SECTION 301.355. Medication Services

(a) Prescribing of psychoactive medication. The LMHA and MCO must ensure that psychoactive medication is prescribed in accordance with Chapter 415, Subchapter A of this title (relating to Prescribing of Psychoactive Medication).

(b) Medication service delivery. The LMHA, MCO, and provider must implement written procedures to ensure safe medication-related service delivery that include, but are not limited to, the following.

(1) A procedure for physician delegation of medical acts to non-physicians. The procedure must address delegation protocols to advanced practice nurses and/or physician assistants, delegation of medical acts to nursing and/or unlicensed staff, and the frequency of physician supervision over the staff member to whom a delegation is made. The procedure must provide a method to ensure the staff members are acting within the scope of their license and is qualified and trained to perform the medical act.

(2) A procedure for RNs to make assignments to LVNs or delegate to unlicensed staff members nursing acts for the care of stable individuals with common, well-defined health problems with predictable outcomes. The procedure must address the types of nursing acts that may be delegated, the method to ensure the staff member is trained and qualified to perform a delegated nursing act, and the frequency of nursing supervision of the unlicensed staff member in accordance with Texas Occupations Code, Chapter 301 (relating to the Nursing Practice Act).

(3) A procedure for medication administration by licensed medical or nursing staff that addresses who may access and administer medications, timely administration, documentation of administration, and monitoring of administration, and that complies with applicable professional licensing standards and rules.

(4) A procedure for medication handling that addresses:

(A) dispensing;

(B) labeling and record keeping of sample medications;

(C) limiting access to physician stock medications;

(D) patient assistance/indigent medication program;

(E) mechanisms to ensure safe temperature-controlled storage and transport of medication;

(F) controlled drugs;

(G) disposal/destruction of medication; and

(H) locked areas and maintaining security.

(5) A procedure by which a physician, a physician's assistant, or an RN assesses and determines whether an individual can self-administer medication and whether it can be done without supervision.

(6) A procedure for training and assessing the competency of staff members to perform supervision of self-administration of medication, including:

(A) medication actions;

(B) target symptoms;

(C) understanding prescription labels;

(D) potential toxicity;

(E) side effects;

(F) adverse reactions;

(G) proper storage of medications; and

(H) reporting and documentation requirements.

(7) A procedure for providing appropriate supervision of staff members who are supervising self-administration of medication.

(8) A procedure for medication errors that defines the most common types of medication errors and provides for:

(A) the accurate documentation of medication errors;

(B) the reporting of medication errors to the physician within one hour of their occurrence;

(C) a mechanism for determining medication error trends;

(D) a mechanism for analyzing both individual medication errors and trends for quality improvement; and

(E) the reporting of medication errors, as appropriate.

Source Note: The provisions of this §301.355 adopted to be effective April 29, 2009, 34 TexReg 2603; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1237