1. (a) All medications shall be made available to the patient in accordance with the orders of a licensed practitioner or other professional with prescriptive powers.

2. (b) The licensee shall have a written policy and system in place instructing how to:

   1. (1) Obtain any medication ordered for use at the hospital;
   2. (2) Reorder medications for use at the hospital; and
   3. (3) Receive and record new medication orders.

3. (c) Each medication order shall include the following information:

   1. (1) The patient’s name;
   2. (2) The medication name, strength, prescribed dose, and route of administration;
   3. (3) The frequency of administration;
   4. (4) For PRN doses, the indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that have such maximum doses;
   5. (5) For titration orders, the medication name, route, initial rate of infusion, for example the dose per unit of time, incremental units to which the rate or dose can be changed, the maximum rate or dose of infusion, and the objective clinical measure to be used to guide changes; and
   6. (6) The dated and timed authentication of the ordering practitioner.
4. (d) All licensees shall comply with RSA 318, RSA 318-B, and the rules adopted thereunder regarding the handling, storage, labeling, ordering, and destruction of medications.
5. (e) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized by a licensed practitioner and indicated, in the medication record, the date the dose or the discontinuance occurred.
6. (f) Health care professionals, within their scope of practice, can accept telephone orders for medications, treatments, and therapeutic diets and shall document and authenticate to telephone orders in the patient’s electronic medical record.
7. (g) The transcribed order in (e) above shall be counter-signed by the authorized prescriber within 48 hours of receipt or as soon as possible but no longer than 30 days.
8. (h) No medications shall be given to or taken by a patient until a written order is received, except as allowed by (f) above or in emergent or urgent situations, to address immediate patient care needs if a verbal order is given by an authorized prescriber.
9. (i) Faxes of signed orders or other electronic media with electronic signatures shall be acceptable to meet the requirements of (h) above.
10. (j) All over-the-counter medications shall have a signed practitioner’s order specifying that the patient may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.
11. (k) All bulk medication at the hospital shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use. This shall not apply to unit-of-use packaging.
12. (l) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

13. (m) The licensee shall maintain a written record for each medication taken by a patient at the facility that contains the following information:

    1. (1) Any allergies or adverse reactions to medications;
    2. (2) The medication name, strength, dose, frequency, and route of administration;
    3. (3) The date and the time the medication was taken;
    4. (4) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;
    5. (5) For PRN medications, the reason the patient required the medication and the effect of the PRN medication; and
    6. (6) Documented reason for any medication refusal or omission.
14. (n) The licensee shall report to the patient’s licensed practitioner any adverse reactions and side effects to medications or medication errors, such as incorrect medications, immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the patient’s record the reaction, the error, and date, time, and person notified.

15. (o) The therapeutic use of cannabis by patients who are qualifying patients possessing a registry identification card may be permitted at a hospital as long as:

    1. (1) The licensee develops, maintains, and implements a general policy relative to patient use of cannabis at the licensed premises, including storage, security, and administration; and
    2. (2) The smoking of cannabis is not permitted on the licensed premises.

Source. #9580, eff 10-24-09; amd by #9851, eff 1-14-11; amd by #10079, eff 1-26-12; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18 New. #13166, eff 1-28-21; ss by #14081, eff 9-25-24, EXPIRES: 9-25-34 (formerly He-P 802.21)