Current through Register No. 40, October 3, 2024
(b) All medications and treatments shall be
reviewed, re-ordered, and signed by a practitioner on an annual
basis.
(d) Medications,
treatments, and diets ordered by the licensed practitioner or other
professional with prescriptive powers shall be available to give to the
resident within 24 hours or when available as in accordance with the licensed
practitioner's written direction.
(e) The licensee shall have a written policy
and system in place instructing how to:
(1)
Obtain any medication ordered for immediate use at the SRHCF;
(2) Reorder medications for use at the SRHCF;
and
(3) Receive and record new
medication orders.
(f)
Each medication order shall legibly display the following information:
(1) The resident's name:
(2) The medication name, strength, prescribed
dose and route, if different then 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 ordering
practitioner.
(g) For
PRN medications the ordering practitioner 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.
(h) Each prescription medication shall
legibly display the following information unless it is an emergency medication
as allowed by (ap) below:
(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 pro re nata (PRN) medications;
(5) The date ordered;
(6) The name of the prescribing practitioner;
and
(7) The expiration date of the
medication(s) .
(i)
Pharmaceutical samples shall be used in accordance with the licensed
practitioners written order and labeled by the licensed practitioner, the
administrator, licensee or their designee with the resident's name and are
exempt from (h) (2) -(6) above.
(j)
The dosage, frequency and route on the labels of all prescription medications
for each resident shall be identical to the dosage, frequency and route on the
facility medication record except as allowed by (k) below.
(k) 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 medication record for a change or discontinuance
shall indicate in writing the date the dose or the discontinuance
occurred.
(m) 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.
(n) Only a licensed nurse shall accept
telephone orders for medications, treatments, and diets, and the licensed nurse
shall immediately transcribe and sign the order.
(p) No medications shall
be given to or taken by a resident until a written order is received, except as
allowed by (o) above.
(q) All
over-the-counter medications as defined by
He-P
805.03(as) 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 medications, including over the
counter medications, shall remain in the original containers except as
authorized by (ae) (5) and (af) (4) c. 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-SRHC, they shall be kept in a separately locked compartment within the
locked medication storage area accessible only to authorized
personnel.
(w) Except as required by (y) 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 becomes contaminated, whichever occurs first.
(y)
Destruction of controlled drugs under (x) above shall:
(1) Be accomplished in the presence of at
least 2 people who must sign, date and record the amount destroyed;
and
(2) Be documented in the record
of the resident for whom the drug was prescribed.
(z) When a resident is going to be absent
from the SRHCF 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-administering without assistance, as described in (ae) below.
(aa) If a resident is going to be absent from
the SRHCF at the time medication is scheduled to be taken and the resident is
not capable of self-administering, the medication container shall be given to
the person responsible for the resident while the resident is away from the
SRHCF.
(ab) Upon discharge or
transfer, the licensee shall make the resident's current medications available
to the resident and the guardian or agent, if any, and upon death of a
resident, the facility shall return or destroy all remaining medications, as
appropriate.
(ac) 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.
(ad)
Residents shall receive their medications by one of the following methods:
(1) Self-administered without assistance as
allowed by (ae) below;
(2)
Self-directed administration of medication as allowed by (af) below;
(3) Self-administered with assistance as
allowed by (ag) and (ah) below; or
(4) Administered by individuals authorized by
law.
(ae) For residents
who self-administer without assistance as defined in 805.03(bn) the licensee
shall:
(1) Obtain a written order from a
licensed practitioner on an annual basis:
a.
Authorizing the resident to self-administer medications without assistance;
and
b. Authorizing the resident to
store the medications in their room;
(2) Evaluate the resident initially and then
on a 6month basis or sooner if the resident experiences a significant change,
to ensure they maintain the physical and mental ability to self-administer
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) Have a copy of
the key to access the locked medication storage area in the resident's room;
and
(5) Allow only the resident to
fill and utilize a medication system that does not require that medication
remain in the container as dispensed by the pharmacist.
(af) The licensee shall allow the resident to
self-direct administration of medications as defined in
He-P
805.03(bj) if the resident:
(1) Has a physical limitation due to a
diagnosis that prevents them from self-administration;
(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 their physical limitation and self-directing
capabilities from their licensed practitioner and requests the SRHCF to file
the verification in their resident record; and
(4) Verbally directs personnel to:
a. Assist them with preparing the correct
dose of medication by pouring, applying, crushing, mixing or cutting;
b. Assist the resident to apply, ingest or
instill the ordered dose of medication; and
c. Fill and utilize a medication system that
does not require that medication remain in the container as dispensed by the
pharmacist.
(ag) If a resident self-administers
medication with assistance, as defined in
He-P
805.03(bm) , personnel shall only:
(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 and open the container, if requested by 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 observed the resident taking his or her
medication;
(5) Document in the
resident's record any observed or reported side effects, adverse reactions, and
refusal to take medications and or medications not taken; and
(6) Not touch the medications or remove them
from the container.
(ah)
Personnel shall remain with the resident until the resident has taken the
medication.
(ai) If a nurse
delegates the task of medication administration to an individual not licensed
to administer medications, the nurse shall only do so as allowed by RSA 326-B
and Nur 404.
(aj) Except for those
residents who self-administer medication without assistance, the licensee shall
maintain a daily medication record for each medication taken by the resident at
the SRHCF 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 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.
(ak) Personnel who are not otherwise licensed
practitioners, nurses, or medication nursing assistants and who assist a
resident with self administration with assistance, self directed administration
or administration of medication via nurse delegation shall 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 the (ak) above.
(am) The medication assistance education
program required by (ak) above shall include:
(1) Infection control and proper hand washing
techniques;
(2) The 5 rights which
are:
a. The right resident;
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 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 SRHCF.
(ao) An SRHCF shall use emergency drug kits
only in accordance with board of pharmacy rule
Ph
705.03 under circumstances where the SRHCF:
(1) Has a director of nursing who is an RN
licensed in accordance with RSA 326-B; and
(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.
(ap) The licensee shall document in the
resident record and report any observed adverse reactions to medication and
side effects, or medication errors such as incorrect medications, to the
licensed practitioner, and to the agent or guardian if applicable, immediately
upon the adverse reaction or medication error.
(aq) The written documentation of the report
in (aq) above shall be maintained in the resident's record.
(ar) No medication, whether prescription
medication or over-the-counter medication, shall be borrowed from another
resident.
(as) Stock medication
shall not be used in the SRHCF.
