Original Notice.

     Preproposal statement of inquiry was filed as WSR 12-20-019.

     Title of Rule and Other Identifying Information: WAC 246-841-586 through 246-841-595, medication assistant endorsement, the proposed rules establish requirements for an optional medication assistant endorsement for nursing assistants-certified working in nursing homes.

     Hearing Location(s): Department of Health, 243 Israel Road S.E., Town Center 3, Room 224, Tumwater, WA 98501, on June 11, 2013, at 1:00 p.m.

     Date of Intended Adoption: June 11, 2013.

     Submit Written Comments to: Mary Dale, P.O. Box 47864, Olympia, WA 98504-7864, e-mail http://www3.doh.wa.gov/policyreview/, fax (360) 236-4738, by June 4, 2013.

     Assistance for Persons with Disabilities: Contact Louise Lloyd by June 4, 2013, TTY (800) 833-6388 or 711.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: ESHB 2473 passed in 2012, creating a new medication assistant endorsement option for nursing assistants-certified working in nursing homes. The legislation requires the nursing care quality assurance commission (NCQAC) to: Establish requirements for the endorsement, including minimum work experience, education, training, examination, and continuing competency; define tasks that can be performed and primary responsibilities of the nursing assistant with an endorsement; and set requirements for the educational programs so that the nursing assistants-certified receive adequate training for these responsibilities.

     Reasons Supporting Proposal: ESHB 2473 allows an expanded role for the nursing assistant-certified who meets specific requirements. This endorsement will allow the nursing assistant-certified to perform specific tasks in nursing home settings. The proposed rule sets the requirements for the endorsement, outlines tasks that may be performed with an endorsement, and sets requirements for the educational programs in order to implement issuing of endorsements. The requirement must be in rule to be enforced.

     Statutory Authority for Adoption: ESHB 2473 (chapter 208, Laws of 2012); RCW 18.88A.060.

     Statute Being Implemented: ESHB 2473 (chapter 208, Laws of 2012).

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: NCQAC, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Paula Meyer, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4713.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry. A copy of the statement may be obtained by contacting Mary Dale, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4744, fax (360) 236-4738, e-mail mary.dale@doh.wa.gov.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Mary Dale, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4744, fax (360) 236-4738, e-mail mary.dale@doh.wa.gov. The agency did not complete a cost-benefit analysis under RCW 34.05.328. RCW 34.05.328 (5)(b)(v) exempts rules the content of which is explicitly and specifically dictated by statute.

April 29, 2013

Paula R. Meyer, MSN, RN

Executive Director

OTS-5217.5

MEDICATION ASSISTANT ENDORSEMENT
NEW SECTION
WAC 246-841-586   Applicability.   WAC 246-841-587 through 246-841-595 apply to the endorsement of a nursing assistant-certified as a medication assistant. A nursing assistant-certified with a medication assistant endorsement administers medications and nursing commission-approved treatments to residents in nursing homes, under the direct supervision of a designated registered nurse.

     Nothing in these rules requires a nursing home to employ a nursing assistant-certified with a medication assistant endorsement. A medication assistant's employer may limit or restrict the range of functions permitted in these rules but may not expand those functions.

     WAC 246-841-587 through 246-841-595 also apply to the approval of education and training programs and competency evaluations for medication assistants.

     A medication assistant is responsible and accountable for his or her specific functions.

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

     (2) "Direct supervision" means that the licensed registered nurse who directs medication administration and nursing commission-approved treatments to a medication assistant is on the premises, is immediately accessible in person and has assessed the residents prior to performance of these duties.

     (3) "Medication assistant" means a nursing assistant-certified with a medication assistant endorsement issued under chapter 18.88A RCW.

     (4) "Nursing home" means a nursing home licensed under chapter 18.51 RCW.

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     (a) Be certified as a nursing assistant-certified, with a certification in good standing, under chapter 18.88A RCW;

     (b) Successfully complete a nursing commission-approved medication assistant education and training program, as described in WAC 246-841-590 (6) and (7) within the immediate year prior to the date of application;

     (c) Complete at least one thousand hours of work experience in a nursing home as a nursing assistant-certified within the immediate year prior to the date of application; and

     (d) After completing the requirements in (a) through (c) of this subsection, pass the nursing commission-approved medication assistant competency evaluation. Each applicant must successfully complete a written competency evaluation. The competency evaluation must measure an individual's knowledge and skills related to the safe, competent performance as a medication assistant. The evaluation assesses the competency specification required in the core curriculum as listed in WAC 246-841-590(6).

     (2) Application requirements:

     (a) To obtain an initial medication assistant endorsement credential, the nursing assistant-certified must submit to the department:

     (i) An application on forms approved by the secretary.

     (ii) The applicable fees under WAC 246-841-990.

     (iii) Proof of completion of a nursing commission approved medication assistant:

     (A) Education and training program under WAC 246-841-590 (6) and (7); and

     (B) Competency evaluation under subsection (1) of this section; and

     (iv) Employer documentation of work experience as required in subsection (1)(c) of this section.

     (b) An applicant who is currently credentialed as a medication assistant in another state or jurisdiction may qualify for a medication assistant endorsement credential under this chapter. An applicant must submit to the department:

     (i) An application on forms approved by the secretary;

     (ii) Written verification directly from the state or jurisdiction in which the applicant is credentialed, attesting that the applicant holds a credential substantially equivalent to the medication assistant endorsement credential in Washington in good standing, and is not subject to charges or disciplinary action;

     (iii) Verification of completion of the required education that is substantially equivalent to the education requirements as described in WAC 246-841-590 (6) and (7) within the immediate year prior to the date of application;

     (iv) Employer documentation of work experience as required in subsection (1)(c) of this section; and

     (v) The applicable fees under WAC 246-841-990.

     (3) Renewal requirements: To renew a medication assistant endorsement credential, the medication assistant must have a current nursing assistant-certified credential in good standing, and meet the requirements of WAC 246-12-030.

     (4) Continuing competency requirements: A medication assistant shall meet the following requirements on an annual basis to coincide with renewal of their nursing assistant-certified credentials:

     (a) Employer documentation of successful completion of two hundred fifty hours of employment as a medication assistant in a nursing home setting under the direct supervision of a registered nurse;

     (b) Documentation of eight hours of continuing education specific to medications, medication administration, and performance of selected patient treatments. Continuing education hours must be obtained through a nursing commission-approved medication education and training program as described in WAC 246-841-590 (6) and (7), continuing education programs approved by a professional association, or staff development programs offered in a nursing home. The education hours must directly relate to the medication assistant's role of medication administration and the performance of selected patient treatments.

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     (2) It is the responsibility of the designated registered nurse to assess the individual needs of each resident and determine that the direction of medication administration or selected treatment tasks poses minimal risks to each resident. The designated registered nurse determines the frequency of resident assessments and decides the number and types of medications to be administered.

     (3) The medication assistant under the direct supervision of a registered nurse in a nursing home, may:

     (a) Administer over-the-counter medications;

     (b) Administer legend drugs, with the exception of chemotherapeutic agents and experimental drugs;

     (c) Administer schedule IV and V medications orally, topically, and through inhalation;

     (d) Perform simple prescriber-ordered treatments which include blood glucose monitoring, noncomplex clean dressing changes, pulse oximetry readings, and oxygen administration. "Prescriber ordered treatment" means an order for drugs or treatments issued by a practitioner authorized by law or rule in the state of Washington to prescribe drugs or treatments in the course of his or her professional practice for a legitimate medical purpose.

     (4) The medication assistant shall document accurately the administration of medication and performance of resident treatments that he or she undertakes into the resident's medical records on facility-approved forms.

     (5) Performance of the tasks identified in subsection (1) of this section will be the sole work assignment to the medication assistant.

     (6) A medication assistant may not perform the following tasks:

     (a) Assessment of resident need for, or response to medication;

     (b) Acceptance of telephone or verbal orders from prescribers;

     (c) Conversion or calculation of drug dosages;

     (d) Injection of any medications;

     (e) Administration of chemotherapeutic agents and experimental drugs;

     (f) Performance of any sterile task or treatment;

     (g) Medication administration through a tube;

     (h) Administration or participation in the handling, including counting or disposal, of any schedule I, II, or III controlled substances;

     (i) Participation in any handling, including counting or disposal, of schedule IV and V controlled substances other than when administering these substances as authorized by subsection (3)(c) of this section;

     (j) Performance of any task requiring nursing judgment, such as administration of as necessary or as needed (prn) medications.

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     (a)(i) Be a nursing commission-approved nursing assistant certified training program in good standing; or

     (ii) Be a nursing commission-approved nursing educational program in good standing; and

     (b) Have a program director and instructional staff who each hold current, active, Washington state licenses in good standing as a registered nurse. The commission may deny or withdraw approval of a program director or instructor if there is or has been any action taken against that person's health care license, or any license that restricts his or her permission to work with vulnerable adults.

     (2) To apply, the program must submit a completed application packet and application forms provided by the department of health to the nursing commission. The packet must include:

     (a) Program objectives;

     (b) Curriculum outline and content as detailed in subsection (6) of this section;

     (c) Written contractual agreements related to the provision of the training. For any program that uses another facility for the clinical practicum, this includes an affiliation agreement between the training program and the facility. "Clinical practicum" means clinical experience under the supervision of a qualified registered nurse instructor. The affiliation agreement must describe how the program will provide clinical experience in the facility. The agreement must specify the rights and responsibilities of students, the residents, the clinical facility, and the school;

     (d) Sample lesson plan for one unit;

     (e) Skills checklists for student lab performance and clinical performance during the practicum with dates of skills testing and signature of the instructor;

     (f) Description of classroom, lab, and clinical practicum facilities;

     (g) Declaration of compliance with administrative guidelines signed by the program director;

     (h) Verification that the program director has completed a course on adult instruction or has one year of experience in the past three years teaching adults. Acceptable experience does not include staff development or patient teaching. A program director working exclusively in post secondary educational setting is exempt from this requirement; and

     (i) Verification that the medication assistant training program or school is approved to operate in the state of Washington by the state board for community and technical colleges; the superintendent of public instruction; or the workforce training and education coordinating board.

     (3) Failure to submit a completed application packet within ninety days will result in closure of the application.

     (4) If a program application is pending for more than ninety days, the proposed program must submit a revised program application.

     (5) The program director, or designee shall:

     (a) Agree to allow and cooperate with on-site surveys and investigations of the training programs, as requested by the nursing commission;

     (b) Comply with any changes in training standards and guidelines in order to maintain approved status;

     (c) Notify the nursing commission and any other approving agency of any changes in overall curriculum plan or major curriculum content changes prior to implementation such as changes in program hours, clinical practice facilities, program name or ownership, legal status, and credit status impacting the program's ability to sustain itself financially;

     (d) Notify the nursing commission and any other approving agency of changes in program director or instructors; and

     (e) Maintain an average annual student pass rate of eighty percent for first-time test takers of the medication assistant competency evaluation.

     (6) Core curriculum competency requirements.

     (a) The program curriculum must include training on the specific tasks that a medication assistant may perform as well as training on identifying tasks that may not be performed by a medication assistant as listed in WAC 246-841-589.

     (b) The program curriculum must include the complete medication assistant-certified model curriculum adopted by the National Council of State Boards of Nursing. The education and training program may add to the required curriculum as stated in these rules but may not delete any content from the required curriculum.

     (c) The curriculum must include a minimum of sixty hours of didactic training which must include work in a skills lab or simulation facility.

     (7) Practicum. The curriculum will include a minimum of forty hours of supervised and progressive clinical practicum in the administration of medications to residents in a nursing home. At no time will the ratio of students to instructor be allowed to exceed ten students to one instructor during clinical practicum.

     (8) The program director must attest to the student's successful completion of the course on forms or electronic methods established by the commission.

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     (a) Complaints relating to violations of the rules;

     (b) Failure to notify the nursing commission of any changes in the overall curriculum plan or major content changes prior to implementation;

     (c) Failure to notify the nursing commission of changes in program director or instructors;

     (d) Providing false or misleading information to students or the public concerning the medication assistant education and training program;

     (e) Failure to secure or retain a qualified program director resulting in substandard supervision and teaching of students;

     (f) Failure to maintain an average annual passing rate of eighty percent of first time test takers for two consecutive years. The nursing commission will require the program to assess the problem and submit a plan of correction.

     (2) If a medication assistant education and training program fails to maintain an annual average passing rate of eighty percent of first time test takers for three out of four consecutive years, the nursing commission may withdraw program approval.

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     (2) Statement of deficiencies. The program must within ten calendar days of notification of the cited deficiencies prepare, sign, date, and provide to the commission a detailed written plan of correction. Such plan of correction will provide notification to the commission of the date by which the program will complete the correction of cited deficiencies. The commission will review the program's plan of correction to determine if it is acceptable. A plan of correction must:

     (a) Address how corrective action will be accomplished;

     (b) Address what measures will be put into place or systematic changes made to assure that the deficient practice will not recur;

     (c) Indicate how the program plans to monitor its performance to assure that solutions are sustained;

     (d) Give the name and title of the person who is responsible for assuring the implementation of the plan of correction;

     (e) Give the day by which the correction will be made.

     (3) Notice of intent to withdraw approval. The commission may issue a notice of intent to withdraw approval from ongoing programs if it determines that a medication assistant endorsement program fails to substantially meet the standards contained in the law and this chapter.

     When the commission withdraws approval, and the program does not appeal the withdrawal under WAC 246-841-594, the program shall submit an action plan to the commission providing for enrolled students to complete the program.

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     A program that is automatically terminated for failure to renew may be immediately reinstated upon meeting all conditions for a new application approval.

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     (2) Commission approval is automatically terminated if the program does not renew.

     (3) The commission may deny renewal approval or grant renewal with provisional status if the program fails to substantially meet the standards contained in the law and this chapter or has pending a statement of deficiencies, plan of correction, intent to withdraw approval, or withdrawal of approval.

     (4) If a program application renewal is not completed within ninety days of its receipt, the commission may close the application renewal.

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