N.H. Admin. Code § He-P 809.16

Current through Register No. 45, November 7, 2024

Section He-P 809.16 - Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

(b) HHCP personnel who are not authorized by law to administer medications may remind and prompt patients to take their medications at the proper time, place medication container(s), including pill planners, within patient reach, opening the medication container when patient is present, reading the medication label to the patient, and utilizing hand over hand technique, as defined in 809.03 (bb), as per the care plan without requiring documentation of specific medications taken.

(c) 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.

(d) A licensed nursing assistant (LNA) may perform hand over hand assistance by following the care plan, as delegated by a licensed nurse, to a competent and stable patient pursuant to RSA 326-B.

(e) The licensee shall allow the patient to self-direct medication administration, as defined in He-P 809.03(bb) , if the patient:

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

(2) Obtains an annual written verification of the patient's physical limitation and self-directing capabilities from the patient's licensed practitioner or the assessment performed by an RN according to He-P 809.15(i) and such documentation is included in the patient record; and

(3) Verbally directs personnel to:

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

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

(f) If personnel, who are authorized by law, administer medication(s) , delegate medication administration, or prepare medication in advance for administration in accordance with RSA 318:42II and XIV, XI, the HHCP shall:

(1) Maintain a list of medications currently being taken by the patient;

(2) Administer all medications in accordance with the orders of the licensed practitioner;

(3) Maintain an order, or a copy thereof, in the patient's record that includes:

a. The patient's name;

b. The medication name, strength, prescribed dose, and route of administration;

c. The frequency of administration;

d. The indications for usage of all PRN medications; and

e. The date ordered;

(4) Only use medications that have been be kept in the original containers, as dispensed by the pharmacy, licensed practioner's samples, or over the counter medications;

(5) Require that any change or discontinuation of medications shall be pursuant to an order from a licensed practitioner or other individual authorized by law;

(6) Require that all telephone orders for medications or treatments are:

a. Taken only by a licensed health care professional if such action is within the scope of their practice act;

b. Immediately transcribed and signed by the individual taking the order; and

c. Counter-signed by the ordering practioner as soon as possible and with a documented reason if signed more than 30 days after the telephone order being taken;

(7) Require that the medication to be administered by HHCP personnel be:

a. Prepared immediately prior to administration; and

b. Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B;

(8) Require that when personnel are assisting or administering medication, they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

(9) Maintain documentation for all medications either assisted by or administered by HHCP personnel that includes:

a. The name of the patient;

b. A list of any allergies or allergic reactions to medications;

c. The name, strength, dose, frequency, and route of administration of the medications;

d. The date and time medication was taken;

e. The signature and identifiable initials and job title of:

1. The person assisting or administering the medication; or

2. The person administering or assisting the patient taking his or her medication;

f. Documented reason for any medication refusal or omission; and

g. For PRN medications, the reason the patient required the medication and the effect of the PRN medication at the time of the next patient contact; and

(10) Develop and implement a system for reporting to the patient's prescribing, licensed practitioner any.

a. Observed adverse reactions to or side effects of medication; and

b. Medication errors such as incorrect medications.

(g) If the HHCP provides "self-administration of medication with assistance" medication services to a patient as defined by He-P 809.03(bb) , the HHCP shall:

(1) Maintain, in the home, a list of medications currently being taken by the patient;

(2) Assist with self-administration of medications in accordance with the orders of the licensed practitioner;

(3) Maintain either the original order, or a copy thereof, in the patient's record that includes:

a. The patient's name;

b. The medication name, strength, prescribed dose and route of administration;

c. The frequency of administration;

d. The indications for usage of all PRN medications; and

e. The date ordered;

(4) Not allow personnel to assist with self-administration of medications if anyone other than a pharmacist has changed prescription medication container labels except as allowed by (7) f. below;

(5) Require that any change or discontinuation of medications shall be pursuant to an order;

(6) Require that all telephone orders for medications or treatments are:

a. Taken only by a licensed health care professional if such action is within the scope of their practice act;

b. Immediately transcribed and signed by the individual taking the order; and

c. Counter-signed by the ordering practioner within 30 days or with a documented reason if more than 30 days;

(7) Allow a patient to self-administer medication with assistance by personnel, as directed by the care plan, and which personnel shall be required to:

a. Remind the patient to take the correct dose of his or her medication at the correct time from the original medication bottle;

b. Place the medication container within reach of the patient;

c. Remain with the patient to observe them taking the appropriate number and type of medication as ordered by the licensed practitioner;

d. Record that they have supervised the patient taking their medication on the patient's daily medication record;

e. Document in the patient's record any observed or reported side effects, adverse reactions, refusal to take medications, and medications not taken; and

f. Require that if the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HHCP are unable to obtain a new prescription label:

1. The RN shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HHCP's written procedure, indicating that there has been a change in the medication order;

2. The RN shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

3. The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first;

(8) Maintain documentation for all medications assisted by HHCP personnel that includes:

a. The name of the patient;

b. A list of any allergies or allergic reactions to medications;

c. The name, strength, dose, frequency, and route of administration of the medications;

d. The date and time medication, including PRN medications, was taken;

e. The signature, identifiable initials, and job title of the person assisting the patient taking his or her medication; and

f. Documented reason for any medication refusal or omission;

(9) Develop and implement a system for reporting to the patient's prescribing, licensed practitioner any:

a. Observed adverse reactions to or side effects of medication; or

b. Medication errors such as incorrect medications; and

(10) Require LNAs who assist patients with self-administration of medications to comply with the board of nursing requirements according to RSA 326-B

(h) A home health personal care service provider shall successfully complete a medication assistance education program taught by a licensed nurse, licensed practitioner, or pharmacist, whether in person or through other means such as electronic media, prior to assisting a patient with self-administration of medication with assistance, self-directed medication administration, or administration via nurse delegation.

(i) The medication assistance education program required by (h) above shall, at a minimum, include training on the following subjects:

(1) Infection control and proper hand washing techniques;

(2) The 5 rights, including:

a. The right patient;

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 antihypertensive medications or antibiotics;

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

(6) Medication precautions and interactions.

(j) For patients who qualify for the use of therapeutic cannabis, the licensee shall keep a copy of the registry identification card in the patient's record.

(k) The licensee shall develop, maintain, and implement a patient specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be handled and administered to the patient.

(l) If allowed by the policy in (k) above, cannabis shall be treated in a manner similar to controlled medications with respect to assisting qualifying patients with the therapeutic use of cannabis.

N.H. Admin. Code § He-P 809.16

#9466, eff 5-2-09

Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12167, Effective 4/29/2017, Expires 10/26/2017.

Amended by Volume XXXVIII Number 41, Filed October 11, 2018, Proposed by #12640, Effective 10/3/2018, Expires 10/3/2028.