Decision guide
A client has a medication. Must the home store it centrally?
Does the medication have to be kept in a refrigerator to stay good?
- Yes
Store it centrally: locked, reachable only by the employees who supervise it, apart from cleaning products and poisons, in its original labeled container, with a line on the client's record.
- No
Has the client's physician found it hazardous if the client keeps it himself?
- Yes
Store it centrally: locked, reachable only by the employees who supervise it, apart from cleaning products and poisons, in its original labeled container, with a line on the client's record.
- No
Has the administrator or the licensing agency found it a safety hazard because of the home's setup or people's condition or habits?
- Yes
Store it centrally: locked, reachable only by the employees who supervise it, apart from cleaning products and poisons, in its original labeled container, with a line on the client's record.
- No
Do you think it could be a danger to the client or to others, though no one has decided?
- Yes
Do not move it yourself. Tell the administrator, who may make a finding or ask the client's physician.
- No
The rule does not require central storage. Staff help the client with it as needed, as the companion course explains.
A job aid, not a rule book. It does not replace the physician's orders, the administrator's findings or your facility's procedures. Whether a medication is hazardous for the client is the physician's decision. Call 911 for an imminent threat to health.
Step through it one question at a time: alwbeta.com/training/courses/arf-medication-storage#decision-guide
Lesson 1
When a medication must be centrally stored
Clients in an ARF are helped as needed to take their own medications. Some medications must be kept by the home instead. This lesson gives the three circumstances the ARF rule names, and who decides each one, so you know when a medication goes into the home's locked storage.
- Needs a refrigerator to stay good: centrally stored, even if the client has his own refrigerator
- Physician finds it hazardous in the client's hands: centrally stored
- Administrator or licensing agency finds it a safety hazard: centrally stored
- A worry is not a finding: tell the administrator
- Do not move a client's medication on your own
Lesson: alwbeta.com/training/courses/arf-medication-storage#lesson-arfs-when
Lesson 2
Locked, apart, labeled and in the original container
Once a medication is centrally stored, the rules say how it is kept. They cover who can reach it, what it is stored apart from, what the container shows, who may change a label and what container it stays in. This lesson helps you check a cabinet, a key or a bottle against those rules.
- Locked; only the employees who supervise the medications can reach them
- Refrigerated medications are locked too
- Apart from disinfectants, cleaning products and poisons
- Label: client, physician, drug, strength, quantity, date filled, Rx number, pharmacy, expiration, refills
- Only the dispensing pharmacist changes a label
- Original container; never pour from one container to another
Lesson: alwbeta.com/training/courses/arf-medication-storage#lesson-arfs-storage
Lesson 3
The centrally stored medication record
Every centrally stored prescription has a record behind it. The next shift relies on it, and licensing staff may read it. This lesson shows the eight items the ARF rule lists, how CDSS form LIC 622 lays them out, and how the client record fits in, so you can tell when a record is complete.
- Each client: a record of centrally stored prescriptions, kept at least one year
- Client, physician, drug, strength, quantity, date filled, Rx number, pharmacy
- Plus expiration date, number of refills and any control and custody instructions
- LIC 622 Part I has a column for each
- Client record: current medications, kept three years after services end
Lesson: alwbeta.com/training/courses/arf-medication-storage#lesson-arfs-record
Lesson 4
Destroying medications no longer used
A client moves out and leaves a bottle behind, or a medication is not to be kept any longer. This lesson shows who destroys a prescription medication in an ARF, who may not be the second adult, and what the signed record holds, so a destruction meets the rule.
- Not taken with the client when services end, or not to be retained: destroy it
- Administrator or designated substitute, plus one other adult
- The other adult is not a client
- Both sign: client, Rx number, pharmacy, drug, strength, quantity, date
- Keep the destruction record at least one year (LIC 622 Part II)
Lesson: alwbeta.com/training/courses/arf-medication-storage#lesson-arfs-destruction
Lesson 5
Oxygen in an ARF
When a client needs oxygen, the home takes on duties toward the client, its staff, the fire authority and the building. This lesson lists what the ARF licensee is responsible for, from watching the client's ability to removing the equipment, so you can set up and check oxygen use.
- Watch the client's ongoing ability to run and care for the equipment
- Client cannot: designate enough staff, trained by a licensed professional
- Written report to the local fire jurisdiction
- "No Smoking - Oxygen in Use" signs; no smoking where oxygen is used
- Spark check, tanks secured, safe tubing, portable source outside the room
- Equipment works; staff can run it; remove it when no longer used
Lesson: alwbeta.com/training/courses/arf-medication-storage#lesson-arfs-oxygen
