AN ACT Relating to the
credentialing of hemodialysis technicians; amending RCW 18.135.020 and
18.135.060; creating new sections; and providing an effective date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF
WASHINGTON:
NEW SECTION. Sec.
1. There are concerns about
the quality of care dialysis patients are receiving due to the lack of uniform
training standards for hemodialysis clinical personnel working in renal
dialysis facilities in this state. Currently, hemodialysis technicians are trained
by the facilities, and most facilities have established training programs
providing from six to eight weeks of ongoing training. Training is not
standardized and varies among facilities. Some facilities offer no on-site
training. National studies indicate that renal dialysis facilities avoid costs
by reducing staffing levels and substituting untrained technicians for
professional nurses generally in response to inadequate medicare
reimbursements. These studies also suggest a resulting increase in patient
morbidity and mortality.
The legislature finds
that the regulation of hemodialysis technicians will increase the level of
professionalism in the state's renal dialysis facilities, providing increased
quality assurance for patients, health care providers, third-party payers, and
the public in general. The legislature declares that this act furthers the
public health, safety, and welfare of the people of the state.
Sec. 2. RCW 18.135.020 and 1997
c 133 s 1 are each amended to read as follows:
As used in this
chapter:
(1)
"Secretary" means the secretary of health.
(2) "Health care
assistant" means an unlicensed person who assists a licensed health care
practitioner in providing health care to patients pursuant to this chapter.
However persons trained by a federally approved end-stage renal disease
facility who perform end-stage renal dialysis in the home setting are
exempt from certification under this chapter.
(3) "Health care
practitioner" means:
(a) A physician licensed
under chapter 18.71 RCW;
(b) An osteopathic
physician or surgeon licensed under chapter 18.57 RCW; or
(c) Acting within the
scope of their respective licensure, a podiatric physician and surgeon licensed
under chapter 18.22 RCW, a registered nurse or advanced registered nurse
practitioner licensed under chapter 18.79 RCW, or a naturopath licensed under
chapter 18.36A RCW.
(4)
"Supervision" means supervision of procedures permitted pursuant to
this chapter by a health care practitioner who is physically present and is
immediately available in the facility during the administration of injections,
as defined in this chapter, but need not be present during procedures to
withdraw blood.
(5) "Health care
facility" means any hospital, hospice care center, licensed or certified
health care facility, health maintenance organization regulated under chapter
48.46 RCW, federally qualified health maintenance organization, renal dialysis
center or facility federally approved under 42 C.F.R. 405.2100, blood bank federally
licensed under 21 C.F.R. 607, or clinical laboratory certified under 20 C.F.R.
405.1301‑16.
(6)
"Delegation" means direct authorization granted by a licensed health
care practitioner to a health care assistant to perform the functions
authorized in this chapter which fall within the scope of practice of the
delegator and which are not within the scope of practice of the delegatee.
Sec. 3. RCW 18.135.060 and 2000
c 171 s 30 are each amended to read as follows:
(1) Except as provided
in subsection (2) of this section:
(a) Any health care
assistant certified pursuant to this chapter shall perform the functions
authorized in this chapter only by delegation of authority from the health care
practitioner and under the supervision of a health care practitioner acting
within the scope of his or her license. In the case of subcutaneous,
intradermal and intramuscular and intravenous injections, a health care
assistant may perform such functions only under the supervision of a health
care practitioner having authority, within the scope of his or her license, to
order such procedures.
(b) The health care
practitioner who ordered the procedure or a health care practitioner who could
order the procedure under his or her license shall be physically present in the
immediate area of a hospital or nursing home where the injection is
administered. Sensitivity agents being administered intradermally or by the
scratch method are excluded from this requirement.
(2) A health care
assistant trained by a federally approved end-stage renal disease facility may
perform venipuncture for blood withdrawal, administration of oxygen as
necessary by cannula or mask, venipuncture for placement of fistula needles,
connect to vascular catheter for hemodialysis, intravenous administration
of heparin and sodium chloride solutions as an integral part of dialysis
treatment, and intradermal, subcutaneous, or topical administration of local
anesthetics in conjunction with placement of fistula needles, and
intraperitoneal administration of sterile electrolyte solutions and heparin for
peritoneal dialysis: (a) In the center or health care facility if a registered
nurse licensed under chapter 18.79 RCW is physically present and immediately
available in such center or health care facility; or (b) in the patient's home
if a physician and a registered nurse are available for consultation during the
dialysis.
NEW SECTION. Sec.
4. The secretary of health
is authorized to establish a task force to assist in the development of core
competencies and minimum training standards for mandatory training programs to
be utilized by renal dialysis facilities for training hemodialysis technicians
as health care assistants pursuant to this act. The secretary shall appoint to
the task force persons knowledgeable in renal dialysis practice, including
nephrologists, dialysis nurses, patient care hemodialysis technicians, dialysis
patients, and other individuals with expertise. The secretary may appoint
succeeding advisory task forces for reviewing and updating future requirements
as necessary.
NEW
SECTION. Sec. 5. Section 2 of this act
takes effect March 1, 2002.
