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 Administrative Code, otherwise known as WAC. On the legislature’s website you can review the full text of WAC 246-865-060, outlining laws specific to pharmaceutical services in a skilled nursing community. Today we’re going to examine this WAC and what it means for your community.
Labeling Medications: Section 4
Legend drug labels (prescription medications) in your community not dispensed in a unit dose must be divided into compartments which are labeled with the name of the resident receiving the medication. Due to space constraints, separation is often achieved by placing the drug in a sealable bag with the patient’s name or room number written on it. Each label requires:
Name and address of the providing pharmacy;
Resident’s full name;
Date of issue;
Initials of the dispensing pharmacist;
Name and strength of the drug;
Controlled substances schedule (if applicable);
Number of tablets or cubic centimeters dispensed;
Labels for compounded drugs containing Schedule II or III drugs also need to include the amount of each controlled substance per cc or teaspoon.
Nonlegend drugs (OTC) repackaged by the pharmacist require the original manufacturer’s label or a pharmacy label as well as labeling with the patient’s name and the community’s date of receipt. The patient’s name is not required on non-legend drugs your community supplies itself (see WAC 388-88-050). The pharmacist is the only person with the authority to alter or replace drug labels. When your community receives a container with a label compromised in any way (missing, soiled, illegible, makeshift, etc.), send it back to the pharmacy. Do not open a container before returning a medication. Drugs in containers having no labels or illegible labels must be destroyed.
Control and Accountability
When you discharge a resident (non-Med A), you can release their medications to them as long as you have written authorization from the attending physician. In this case, be sure to create a receipt for the resident’s health record that includes the drug’s destination, the person who received it, the name of the drug and the quantity released.
Your community is required to destroy any medication remaining unused after a physician discontinues it, including Schedule III, IV and V, within 90 days. Keep detailed records of all destroyed drugs, with the exception of drugs sealed in unit dose packages. Scheduled ll controlled substances need to be immediately and irretrievably disposed of by a licensed nurse employee in the presence of a witness with proper records maintained of such disposal.
Never use outdated, unapproved, contaminated, deteriorated, adulterated or recalled medications in your community.
Once a resident no longer resides in your community, their medications must be disposed of properly and according to their classification