Current through Register No. 52, December 26, 2024
(a) All medications
shall be made available to the resident in accordance with the written and
signed orders of the licensed practitioner or other professional with
prescriptive powers.
(b) All
medications and treatments shall be reviewed, re-ordered, and signed by a
licensed practitioner on an annual basis or when indicated by a change in the
resident's condition.
(c)
Medications, treatments, and therapeutic diets ordered by a licensed
practitioner or other professional with prescriptive powers shall be available
to give to the resident within 24 hours, or when available in accordance with
the licensed practitioner's written 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 ALR-RC;
(2) Reorder medications for use at the
ALR-RC; and
(3) Receive and record
new medication orders.
(e) Each medication order shall legibly
display the following information:
(2) The medication
name, strength, prescribed dose, and route, if different than by
mouth;
(3) The frequency of
administration;
(4) The indications
for usage, to include the maximum allowed dose in a 24-hour period, for all
medications that are used PRN; and
(5) The dated signature of the ordering
practitioner as allowed by
He-P 804.03(ca)
.
(f) Except for pharmaceutical samples, each
prescription medication container and medication record together shall
collectively legibly display the following information in such a way so as to
clearly identify the intended recipient, unless it is an emergency medication
as allowed by (ab) below:
(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;
(6) The name of the prescribing practitioner;
and
(7) The expiration date of the
medication(s) .
(g)
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 resident's name, and shall
be exempt from (f) (2) -(6) above.
(h) The dosage, frequency and route of
administration on the labels of all prescription medications for each resident
shall be identical to the dosage, frequency, and route of administration on the
facility medication record except as allowed by (i) below.
(i) The change in the dose of a medication,
or the discontinuation of a medication, shall be authorized in writing by a
licensed practitioner and the ALR-RC shall indicate in writing, in the
medication record, the date the dose or the discontinuance occurred.
(j) Only a pharmacist shall make changes to
prescription medication container labels except as allowed by (k)
below.
(k) When the licensed
practitioner or other professional with prescriptive powers changes the dose
and personnel are unable to obtain a new prescription label, the original
container shall be clearly marked without obstructing the pharmacy label to
indicate a change in the medication order.
(l) Only a licensed nurse shall accept
telephone orders for medications, treatments, and therapeutic diets, and the
licensed nurse shall immediately transcribe and sign the order.
(m) The transcribed order in (l) above shall
be counter-signed by the authorized prescriber within 30 days of
receipt.
(n) No medications shall
be given to or taken by a resident until a written order is received, except as
allowed by (l) or (m) above.
(o)
ALR-RCs that do not have a licensed nurse as described in (l) above on duty at
the time an order for medications, treatments, or therapeutic diets are to be
given shall receive said order in written form with the licensed practitioner's
signature and the date of the order.
(p) Faxes of signed orders or other
electronic media with electronic signatures shall be acceptable to meet the
requirements of (o) above.
(q) All
over-the-counter medications as defined by
He-P 804.03(av)
shall have a signed practitioner's order
specifying that the resident may take the medication according to the
instructions of the manufacturer, or specifying the dosage, frequency, and
route.
(r) The medication storage
area for medications not stored in the resident's room shall be:
(1) Locked and accessible only to authorized
personnel;
(2) Clean and organized
with adequate lighting to ensure correct identification of each resident's
medication(s); and
(3) Equipped to
maintain medication at the proper temperature.
(s) All medication at the ALR-RC shall be
kept in the original containers as dispensed by the pharmacy and properly
closed after each use except as authorized by (ad) (6) below.
(t) 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.
(u) If controlled
substances, as defined by RSA 318-B, are stored in a central storage area in
the ALR-RC, they shall be kept in a separately locked compartment within the
locked medication storage area accessible only to authorized
personnel.
(v) The licensee shall
develop and implement written policies and procedures regarding a system for
maintaining counts of controlled drugs.
(w) Except as required by (x) below, any
contaminated, expired, or discontinued medication shall be destroyed within 30
days following the expiration date, the date a licensed practitioner
discontinued the order, or the medication becomes contaminated, whichever
occurs first.
(x) Destruction of
contaminated, expired, or discontinued controlled drugs shall:
(1) Be in accordance with acceptable
standards of practice;
(2) Be
accomplished in the presence of at least 2 people who shall sign, date, and
record the amount destroyed; and
(3) Be documented in the record of the
resident for whom the drug was prescribed.
(y) When a resident is going to be absent
from the ALR-RC at the time medication is scheduled to be taken, the medication
container shall be given to the resident if the resident is capable of self
administration of medication without assistance.
(z) If a resident is going to be absent from
the ALR-RC at the time medication is scheduled to be taken and the resident is
not capable of self administration of medication without assistance, the
medication container shall be given to the person responsible for the resident
while the resident is away from the ALR-RC.
(aa) Upon discharge or transfer, the licensee
shall make the resident's current medications available to the resident and the
guardian, agent, or personal representative, if any, and upon death of a
resident, the facility shall return or destroy all remaining medications, as
appropriate, and document in patient record.
(ab) A written order from a licensed
practitioner shall be required annually for any resident who is authorized to
carry emergency medications, including but not limited to nitroglycerine and
inhalers.
(ac) Residents shall
receive their medications by one of the following methods:
(1) Self administration of medication without
assistance as defined by
He-P 804.03(br)
;
(2) Self-directed medication administration
as defined by
He-P 804.03(bs)
;
(3) Self administration of medication with
assistance as defined by
He-P 804.03(bq)
; or
(4) Administered by individuals authorized by
law, including via delegation.
(ad) If a nurse delegates care, including the
task of medication administration, to an individual not licensed to administer
medications, the nurse and delegate shall comply with the rules of medication
delegation pursuant to Nur 404, as applicable, and RSA 326-B.
(ae) For residents who self administer
medication without assistance, the licensee shall:
(1) Obtain a written order from a licensed
practitioner on an annual basis:
a.
Authorizing the resident to self administer medication without assistance;
and
b. Authorizing the resident to
store the medications in their room;
(2) Evaluate the resident on a 6 month basis
or sooner, based on a significant change in the resident, to ensure they
maintain the physical and mental ability to self administer medication without
assistance;
(3) Have the resident
store the medication(s) in his or her room by keeping them in a locked drawer
or container to safeguard against unauthorized access and making sure that this
arrangement will maintain the medications at proper temperatures;
(4) If a resident requests, allow the
resident's medication to be placed in a central locked storage area provided by
the ALR-RC;
(5) Have a copy of the
key to access the locked medication storage area in the resident's
room;
(6) Allow the resident to
fill and utilize a medication system that does not require that medication
remain in the container as dispensed by the pharmacist; and
(7) Except as provided for in (4) above, not
be responsible, in any way, for management or control of the resident's
medications.
(af) The
licensee shall allow the resident to self direct administration of medications
if the resident:
(1) Has a physical limitation
due to a diagnosis that prevents the resident from self administration of
medications with or without assistance;
(2) Receives evaluations every 6 months or
sooner, based on a significant change in the resident, to ensure the resident
maintains the physical and mental ability to self direct administration of
medications;
(3) Obtains an annual
written verification of the resident's physical limitation and self-directing
capabilities from the resident's licensed practitioner and requests the ALR-RC
to file the verification in their resident record; and
(4) Verbally directs personnel to:
a. Assist the resident with preparing the
correct dose of medication by pouring, applying, crushing, mixing, or cutting;
and
b. Assist the resident to
apply, ingest, or instill the ordered dose of medication.
(ag) If a resident self
administers medication with assistance, personnel shall be permitted to:
(1) Remind the resident to take the correct
dose of his or her medication at the correct time;
(2) Place the medication container within
reach of the resident;
(3) Remain
with the resident to observe the resident taking the appropriate amount and
type of medication as ordered by the licensed practitioner;
(4) Record on the resident's daily medication
record that they have supervised the resident taking his or her medication;
and
(5) Document in the resident's
record any observed or reported side effects, adverse reactions, refusal to
take medications, or medications not taken.
(ah) If a resident self administers
medication with assistance, personnel shall not physically handle the
medication in any manner.
(ai)
Except for those residents who self administer medication without assistance,
the licensee shall maintain a written record for each medication taken by a
resident at the ALR-RC that contains the following information:
(1) Any allergies or adverse 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 resident taking medication;
(5) For PRN medications, the reason the
resident required the medication and the effect of the PRN medication;
and
(6) Documented reason for any
medication refusal or omission.
(aj) The facility shall have a written policy
that incorporates the requirements listed in (ad) -(ai) for use in training and
for reference by employees supervising medication administration.
(ak) Personnel who are not licensed
practitioners or nurses but who assist a resident with self administration of
medication with assistance or self-directed administration of medication shall,
prior to providing such assistance, complete, at a minimum, a 4-hour medication
assistance education program covering both prescription and non-prescription
medication.
(al) A licensed nurse,
licensed practitioner, or pharmacist shall teach the medication assistance
education program, whether in-person or through other means such as electronic
media provided it meets the requirements of (ak) above and (am)
below.
(am) The medication
supervision education program required by (ak) above shall include:
(1) Infection control and proper hand washing
techniques;
(2) The 5 rights
relative to medication, which are:
d. Medication administered at
the right time; and
e. Medication
administered via the right route;
(3) Documentation requirements;
(4) General categories of medications such as
antihypertensives 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 (ak) above if it was previously obtained
by the applicant for employment at another licensed ALR-RC.
(ao) The licensee shall report to the
resident's licensed practitioner any adverse reactions and side effects to
medications or medication errors, such as incorrect medications, immediately
but not to exceed 24 hours depending on the severity of the reaction or error,
and shall document in the resident's record the reaction, the error, and date,
time, and person notified.
(ap) No
medication, whether prescription medication or over-the-counter medication,
shall be borrowed from another resident.
(aq) An ALR-RC shall have written orders from
the licensed practitioner for all medications being taken by residents except
for residents who have a licensed practitioner's order to self administer
medications without assistance and keep the medicine in their room.
(ar) An ALR-RC may keep non-prescription
stock medications for a resident when accompanied by a licensed practicioner's
order and each resident has his or her own container for the
medication.
(as) The therapeutic
use of cannabis by residents who are qualifying patients possessing a registry
identification card shall be permitted at an ALR-RC provided:
(1) The facility designates itself as a
facility caregiver as allowed by RSA 126-:2, VIX; or
(2) The facility permits a resident to
possess and use cannabis at the licensed premises, the resident is able to
self-administer medication without assistance, and the cannabis remains in the
possession of the resident.
(at) An ALR-RC that permits the therapeutic
use of cannabis in accordance with (as) above shall develop, maintain, and
implement a general policy relative to resident use of cannabis at the licensed
premises, including storage, security, and administration.
(au) An ALR-RC that designates itself as a
facility caregiver according to (as) (1) above shall:
(1) Have a resident-specific policy relative
to the therapeutic use of cannabis that identifies how the cannabis will be
obtained, stored, and administered to the resident; and
(2) Treat cannabis in a manner similar to
medications with respect to its storage and security when assisting qualifying
patients with the therapeutic use of cannabis.
(av) An ALR-RC shall not permit the smoking
of cannabis if smoking is not allowed on the ALR-RC premises.
#9121, eff
4-3-08
