BP BHEAD INT H

AN ACT Relating to nurse delegation; adding new sections to chapter 74.04 RCW; and adding a new section to chapter 18.88A RCW.

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

NEW SECTION. Sec. 1. There is need to provide economical, quality care in the community long-term care program of the department of social and health services. In order to do this the legislature finds that trained unlicensed persons should be allowed to help in the care of persons in the community long-term care system, with nurse delegation, training, and supervision.

NEW SECTION. Sec. 2. As used in section 3 of this act:

(1) "Stable condition" means a situation where the client's clinical and behavioral status and nursing care needs are determined by the registered nurse to be nonfluctuating and consistent. Excluded from this definition is a situation where the client's clinical and behavioral status is changing and where frequent reassessment by a registered nurse is needed.

(2) "Unlicensed person" means an individual who is not licensed to practice nursing, medicine, or any other health occupation requiring a license in Washington state, but who provides basic or special tasks of nursing/client care in the following settings: Adult family homes and assisted living settings. For the purposes of section 3 of this act, a nursing assistant-certified, as defined by RCW 18.88A.020, is an unlicensed person. For the purpose of section 3 of this act and rules adopted under section 3 of this act, unlicensed persons do not include members of the client's immediate family. Family members may perform tasks of nursing without specific delegation from a registered nurse per RCW 18.88.030.

NEW SECTION. Sec. 3. (1) In accordance with rules adopted jointly by the department of health and the department of social and health services, trained unlicensed persons employed in the community-based long-term care service system regulated by the department of social and health services shall be allowed to administer; provided that expansion or contraction of task delegation within the scope of this subsection shall be at the discretion of the delegating registered nurse and will be based upon the registered nurse's assessment of the skills of the unlicensed person.

(a) Oral medication;

(b) Topical medication, including ear, nose, and eye drops;

(d) Suppositories and unit dose enemas;

(e) Home blood glucose testing and monitoring;

(f) Injectable insulin;

(g) Gastrostomy tube feedings;

(h) Clean intermittent catheterization;

(i) Inhalants; and

(j) Oro-pharyngeal suctioning.

(2) The rules shall provide for the following and such other matters as deemed necessary to the proper implementation of this section, including:

(a) Such care as shall be delegated and taught, which shall be ordered by a health care practitioner licensed under Title 18 RCW, and who has prescriptive authority. If the registered nurse obtains verbal orders amending the existing orders, the verbal orders shall be reduced to writing per standards established by rule.

(b) A requirement that such delegation be made only in the case of stable clients not requiring ongoing nursing assessment.

(d) A requirement for appropriate training using standards established jointly by the department of health and the department of social and health services, which should include such matters as return demonstrations, and other quality control checks.

(e) A requirement that there be written instructions and appropriate supervision of the trained unlicensed person, which may be indirect.

(f) A requirement that each unlicensed person be allowed to only perform delegated tasks for a client for which they have been trained; such training shall not be transferable, but shall be specific to each client.

(g) A requirement that the trained unlicensed person follow directions, or take appropriate corrective action upon notice of inappropriate care to comply with the care plan and directions of the supervising nurse in charge, and the department of social and health services shall take action to discipline or to prevent further inappropriate care by any contract provider or licensee.

(h) A requirement that each nurse involved, or any agency involved in providing care shall keep a list of each person to whom tasks have been delegated, and the training, and the results of each follow-up visit; such record shall be distinct from any clinical record.

(i) A requirement that an appropriate quality assurance system be developed, including both evaluation of the program, individual clients, and outcomes, and a method to make regular adjustments in the program or level of care of clients, and the training of trained unlicensed persons.

(j) A requirement that appropriate protocols and procedures be developed, and that there be an ongoing mechanism to revise and update such policies.

(3) The accountability of a registered nurse providing services under this chapter shall be limited to the assessment, training, evaluation, delegation, and plan for supervision as defined in this chapter.

NEW SECTION. Sec. 4. A new section is added to chapter 18.88A RCW to read as follows:

Sections 1 through 3 of this act do not apply to persons working in community-based long-term care service system regulated by the department of social and health services. The department of social and health services shall keep a registry of those persons working as trained unlicensed persons.

NEW SECTION. Sec. 5. Sections 1 through 3 of this act are each added to chapter 74.04 RCW.