11/30/2015 DAYMARK RECOVERY SERVICES PROCEDURES. Procedure #: 2210 Page: 1 of 3

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1 Section 2 General Program Standards; E. Medication Procedure Consumer of Medications and Medical Services Effective 7/03/14 Review By: 7/03/15 Procedure #: 6040 Consumer of Medications and Medical Services Effective 12/01/03; 6/01/08; 12/02/10; 4/22/11 Procedure #: 2210 Page: 1 of 3 Name: Billy R. West, Jr., Executive Director 7/03/14 Scope: These procedures apply to all Daymark Recovery Services, Inc. (DAYMARK) service sites. Purpose: To assure that medication is accessible and administered safely. Responsibility: All employees trained and designated to provide these services. Process: 1) Each consumer that engages our clinic for assessment and treatment has the right to see our medical staff for additional treatment through pharmacology. 2) A consumer may be referred to our medical services by any of the following, a) Referral from emergency services; b) Self referral; c) Referral from a primary care physician or other provider; d) Referral from our treatment teams, emergency services, primary therapist or case manager. 3) Typically referrals first see a therapist for an intake to complete all necessary clinical, medical and regulatory paper work. From this meeting it is determined with the consumer if an appointment with medical services is needed and if so with whom and if it is an urgent need or not. Then the referral is made accordingly. 4) Each consumer receiving services shall have the right to be free from unnecessary or excessive medication. 5) Medication shall be prohibited when used as punishment, discipline or for staff convenience 6) Medication shall be dispensed by acceptable standards and only upon the order of a licensed physician, nurse practitioner or physician assistant as documented in the consumer record. 7) When prescribing medications our physicians shall consider a consumer s whole system of care and pay special attention to drug interactions, side effects, allergies, dietary concerns, needs for lab work, ability of the consumer to continue the medication and 1) other indications as applicable and unique to each consumer as documented in the psychiatric evaluations and medication check notes. 2) Effectiveness of medications will be reviewed at each medication check and the consumer s overall symptom relief, benefit and overall satisfaction noted. 3) To promote state-of-the-art prescribing and to ensure safety of the consumer, the prescribing of medications will be based on the current standard of care as defined by psychiatric training, continuing medical education activities, and published guidelines from the American Psychiatric Association, the American Association of Child and Adolescent Psychiatrists or other reputable professional organizations. 4) Safeguards shall be instituted in accordance with sound medical practice when a medication is known to present serious risks to the individual receiving services is prescribed. 5) Particular attention shall be given to the use of neuroleptic medications. 6) Each individual receiving service shall have the right to receive medication education and information that shall detail the benefits and the potential negative side effects of the medication. Evidence of such medication education shall be maintained in the individual s medical record. Medication education shall include, but not be limited to, explaining how the drug works, side effects, contraindications, benefits of medications, other wellness and recovery programs that may be beneficial and others as medically indicated. When the consumer is a minor or has a legal guardian this information will be provided to the appropriate party. 7) Each consumer receiving services shall retain the right to refuse the use of medication except when ordered to do so by a court of competent jurisdiction. 8) Each DAYMARK employee engaged in the administration of medication to individuals receiving services shall do so only when properly trained according to the applicable standard. Documentation of training in medication administration will be maintained in the employee file. 9) Prescription medication shall be dispensed/administered only on a written order signed by a physician, nurse practitioner or physician assistant (or verbal order to a registered nurse or licensed practical nurse and co-signed by a physician, nurse practitioner or physician assistant.) 10) Consumer requests for medication changes or checks shall be recorded and kept in the electronic health record or with the MAR file and followed up by appointment or consultation with a physician. 11) Over the counter medication shall be administered only on the written approval of a physician or person authorized to prescribe legend drugs. If the consumer is a minor or incompetent adult, the authorization of the parent/guardian should be secured. 12) Authorization for the use of non-prescription medication shall be so designated through the completion of a non-prescription medication authorization form developed by the medical director. 13) At 24 hour facilities, non-prescription drug containers not dispensed by a pharmacist shall retain the manufacturer's label with expiration dates clearly visible; In general, DAYMARK Staff administer only injections in administering medications to consumers. All other medications should be dispensed to the consumer for self- 1) consumption unless otherwise clinically indicated or the consumer is part of a residential or inpatient program operated by DAYMARK. 2) DAYMARK has a psychiatrist available 24 hour per day, seven days per week to field medication questions related to side effects, benefits, refills or other consultation. 3) Daymark provides staff and consumers ready access to the phone number for a poison control center. 4) Daymark Medical Directors periodically (at least annually) review a sample of each prescriber s records to assess the appropriateness of medication treatment. Definitions: CARF Behavioral Health Standards Manual: Prescribing is the practice of evaluating, prescribing, dispensing and/or administering medications to persons served in response to specific symptoms, behaviors and conditions for which the use of medications is indicated and efficacious and of giving direction to the person served in the preparation and administering of a remedy to be used in the treatment of disease. Training: All employees designated to provide these services shall be licensed, certified and otherwise trained in the practice of evaluating, prescribing, dispensing and/or administering medications. Monitoring: Pharmacotherapy services shall be monitored in accordance with DAYMARK performance improvement criteria. References: APSM 30-1; CARF 2014 Behavioral Health Standards Manual Appendices: See other related documents as contained on the Daymark intranet 1

2 Procedures #: 2220 Section 2 General Program Standards; E. Medication Page: 1 of 3 Procedures Dispensing of Medications/Storage of Sample Medications Effective 11/6/14 Review 11/6/15 No.: 6060 Name: Billy R. West, Jr., Dispensing of Medications/Storage of Sample Executive Director Medications Effective 6/01/08; ; ; 03/30/11; 4/16/13; 7/3/14 Scope: these procedures apply to all Daymark Recovery Services, Inc. (DAYMARK) outpatient service sites (NOTE: see also Policy #927 Safeguards Regarding Medications and Research) Purpose: DAYMARK service sites may maintain a limited supply of prescription medication samples provided by established pharmaceutical companies for dispensing to indigent consumers. These medications shall be stored in a safe and secure, double locked system accessible only to physicians, nurse practitioners, physician assistants and registered or licensed practical nurses. Daymark does not dispense any medications other than samples or medications provided through patient assistance programs (PAP) by pharmaceutical companies. Responsibility: all employees designated and trained, licensed and/or certified to provide these services. Process: 1. Receipt and Storage of Prescription medication samples: a. Physicians, nurse practitioners, and physician assistants shall be in contact with pharmaceutical company representatives. They will identify medications typically needed in emergency or gap or starter situations and sign for receipt of the identified medication samples. b. All prescription medications shall be stored in locked cabinets within a locked room, accessible only to DAYMARK physicians, nurse practitioners, registered nurses, licensed practical nurses, or staff trained in state curriculum standards for medication administration in individual cabinets or bins labeled to designate each medication and identifying the strengths, if applicable. c. Only prescription medications samples or PAP medications shall be stored in the designated locked cabinets. Medications maintained by DAYMARK shall be limited to a small supply of emergency medications most typically ordered by our physicians which a. indigent consumers are least likely to be able to afford and/or which are needed most often to use as starter doses and sample medications obtained for specific consumers through pharmaceutical indigent care programs. b. Medications obtained for specific consumers through pharmaceutical indigent care programs shall be labeled with each consumers name and date received, and shall be stored separately from the supply of starter or gap doses. A log shall be maintained of these medications identifying date received, consumer, type of medication, date dispensed to the consumer and the initials of the physician, nurse practitioner, or physician assistant who dispensed the medication to the consumer. c. A separate log shall be kept of sample medications stored for use as gap or starter doses for different consumers, which identifies the date received, type of medication, strengths and number of each received and dispensed. 2. Dispensing of prescription medication samples: a. Unless clinically indicated and addressed through additional procedures, those service sites that do maintain medication samples or PAP, provide all medications directly to the consumer. b. There shall be accompanying orders for each specific medication written by a DAYMARK physician, nurse practitioner or physician assistant, or by a registered nurse and reviewed/confirmed by a qualified prescriber in the consumer s record. c. Medications may be dispensed only by a DAYMARK physician, nurse practitioner, or physician assistant. A registered nurse or other designated staff member may assist in this process. d. Medication samples must be labeled with: date dispensed, consumer name, name and address of the prescribing physician who ordered medication, name of medication, strength of medication, quantity and expiration date of the medication, specific directions to the consumer regarding dosage, times, etc,. e. Medication samples and instructions must be reviewed and approved by the physician prior to the consumer receiving them. When the prescriber is working via telemedicine, the local nurse should physically demonstrate to the prescriber the medication package and content and full content of the label. f. Medication sample instructions must be reviewed with the consumer, including benefits and side effects. g. Documentation is made on a progress note or med call sheet that the prescriber reviewed the samples and labeling provided to the consumer. h. Documentation is made on the designated log regarding date, consumer s service record number, medication and strength and dosage. i. Documentation is made in the service record on the medications orders form or in the e-prescribing system. j. Medications shall be dispensed in tamper-resistant packaging that will minimize the risk of accidental ingestion by children. In the case of unit-of-use packaged drugs, a zip-lock plastic bag may be adequate 3. Utilizing Medicaid prescription benefits and pharmaceutical indigent care programs: a. First priority is to ensure all Medicaid eligible consumers are fully utilizing their prescription medications benefits, including assisting consumers who are eligible in applying for Medicaid benefits. b. Staff, including physicians, nurse practitioners, physician assistants and registered nurses, shall identify those pharmaceutical representatives who provide free samples of the medications typically used or obtain coupons for frees samples through the same companies. c. Staff shall maintain an up-to-date list of pharmaceutical companies that do have indigent care programs, the contact phone numbers and listing of medications available, and a supply of the required applications, where applicable. d. Consumers who are not Medicaid eligible, do not have a prescription drug plan through their insurance and are unable to afford their prescription medication will be assisted in completing whatever steps are necessary to become eligible for the indigent care programs as soon as possible. Medications samples or coupons may be used in the interim period if the physician believes the consumer needs to start on the medication for symptom relief/control immediately. e. Under no circumstances will medications samples or coupons be used on a continuous, ongoing basis if a consumer is found to be ineligible for Medicaid and for the indigent care programs. f. A tickler system will be used for each consumer who is receiving assistance through an indigent care program to assure continuity is maintained. Training: All employees designated to provide these services shall be licensed, certified or otherwise trained in the practice of evaluating, prescribing, dispensing and/or administering medications and documentation of training shall be maintained in their personnel files. Monitoring: Pharmacotherapy services shall be monitored in accordance with DAYMARK performance improvement criteria. References: APSM 30-1; CARF 2014 Behavioral Health Standards Manual 2

3 Section 2 General Program Standards; E. Medication Procedures Medication Documentation in Service Records Effective 7/03/14 Review 7/03/15 Procedure #: 6090 Medications Documentation in Service Records Effective 12/01/03; 6/01/08; 12/01/10; 5/15/11 Procedure #: 2250 Page: 1 of 4 Name: Billy R. West, Jr. Executive Director 7/03/14 Scope: These procedures apply to all Daymark Recovery Services, Inc. (DAYMARK) service sites. Purpose: To define methods for documenting medication(s) in the service record of the person served. Responsibility: All employees who are designated and trained to provide this service. Process: Prior to the prescribing or administration of medication, the following information shall be documented: Informed Consent- explanation of the purpose, intended benefits, potential risks and possible side effects of the medication(s), contraindications and documentation of the consumer s understanding and consent and/or documentation of the understanding and consent of the legally responsible person. Medication History- list of active and discontinued medications, including psychotropic and non-psychotropic medications, for at least the past six months, noting current or past use, strength and dosage when known, consumer s report of whether the medication was helpful, any side effects reported and whether other family members benefited from taking the same medication in the past. Allergies/Hypersensitivities- list of allergies and adverse reactions shall be clearly documented. A lack of known allergies and sensitivities to medications and other substances shall be noted. Previous Drug Overdose- The Physician, psychiatric nurse practitioner, or physician assistant shall document any previous overdose attempt and include the date of overdose when known, substance when known and record the date that the information was documented in the service record. This information may be gathered by the admitting/assessing clinician and recorded in the assessment and/or admission document and confirmed by the physician, nurse practitioner or physician assistant during the psychiatric assessment/evaluation. Medication Orders: The Physician, psychiatric nurse practitioner, or physician assistant shall complete the medication order form or document in the e-prescribing system each time a prescription is written or a medication is changed. The physician, psychiatric nurse practitioner, or physician assistant s orders shall also be recorded in the service record documentation (i.e. psychiatric evaluation, medication check service note, etc.) when appropriate and/or in the nurse s progress note in the event of a verbal order (and co-signed by the physician, nurse practitioner or physician s assistant within 72 work hours). Medication orders shall include: The date the medication is ordered, name of medication without abbreviations, strength of medications, administration directions, quantity prescribed, number of authorized refills (or samples to be given as appropriate), and signature of prescribing Physician, psychiatric nurse practitioner, or physician assistant. If a medication is discontinued, the date discontinued must be clearly documented and the reason for the discontinuation documented in the medical record.. The Physician, psychiatric nurse practitioner, or physician assistant may fill out a Report of Health Services to Residents Form when the consumer is brought from a Nursing Home, assisted living/domiciliary home, or group home for medication services. The completed form is returned to the residential facility. A copy may be maintained in the medical record but is not necessary because the Physician, psychiatric nurse practitioner, or physician assistant is required to record all medications prescribed on the agency medication order form. Orders for lab work and x-rays must be documented on the Physician, psychiatric nurse practitioner, or physician assistant s orders, medical monitoring form, or in the service record documentation. Consumers on psychotropic medications shall be monitored for evidence that they are being maintained within established therapeutic levels of their medications, when applicable. Consumers shall be monitored for evidence of undesirable reactions to medications prescribed such as weight gain via weight checks, changes in blood pressure via blood pressure checks, changes in lab results that may indicate the potential for medical problems such as diabetes via routine orders for labs as recommended in best practices for the use of different types of psychotropic medications. The results of all monitoring shall be documented in the medical record within the actual notes or on the medical monitoring form as appropriate. Consumers shall also be monitored for evidence of potentially irreversible side effects to medication of tardive dyskinesia via completion of the Abnormal Involuntary Movement Scale (AIMS) utilizing any approved form or documenting results directly in the evaluation or notes. The AIMS shall be completed at the initiation of treatment, when applicable, and at least every 6 months thereafter. Verbal Orders: Verbal or telephone orders may be taken by a Registered Nurse or Licensed Practical Nurse and shall be documented on the medication order form or in the e-prescribing system following all requirements of documentation of medication orders and including the documentation of signature with date (either handwritten or electronic) of the responsible Physician, psychiatric nurse practitioner, or physician assistant. Medication Review: 1) If the consumer receives psychotropic drugs, a pharmacist, Physician, psychiatric nurse practitioner, or physician assistant shall review the consumer s drug regimen at least every six months. The findings of the review shall be recorded in the service record along with corrective action, if applicable. This review can be part of a psychiatric medication management appointment. 2) Documentation of review with the consumer regarding withdrawal shall include discussion of Methadone or other medications approved for use in narcotic addiction treatment when deemed appropriate within a 24 hour facility. Refer to procedures related to Suboxone treatment at Daymark facility-based crisis. Medication Education: Whenever a new medication is prescribed, the Physician, psychiatric nurse practitioner, or physician assistant shall provide medication education prior to the client taking prescribed medication. 1) Whenever a DAYMARK Physician, psychiatric nurse practitioner, or physician assistant prescribes medication, there shall be documentation by the Physician, psychiatric nurse practitioner, or physician assistant or designee to demonstrate that oral and/or written medication education was provided to either the consumer and/or legally responsible person, if the ability of the consumer to understand is questionable. 2) The medication education provided shall be sufficient to enable the client or other responsible person to make an informed consent, to safely administer the medication and to encourage compliance with the prescribed regimen. 3) The physician, nurse practitioner, or physician assistant shall document in the client record that education for the prescribed psychotropic medication was offered and either provided or declined. If provided, it shall be documented in what manner it was provided (either orally or written or both) and to whom (client and/or responsible person). 4) Medication Education shall include: date medication prescribed, medication name, whether consumer can self administer medication, type of medication education given, via individual or group; frequency/duration how often medication education is anticipated; and physician, psychiatric nurse practitioner, or physician assistant signature after medication education is provided. Medication Education shall also include: 1) The name, form and dosage regimen, intended use, intended benefits, and any common side effects of the medication; 2) Potential adverse reactions or uncomfortable side effects that should prompt calling a physician; 3

4 3) Food, drugs, or beverages that should be avoided/taken with medication; 4) An alternative dosage regimen if a dose is missed; 5) The expected length of the medication treatment; 6) Refill instructions; 7) The proper place to store medication; 8) The need to communicate and coordinate with other physicians of the client those medications prescribed by the program; and 9) For females of child bearing age and ability, the risk factors of medication with pregnancy and the need for client to report any changes in pregnancy status (LMP, birth control, intent to become pregnant) to the physician, 10) Additional Education note if it is desired that the nurse follow-up with additional medication education. The Physician, psychiatric nurse practitioner, or physician assistant shall identify through consultation with the nurse or through written documentation that additional medication education is desired. Medication Errors: 1) Drug administration error and significant adverse drug reactions shall be reported immediately to a Physician, psychiatric nurse practitioner, or physician assistant or pharmacist. The individual making the error will follow the directives of the physician, nurse practitioner or physician assistant in notifying the consumer and/or the legally responsible party of the error and any potential harmful effects. 2) An entry of the drug administered and the drug reaction shall be properly recorded in the drug record. 3) An Incident Death Reporting Form shall be completed and submitted to required agencies as indicated following established procedure. Refusal of Medication: A consumer s refusal of a drug, and reason for same if known, shall be documented in the service record and shall be reported to the physician, nurse practitioner or physician assistant following his/her directives regarding notification. Training: All employees designated to provide these services shall be licensed, certified and/or otherwise trained in the practice of evaluating, prescribing, dispensing and/or administering medications. (See documentation in Human Resources personnel file regarding licensure and refer to on-site personnel files regarding Medication Administration/Education training in residential and 24 hour facilities) Monitoring: Pharmacotherapy services shall be monitored in accordance with DAYMARK performance improvement criteria. References: APSM 30-1; CARF 2014 Behavioral Health Standards Manual Appendices: See other related documents on the Daymark intranet Section 2 General Program Standards; E. Medication Procedures Storage and Disposal of Medications and Equipment Effective 7/03/14 Review 7/03/15 Procedure #: 6150 Storage and Disposal of Medications and Equipment Effective 12/01/03; 6/01/08; 12/22/10; 1/31/12 Procedure #: 2270 Page: 1 of 3 Name: Billy R. West, Jr., Executive Director 7/03/14 Scope: These procedures apply to all Daymark Recovery Services, Inc. (DAYMARK) service sites. Purpose: To assure the proper storage and disposal of medications and related equipment. Responsibility: All employees designated, licensed, certified or otherwise trained to provide these services. Process: 1) Storage/Disposal of Medications: a) Only a small supply of medications will be maintained. b) Medications are stored in observable, locked storage areas that are accessible only to authorized personnel. c) Medications shall be stored under proper conditions of sanitation, temperature, light, moisture, and ventilation. d) Medications for external use shall be segregated from medications for internal use. e) Medication stored in a refrigerator used for other purposes shall be stored in a separate, securely locked compartment. f) Medications of consumers, which are stored by DAYMARK personnel, shall be labeled clearly with the person s name and specifically ordered dosage of the medication, the name of the prescribing physician, the expiration date and the dispensing pharmacy/ pharmacist. g) Medications stored by DAYMARK shall be routinely checked for expiration no less often than prior to each administration by personnel. h) Medications will be stored in a secure manner if approved by a physician, nurse practitioner or physician assistant for a person to self-medicate. Upon discharge of a patient or resident from a 24-hour facility, the remainder of his or her drug supply shall be disposed of promptly unless it is reasonably expected that the a) patient or resident shall return to the facility and in such case, the remaining drug supply shall not be held for more than 30 calendar days after the date of discharge. b) All prescription and non-prescription medication shall be disposed of in a manner that guards against diversion or accidental ingestion. c) 24-hour facilities may utilize controlled substances and these shall be disposed of in accordance with the North Carolina Controlled Substances Act, G.S. 90, Article 5, including any subsequent amendments. (Medication will be incinerated, returned to a pharmacy, or placed in secure sharps container with 2 witnesses and the disposal of the medication will be documented and signed by involved parties). d) Any 24-hour facility which utilizes controlled substances must be currently registered under the North Carolina Controlled Substances Act and shall be in compliance with the North Carolina Controlled Substances Act, G.S. 90, Article 5, including any subsequent amendments. e) Medications turned in by consumers shall be disposed of by one of the following methods: i) Send to the local pharmacy as witnessed by two staff for destruction; ii) Sent for incineration as witnessed by two staff; iii) Placed in a secure sharps container in the presence of two staff members. f) A record of medication disposal shall be maintained and shall include: i) Name of consumer for whom it was ordered. ii) Name and strength of the medication; iii) Quantity of be disposed; iv) Date of disposal; v) Signature of person disposing the medication and signature of witness. 2) Storage and disposal of equipment: a) DAYMARK shall maintain only a small number of supplies needed to administer injectable medications, such as syringes and alcohol swabs; general first aid supplies and medical waste clean up supplies. Equipment for injections shall be maintained in secure, locked storage areas accessible only by authorized staff. b) Syringes and all sharp instruments shall be disposed of in a container specifically designed for sharp instruments that prevent accidental punctures immediately after use. Disposable syringes shall not be broken, recapped or bent, but put in the container as a whole. c) All equipment used in the rendering of first aid, such as swabs, etc. or in administration of injectable medications shall be disposed of in containers specifically designed for disposal of items that have been contaminated with blood and or other body fluids. d) Trashcans used in the area where injections are given or first aid is provided shall have foot-controlled lids. e) Trashcan liners shall be used and garbage will be double-bagged. Medical staff will allow access to the area for picking up contaminated equipment to person responsible for disposing of contaminated supplies. 4

5 Training: All employees designated to provide these services shall be licensed, certified and/or otherwise trained in the practice of evaluating, prescribing, dispensing and/or administering medications. Non-medical personnel in residential settings will be trained according to state standards of training. Monitoring: Pharmacotherapy services shall be monitored in accordance with DAYMARK performance improvement criteria. References: APSM 30-1; CARF 2014 Behavioral Health Standards Manual Appendices: See other related documents on the Daymark intranet POLICY 2, E. Medication Policy #: 6061 Page: 1 of 3 Policy Medication Effective 5/26/2011 No.: 6061 Medication Effective June 2008; 12/1/2010 Name & Jim Cook, Board Chairman 08/01/2015 No.: 750 Medication Requirements Effective Dec Reviewed By (name of Board member): Felicia Wilson Review August 1, 2015 Next Review Date (one year from current review date): August 1, 2016 Scope: this policy shall apply to all Daymark Recovery Services, Inc. (DAYMARK) programs and service locations that engage in the practice of prescribing, dispensing, and/or administering medications to persons served. Purpose: to assure that DAYMARK pharmacotherapy procedures meet the legal, clinical and ethical standards of best practice. Responsibility: responsibility for implementing the intent and requirements of this policy is delegated to the DAYMARK executive leadership who shall appoint a medical team that assures that all applicable State and Federal standards are followed while practicing pharmacotherapy. The executive leadership shall assure that: 1) Persons served (and/or their responsible parties) have access to pharmacotherapy services 2) Indigent medications (when applicable) are made available whenever possible 3) Persons served (and/or their responsible parties) are provided with education that includes the benefits and risks of medication 4) Procedures for safe handling and storage are observed 5) The safety and well-being of persons served shall take precedent in the practice of pharmacotherapy 6) Each person served has the right to be free from unnecessary or excessive medication. Medication shall not be used for punishment, discipline or staff convenience. 7) of drugs and medications as a treatment measures shall be governed by G.S. 122-C-57 and G.S. 90, Articles 1, 4A and 9A Directive: 1) DAYMARK provides pharmacotherapy practices that include evaluating, prescribing, dispensing and/or administering medications. 2) Daymark shall also monitor the use of medications prescribed, dispensed and/or administered by licensed and authorized DAYMARK medical personnel (within the limits imposed by the collaboration of the persons served). An order from personnel licensed to prescribe will be maintained in the record. 3) DAYMARK shall develop procedures that describe the methods utilized in providing pharmacotherapy practices including safe handling, safe storage, safe disposal and documentation of medication use. 4) DAYMARK shall also develop procedures that include: a) Access, when needed, through direct provision or referral. b) Continuity of pharmacotherapy. c) Integrating medications into a person's overall plan. d) Identifying and documenting medication reactions. e) Actions to follow in case of emergencies related to the use of medications. f) Continuing the prescribed medication if a generic medication is not available. 5) DAYMARK shall develop procedures that include: a) Compliance with all applicable local, state or provincial, and federal laws and regulations pertaining to medications and controlled substances, including on-site pharmacy services and dispensing. b) Availability of a physician for consultation 24 hours a day, 7 days a week. c) Documentation of reported medication reactions. d) Review of past medication use, including: i) Effectiveness ii) Side effects. iii) Allergies or adverse reactions. e) Screening for common medical co-morbidities using evidence- or consensus-based protocols. f) Evaluation of co-existing medical conditions for potential impact. g) Identification of alcohol, tobacco and other drug use. h) Documentation or confirmation of informed consent for each medication prescribed, when possible. i) Documentation and reporting of medication errors. j) of over-the-counter medications. k) of medications by women of child bearing age. l) of medications during pregnancy. m) Management of biohazards associated with the use of medications. n) Ready access to the telephone number of a poison control center by: i) The program personnel. ii) The persons served. o) Review of pharmacotherapy activities, including medication errors and drug reactions, as part of the quality monitoring and improvement system. 5

6 a) Special dietary needs and restrictions associated with medication use. b) Notification of the prescribing professional regarding medication reactions or problems, including errors. c) Necessary laboratory studies, tests, or other procedures. d) Coordination when a medication is prescribed by a source other than the organization. e) Coordination with the physician providing primary care needs. 2) In addition, DAYMARK shall develop procedures that address: a) To the extent possible, the use of treatment guidelines and protocols to: i) Promote state-of-the-art pharmacotherapy. ii) Ensure safety of the person served. b) A program of medication utilization evaluation, which includes measures of: i) Effectiveness. ii) Satisfaction of person served. 3) Daymark shall develop procedures that address: a) Purchase. b) Transportation and delivery. c) Storage. d) Safe handling. e) Packaging and labeling. f) Safe disposal. g) Inventory. h) Off-site use. i) Administration of medications by personnel, including: i) Staff credentials and training. ii) Documentation of medication administration, errors, and reactions. iii) Documentation of the use and benefits of as needed (prn) doses. References: CARF 2011 Behavioral Health Standards Manual: Medication use is the practice of evaluating, prescribing, dispensing and/or administering medications to persons served in response to specific symptoms, behaviors and conditions for which the use of medications is indicated and efficacious. It is the process for persons served to obtain medications and/or desired treatment/service outcomes. APSM