The adult family home medication rules in Washington are the area where homes get cited most often. The chapter is not that long. The trouble is that the rules cluster across half a dozen sections, and operators usually read one and miss the next. This post walks the WAC 388-76 medication cluster in plain English, with the operator action for each section and the most common citation patterns.
Key takeaways
- The WAC 388-76 medication cluster covers the system, the assessment, who may administer, the log, refusals, and disposal.
- The most-cited rule in the chapter is the medication system at 388-76-10430 and the medication log at 388-76-10475.
- "Administration" and "assistance" are different things. Only legally authorized persons administer.
- The medication disposal rule was updated March 10, 2025. Most homes have not refreshed their written policy.
- A daily 60-second box-check at end of pass closes most documentation gaps.
The medication cluster at a glance
Here is the map. Print it and tape it to the back of the med cart.
| WAC section | Topic | Plain-language take |
|---|---|---|
| 388-76-10430 | Medication system | You must have a system. The system has to make sure each resident is assessed, has a care plan, and has a current log and med list. |
| 388-76-10440 | Medication assessment | The resident assessment has to identify the amount of help the resident needs with medications. |
| 388-76-10455 | Medication administration | Administration is by a practitioner, a nurse-delegated caregiver, or a family member or representative. Not anyone else. |
| 388-76-10435 | Medication refusal | Residents have the right to refuse. If they do, the home notifies the practitioner unless a qualified clinician on staff can judge the impact. |
| 388-76-10475 | Medication log | The daily log lists every med with dose, frequency, time, and initials. Refusals get a reason. Changes get logged. |
| 388-76-10490 | Medication disposal | You need a written disposal policy. Discontinued or expired meds are disposed of within 30 days. Updated rule effective March 10, 2025. |
The medication system (388-76-10430)
This is the umbrella rule. If you admit anyone who needs medication assistance or administration, you must have a system. The system has to ensure that each resident has an assessment that names the amount of help, a care plan that names the medication service, and a log that stays current, plus records of all prescribed and over-the-counter medications with dose, frequency, and the prescriber.
WAC 388-76-10430
Adult family homes that admit residents needing medication help must operate a medication system that meets the assessment, care-plan, log, and current-list requirements above. The rule is about content. The format (paper or electronic) is your choice as long as the content stays complete. Plain-language summary, not legal advice.
The assessment (388-76-10440)
The resident assessment names the amount of help the resident needs with medications. The home also has to let the practitioner know when physical or mental limitations, or the home itself, may affect the resident's ability to take their meds. This is where the work begins. If the assessment says the resident is independent, the home does not have to keep a log for that resident. If the assessment says the resident needs help, the cluster turns on.
Administration vs assistance (388-76-10455)
The most misunderstood rule in the chapter. Administration is a specific clinical act. Only three categories of person can administer in an AFH: a practitioner (as defined in chapter 69.41 RCW), a caregiver acting under nurse delegation (WAC 246-840-910 through -970), or a family member or legally appointed representative. Assistance with self-administration, on the other hand, includes prompts, reminders, opening containers, and preparing items. A non-delegated caregiver doing more than assistance is a tag.
WAC 388-76-10455
Medication administration is performed by a practitioner, or by nurse delegation, unless done by a family member or legally appointed resident representative. Anyone else is providing assistance, not administration. Plain-language summary, not legal advice.
Refusals (388-76-10435)
Residents may refuse meds. When the home is administering or assisting, and the resident refuses or does not receive a dose, the home notifies the practitioner. The only out is when the qualified clinician on staff (a provider, entity representative, resident manager, or caregiver who is a nurse or other health professional within scope) can judge the impact themselves. Even then, the refusal goes on the log with a reason.
The medication log (388-76-10475)
This is the documentation core. The log includes the resident name, every prescribed and over-the-counter medication, dose, frequency, the time the dose is due, and the initials of the staff who gave or assisted with each dose. Refusals get a reason. Held doses get a reason. New orders and changes get logged with the date and a note about the call confirming the order. Surveyors read these line by line.
WAC 388-76-10475
The medication log has to be current for every resident who is not assessed as medication-independent. Initials. Refusal reasons. Dates of new orders. The state is not picky about whether the log is paper or electronic, as long as it is complete. Plain-language summary, not legal advice.
Disposal (388-76-10490, updated 2025)
You must have a written policy for medication disposal. The rule was refreshed in March 2025 with clearer windows. Discontinued, expired, or refused meds for current residents have to be disposed of within 30 calendar days of the discontinuation, expiration, or refusal. Meds for deceased residents go within 30 days of death. Any meds left at the home 90 days after discharge get disposed of too. Most homes still have the old policy on file. Update it.
Check your written disposal policy
The 2025 update to WAC 388-76-10490 changed the windows. If your policy still says "as soon as possible" without the 30-day and 90-day windows spelled out, an inspector will ask you to update it.
The four most common citations and how to prevent each
From the DSHS top-citations data, the chapter's medication rules dominate. Here are the patterns.
1. A blank box on the MAR
Inspector cannot tell a missed dose from a missed initial. Both are tags under 388-76-10475. Fix with a 60-second box-check at the end of every pass.
2. A refused dose with no reason
A circled R is not a refusal note. The rule expects a reason and a notification to the prescriber (with the clinician exception). Train caregivers to write a one-line refusal note.
3. Administration without nurse delegation
A caregiver giving a med that requires administration without the right delegation in place is a 388-76-10455 tag. The fix is paperwork. Get the delegation in writing and keep it in the staff file.
4. Stale medication list with a current MAR
The MAR shows a new med, the master list does not. Under 388-76-10430, the records have to be current. Update the list the same shift a new order arrives.
One operator scenario
Yolanda runs a 6-bed AFH in Bremerton. After her 2024 inspection (one citation under 388-76-10475 for missing initials), she rebuilt her pass to include three habits: a 60-second box-check before clocking out, a one-line refusal template on the cart, and a Friday MAR review with two pages signed off by her resident manager. Her 2025 inspection closed in three hours with zero medication tags.
How Marpass fits into the cluster
The cluster looks complicated because it lives across six WAC sections. On a tablet, those six rules collapse into one workflow. The pass is the assessment review. The pass is the administration record. The pass is the log entry. Refusals force a reason and a prescriber notice. Disposal events get a separate page with the dates auto-stamped. The whole stack is built for adult family homes. Pricing is flat per home and published on the site.
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