BP BHEAD INT H

AN ACT Relating to health treatment for individuals with developmental disabilities; amending RCW 18.88A.020; and adding new sections to chapter 71A.10 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 71A.10 RCW to read as follows:

(1) In order to enhance the independence and to protect the health and safety of people with developmental disabilities, community residential programs certified by the department of social and health services under chapter 71A.12 RCW and adult family homes licensed under chapter 70.128 RCW may permit certain staff who are employed as direct care staff who have been trained and have registered as nursing assistants specializing in developmental disabilities as required in section 3 of this act to administer the following medications or treatments to persons with developmental disabilities:

(a) Oral medication;

(b) Topical medication;

(d) Suppositories;

(e) Home glucose testing and monitoring procedures;

(f) Enemas packaged in unit doses only;

(g) Prescribed emergency procedures to treat identified anaphylactic reactions;

(h) Insulin injections, under conditions provided in subsection (4) of this section; and

(i) Gastrostomy tube feedings, under conditions provided in subsection (4) of this section.

(2) Treatment authorized by this section must be prescribed by a health care practitioner licensed under Title 18 RCW and who has prescriptive authority, acting within the scope of his or her license, and may be administered only after proper training as specified in subsection (3) of this section.

(3) A registered nurse licensed under chapter 18.88 RCW must train the nursing assistant specializing in developmental disabilities. Training shall include the following:

(a) Teaching of the nursing assistant specializing in developmental disabilities the task, including, the nature of the condition requiring treatment, risks of the treatment, side effects, and interaction of prescribed medications;

(b) Observation of the nursing assistant specializing in developmental disabilities performing the task to assure that the nursing assistant specializing in developmental disabilities does the task safely and accurately;

(c) Written instructions for performance of the task for the nursing assistant specializing in developmental disabilities to use as a reference;

(d) Instructions to the nursing assistant specializing in developmental disabilities that the task being taught is specific to this client only and is not transferable to other clients or taught to other care providers;

(e) Documentation of how the task was taught, the teaching outcome, the content and type of instructions left for the nursing assistant specializing in developmental disabilities, evidence that the nursing assistant specializing in developmental disabilities understands risks involved in performing the task and has a plan for how to respond to the consequences, and evidence that the nursing assistant specializing in developmental disabilities was instructed that the task is client-specific and not transferable to other clients or providers;

(f) Performance of the administration of medications or treatments by nursing assistants specializing in developmental disabilities authorized in this section shall be reviewed at least annually by a registered nurse.

(4) A registered nurse may delegate administration of subcutaneous insulin injections and gastrostomy, but not nasogastric, tube feedings to a nursing assistant or assistants specializing in developmental disabilities specific to one client under the following conditions:

(a) The registered nurse shall consider the nature of the task to be provided, its complexity, risk involved, and the necessary skill needed;

(b) The registered nurse shall assess the client's condition and determine that there is not a significant risk to the client if the nursing assistant specializing in developmental disabilities performs the task in the absence of direct supervision;

(c) The registered nurse shall determine how frequently the client's condition shall be reassessed to determine the appropriateness of the continued delegation of the task to a nursing assistant specializing in developmental disabilities;

(d) If there is some risk involved to the client, the registered nurse shall determine that the nursing assistant specializing in developmental disabilities is prepared to respond effectively to the consequences;

(e) The registered nurse shall assess the ability of the nursing assistant specializing in developmental disabilities to perform the task;

(f) The registered nurse shall determine the frequency of supervision of the nursing assistant specializing in developmental disabilities;

(g) The registered nurse shall document the process for deciding that the task can be safely delegated for the specific client to the specific nursing assistant specializing in developmental disabilities;

(h) The registered nurse shall document how frequently the client should be reassessed by a registered nurse regarding continued delegation of the task to the nursing assistant specializing in developmental disabilities;

(i) The responsibility, accountability, and authority for teaching and delegation of administration of insulin injections and gastrostomy tube feeding to the nursing assistant specializing in developmental disabilities shall remain with the registered nurse;

(j) The registered nurse shall have the responsibility and accountability to determine which nursing assistants specializing in developmental disabilities and the number of nursing assistants specializing in developmental disabilities that must be taught and delegated the task of administration of insulin and gastrostomy tube feedings;

(k) The number of persons to whom the tasks are taught and delegated shall be limited to the number that can be safely supervised by the registered nurse; and

(l) The registered nurse shall assure that the nursing assistant specializing in developmental disabilities maintains proficiency in performing the tasks through periodic supervision by the registered nurse.

(5) The delegating registered nurse has a responsibility to determine that the nursing assistant specializing in developmental disabilities is indeed competent to perform the delegated act. Nonnursing and managerial persons shall not coerce the registered nurse into compromising client safety by requiring the registered nurse to delegate. Both the delegating registered nurse and the nursing assistant specializing in developmental disabilities are accountable for their own actions in the delegation process.

(6) This section may not be construed to apply to persons who are not developmentally disabled or to persons who are living in residential habilitation centers.

NEW SECTION. Sec. 2. A new section is added to chapter 71A.10 RCW to read as follows:

The definitions in this section apply throughout this chapter.

(1) "Delegation" means direct authorization granted by a registered nurse to an unlicensed nursing assistant specializing in developmental disabilities to perform the functions authorized in this chapter that fall within the scope of practice of the delegator and that are not within the scope of practice of the delegatee.

(2) "Supervision of unlicensed nursing assistants specializing in developmental disabilities" means the provision of guidance and evaluation by a qualified registered nurse for the accomplishment of the specific tasks enumerated in section 1 of this act with the initial direction of the task or activity, periodic inspection of the actual act of accomplishing the task or activity, and the authority to require corrective action. The licensed registered nurse is not required to be on the premises but has given oral and written instructions relating to the specific task or activity and the client has been assessed by the licensed registered nurse prior to authority or delegation being granted to perform the task or activity.

Sec. 3. RCW 18.88A.020 and 1991 c 16 s 2 are each amended to read as follows:

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Department" means the department of health.

(2) "Secretary" means the secretary of health.

(3) "Board" means the Washington state board of nursing.

(4) "Nursing assistant" means an individual, regardless of title, who, under the direction and supervision of a registered nurse or licensed practical nurse, assists in the delivery of nursing and nursing-related activities to patients in a health care facility. The two levels of nursing assistants are (a) "nursing assistant-certified," an individual certified under this chapter, (b) "nursing assistant-registered," an individual registered under this chapter.

(5) "Nursing assistant specializing in developmental disabilities" means an individual employed as direct care staff in a community residential program certified by the department of social and health services under chapter 71A.12 RCW or an adult family home licensed under chapter 70.128 RCW and who has been trained by a registered nurse licensed under chapter 18.88 RCW to administer the specific medications or treatments authorized in chapter 71A.10 RCW. For the sole purpose of maintaining a registry of qualified persons, an unlicensed person administering medications or treatments authorized under chapter 71A.10 RCW shall register with the Washington state board of nursing as a nursing assistant specializing in developmental disabilities.

(6) "Committee" means the Washington state nursing assistant advisory committee.

((~~(6)~~)) (7) "Approved training program" means a nursing assistant-certified training program approved by the board. For community college, vocational-technical institutes, skill centers, and secondary school as defined in chapter 28B.50 RCW, nursing assistant-certified training programs shall be approved by the board in cooperation with the board for community and technical colleges ((~~education~~)) or the superintendent of public instruction.

((~~(7)~~)) (8) "Health care facility" means a nursing home, hospital, hospice care facility, home health care agency, hospice agency, or other entity for delivery of health care services as defined by the board.

((~~(8)~~)) (9) "Competency evaluation" means the measurement of an individual's knowledge and skills as related to safe, competent performance as a nursing assistant.