N.H. Admin. Code § He-P 813.18

Current through Register No. 45, November 7, 2024

Section He-P 813.18 - Medication Services

(a) All medications shall be administered in accordance with the orders of the resident's prescribing licensed practitioner or other licensed professional with prescriptive authority.

(b) Medications and treatments ordered by the licensed practitioner or other licensed professional with prescriptive authority shall be available to give to the resident within 24 hours of being ordered.

(c) The family provider shall have a system in place to:

(1) Obtain any medication ordered for immediate use by the resident;

(2) Re-order medications for use by the resident; and

(3) Receive new medication orders.

(d) For each prescription medication being taken by a resident, the family provider shall have a copy of the signed order in the resident's record.

(e) Family providers shall not make changes to the label of any residents' prescription container.

(f) Any licensed practitioner's order for a change or discontinuation of medications taken by the resident in the AFCR shall be noted by the home family provider, who shall:

(1) Notify the oversight agency and case manager of the change or discontinuation; and

(2) Follow up with the licensed practitioner or other individual authorized by law to ensure the receipt of written documentation of same.

(g) The change in dosage, without a pharmacist changing the prescription label as described in (h) above, shall be allowed for a maximum of 30 days from the date of the new medication order, or 90 days for mail order medications.

(h) At the time of admission and on an annual basis, the family provider shall obtain from a licensed practitioner written approval for the specific over-the counter medications requested by, or on behalf of, the resident.

(i) Family providers shall store all over-the-counter medications in a secure area to restrict access by other residents, household members and children residing in the home.

(j) All over-the-counter medication containers shall be:

(1) Marked by the family provider with the name of the resident using the medication; and

(2) Taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

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

(1) Locked and accessible only to the family provider;

(2) Clean, organized and lit in a fashion to ensure correct identification of each resident's medication(s); and

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

(l) Except as allowed by RSA 318:42, all medication at the AFCR shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(m) 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.

(n) When a resident is going to be absent from the AFCR at the time medication is scheduled to be taken, the medication container shall be given to the resident or to the person responsible for the resident's care during the absence.

(o) Upon discharge or transfer, a resident shall be provided with his or her current medication(s) .

(p) A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry and self-administer without supervision emergency medications such as nitroglycerine, inhalers or EpiPens.

(q) Residents shall receive their medications in the following manner:

(1) Self-administer medication as allowed by (v) below;

(2) Self-administer with supervision as allowed by (w) below;

(3) Administered by an individual that a nurse has delegated the task of medication administration to.

(r) For residents who self-administer medication, the family provider shall:

(1) Obtain on a bi-annual basis a written order from a licensed practitioner authorizing him or her to self-administer medications without supervision;

(2) Ensure that the resident receives quarterly evaluations by the oversight agency to ensure that he or she maintains the physical and cognitive ability to self-administer;

(3) Assist the resident in storing the medications in their room by locking them up to safeguard against unauthorized access and to maintain them at proper temperatures; and

(4) Maintain a key to access the locked medication storage area in the resident's room with a copy of the key being given to the home family provider.

(s) If a resident self-administers medication with supervision, family providers 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 them taking the appropriate dose and type of medication as ordered by the licensed practitioner;

(4) Record on a 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, and refusal to take medications or medications not taken.

(t) If a resident self-administers medication with supervision, home family providers shall not physically handle the medication in any manner.

(u) The licensed practitioner shall allow the resident to self-direct medications if the resident has a physical limitation and wishes to self-direct.

(v) If a resident self-directs the administration of medication, the family provider may, upon the request of the resident, physically assist the resident with his or her medication, including opening the medication container, handing the resident the medication and closing the container.

(w) If individuals authorized by law administer medications, the medication shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person pursuant to RSA 318 and RSA 326-B.

(x) When administering medication, the family provider or other individual authorized by law shall remain with the resident until the resident has taken all of the medication.

(y) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall comply with RSA 326-B concerning nurse delegation.

(z) Except for those residents who self-administer prescription and over the counter medications, family providers shall maintain a written record for each medication taken by the resident at the AFCR, containing the following:

(1) The name and strength of the medication;

(2) The dose taken by the resident;

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

(4) The signatures, identifiable initials and job titles of the home family providers or family providers who supervise, assist with, or administer the medications;

(5) The reason for any medication refused or omitted;

(6) For medication taken as needed, the reason the resident required the medication and the effect of the medication; and

(7) Any allergies or allergic reactions to medications.

(aa) The licensed nurse from the oversight agency shall provide, at a minimum, an initial 4-hour medication supervision education program to family providers who assist residents with self administration with supervision, self-directed administration, or who administer medication, via nurse delegation which shall cover the administration of both prescription and non-prescription medication.

(ab) On an annual basis home family providers and family providers who administer medication via nurse delegation shall complete a minimum of 2 hours of training to review the medication supervision education program referenced in (aa) above.

(ac) The medication supervision education program and annual in-service training required by (aa) and (ab) above shall include:

(1) A review of the medications that the resident is currently taking;

(2) Infection control and proper hand washing techniques;

(3) 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;

(4) Documentation requirements;

(5) General categories of medications, such as anti-hypertensives and antibiotics;

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

(7) Medication precautions and interactions.

(ad) The family provider shall develop and implement a system for immediately notifying the resident's prescribing, licensed practitioner and the oversight agency RN within 24 hours of the occurrence of any:

(1) Observed adverse reactions to medication; or

(2) Medication errors such as incorrect medications or omissions.

N.H. Admin. Code § He-P 813.18

#8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 803.17 )

Amended by Volume XXXIX Number 16, Filed April 18, 2019, Proposed by #12740, Effective 3/20/2019, Expires 9/16/2019.