1. (a) The licensee shall have and implement written policies and procedures regarding medication administration, including at a minimum:

   1. (1) The documentation requirements;
   2. (2) A system for maintaining counts of controlled drugs;
   3. (3) The process for ordering or re-ordering medication timely to assure a resident’s medication does not run out;
   4. (4) Protocols for medication occurrences;
   5. (5) Protocols for administration of PRN medications; and
   6. (6) The control and safety of medication consistent with the requirements of this section.
2. (b) Administration of medication to residents shall be performed by authorized staff, registered nurses (RNs), licensed practical nurses (LPNs), or licensed practitioners, accurately and in accordance with the resident’s treatment plan and the licensee’s policies.

3. (c) Authorized staff shall:

   1. (1) Know and understand the program’s written policies and procedures regarding the administration, documentation, control, and safety of medication;
   2. (2) Administer only those prescription medications for which there is a medication order;
   3. (3) Administer medications only to the residents about whom they have current knowledge relative to their medication regimes; and
   4. (4) Administer PRN medication in accordance with a medication order and a PRN protocol approved by the licensed practitioner, including the specific condition(s) for which the PRN medication is given.

4. (d) All residents shall be initially assessed to determine the level of support needed specific to medication administration, including the resident’s:

   1. (1) Medication order(s) and medications prescribed;
   2. (2) Health status and health history; and
   3. (3) Ability to manage their medication, consistent with their treatment plan.
5. (e) Program staff shall obtain, or document their efforts to obtain, oral or written consent from the parent or guardian prior to administering any new or changed prescription medications.

6. (f) When the responsibility of providing care to a resident is transferred to persons outside the program, such as a home visit, and the resident is taking prescription medication:

   1. (1) The pharmacy container(s) shall be given to the person responsible for the resident;
   2. (2) The program shall document the name, strength, prescribed dose, route of administration, and quantity of each medication provided to the person(s) outside the program, upon the resident’s transfer of care; and
   3. (3) Upon the resident’s return to the program, the program shall document the return of any medications including the name, strength, prescribed dose, route of administration, and quantity of each medication, with an explanation of why the medication was not given per the medication order.
7. (g) The program shall maintain a copy of each resident’s medication orders in the resident’s record.
8. (h) Medication orders shall be valid for no more than one year unless otherwise specified by the prescribing licensed practitioner.

9. (i) Each medication order shall legibly display the following information:

   1. (1) The resident’s name;
   2. (2) The medication name, strength, the prescribed dose, and route of administration;
   3. (3) The frequency of administration; and
   4. (4) The dated signature of the licensed practitioner.

10. (j) The program shall obtain written orders from a licensed practitioner regarding any prescription medication that is to be administered PRN, which shall include:

    1. (1) The specific conditions for which the medication is given;
    2. (2) The indications and any special precautions or limitations regarding administration of the medication;
    3. (3) The maximum dosage allowed in a 24-hour period; and
    4. (4) The dated signature of the licensed practitioner.

11. (k) Prior to the administration of medication, authorized staff shall obtain information specific to each medication, including, at a minimum:

    1. (1) The purpose and effect(s) of the medication;
    2. (2) Response time of the medication;
    3. (3) Possible side effects, adverse reactions, and symptoms of overdose;
    4. (4) Possible medication interactions; and
    5. (5) Special storage or administration procedures.
12. (l) In the event of a medication occurrence, the authorized staff responsible for the administration of the medication shall forward written notification to the program director by the close of the next business day.

13. (m) When any medication that is administered by program staff results in serious adverse reactions including, but not limited to, impaired speech, mobility, or breathing, semi-consciousness, or unconsciousness, program staff shall:

    1. (1) Immediately call 911 or notify a licensed practitioner for instructions regarding the need for emergency or other medical treatment;
    2. (2) Immediately comply with the instructions provided by the licensed practitioner;
    3. (3) Remain with the resident until they are fully alert and oriented and have recovered all physical capabilities that had been impaired by the medication, or until responsibility for the resident’s care is transferred to a licensed practitioner in a medical facility; and
    4. (4) Notify the parents or guardian within 24 hours with documentation of the notice, or documentation of the efforts to notify them.
14. (n) Prior to administering medication to any resident, program staff shall complete and document training on medication safety and administration, as specified in (o) below.

15. (o) Training in medication safety and administration, as required in (n) above, shall:

    1. (1) Be delivered by a physician, APRN, RN, or LPN practicing under the direction of an APRN, RN, or physician, or by another qualified individual;
    2. (2) Be provided in person, via distance learning, a video presentation, or web-based; and

    3. (3) Address the following:

       1. a. The safe administration of medication, including but not limited to:

          1. 1. Administration of the correct medication;
          2. 2. Administration of the correct dosage of the medication;
          3. 3. Administration of the medication to the correct resident;
          4. 4. Administration of the medication to the resident at the correct times and frequency;
          5. 5. Administration of the medication to the resident by the correct method of administration;
          6. 6. Infection control and aseptic procedures related to administration of medication; and
          7. 7. Resident’s rights regarding refusing medications;
       2. b. Possible side effects and adverse reactions to the medications to be administered and required reporting regarding those issues;
       3. c. Proper storage, disposal, security, error control, and documentation as related to the medications to be administered;
       4. d. Any other unusual occurrence related to the safe storage or administration of medication and reporting requirements regarding those issues;
       5. e. Conditions or situations requiring emergency medical intervention; and
       6. f. Methods of administration including, but not limited to oral, injection, topical application, or inhalation.
16. (p) In addition to (o) above, authorized staff shall complete 2 hours of training annually on medication safety and administration.
17. (q) Documentation of training in medication safety and administration shall be maintained on file at the program available for review by the unit, and shall include the staffs’ name, certification of successful completion of the training, the name and qualifications of the trainer, and the date completed.

18. (r) For each resident, program staff shall maintain medication information on file and available for review by the unit, which includes, at a minimum:

    1. (1) A written medication order, as specified in (i) above;
    2. (2) Written authorization from the parent or guardian to administer medication, if applicable;
    3. (3) The name and contact information of the parent or guardian, if applicable; and
    4. (4) Allergies, if applicable.
19. (s) Program staff shall maintain a daily medication log for each dose of medication administered to each resident.

20. (t) The medication log required in (s) above shall:

    1. (1) Be maintained on file in the program, available for review by the unit;
    2. (2) Be completed by the authorized staff who administered the medication immediately after the medication is administered; and

    3. (3) For each medication prescribed, include at a minimum:

       1. a. The name of the resident;
       2. b. The date and time the medication was taken;
       3. c. A notation of any medication occurrence or the reason why any medication was not administered or taken as ordered or approved;
       4. d. The dated signature of the authorized staff who administered the medication to the resident; and
       5. e. For administration of a PRN, documentation including the reason for administration and the name and title of the person who authorized the PRN.
21. (u) The licensee shall require that all telephone orders from a licensed e practitioner or their agent, for medications, treatments, and diets are documented in writing, including facsimiles, by the licensed practitioner within 24 hours.
22. (v) Authorized staff shall record any changes regarding prescription medications in the resident’s medication log, including the name or initials of the authorized staff recording the change, and the date and time.
23. (w) No person other than a licensed practitioner shall make changes to the written order of a licensed practitioner regarding prescribed medication.

24. (x) All medication maintained by the program shall be stored in accordance with the following:

    1. (1) Medication shall be kept in a storage area that is:

       1. a. Locked and accessible only to authorized personnel;
       2. b. Organized to allow correct identification of each resident’s medication(s);
       3. c. Illuminated in a manner sufficient to allow reading of all medication labels; and
       4. d. Equipped to maintain medication at the proper temperature;
    2. (2) Schedule II controlled substances, as defined by RSA 318-B:1-b, shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel;
    3. (3) Topical liquids, ointments, patches, creams, and powder forms of products shall be stored in a manner such that cross-contamination with oral, optic, ophthalmic, and parenteral products shall not occur; and
    4. (4) All medication shall be kept in the original containers or pharmacy packaging and properly closed after each use unless otherwise allowed by law.

25. (y) All medication shall be accompanied by:

    1. (1) The physician’s written order, which may be the prescription label; and
    2. (2) The manufacturer’s written instructions for dosage for non-prescription medication.
26. (z) Medications such as insulin, inhalers, and epi pens shall be permitted to be in the possession of a resident in accordance with their ability, as specified in their treatment plan.
27. (aa) All medications belonging to staff shall be stored in a locked area, separate from residents’ medications or otherwise inaccessible to residents.
28. (ab) The program director or designee may elect to have a supply of non-prescription medication available, including but not limited to acetaminophen, ibuprofen, aspirin, cold medicines, or antacids that may be administered to residents for minor illnesses, provided those medications are stored and administered in accordance with the requirements in this section.
29. (ac) Any contaminated, expired, or discontinued medication, whether prescription or over the counter, shall be destroyed within 7 days of identification as contaminated, expired, or discontinued.
30. (ad) All medication shall be destroyed in accordance with the United States Environmental Protection Agency’s, “How to Dispose of Medicines Properly” guidance, (April 2011), available as noted in Appendix A.

31. (ae) Destruction of prescription drugs under (ad) above shall:

    1. (1) Be accomplished by an authorized staff and witnessed by one staff; and
    2. (2) Be documented in the resident’s medication record, including the legible, dated signature of the staff person who disposed of the drugs and the staff person who witnessed the disposal.

32. (af) Programs providing SUD services shall have a clearly identified policy for storage and administration of naloxone that includes the following:

    1. (1) The process for regularly reviewing and updating the standing order for the naloxone kits on the premises;
    2. (2) The process for ensuring regular review of naloxone kits for expiration;
    3. (3) A statement that staff shall call 911 immediately if naloxone is administered; and
    4. (4) A statement that staff shall call 911 immediately if naloxone is not administered but an overdose is suspected.

33. (ag) Medication administered by individuals authorized by law to administer medications shall be:

    1. (1) Prepared immediately prior to administration; and
    2. (2) Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.
34. (ah) Authorized staff may plan for medication administration off-site, such as for an outing or field trip, or at school when the school is on the same campus as the residential program, by preparing a dose or doses of medication for administration when the resident is off-site. Authorized staff shall not repackage medication for administration to residents when they are present in the program.
35. (ai) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.
36. (aj) Programs shall have a written policy establishing procedures for the prevention, detection, and resolution of controlled substance misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

37. (ak) The policy in (aj) above shall include:

    1. (1) Education;
    2. (2) Procedures for monitoring the distribution and storage of controlled substances;
    3. (3) Voluntary self-referral by employees who are misusing substances;
    4. (4) Co-worker reporting procedures;
    5. (5) Drug testing procedures to include, at a minimum, testing where reasonable suspicion exists;
    6. (6) Employee assistance procedures;
    7. (7) Confidentiality;
    8. (8) Investigation, reporting, and resolution of controlled drug misuse or diversion; and
    9. (9) The consequences for violation of the controlled substance misuse, and diversion prevention policy.
38. (al) Programs that opt to obtain epinephrine auto-injectors for use in emergencies, in accordance with RSA 329:1-h, shall have and abide by a policy for the storage, maintenance, control, and general oversight of epinephrine auto-injectors acquired by the program, in accordance with RSA 329:1-h, III.

39. (am) Pursuant to RSA 329:1-h, V, programs that opt to obtain epinephrine auto-injectors under (al) above shall designate staff to administer them and assure those staff are trained in accordance with the following:

    1. (1) Complete an anaphylaxis training program at least every 2 years, following completion of the initial anaphylaxis training program;
    2. (2) Such training shall be conducted by a nationally recognized organization experienced in training unlicensed persons in emergency health care treatment or an entity or individual approved by the board of medicine; and

    3. (3) Training may be conducted online or in person and, at a minimum, shall cover:

       1. a. How to recognize signs and symptoms of severe allergic reactions, including anaphylaxis;
       2. b. Standards and procedures for the storage and administration of an epinephrine auto-injector; and
       3. c. Emergency follow-up procedures.
40. (an) Programs shall keep on file the certificate of successful completion of the training under (am) above.
41. (ao) Programs shall have on file written authorization from the parent or guardian of a resident for use of an epinephrine auto-injector in an emergency.
42. (ap) Programs shall educate residents regarding all medication prescribed, including the name of the medication and why they take it, based upon the residents’ age and intellectual abilities.

Source. #2664, eff 3-30-84, EXPIRED: 3-30-90 New. #8581, eff 4-20-06, EXPIRED: 4-20-14 New. #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20; ss by #14214, eff 4-1-25