse or pharmacist immediately. Unless otherwise directed by the prescribing practitioner, the CBRF shall report to the prescribing practitioner, supervising nurse or pharmacist as soon as possible after the resident refuses a medication for 2 consecutive days.

DHS 83.37(1)(L) (L) Medication information. The CBRF shall make available written information to resident care staff on the purpose and side effects of medications taken by residents.

DHS 83.37(2) (2) Medication administration.

DHS 83.37(2)(a) (a) Self-administered by resident.

DHS 83.37(2)(a)1. 1. The resident shall self-administer prescribed and over-the-counter medications and dietary supplements, unless the resident has been found incompetent under ch. 54, Stats., or does not have the physical or mental capacity to self-administer as determined by the resident’s physician, or the resident requests in writing that CBRF employees manage and administer medication.

DHS 83.37(2)(a)2. 2. Except as specified under sub. (4), when a resident self-administers medications, prescribed and over-the-counter medications and dietary supplements shall remain under the control of the resident. The CBRF shall provide a secure place for the storage of medications in the resident’s room.

DHS 83.37(2)(a)3. 3. A resident with the mental and physical capacity to develop increased independence in medication administration shall receive self-administration instruction.

DHS 83.37(2)(b) (b) Medication administration supervised by a registered nurse, practitioner or pharmacist. When medication administration is supervised by a registered nurse, practitioner or pharmacist, the CBRF shall ensure all of the following:

DHS 83.37(2)(b)1. 1. The registered nurse, practitioner or pharmacist coordinates, directs and inspects the administration of medications and the medication administration system.

DHS 83.37(2)(b)2. 2. The registered nurse, practitioner or pharmacist participates in the resident’s assessment under s. DHS 83.35 (1) and development and review of the individual service plan under s. DHS 83.35 (3) regarding the resident’s medical condition and the goals of the medication regimen.

DHS 83.37(2)(c) (c) Medication administration not supervised by a registered nurse, practitioner or pharmacist. When medication administration is not supervised by a registered nurse, practitioner or pharmacist, the CBRF shall arrange for a pharmacist to package and label a resident’s prescription medications in unit dose. Medications available over-the-counter may be excluded from unit dose packaging requirements, unless the physician specifies unit dose.