65G-7.005. Medication Administration Procedures

(1) Upon receipt of the Basic Medication Administration training certification and validation certification, MAPs are authorized to administer medications or to supervise the self-administration of medications via the following medication routes for which the MAP has been validated:

(a) Oral;

(b) Enteral, with the exception of prescribed enteral formulas;

(c) Transdermal;

(d) Otic;

(e) Ophthalmic;

(f) Rectal;

(g) Inhaled; and

(h) Topical.

(2) MAPs that have not completed the Prescribed Enteral Formula Administration Training and received the corresponding training certification and validation certification shall not administer Prescribed Enteral Formula.

(3) Licensed health care practitioners shall administer or supervise the self-administration of medications within their scope of practice.

(4) MAPs and licensed health care practitioners shall:

(a) Only provide administration of medication or supervision with self-administration of medications as prescribed or ordered by the client’s health care practitioner and which are properly labeled and dispensed in accordance with chapters 465 and 499, F.S.  If multiple clients are prescribed identical OTC medications, the facilities may utilize a single stock container to provide the medications to multiple clients;

(b) Comply with new or changed orders for a specific medication, which override the previous orders for that medication. No order to discontinue the previous order is necessary;

(c) Comply with the time limit as provided for in time-limited orders (i.e. those that are ordered for a specific number of doses or days). Such orders do not require an order to discontinue at the completion of the time allotted in the time-limit;

(d) Before administering medication or supervising the self-administration of medication, become familiar with the client’s medical history and medication background and locate the name and contact numbers of the client’s prescribing practitioner for consultation regarding the prescribed medications;

(e) Perform appropriate hand sanitation measures before administering medication or supervising the self-administration of medication, with repeated sanitization as needed during medication administration;

(f) Assist only one client at a time with medication administration in a quiet location free from distraction;

(g) Only prepare medications for one client, at the time the medication is given;

(h) Following the administration of medication or supervision of self-administration of medication, return each client’s medication to its portable or permanent medication storage location before assisting another client;

(i) Call the client’s primary care provider within 24 hours to reconcile the client’s medications with those ordered upon the client’s discharge from any inpatient, emergency, or urgent care facility. This call must be documented, along with the primary care provider’s response, including any instructions for medication administration and follow up. The primary care provider’s failure to respond should also be documented, along with continued attempts to contact him or her. If no licensed person is present to take the instructions from the primary care provider, the MAP must also ask for faxed or electronically supplied instructions;

(j) Immediately report torn, damaged, illegible, or mislabeled prescription labels to the dispensing pharmacist and, if a client is residing in a residential facility, notify the facility supervisor;

(k) Check the directions and expiration date of each medication to ensure that expired medications (those which are no longer current) or those no longer prescribed are not administered;

(l) Continue to provide medications for which there is a current prescriber order and the medication is not expired, but the prescription itself is expired, until the current supply is exhausted, or, in the case of a PRN medication, for no longer than 6 months after the date the prescription expired;

(m) Verify that the correct medication is administered to the correct client, at the correct time, with the correct dosage, by the correct route, and for the correct reason, as prescribed by the health care practitioner;

(n) Observe complete ingestion of oral medication before leaving the client and before recording or documenting the administration of the medication on the MAR;

(o) Record the date, time, dosage, and name of each regularly scheduled medication or PRN medication on the MAR immediately following administration or supervision of self-administration and sign or initial the entries. For PRN medications, the MAP or licensed health care practitioner must also enter the reason for the medication on the back of the MAR (if using the APD MAR form adopted in rule 65G-7.008, F.A.C.) or in a place provided for such an entry on a pharmacy-provided or electronic MAR;

(p)Following the first three doses of a new medication, including PRN medications, observe the client directly for a minimum of 20 minutes and document observations to detect and respond immediately to potential side effects, unless ordered differently by the prescribing health care practitioner, and review the MAR for any special instructions by the prescribing practitioner regarding required observations.  This documentation shall include both adverse reactions or a lack of adverse reactions to the new medication;

(q) Enter the response to the medication on the back of the MAR for PRN medications (state whether the medication alleviated the symptom for which it was given, e.g. “headache is better”) or in the place provided for such an entry on a pharmacy provided or electronic MAR. This entry should indicate date and time of entry, and be initialed or signed by the MAP or licensed health care practitioner;

(r) Ensure that the prescription for a medication is promptly refilled so that a client does not miss a prescribed dosage of medication. If the MAP or licensed health care practitioner is not responsible for routine refills of a medication, he or she shall notify the individual responsible for refilling the client’s prescriptions that the client needs a medication refill and document this notification;

(s) Keep on-site a copy of the prescription, order, or pharmacy profile with the client’s MAR or medical record, written or printed legibly and displaying the following information:

1. The client’s name;

2. The name of the medication;

3. The prescribed dosage;

4. The time intervals or specific times the medication must be given;

5. The administration route by which the medication must be given;

6. Specific directions for use;

7. The medical reason or diagnosis for which the medication was ordered or prescribed; and

8. For PRN medications, the complaint for which the medication is ordered, the maximum number of days that the medication should be given, the maximum number of doses per day, and conditions under which the health care practitioner should be notified.

(5) Licensed health care practitioners and MAPs who are validated to administer or supervise self-administration of whole (not crushed) oral medication may give the medication in any substance that facilitates swallowing and is tolerated by the client.

(6) A MAP who has been validated to administer or supervise self-administration of prescribed enteral formulas may administer prescribed enteral formulas through gastrostomy tubes, including percutaneous endoscopic gastrostomy (“PEG”), button-style gastrostomy, and jejunal (“JT”).

(7) In the administration of medications, a MAP shall not:

(a) Assist with the administration or supervise the self-administration of any OTC medication or medication samples without a written order by the client’s physician, PA, or APRN;

(b) Crush, dilute, or mix crushed medications without instructions from the prescribing health care practitioner or licensed pharmacist that have been transcribed to the MAR;

(c) Administer medications or supervise the self-administration of medications, including PRN and OTC medications, unless a health care practitioner has provided directions for the medication;

(d) Prepare syringes for a client’s use during the self-administration of medication via a subcutaneous, intra-dermal, intra-muscular or intravenous route;

(e) Administer medications or supervise the self-administration of medication route for which the MAP has not been validated, with the exception of a rectal gel prescribed for seizures and administered in an emergency situation;

(f) Administer medications or supervise the self-administration of medication via a parenteral, subcutaneous, intra-dermal, intra-muscular or intravenous route, with the exception of an epi-pen administered in an emergency situation.  This prohibition includes the administration of insulin. However, a MAP may test blood sugar if the test is not associated with insulin administration;

(g) Administer or supervise self-administration of medications that are inserted vaginally, or administered via a tracheostomy;

(h) Perform irrigation of partial or full thickness wounds (such as vascular ulcers, diabetic ulcers, pressure ulcers, surgical wounds) or apply agents used in the debridement of necrotic tissues in wounds of any type;

(i) Supervise, monitor, prompt, assist or cue a client to correctly fill a pill organizer (also known as a “pill minder” and “pill box”); and

(j) Assist a client with medications for which the health care provider’s prescription or order does not specify the medication schedule, medication amount, dosage, route of administration, purpose for the medication, or with medication that would require professional medical judgment by the MAP.

(k) Administer medications or supervise the self-administration of medications from a pill organizer.

(8) A MAP who has been validated to administer or supervise self-administration of prescribed enteral formulas shall not:

(a) Administer prescribed enteral formulas through a Gastrojejunal (“GJ”) tube or any tube that requires venting or suction;

(b) Administer prescribed enteral formulas utilizing any procedures that require clinical judgement, which is the process by which a licensed health care professional decides on data to be collected about a client, makes an interpretation of the data, arrives at a diagnosis, and identifies appropriate medical intervention; this involves problem solving, decision making, and critical thinking;

(c) Attempt to unclog an obstructed tube;

(d) Replace or attempt to replace a dislodged tube;

(e) Administer prescribed enteral formulas through nasal tubes of any type. These are commonly known as, but not limited, to nasogastric (“NG”), nasoduodenal (“ND”), and nasojejunal (“NJ”) tubes.

(9) MAPs shall comply with section 393.506, F.S., and this chapter.

(10) MAPs shall not:

(a) Obtain or attempt to obtain a passing grade on either the training course exam or validation through fraud, deceit, false statements, or misrepresentation of material facts, whether such statements are made knowingly or negligently;

(b) Falsify any records regarding medication administration;

(c) Continue to provide services as a MAP if he or she fails to successfully pass required re-validation on his or her primary route(s);

(d) Continue to provide medication administration or supervision of medication administration via any of the non-primary routes if he or she fails to successfully maintain his or her validation for the non-primary route.

(d) Provide services as a MAP while not currently authorized to do so by the State of Florida;

(e) Provide services as a MAP after the Agency has determined the MAP shall not continue to provide medication administration assistance.

(11) If a MAP violates any provision of section 393.506, F.S., or this chapter, the Agency shall:

(a) Prohibit the MAP from providing medication administration services to clients of the Agency;

(b) Request the MAP:

1. Successfully complete the Basic Medication Administration Course and corresponding validation;

2. Successfully complete the Prescribed Enteral Formula Administration Course and corresponding validation;

3. Participate in and successfully complete a corrective action plan; and

4. Comply with remediation requests.

(12) If a MAP or licensed health care practitioner violates any provision of section 393.506, F.S., or this chapter within an Agency-licensed residential facility, the Agency shall take such actions as set forth in chapter 65G-2, F.A.C. against the residential facility where the MAP or licensed health care practitioner is providing services  as is necessary to ensure the health, safety, and welfare of the Agency’s clients and third parties.

(13) Any person, including licensed health care practitioners, who in good faith renders emergency care or treatment in violation of this chapter, either in direct response to emergency situations related to and arising out of a public health emergency declared pursuant to section 381.00315, F.S., a state of emergency which has been declared pursuant to section 252.36, F.S., or at the scene of an emergency outside of a hospital, doctor’s office, or other place having proper medical equipment, without objection of the injured victim or victims, shall not be held responsible for the administrative violation as a result of such care or treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.

Rulemaking Authority 393.501, 393.506 FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19.