Section 116.100 Quality Assurance

Section 116

Section 116.100  Quality

Assurance

a)         A registered professional nurse, advanced practice nurse,

licensed practical nurse, pharmacist or physician shall review the following

for all individuals:

1)         medication orders;

2)         medication labels and medications listed on the MAR to ensure

that they match physician orders; and

3)         MARs (for persons who are not self-medicating) to ensure that

they are completed appropriately for:

A)        medication administered as prescribed;

B)        refusal by the individual; and

C)        full signatures provided for all initials used.

b)         Reviews, as described in subsection (a), shall occur at least

quarterly, but may be done more frequently at the discretion of the registered

professional nurse and/or advanced practice nurse.

c)         At least annually, the agency, inclusive of the Nurse-Trainer,

shall summarize and analyze all medication errors to identify patterns and

trends and establish corresponding corrective action.  The analysis and

corrective action must be documented and that documentation shall be retained

by the agency for at least five years.

d)        All quality assurance records shall be confidential and may

only be disclosed in accordance with Article VIII, Part 21, of the Code of

Civil Procedure [735 ILCS 5/8-2101 through 8-2105].