Overview of Who can be Delegated and Why
Overview of Who can be Delegated and Why
Copied from DADS Texas website, this material does not belong to WhatsUpJayTee and is subject to change. Click the “date” link for reference or refer to HHS site.
September 4, 2015
To: Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions
Subject: Provider Letter 15-23 – Medication Administration by an Unlicensed Person and Clarification of the Texas Board of Nursing (BON) Registered Nurse (RN)
Delegation Rules (Replaces Provider Letter 12-12)
The Department of Aging and Disability Services (DADS) is issuing this provider letter to remove references to the Licensed Vocational Nurse On-Call Pilot related to Senate Bill (SB) 1857, 82nd Texas Legislature, Regular Session, 2011. SB 1857 added §§161.091 – 161.096 to the Texas Human Resource Code (HRC) to allow an unlicensed person to administer medications in ICFs/IID that have 13 or fewer beds without the requirement that the RN delegate or oversee each dose of medication.
Medication Administration by an Unlicensed Person in all ICFs/IID with a Capacity of 13 or Fewer Beds
An unlicensed person may provide administration of medication to an individual without the requirement that a registered nurse (RN) delegate or oversee each administration of the medication if the following conditions are met:
Each individual who has medications administered by an unlicensed person is assessed by an RN to identify the individual's needs and abilities regarding the individual's medication.
The administration of medication is performed in such a manner as to ensure the greatest degree of independence as possible (including the use of adaptive equipment).
The medication administered by an unlicensed person is an oral medication, a topical medication or a metered dose inhaler.
The medication is administered for a stable or predictable condition. An RN has personally assessed the individual:
(a) prior to initiation of an unlicensed person administering medications,
(b) in response to significant changes in health status, and
(c) to determine that the individual’s health status permits the administration of medication by an unlicensed person.
The unlicensed person has been:
(a) trained by an RN or licensed vocational nurse (LVN) under the direction of an RN regarding proper administration of medication, or
(b) determined to be competent by an RN or LVN under the direction of an RN regarding proper administration of medication, including through a demonstration of proper technique by the unlicensed person.
The facility has policies to ensure that the determination of whether an unlicensed person may provide administration of medication to an individual may be made only by an RN.
The administration of medication other than an oral medication, a topical medication or a metered dose inhaler is subject to the BON rules regarding the delegation of nursing tasks.
DADS has initiated a rule change at Texas Administrative Code, Title 40, Part 1, Chapter 90, Subchapter C, §90.43 Standards for Facilities Serving Persons with Mental Retardation or Related Conditions, to implement §§161.091 – 161.096 of the Human Resource Code as established by SB 1857.
Although an unlicensed person may administer medications to certain individuals in all ICFs/IID with a capacity of 13 or fewer beds, an ICF/IID must still comply with the Code of Federal Regulations (CFR) regarding medication administration, including but not limited to:
drug administration (42 CFR §483.460(k), W367 through W376); drug storage and recordkeeping (42 CFR §483.460(l), W377 - W387); and drug labeling (42 CFR §483.460(l), W388 -W392).
42 CFR §483.460(k)(3) (W370) states, “Unlicensed personnel are allowed to administer drugs only if State law permits.”
In the Texas ICF/IID program, unlicensed personnel can only administer medications via the delegation process by a registered nurse (RN) or through the Human Resource Code §§161.091 – 161.096 (as established by SB 1857). If the conditions outlined in HRC §§161.091 – 161.096 are not met, the RN will have to make a decision about whether to delegate the administration of medication to unlicensed staff. If the RN chooses not to delegate the administration of medication to unlicensed staff (i.e., supervise the self-administration medication (SAM) training program), then the RN or LVN will have to administer the medication (i.e., supervise the SAM training program).
In addition, the following Centers for Medicare & Medicaid Services Appendix Q - Guidelines for Determining Immediate Jeopardy triggers still apply:
1. administration of medication to an individual with a known history of allergic reaction to that medication;
2. lack of monitoring and identification of potential serious drug interaction, side effects, and adverse reactions;
3. administration of contraindicated medications;
4. pattern of repeated medication errors without intervention;
5. lack of diabetic monitoring resulting or likely to result in serious hypoglycemic or hyperglycemic reaction; or
6. lack of timely and appropriate monitoring required for drug titration.
In training an unlicensed person to administer medications in accordance with HRC §§161.091 – 161.096, DADS encourages providers to utilize the “Six Rights of Medication Administration,” which include giving the right medication to the right person in the right dosage at the right time by the right route of administration and recording the dosage and time that the medication was given.
Nurse Accountability
In accordance with Texas Human Resources Code, §161.095, an RN performing an individual assessment or an RN or LVN training an unlicensed person or determining whether an unlicensed person is competent to perform administration of medication may be held accountable or civilly liable only in relation to whether the nurse properly performed the assessment, conducted the training, and determined whether the unlicensed person is competent to provide administration of medication to individuals.
Section 161.095(c) provides that an RN or LVN may not be held accountable or civilly liable for the acts or omissions of an unlicensed person performing administration of medication if the assessment and training were properly performed.
Texas BON RN Delegation Rules
Texas Board of Nursing
An RN working in an ICF/IID may delegate tasks other than medication administration if the situation and task delegated meet all the requirements for delegation under the BON’s rules at Texas Administrative Code, Title 22, Part 11, Chapter 224 and Chapter 225. 22 TAC §225.9(c) states that “if the RN is employed, the employing entity must have a written policy acknowledging that the final decision to delegate shall be made by the RN in consultation with the individual or client's responsible adult.”
All rules and regulations are subject to change.
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