Can a nurse delegate tasks to home care caregivers in New Hampshire?

Yes. New Hampshire lets a nurse delegate medication administration to a competent unlicensed caregiver for a specific stable client, after teaching the task and watching the caregiver do it. Delegable routes include oral, topical, drops, rectal, enteral tube, and insulin from a pre-set or pre-drawn pen or syringe. The first dose of a new medicine, dose changes, other injections and anything needing dose calculation cannot be delegated. The nurse must supervise and can rescind delegation at any time.

What conditions apply?

• The nurse assesses the client and confirms the condition is stable and predictable, and that the task needs no nursing assessment
• The nurse teaches the task, watches the caregiver do it, and documents the delegation with written instructions; delegation is for one specific client only
• For medications, eligible delegatees include unlicensed assistive personnel with competency in the specific task, and licensed nursing assistants with a medication certificate
• Delegable routes: topical, oral, nasal, eye, ear, vaginal, rectal, enteral tube, and insulin or epinephrine from a labeled, pre-set or pre-drawn device
• Not delegable: other injections or IV medications, nasogastric tube medications, the first dose of a new medication or a changed dose, and anything requiring dose calculation
• PRN medications need written instructions and authorization by the supervising nurse on duty or on call
• The nurse supervises at a frequency based on task complexity, client condition and caregiver skill, and must rescind delegation if the client objects or conditions change

What is the difference between medication reminders and administration?

Reminding a client to take their medicine, or handing them a container they open themselves, is usually treated as assistance. Giving the medicine, such as placing pills in the mouth, giving an injection or crushing tablets, is administration and generally needs a license or nurse delegation. Check your state's rule and the client's care plan.