N.H. Admin. Code § He-P 816.17

Current through Register No. 50, December 12, 2024

Section He-P 816.17 - Medication Services

(a) If the licensee maintains a pharmacy on the licensed premises, it shall comply with RSA 318.

(b) All procedures for managing and distributing medication(s) shall comply with all applicable federal and state laws and rules.

(c) The licensee shall develop and implement written policies and procedures governing the management and distribution of student medications provided by the EHC.

(d) The written policies and procedures shall include, but not be limited to, the following:

(1) How medication is provided to students;

(2) What type of medications students are allowed to keep on their person, including number of doses;

(3) What personnel of the educational institution, such as teachers and residential staff, are allowed to assist students with medications when not given at the EHC;

(4) What training such personnel of the educational institution who can assist students with medication will receive from EHC personnel; and

(5) How EHC personnel shall:

a. Administer medication; and

b. Facilitate medication delivery if a student self-administers off the premises of the EHC or is assisted by or has his or her medication administered by educational facility personnel, in compliance with RSA 326-B.

(e) All medications shall be administered in accordance with the orders of the licensed practitioner or other individual authorized by law.

(f) EHC nursing staff shall follow their nurse practice act when administering medications or filling pill planners for students.

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

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

(2) Obtain any routine medications required within 24 hours for use at the EHC;

(3) Reorder medications for use at the EHC;

(4) Receive new medication orders; and

(5) Report any observed adverse reactions to medication, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error to the student's licensed provider and guardian, if applicable.

(h) For each prescription medication being taken by a student in grades K-12 and all other students while under the care of the EHC, the licensee shall maintain in the student's record, one of the following:

(1) The original written order, signed by a licensed practitioner or other individual authorized by law; or

(2) A copy of the original written order, signed by a licensed practitioner or other individual authorized by law.

(i) Each prescription medication shall legibly display the following information:

(1) The student'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; and

(5) The dated signature of the ordering practitioner.

(j) The label of all medication containers maintained in the EHC shall match the current written orders of the licensed practitioner.

(k) Pharmaceutical samples shall be:

(1) Used in accordance with the licensed practitioner's written order;

(2) Labeled with the participant's name by the licensed practitioner, the licensee, or their designee; and

(3) Exempt from (i) (2) -(5) above.

(l) Only a pharmacist or other licensed practitioner shall make changes to the labels on prescription medication container labels.

(m) Any change or discontinuation of prescription medications taken at the EHC shall be pursuant to a written order from a licensed practitioner or other individual authorized by law.

(n) When the licensed practitioner or other individual authorized by law changes the dose of a medication and the personnel of the EHC are unable to obtain a new prescription label:

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

(2) Personnel 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:

a. For a maximum of 90 days from the date of the new medication order;

b. Until the medications in the marked container are exhausted; or

c. In the case of PRN medication, until the expiration date on the container, whichever occurs first.

(o) Prescription medication that is not ordered, approved or labeled for a specific student, including but not limited to pharmaceutical samples, may be kept at the EHC provided that these medications are dispensed to the student only upon the order of an authorized licensed practitioner. A signed copy of the order shall be filed in the student's medical record within 3 business days following the order.

(p) The medication in (o) above shall be the responsibility of the medical director.

(q) Only a licensed nurse or other licensed health care professional shall take telephone orders for medications, treatments, and diets, if such action is within the scope of their practice act.

(r) Telephone orders specified in (q) above shall be:

(1) Immediately transcribed and signed by the individual receiving the order; and

(2) Counter-signed by the authorized prescriber within 30 days.

(s) All medications taken by a student at the EHC shall require written approval for its use by a licensed practitioner.

(t) The medication storage area or units shall be:

(1) Locked and accessible only to authorized personnel;

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

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

(u) All medication at the EHC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use, except as allowed by (o) above.

(v) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner as to prevent cross contamination.

(w) If controlled substances, as defined by RSA 318-B:1, VI, are stored in the EHC they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

(x) Except as required below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, at the end date of a licensed practitioner's orders, or if the medication becomes contaminated, whichever occurs first.

(y) If the licensee employs or contracts with a pharmacist who has been designated an agent of the NH pharmacy board, then controlled medications shall be destroyed in accordance with the pharmacy board rules Ph 707.

(z) Destruction of controlled drugs shall:

(1) Be destroyed only in accordance with state law;

(2) Be accomplished in the presence of at least 2 EHC personnel; and

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

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

(ab) The department shall order a licensee to obtain the routine services of a consultant pharmacist for 12 months if medication deficiencies which present a risk to the student's health and safety are identified during any inspection.

(ac) When a student leaves the educational institution, the student or their guardian may take any current medication(s) with them.

(ad) Medication(s) may be returned to pharmacies for credit only under the provisions of Ph 704.07.

(ae) Medications left at the EHC upon the student leaving the educational institution, either permanently or for an extended absence, shall be destroyed and documented in the student's record.

(af) Students shall receive their medications in accordance with the policies of the EHC developed in accordance with (c) above

(ag) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse and delegatee shall comply with the rules of medication delegation in accordance with Nur 404, as applicable, and RSA 326-B.

(ah) The licensee shall maintain a written record for each medication taken by the student at the EHC 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 and identifiable initials and job title of the person administering the medication or supervising the student taking his or her medication;

(5) For PRN medications, the reason the student required the medication and the effect of the PRN medication, if known;

(6) Documented reason for any medication refused or omitted; and

(7) Observed side effects and adverse reactions.

(ai) Personnel who are not otherwise licensed practitioners, and nurses who assist with observing a student self-administer medication, shall complete an orientation class taught by the EHC nurse which shall include the review of the policies and procedures set forth by the EHC for medication observation.

(aj) Non-prescription stock medications may be kept at the EHC.

(ak) An EHC shall use emergency drug kits only in accordance with NH pharmacy board rule, Ph 705.03, under circumstances where the EHC:

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

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

(3) Has the contents approved, in writing, by the licensee's medical director.

(al) The emergency drug kit in (ak) above shall be accessed only by the licensed nurse or licensed practitioner on duty.

(am) The licensee shall develop and implement a system for reporting to the student's primary care licensed practitioner any adverse reactions to medications, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

(an) The written documentation of the report in (am) above shall be maintained in the student's record.

(ao) The licensee shall conduct an annual review of its policies and procedures relative to medications.

N.H. Admin. Code § He-P 816.17

#9193, eff 6-26-08; ss by #9565, eff 10-16-09

Amended by Volume XXXVII Number 23, Filed June 8, 2017, Proposed by #12197, Effective 6/2/2017, Expires 6/2/2027.