(a) Administration.
  (1) A facility must ensure that a person who administers medications to clients who choose not to or who cannot self-administer his or her medications holds a current license under applicable state law that authorizes the licensee to administer medications.
  (2) A facility must ensure that all medication prescribed to a client that is administered at the facility is dispensed through a pharmacy or by the client's prescribing practitioner.
  (3) A facility may administer sample medications at the facility if the medication has been prescribed to the client and includes specific dosage instructions for the client.
  (4) A facility must record a client's medications on the client's medication profile record. The recorded information must be obtained from the prescription label and must include the medication name, strength, dosage, amount received, directions for use, route of administration, prescription number, pharmacy name, and date each medication was issued by the pharmacy.
(b) Assistance with self-administration. A nurse may assist with self-administration of a client's medication if the client is unable to administer the medication without assistance. Assistance with self-administration of medication is limited to:
  (1) reminding the client to take medications at the prescribed time;
  (2) opening and closing containers or packages;
  (3) pouring prescribed dosage according to the client's medication profile record;
  (4) returning medications to the proper locked areas;
  (5) obtaining medications from a pharmacy; and
  (6) listing on the client's medication profile record the medication name, strength, dosage, amount received, directions for use, route of administration, prescription number, pharmacy name, and the date each medication was issued by the pharmacy.
(c) Self-administration.
  (1) A nurse must counsel a client who self-administers medication or treatment at least once per month to ascertain if the client continues to be able to self-administer the medication or treatment. The facility must keep a written record of the counseling.
  (2) A facility may permit a client who chooses to keep the client's medication locked in the facility's central medication storage area to enter or have access to the area for the purpose of self-administering medication or treatment. A facility staff member must remain in or at the storage area the entire time the client is present in the area.
(d) General.
  (1) A facility director, an activities director, or a facility nurse must immediately report to a client's prescribing practitioner and responsible party any unusual reactions to a medication or treatment.
  (2) When a facility supervises or administers medications, the facility must document in writing if a client does not receive or take the medication and treatment as prescribed. The documentation must include the date and time the dose should have been taken and the name and strength of medication missed.
(e) Storage.
  (1) A facility must provide a locked area for all medications, which may include:
    (A) a central storage area; or
    (B) a medication cart.
  (2) A facility must store a client's medication separately from other clients' medications within the storage area.
  (3) A facility must store medication requiring refrigeration in a locked refrigerator that is used only for medication storage or in a separate, permanently attached, locked medication storage box in a refrigerator.
  (4) A facility must store poisonous substances and medications labeled for "external use only" separately from other substances within the locked area.
  (5) A facility must store drugs covered by Schedule II of the Controlled Substances Act of 1970 in a locked, permanently attached cabinet, box, or drawer that is separate from the locked storage area for other medications.
(f) Disposal.
  (1) In accordance with applicable federal and state laws, a facility must dispose of medication that:
    (A) has been discontinued by order of the client's prescribing practitioner;
    (B) remains after the client no longer attends the DAHS; or
    (C) has passed the medication expiration date.
  (2) A facility must ensure the medication identified in paragraph (1) of this subsection is disposed by:
    (A) a registered pharmacist licensed in the State of Texas;
    (B) a local pharmacy on-site medication drop-off box; or
    (C) a local law enforcement or community drug take-back program.
  (3) A facility must inventory and store medications awaiting disposal separate from current client medications.
  (4) A facility must dispose of needles and hypodermic syringes with needles attached as required by 25 TAC Chapter 1, Subchapter K (relating to the Definition, Treatment, and Disposition of Special Waste from Health Care-Related Facilities).
  (5) A facility must obtain a signed receipt from the client or the client's responsible party if the facility releases medication to the client or responsible party.

Source Note: The provisions of this §559.69 adopted to be effective July 10, 2024, 49 TexReg 4909