N.H. Admin. Code § He-C 4001.15

Current through Register No. 50, December 12, 2024

Section He-C 4001.15 - Medication Services

(a) The licensee shall develop and implement written policies and procedures regarding administration, documentation, including a system for maintaining counts of controlled drugs, protocols for medication occurrences, and control and safety of medication that are consistent with the requirements of this section.

(b) Administration of medications to residents shall be performed by authorized staff, registered nurse (RN), licensed practical nurse (LPN) or licensed health care practitioners, accurately and in accordance with the resident's treatment plan and the licensee's policies.

(c) Authorized staff shall know and understand the program's written policies and procedures regarding the administration, control, and safety of medication.

(d) All residents shall be initially assessed to determine the level of support needed specific to medication administration.

(e) The assessment pursuant to (d) above shall include the resident's:

(1) Medication order(s) and medications prescribed;

(2) Health status and health history; and

(3) Ability to manage his or her medication, consistent with the resident's treatment plan.

(f) Program staff shall obtain, or document their efforts to obtain, oral or written consent from the parent prior to administering any new or changed prescription medications.

(g) When the resident's parent(s) is responsible for supplying the program with the resident's medication, program staff shall contact the parent 2 weeks prior to the end of the supply of medication.

(h) When the responsibility of providing care to a resident is transferred to persons outside the program, for example for a home visit, and the resident is taking prescription medication:

(1) The pharmacy container(s) shall be given to the person responsible for the resident;

(2) The program shall document the medication name, strength, prescribed dose, route of administration, and quantity of each medication provided to the persons outside the program, upon the resident's transfer of care; and

(3) Upon the resident's return to the program, the program shall document the return of any medications including medication name, strength, prescribed dose, route of administration, and quantity of each medication with a description of why the medication was not given as the medication order stated.

(i) Authorized staff shall administer only those prescription medications for which there is a medication order.

(j) Authorized staff shall administer medications only to the residents about whom they have current knowledge relative to their medication regimes.

(k) Authorized staff shall maintain a copy of each resident's medication orders in the resident's record.

(l) Medication orders shall be valid for no more than one year unless otherwise specified by the licensed health care practitioner.

(m) Each medication order shall legibly display the following information:

(1) The resident's name;

(2) The medication name, strength, the prescribed dose, and route of administration;

(3) The frequency of administration;

(4) The indications for usage of all medications to be used PRN; and

(5) The dated signature of the licensed health care practitioner.

(n) Written orders from a licensed health care practitioner regarding any prescription medication that is to be administered PRN shall include:

(1) The indications and any special precautions or limitations regarding administration of the medication;

(2) The maximum dosage allowed in a 24-hour period; and

(3) The dated signature of the licensed health care practitioner.

(o) In addition to (n) above, authorized staff shall administer PRN medication in accordance with:

(1) A medication order; and

(2) A PRN protocol approved by the licensed health care practitioner that includes the specific condition(s) for which the medication is given.

(p) Prior to the administration of medication, authorized staff shall obtain information specific to each medication, including, at a minimum:

(1) The purpose and effect(s) of the medication;

(2) Response time of the medication;

(3) Possible side effects, adverse reactions, and symptoms of overdose;

(4) Possible medication interactions; and

(5) Special storage or administration procedures.

(q) In the event of a medication occurrence, the authorized staff responsible for the administration of the medication shall forward written notification to the program director by the close of the next business day.

(r) When any medication that is administered by program staff results in serious adverse reactions including, but not limited to, impaired speech, mobility or breathing, semi-consciousness, or unconsciousness, program staff shall:

(1) Immediately call 911 or notify a licensed health care practitioner for instructions regarding the need for emergency or other medical treatment;

(2) Immediately comply with the instructions provided by the licensed health care practitioner;

(3) Remain with the resident until he or she is fully alert and oriented and has recovered all physical capabilities that had been impaired by the medication, or until responsibility for the resident's care is transferred to a licensed health care practitioner in a medical facility; and

(4) Notify or document efforts to notify the parents within 24 hours.

(s) Prior to administering medication to any resident, program staff shall complete and document training on medication safety and administration, as specified in (t) below.

(t) Training in medication safety and administration, as required in (s) above, shall:

(1) Be delivered by a physician, APRN, RN, or LPN practicing under the direction of an APRN, RN, or physician, or by another qualified individual;

(2) Be provided in person, via distance learning, a video presentation, or web-based; and

(3) Address the following:

a. The safe storage and administration of medication, including but not limited to:

1. Administration of the correct medication;

2. Administration of the correct dosage of the medication;

3. Administration of the medication to the correct resident;

4. Administration of the medication to the resident at the correct times and frequency;

5. Administration of the medication to the resident by the correct method of administration;

6. Infection control and aseptic procedures related to administration of medication; and

7. Resident's rights regarding refusing medications;

b. Possible side effects and adverse reactions to the medications to be administered and required reporting regarding those issues;

c. Proper storage, disposal, security, error control, and documentation as related to the medications to be administered;

d. Any other unusual occurrence related to the safe storage or administration of medication and reporting requirements regarding those issues;

e. Conditions or situations requiring emergency medical intervention; and

f. Methods of administration including, but not limited to oral, injection, topical application or inhalation.

(u) In addition to (t) above, authorized staff shall complete 2 hours of training annually on medication safety and administration.

(v) Documentation of training in medication safety and administration shall be maintained on file at the child care program available for review by the department.

(w) For each resident, program staff shall maintain medication information on file and available for review by the department, which includes, at a minimum:

(1) A written medication order, as specified in (m) above, including special considerations for administration for each prescription medication being taken by a resident;

(2) Written parental authorization to administer medication, if applicable;

(3) The name and contact information of the parent, if applicable; and

(4) Allergies, if applicable.

(x) In addition to (w) above, program staff shall maintain a daily medication log for each dose of medication administered to each resident.

(y) The medication log required in (x) above shall:

(1) Be maintained on file in the program, available for review by the department;

(2) Be completed by the authorized staff who administered the medication immediately after the medication is administered; and

(3) For each medication prescribed, include at a minimum:

a. The name of the resident;

b. The date and time the medication was taken;

c. A notation of any medication occurrence or the reason why any medication was not taken as ordered or approved;

d. The dated signature of the authorized staff who administered the medication to the resident; and

e. For administration of a PRN, documentation including the reason for administration.

(z) The licensee shall require that all telephone orders from a licensed health care practitioner or their agent, for medications, treatments, and diets are documented in writing, including facsimiles, by the licensed health care practitioner within 24 hours.

(aa) In addition to (z) above, authorized staff shall record any changes regarding prescription medications in the resident's medication log.

(ab) All physician medication samples shall legibly display the information described in (m)(1)-(5) above.

(ac) No person other than a licensed health care practitioner shall make changes to the written order of a licensed health care practitioner regarding prescribed medication.

(ad) All medication maintained by the program shall be stored as follows:

(1) Kept in a storage area that is:

a. Locked and accessible only to authorized personnel;

b. Organized to allow correct identification of each resident's medication(s);

c. Illuminated in a manner sufficient to allow reading of all medication labels; and

d. Equipped to maintain medication at the proper temperature;

(2) Schedule II controlled substances, as defined by RSA 318-B:1-b, shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel; and

(3) Topical liquids, ointments, patches, creams, and powder forms of products shall be stored in a manner such that cross-contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(ae) All medication shall be accompanied by:

(1) The physician's written order, which may be the prescription label; and

(2) The manufacturer's written instructions for dosage.

(af) Medications such as insulin, inhalers, and epi pens shall be permitted to be in the possession of a resident in accordance with the resident's ability, as specified in the resident's treatment plan.

(ag) All medications belonging to staff shall be stored in a locked area, separate from residents' medications or otherwise inaccessible to residents.

(ah) The program director or designee may elect to have a supply of non-prescription medication available, including but not limited to acetaminophen, ibuprofen, aspirin, cold medicines, or antacids that may be administered to residents for minor illnesses, provided those medications are stored and administered in accordance with the requirements in this section.

(ai) All medication shall be kept in the original containers or pharmacy packaging and properly closed after each use unless otherwise allowed by law.

(aj) Any contaminated, expired, or discontinued medication, whether prescription or over the counter, shall be destroyed within 7 days of identification as contaminated, expired, or discontinued.

(ak) Destruction of prescription drugs under (aj) above shall:

(1) Be accomplished by an authorized staff and witnessed by one staff; and

(2) Be documented in the resident's medication record, including the legible, dated signature of the staff person who disposed of the drugs and the staff person who witnessed the disposal.

(al) All medication shall be destroyed in accordance with the United States Environmental Protection Agency's, "How to Dispose of Medicines Properly" guidance, (April 2011), available as noted in Appendix A.

(am) Programs providing SUD services shall have a clearly identified policy for storage and administration of naloxone that includes the following:

(1) The process for regularly reviewing and updating the standing order for the naloxone kits on the premises;

(2) The process for ensuring regular review of naloxone kits for expiration;

(3) If naloxone is administered, the policy shall include a statement that 911 shall be called immediately; and

(4) If naloxone is not administered but an overdose is suspected, the policy shall include a statement that 911 shall be called immediately.

(an) Medication administered by individuals authorized by law to administer medications shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.

(ao) Personnel shall remain with the resident until the youth has taken the medication.

(ap) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.

(aq) Programs providing SUD services shall have a written policy establishing procedures for the prevention, detection, and resolution of controlled substance misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

(ar) The policy in (aq) above shall include:

(1) Education;

(2) Procedures for monitoring the distribution and storage of controlled substances;

(3) Voluntary self-referral by employees who are misusing substances;

(4) Co-worker reporting procedures;

(5) Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

(6) Employee assistance procedures;

(7) Confidentiality;

(8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and

(9) The consequences for violation of the controlled substance misuse, and diversion prevention policy.

N.H. Admin. Code § He-C 4001.15

#2664, eff 3-30-84, EXPIRED: 3-30-90

New. #8581, eff 4-20-06, EXPIRED: 4-20-06

New. #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14

Amended byVolume XXXIV Number 46, Filed November 13, 2014, Proposed by #10705, Effective 10/23/2014, Expires10/23/2024.

Amended by Volume XLI Number 06, Filed February 11, 2021, Proposed by #13151, Effective 12/30/2020, Expires 12/30/2020.