105 Mass. Reg. 700.003

Current through Register 1520, April 26, 2024

Section 700.003 - Registration of Persons for a Specific Activity or Activities in Accordance with M.G.L. c. 94C, Section 7(g)

(A)

(1) A Paramedic or a Paramedic student, as part of their participation in a Department-approved Paramedic training program, may administer only those controlled substances, in quantity and kind, that are necessary for the performance of their duties in accordance with 105 CMR 170.000: Emergency Medical Services System and the STPs, or in accordance with their duties as authorized by clinical protocols in a Department-approved MIH program or community EMS program pursuant to M.G.L. c. 111O;

(2) An Advanced EMT, Advanced EMT student as part of their participation in a Department-approved training program, EMT or EFR may administer only those controlled substances for which they have been approved by the Department and that are necessary for the performance of their duties in accordance with 105 CMR 170.000: Emergency Medical Services System and the provisions of the Statewide Treatment Protocols, or in accordance with their duties as authorized by clinical protocols in a Department-approved MIH program or community EMS program pursuant to M.G.L. c. 111O;

(3) Administration of controlled substances by EMTs at all levels, and EMT students at all levels, is also subject to the following conditions:

(a) The ambulance service, EFR service, or Department-approved MIH or community EMS program for which the individual serves, shall be registered in accordance with 105 CMR 700.004 for the appropriate controlled substances;

(b) The ambulance service, EFR service, or Department-approved MIH or community EMS program shall maintain a current listing of names of its employees and volunteers who are authorized to administer controlled substances;

(c) The EMT, Paramedic student, Advanced EMT student or EFR shall perform only those functions for which they are authorized by, and trained in accordance with 105 CMR 170.000: Emergency Medical Services System;

(d) Administration of controlled substances shall be conducted:

1. pursuant to the order of a practitioner and the STP; and

2. in accordance with 105 CMR 170.000: Emergency Medical Services System and the provisions of the STP.

(4) A Paramedic may dispense by administration influenza vaccine and other immunizations designated by the Department to persons 18 years of age or older, as authorized by clinical protocols in a Department-approved MIH program or community EMS program.

(B) Dental hygienists and fluoride program monitors employed by or affiliated with a registered school may administer fluoride tablets or fluoride mouth rinse to school children three through 18 years old provided that:

(1) The school has registered with the Department by sending a letter of intent to administer fluoride treatments to the Division of Dental Health and by providing whatever further information the Commissioner may require; and

(2) The child's parent or guardian has been informed in writing of the nature, dose and effects of fluoride tablets and mouth rinse, and has consented in writing to the administration of fluoride tablets or mouth rinse on behalf of the child; and

(3) The tablets or mouth rinse is administered in accordance with the order of a physician or dentist employed by or associated with a local Board of Health or school; and

(4) The fluoride program monitor has been trained to administer and store fluoride tablets and mouth rinse in accordance with a training program designed by the Commissioner; and

(5) All fluoride mouth rinse and tablets possessed by the registered school are stored securely under lock and key; and

(6) The registered school shall maintain such records and files such reports concerning the fluoride program for a period of two years or for such longer period as the Commissioner may require.

(C) Persons specified in 105 CMR 700.003(C) may purchase, distribute, possess and administer rescue medications in a life threatening emergency, where medical professionals are not readily available, in accordance with any applicable Department protocols and the following:

(1) Any administration is pursuant to the order of a practitioner and, in the case of first responders, the STP, except as provided in 105 CMR 700.003(C)(6)(d);

(2) The rescue medication is:

(a) dispensed by a pharmacy pursuant to the order or prescription of a practitioner or other authorized prescriber;

(b) obtained by a municipality or agency in accordance with 105 CMR 700.003(C)(4);

(c) obtained by a registered facility or program funded, operated or licensed by a municipality or agency in accordance with 105 CMR 700.003(C)(5).

(3) The rescue medication is packaged in a prefilled, automatic delivery device intended for self-administration, and the opioid antagonist is in the manufacturer's original packaging;

(4) A municipality or an agency, department or authority of the Commonwealth, through a public official or law enforcement officer, may purchase and distribute rescue medications without obtaining registration, and may train its employees or volunteers to administer the same in accordance with Department guidance.

(5) A facility or program funded, operated or licensed by a municipality or agency of the Commonwealth may register in accordance with 105 CMR 700.003(C)(7) to purchase and possess naloxone or other opioid antagonist approved by the Department for the purpose of training its employees and volunteers to administer in accordance with Department guidance

(6) To the extent authorized by 105 CMR 700.003(C), the following persons may administer rescue medications:

(a) a first responder may administer rescue medication approved by the Department in accordance with 105 CMR 171.000: Massachusetts First Responder Training, and the STP;

(b) an employee of or volunteer to a municipality or agency who is trained to administer in accordance Department guidance;

(c) an employee of or volunteer to a facility or program funded, operated or licensed by a municipality or agency who is trained to administer in accordance with Department guidance;

(d) A non-licensed staff member of a health facility, health care entity, community program, or practitioner's office may administer rescue medications to an individual the staff person reasonably believes to be experiencing a life-threatening emergency, provided that:

1. for naloxone and other Department approved opioid antagonists, the person responding to the emergency is in possession of the rescue medication; or

2. the individual experiencing the emergency is in possession of the rescue medication to be administered; or

3. the facility, entity, community program or practitioner's office is in possession of the rescue medication in accordance with all applicable laws and regulations and policies and procedures for storage and security; and

4. the rescue medication is administered pursuant to a prescription or practitioner's order, which may include a standing order issued by the Department, and in accordance with the directions in the manufacturer's package insert.

(7) A facility or program funded, operated or licensed by a municipality or agency of the Commonwealth and registered pursuant to 105 CMR 700.003(C)(5) may approve administration of epinephrine or opioid antagonist approved by the Department, or nerve agent antidotes by persons designated in 105 CNR 70.003(C)(6)(c), and a municipality or agency may approve administration of rescue medications by persons designated in 105 CMR 700.003(C)(6)(b), in accordance with Department guidance;

(8) The person registered pursuant to 105 CMR 700.003(C)(5) shall Designate a qualified, licensed practitioner as medical director for purposes of 105 CMR 700.003(C).

Such medical director shall:

(a) be the responsible person named on the registration application;

(b) authorize administration of rescue medication, as appropriate, and oversee compliance with 105 CMR 700.003(C);

(c) establish and enforce written protocols and procedures to ensure that individuals administering rescue medication are properly trained, evaluated for competence, and up to date in their skills and knowledge.

Training shall include, but not be limited to:

1. procedures for risk reduction;

2. recognition of the symptoms of an opioid overdose or a severe allergic or nerve agent reaction;

3. proper use of an inhaler, auto-injector for epinephrine or nerve agent antidote, and other acceptable method of administration for opioid antagonists approved by the Department;

4. procedures for notification of emergency medical services and other appropriate persons following administration;

(d) establish and enforce written protocols and procedures to ensure:

1. proper storage, handling and return or disposal of rescue medication;

2. review and evaluation of an emergency response;

3. reporting of adverse events to the medical director;

4. monitoring of program compliance with 105 CMR 700.003(C); and

(e) establish and enforce written protocols and procedures to ensure that a municipality or agency, or a facility or program funded, operated or licensed by a municipality or agency and registered in accordance with 105 CMR 700.003(C)(5), maintains current and readily retrievable records of:

1. the authorized employees or volunteers who may administer rescue medication;

2. individual trainings and evaluations;

3. receipt and any return or disposal of rescue medication; and

4. administration of rescue medication;

(9) Each person registered pursuant to 105 CMR 700.003(C)(5) shall:

(a) comply with the policies and procedures established pursuant to 105 CMR 700.003(C)

(b) designate a licensed health care practitioner, whenever possible, or the program director or designee, to oversee the program's implementation of said policies and procedures;

(c) in the case of minors served by the program, obtain prior informed consent whenever possible from the minor's parent or legal guardian for the administration of rescue medication;

(d) develop individualized medication administration plans that address indications for administration of rescue medication, any unique issues around storage or handling of the rescue medication and persons to be notified in the event that rescue medication is administered.

(e) immediately notify emergency medical services and designated contact persons, including those identified in the medication plan, in the event that rescue medication is administered; and

(10) The municipality or agency, and the Department shall have full access to all pertinent records for monitoring purposes.

(D) A school district or private school shall register in order to permit a school nurse to store and deligate administration of patient specific controlled substances to trained school personnel in accordance with 105 CMR 210.000: The Administration of Prescription Medications in Public and Private Schools.

(E) An employee of a community program may administer or assist in the administration of a controlled substance or other prescription medication to a stable non-self-administering person as those terms are defined in applicable Department guidance, provided that:

(1)Registration. The community program is registered with the Department in accordance with 105 CMR 700.004, and meets the following requirements:

(a) Administration or assistance in the administration of prescription medication to a non-self-administering individual shall be carried out only by a duly licensed professional staff or by an unlicensed program staff of a registered community program who has successfully completed the training specified in 105 CMR 700.003(E)(2);

(b) The community program shall establish, maintain, and operate in accordance with policies that ensure that only properly trained and certified personnel administer medication;

(c) The community program shall maintain a current written list of those staff members who have successfully completed a training program meeting the requirements of 105 CMR 700.003(E)(2);

(d) The community program shall permit the Department to inspect program and individuals' records pertaining to the use and administration of prescription medications. The Department may make announced or unannounced on-site visits or inspections of common areas and such other inspections as the Department is authorized to make in order to monitor the program's compliance with 105 CMR 700.000.

(e) The Drug Control Program within the Department shall promptly be notified by the program of any suspected shortages, tampering, or diversion of prescription medication;

(f) The community program shall document in the individual's record any administration of prescription medication in a manner inconsistent with the practitioner's prescription or order or in violation of 105 CMR 700.000. The program must also promptly report to each community program sponsor which funds, licenses or operates such community program, in accordance with procedures and on a form approved jointly by the Department and said community program sponsors, any administration of prescription medication in a manner inconsistent with the practitioner's prescription or in violation of 105 CMR 700.000. Such form shall be provided, upon request, to the Department;

(g) The community program shall provide or arrange for technical assistance and advice to be provided as needed by a registered nurse, registered pharmacist, or other licensed practitioner when questions arise regarding appropriate administration practices or the effects of medications. The program shall establish policies and procedures that ensure reasonable access to such assistance and advice;

(h) The community program, professional staff and program staff shall comply with all applicable requirements of M.G.L. c. 94C: The Controlled Substances Act, as well as 105 CMR 700.000 and all pertinent regulations of the community program sponsor which funds, licenses or operates such community program, as appropriate, including those pertaining to storage, labeling, administration and documentation of prescription medication, medical back-up, review of medication, and emergency procedures.

(i) Community program and professional staff may not engage in other duties or obligations while performing documentation and medication administration tasks under 105 CMR 700.003 and shall comply with applicable Department guidance.

(2)Training. No unlicensed staff person may administer or assist in the administration of a prescription medication without successfully completing a training program that meets the specifications for a training curriculum and examination process established jointly by the Department and any community program sponsor which funds, licenses or operates such community program, as well as the following requirements:

(a) The training program shall be taught by a registered nurse, certified nurse practitioner, physician assistant, pharmacist, or physician who meets applicable requirements for a trainer established jointly by the Department and the community program sponsors;

(b) The Department and, as appropriate, the community program sponsors shall have the authority to monitor the training program for compliance with established standards;

(c) The training program shall keep records of all persons who have successfully completed the training program which shall be made available to the Department and, as appropriate, to community program sponsors upon request;

(d) Each person who successfully completes the training program must be certified by one or more of the community program sponsors, and shall be provided with such documentation of completion of the training program as approved by said community program sponsors. Documentation of certification shall be provided to and maintained by the community program;

(e) No person shall continue to administer or assist in the administration of prescription medication beyond two years from the completion of the initial certification unless such person has met standards for retraining and/or retesting established by the community program sponsors and approved by the Department.

(3)Storage. The community program meets all applicable regulations of the community program sponsors, and of the Department regarding storage and handling of prescription medications as well as the following requirements:

(a) All prescription medications that are consumed by individuals who are non-self administering shall be appropriately secured in a locked container or area. The community program shall have a written policy on which persons may have access to such container or area, how access to the key or combination and container or area is to be restricted, and under what conditions authorized persons may have access to the container or area;

(b) Prescription medications for individuals who are self-administering shall be stored in a locked container or area unless the community program director makes a determination that unlocked storage of the prescription medication poses no threat to the health or safety of the individual or other individuals; provided, however, that all controlled substances in Schedules II through V shall be appropriately secured in a locked container or area;

(c) Outdated prescription medications and prescription medications that have not been administered shall be disposed of and the disposal documented in accordance with policies established by the community program, provided that disposal occurs in the presence of at least two witnesses and in accordance with any policies of the Department.

(4)Labeling. All medications shall be properly labeled in accordance with M.G.L. c. 94C, § 21 and the following requirements:

(a) Community program staff shall not repack or relabel prescription medications. If an individual needs to bring prescription medication for administration at a location or program regularly or frequently attended, such prescription medications shall be packed and labeled by a pharmacist or, in the case of prescription medication dispensed for immediate treatment, by the dispensing practitioner;

(b) Where prescription medication is consumed by an individual at two or more locations on a regular or frequent basis, the prescription medication shall be stored in a separate, properly packaged, labeled, and appropriately secured medication container at each location. In circumstances in which this is not practical or feasible, the community program sponsor which funds, licenses or operates the site shall establish an alternative procedure approved by the Department;

(c) The community program shall have policies for obtaining a properly labeled container where there is a change in prescription or where the individual frequently or regularly receives prescription medication in two or more locations.

(5)Administration. All prescription medications shall be administered in accordance with M.G.L. c. 94C, the appropriate regulations for any community program sponsor which funds, licenses or operates such site, and the following requirements:

(a) All prescription medications shall be administered in accordance with the prescription of a practitioner;

(b) Prescribed medications shall only be administered to or taken by the individual for whom the prescription has been issued;

(c) The community program shall have a policy that specifies the administrative procedures to be followed when there is a medical emergency relating to medication. Such policy shall include a list of staff persons and medical personnel to be contacted which is up to date, readily available to staff and clearly indicates who is to be contacted on a 24-hour a day, seven days a week basis. The medical personnel to be contacted shall include the prescribing practitioner or, if unavailable, another licensed practitioner or appropriate emergency room personnel;

(d) Certified staff employed by community programs registered with the Department may only administer prescription medications that are oral, topical, ophthalmic, otic, internasal, suppository, or products that are administered by inhalation, without additional training as authorized by 105 CMR 700.003(E)(5)(e);

(e) Parenteral drugs generally intended for self administration, or drugs administered via a gastrostomy/jejunostomy tube may be administered by certified staff members who have successfully completed a specialized training program in such technique taught by a physician, physician assistant, pharmacist, registered nurse, or certified nurse practitioner, approved by the Department and the comminoty program sponsor which funds, licenses or operates such site;

(f) Whenever possible, a prescription for medication shall be limited to a 37-day supply and one refill. The prescribing practitioner shall be notified by community program staff of this requirement;

(g) Where an individual who is non-self-administering receives prescription medication at a location other than a community program site (off-site), the community program whenever possible shall identify the individual who will be responsible for administering the medication at the off-site location, and make available to that person instructions as to how the medication is to be administered;

(h) An over-the-counter drug may be consumed or applied by a non-self administering individual who is already receiving prescription medication only:

1. with the prior approval of a practitioner; or

2. after consultation with a pharmacist or registered nurse; or

3. in accordance with applicable guidelines established by the community program sponsors, with the approval of the Department.

(6)Documentation. All prescriptions and administration of prescription medications must be documented in accordance with applicable regulations of the community program sponsor which funds, licenses or operates such site, and the following requirements:

(a) All prescriptions for medication shall be documented in the individual's record. Such documentation shall specify for each individual the name and dosage of medication, the indication for which the medication is prescribed, and contraindications or possible allergic reactions, possible side effects and appropriate staff response, and special instructions, including steps to be taken if a dose is missed. The community program shall establish appropriate policies and procedures to address how community program staff shall obtain relevant prescription information in accordance with the requirements of 105 CMR 700.003(E)(6). In addition, such policy and procedures shall ensure that medication changes are received from practitioners and properly documented in the individual's record;

(b) The community program shall ensure that staff have ready access to such information as listed in 105 CMR 700.003(E)(6)(a), by maintaining on site either an appropriate reference approved by the Department or, for each drug administered, a copy of the pertinent section of such reference or a medication-specific drug information sheet that states in plain language generally why the drug is used, when it is to be administered, how it should be administered, any special instructions or precautions, proper storage conditions, possible side effects and what is to be done if a dose is missed;

(c) The taking or applying of medications for non-self-administering individuals, including over-the-counter drugs, shall be documented in the individual's record;

1. the time that the medication is taken or applied shall be noted in the record;

2. the record shall indicate any off-site taking or applying of medication by a non-self-administering individual that would normally occur at the program site;

3. individuals who are self-administering shall not be required to document their own self-administration of medication;

(d) Any change in medications or dosage levels of a medication shall be treated as a new health care provider order for the purposes of documentation;

(e) A non-self-administering individual's residential community program shall notify the individual's day community program of any prescription medications that the individual is taking and must provide the day community program with a copy of the health care provider order for each prescription medication that the individual receives. Where a non-self-administering individual receives prescription medication solely at the day community program, the day community program must have responsibility for notifying the residential community program and providing it with a copy of the health care provider order;

(f) The community program must establish procedures to document the date that any individual's prescription is filled and the quantity of medication dispensed by the pharmacy;

(g) Except for persons who are self-administering, the community program must maintain a documented accounting of the quantities of all controlled substances in Schedules II through V, stored by the community program, which must be reconciled at the end of each shift or as otherwise approved by the Department.

(F) Notwithstanding any other Department regulation, a health care professional duly licensed or certified by the Department, or a student duly enrolled in an approved or accredited program for licensure as a health care professional and acting in accordance with the policies of that program, may possess and administer any vaccine designated by the Commissioner for the prevention of a pandemic, novel, or other vaccine-preventable disease, provided the Commissioner determines that there are or will be insufficient health care professionals available for timely vaccine administration and issues an order authorizing such administration.

(1) To the extent authorized by 105 CMR 700.003(F), a health care professional duly licensed or certified by the Department, or a student duly enrolled in an approved or accredited program for licensure as a health care professional and acting in accordance with the policies of that program, may administer vaccine if:

(a) authorized to administer vaccine by order of the Commissioner;

(b) administration is in accordance with the Commissioner's order and the order or prescription of a duly registered practitioner authorized to issue an order or prescription for a vaccine pursuant to 105 CMR 700.000; and

(c) with respect to a student administering vaccine pursuant to 105 CMR 700.003(F), authorized and supervised by a licensed and qualified health care professional.

(2) In accordance with the Commissioner's order, a person administering vaccine shall:

(a) receive proper training and supervision in the administration of the vaccine;

(b) comply with written protocols to ensure proper storage, handling and return of vaccine, recordkeeping regarding administration, response to adverse events, and safe and appropriate administration of vaccine.

(G) A pharmacist may issue, modify or discontinue a prescription or medication order as authorized in a collaborative practice agreement meeting the requirements of 247 CMR 16.00: Collaborative Drug Therapy Management, 243 CMR 2.12: Collaborative Drug Therapy Management (CDTM) with Authorized Pharmacists, and M.G.L. c. 112, § 24BL, provided the following requirements are met:

(1) the pharmacist meets all applicable requirements of the Board of Registration in Pharmacy established in accordance with M.G.L. c. 112, § 24, and 247 CMR 1.00 through 16.00;

(2) the pharmacist registers with the Department, in accordance with 105 CMR 700.004, and the DEA, if applicable, in accordance with 21 CFR 1300, for the purpose of prescribing under 105 CMR 700.000;

(3) the pharmacist issues, modifies or discontinues a prescription or medication order in accordance with M.G.L. c. 112, § 24B½105 CMR 700.000, 247 CMR 16.00: Collaborative Drug Therapy Management, 243 CMR 2.12: Collaborative Drug Therapy Management (CDTM) with Authorized Pharmacists, and the collaborative practice agreement between the pharmacist and supervising physician established in accordance with 247 CMR 16.00 and 243 CMR 2.12;

(4) the pharmacist, if practicing in a retail setting, may issue a prescription for a controlled substance in Schedule VI only, in accordance with 105 CMR 700.003(G)(3);

(5) the pharmacist may dispense a controlled substance for immediate treatment in accordance with M.G.L. c. 94C, § 9, provided the pharmacist is authorized by 105 CMR 700.003(G) to prescribe such controlled substance;

(6) the pharmacist may order from a drug wholesaler, manufacturer, laboratory or distributor, for purposes of dispensing for immediate treatment, those controlled substances in Schedule VI which the pharmacist is authorized by 105 CMR 700.003(G) and the collaborative practice agreement to prescribe. For the purposes of dispensing controlled substances in Schedules II through V for immediate treatment in accordance with 105 CMR 700.003(G)(5), the pharmacist may obtain such controlled substances only as supplied by the supervising physician or obtained through a prescription or medication order for the patient;

(7) the pharmacist may issue a prescription in accordance with M.G.L. c. 94C, § 20, provided that the prescribing pharmacist clearly identifies their name and professional designation to the dispensing pharmacist and provides their registration number, work address, phone number, and the name of the supervising physician.

(8) the pharmacist may prescribe a controlled substance for a patient in a licensed health facility, including a hospital, long term care facility, ambulatory care clinic or hospice, through the use of a written medication order entered on the patient's medical record maintained at the facility, provided that such a written order meets all applicable provisions of 105 CMR 700.000;

(9) the pharmacist maintains a record of any controlled substance maintained for the purpose of dispensing for immediate treatment or administering pursuant to 105 CMR 700.000 and any related Department guidelines;

(10) the pharmacist provides a copy of an initial prescription or a modification or discontinuation of a prescription to the supervising physician within 24 hours of its issuance, unless more urgent notification is required under the circumstances.

(H) Notwithstanding any other provision of 105 CMR 700.000, a registered physician, physician assistant, certified nurse practitioner, or nurse midwife may provide expedited partner therapy (EPT) for the treatment of chlamydia infection, which is the prescribing or dispensing for immediate treatment of an appropriate therapeutic agent in Schedule VI for the treatment of a sex partner or partners of a patient diagnosed with chlamydia infection, provided that:

(1) The prescribing or dispensing is in accordance with 105 CMR 700.003 (H,) 243 CMR 2.00: Licensing and the Practice of Medicine, 263 CMR 5.00: Scope of Practice and Employment of Physician Assistants, 244 CMR 4.00: Advanced Practice Registered Nursing, as well as any applicable guidelines of the Department, Board of Registration in Medicine, Board of Registration of Physician Assistants, Board of Registration in Nursing, and U.S. Centers for Disease Control and Prevention;

(2) In a case in which the patient is provided with a therapeutic agent for immediate treatment of the patient's sex partner, the therapeutic agent shall be provided to the patient in a separate, properly labeled container for the sex partner to be given the therapeutic agent;

(3) In a case in which the patient is provided with a prescription for the patient's sex partner, there shall be a separate prescription for the sex partner, which includes on the prescription form, where the name and address of the patient is to be noted, either the name of the sex partner or the words "Expedited Partner Therapy," "E.P.T." or "EPT"; and

(4) The physician, physician assistant, certified nurse practitioner, or nurse midwife counsels the patient about EPT and whenever possible provides the patient with an information sheet provided by the Department, or comparable to that provided by the Department, for the sex partner. Such information sheet shall include pertinent information about procedures for taking the medication, avoiding sexual activity as required during treatment, possible allergic reactions, and avoiding future infection. As appropriate, patient counseling may also include suggested ways of notifying and providing the medication or prescription to the sex partner.

(I) A non-licensed individual authorized by a practitioner registered pursuant to 105 CMR 700.000 may administer topical fluoride varnish or comparable fluoride agent approved by the Department for topical administration to prevent dental caries, provided that:

(1) the non-licensed individual administering the fluoride varnish or other approved fluoride agent has successfully completed a Department approved training and any Department mandated refresher courses in proper administration, storage, handling, record keeping, and reporting of adverse reactions;

(2) the fluoride varnish or other approved fluoride agent is administered in accordance with the order of a practitioner; and

(3) the non-licensed individual administering the fluoride varnish or other approved fluoride agent is supervised by a practitioner.

The requirements of 105 CMR 700.003(I)(1) do not apply to any individual subject to 234 CMR: Board of Registration in Dentistry.

(J) A medical device manufacturer may register solely for the purpose of purchasing and storing specific controlled substances which are to be used solely as part of the manufacturing and quality control processes.

(K) A medical specialty camp shall register as required by St. 2020, c. 227, § 90, in order to permit unlicensed personnel to administer diabetes medication in accordance with 105 CMR 430.000: Minimum Standards for Recreational Camps for Children (State Sanitary Code Chapter IV). Supervision of persons administering diabetes medication pursuant to this section must be as outlined in regulation or specified in guidance issued by the Department.

(L) A non-licensed staff member of a health facility, health care entity, community program, or practitioner's office may administer rescue medications, without registration, to an individual the staff person reasonably believes to be experiencing a life-threatening emergency, provided that:

(1) the individual is in possession of the rescue medication to be administered; or

(2) the facility, entity, community program or practitioner's office is in possession of the rescue medication in accordance with all applicable laws and regulations and policies and procedures for storage and security; and

(3) the rescue medication is administered pursuant to a prescription or practitioner's order and in accordance with the directions in the manufacturer's package insert.

(M) Licensed nurses employed at Massachusetts correctional facilities may delegate medication administration, pursuant to existing patient prescriptions and administration orders, to unlicensed personnel, identified and trained and deemed competent by the nurse, as outlined in Department guidance.