Current through Register No. 40, October 3, 2024
(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.
#9106, eff
3-18-08
