- Stephen Boulanger
WAC Series: Part One
The requirements for skilled nursing communities in the state of Washington concerning pharmacy services are extensive and detailed. The information for this article comes from the Washington State Legislature’s Adminstrative Code, otherwise known as WAC. On the legislature’s website you can review the full text of WAC 388-97-1300, outlining the laws surrounding pharmacy services in skilled nursing communities. Today we’re going to take a close look at this WAC and what it requires of skilled nursing communities across the state
In Washington, communities are required to fulfill the following obligations:
1. Under agreement with a licensed pharmacy, obtain routine medications, emergency medications and biologicals for its residents.
2. Ensure services from the pharmacy:
3. Meet the needs of each resident;
4. Establish systems for accurately acquiring, receiving, dispensing and administering all medications and biologicals;
5. Monitor these systems.
6. Enlist the services of a licensed pharmacist. This pharmacist is required to:
7. Consult on all aspects of pharmacy services throughout the community;
8. Ensure the correct maintenance of medication records;
9. Review the drug therapy of every resident in the community at least monthly;
10. Record any irregularities in medications and report these to the attending physician and director of nursing.
The state also requires every community provide its staff with reference material covering the use of medication, adverse reactions, toxicology and poison control center information.
Services Your Pharmacy/Pharmacist Provides
Your pharmacy is required to supply drugs in a timely manner so your staff is able to follow physicians’ orders. You may operate your own licensed pharmacy and employ a director of pharmaceutical services. Otherwise, you must have a written agreement with at least one pharmacist who provides for pharmaceutical consultant services. Either way, your pharmacist is responsible for supervising and consulting on all pharmaceutical services throughout your community. These services include:
Evaluation of pharmaceutical services and recommendations to administration;
On-site evaluations to ensure adherence to industry standards for the handling of medication;
Regular screenings of every resident’s therapy for potential or existing problems, followed up with documented recommendations;
Informing staff and doctors concerning medications as needed.
This pharmacist is also required to work with the community in developing staff and consult with other departments concerning resident services.
Your pharmacy must meet all recognized and accepted standards of pharmacy practice as well as all WAC regulations. (One exception to these regulations is that staff in a nursing home may document administration immediately after giving the med or when they pour it).
Nursing homes must arrange for their licensed pharmacist to educate and train staff on standards of pharmacy practice, applicable laws and rules, monitoring residents for desired results, monitoring for undesirable side effects and the use of psychotropic drugs. The nursing home must also provide:
Adherence to regulations governing the administration and receipt of medications;
Reference materials covering medication administration, adverse reactions, toxicology and poison control center information;
Accountability for acting upon the pharmacist’s recommendations arising from their monthly medication review;
For drug errors and adverse reactions, detection, documentation, reporting and resolution.
Residents who prefer to choose their own pharmacy have the right to do so as long as their pharmacy of choice delivers medications in a timely manner and in units compatible with the community’s established dispensing systems. Ultimately, any pharmacy contracted by a resident must meet conditions to protect the resident from medication errors.