1. (a) All medications and treatments shall be administered in accordance with the orders of the licensed practitioner.

2. (b) 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 ESRDDC;
   2. (2) Reorder medications for use at the ESRDDC; and
   3. (3) Receive and record new medication orders.
3. (c) For each prescription medication being taken by a patient at the ESRDDC, the licensee shall maintain in the patient’s record, the original or a copy of, the written or electronic order, signed by a licensed practitioner or other licensed professional licensed by law to prescribe.

4. (d) Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

   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;
   5. (5) The dated signature of the licensed practitioner; and
   6. (6) For PRN medications, the licensed practitioner shall indicate, in writing, the indications for use and any special precautions or limitations for use of the medication, including the maximum allowed dose in a 24-hour period.
5. (e) Medications shall be kept in locked storage.

6. (f) Except as allowed by (d)(6) above, each prescription medication shall legibly display the following information:

   1. (1) The patient’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 PRN medications;
   5. (5) The date ordered;
   6. (6) The name of the prescribing licensed practitioner; and
   7. (7) The expiration date of the medication(s).
7. (g) Any change or discontinuation of medications taken at the ESRDDC shall be pursuant to a written order from a licensed practitioner.
8. (h) The label of all medication containers maintained at the ESRDDC shall match the current written orders of the licensed practitioner unless authorized by (i) below.

9. (i) When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the ESRDDC are unable to obtain a new prescription label:

   1. (1) The 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 ESRDDC’s written procedure, indicating that there has been a change in the medication order;
   2. (2) The 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.

10. (j) The licensee shall require that all telephone orders for medications or treatments are:

    1. (1) Taken only by a licensed health care professional if such action is within the scope of their practice act;
    2. (2) Immediately transcribed and signed by the individual taking the order; and
    3. (3) Be counter-signed by the authorized licensed practitioner authorized by law within 30 days.
11. (k) Over-the-counter medications shall be kept at the ESRDDC provided that these medications shall only be dispensed to a patient with a signed annual order from an authorized licensed practitioner specifying administration according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

12. (l) There shall be a medication storage area for all medications kept at the ESRDDC, which 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.
13. (m) All medication at the ESRDDC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.
14. (n) If controlled drugs, as defined by RSA 318-B:1, are stored in a central storage area in the ESRDDC, they shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel.
15. (o) The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.
16. (p) 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.

17. (q) Except as allowed by (s) 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 becoming contaminated, whichever occurs first and shall:

    1. (1) Be documented in the record of the patient for whom the drug was prescribed; and
    2. (2) Be accomplished in the presence of at least 2 people if a controlled substance.
18. (r) Controlled drugs shall be destroyed only in accordance with RSA 318-B.
19. (s) If medication(s) are to be returned to pharmacies, the medication(s) shall be returned to pharmacies for credit only as allowed by the law.
20. (t) Medication administered by individuals authorized by law to administer medications shall be prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B and in accordance with manufacturer instructions.
21. (u) Personnel shall remain with the patient until the patient has taken the medication.
22. (v) If a nurse delegates the task of medication administration to a patient care technician, the nurse shall follow the requirements of the nurse practice act, RSA 326-B.

23. (w) The licensee shall maintain a written record for each medication taken by the patient at the ESRDDC which contains the following information:

    1. (1) The name of the patient;
    2. (2) Any allergies or allergic reactions to medications;
    3. (3) The medication name, strength, dose, frequency, and route of administration;
    4. (4) The date and the time the medication was taken;
    5. (5) The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;
    6. (6) For PRN medications, the reason the patient required the medication and the effect of the PRN medication; and
    7. (7) Documented reason for any medication refusal or omission.

24. (x) Each ESRDDC which permits patient care technicians to administer heparin or its derivatives shall:

    1. (1) Require patient care technicians to be under the direction of a registered nurse as required by the nurse practice act for nurse delegation of medications;
    2. (2) Require the delegating licensed nurse to document that patient care technicians have received the required initial competency verification and annual competency evaluations as required by the nurse practice act; and
    3. (3) Have a copy of the patient assessment documented in the patient record, verifying the patient is stable and is an acceptable candidate to receive heparin via nurse delegation, as required by the nurse practice act.
25. (y) The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, to the department within 24 hours of the adverse reaction or medication error.
26. (z) The written documentation of any reports in (y) above shall be maintained in the patient’s record.
27. (aa) If ordered by the department to do so, the ESRDCC 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.

Source. #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20 New. #12985, eff 1-29-20; ss by #14206, eff 2-28-25 (formerly He-P 811.13)