1. (a) For the purposes of this section, “administer” means an act whereby a single dose of a medication is instilled into the body of, applied to the body of, or otherwise given to a child for immediate consumption or use.

2. (b) For programs that administer medication:

   1. (1) Only authorized staff, a registered nurse (RN), licensed practical nurse (LPN), or licensed practitioner shall administer prescription and over-the-counter medications to children, in accordance with the child’s medication order;
   2. (2) Authorized staff shall administer only those medications for which there is a medication order provided by a licensed practitioner, and written permission from the parent or guardian; and
   3. (3) Programs shall not accept any prescription medications that do not include a prescription label or medication order from a licensed practitioner.

3. (c) Each medication order shall legibly display:

   1. (1) The child’s name;
   2. (2) The medication name, strength, the prescribed dose and method of administration;
   3. (3) The frequency of administration;
   4. (4) The indications for usage of all medications to be used pro re nata (PRN), meaning when necessary; and
   5. (5) The dated signature of the licensed practitioner for orders other than the prescription label.

4. (d) Medication orders for PRN medication shall include:

   1. (1) The indications and any special precautions or limitations regarding administration of the medication;
   2. (2) The maximum dosage allowed in a 24-hour period;
   3. (3) The dated signature of the parent or guardian for topical substances or over-the-counter medication; and
   4. (4) For other than the prescription label, the dated signature of the licensed practitioner for prescription medication.
5. (e) In the event of a medication error in the administration of medication, the family child care provider, center director, site director, or designee shall notify the child’s parents or guardians immediately.
6. (f) Prior to administering prescription and over-the-counter medication to any child, child care staff shall complete and document training on medication administration, as required by He-C 4002.32(b)(4), delivered by the department, a physician, RN, or LPN practicing under the direction of an APRN, RN, or physician, or online training approved by the department.
7. (g) Authorized staff shall complete training in medication safety and administration every year.
8. (h) For each child receiving medication, child care staff shall maintain medication information on file and available for review by the department, including medication orders, parental or guardian authorization to administer medication, and information regarding a child’s allergies, if applicable.

9. (i) Child care staff shall maintain a written record for each dose of medication administered to each child, which shall:

   1. (1) Be completed by the authorized staff who administered the medication immediately after the medication is administered; and

   2. (2) For each administered medication, include at a minimum:

      1. a. The name of the child;
      2. b. The date and time the medication was taken;
      3. c. A notation of any medication error or the reason why any medication was not taken as ordered or approved;
      4. d. The dated signature of the authorized staff who administered the medication to the child; and
      5. e. For administration of a PRN, documentation shall also include the reason for administration.

10. (j) All medication shall be:

    1. (1) Inaccessible to children;
    2. (2) Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label;
    3. (3) Stored in a secondary container separate from food if in a refrigerator; and
    4. (4) Labeled with the child’s name to ensure correct identification of each child's medication.
11. (k) Medications such as insulin, inhalers, and epi-pens shall be readily accessible to child care staff caring for children requiring such medications, to assure timely administration when needed and in accordance with parental or guardian instructions in He-C 4002.19(h)(2)a.
12. (l) Programs may permit school-age children to possess medications described in (k) above provided there is written authorization from the prescribing licensed practitioner and written permission from the child’s parent or guardian on file at the program.
13. (m) The only exception to (l) above shall be when a school-age child is with children younger than 6 years of age, insulin, inhalers, and epi-pens shall not be in the school-age child’s possession but shall be readily accessible to child care staff.
14. (n) All medications belonging to child care staff shall be stored separate from children’s medications in a locked area, or otherwise inaccessible to children.
15. (o) All prescription or over-the-counter medication shall be kept in the original containers or pharmacy packaging and properly closed after each use.
16. (p) Topical substances shall be labeled with ingredients and indicated use.
17. (q) Any contaminated, expired, or discontinued medication, whether prescription or over-the-counter, and topical substances shall be returned to the child’s parents or guardians whenever possible or, if belonging to the program, disposed of properly by authorized staff.
18. (r) Child care staff shall administer over-the-counter medications in accordance with the manufacturer’s instructions or written instructions from the child’s licensed practitioner.
19. (s) Programs that opt to obtain epinephrine devices for use in emergencies, in accordance with RSA 329:1-h, II, shall have and abide by a policy for the storage, maintenance, control, and general oversight of epinephrine devices acquired by the program, for compliance with RSA 329:1-h, III.

20. (t) Pursuant to RSA 329:1-h, V, programs that opt to obtain a prescription for epinephrine devices under (s) above shall designate and train authorized staff to administer epinephrine in accordance with the following:

    1. (1) Authorized staff shall 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;

    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 device; and
       3. c. Emergency follow-up procedures; and
    4. (4) The certificate of completion for the training shall be on file for review by the unit.

Source. #4871, eff 7-24-90; ss by #5203, eff 8-16-91; ss by #6558, INTERIM, eff 8-16-97, EXPIRED: 12-14-97 New. #6719, eff 3-25-98; ss by #7294, eff 5-26-00; ss by #9160, INTERIM, eff 5-26-08; ss by #9310, eff 11-23-08 (from He-C 4002.23); ss by #12046, INTERIM, eff 11-19-16; ss by #12174, EMERGENCY RULE, eff 5-17-17; ss by #12415, eff 11-6-17; ss by #13373, eff 4-22-22 (formerly He-C 4002.18); ss by #14356, eff 9-22-25, EXPIRES: 9-22-35 (formerly He-C 4002.21)