Current through Register No. 40, October 3, 2024
(a) 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, and open the
medication container(s) when the patient is present, reading the medication
label to the patient and utilizing hand over hand technique if the patient is
competent and stable, as per the care plan.
(b) 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.
(c) 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.
(d) 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 written and signed orders of
the licensed practitioner;
(3)
Maintain a written and signed order, or a copy thereof, in the patient's record
that includes:
a. The patient's
name;
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
e. The date
ordered;
(4) Only use
medications that have been 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 a written and
signed 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.
(e) If the HHCP provides
"self-administration of medication with assistance" medication services to a
patients defined by
He-P 823.03(bk)
, 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 written and signed orders of the licensed
practitioner;
(3) Maintain either
the original written and signed order, or a copy thereof, in the patient's
record that includes:
a. The patient's
name;
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
e. The date
ordered;
(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 (e) (7) f. below;
(5)
Require that any change or discontinuation of medications shall be pursuant to
a written and signed 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 (e) (7) f.1. and (e) (7)
f.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) Permit personnel who assist a patient
that self-administers medication with assistance to open the medication
container and place it within reach of the patient, but not permit that person
to physically handle the medication in any manner;
(9) Require that when personnel are assisting
that they remain with the patient until the patient has taken all of the
medication, excluding infusion therapy;
(10) 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;
(11) 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
(12) Require LNAs who assist patients with
self-administration of medications to comply with the board of nursing
requirements according to RSA 326-B.
(f) 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.
(g) The medication assistance education
program required by (f) above shall, at a minimum, include training on the
following subjects:
(1) Infection control and
proper hand washing techniques;
(2)
The 5 rights, including:
a. The right
patient;
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 versus adverse effects of medications; and
(6) Medication precautions and
interactions.
(h) 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.
#9292, eff 10-9-08, EXPIRED: 10-9-16
New. #12168, INTERIM, eff
4-29-17, EXPIRED: 10-26-17
New. #12642, eff
10-9-18
