N.H. Admin. Code § He-P 804.17

Current through Register No. 45, November 7, 2024

Section He-P 804.17 - Medication Services

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

(b) All medications and treatments shall be reviewed, re-ordered, and signed by a licensed practitioner on an annual basis or when indicated by a change in the resident's condition.

(c) Medications, treatments, and therapeutic diets ordered by a licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours, or when available in accordance with the licensed practitioner's written direction.

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

(1) Obtain any medication ordered for immediate use at the ALR-RC;

(2) Reorder medications for use at the ALR-RC; and

(3) Receive and record new medication orders.

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

(1) The resident's name;

(2) The medication name, strength, prescribed dose, and route, if different than by mouth;

(3) The frequency of administration;

(4) The indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that are used PRN; and

(5) The dated signature of the ordering practitioner as allowed by He-P 804.03(ca) .

(f) Except for pharmaceutical samples, 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, unless it is an emergency medication as allowed by (ab) below:

(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 PRN medications;

(5) The date ordered;

(6) The name of the prescribing practitioner; and

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

(g) Pharmaceutical samples shall be used in accordance with the licensed practitioner's written order and labeled by the licensed practitioner, the administrator, licensee, or their designee, with the resident's name, and shall be exempt from (f) (2) -(6) above.

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

(i) 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 ALR-RC shall indicate in writing, in the medication record, the date the dose or the discontinuance occurred.

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

(k) 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.

(l) 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.

(m) The transcribed order in (l) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

(n) No medications shall be given to or taken by a resident until a written order is received, except as allowed by (l) or (m) above.

(o) ALR-RCs that do not have a licensed nurse as described in (l) above on duty at the time an order for medications, treatments, or therapeutic diets are to be given shall receive said order in written form with the licensed practitioner's signature and the date of the order.

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

(q) All over-the-counter medications as defined by He-P 804.03(av) shall have a signed practitioner's order specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

(r) The medication storage area for medications not stored in the resident's room shall be:

(1) Locked and accessible only to authorized personnel;

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

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

(s) All medication at the ALR-RC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use except as authorized by (ad) (6) below.

(t) 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.

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

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

(w) Except as required by (x) 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.

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

(1) Be in accordance with acceptable standards of practice;

(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 resident for whom the drug was prescribed.

(y) When a resident is going to be absent from the ALR-RC at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self administration of medication without assistance.

(z) If a resident is going to be absent from the ALR-RC at the time medication is scheduled to be taken and the resident is not capable of self administration of medication without assistance, the medication container shall be given to the person responsible for the resident while the resident is away from the ALR-RC.

(aa) Upon discharge or transfer, the licensee shall make the resident's current medications available to the resident and the guardian, agent, or personal representative, if any, and upon death of a resident, the facility shall return or destroy all remaining medications, as appropriate, and document in patient record.

(ab) A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

(ac) Residents shall receive their medications by one of the following methods:

(1) Self administration of medication without assistance as defined by He-P 804.03(br) ;

(2) Self-directed medication administration as defined by He-P 804.03(bs) ;

(3) Self administration of medication with assistance as defined by He-P 804.03(bq) ; or

(4) Administered by individuals authorized by law, including via delegation.

(ad) If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

(ae) For residents who self administer medication without assistance, the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the resident to self administer medication without assistance; and

b. Authorizing the resident to store the medications in their room;

(2) Evaluate the resident on a 6 month basis or sooner, based on a significant change in the resident, to ensure they maintain the physical and mental ability to self administer medication without assistance;

(3) Have the resident store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

(4) If a resident requests, allow the resident's medication to be placed in a central locked storage area provided by the ALR-RC;

(5) Have a copy of the key to access the locked medication storage area in the resident's room;

(6) Allow the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist; and

(7) Except as provided for in (4) above, not be responsible, in any way, for management or control of the resident's medications.

(af) The licensee shall allow the resident to self direct administration of medications if the resident:

(1) Has a physical limitation due to a diagnosis that prevents the resident from self administration of medications with or without assistance;

(2) Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure 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 resident's licensed practitioner and requests the ALR-RC to file the verification in their resident record; and

(4) Verbally directs personnel to:

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

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

(ag) If a resident self administers medication with assistance, personnel shall be permitted to:

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

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

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

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

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

(ah) If a resident self administers medication with assistance, personnel shall not physically handle the medication in any manner.

(ai) Except for those residents who self administer medication without assistance, the licensee shall maintain a written record for each medication taken by a resident at the ALR-RC 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 resident taking medication;

(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.

(aj) The facility shall have a written policy that incorporates the requirements listed in (ad) -(ai) for use in training and for reference by employees supervising medication administration.

(ak) Personnel who are not licensed practitioners or nurses but who assist a resident with self administration of medication with assistance or self-directed administration of medication shall, prior to providing such assistance, complete, at a minimum, a 4-hour medication assistance education program covering both prescription and non-prescription medication.

(al) A licensed nurse, licensed practitioner, or pharmacist shall teach the medication assistance education program, whether in-person or through other means such as electronic media provided it meets the requirements of (ak) above and (am) below.

(am) The medication supervision education program required by (ak) above shall include:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights relative to medication, which are:

a. The right resident;

b. The right medication;

c. The right dose;

d. Medication administered at the right time; and

e. Medication administered via the right route;

(3) Documentation requirements;

(4) General categories of medications such as antihypertensives or antibiotics;

(5) Desired effects and potential side effects of medications; and

(6) Medication precautions and interactions.

(an) The administrator may accept documentation of training required by (ak) above if it was previously obtained by the applicant for employment at another licensed ALR-RC.

(ao) The licensee shall report to the resident'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 resident's record the reaction, the error, and date, time, and person notified.

(ap) No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident.

(aq) An ALR-RC shall have written orders from the licensed practitioner for all medications being taken by residents except for residents who have a licensed practitioner's order to self administer medications without assistance and keep the medicine in their room.

(ar) An ALR-RC may keep non-prescription stock medications for a resident when accompanied by a licensed practicioner's order and each resident has his or her own container for the medication.

(as) The therapeutic use of cannabis by residents who are qualifying patients possessing a registry identification card shall be permitted at an ALR-RC provided:

(1) The facility designates itself as a facility caregiver as allowed by RSA 126-:2, VIX; or

(2) The facility permits a resident to possess and use cannabis at the licensed premises, the resident is able to self-administer medication without assistance, and the cannabis remains in the possession of the resident.

(at) An ALR-RC that permits the therapeutic use of cannabis in accordance with (as) above shall develop, maintain, and implement a general policy relative to resident use of cannabis at the licensed premises, including storage, security, and administration.

(au) An ALR-RC that designates itself as a facility caregiver according to (as) (1) above shall:

(1) Have a resident-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the resident; and

(2) Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying patients with the therapeutic use of cannabis.

(av) An ALR-RC shall not permit the smoking of cannabis if smoking is not allowed on the ALR-RC premises.

N.H. Admin. Code § He-P 804.17

#9121, eff 4-3-08

Amended by Volume XXXVI Number 49, Filed December 8, 2016, Proposed by #12047, Effective 11/19/2016, Expires 5/18/2017.

Amended by Volume XXXVII Number 45, Filed November 09, 2017, Proposed by #12414, Effective 11/3/2017, Expires 11/3/2027.