Current through Register No. 52, December 26, 2024
(a) All medications
and treatments shall be administered in accordance with the orders of the
licensed practitioner or other professional with prescriptive powers.
(b) HHCP personnel who are not authorized by
law to administer medications may remind and prompt patients to take their
medications at the proper time, place medication container(s), including pill
planners, within patient reach, opening the medication container when patient
is present, reading the medication label to the patient, and utilizing hand
over hand technique, as defined in 809.03 (bb), as per the care plan without
requiring documentation of specific medications taken.
(c) 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.
(d) A licensed nursing assistant (LNA) may
perform hand over hand assistance by following the care plan, as delegated by a
licensed nurse, to a competent and stable patient pursuant to RSA
326-B.
(e) The licensee shall allow
the patient to self-direct medication administration, as defined in
He-P 809.03(bb)
, if the patient:
(1) Has a physical limitation due to a
diagnosis that prevents the patient from self-administration of medication with
or without assistance;
(2) Obtains
an annual written verification of the patient's physical limitation and
self-directing capabilities from the patient's licensed practitioner or the
assessment performed by an RN according to
He-P 809.15(i)
and such documentation is included in the
patient record; and
(3) Verbally
directs personnel to:
a. Assist the patient
with preparing the correct dose of medication by pouring, applying, crushing,
mixing, or cutting; and
b. Assist
the patient to apply, ingest, or instill the ordered dose of
medication.
(f) If personnel, who are authorized by law,
administer medication(s) , delegate medication administration, or prepare
medication in advance for administration in accordance with RSA 318:42II and
XIV, XI, the HHCP shall:
(1) Maintain a list
of medications currently being taken by the patient;
(2) Administer all medications in accordance
with the orders of the licensed practitioner;
(3) Maintain an order, or a copy thereof, in
the patient's record that includes:
b. The medication
name, strength, prescribed dose, and route of administration;
c. The frequency of administration;
d. The indications for usage of all PRN
medications; and
(4) Only use
medications that have been be kept in the original containers, as dispensed by
the pharmacy, licensed practioner's samples, or over the counter
medications;
(5) Require that any
change or discontinuation of medications shall be pursuant to an order from a
licensed practitioner or other individual authorized by law;
(6) Require that all telephone orders for
medications or treatments are:
a. Taken only
by a licensed health care professional if such action is within the scope of
their practice act;
b. Immediately
transcribed and signed by the individual taking the order; and
c. Counter-signed by the ordering practioner
as soon as possible and with a documented reason if signed more than 30 days
after the telephone order being taken;
(7) Require that the medication to be
administered by HHCP personnel be:
a.
Prepared immediately prior to administration; and
b. Prepared, identified, and administered by
the same person in compliance with RSA 318 and RSA 326-B;
(8) Require that when personnel are assisting
or administering medication, they remain with the patient until the patient has
taken all of the medication, excluding infusion therapy;
(9) Maintain documentation for all
medications either assisted by or administered by HHCP personnel that includes:
a. The name of the patient;
b. A list of any allergies or allergic
reactions to medications;
c. The
name, strength, dose, frequency, and route of administration of the
medications;
d. The date and time
medication was taken;
e. The
signature and identifiable initials and job title of:
1. The person assisting or administering the
medication; or
2. The person
administering or assisting the patient taking his or her medication;
f. Documented reason for any
medication refusal or omission; and
g. For PRN medications, the reason the
patient required the medication and the effect of the PRN medication at the
time of the next patient contact; and
(10) Develop and implement a system for
reporting to the patient's prescribing, licensed practitioner any.
a. Observed adverse reactions to or side
effects of medication; and
b.
Medication errors such as incorrect medications.
(g) If the HHCP provides
"self-administration of medication with assistance" medication services to a
patient as defined by
He-P 809.03(bb)
, the HHCP shall:
(1) Maintain, in the home, a list of
medications currently being taken by the patient;
(2) Assist with self-administration of
medications in accordance with the orders of the licensed
practitioner;
(3) Maintain either
the original order, or a copy thereof, in the patient's record that includes:
b. The medication name, strength, prescribed
dose and route of administration;
c. The frequency of administration;
d. The indications for usage of all PRN
medications; and
(4) Not allow
personnel to assist with self-administration of medications if anyone other
than a pharmacist has changed prescription medication container labels except
as allowed by (7) f. below;
(5)
Require that any change or discontinuation of medications shall be pursuant to
an order;
(6) Require that all
telephone orders for medications or treatments are:
a. Taken only by a licensed health care
professional if such action is within the scope of their practice
act;
b. Immediately transcribed and
signed by the individual taking the order; and
c. Counter-signed by the ordering practioner
within 30 days or with a documented reason if more than 30 days;
(7) Allow a patient to
self-administer medication with assistance by personnel, as directed by the
care plan, and which personnel shall be required to:
a. Remind the patient to take the correct
dose of his or her medication at the correct time from the original medication
bottle;
b. Place the medication
container within reach of the patient;
c. Remain with the patient to observe them
taking the appropriate number and type of medication as ordered by the licensed
practitioner;
d. Record that they
have supervised the patient taking their medication on the patient's daily
medication record;
e. Document in
the patient's record any observed or reported side effects, adverse reactions,
refusal to take medications, and medications not taken; and
f. Require that if the licensed practitioner
or other professional authorized by law changes the dose of a medication and
personnel of the HHCP are unable to obtain a new prescription label:
1. The RN shall clearly and distinctly mark
the original container, for example, with a colored sticker that does not cover
the pharmacy label, in a manner consistent with the HHCP's written procedure,
indicating that there has been a change in the medication order;
2. The RN 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,
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;
(8)
Maintain documentation for all medications assisted by HHCP personnel that
includes:
a. The name of the
patient;
b. A list of any allergies
or allergic reactions to medications;
c. The name, strength, dose, frequency, and
route of administration of the medications;
d. The date and time medication, including
PRN medications, was taken;
e. The
signature, identifiable initials, and job title of the person assisting the
patient taking his or her medication; and
f. Documented reason for any medication
refusal or omission;
(9)
Develop and implement a system for reporting to the patient's prescribing,
licensed practitioner any:
a. Observed adverse
reactions to or side effects of medication; or
b. Medication errors such as incorrect
medications; and
(10)
Require LNAs who assist patients with self-administration of medications to
comply with the board of nursing requirements according to RSA 326-B
(h) A home health personal care
service provider shall successfully complete a medication assistance education
program taught by a licensed nurse, licensed practitioner, or pharmacist,
whether in person or through other means such as electronic media, prior to
assisting a patient with self-administration of medication with assistance,
self-directed medication administration, or administration via nurse
delegation.
(i) The medication
assistance education program required by (h) above shall, at a minimum, include
training on the following subjects:
(1)
Infection control and proper hand washing techniques;
(2) The 5 rights, including:
d. Administered at the right time;
and
e. Administered via the right
route;
(3) Documentation
requirements;
(4) General
categories of medications such as antihypertensive medications or
antibiotics;
(5) Desired effects
and potential side effects versus adverse effects of medications; and
(6) Medication precautions and
interactions.
(j) For
patients who qualify for the use of therapeutic cannabis, the licensee shall
keep a copy of the registry identification card in the patient's
record.
(k) The licensee shall
develop, maintain, and implement a patient specific policy relative to the
therapeutic use of cannabis that identifies how the cannabis will be handled
and administered to the patient.
(l) If allowed by the policy in (k) above,
cannabis shall be treated in a manner similar to controlled medications with
respect to assisting qualifying patients with the therapeutic use of
cannabis.
#9466, eff
5-2-09
