N.H. Admin. Code § He-P 826.17

Current through Register No. 45, November 7, 2024

Section He-P 826.17 - Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner, except as allowed in (b) below.

(b) The facility shall have written approval from the client's licensed practitioner, at time of admission, of a list of approved over-the-counter (OTC) medications taken in accordance with the directions on the medication container or as ordered by the client's licensed practitioner.

(c) Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24-hours or in accordance with the licensed practitioner's direction.

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

(1) Obtain any medication ordered for immediate use at the SUD-RTF;

(2) Reorder medications for use at the SUD-RTF; and

(3) Receive and record new medication orders.

(e) For each prescription medication being taken by a client, the licensee shall maintain, in the client's record, either the original or a copy of the written order signed by a licensed practitioner.

(f) Each medication order shall legibly display the following information:

(1) The client'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 licensed practitioner.

(g) For PRN medications the licensed 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.

(h) All prescription medications brought by a client to program shall be in their original containers and comply with (f) above.

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

(1) The client'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;

(5) The date ordered;

(6) The name of the prescribing licensed practitioner; and

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

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

(k) The label of all medication containers maintained in the SUD-RTF shall match the current written orders of the licensed practitioner unless authorized by (n) below.

(l) Only a pharmacist shall make changes to prescription medication container labels.

(m) Any change or discontinuation of medications taken at the SUD-RTF shall be pursuant to a written order from a licensed practitioner.

(n) When the licensed practitioner changes the dose of a medication and personnel of the SUD-RTF 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 SUD-RTF'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 for a maximum of 90 days from the date of the new medication order or 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.

(o) Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

(p) All prescription medications, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be kept on the client's person or stored in the client's room, shall be stored as follows:

(1) Kept in a storage area that is:

a. Locked and accessible only to authorized personnel;

b. Organized to allow correct identification of each client's medication(s);

c. Illuminated in a manner sufficient to allow reading of all medication labels; and

d. Equipped to maintain medication at the proper temperature;

(2) Schedule II controlled substances, as defined by RSA 318-B:1-b, shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel; and

(3) Topical liquids, ointments, patches, creams, and powder forms of products shall be stored in a manner such that cross-contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

(q) Over-the-counter (OTC) medications shall be handled in the following manner:

(1) Only original, unopened containers of OTC medications shall be allowed to be brought into the program;

(2) OTC medication shall be stored in accordance with (p) (1) above; and

(3) OTC medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

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

(s) The SUD-RTF shall have a clearly identified policy for storage and administration of naloxone that includes the following:

(1) The process for regularly reviewing and updated the standing order for the naloxone kits on the premises;

(2) The process for ensuring regular review of naloxone kits for expiration;

(3) If naloxone is administered, the policy shall include a statement that 911 shall be called immediately; and

(4) If naloxone is not administered but an overdose is suspected, the policy shall include a statement that 911 shall be called immediately.

(t) All medications self-administered by a client, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be taken by the client without supervision, shall be supervised by the program staff, as follows:

(1) Staff shall remind the client to take the correct dose of his or her medication at the correct time;

(2) Staff may open the medication container but shall not be permitted to physically handle the medication itself in any manner;

(3) Staff shall remain with the client to observe them taking the prescribed dose and type of medication; and

(4) For each medication taken, staff shall document in an individual client medication log the following:

a. The medication name, strength, dose, frequency, and route of administration;

b. The date and the time the medication was taken;

c. The signature or identifiable initials of the person supervising the taking of said medication; and

d. The reason for any medication refused or omitted.

(u) Except as allowed by (w) 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.

(v) Controlled drugs shall be destroyed only in accordance with state law and;

(1) Be accomplished in the presence of at least 2 people; and

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

(w) Medication(s) may be returned to pharmacies for credit only as allowed by the law.

(x) When a client is going to be absent from the SUD-RTF at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering, as described in (ad) and (ae) below.

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

(z) Upon discharge or transfer, the licensee shall make the client's current medications available to the client and the guardian, agent, or surrogate decision-maker if any, unless determined by a licensed practitioner, licensed clinical supervisor, or licensed counselor that the client is a risk to themselves or others.

(aa) A written order from a licensed practitioner shall be required for any client who is authorized to carry emergency medications, including nitroglycerine and inhalers.

(ab) Clients shall receive their medications by one of the following methods:

(1) Self-administered as described in (s) above;

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

(3) Self-administered with assistance as allowed by (ae) and (af) below; or

(4) Administered by individuals authorized by law.

(ac) The licensee shall allow the client to self-direct administration of medications as defined in He-P 826.03(cf) if the client:

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

(2) Receives evaluations every month or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-direct administration of medications;

(3) Obtains written verification of the client's physical limitation and self-directing capabilities from their licensed practitioner and requests the SUD-RTF to file the verification in the client record; and

(4) Verbally directs personnel to:

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

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

(ad) If a client self-administers medication with assistance, as defined in He-P 826.03(cd) , personnel shall:

(1) Remind the client to take the correct dose of his or her medication at the correct time;

(2) Place the medication container within reach of the client;

(3) Remain with the client to observe the client taking the appropriate amount and type of medication as ordered by the licensed practitioner;

(4) Record on the client's daily medication record that they have supervised the client taking his or her medication; and

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

(ae) If a client self-administers medication with assistance, personnel shall not physically handle the medication in any manner.

(af) 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.

(ag) Personnel shall remain with the client until the client has taken the medication.

(ah) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.

(ij) A licensed nursing assistant (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 SUD-RTF:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

(3) Medicinal topical products to intact skin as ordered by the licensed practitioner.

(aj) The licensee shall maintain a written record for each medication taken by the client at the SUD-RTF 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 client taking medication;

(5) For PRN medications, the reason the client 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 client with self-administration with supervision, self-directed administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

(al) The medication supervision education program shall be taught by a licensed nurse, licensed practitioner, or pharmacist, whether in-person or through other means such as electronic media.

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

(1) Infection control and proper hand washing techniques;

(2) The 5 rights which shall include:

a. The right client;

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 antidepressants 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 (am) above if it was previously obtained by the applicant for employment at another licensed facility.

(ao) 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.

(ap) The written documentation of the report in (ak) above shall be maintained in the client's record.

(aq) The licensee shall provide an annual review of its policies and procedures for self-administration of medication, self-administration of medication with supervision, and self-directed medication administration to all direct care personnel, as applicable.

(ar) The facility administrator, licensed nurse if available, or the administrator's designee who has completed the 4-hour medication assistance supervision program required by He-P 804.17(al) shall provide and document in writing, an annual review of its policies and procedures for self-administration of medication without assistance, self-administration of medication with assistance, and self-directed medication administration to all direct care personnel.

N.H. Admin. Code § He-P 826.17

Derived From Volume XXXVIII Number 45, Filed November 8, 2018, Proposed by #12658, Effective 11/1/2018, Expires 11/1/2028.

Amended by Volume XXXIX Number 50, Filed December 12, 2019, Proposed by #12928, Effective 11/26/2019, Expires 11/26/2029.