Section He-P 824.18 - Medications(a) All medications shall be administered in accordance with the orders of the licensed practitioner or other professional authorized by law.(b) Medications, treatments, and diets ordered by the licensed practitioner or other professional authorized by law shall be available to give to the patient within 24 hours or in accordance with the licensed practitioner's direction.(c) The licensee shall have a written policy and system in place instructing how to:(1) Obtain any medication ordered for immediate use at the HH;(2) Reorder medications for use at the HH; and(3) Receive and record new medication orders.(d) Each medication order shall legibly display the following information: (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.(e) For PRN medications the ordering practitioner or a pharmacist 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.(f) For each prescription medication being taken by a patient, the licensee shall maintain either the original written order or a copy of the order in the patient's record, signed by a licensed practitioner or other individual authorized by law.(g) Each medication, including licensed practitioner's samples, shall legibly display the following information: (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(h) The label of all medication containers maintained in the HH shall match the current written orders of the licensed practitioner unless authorized by (j) below.(i) Only a pharmacist shall make changes to a prescription medication container label. Any change or discontinuation of medications taken at the HH shall be pursuant to a written order licensed practitioner or other professional authorized by law.(j) When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HH are unable to obtain a new prescription label: (1) The licensed nurse 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 HH's written procedure, indicating that there has been a change in the medication order;(2) Licensed nurse 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.(k) The licensee shall require that all telephone orders for medications or treatments are: (1) Taken only by a licensed health care professional if such action is within the scope of their practice act; (2) Immediately transcribed and signed by the individual taking the order; and(3) Be counter-signed by the authorized licensed practitioner authorized by law within 30 days.(l) Over-the-counter medications shall be handled in the following manner: (1) The licensee shall obtain written approval from the patient's licensed practitioner annually; and(2) Over-the-counter medication containers shall be marked with the name of the patient using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.(m) The medication storage area for medications not stored in the patient'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 patient's medication(s); and(3) Equipped to maintain medication at the proper temperature.(n) All medication at the HH shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use except as authorized by (x)(5) below.(o) 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.(p) If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the HH, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.(q) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.(r) The destruction of contaminated, expired, or discontinued medication shall be completed within 15 days of the expiration date, the end date of a licensed practitioner's orders or the medication becomes contaminated, whichever occurs first and shall:(1) Be accomplished in the presence of at least 2 people if a controlled substance; and(2) Be documented in the record of the patient for whom the drug was prescribed.(s) Upon discharge or transfer, the licensee shall make the patient's current medications, except for controlled drugs which shall be destroyed in accordance with (r) above, available to the patient and the guardian or agent, if any.(t) Medication(s) may be returned to pharmacies for credit only as allowed by the law.(u) When a patient is going to be absent from the HH at the time medication is scheduled to be taken, the medication container shall be given to the patient if the patient is capable of self-administering, as described in (x) below.(v) A written order from a licensed practitioner shall be required every 90 days for any patient who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.(w) Patients shall receive their medications by one of the following methods: (1) Self-administered medication as allowed by (x) below; or(2) Administered by individuals authorized by law.(x) For patients who self-administer medication as defined in He-P 824.03(bf), the licensee shall: (1) Obtain a written order from a licensed practitioner on an annual basis:a. Authorizing the patient to self-administer medications without supervision;b. Authorizing the patient to store the medications in their room; andc. Identifying the medications that may be kept in the patient's room;(2) Evaluate the patient's ability to self-administer medication upon admission and whenever there is a significant change in the patient, as defined in 824.03(bg), to ensure they maintain the physical and mental ability to self-administer;(3) Have the patient 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 patient's room; and(5) Allow the patient to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.(y) Medication administered by individuals authorized by law to administer medications shall be: (1) Prepared immediately prior to administration; and(2) Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.(z) Personnel shall remain with the patient until the patient has taken the medication.(aa) The licensee shall maintain a written record for each medication taken by the patient at the HH that contains the following information: (2) Any allergies or allergic reactions to medications;(3) The name, strength dose, frequency, and route of the medication;(4) The date and the time the medication was taken;(5) The signature and identifiable initials and job title of the person administering the medication;(6) Documented reason for any medication refused or omitted; and(7) For PRN medications, the reason the patient required the medication and the effect of the PRN medication.(ab) An LNA who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the HH: (1) Medicinal shampoos and baths;(2) Glycerin suppositories and enemas; and(3) Medicinal topical products to intact skin as ordered by the licensed practitioner.(ac) Non-prescription stock medications shall only be accessed and administered by the licensed nurse or medication nurse assistant on duty.(ad) An HH shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.03 under circumstances where the HH: (1) Has a director of nursing who is a 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.(ae) The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.(af) If ordered by the department to do so, the HH shall obtain the services of a consulting pharmacist to rectify medication deficiencies, which present a risk to the patient's health and safety, as identified during an inspection or investigation.N.H. Admin. Code § He-P 824.18
Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12169, Effective 4/29/2017, Expires 10/26/2017.Amended by Number 15, Filed April 13, 2023, Proposed by #13572, Effective 3/1/2023, Expires 3/1/2033.