N.H. Admin. Code § He-P 818.18

Current through Register No. 45, November 7, 2024

Section He-P 818.18 - Medication Services

(a) All medications shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

(b) Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the participant 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 ADP;

(2) Reorder medications for use at the ADP;

(3) Receive and record new medication orders; and

(4) 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 paticipant's licensed provider and guardian, if applicable.

(d) For each prescription medication being taken by a participant, the licensee shall maintain one of the following:

(1) The original written order in the participant's record, signed by a licensed practitioner or other professional with prescriptive powers; or

(2) A copy of the original written order in the participant's record, signed by a licensed practitioner or other professional with prescriptive powers.

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

(1) The participant'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.

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

(g) 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 (e) (2) -(5) above.

(h) Only a pharmacist shall make changes to the labels on prescription medication container labels.

(i) Any change or discontinuation of medications taken at the ADP shall be pursuant to a written order from a licensed practitioner or other professional with prescriptive powers.

(j) When the licensed practitioner or other professional with prescriptive powers changes the dose of a medication and the personnel of the ADP 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 ADP'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) -(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.

(k) If the ADP has a medical director, either on staff or otherwise contracted, prescription medication that is not ordered, approved, or labeled for a specific participant, including but not limited to pharmaceutical samples, may be kept at the ADP.

(l) The medication in (k) above shall be the responsibility of the medical director.

(m) 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.

(n) Telephone orders specified in (m) 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.

(o) OTC medications shall be handled in the following manner:

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

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

(p) The medication storage area for medications shall be:

(1) Locked and accessible only to authorized personnel;

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

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

(q) All medication taken by participants at the ADP shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

(r) A licensed nurse may organize participant medications for use in the participant's home as allowed by RSA 318:42, XIV.

(s) 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 does not occur.

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

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

(v) Except as required by (x) 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 when the medication becomes contaminated, whichever occurs first.

(w) Controlled drugs shall be destroyed only in accordance with state law.

(x) Destruction of controlled drugs under (w) above shall:

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

(2) Be documented in the participant's medication record for whom the drug was prescribed.

(y) Upon discharge, a participant, or the participant's guardian or agent, may take the participant's current medication(s) with them.

(z) Neither the licensee nor any other personnel working for the ADP shall accept money, goods, or services for free or below cost as compensation or inducement for supplying the participant's medications.

(aa) A written order from a licensed practitioner shall be required annually for any participant who is authorized to carry and self-administer without assistance emergency medications such as nitroglycerine or inhalers.

(ab) Participants shall receive their medications in one of the following manners:

(1) Self administration of medication without assistance;

(2) Self-directed medication administration;

(3) Self administration of medication with assistance; or

(4) Administered by individuals authorized by law.

(ac) For participants who self administer medication without assistance, as defined in He-P 818.03(ba) , the licensee shall:

(1) Obtain a written order from a licensed practitioner on an annual basis:

a. Authorizing the participant to self administer medications without assistance;

b. Authorizing the participant to store the medications in their possession; and

c. Identifying the medications that may be kept by the participant;

(2) Evaluate the participant every 6 months or sooner, based on a significant change in the participant, to ensure they maintain the physical and mental ability to self-administer medication without assistance;

(3) Have the participant store the medication(s) in a manner that prohibits other people from accessing the medications and in a manner that will maintain the medications at proper temperatures; and

(4) Allow the participant to fill and utilize a medication system that does not require medication to remain in the container as dispensed by the pharmacist.

(ad) The licensee shall allow the participant to self-direct medication administration, as defined in He-P 818.03(bb) , if the participant:

(1) Has a physical limitation due to a diagnosis that prevents the participant from self administration of medication, with or without assistance;

(2) Receives evaluations every 6 months or sooner based on a significant change in the participant, to ensure the participant maintains the physical and mental ability to self-direct medication administration;

(3) Obtains an annual written verification of their physical limitation and self-directing capabilities from the participant's licensed practitioner and requests the ADP to file the verification in their participant record; and

(4) Verbally directs personnel to:

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

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

(ae) Personnel assisting with self-directed medication administration, other than those permitted by their licensing board to administer medications, shall not be permitted to assist with injections or filling insulin syringes.

(af) If a participant self-administers medication with assistance, as defined by He-P 818.03(az) , personnel shall be permitted to:

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

(2) Open the medication container and place the medication container within reach of the participant;

(3) Remain with the participant to observe them taking the prescribed dose and type of medication as ordered by the licensed practitioner;

(4) Record on the participant's medication record that they have supervised the participant taking their medication; and

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

(ag) If a participant self-administers medication with assistance, personnel shall not be permitted to physically handle the medication in any manner.

(ah) Medication administered by individuals authorized by law to administer medication shall be:

(1) Prepared immediately prior to administration; and

(2) Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B.

(ai) Personnel shall remain with the participant until the participant has taken all of the medication.

(aj) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall:

(1) Only delegate medications that are administered by mouth;

(2) Document in the individual's personnel file the evaluation method and tools used to determine that the individual receiving the delegation of medication administration has the necessary skills to administer medication;

(3) Document in the individual's personnel file that the individual continues to be delegated the task of administering medication, based on the nurse's ongoing evaluation;

(4) Document in the individual's personnel file any notice that the delegation of medication administration has been rescinded, if applicable; and

(5) Document in the participant record the:

a. Specific medication to be administered;

b. Dosage, route, and specific time that the medication is to be administered;

c. The names of personnel to whom the nurse has delegated responsibility for the administration of medications; and

d. The results of the nurse's assessment, completed no more than 30 days prior to the delegation occurring, that determined that the participant's condition is stable and that the participant is appropriate for receipt of medication administration via nurse delegation.

(ak) A licensed nursing assistant (LNA) may administer the following when under the direction of the licensed nurse employed by the ADP:

(1) Medicinal shampoos and baths;

(2) Glycerin suppositories and enemas; and

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

(al) Except for those participants who self-administer medication without assistance, the licensee shall maintain a written record for each medication taken by the participant at the ADP 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 time the medication was taken;

(4) The signature, identifiable initials, and job title of the person who administers or assists the participant taking medication;

(5) For PRN medications, the reason the participant required the medication and the effect of the PRN medications; and

(6) Documented reason for any medication refusal or omission.

(am) Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a participant with self administration of medication with assistance, self-directed medication 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.

(an) The medication supervision education program shall be taught by a licensed nurse, licensed practitioner, or pharmacist, or other person who has undergone training by a licensed nurse, licensed practitioner, or pharmacist.

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

(1) Infection control and proper hand washing techniques;

(2) The "5 rights" of medication administration which are:

a. The right participant;

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 anti-hypertensives or antibiotics;

(5) Desired effects and potential side effects of medications; and

(6) Medication precautions and interactions.

(ap) The administrator may accept documentation of training required by (am) above if it was previously obtained by the applicant for employment at another facility licensed under RSA 151.

(aq) Non-prescription stock medication may be kept at the ADP, but it shall be accessed and administered only by the licensed nurse or medication nurse assistant on duty.

(ar) An ADP shall use emergency drug kits only in accordance with NH pharmacy board rules, Ph 705.03, under circumstances where the ADP:

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

(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; and

(3) Has the contents approved in writing by the licensed medical director.

(as) The licensee shall conduct 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.

N.H. Admin. Code § He-P 818.18

#9106, eff 3-18-08

Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12006, Effective 10/15/2016, Expires 4/13/2017.

Amended by Volume XXXVII Number 23, Filed June 8, 2017, Proposed by #12198, Effective 6/2/2017, Expires 6/2/2027.