N.H. Admin. Code § He-P 802.21

Current through Register No. 45, November 7, 2024

Section He-P 802.21 - Medication Services

(a) All medications shall be made available to the patient in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

(b) The licensee shall have a written policy and system in place instructing how to:

(1) Obtain any medication ordered for use at the hospital;

(2) Reorder medications for use at the hospital; and

(3) Receive and record new medication orders.

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

(1) The patient's name;

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

(3) The frequency of administration;

(4) For PRN doses, the indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that have 24-hour contra-indicated maximum doses; and

(5) The dated and timed signature of the ordering practitioner.

(d) Each prescription medication container and medication record together shall collectively legibly display the following information in such a way so as to clearly identify the intended recipient:

(1) The patient'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 PRN medications;

(5) The date ordered;

(6) The name of the prescribing practitioner; and

(7) The expiration date of the medication(s) .

(e) The dosage, frequency, and route of administration on the labels of all prescription medications for each patient shall be identical to the dosage, frequency, and route of administration on the facility medication record except as allowed by (h) below.

(f) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the licensee shall indicate in writing, in the medication record, the date the dose or the discontinuance occurred.

(g) Only a pharmacist shall make changes to prescription medication container labels except as allowed by (j) below.

(h) When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

(i) Only a licensed nurse shall accept telephone orders for medications, treatments, and therapeutic diets, and the licensed nurse shall immediately transcribe and sign the order.

(j) The transcribed order in (i) above shall be counter-signed by the authorized prescriber within 48 hours of receipt or as soon as possible but no longer than 30 days.

(k) No medications shall be given to or taken by a patient until a written order is received, except as allowed by (h) or (i) above.

(l) Faxes of signed orders or other electronic media with electronic signatures shall be acceptable to meet the requirements of (k) above.

(m) All over-the-counter medications shall have a signed practitioner's order specifying that the patient may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(n) The medication storage area for medications shall be:

(1) Locked and accessible only to authorized personnel;

(2) Clean and organized with adequate lighting to ensure correct identification of each patient's medication(s); and

(3) Equipped to maintain medication at the proper temperature and humidity.

(o) All medication at the hospital shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

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

(q) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the hospital, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(r) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

(s) Except as required by (t) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days following the expiration date, the date a licensed practitioner discontinued the order, or the medication becomes contaminated, whichever occurs first.

(t) Destruction of contaminated, expired, or discontinued controlled drugs shall:

(1) Be in accordance with acceptable standards of practice identified by the manufacturer, as well as federal and state law, and rules;

(2) Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

(3) Be documented in the record of the patient for whom the drug was prescribed.

(u) The licensee shall maintain a written record for each medication taken by a patient at the facility 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 the time the medication was taken;

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

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

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

(v) The licensee shall report to the patient's licensed practitioner any adverse reactions and side effects to medications or medication errors, such as incorrect medications, immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the patient's record the reaction, the error, and date, time, and person notified.

(w) The therapeutic use of cannabis by patients who are qualifying patients possessing a registry identification card may be permitted at a hospital as long as:

(1) The licensee develops, maintains, and implements a general policy relative to patient use of cannabis at the licensed premises, including storage, security, and administration; and

(2) The smoking of cannabis is not permitted on the licensed premises.

N.H. Admin. Code § He-P 802.21

#9580, eff 10-24-09; amd by #9851, eff 1-14-11; amd by #10079, eff 1-26-12

Amended by Volume XXXVII Number 45, Filed November 09, 2017, Proposed by #12407, Effective 10/24/2017, Expires 4/22/2018.

Amended by Volume XLI Number 6, Filed February 11, 2021, Proposed by #13166, Effective 1/28/2021, Expires 1/28/2031.