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"(2) review the drug regimen, and any changes, for potential adverse reactions, allergies, interactious, contraindications, rationality, and laboratory test modifications, and advise the physician of any recommended changes, with reasons and with an alternate drug regimen;

"(3) maintain for each resident an individual record of all medications (prescription and nonprescription) dispensed, including quantities and frequency of refills;

“(4) participate, as appropriate, in the continuing interdisciplinary evaluation of individual residents, for the purposes of initiation, monitoring, and followup of individualized habilitation programs;

“(5) participate in any of the following activities

that are undertaken in the facility:

"(A) drug research;

"(B) drug utilization review;

“(C) infection and communicable disease com

mittee;.

"(D) safety committee;

"(E) patient care incident review; and

"(6) establish quality specifications for drug pur

chases, and insure that they are met.

"(d) The pharmacist should

“(1) prepare a drug treatment plan, as prescribed

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by the attending physician, for inclusion in the resident's

record and for use by the staff, that includes

"(A) the drug product, dosage form, route of administration, and time of administration, including, when appropriate, the time with respect to meals, other drugs, and activities;

"(B) a schedule of laboratory tests necessary to detect adverse reactions;

"(C) nothing of any potential adverse reactions for the staff's information;

"(2) regularly review the record of each resident

on medication, and have contact with selected residents

with potential problems, noting in the residents' records and reporting to physicians any observations of response

to drug therapy, and of adverse reactions and over or underutilization of drugs;

"(3) provide instructions and counseling on the correct use of his drugs, as prescribed by the attending

physician, to each resident on home visit and discharge,

and/or to this parents;

"(4) provide education and counseling to residents in independent living units on the correct use of their drugs, as prescribed by the attending physician, and

on the results expected from correct use and from over or underuse:

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"(5) participate in programs for sex education and

drug abuse education;

"(6) provide information on the resident's drug regimen to the receiving facility pharmacist, when the

resident is transferred, and, with the approval of the resident or his guardian, to the resident's community pharmacist, his private physician, and/or the community mental retardation service when the resident is discharged from the facility, so as to insure continuity

of care;

"(7) participate in inservice education programs for professional and direct-care staff;

"(8) orient and teach students in pharmacy and other professions, regarding pharmacy's services to the residents and regarding drugs and their uses; and

"(9) participate in public education and informational programs on mental retardation.

"(e) Where appropriate to the facility, there shall be

a pharmacy and therapeutics committee, that includes one 20 or more pharmacists, to develop policy on drug usage in the 21 facility, and to develop and maintain a current formulary. 22 This committee shall meet not less than once every three 23 months. Minutes of the committee meetings shall be kept on file.

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"(f) Written policies and procedures that govern the

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safe administration and handling of all drugs shall be devel2 oped by the responsible pharmacist, physician, nurse, and 3 other professional staff, as appropriate to the facility. The 4 compounding, packaging, labeling, and dispensing of drugs, 5 including samples and investigational drugs, shall be done 6 by the pharmacist, or under his direct supervision, with proper controls and records. Each drug shall be identified

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up to the point of administration. Procedures shall be estab9 lished for obtaining drugs when the pharmacy is closed. "(g) The unit dose or individual prescription system 11 of drug distribution should be used. Wherever possible, 12 drugs that require dosage measurement shall be dispensed 13 by the pharmacist in a form ready to be administered to 14 the patient.

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"(h) There shall be a written policy regarding the ad16 ministration of all drugs used by the residents, including 17 those not specifically prescribed by the attending practitioner. 18 There shall be a written policy regarding the routine of drug administration, including standardization of abbrevia20 tions indicating dose schedules. Medications shall not be used

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by any resident other than the one for whom they were is22 sued. Only appropriately trained staff shall be allowed to

23 administer drugs.

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"(i) There shall be a written policy governing the selfadministration of drugs, whether prescribed or not.

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1 "(j) Drugs shall be stored under proper conditions of 2 sanitation, temperature, light, moisture, ventilation, segre3 gation, and security. All drugs shall be kept under lock and 4 key except when authorized personnel are in attendance. 5 The security requirements of Federal and State laws shall be 6 satisfied in storerooms, pharmacies, and living units. Poisons, 7 drugs used externally, and drugs taken internally shall be 8 stored on separate shelves or in separate cabinets, at all lo9 cations. Medications that are stored in a refrigerator con10 taining things other than drugs shall be kept in a separate 11 compartment with proper security. A perpetual inventory 12 shall be maintained of each narcotic drug in the pharmacy, 13 and in each unit in which such drugs are kept, and inventory 14 records shall show the quantities of receipts and issues and 15 the person to whom issued or administered. If there is a 16 drug storeroom separate from the pharmacy, there shall be a perpetual inventory of receipts and issues of all drugs by 18 such storeroom.

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"(k) The pharmacist should review the drugs in each 20 living uait monthly, and should remove outdated and de21 teriorated drugs and drugs not being used. Discontinued and

22 outdated drugs, and containers with worn, illegible, or miss

21

ing labels, shall be returned to the pharmacy for proper dis

position.