Current through Register No. 40, October 3, 2024
(a) The licensee shall develop and implement
written policies and procedures regarding administration, documentation,
including a system for maintaining counts of controlled drugs, protocols for
medication occurrences, and control and safety of medication that are
consistent with the requirements of this section.
(b) Administration of medications to
residents shall be performed by authorized staff, registered nurse (RN),
licensed practical nurse (LPN) or licensed health care practitioners,
accurately and in accordance with the resident's treatment plan and the
licensee's policies.
(c) Authorized
staff shall know and understand the program's written policies and procedures
regarding the administration, control, and safety of medication.
(d) All residents shall be initially assessed
to determine the level of support needed specific to medication
administration.
(e) The assessment
pursuant to (d) above shall include the resident's:
(1) Medication order(s) and medications
prescribed;
(2) Health status and
health history; and
(3) Ability to
manage his or her medication, consistent with the resident's treatment
plan.
(f) Program staff
shall obtain, or document their efforts to obtain, oral or written consent from
the parent prior to administering any new or changed prescription
medications.
(g) When the
resident's parent(s) is responsible for supplying the program with the
resident's medication, program staff shall contact the parent 2 weeks prior to
the end of the supply of medication.
(h) When the responsibility of providing care
to a resident is transferred to persons outside the program, for example for a
home visit, and the resident is taking prescription medication:
(1) The pharmacy container(s) shall be given
to the person responsible for the resident;
(2) The program shall document the medication
name, strength, prescribed dose, route of administration, and quantity of each
medication provided to the persons outside the program, upon the resident's
transfer of care; and
(3) Upon the
resident's return to the program, the program shall document the return of any
medications including medication name, strength, prescribed dose, route of
administration, and quantity of each medication with a description of why the
medication was not given as the medication order stated.
(i) Authorized staff shall administer only
those prescription medications for which there is a medication order.
(j) Authorized staff shall administer
medications only to the residents about whom they have current knowledge
relative to their medication regimes.
(k) Authorized staff shall maintain a copy of
each resident's medication orders in the resident's record.
(l) Medication orders shall be valid for no
more than one year unless otherwise specified by the licensed health care
practitioner.
(m) Each medication
order shall legibly display the following information:
(1) The resident'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 medications to be used PRN; and
(5) The dated signature of the licensed
health care practitioner.
(n) Written orders from a licensed health
care practitioner regarding any prescription medication that is to be
administered PRN shall include:
(1) The
indications and any special precautions or limitations regarding administration
of the medication;
(2) The maximum
dosage allowed in a 24-hour period; and
(3) The dated signature of the licensed
health care practitioner.
(o) In addition to (n) above, authorized
staff shall administer PRN medication in accordance with:
(1) A medication order; and
(2) A PRN protocol approved by the licensed
health care practitioner that includes the specific condition(s) for which the
medication is given.
(p) Prior to the administration of
medication, authorized staff shall obtain information specific to each
medication, including, at a minimum:
(1) The
purpose and effect(s) of the medication;
(2) Response time of the
medication;
(3) Possible side
effects, adverse reactions, and symptoms of overdose;
(4) Possible medication interactions;
and
(5) Special storage or
administration procedures.
(q) In the event of a medication occurrence,
the authorized staff responsible for the administration of the medication shall
forward written notification to the program director by the close of the next
business day.
(r) When any
medication that is administered by program staff results in serious adverse
reactions including, but not limited to, impaired speech, mobility or
breathing, semi-consciousness, or unconsciousness, program staff shall:
(1) Immediately call 911 or notify a licensed
health care practitioner for instructions regarding the need for emergency or
other medical treatment;
(2)
Immediately comply with the instructions provided by the licensed health care
practitioner;
(3) Remain with the
resident until he or she is fully alert and oriented and has recovered all
physical capabilities that had been impaired by the medication, or until
responsibility for the resident's care is transferred to a licensed health care
practitioner in a medical facility; and
(4) Notify or document efforts to notify the
parents within 24 hours.
(s) Prior to administering medication to any
resident, program staff shall complete and document training on medication
safety and administration, as specified in (t) below.
(t) Training in medication safety and
administration, as required in (s) above, shall:
(1) Be delivered by a physician, APRN, RN, or
LPN practicing under the direction of an APRN, RN, or physician, or by another
qualified individual;
(2) Be
provided in person, via distance learning, a video presentation, or web-based;
and
(3) Address the following:
a. The safe storage and administration of
medication, including but not limited to:
1.
Administration of the correct medication;
2. Administration of the correct dosage of
the medication;
3. Administration
of the medication to the correct resident;
4. Administration of the medication to the
resident at the correct times and frequency;
5. Administration of the medication to the
resident by the correct method of administration;
6. Infection control and aseptic procedures
related to administration of medication; and
7. Resident's rights regarding refusing
medications;
b. Possible
side effects and adverse reactions to the medications to be administered and
required reporting regarding those issues;
c. Proper storage, disposal, security, error
control, and documentation as related to the medications to be
administered;
d. Any other unusual
occurrence related to the safe storage or administration of medication and
reporting requirements regarding those issues;
e. Conditions or situations requiring
emergency medical intervention; and
f. Methods of administration including, but
not limited to oral, injection, topical application or inhalation.
(u) In addition to (t)
above, authorized staff shall complete 2 hours of training annually on
medication safety and administration.
(v) Documentation of training in medication
safety and administration shall be maintained on file at the child care program
available for review by the department.
(w) For each resident, program staff shall
maintain medication information on file and available for review by the
department, which includes, at a minimum:
(1)
A written medication order, as specified in (m) above, including special
considerations for administration for each prescription medication being taken
by a resident;
(2) Written
parental authorization to administer medication, if applicable;
(3) The name and contact information of the
parent, if applicable; and
(4)
Allergies, if applicable.
(x) In addition to (w) above, program staff
shall maintain a daily medication log for each dose of medication administered
to each resident.
(y) The
medication log required in (x) above shall:
(1) Be maintained on file in the program,
available for review by the department;
(2) Be completed by the authorized staff who
administered the medication immediately after the medication is administered;
and
(3) For each medication
prescribed, include at a minimum:
a. The name
of the resident;
b. The date and
time the medication was taken;
c. A
notation of any medication occurrence or the reason why any medication was not
taken as ordered or approved;
d.
The dated signature of the authorized staff who administered the medication to
the resident; and
e. For
administration of a PRN, documentation including the reason for
administration.
(z) The licensee shall require that all
telephone orders from a licensed health care practitioner or their agent, for
medications, treatments, and diets are documented in writing, including
facsimiles, by the licensed health care practitioner within 24 hours.
(aa) In addition to (z) above, authorized
staff shall record any changes regarding prescription medications in the
resident's medication log.
(ab) All
physician medication samples shall legibly display the information described in
(m)(1)-(5) above.
(ac) No person
other than a licensed health care practitioner shall make changes to the
written order of a licensed health care practitioner regarding prescribed
medication.
(ad) All medication
maintained by the program 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 resident'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.
(ae) All
medication shall be accompanied by:
(1) The
physician's written order, which may be the prescription label; and
(2) The manufacturer's written instructions
for dosage.
(af)
Medications such as insulin, inhalers, and epi pens shall be permitted to be in
the possession of a resident in accordance with the resident's ability, as
specified in the resident's treatment plan.
(ag) All medications belonging to staff shall
be stored in a locked area, separate from residents' medications or otherwise
inaccessible to residents.
(ah) The
program director or designee may elect to have a supply of non-prescription
medication available, including but not limited to acetaminophen, ibuprofen,
aspirin, cold medicines, or antacids that may be administered to residents for
minor illnesses, provided those medications are stored and administered in
accordance with the requirements in this section.
(ai) All medication shall be kept in the
original containers or pharmacy packaging and properly closed after each use
unless otherwise allowed by law.
(aj) Any contaminated, expired, or
discontinued medication, whether prescription or over the counter, shall be
destroyed within 7 days of identification as contaminated, expired, or
discontinued.
(ak) Destruction of
prescription drugs under (aj) above shall:
(1)
Be accomplished by an authorized staff and witnessed by one staff;
and
(2) Be documented in the
resident's medication record, including the legible, dated signature of the
staff person who disposed of the drugs and the staff person who witnessed the
disposal.
(al) All
medication shall be destroyed in accordance with the United States
Environmental Protection Agency's, "How to Dispose of Medicines Properly"
guidance, (April 2011), available as noted in Appendix A.
(am) Programs providing SUD services shall
have a clearly identified policy for storage and administration of naloxone
that includes the following:
(1) The process
for regularly reviewing and updating 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.
(an)
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.
(ao) Personnel shall remain with
the resident until the youth has taken the medication.
(ap) 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.
(aq) Programs providing SUD services shall
have a written policy establishing procedures for the prevention, detection,
and resolution of controlled substance misuse, and diversion, which shall apply
to all personnel, and which shall be the responsibility of a designated
employee or interdisciplinary team.
(ar) The policy in (aq) above shall include:
(1) Education;
(2) Procedures for monitoring the
distribution and storage of controlled substances;
(3) Voluntary self-referral by employees who
are misusing substances;
(4)
Co-worker reporting procedures;
(5)
Drug testing procedures to include at a minimum, testing where reasonable
suspicion exists;
(6) Employee
assistance procedures;
(7)
Confidentiality;
(8) Investigation,
reporting, and resolution of controlled drug misuse or diversion; and
(9) The consequences for violation of the
controlled substance misuse, and diversion prevention policy.
#2664, eff 3-30-84, EXPIRED: 3-30-90
New. #8581, eff 4-20-06,
EXPIRED: 4-20-06
New. #10576, INTERIM, eff
4-26-14, EXPIRES: 10-23-14
