Section 57.25. Medical care.

 

(1)   Consent.

(a) Any medical examination or service provided to a resident shall be provided only by an individual licensed to perform the examination or service being provided. Before an examination or service is provided, written consent to perform the examination or service shall be obtained as follows:

1. For a resident who is under 14 years of age, written consent of a resident's parent or guardian.

2. For a resident who is between 14 and 18 years of age, consent of the resident's parent or guardian with the consent of the resident whenever feasible.

3. For a resident who is 18 years of age or older, consent of the resident is required unless the resident has been deemed incompetent by a court and has a court appointed guardian or legal custodian, in which case the consent of the guardian or legal custodian is required.

(b) Consent shall include consent to administer emergency medical services including surgery for life threatening situations when a parent, cannot immediately be reached. Verbal consent may be obtained in an emergency situation where time or distance precludes obtaining written consent. Both the written consent and any verbal consent shall be documented in the resident's record, by indicating who obtained the consent, who gave the consent and that person's relationship to the resident, and what specific services are authorized by the consent. A verbal consent shall be valid for 10 calendar days, during which time there shall be a good faith effort to obtain written consent.

(2)   Medication administration.

(a) Information required to administer medication. No staff member may administer medication to a resident unless the staff member has received the group home's policies established under s. DCF 57.05 (2) (c) for administering and monitoring medication use.

(am) After receiving the information described in sub. (2) (a) , staff shall receive the following:

1. Procedure for administering the medication being given as described by the physician, pharmacist or as indicated on the label of an over the counter medication or a prescribed medication or both. If the label on prescribed medication is not clear, a staff member shall contact the pharmacy that filled the prescription for clarification.

2. Procedures for documenting the administration of medication as specified under sub. (3) .

3. The purpose of the medication.

4. Any potential adverse side effects of the medication being administered.

5. Procedure to follow if a resident refuses medication, including refusal of psychotropic medication as described in sub. (7) .

6. Known drug allergies of the resident.

7. Any other information that may be relevant to administration of the medication.

(b) Limitation on who can administer medication. Medication may be administered to a resident only in the presence of a staff member that has been authorized in writing by the program director or the group home manager, to administer medication.

(c) Self administration. Medication may be self-administered by a resident only under all of the following conditions:

1. Self-administration is authorized in writing from the prescribing practitioner.

2. There is no demonstrated history of risk that the resident may harm self through abuse or overdose.

3. The resident's treatment plan includes an evaluation by the program director of the resident's capability to self-administer medication.

4. The resident recognizes and distinguishes the medication or treatment and knows the condition or illness for which the medication or treatment is prescribed, the correct dosage, and when the medication or treatment is to be taken.

5. The medication is not a psychotropic medication as defined in sub. (7) (a) .

(3)   Medication Administration documentation.

(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:

1. Full name of the resident to whom the medication was administered.

2. Date and time the medication was administered.

3. Name and dosage of the medication administered or medical treatments received.

4. Signature of the staff member who administered or supervised the administration of medication.

5. Any refusal of medication.

6. Any adverse reaction to the medication and steps taken to notify the resident's health care provider, parent, guardian, or legal custodian.

7. Any error in medication administration and the steps taken to notify the resident's physician as required in sub. (5) .

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

(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.

(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 .

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

(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.

(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.

(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.

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

(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.

(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.

(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.

(7)   Psychotropic medication.

(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.

(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.

(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:

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.

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.

3. All group home staff understand the potential benefits and side effects of the medication and have received information relating to contraindicated medications.

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

1. Have authorization from a physician.

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

3. Comply with the group home's emergency medical procedures.

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.

5. Document the physician's reasons for ordering emergency administration of psychotropic medication in the resident's treatment record.

(e) Revocation of consent or refusal to take.

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 .

2. When a consent is revoked, the group home shall do all of the following:

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.

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.

3. When a resident refuses to take a prescribed psychotropic medication, the group home shall do all of the following:

a. Document the resident's reasons for refusal in the resident's treatment record.

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.

(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.

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 .

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. Microsoft Windows NT 6.1.7601 Service Pack 1