N.H. Admin. Code § He-P 805.17

Current through Register No. 45, November 7, 2024

Section He-P 805.17 - Medication Services

(a) All medications shall be administered 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 practitioner on an annual basis.

(c) All personnel shall follow the written and signed orders of the licensed practitioner for each resident.

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

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

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

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

(3) Receive and record new medication orders.

(f) 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 then by mouth;

(3) The frequency of administration;

(4) The indications for usage for all medications that are used PRN; and

(5) The dated signature of the ordering practitioner.

(g) For PRN medications the ordering practitioner shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

(h) Each prescription medication shall legibly display the following information unless it is an emergency medication as allowed by (ap) 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 pro re nata (PRN) medications;

(5) The date ordered;

(6) The name of the prescribing practitioner; and

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

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

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

(k) 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 medication record for a change or discontinuance shall indicate in writing the date the dose or the discontinuance occurred.

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

(m) 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.

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

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

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

(q) All over-the-counter medications as defined by He-P 805.03(as) 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 medications, including over the counter medications, shall remain in the original containers except as authorized by (ae) (5) and (af) (4) c. 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-SRHC, 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 (y) below, any contaminated, expired or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner's orders or the medication becomes contaminated, whichever occurs first.

(x) Controlled drugs shall be destroyed only in accordance with state law.

(y) Destruction of controlled drugs under (x) above shall:

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

(2) Be documented in the record of the resident for whom the drug was prescribed.

(z) When a resident is going to be absent from the SRHCF 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-administering without assistance, as described in (ae) below.

(aa) If a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication container shall be given to the person responsible for the resident while the resident is away from the SRHCF.

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

(ac) 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.

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

(1) Self-administered without assistance as allowed by (ae) below;

(2) Self-directed administration of medication as allowed by (af) below;

(3) Self-administered with assistance as allowed by (ag) and (ah) below; or

(4) Administered by individuals authorized by law.

(ae) For residents who self-administer without assistance as defined in 805.03(bn) the licensee shall:

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

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

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

(2) Evaluate the resident initially and then on a 6month basis or sooner if the resident experiences a significant change, to ensure they maintain the physical and mental ability to self-administer 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) Have a copy of the key to access the locked medication storage area in the resident's room; and

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

(af) The licensee shall allow the resident to self-direct administration of medications as defined in He-P 805.03(bj) if the resident:

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

(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 their physical limitation and self-directing capabilities from their licensed practitioner and requests the SRHCF to file the verification in their resident record; and

(4) Verbally directs personnel to:

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

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

c. Fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

(ag) If a resident self-administers medication with assistance, as defined in He-P 805.03(bm) , personnel shall only:

(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 and open the container, if requested by 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 observed the resident taking his or her medication;

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

(6) Not touch the medications or remove them from the container.

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

(ai) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall only do so as allowed by RSA 326-B and Nur 404.

(aj) Except for those residents who self-administer medication without assistance, the licensee shall maintain a daily medication record for each medication taken by the resident at the SRHCF that contains the following information:

(1) Any allergies or allergic 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.

(ak) Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a resident with self administration with assistance, self directed administration or administration of medication via nurse delegation shall 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 the (ak) above.

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

(1) Infection control and proper hand washing techniques;

(2) The 5 rights which are:

a. The right resident;

b. The right medication;

c. The right dose;

d. Administered at the right time; and

e. 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 SRHCF.

(ao) An SRHCF shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.03 under circumstances where the SRHCF:

(1) Has a director of nursing who is an RN licensed in accordance with RSA 326-B; and

(2) Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

(ap) The licensee shall document in the resident record and report any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, to the licensed practitioner, and to the agent or guardian if applicable, immediately upon the adverse reaction or medication error.

(aq) The written documentation of the report in (aq) above shall be maintained in the resident's record.

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

(as) Stock medication shall not be used in the SRHCF.

N.H. Admin. Code § He-P 805.17

#8746, eff 10-25-06

Amended byVolume XXXV Number 18, Filed May 7, 2015, Proposed by #10813, Effective 4/21/2015, Expires4/21/2025.