1. (a) All medications shall be made available and administered in accordance with the written and signed orders of the licensed practitioner.
2. (b) All medications and treatments shall be reviewed, re-ordered, and signed by a licensed practitioner on an annual basis.
3. (c) All personnel shall follow the written and signed orders of the licensed practitioner for each resident.
4. (d) Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours or when available as in accordance with the licensed practitioner’s written direction.

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

   1. (1) Obtain any medication ordered for immediate use at the SRHCF;
   2. (2) Reorder medications for use at the SRHCF;
   3. (3) Handle unavailable medications at dispensing pharmacy;
   4. (4) Receive, record, and reconcile new medication orders; and
   5. (5) Administer or assist with the administration of medications.

6. (f) Each medication order shall legibly display the following information:

   1. (1) The resident’s name:
   2. (2) The medication name, strength, prescribed dose, and route of administration;
   3. (3) The frequency of administration;
   4. (4) The indications for use and any special precautions or limitations for use of all medications to include the maximum allowed dose in a 24-hour period, for all pro re nata (PRN) medications; and
   5. (5) The order from the licensed practitioner.

7. (g) Each prescription medication container shall legibly display the following information unless it is an emergency medication as allowed by (y) below:

   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;
   4. (4) The indications for usage of all pro re nata (PRN) medications;
   5. (5) The date ordered;
   6. (6) The name of the prescribing practitioner; and
   7. (7) The expiration date of the medication(s).
8. (h) The dosage, frequency, and route of administration on the labels of all prescription medications for each resident shall be identical to the dosage, frequency, and route on the SRHCF medication record except as allowed by (i) below.
9. (i) The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the medication record for a change or discontinuance shall indicate in writing the date the dose changed or the discontinuance occurred.
10. (j) Only a pharmacist shall make changes to prescription medication container labels except as allowed by (k) below.
11. (k) When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.
12. (l) Only a licensed nurse shall accept telephone orders for medications, treatments, and diets, and the licensed nurse shall immediately transcribe and sign the telephone order.
13. (m) The transcribed order referenced in (l) above shall be counter-signed by the authorized prescriber within 30 days of receipt.
14. (n) No medications shall be given to or taken by a resident until a written order is received, except as allowed by (m) above.

15. (o) The medication storage area for medications not stored in the resident’s room shall be:

    1. (1) Locked and accessible only to authorized personnel;
    2. (2) Clean and organized with adequate lighting to ensure correct identification of each resident's medication(s); and
    3. (3) Equipped to maintain medication at the proper temperature.
16. (p) All medications, including over the counter medications, shall remain in the original containers except as authorized by (ab)(5) below.
17. (q) Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur.
18. (r) If controlled drugs, as defined by RSA 318-B, are stored in a central storage area in the facility, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.
19. (s) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.
20. (t) Except as required by (u) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders, or the medication becomes contaminated, whichever occurs first.

21. (u) Destruction of contaminated, expired, or discontinued controlled drugs shall:

    1. (1) Be in accordance with acceptable standards of practice;
    2. (2) Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and
    3. (3) Be documented in the record of the resident for whom the drug was prescribed.
22. (v) When a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self-administering without assistance, as described in (ab) below.
23. (w) If a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication container shall be given to the person responsible for the resident while the resident is away from the SRHCF.
24. (x) Upon discharge or transfer, the licensee shall make the resident’s current medications available to the resident, personal representative, guardian, or agent, and upon death of a resident, the SRHCF shall return or destroy all remaining medications, as appropriate, and document it in the resident record.
25. (y) A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

26. (z) Residents shall receive their medications by one of the following methods:

    1. (1) Self-administered without assistance as allowed by (ab) below;
    2. (2) Self-directed administration of medication as allowed by (ac) below;
    3. (3) Self-administered with assistance as allowed by (ad) below; or
    4. (4) Administered by individuals authorized by law.

27. (aa) 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.

28. (ab) For residents who self-administer without assistance as defined in He-P 805.03(cj) the licensee shall:

    1. (1) Obtain a written order from a licensed practitioner on an annual basis:

       1. a. Authorizing the resident to self-administer medications without assistance; and
       2. b. Authorizing the resident to store the medications in their room;
    2. (2) Evaluate the resident initially and then on a 6 month basis or sooner if the resident experiences a significant change, to ensure they maintain the physical and mental ability to self-administer without assistance;
    3. (3) Have the resident store the medication(s) in their room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;
    4. (4) Have a copy of the key to access the locked medication storage area in the resident’s room; and
    5. (5) Allow the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

29. (ac) The licensee shall allow the resident to self-direct administration of medications as defined in He-P 805.03(ck) if the resident:

    1. (1) Has a physical limitation due to a diagnosis that prevents them from self-administration;
    2. (2) Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure the resident maintains the physical and mental ability to self-direct administration of medications;
    3. (3) Obtains an annual written verification of their physical limitation and self-directing capabilities from their licensed practitioner and requests the SRHCF to file the verification in their resident record; and

    4. (4) Verbally directs personnel to:

       1. a. Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting;
       2. b. Assist the resident to apply, ingest, or instill the ordered dose of medication; and
       3. c. Fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

30. (ad) If a resident self-administers medication with assistance, as defined in He-P 805.03(ci), personnel shall only:

    1. (1) Remind the resident to take the correct dose of their medication at the correct time;
    2. (2) Place the medication container within reach of the resident and open the container, if requested by the resident;
    3. (3) Remain with the resident to observe the resident taking the appropriate amount and type of medication as ordered by the licensed practitioner;
    4. (4) Record on the resident's daily medication record that they have observed the resident taking their medication;
    5. (5) Document in the resident’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken; and
    6. (6) Personnel shall not physically handle the medication in any manner.

31. (ae) Except for those residents who self-administer medication without assistance, the licensee shall maintain a daily medication administration record for each medication taken by the resident at the SRHCF that contains the following information:

    1. (1) Any allergies or allergic 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 resident taking medication;
    5. (5) For PRN medications, the reason the resident required the medication and the effect of the PRN medication within 4 hours of consumption;
    6. (6) Documented reason for any medication refusal or omission; and
    7. (7) Any observed or reported side effects and adverse drug reactions.
32. (af) Unlicensed staff who assist a resident with self administration with assistance, self directed administration, or administration medication via nurse delegation shall complete a medication assistance education program described in (ag) below.

33. (ag) The medication assistance education program required by (af) above shall be taught by a licensed nurse or practitioner and include:

    1. (1) Four hours of initial instruction;
    2. (2) Two hours of annual continuing education;

    3. (3) The rights of medication administration to include:

       1. a. Right patient;
       2. b. Right drug;
       3. c. Right dosage;
       4. d. Right route;
       5. e. Right time; and
       6. f. Right documentation;
    4. (4) Infection control specific to medication administration and proper hand washing techniques;
    5. (5) Documentation requirements;
    6. (6) General categories of medications;
    7. (7) Desired effects and potential side effects of medications;
    8. (8) Medication precautions and interactions;
    9. (9) Both prescription and non-prescription medications;
    10. (10) Methods of medication administration to include demonstrations;
    11. (11) Common abbreviations;
    12. (12) PRN protocols; and
    13. (13) Final exam.

34. (ah) The licensee shall:

    1. (1) Accept documentation of training required by (ag) above, if previously completed by an individual; and
    2. (2) Maintain initial and annual certificates of the medication assistance education in the personnel file.

35. (ai) The SRHCF shall use emergency drug kits only under circumstances where the SRHCF:

    1. (1) Has a director of nursing who is an RN licensed in accordance with RSA 326-B; and
    2. (2) Has a contractual agreement with a consultant pharmacist who is licensed in accordance with RSA 318.
36. (aj) The licensee shall document in the resident record and report any observed adverse drug reactions and side effects to the licensed practitioner and the guardian, personal representative, or agent.
37. (ak) The licensee shall document in the resident record and report any medication errors that cause adverse reactions that require medical intervention to the licensed practitioner and the guardian, personal representative, or agent.
38. (al) The licensee shall report to the department any medication error that requires medical intervention as required by He-P 805.14(k).
39. (am) The written documentation of the reports in (aj) and (ak) above shall be maintained in the resident’s record.
40. (an) No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident.
41. (ao) Medications shall be prepared immediately prior to assisting, supervising, or administering.
42. (ap) Over-the-counter medications that are not labeled for a specific resident, including but not limited to pharmaceutical samples and “house stock” medications, may be kept at the SRHCF provided that these medications are only dispensed to a resident with a signed order from an authorized licensed practitioner specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.
43. (aq) The department shall order a SRHCF to obtain the routine services of a consultant pharmacist for 12 months if areas of noncompliance regarding medications, which the department determines present a potential risk to residents health, are found during any inspection or investigation.
44. (ar) The licensee shall develop and implement policies and procedures for each medication administration method.

45. (as) The therapeutic use of cannabis by residents who are qualifying residents possessing a registry identification card shall be permitted provided:

    1. (1) The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or
    2. (2) The facility permits a resident to possess and use cannabis at the licensed premises, the resident is able to self-administer medication without assistance, and the cannabis remains in the possession of the resident.
46. (at) The facility that permits the therapeutic use of cannabis in accordance with (as) above shall develop, maintain, and implement a general policy relative to resident use of cannabis at the licensed premises, including storage, security, and administration.

47. (au) The facility that designates itself as a facility caregiver according to (as)(1) above shall:

    1. (1) Have a resident-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the resident; and
    2. (2) Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying residents with the therapeutic use of cannabis.
48. (av) The SRHCF shall not permit the smoking of cannabis if smoking is not allowed on the SRHCF premises.

Source. #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35