Chapter DCF 52

DCF 52.44(5)(g) (g) A center may not use disposable dinnerware at meals on a regular basis, except when it documents that use of disposable dinnerware for a particular resident is necessary to protect the health or safety of the resident or others.

DCF 52.44 History History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (4) (b), (c) and (5) (a) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DCF 52.45 DCF 52.45 Health.

DCF 52.45(1) (1) Ongoing care.

DCF 52.45(1)(a) (a) A center shall arrange a physical examination comparable to a comprehensive HealthCheck screening for each resident at intervals recommended by the medical assistance program for HealthCheck screening, except if a resident is privately insured. A privately insured resident shall be reexamined no less frequently than as required by HealthCheck or in accordance with policy coverage. The physical examination shall be conducted by a HealthCheck provider or by a physician and shall document areas found on department HealthCheck age-appropriate forms.

DCF 52.45 Note Note: A HealthCheck form may be obtained from any local public health agency, from the Department of Health Services website at http://dhs.wisconsin.gov/forms/FtoM.asp or by writing or telephoning any field office listed in Appendix D.

DCF 52.45(1)(b) (b) A center shall arrange a thorough dental examination for each resident at intervals recommended by the medical assistance program for HealthCheck screening, except if a resident is privately insured. A privately insured resident shall be reexamined no less frequently than as required by Healthcheck or in accordance with policy coverage. The dental examination shall be conducted by a licensed dentist.

DCF 52.45(1)(c) (c) A center shall arrange and provide for necessary remedial and corrective measures for every resident as soon as possible after a physical or dental examination which indicates need for remedial or corrective measures.

DCF 52.45(1)(d) (d) A center shall have in each building housing residents when residents are present, at least one staff member certified by the American Red Cross to administer first aid and certified by the American Red Cross or American heart association to administer cardiopulmonary resuscitation (CPR). The center shall keep all staff certifications current and shall maintain documentation of all certifications.

DCF 52.45(1)(e) (e) There shall be a first aid kit on every floor level of every center building housing residents, in buildings where resident activities take place and in every vehicle used to transport residents. The first aid kit shall be placed where it is inaccessible to residents but accessible to staff. Contents of first aid kits shall meet recommendations of the American Red Cross. A first aid kit shall be inventoried and resupplied after each use.

DCF 52.45(1)(f) (f) A center shall separate an ill resident from other residents only if necessary because of the severity of the illness and if it is contagious or infectious, or when requested by the ill resident.

DCF 52.45(2) (2) Basic sanitation and hygiene practices. Center staff shall follow the guidelines in appendix A to prevent transmission of infection from all blood or other body fluid exposures.

DCF 52.45(3) (3) Pregnant residents or resident mothers.

DCF 52.45(3)(a) (a) If a center serves pregnant residents or residents who are mothers who keep their babies at the center, the center shall do all of the following:

DCF 52.45(3)(a)1. 1. Refer those residents for enrollment to the women, infants and children (WIC) supplemental food and nutrition counseling program.

DCF 52.45(3)(a)2. 2. Ensure that pregnant residents receive prenatal health care.

DCF 52.45(3)(a)3. 3. Ensure that resident mothers and their infant or toddler children receive health care through a HealthCheck provider or, if through private insurance, a physician, according to the frequency recommended under medical assistance program HealthCheck guidelines or as described by the private insurance policy.

DCF 52.45(3)(b) (b) A center which serves residents who are mothers with infants or toddlers shall comply with s. DCF 250.07, family day care standards for infant and toddler care. The center shall provide an additional 35 square feet of resident living space for each infant and toddler in addition to the resident living space required under s. DCF 52.52 (1).

DCF 52.45(4) (4) Health care record. A center shall maintain a separate health care record as part of each resident’s case record. The health care record shall include all of the following:

DCF 52.45(4)(a) (a) The signed written consent required under s. DCF 52.21 (5).

DCF 52.45(4)(b) (b) The dates and results of all physical health, mental health and dental examinations.

DCF 52.45(4)(c) (c) The resident’s health history and, if applicable, medications history prior to admission and during the resident’s stay at the center.

DCF 52.45(4)(d) (d) Information about any of the following medical procedures received while the young person was a resident of the center, including dates, person administering and results:

DCF 52.45(4)(d)1. 1. Immunizations.

DCF 52.45(4)(d)2. 2. Laboratory tests.

DCF 52.45(4)(d)3. 3. Routine health care examinations and treatment.

DCF 52.45(4)(d)4. 4. Emergency health care examinations and treatment.

DCF 52.45(4)(d)5. 5. Dental examinations and treatment.

DCF 52.45(4)(e) (e) The medications administration record required under s. DCF 52.46 (4).

DCF 52.45(4)(f) (f) If applicable, the nutritional care plan required under s. DCF 52.44 (2) (c).

DCF 52.45 History History: Cr. Register, February, 2000, No. 530, eff. 9-1-00; corrections in (3) (b), (4) (a), (e) and (f) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DCF 52.46 DCF 52.46 Medications.

DCF 52.46(1) (1) Definitions. In this section:

DCF 52.46(1)(a) (a) “General supervision” means regular coordination, direction and inspection of the exercise of delegation of medication administration by a physician or registered nurse of someone who is not licensed to administer medications.

DCF 52.46(1)(b) (b) “Staff administration” means proper administration of medication to a resident by center nonmedically nonlicensed staff under a valid medical order from a medically licensed practitioner who specifically designates, trains and supervises center staff administration of medications.

DCF 52.46(1)(c) (c) “Staff monitoring of self-administration” means handing the medication to the resident by center staff according to physician and medication label instructions and observing and ensuring the proper ingestion, injection, application or inhalation of the medication by the resident.

DCF 52.46(2) (2) Medications administration. Each staff person responsible for administering or monitoring resident use of medications shall receive a copy of the center policies and procedures required under s. DCF 52.41 (1) (c) 9. for medication administration and monitoring and shall be knowledgeable of them. The policies and procedures shall include:

DCF 52.46(2)(a) (a) For all medications, all of the following:

DCF 52.46(2)(a)1. 1. Having written informed consent on file as required under s. DCF 52.21 (5).

DCF 52.46(2)(a)2. 2. Having information in each resident’s health record about any health allergies or health-related restrictions.

DCF 52.46(2)(a)3. 3. Having on file written authorization from a physician or registered nurse for each staff person permitted to administer medications or to monitor self-administration of medications.

DCF 52.46(2)(a)4. 4. Instructions for center staff concerning administration of medications and monitoring of resident self-administration of medications, secure storage of medications and recording medication administration information as required under sub. (4) (a) in the resident’s health record.

DCF 52.46(2)(a)5. 5. Immediate notification of the resident’s attending physician in the event of a medication error or adverse drug reaction.

DCF 52.46(2)(a)6. 6. Medications may only be made available when an individual authorized by the center is present.

DCF 52.46(2)(b) (b) For prescription medications, all of the following:

DCF 52.46(2)(b)1. 1. Requiring that a medication be administered by center staff to a resident only when:

DCF 52.46(2)(b)1.a. a. The resident’s attending physician or center medical consultant provides center staff with clear written instructions for administering the medication and authorizes specific center staff to administer the medication.

DCF 52.46(2)(b)1.b. b. The administration takes place under the general supervision of a physician or registered nurse.

DCF 52.46(2)(b)1.c. c. The label on the medication container gives clear instruction for administration of the medication and, if not clear, center staff contact the physician or pharmacy for clarification before administration of the medication.

DCF 52.46(2)(b)2. 2. Allowing a medication, including a self-injectable medication, to be self-administered by a resident only while the resident is under direct supervision of center staff and if self-administration is authorized in writing from the prescribing physician or center medical consultant under s. DCF 52.41 (1) (c) 4., and that authorization is confirmed by review of the authorization for self-administration by center staff before allowing self-administration by a resident.

DCF 52.46(2)(b)3. 3. Providing information to a resident and the resident’s resident care workers and resident services case manager about any medication prescribed for the resident and when a physician orders or changes the resident’s medication. Information provided shall include expected benefits and potential adverse side effects which may affect the resident’s overall treatment and, for staff, what to do if the resident refuses medication.

DCF 52.46(2)(b)4. 4. Instructions for center staff on what to look for in monitoring physical or mental changes to a resident that may occur from a medication, what to do if physical or mental changes are observed and recording them in the resident’s health record.

DCF 52.46(2)(b)5. 5. Arranging a second medical consultation when a resident or the resident’s parent or guardian or legal custodian, if any, has concerns about any medication received by the resident or the resident’s medication plan.

DCF 52.46(2)(b)6. 6. Having the resident’s physician or center medical consultant review a resident’s prescription medications when there are noted adverse effects from the medication. Documentation showing the date of review and reviewer’s name shall appear in the resident’s health record.

DCF 52.46(2)(b)7. 7. Ensuring that any use-as-needed medication is based on an assessment by a physician or registered nurse and is approved by either a physician or registered nurse.

DCF 52.46(2)(b)8. 8. Arranging for administration of prescribed medications to a resident when the resident is away from the center, for example, at school or on a home visit. A resident may not be given access to medications if there is a possibility that the resident may harm self through abuse or overdose.

DCF 52.46(3) (3) Medications storage.

DCF 52.46(3)(a) (a) A center shall comply with all the following requirements for storage of medications:

DCF 52.46(3)(a)1. 1. All medications shall be kept in the original container or, when authorized in writing by a physician, in a dispensing container, and shall:

DCF 52.46(3)(a)1.a. a. If a prescription medication, be labeled with the expiration date and information required under s. 450.11 (4), Stats.

DCF 52.46(3)(a)1.b. b. If a non-prescription medication, be labeled with the name of the medication, directions for use, expiration date and the name of the resident taking the medication.

DCF 52.46(3)(a)2. 2. Medications shall be kept in locked cabinets or containers and under proper conditions of sanitation, temperature, light, moisture and ventilation to prevent deterioration.

DCF 52.46(3)(a)3. 3. Medications used externally and medications taken internally shall be stored on separate shelves or in separate cabinets.

DCF 52.46(3)(a)4. 4. Medications stored in a refrigerator containing other items shall be stored in a separate locked compartment.

DCF 52.46(3)(a)5. 5. Medications may not be stored with disinfectants or poisons.

DCF 52.46(3)(b) (b) A center shall immediately destroy all outdated prescription and over-the-counter medications and all prescription medication no longer in use. The center shall maintain a log of the medication destroyed, who destroyed it and what amount was destroyed.

DCF 52.46(4) (4) Medications administration record.

DCF 52.46(4)(a) (a) A center shall have in each resident’s health record a written medications administration record which lists each prescribed and over-the-counter medication the resident receives. The record shall contain the following information:

DCF 52.46(4)(a)1. 1. For an over-the-counter medication, the resident’s name, type of medicine, reason for use, time and day of administration and staff person authorizing its use.

DCF 52.46(4)(a)2. 2. For a prescription medication, all of the following:

DCF 52.46(4)(a)2.a. a. The name of the resident.

DCF 52.46(4)(a)2.b. b. The generic or commercial name of the medication.

DCF 52.46(4)(a)2.c. c. The date the medication was prescribed.

DCF 52.46(4)(a)2.d. d. The name and telephone number of the prescribing physician to call in case of a medical emergency.

DCF 52.46(4)(a)2.e. e. The reason the medication was prescribed.

DCF 52.46(4)(a)2.f. f. The dosage.

DCF 52.46(4)(a)2.g. g. The time or times of day for administering the medication. Staff shall document all medication administered with the date and time of administration or, if not administered, with the date and time of resident refusal to take it.

DCF 52.46(4)(a)2.h. h. The method of administration, such as orally or by injection.

DCF 52.46(4)(a)2.i. i. The name of the center-authorized person who administered or monitored resident self-administration of the medication.

DCF 52.46(4)(a)2.j. j. Any adverse effects observed.

DCF 52.46(4)(a)2.k. k. Any medication administration errors and corrective or other action taken.

DCF 52.46(4)(b) (b) The center shall have a copy of a resident’s medication administration record readily available for all center authorized personnel responsible for administering medications to the resident.

DCF 52.46(5) (5) Psychotropic medications.

DCF 52.46(5)(a) (a) Definition. In this subsection, “psychotropic medication” means any drug that affects the mind and is used to manage inappropriate resident behavior or psychiatric symptoms, which may include an antipsychotic, an antidepressant, lithium carbonate or a tranquilizer.

DCF 52.46 Note Note: This definition does not include a drug that can be used to manage inappropriate symptoms when it is prescribed only for a different medical use, such as carbamazapine (Tegretol), which is usually used for control of seizures but may be used to control labile behavior, and propranolol (Inderal), which is usually used to control high blood pressure but may be used to control anxiety states or side effects from antipsychotic medication.

DCF 52.46(5)(b) (b) Rights of patients. A center shall comply with the provisions of s. 51.61 (1) (g) and (h), Stats., for all residents who are prescribed psychotropic medications.

DCF 52.46(5)(c) (c) Non-emergency procedures. A center serving a resident for whom psychotropic medications are prescribed shall ensure that all of the following requirements are met:

DCF 52.46(5)(c)1. 1. Arrangements have been made for a physician to perform an initial medical work up or conduct a medical screening of the resident for the type of psychotropic medication to be prescribed for the resident. If the prescribing physician is not a board-certified pediatrician or psychiatrist, consultation shall be obtained from a board-certified pediatrician or psychiatrist.

DCF 52.46(5)(c)2. 2. The resident, if 14 years of age or older, and the resident’s parent or guardian and legal custodian shall have signed written consent forms as required under s. DHS 94.03.