N.H. Code Admin. R. He-C 4003.40 – Administration of Medication

(a) The availability, use, and possession of epinephrine devices and asthma inhalers shall be as specified in RSA 170-E:59 through RSA 170-E:64.
(b) Prescription medications other than those listed in (a), above, and non-prescription medications other than topical substances shall be administered to campers only by authorized staff and only in accordance with the applicable medication order as specified in (f) below.
(c) If a camper’s parent or legal guardian provides written permission, YRC staff who have not been trained as specified in He-C 4003.43(n) may administer non-prescription topical substances to the camper.
(d) Authorized staff shall administer only those prescription medications for which there is a prescription label, or written directions provided by a licensed practitioner who is legally authorized to write the prescription, and written permission from the camper’s parent or legal guardian.
(e) Medication orders shall be valid for no more than one year.
(f) Each medication order shall legibly display the following information:
1. (1) The camper’s name;
2. (2) The name, strength, prescribed dose, and method of administration of the medication;
3. (3) The frequency of administration of the medication, or if the medication is to be used on an as-needed, pro re nata (PRN) basis, the information specified in (g), below; and
4. (4) The dated signature of the camper’s parent or legal guardian or a licensed practitioner for orders other than as shown on the prescription label.
(g) A medication order from a parent or legal guardian or a licensed practitioner regarding any medication to be administered PRN 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 legal guardian for topical substances and non-prescription medication; and
4. (4) For orders other than as shown on the prescription label, the dated signature of the licensed health care practitioner for prescription medication.
(h) A written order regarding prescription medication shall not be changed except by a licensed practitioner having legal authority to prescribe.
(i) All prescription medications, including physician medication samples, shall:
1. (1) Bear a label that legibly displays the information described in (f)(1)-(3), above; and
2. (2) Be stored, dispensed, and administered in accordance with:
  1. a. RSA 318 and requirements adopted pursuant thereto by the NH board of pharmacy; and
  2. b. RSA 326-B and requirements adopted pursuant thereto by the NH board of nursing.
(j) All non-prescription medication and topical substances shall be kept in the original containers and properly closed after each use.
(k) The YRC may provide age-appropriate non-prescription topical substances, such as sunscreen, insect repellent, and over-the-counter anti-itch or anti-bacterial creams or ointments, and common non-prescription medications such as over-the-counter pain relievers and gastro-intestinal calming agents to a camper with the written permission of the camper’s parent or legal guardian.
(l) Any items provided pursuant to (k), above, shall be stored and administered as specified on the product label and in this section.
(m) The camp administrator or camp director shall return any remaining medication and topical substances provided by a camper’s parent or legal guardian to the parent or legal guardian when the camper departs the YRC.
(n) Prior to administering prescription or non-prescription medication to any camper, YRC staff shall:
1. (1) Complete and document training on medication safety and administration or training delivered by a physician, an APRN, an RN, or an LPN practicing under the direction of an APRN, RN, or physician; or
2. (2) Successfully complete a nationally recognized course on medication safety and administration having standards that are no less stringent than the Academy of Pediatrics on-line course, Medicine Administration in Early Education and Child Care.
(o) YRC staff administering medications shall complete training in medication safety and administration every 3 years.
(p) For each camper receiving medication, the YRC’s licensed practitioner shall maintain the following information on file:
1. (1) For each medication prescribed for a camper, the written medication order as specified in He-C 4003.40 and any special considerations for administration of the medication;
2. (2) Written authorization from the camper’s parent or legal guardian to administer the medication, which includes a statement that the camper has received the specific medication prior to entering the YRC;
3. (3) The name and contact information of the camper’s parent or legal guardian who is to be notified if required by (s), below; and
4. (4) Any allergies the camper is known to have or is suspected to have.
(q) The record required by (p), above, shall be updated with a written record of each dose of medication, excluding topical substances, administered to the camper.
(r) The written record required by (p), above, shall:
1. (1) Be completed by the YRC staff who administered the medication immediately after the medication is administered; and
2. (2) For each administered medication, include:
  1. a. The name of the camper;
  2. b. The date and time the medication was taken;
  3. c. A notation of any deviation from the medication order provided pursuant to He-C 4003.40 in the administration of a medication and the reason why the medication was not taken as ordered or approved;
  4. d. The dated signature of the authorized staff who administered the medication to the camper;
  5. e. For administration of an as-needed medication, the reason for administration; and
  6. f. Any other information that is relevant to the administration of the medication.
(s) In the event of any deviation from the administration of medication as described in (2)c., above, the camp director or designee shall:
1. (1) Note the deviation in the record required by (s), above; and
2. (2) Notify the camper’s parent or legal guardian immediately.
(t) In the event of an error in the documentation of the administration of medication, the camp director or designee shall identify the error and provide correct information in the record as soon as the error is identified.
(u) YRCs that opt to obtain epinephrine devices for use in emergencies, shall have and abide by a policy for the storage, maintenance, control, and general oversight of epinephrine devices acquired by the residence camp, for compliance with RSA 329:1-h, III.
(v) Pursuant to RSA 329:1-h, V., YRCs that opt to obtain a prescription for epinephrine devices under (u) above shall designate and train YRC staff to administer epinephrine in accordance with the following:
1. (1) YRC 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 units.
(w) YRCs shall obtain written authorization from the parent or guardian of a camper prior to administering epinephrine devices.

Source. #12981, INTERIM, eff 1-24-20, EXPIRED: 7-22-20 New. #13073, eff 7-23-20; ss by #14046, EMERGENCY RULE, eff 8-8-24, EXPIRES: 2-4-25; ss by #14155, eff 12-21-24; ss by #14256, eff 5-23-25, EXPIRES: 5-23-35 (formerly He-C 4003.39)