N.H. Admin. Code § He-M 1202.03

Current through Register No. 45, November 7, 2024

Section He-M 1202.03 - Medication Administration

(a) With the exception of (d) below, administration of medications to individuals shall be performed by authorized providers or licensed persons only.

(b) All individuals shall be initially assessed by a licensed physician, APRN, physician assistant, or nurse trainer to determine the level of support needed specific to medication administration.

(c) The assessment pursuant to (b) above shall include the individual's:

(1) Medication orders and medications prescribed;

(2) Health status and health history; and

(3) Ability to self-administer medications as outlined in He-M 1202.04(a) .

(d) Individuals shall receive their medications by one of the following methods:

(1) Self-administration of medication;

(2) Self-directed medication administration; or

(3) Self-administration of medication with supervision.

(e) If a guardian with authority regarding health care decisions has been appointed for an individual, the agency shall obtain the approval of the guardian prior to the self-administration of medications.

(f) Authorized providers shall administer only those medications for which there is a medication order.

(g) The licensed person shall allow the individuals to self-direct administration of medications as defined in He-M 1202.02(aa) if the resident:

(1) Has a physical limitation due to a diagnosis that prevents the resident from self-administration;

(2) Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure that the resident maintains the physical and mental ability to self-direct administration of medications

(3) Obtains an annual written verification of the resident's physical limitation and self-directing capabilities from the individual's licensed practitioner and requires the community residence to file the verification in their resident record; and

(4) Verbally directs personnel to:

a. Assist the individual with preparing the correct dose of medications by pouring, applying, crushing, mixing, or cutting; and

b. Assist the individual to apply, ingest, or instill the ordered dose of medication.

(h) If an individual self-administers medication with supervision, as defined in He-M 1202.02(z) , personnel shall be permitted to:

(1) Remind the individual to take the correct dose of his or her medication at the correct time;

(2) Place medication container within reach of the individual;

(3) Remain with the individual to observe the individual taking the appropriate amount and type of medication as ordered by the licensed practitioner;

(4) Record on the individual's daily medication record that they have supervised the individual taking his or her medication; and

(5) Document in the individual's record any observed or reported side effects, adverse reactions, and refusal to take medications or medications not taken.

(i) If an individual self-administers medication with supervision, the authorized provider shall not physically handle the medication in any manner.

(j) The authorized provider shall maintain a written record for each medication taken by an individual at the community residence that contains the following information:

(1) Any allergies or adverse reactions to medications;

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

(3) The date and time the medication was taken;

(4) The signature, identifiable initials and job title of the person who administers, supervises, or assists the resident taking medications;

(5) For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

(6) Documented reason for any medication refusal or omission.

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

(l) When an individual is going to be absent from the community residence at the time medication is scheduled to be taken, the medication container shall be given to the individual if the individual is capable of self-administering.

(m) If an individual is going to be absent from the community residence at the time medication is scheduled to be taken and the individual is not capable of self-administration, the medication container shall be given to the person responsible for the individual while the individual is away from the community residence.

(n) Authorized providers shall administer PRN medication in accordance with:

(1) A medication order; and

(2) A PRN protocol approved by the prescribing practitioner or the nurse trainer that includes:

a. The specific condition(s) for which the medication is given;

b. A maximum daily dosage; and

c. Any special instructions.

(o) Authorized providers shall administer medications only to the individuals about whom they have current knowledge relative to their medication regimes.

(p) Information specific to each medication shall be obtained by the authorized provider prior to administration of medications, 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 discovery of a medication error, an authorized provider shall:

(1) Consult immediately with a licensed person concerning any actions to be taken;

(2) Document each medication error pursuant to He-M 1202.06(f) within 8 hours of discovery of the error; and

(3) Forward the documentation to the nurse trainer within one business day.

(r) In the event of medication refusal, the authorized provider shall:

(1) Consult immediately with a licensed person concerning any actions to be taken except if an individual has a history of medication refusal and the individualized service plan (ISP) includes actions to be taken to address the refusal;

(2) Document each medication refusal pursuant to He-M 1202.06(f) within 8 hours of discovery of the refusal; and

(3) Forward the documentation to the nurse trainer within one business day.

(s) Copies of medication error and medication refusal reports shall be maintained in the quality improvement office at the agency.

N.H. Admin. Code § He-M 1202.03

#7957, eff 9-19-03; ss by #9978, INTERIM, eff 9-19-11, EXPIRES: 3-19-12

Amended by Volume XXXVII Number 23, Filed June 8, 2017, Proposed by #12192, Effective 5/26/2017, Expires 5/26/2027.