APPENDIX C:

Modified on Fri, 28 Apr, 2023 at 2:51 PM

APPENDIX C:

UPDATED Medication Requirements for Child/Adolescent Day

Treatment and Assertive Community Treatment Team Programs Only

MEDICATION REQUIREMENTS

(A) MEDICATION DISPENSING:

(1) Medications shall be dispensed only on the written order of a physician or other practitioner

licensed to prescribe.

(2) Dispensing shall be restricted to registered pharmacists, physicians, or other health care

practitioners authorized by law and registered with the North Carolina Board of Pharmacy. If a

permit to operate a pharmacy is not required, a nurse or other designated person may assist a

physician or other health care practitioner with dispensing so long as the final label, container,

and its contents are physically checked and approved by the authorized person prior to

dispensing.

(3) Methadone for take-home purposes may be supplied to a client of a methadone treatment service

in a properly labeled container by a registered nurse employed by the service, pursuant to the

requirements of 10A NCAC 26E .0306 SUPPLYING OF METHADONE IN TREATMENT

PROGRAMS BY RN. Supplying of methadone is not considered dispensing.

(4) Other than for emergency use, facilities shall not possess a stock of prescription legend drugs for

the purpose of dispensing without hiring a pharmacist and obtaining a permit from the NC Board

of Pharmacy. Physicians may keep a small locked supply of prescription drug samples. Samples

shall be dispensed, packaged, and labeled in accordance with state law and this Rule.

(B) MEDICATION PACKAGING AND LABELING:

(1) Non-prescription drug containers not dispensed by a pharmacist shall retain the manufacturer's

label with expiration dates clearly visible;

(2) Prescription medications, whether purchased or obtained as samples, shall be dispensed in

tamper-resistant packaging that will minimize the risk of accidental ingestion by children. Such

packaging includes plastic or glass bottles/vials with tamper-resistant caps, or in the case of unitof-use packaged drugs, a zip-lock plastic bag may be adequate;

(3) The packaging label of each prescription drug dispensed must include the following:

(A) the client's name;

(B) the prescriber's name;

(D) clear directions for self-administration;

(E) the name, strength, quantity, and expiration date of the prescribed drug; and

(F) the name, address, and phone number of the pharmacy or dispensing location

(e.g., MH/DD/SA center), and the name of the dispensing practitioner.

(C) MEDICATION ADMINISTRATION:

(1) Prescription or non-prescription drugs shall only be administered to a client on the written order

of a person authorized by law to prescribe drugs.

(2) Medications shall be self-administered by clients only when authorized in writing by the client's

physician.

(3) Medications, including injections, shall be administered only by licensed persons, or by unlicensed

persons trained by a registered nurse, pharmacist or other legally qualified person and privileged

to prepare and administer medications.

(4) A Medication Administration Record (MAR) of all drugs administered to each client must be kept

current. Medications administered shall be recorded immediately after administration. The MAR

is to include the following:

(A) client's name;

(B) name, strength, and quantity of the drug;

(D) date and time the drug is administered; and

(E) name or initials of person administering the drug.

(5) Client requests for medication changes or checks shall be recorded and kept with the MAR file

followed up by appointment or consultation with a physician.

(D) MEDICATION DISPOSAL:

(1) All prescription and non-prescription medication shall be disposed of in a manner that guards

against diversion or accidental ingestion.

(2) Non-controlled substances shall be disposed of by incineration, flushing into septic or sewer

system, or by transfer to a local pharmacy for destruction. A record of the medication disposal

shall be maintained by the program. Documentation shall specify the client's name, medication

name, strength, quantity, disposal date and method, the signature of the person disposing of

medication, and the person witnessing destruction.

(3) Controlled substances shall be disposed of in accordance with the North Carolina Controlled

Substances Act, G.S. 90, Article 5, including any subsequent amendments.

(4) Upon discharge of a consumer, the remainder of his or her drug supply shall be disposed of

promptly unless it is reasonably expected that the consumer shall return to the facility/program

and in such case, the remaining drug supply shall not be held for more than 30 calendar days

after the date of discharge.

(E) MEDICATION STORAGE:

(1) All medication shall be stored:

(A) in a securely locked cabinet in a clean, well-lighted, ventilated room between 59º and 86º

F.;

(B) in a refrigerator, if required, between 36º and 46º F. If the refrigerator is used for food

items, medications shall be kept in a separate, locked compartment or container;

(D) separately for external and internal use;

(E) in a secure manner if approved by a physician for a client to self-medicate.

(2) Each facility/program that maintains stocks of controlled substances shall be currently registered

under the North Carolina Controlled Substances Act and shall be in compliance with the North

Carolina Controlled Substances Act, G.S. 90, Article 5, including any subsequent amendments.

(F) MEDICATION REVIEW:

(1) If the client receives psychotropic drugs, the governing body or Program Director shall be

responsible for obtaining a review of each client's drug regimen at least every six months. The

review shall be to be performed by a pharmacist or physician. The on-site manager shall assure

that the client's physician is informed of the results of the review when medical intervention is

indicated.

(2) The findings of the drug regimen review shall be recorded in the client record along with corrective

action, if applicable.

(G) MEDICATION EDUCATION:

(1) Each client started or maintained on a medication by an area program physician shall receive

either oral or written education regarding the prescribed medication by the physician or their

designee. In instances where the ability of the client to understand the education is questionable,

a responsible person shall be provided either oral or written instructions on behalf of the client.

(2) The medication education provided shall be sufficient to enable the client or other responsible

person to make an informed consent, to safely administer the medication and to encourage

compliance with the prescribed regimen.

(3) The area program physician or designee shall document in the client record that education for the

prescribed psychotropic medication was offered and either provided or declined. If provided, it

shall be documented in what manner it was provided (either orally or written or both) and to whom

(client or responsible person).

(H) MEDICATION ERRORS:

Drug administration errors and significant adverse drug reactions shall be reported immediately to a physician or

pharmacist. An entry of the drug administered and the drug reaction shall be properly recorded in the drug

record. A client's refusal of a drug shall be charted.