PROPOSED RULES
Original Notice.
Preproposal statement of inquiry was filed as WSR 09-15-189.
Title of Rule and Other Identifying Information: Chapter 246-826 WAC, amending the chapter to expand the scope of practice for health care assistants.
Hearing Location(s): Department of Health, Point Plaza East, Room 152, 310 Israel Road S.E., Olympia, WA 98501, on June 8, 2010, at 1:30 p.m.
Date of Intended Adoption: June 8, 2010.
Submit Written Comments to: Erin Obenland, P.O. Box 47852, Olympia, WA 98504-7852, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-2406, by June 4, 2010.
Assistance for Persons with Disabilities: Contact Erin Obenland by May 20, 2010, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: SHB 1414 (chapter 43, Laws of 2009) expands the scope of practice for a health care assistant allowing them to administer certain over-the-counter and prescription drugs. Rules need to be amended to add what drugs health care assistants can administer, which categories can administer the drugs, and the routes of administration. The proposed rules will also specify how a health care assistant may demonstrate initial and ongoing competency to administer specific drugs as determined by the health care practitioner.
Reasons Supporting Proposal: The department of health is proposing amending existing rules to reflect the change in the scope of practice and to include the legislation expiration date of July 1, 2013.
Statutory Authority for Adoption: RCW 18.135.030.
Statute Being Implemented: Chapter 18.135 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, health care assistant program, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Erin Obenland, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4945.
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 cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Erin Obenland, Program Manager, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4945, fax (360) 236-2406, e-mail erin.obenland@doh.wa.gov.
April 29, 2010
Mary C. Selecky
Secretary
OTS-3030.2
AMENDATORY SECTION(Amending WSR 09-02-081, filed 1/7/09,
effective 2/7/09)
WAC 246-826-030
Supervision of health care assistants.
A health care assistant may be supervised by either the
delegator or by another practitioner who can order the act
under his or her own license. The practitioner who is
supervising the health care assistant must be physically
present and immediately available in the facility during the
administration of injections ((or)), vaccines or drugs
authorized in RCW 18.135.130. The supervising practitioner
need not be present during procedures to withdraw blood.
[Statutory Authority: RCW 18.135.030, 2008 c 58. 09-02-081, § 246-826-030, filed 1/7/09, effective 2/7/09. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-826-030, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.135.030. 85-06-018 (Order PL 515), § 308-175-020, filed 2/25/85.]
OTS-3031.4
AMENDATORY SECTION(Amending WSR 09-02-081, filed 1/7/09,
effective 2/7/09)
WAC 246-826-100
Health care assistant classification.
(1) There are seven categories of health care assistants. ((All categories may administer vaccines with appropriate
delegation and supervision. This can be done by injection,
orally, topically, or by nasal administration.
(1) Category A assistants may perform venous and capillary invasive procedures for blood withdrawal.
(2) Category B assistants may perform arterial invasive procedures for blood withdrawal.
(3) Category C assistants may perform intradermal, subcutaneous and intramuscular injections for diagnostic agents and administer skin tests.
(4) Category D assistants may perform intravenous injections for diagnostic agents.
(5) Category E assistants may perform intradermal, subcutaneous and intramuscular injections for therapeutic agents and administer skin tests.
(6) Category F assistants may perform intravenous injections for therapeutic agents.
(7) Category G assistants may perform hemodialysis.)) The table in this subsection outlines the tasks authorized for each category of health care assistant. The administration of drugs pursuant to RCW 18.135.130 expires on July 1, 2013.
| Categories | A | B | C | D | E | F | G |
| May perform: | Venous and capillary invasive procedures for blood withdrawal | Arterial invasion procedures for blood withdrawal | Intradermal, subcutaneous and intramuscular injections for diagnostic agents and administer skin tests | Intravenous injections for diagnostic agents | Intradermal, subcutaneous and intramuscular injections for therapeutic agents and administer skin tests | Intravenous injections for therapeutic agents | Hemodialysis |
| Injection | Not authorized | Not authorized | V, I | I | V, I | I | Not authorized |
| Oral | V | V | D, V | V | D, V | V | V |
| Topical | D, V | D, V | D, V | D, V | D, V | D, V | D, V |
| Nasal | D, V | D, V | D, V | D, V | D, V | D, V | D, V |
| Rectal | D | D | D | D | D | D | D |
| Otic | D | D | D | D | D | D | D |
| Ophthalmic | D | D | D | D | D | D | D |
| Inhaled | D | D | D | D | D | D | D |
| D - Drugs administered under RCW 18.135.130. | |
| I - Drugs by injection under WAC 246-826-200. | |
| V - Vaccines administered under RCW 18.135.120. |
(3) Health care assistants may perform supervised delegated functions as provided under WAC 246-826-020 and 246-826-030.
(4) Health care assistants must be able to demonstrate initial and ongoing competency to the supervisor or delegator on the administration of authorized drugs listed in RCW 18.135.130. Competency may be demonstrated by:
(a) Practicing techniques in a simulated situation; or
(b) Observing and performing procedures on patients until the health care assistant demonstrates proficiency to administer authorized drugs identified in the table in subsection (1) of this section; or
(c) Documenting all training on a checklist appropriate to the facility of the administration of drugs by the health care assistant. The health care assistant must complete and sign the form, have the form signed by the supervisor and the delegator, and have the form placed in their employee personnel file; or
(d) Other methods determined by the delegator.
[Statutory Authority: RCW 18.135.030, 2008 c 58. 09-02-081, § 246-826-100, filed 1/7/09, effective 2/7/09. Statutory Authority: RCW 18.135.030 and 18.135.020. 02-06-115, § 246-826-100, filed 3/6/02, effective 4/6/02. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-826-100, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.135.030. 87-23-022 (Order PM 689), § 308-175-075, filed 11/12/87.]
OTS-3032.3
AMENDATORY SECTION(Amending Order 121, filed 12/27/90,
effective 1/31/91)
WAC 246-826-200
Hospital or nursing home drug injection.
(1) ((Class C, D, E, or F)) Health care assistants certified
in categories C, D, E or F and working in a hospital or
nursing home may administer by injection the ((following types
of)) drugs ((by injection as)) listed in subsection (2) of
this section if:
(a) Authorized and directed by a delegator; and ((as
permitted by the category of certification of the health care
assistant:))
(b) It is within their scope of practice as identified in the table of WAC 246-826-100.
(2) Drugs authorized to be administered by injection include:
| Antihistamines | |
| Antiinfective agents | |
| Antineoplastic agents | |
| Autonomic drugs | |
| Blood derivatives | |
| Blood formation and coagulation | |
| Cardiovascular drugs | |
| CNS agents | |
| Diagnostic agents | |
| Electrolytic, caloric and water balance | |
| Enzymes | |
| Gastrointestinal drugs | |
| Gold compounds | |
| Heavy metal antagonists | |
| Hormones/synthetic substitutes | |
| Local anesthetics | |
| Oxytocics | |
| Radioactive agents | |
| Serums toxoids, vaccines | |
| Skin and mucous membrane agents | |
| Smooth muscle relaxants | |
| Vitamins | |
| Unclassified therapeutic agents |
(a) Any controlled substances as defined in RCW 69.50.101
(1)(d)((,)); or
(b) Any experimental drug ((and)); or
(c) Any cancer chemotherapy agent ((unless a delegator is
physically present in the immediate area where the drug is
administered)).
[Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-826-200, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.135.030. 87-23-022 (Order PM 689), § 308-175-130, filed 11/12/87.]
OTS-3033.3
AMENDATORY SECTION(Amending WSR 02-06-115, filed 3/6/02,
effective 4/6/02)
WAC 246-826-300
Definitions.
((This section defines
terms used in hemodialysis.
(1))) The definitions in this section apply throughout hemodialysis rules, WAC 246-826-301 through 246-826-303, unless the context clearly requires otherwise.
(1) "Competency" means the demonstration of knowledge in a specific area and the ability to perform specific skills and tasks in a safe, efficient manner.
(2) "Dialysis facility or center" means a place awarded conditional or unconditional status by the center for medicaid/medicare services to provide dialysis services. This does not include in the home setting.
(3) "Direct supervision" means the licensed health care practitioner, as required by or authorized by RCW 18.135.020, is physically present and accessible in the immediate patient care area and available to intervene, if necessary.
(4) "End-stage renal disease" (ESRD) means the stage of renal impairment that appears irreversible and permanent, and requires either the replacement of kidney functions through renal transplantation or the permanent assistance of those functions through dialysis.
(5) "Hemodialysis" means a process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another across a semipermeable membrane.
(6) "Hemodialysis technician" means a person certified as a health care assistant, Category G, by the department of health, who is authorized under chapter 18.135 RCW and these rules to assist with the direct care of patients undergoing hemodialysis and to perform certain invasive procedures under proper delegation and supervision by health care practitioners.
(((2) "Competency" means the demonstration of knowledge
in a specific area and the ability to perform specific skills
and tasks in a safe, efficient manner.
(3) "Hemodialysis" means a process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another across a semipermeable membrane.
(4) "Dialysis facility or center" means a place awarded conditional or unconditional status by the center for medicaid/medicare services to provide dialysis services. This does not include in the home setting.
(5) "Direct supervision" means the licensed health care practitioner, as required by or authorized by RCW 18.135.020, is physically present and accessible in the immediate patient care area and available to intervene, when necessary.
(6))) (7) "Preceptor" means the licensed health care practitioner, as required by or authorized by RCW 18.135.020, who supervises, trains, and/or observes students providing direct patient care in a dialysis facility or center.
(((7))) (8) "Training monitor" means the certified
hemodialysis technician who with limited accountability
mentors skill building and monitors for safety. The training
monitor does not replace or substitute for the preceptor.
(((8) "End-stage renal disease" (ESRD) means the stage of
renal impairment that appears irreversible and permanent, and
requires either the replacement of kidney functions through
renal transplantation or the permanent assistance of those
functions through dialysis.))
[Statutory Authority: RCW 18.135.030 and 18.135.020. 02-06-115, § 246-826-300, filed 3/6/02, effective 4/6/02.]