WSR 10-19-044

PERMANENT RULES

DEPARTMENT OF HEALTH


[ Filed September 13, 2010, 10:15 a.m. , effective October 14, 2010 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: SHB 1414 (2009) expands the scope of practice for a health care assistant (HCA) to administer certain over-the-counter and prescription drugs. The amended rules add what drugs health care assistants can administer and the routes of administration. The rules also specify how a health care assistant may demonstrate initial and ongoing competency to administer specific drugs as determined by the health care practitioner.

Citation of Existing Rules Affected by this Order: Amending WAC 246-826-030, 246-826-100, 246-826-200, and 246-826-300.

Statutory Authority for Adoption: RCW 18.135.030 (SHB 1413, chapter 43, Laws of 2009).

Adopted under notice filed as WSR 10-10-051 on April 29, 2010.

Changes Other than Editing from Proposed to Adopted Version: WAC 246-826-100 was revised to include a reference in the table to existing WAC 246-826-303, which states that injectable drugs may be administered by category G health care assistants. A sentence was also added to clarify that the supervisor is responsible for ensuring the HCA has proper education and training.

A final cost-benefit analysis is available by contacting Erin Obenland, Program Manager, Department of Health, Health Care Assistant Program, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4945, fax (360) 236-2901, e-mail erin.obenland@doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 4, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 4, Repealed 0.

Date Adopted: September 13, 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-3031.6


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 under 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 ***
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.
*** - Drugs by injection listed under WAC 246-826-303 (2)(c).

(2) A written order from a supervising health care practitioner authorizing the administration of drugs listed in RCW 18.135.130 must be provided to the health care assistant.

(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.

(5) The supervisor or delegator is responsible for the patient's care. The tasks delegated to any category of health care assistant must be based on the health care assistant's individual education and training.

[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

(((2))) (3) The schedule of drugs in subsection (((1))) (2) of this section shall not include the following unless the delegator is physically present in the immediate area where the drug is administered:

(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.]

Washington State Code Reviser's Office