PROPOSAL
Maryland Register
Issue Date: December 9, 2016
Volume 43 • Issue 25• Pages 1415—1417
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
10.16.07 Health and Medication Requirements for Youth Camps
Authority: Health-General Article, §14-403, and Health Occupations Article, §§8-6A-01—8-6A-16 and 14-306, Annotated Code of Maryland
Notice of Proposed Action
[16-318-P]
The Secretary of Health and Mental Hygiene proposes to amend Regulation .03 and adopt new Regulation .14 under COMAR 10.16.07 Health and Medication Requirements for Youth Camps.
Statement of Purpose
The purpose of this action is to establish requirements regarding the management and administration of medications for camp attendees. This proposed Regulation .14 replaces the emergency Regulation .14 that was approved by the AELR Committee and is effective from June 30, 2016 through December 26, 2016 (43:15 Md. R. 861—863 (July 22, 2016) The proposal updates the emergency text by:
(1) Removing the requirement that an individual designated by the parent or guardian must have “written” authorization to pick up the camper and the medication;
(2) Clarifying who may administer medications other than insulin and emergency medications;
(3) Clarifying the names of the individuals who shall be included on the Medication Administration Form; and
(4) Adding a requirement that youth camps keep for three years a record of successful training for each staff member who is trained to administer medication.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 9, 2017. A public hearing has not been scheduled.
.03 Health Program.
A. An operator shall prepare and implement a written health program that:
(1)—(4) (text unchanged)
(5) Includes procedures for handling medication at camp in accordance with Regulation .14 of this chapter; and
(6) (text unchanged)
B.—C. (text unchanged)
.14 Medications.
A. An operator shall ensure that:
(1) Except for medication covered by standing orders as described in §I of this regulation, before administration of a medication, written authorization is provided on a Medication Administration Authorization Form meeting the requirements of §F of this regulation;
(2) Except for a primitive camp as defined in COMAR 10.16.06.02, emergency medication, or while a medication is being administered, medication is kept in a locked storage compartment;
(3) A prescription medication is kept in the original container bearing a pharmacy label that includes the:
(a) Prescription number;
(b) Date filled;
(c) Authorized prescriber’s name;
(d) Patient’s name;
(e) Name of the medication;
(f) Dose of the medication;
(g) Route of administration for the medication;
(h) Time or frequency of administration for the medication; and
(i) Expiration date;
(4) A nonprescription medication is kept in the original container that includes the directions for use;
(5) Medication is given to the camper from the original container;
(6) The directions provided in the prescriptive order for the medication found on the Medication Administration Authorization Form or the standing order is followed;
(7) The staff member or designated volunteer administering the medication or supervising a camper who is self-administering medication knows the side effects and toxic effects of the medication;
(8) Medication is kept in a secure manner;
(9) Emergency medications are handled according to §D of this regulation;
(10) Medication is stored according to the manufacturer’s directions;
(11) A staff member or designated volunteer documents medication administration on a Medication Administration Form meeting the requirements of §G of this regulation;
(12) A staff member or designated volunteer documents the final disposition of the medication on a Medication Final Disposition Form meeting the requirements of §H of this regulation;
(13) Except as allowed in §A(14) of this regulation, within 2 weeks after the end of the camping session or when the medication is discontinued, medication is:
(a) Returned to:
(i) The parent;
(ii) The guardian; or
(iii) An individual designated by the parent or guardian who has authorization to pick-up the camper and the medication; or
(b) Destroyed; and
(14) If authorized by the parent or guardian, a camper may take their medication with them at the end of the camping session.
B. Staff Administration — Routine Medication. Except as allowed in §E of this regulation, an operator shall ensure that a routine medication, other than insulin, is administered by:
(1) A licensed or certified professional:
(a) Who is authorized to practice in Maryland; and
(b) Whose scope of practice includes medication administration; or
(2) An adult staff member or a volunteer who:
(a) Is designated by the operator; and
(b) On an annual basis successfully completes a training course approved annually by the Department.
C. Staff Administration — Insulin. Except as allowed in §E of this regulation, an operator shall ensure that insulin is administered by a licensed or certified professional:
(1) Who is authorized to practice in Maryland; and
(2) Whose scope of practice includes medication administration.
D. Staff Administration — Emergency Medication.
(1) Except as allowed in Regulation .15 of this chapter, an operator shall ensure that:
(a) Emergency medication is:
(i) Carried by the camper needing the medication if authorized according to §E(2) of this regulation;
(ii) Carried by an adult staff member or volunteer directly supervising the camper; or
(iii) Stored at a designated easily accessible location; and
(b) Emergency medication is administered by:
(i) The camper so long as the camper is capable and authorized to self-administer according to §E of this regulation;
(ii) An adult staff member or volunteer meeting the requirements of §B of this regulation; or
(iii) An adult staff member or volunteer trained by a health supervisor.
(2) An operator may allow a camper to self-carry an emergency medication if both the parent or guardian and a licensed or authorized prescriber have provided written consent for the camper to self-carry the emergency medication.
E. Self-Administration. An operator may allow a camper to self-administer medication, including insulin, if:
(1) Both the parent or guardian and a licensed or authorized prescriber have provided written consent for the camper to self-administer the medication;
(2) The health supervisor has designated an adult staff member or volunteer to supervise the camper while the camper is self-administering medication; and
(3) The designated adult staff member or volunteer supervises the camper while the camper is self-administering medication.
F. Medication Administration Authorization Form. A Medication Administration Authorization Form shall include:
(1) The written prescriptive order for the medication that includes:
(a) The child’s name;
(b) The child’s date of birth;
(c) The condition for which the medication is being administered;
(d) Whether or not the medication is an emergency medication;
(e) The name of the medication;
(f) The dose of the medication;
(g) The route of administration for the medication;
(h) The time or frequency of administration for the medication;
(i) If PRN, the frequency and for what symptoms the medication should be administered;
(j) The known side effects of the medication specific to the camper;
(k) The date medication administration shall begin;
(l) The date medication administration shall end, not to exceed 1 year from the beginning date;
(m) The authorized prescriber’s name;
(n) The authorized prescriber’s title;
(o) The authorized prescriber’s telephone number;
(p) The authorized prescriber’s fax number;
(q) The authorized prescriber’s address;
(r) The authorized prescriber’s signature; and
(s) The date the form is signed by the authorized prescriber;
(2) The following statement: “I request the authorized youth camp operator, staff member or volunteer to administer the medication or to supervise the camper in self-administration as prescribed by the above authorized prescriber. I certify that I have legal authority to consent to medical treatment for the child named above, including the administration of medication at the facility. I understand that at the end of the authorized period an authorized individual must pick up the medication; otherwise, it will be discarded. I authorize camp personnel and the authorized prescriber indicated on this form to communicate in compliance with HIPAA”;
(3) The parent’s or guardian’s signature;
(4) The date the parent or guardian signed the form;
(5) The parent’s or guardian’s primary phone number;
(6) The parent’s or guardian’s alternative phone number;
(7) If a camp allows a camper to self-administer medication, authorization to self-administer medication that includes:
(a) The following statement: “I authorize self-administration of the above listed medication for the child named above under the supervision of the youth camp operator, a designated staff member or volunteer”;
(b) The signature of the authorized prescriber and the date the form is signed under the statement in §F(7)(a) of this regulation; and
(c) The signature of the parent or guardian and the date the form is signed under the statement in §F(7)(a) of this regulation; and
(8) If a camp allows a camper to self-carry emergency medication, authorization to self-carry emergency medication that includes whether the:
(a) Authorized prescriber gives permission for the child to self-carry emergency medication; and
(b) Parent or guardian gives permission for the child to self-carry emergency medication.
G. Medication Administration Form. A Medication Administration Form shall include the:
(1) Child’s name;
(2) Child’s date of birth;
(3) Name of the medication;
(4) Dose of the medication;
(5) Route of administration for the medication;
(6) Time or frequency of administration for the medication;
(7) Amount of medication administered;
(8) Date and time of administration; and
(9) Name of the individual who:
(a) Administered the medication to the child; or
(b) Supervised self-administration if the child self-administered the medication.
H. Medication Final Disposition Form. A Medication Final Disposition Form shall include:
(1) The child’s name;
(2) The child’s date of birth;
(3) The name of the medication;
(4) The final disposition of the medication;
(5) Documentation that the medication is returned to the parent or guardian, or authorized individual, including the:
(a) Name of the individual to whom the medication was returned; and
(b) Signature of the staff member or volunteer who returned the medication; and
(6) A section for documenting that the medication was destroyed that includes the:
(a) Signature of the individual responsible for destroying the medication;
(b) Signature of the individual witnessing the destruction of the medication; and
(c) Dates each individual signed the form.
I. Standing Orders. When standing orders from a licensed or certified professional authorized to prescribe medication are used in place of the Medication Administration Authorization Form required in §A(1) of this regulation, an operator shall ensure that:
(1) Written permission is obtained from the child’s parent or guardian to administer the medication; and
(2) The medication is administered by a staff member or volunteer who meets the requirements in §B of this regulation.
J. Medications at Primitive Camps. Except for emergency medication that the camper is authorized to self-carry according to §E(2) of this regulation, in a primitive camp as defined in COMAR 10.16.06.02, medication is kept inaccessible to the camper.
K. Staff Member or Volunteer Medication.
(1) An operator shall:
(a) Provide a means to secure medication for a staff member or volunteer when a medication is brought to camp; and
(b) Ensure that all staff member or volunteer medications are maintained in a secure manner at all times.
(2) Except when a staff member or volunteer is self-administering a medication, an operator shall:
(a) Ensure that a staff member or volunteer:
(i) Provides written authorization on a Medication Administration Authorization Form meeting the requirements of §F of this regulation for each medication brought to camp; and
(ii) Who is an adult, signs the Medication Administration Authorization Form in lieu of a parent or guardian; and
(b) For a staff member or volunteer taking medication, have on file for each medication:
(i) A Medication Administration Authorization Form;
(ii) A Medication Administration Form; and
(iii) A Medication Final Disposition Form.
L. Form Retention. An operator shall retain for 3 years and make available to the Department the completed:
(1) Medication Administration Authorization Form;
(2) Medication Administration Form;
(3) Medication Final Disposition Form; and
(4) Record of successful training for each staff member or volunteer who is trained to administer medication under §B(2) of this regulation.
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
