1. (a) If the licensee maintains a pharmacy on the licensed premises it shall comply with RSA 318.
2. (b) All prescription medications listed under He-P 810.17(p) may be maintained as stock medications at the birthing center.
3. (c) The licensed practitioner shall approve all over-the-counter medications taken by patients at the birthing center.
4. (d) All medications shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.
5. (e) Licensees shall maintain either the original, or a copy of the original written order in the patient’s record, signed by a licensed practitioner or other individual authorized by law, for each prescription medication being taken by a patient at the birthing center.

6. (f) 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 birthing center;
   2. (2) Reorder medications for use at the birthing center; and
   3. (3) Receive and record new medication orders.

7. (g) Each medication order shall legibly display the following information:

   1. (1) The patient’s name:
   2. (2) The medication name, strength, prescribed dose, and route, if different then by mouth;
   3. (3) The frequency of administration;
   4. (4) The indications for usage for all medications that are used PRN; and
   5. (5) The dated signature of the ordering practitioner.
8. (h) For PRN medications the ordering practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

9. (i) Each medication, including licensed practitioner’s samples, shall legibly display the following information:

   1. (1) The patient’s name, unless it is a stock medication as allowed in (b) above;
   2. (2) The medication name, strength, prescribed dose, and the route of administration;
   3. (3) The frequency of administration;
   4. (4) The indications for usage of all PRN medications;
   5. (5) The date ordered; and
   6. (6) The name of the prescribing practitioner.
10. (j) Except for stock medications identified in He-P 810.17(p), the label of all medication containers maintained in the birthing center shall match the current written orders of the licensed practitioner.
11. (k) Only a pharmacist shall make changes to prescription medication container labels.
12. (l) Any change or discontinuation of medications taken at the birthing center shall be pursuant to a written order from a licensed practitioner or other individual authorized by law.

13. (m) When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the birthing center are unable to obtain a new prescription label the following shall apply:

    1. (1) Licensed nurse shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the birthing center’s written procedure, indicating that there has been a change in the medication order;
    2. (2) Licensed nurse shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and
    3. (3) The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.
14. (n) All prescription medication not ordered, approved, or labeled for a specific patient, including but not limited to pharmaceutical samples, which is stored at the birthing center, shall be the responsibility of the medical director.
15. (o) All verbal orders from an authorized prescriber, including but not limited to telephone orders, shall be taken only by a licensed healthcare professional such as a nurse, if such action is within the scope of their practice act, and immediately transcribed and signed by the individual taking the order, and shall be counter-signed by the authorized prescriber within 48 hours.

16. (p) Over-the-counter medications shall be handled in the following manner:

    1. (1) The licensee shall obtain written approval from the patient’s licensed practitioner annually; and
    2. (2) Over-the-counter medication containers shall be marked with the name of the patient using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

17. (q) The medication storage area shall be:

    1. (1) Locked and accessible only to authorized personnel;
    2. (2) Clean, organized in a fashion to ensure correct identification of each patient’s medication(s), and have lighting adequate to read all medication labels; and
    3. (3) Equipped to maintain medication at the proper temperature.
18. (r) Medication kept at the birthing center shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.
19. (s) Topical liquids, ointments, 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.

20. (t) Controlled drugs, as defined by RSA 318-B, stored in a central storage area of the birthing center shall be:

    1. (1) Kept in a separately locked compartment within the locked medication storage area; and
    2. (2) Accessible only to authorized personnel.
21. (u) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.
22. (v) Except as allowed by (x) 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 if the medication becomes contaminated, whichever occurs first.

23. (w) The destruction of contaminated, expired, or discontinued controlled drugs medication 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 patient for whom the medication was prescribed.
24. (x) Medication(s) may be returned to pharmacies for credit only under the provisions of Ph 703.06.
25. (y) If ordered by the department to do so, the birthing center shall obtain the services of a consulting pharmacist to rectify medication deficiencies, which present a risk to the patient’s health and safety, as identified during an inspection or investigation.
26. (z) Only individuals authorized by law shall administer medications to patients.
27. (aa) Medication shall be prepared immediately prior to administration and shall be prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B.
28. (ab) When administering medication, personnel shall remain with the patient until the patient has taken all of the medication.

29. (ac) The licensee shall maintain a written record for each medication taken by the patient at the birthing center, containing the following information:

    1. (1) Name of the patient;
    2. (2) Any allergies or allergic reactions to medication;
    3. (3) The name, strength, and frequency of the medication;
    4. (4) The date and time the medication was taken;
    5. (5) The dose taken by the patient;
    6. (6) The route of administration, if other than by mouth;

    7. (7) The signature and identifiable initials and job title of:

       1. a. The person administering the medication; and
       2. b. The person supervising or assisting the patient taking their medication;
    8. (8) Documented reason for any medication refused or omitted; and
    9. (9) For PRN medications, the reason the patient required the medication and the effect of the PRN medication.
    10. (ae) The licensee shall develop and implement a system for reporting any observed adverse medication reaction and side effects or medication errors, such as incorrect medications, within 24 hours of the adverse medication reaction or medication error.

Source. #8957, eff 7-27-07, EXPIRED: 7-27-15 New. #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16; ss by #14074, eff 9-20-24, EXPIRES: 9-20-34 (formerly He-P 810.17)