N.H. Admin. Code § He-P 830.17

Current through Register No. 45, November 7, 2024

Section He-P 830.17 - Medication Services

(a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner.

(b) Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24 hours of the order 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 PRTP;

(2) Reorder medications for use at the PRTP; and

(3) Receive and record new medication orders.

(d) 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.

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

(1) The client's name;

(2) The medication name, strength, prescribed dose, and route of administration, if different than 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.

(f) 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.

(g) 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 pro re nata (PRN) medications;

(5) The date ordered;

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

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

(h) 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 (g)(2)-(6) above.

(i) The label of all medication containers maintained in the PRTP shall match the current written orders of the licensed practitioner unless authorized by (l) below.

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

(k) Any change or discontinuation of medications taken at the PRTP shall be pursuant to a written order from a licensed practitioner.

(l) When the licensed practitioner changes the dose of a medication and personnel of the PRTP 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 PRTP'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.

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

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

(1) The licensee shall obtain written approval from the client's licensed practitioner annually; and

(2) Over-the-counter 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.

(o) The medication storage area shall be:

(1) Locked and accessible only to authorized personnel;

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

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

(p) All medication at the PRTP shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(q) 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.

(r) Schedule II substances, as defined by RSA 318-B, shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

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

(t) Except as required by (u) 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 becoming contaminated, whichever occurs first.

(u) 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.

(v) When a client is going to be absent from the PRTP 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 medications.

(w) If a client is going to be absent from the PRTP 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 PRTP.

(x) Upon discharge or transfer, the licensee shall make the client's current medications available to the client and the guardian or agent, if any.

(y) Except as described in (ab) below, medications shall only be administered by individuals authorized by law to administer medications in the PRTP.

(z) 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.

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

(ab) 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.

(ac) Nursing assessment and evaluation for the purpose of reviewing medication compliance, educations, and symptomatology shall be completed.

(ad) Comprehensive medication assessment for those medications requiring specialized therapeutic monitoring shall:

(1) Ensure that the required blood sample is drawn;

(2) Ensure that the lab values are within established limits;

(3) Record results; and

(4) Ensure appropriate does is adjusted as needed.

(ae) 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 PRTP:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

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

(af) The licensee shall maintain a written record for each medication taken by the client at the PRTP 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) Documentation of any medication refusal or omission.

(ag) 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.

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

(ai) If multiple medication problems are identified during the department's annual survey or other investigations in which the safety of clients might be at risk, the department shall require the facility to obtain the routine services of a consultant pharmacist as a condition of continued licensure. This requirement shall be reviewed at the next inspection to determine if consultant pharmacy services shall continue to be required.

N.H. Admin. Code § He-P 830.17

Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by #12952, Effective 12/21/2019, Expires 6/18/2020.

Amended by Volume XLI Number 19, Filed May 13, 2021, Proposed by #13195, Effective 4/24/2021, Expires 4/24/2031.