Passed by the House April 21, 2003 Yeas 97   FRANK CHOPP ________________________________________ Speaker of the House of Representatives Passed by the Senate April 15, 2003 Yeas 45   BRAD OWEN ________________________________________ President of the Senate | I, Cynthia Zehnder, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is HOUSE BILL 1753 as passed by the House of Representatives and the Senate on the dates hereon set forth. CYNTHIA ZEHNDER ________________________________________ Chief Clerk | |
Approved May 7, 2003. GARY LOCKE ________________________________________ Governor of the State of Washington | May 7, 2003 - 3:12 p.m. Secretary of State State of Washington |
State of Washington | 58th Legislature | 2003 Regular Session |
Read first time 02/07/2003. Referred to Committee on Health Care.
AN ACT Relating to nursing practices in community-based and in-home care; amending RCW 18.79.040, 18.79.260, 18.88A.140, 18.88A.200, 18.88A.210, 18.88A.230, 70.127.010, 70.127.040, 70.127.120, 70.127.170, 69.41.010, and 69.41.085; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 18.79.040 and 1995 1st sp.s. c 18 s 50 are each
amended to read as follows:
(1) "Registered nursing practice" means the performance of acts
requiring substantial specialized knowledge, judgment, and skill based
on the principles of the biological, physiological, behavioral, and
sociological sciences in either:
(a) The observation, assessment, diagnosis, care or counsel, and
health teaching of ((the ill, injured, or infirm)) individuals with
illnesses, injuries, or disabilities, or in the maintenance of health
or prevention of illness of others;
(b) The performance of such additional acts requiring education and
training and that are recognized by the medical and nursing professions
as proper and recognized by the commission to be performed by
registered nurses licensed under this chapter and that are authorized
by the commission through its rules;
(c) The administration, supervision, delegation, and evaluation of
nursing practice. However, nothing in this subsection affects the
authority of a hospital, hospital district, in-home service agency,
community-based care setting, medical clinic, or office, concerning its
administration and supervision;
(d) The teaching of nursing;
(e) The executing of medical regimen as prescribed by a licensed
physician and surgeon, dentist, osteopathic physician and surgeon,
podiatric physician and surgeon, physician assistant, osteopathic
physician assistant, or advanced registered nurse practitioner.
(2) Nothing in this section prohibits a person from practicing a
profession for which a license has been issued under the laws of this
state or specifically authorized by any other law of the state of
Washington.
(3) This section does not prohibit (a) the nursing care of the
sick, without compensation, by an unlicensed person who does not hold
himself or herself out to be a registered nurse, (b) the practice of
licensed practical nursing by a licensed practical nurse, or (c) the
practice of a nursing assistant, providing delegated nursing tasks
under chapter 18.88A RCW.
Sec. 2 RCW 18.79.260 and 2000 c 95 s 3 are each amended to read
as follows:
(1) A registered nurse under his or her license may perform for
compensation nursing care, as that term is usually understood, ((of the
ill, injured, or infirm)) to individuals with illnesses, injuries, or
disabilities.
(2) A registered nurse may, at or under the general direction of a
licensed physician and surgeon, dentist, osteopathic physician and
surgeon, naturopathic physician, podiatric physician and surgeon,
physician assistant, osteopathic physician assistant, or advanced
registered nurse practitioner acting within the scope of his or her
license, administer medications, treatments, tests, and inoculations,
whether or not the severing or penetrating of tissues is involved and
whether or not a degree of independent judgment and skill is required.
Such direction must be for acts which are within the scope of
registered nursing practice.
(3) A registered nurse may delegate tasks of nursing care to other
individuals where the registered nurse determines that it is in the
best interest of the patient.
(a) The delegating nurse shall:
(i) Determine the competency of the individual to perform the
tasks;
(ii) Evaluate the appropriateness of the delegation;
(iii) Supervise the actions of the person performing the delegated
task; and
(iv) Delegate only those tasks that are within the registered
nurse's scope of practice.
(b) A registered nurse, working for a home health or hospice agency
regulated under chapter 70.127 RCW, may delegate the application,
instillation, or insertion of medications to a registered or certified
nursing assistant under a plan of care.
(c) Except as authorized in (b) or (e) of this subsection, a
registered nurse may not delegate the administration of medications.
Except as authorized in (e) of this subsection, a registered nurse may
not delegate acts requiring substantial skill, ((the administration of
medications, or)) and may not delegate piercing or severing of tissues
((except to registered or certified nursing assistants who provide care
to individuals in community-based care settings as authorized under (d)
of this subsection)). Acts that require nursing judgment shall not be
delegated.
(((c))) (d) No person may coerce a nurse into compromising patient
safety by requiring the nurse to delegate if the nurse determines that
it is inappropriate to do so. Nurses shall not be subject to any
employer reprisal or disciplinary action by the nursing care quality
assurance commission for refusing to delegate tasks or refusing to
provide the required training for delegation if the nurse determines
delegation may compromise patient safety.
(((d))) (e) For delegation in community-based care settings or in-home care settings, a registered nurse may delegate nursing care tasks
only to registered or certified nursing assistants. Simple care tasks
such as blood pressure monitoring, personal care service, or other
tasks as defined by the nursing care quality assurance commission are
exempted from this requirement.
(i) "Community-based care settings" includes: Community
residential programs for the developmentally disabled, certified by the
department of social and health services under chapter 71A.12 RCW;
adult family homes licensed under chapter 70.128 RCW; and boarding
homes licensed under chapter 18.20 RCW. Community-based care settings
do not include acute care or skilled nursing facilities.
(((i))) (ii) "In-home care settings" include an individual's place
of temporary or permanent residence, but does not include acute care or
skilled nursing facilities, and does not include community-based care
settings as defined in (e)(i) of this subsection.
(iii) Delegation of nursing care tasks in community-based care
settings and in-home care settings is only allowed for individuals who
have a stable and predictable condition. "Stable and predictable
condition" means a situation in which the individual's clinical and
behavioral status is known and does not require the frequent presence
and evaluation of a registered nurse.
(((ii))) (iv) The determination of the appropriateness of
delegation of a nursing task is at the discretion of the registered
nurse. However, the administration of medications by injection,
sterile procedures, and central line maintenance may never be
delegated.
(((iii))) (v) The registered nurse shall verify that the nursing
assistant has completed the required core nurse delegation training
required in chapter 18.88A RCW prior to authorizing delegation.
(((iv))) (vi) The nurse is accountable for his or her own
individual actions in the delegation process. Nurses acting within the
protocols of their delegation authority are immune from liability for
any action performed in the course of their delegation duties.
(((v) On or before June 30, 2001, the nursing care quality
assurance commission, in conjunction with the professional nursing
organizations and the department of social and health services, shall
make any needed revisions or additions to nurse delegation protocols by
rule, including standards for nurses to obtain informed consent prior
to the delegation of nursing care tasks.))
(vii) Nursing task delegation protocols are not intended to
regulate the settings in which delegation may occur, but are intended
to ensure that nursing care services have a consistent standard of
practice upon which the public and the profession may rely, and to
safeguard the authority of the nurse to make independent professional
decisions regarding the delegation of a task.
(((e))) (f) The nursing care quality assurance commission may adopt
rules to implement this section.
(4) Only a person licensed as a registered nurse may instruct
nurses in technical subjects pertaining to nursing.
(5) Only a person licensed as a registered nurse may hold herself
or himself out to the public or designate herself or himself as a
registered nurse.
Sec. 3 RCW 18.88A.140 and 2000 c 171 s 25 are each amended to
read as follows:
Nothing in this chapter may be construed to prohibit or restrict:
(1) The practice by an individual licensed, certified, or
registered under the laws of this state and performing services within
their authorized scope of practice;
(2) The practice by an individual employed by the government of the
United States while engaged in the performance of duties prescribed by
the laws of the United States;
(3) The practice by a person who is a regular student in an
educational program approved by the secretary, and whose performance of
services is pursuant to a regular course of instruction or assignments
from an instructor and under the general supervision of the instructor;
(4) A nursing assistant, while employed as a personal aide as
defined in RCW 74.39.007, from accepting direction from an individual
who is self-directing their care.
Sec. 4 RCW 18.88A.200 and 1995 1st sp.s. c 18 s 45 are each
amended to read as follows:
The legislature recognizes that nurses have been successfully
delegating nursing care tasks to family members and auxiliary staff for
many years. The opportunity for a nurse to delegate to nursing
assistants qualifying under RCW 18.88A.210 may enhance the viability
and quality of health care services in ((community health)) community-based care settings ((for long-term care services)) and in-home care
settings to allow ((citizens)) individuals to live as independently as
possible with maximum safeguards.
Sec. 5 RCW 18.88A.210 and 2000 c 95 s 1 are each amended to read
as follows:
(1) A nursing assistant meeting the requirements of this section
who provides care to individuals in community-based care settings or
in-home care settings, as defined in RCW 18.79.260(3), may accept
delegation of nursing care tasks by a registered nurse as provided in
RCW 18.79.260(3).
(2) For the purposes of this section, "nursing assistant" means a
nursing assistant-registered or a nursing assistant-certified. Nothing
in this section may be construed to affect the authority of nurses to
delegate nursing tasks to other persons, including licensed practical
nurses, as authorized by law.
(3) Before commencing any specific nursing care tasks authorized
under this chapter, the nursing assistant must (a) provide to the
delegating nurse a certificate of completion issued by the department
of social and health services indicating the completion of basic core
nurse delegation training, (b) be regulated by the department of health
pursuant to this chapter, subject to the uniform disciplinary act under
chapter 18.130 RCW, and (c) meet any additional training requirements
identified by the nursing care quality assurance commission.
Exceptions to these training requirements must adhere to RCW
18.79.260(3)(((d)(iii))) (e)(v).
Sec. 6 RCW 18.88A.230 and 2000 c 95 s 2 are each amended to read
as follows:
(1) The nursing assistant shall be accountable for their own
individual actions in the delegation process. Nursing assistants
following written delegation instructions from registered nurses
performed in the course of their accurately written, delegated duties
shall be immune from liability.
(2) Nursing assistants shall not be subject to any employer
reprisal or disciplinary action by the secretary for refusing to accept
delegation of a nursing task based on patient safety issues. No
community-based care setting as defined in RCW 18.79.260(3)(((d))) (e),
or in-home services agency as defined in RCW 70.127.010, may
discriminate or retaliate in any manner against a person because the
person made a complaint or cooperated in the investigation of a
complaint.
Sec. 7 RCW 70.127.010 and 2000 c 175 s 1 are each amended to read
as follows:
Unless the context clearly requires otherwise, the definitions in
this section apply throughout this chapter.
(1) "Administrator" means an individual responsible for managing
the operation of an agency.
(2) "Department" means the department of health.
(3) "Director of clinical services" means an individual responsible
for nursing, therapy, nutritional, social, and related services that
support the plan of care provided by in-home health and hospice
agencies.
(4) "Family" means individuals who are important to, and designated
by, the patient or client and who need not be relatives.
(5) "Home care agency" means a person administering or providing
home care services directly or through a contract arrangement to
individuals in places of temporary or permanent residence. A home care
agency that provides delegated tasks of nursing under RCW
18.79.260(3)(e) is not considered a home health agency for the purposes
of this chapter.
(6) "Home care services" means nonmedical services and assistance
provided to ill, disabled, ((infirm,)) or vulnerable individuals that
enable them to remain in their residences. Home care services include,
but are not limited to: Personal care such as assistance with
dressing, feeding, and personal hygiene to facilitate self-care;
homemaker assistance with household tasks, such as housekeeping,
shopping, meal planning and preparation, and transportation; respite
care assistance and support provided to the family; or other nonmedical
services or delegated tasks of nursing under RCW 18.79.260(3)(e).
(7) "Home health agency" means a person administering or providing
two or more home health services directly or through a contract
arrangement to individuals in places of temporary or permanent
residence. A person administering or providing nursing services only
may elect to be designated a home health agency for purposes of
licensure.
(8) "Home health services" means services provided to ill,
disabled, ((infirm,)) or vulnerable individuals. These services
include but are not limited to nursing services, home health aide
services, physical therapy services, occupational therapy services,
speech therapy services, respiratory therapy services, nutritional
services, medical social services, and home medical supplies or
equipment services.
(9) "Home health aide services" means services provided by a home
health agency or a hospice agency under the supervision of a registered
nurse, physical therapist, occupational therapist, or speech therapist
who is employed by or under contract to a home health or hospice
agency. Such care includes ambulation and exercise, assistance with
self-administered medications, reporting changes in patients'
conditions and needs, completing appropriate records, and personal care
or homemaker services.
(10) "Home medical supplies" or "equipment services" means
diagnostic, treatment, and monitoring equipment and supplies provided
for the direct care of individuals within a plan of care.
(11) "Hospice agency" means a person administering or providing
hospice services directly or through a contract arrangement to
individuals in places of temporary or permanent residence under the
direction of an interdisciplinary team composed of at least a nurse,
social worker, physician, spiritual counselor, and a volunteer.
(12) "Hospice care center" means a homelike, noninstitutional
facility where hospice services are provided, and that meets the
requirements for operation under RCW 70.127.280.
(13) "Hospice services" means symptom and pain management provided
to a terminally ill individual, and emotional, spiritual, and
bereavement support for the individual and family in a place of
temporary or permanent residence, and may include the provision of home
health and home care services for the terminally ill individual.
(14) "In-home services agency" means a person licensed to
administer or provide home health, home care, hospice services, or
hospice care center services directly or through a contract arrangement
to individuals in a place of temporary or permanent residence.
(15) "Person" means any individual, business, firm, partnership,
corporation, company, association, joint stock association, public or
private agency or organization, or the legal successor thereof that
employs or contracts with two or more individuals.
(16) "Plan of care" means a written document based on assessment of
individual needs that identifies services to meet these needs.
(17) "Quality improvement" means reviewing and evaluating
appropriateness and effectiveness of services provided under this
chapter.
(18) "Service area" means the geographic area in which the
department has given prior approval to a licensee to provide home
health, hospice, or home care services.
(19) "Survey" means an inspection conducted by the department to
evaluate and monitor an agency's compliance with this chapter.
Sec. 8 RCW 70.127.040 and 2000 c 175 s 4 are each amended to read
as follows:
The following are not subject to regulation for the purposes of
this chapter:
(1) A family member providing home health, hospice, or home care
services;
(2) A person who provides only meal services in an individual's
permanent or temporary residence;
(3) An individual providing home care through a direct agreement
with a recipient of care in an individual's permanent or temporary
residence;
(4) A person furnishing or delivering home medical supplies or
equipment that does not involve the provision of services beyond those
necessary to deliver, set up, and monitor the proper functioning of the
equipment and educate the user on its proper use;
(5) A person who provides services through a contract with a
licensed agency;
(6) An employee or volunteer of a licensed agency who provides
services only as an employee or volunteer;
(7) Facilities and institutions, including but not limited to
nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41
RCW, adult family homes under chapter 70.128 RCW, boarding homes under
chapter 18.20 RCW, developmental disability residential programs under
chapter ((71.12)) 71A.12 RCW, other entities licensed under chapter
71.12 RCW, or other licensed facilities and institutions, only when
providing services to persons residing within the facility or
institution;
(8) Local and combined city-county health departments providing
services under chapters 70.05 and 70.08 RCW;
(9) An individual providing care to ill, disabled, ((infirm,)) or
vulnerable individuals through a contract with the department of social
and health services;
(10) Nursing homes, hospitals, or other institutions, agencies,
organizations, or persons that contract with licensed home health,
hospice, or home care agencies for the delivery of services;
(11) In-home assessments of an ill, disabled, or vulnerable((, or
infirm)) individual that does not result in regular ongoing care at
home;
(12) Services conducted by and for the adherents of a church or
religious denomination that rely upon spiritual means alone through
prayer for healing in accordance with the tenets and practices of such
church or religious denomination and the bona fide religious beliefs
genuinely held by such adherents;
(13) A medicare-approved dialysis center operating a medicare-approved home dialysis program;
(14) A person providing case management services. For the purposes
of this subsection, "case management" means the assessment,
coordination, authorization, planning, training, and monitoring of home
health, hospice, and home care, and does not include the direct
provision of care to an individual;
(15) Pharmacies licensed under RCW 18.64.043 that deliver
prescription drugs and durable medical equipment that does not involve
the use of professional services beyond those authorized to be
performed by licensed pharmacists pursuant to chapter 18.64 RCW and
those necessary to set up and monitor the proper functioning of the
equipment and educate the person on its proper use;
(16) A volunteer hospice complying with the requirements of RCW
70.127.050; and
(17) A person who provides home care services without compensation.
Sec. 9 RCW 70.127.120 and 2000 c 175 s 10 are each amended to
read as follows:
The department shall adopt rules consistent with RCW 70.127.005
necessary to implement this chapter under chapter 34.05 RCW. In order
to ensure safe and adequate care, the rules shall address at a minimum
the following:
(1) Maintenance and preservation of all records relating directly
to the care and treatment of individuals by licensees;
(2) Establishment and implementation of a procedure for the
receipt, investigation, and disposition of complaints regarding
services provided;
(3) Establishment and implementation of a plan for ongoing care of
individuals and preservation of records if the licensee ceases
operations;
(4) Supervision of services;
(5) Establishment and implementation of written policies regarding
response to referrals and access to services;
(6) Establishment and implementation of written personnel policies,
procedures and personnel records for paid staff that provide for
prehire screening, minimum qualifications, regular performance
evaluations, including observation in the home, participation in
orientation and in-service training, and involvement in quality
improvement activities. The department may not establish experience or
other qualifications for agency personnel or contractors beyond that
required by state law;
(7) Establishment and implementation of written policies and
procedures for volunteers who have direct patient/client contact and
that provide for background and health screening, orientation, and
supervision;
(8) Establishment and implementation of written policies for
obtaining regular reports on patient satisfaction;
(9) Establishment and implementation of a quality improvement
process; ((and))
(10) Establishment and implementation of policies related to the
delivery of care including:
(a) Plan of care for each individual served;
(b) Periodic review of the plan of care;
(c) Supervision of care and clinical consultation as necessary;
(d) Care consistent with the plan;
(e) Admission, transfer, and discharge from care; and
(f) For hospice services:
(i) Availability of twenty-four hour seven days a week hospice
registered nurse consultation and in-home services as appropriate;
(ii) Interdisciplinary team communication as appropriate and
necessary; and
(iii) The use and availability of volunteers to provide family
support and respite care; and
(11) Establishment and implementation of policies related to agency
implementation and oversight of nurse delegation as defined in RCW
18.79.260(3)(e).
Sec. 10 RCW 70.127.170 and 2000 c 175 s 14 are each amended to
read as follows:
Pursuant to chapter 34.05 RCW and RCW 70.127.180(3), the department
may deny, restrict, condition, modify, suspend, or revoke a license
under this chapter or, in lieu thereof or in addition thereto, assess
monetary penalties of a civil nature not to exceed one thousand dollars
per violation, or require a refund of any amounts billed to, and
collected from, the consumer or third-party payor in any case in which
it finds that the licensee, or any applicant, officer, director,
partner, managing employee, or owner of ten percent or more of the
applicant's or licensee's assets:
(1) Failed or refused to comply with the requirements of this
chapter or the standards or rules adopted under this chapter;
(2) Was the holder of a license issued pursuant to this chapter
that was revoked for cause and never reissued by the department, or
that was suspended for cause and the terms of the suspension have not
been fulfilled and the licensee has continued to operate;
(3) Has knowingly or with reason to know made a misrepresentation
of, false statement of, or failed to disclose, a material fact to the
department in an application for the license or any data attached
thereto or in any record required by this chapter or matter under
investigation by the department, or during a survey, or concerning
information requested by the department;
(4) Refused to allow representatives of the department to inspect
any book, record, or file required by this chapter to be maintained or
any portion of the licensee's premises;
(5) Willfully prevented, interfered with, or attempted to impede in
any way the work of any representative of the department and the lawful
enforcement of any provision of this chapter. This includes but is not
limited to: Willful misrepresentation of facts during a survey,
investigation, or administrative proceeding or any other legal action;
or use of threats or harassment against any patient, client, or
witness, or use of financial inducements to any patient, client, or
witness to prevent or attempt to prevent him or her from providing
evidence during a survey or investigation, in an administrative
proceeding, or any other legal action involving the department;
(6) Willfully prevented or interfered with any representative of
the department in the preservation of evidence of any violation of this
chapter or the rules adopted under this chapter;
(7) Failed to pay any civil monetary penalty assessed by the
department pursuant to this chapter within ten days after the
assessment becomes final;
(8) Used advertising that is false, fraudulent, or misleading;
(9) Has repeated incidents of personnel performing services beyond
their authorized scope of practice;
(10) Misrepresented or was fraudulent in any aspect of the conduct
of the licensee's business;
(11) Within the last five years, has been found in a civil or
criminal proceeding to have committed any act that reasonably relates
to the person's fitness to establish, maintain, or administer an agency
or to provide care in the home of another;
(12) Was the holder of a license to provide care or treatment to
ill, disabled, ((infirm,)) or vulnerable individuals that was denied,
restricted, not renewed, surrendered, suspended, or revoked by a
competent authority in any state, federal, or foreign jurisdiction. A
certified copy of the order, stipulation, or agreement is conclusive
evidence of the denial, restriction, nonrenewal, surrender, suspension,
or revocation;
(13) Violated any state or federal statute, or administrative rule
regulating the operation of the agency;
(14) Failed to comply with an order issued by the secretary or
designee;
(15) Aided or abetted the unlicensed operation of an in-home
services agency;
(16) Operated beyond the scope of the in-home services agency
license;
(17) Failed to adequately supervise staff to the extent that the
health or safety of a patient or client was at risk;
(18) Compromised the health or safety of a patient or client,
including, but not limited to, the individual performing services
beyond their authorized scope of practice;
(19) Continued to operate after license revocation, suspension, or
expiration, or operating outside the parameters of a modified,
conditioned, or restricted license;
(20) Failed or refused to comply with chapter 70.02 RCW;
(21) Abused, neglected, abandoned, or financially exploited a
patient or client as these terms are defined in RCW 74.34.020;
(22) Misappropriated the property of an individual;
(23) Is unqualified or unable to operate or direct the operation of
the agency according to this chapter and the rules adopted under this
chapter;
(24) Obtained or attempted to obtain a license by fraudulent means
or misrepresentation; or
(25) Failed to report abuse or neglect of a patient or client in
violation of chapter 74.34 RCW.
Sec. 11 RCW 69.41.010 and 2000 c 8 s 2 are each amended to read
as follows:
As used in this chapter, the following terms have the meanings
indicated unless the context clearly requires otherwise:
(1) "Administer" means the direct application of a legend drug
whether by injection, inhalation, ingestion, or any other means, to the
body of a patient or research subject by:
(a) A practitioner; or
(b) The patient or research subject at the direction of the
practitioner.
(2) "Community-based care settings" include: Community residential
programs for the developmentally disabled, certified by the department
of social and health services under chapter 71A.12 RCW; adult family
homes licensed under chapter 70.128 RCW; and boarding homes licensed
under chapter 18.20 RCW. Community-based care settings do not include
acute care or skilled nursing facilities.
(3) "Deliver" or "delivery" means the actual, constructive, or
attempted transfer from one person to another of a legend drug, whether
or not there is an agency relationship.
(((3))) (4) "Department" means the department of health.
(((4))) (5) "Dispense" means the interpretation of a prescription
or order for a legend drug and, pursuant to that prescription or order,
the proper selection, measuring, compounding, labeling, or packaging
necessary to prepare that prescription or order for delivery.
(((5))) (6) "Dispenser" means a practitioner who dispenses.
(((6))) (7) "Distribute" means to deliver other than by
administering or dispensing a legend drug.
(((7))) (8) "Distributor" means a person who distributes.
(((8))) (9) "Drug" means:
(a) Substances recognized as drugs in the official United States
pharmacopoeia, official homeopathic pharmacopoeia of the United States,
or official national formulary, or any supplement to any of them;
(b) Substances intended for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease in man or animals;
(c) Substances (other than food, minerals or vitamins) intended to
affect the structure or any function of the body of man or animals; and
(d) Substances intended for use as a component of any article
specified in ((clause)) (a), (b), or (c) of this subsection. It does
not include devices or their components, parts, or accessories.
(((9))) (10) "Electronic communication of prescription information"
means the communication of prescription information by computer, or the
transmission of an exact visual image of a prescription by facsimile,
or other electronic means for original prescription information or
prescription refill information for a legend drug between an authorized
practitioner and a pharmacy or the transfer of prescription information
for a legend drug from one pharmacy to another pharmacy.
(((10))) (11) "In-home care settings" include an individual's place
of temporary and permanent residence, but does not include acute care
or skilled nursing facilities, and does not include community-based
care settings.
(12) "Legend drugs" means any drugs which are required by state law
or regulation of the state board of pharmacy to be dispensed on
prescription only or are restricted to use by practitioners only.
(((11))) (13) "Legible prescription" means a prescription or
medication order issued by a practitioner that is capable of being read
and understood by the pharmacist filling the prescription or the nurse
or other practitioner implementing the medication order.
(((12))) (14) "Medication assistance" means assistance rendered by
a nonpractitioner to an individual residing in a community-based care
setting ((specified in RCW 69.41.085)) or in-home care setting to
facilitate the individual's self-administration of a legend drug or
controlled substance. It includes reminding or coaching the
individual, handing the medication container to the individual, opening
the individual's medication container, using an enabler, or placing the
medication in the individual's hand, and such other means of medication
assistance as defined by rule adopted by the department. ((The)) A
nonpractitioner may help in the preparation of legend drugs or
controlled substances for self-administration where a practitioner has
determined((, in consultation with the individual or the individual's
representative,)) and communicated orally or by written direction that
such medication preparation assistance is necessary and appropriate.
Medication assistance shall not include assistance with intravenous
medications or injectable medications, except prefilled insulin
syringes.
(((13))) (15) "Person" means individual, corporation, government or
governmental subdivision or agency, business trust, estate, trust,
partnership or association, or any other legal entity.
(((14))) (16) "Practitioner" means:
(a) A physician under chapter 18.71 RCW, an osteopathic physician
or an osteopathic physician and surgeon under chapter 18.57 RCW, a
dentist under chapter 18.32 RCW, a podiatric physician and surgeon
under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a
registered nurse, advanced registered nurse practitioner, or licensed
practical nurse under chapter 18.79 RCW, an optometrist under chapter
18.53 RCW who is certified by the optometry board under RCW 18.53.010,
an osteopathic physician assistant under chapter 18.57A RCW, a
physician assistant under chapter 18.71A RCW, a naturopath licensed
under chapter 18.36A RCW, or a pharmacist under chapter 18.64 RCW;
(b) A pharmacy, hospital, or other institution licensed,
registered, or otherwise permitted to distribute, dispense, conduct
research with respect to, or to administer a legend drug in the course
of professional practice or research in this state; and
(c) A physician licensed to practice medicine and surgery or a
physician licensed to practice osteopathic medicine and surgery in any
state, or province of Canada, which shares a common border with the
state of Washington.
(((15))) (17) "Secretary" means the secretary of health or the
secretary's designee.
Sec. 12 RCW 69.41.085 and 1998 c 70 s 1 are each amended to read
as follows:
Individuals residing in community-based care settings, such as
adult family homes, boarding homes, and residential care settings for
the developmentally disabled, including an individual's home, ((might
need medication assistance due to physical or mental limitations that
prevent them from self-administering their legend drugs or controlled
substances. The practitioner in consultation with the individual or
his or her representative and the community-based setting, if involved,
determines that medication assistance is appropriate for this
individual. Medication assistance can take different forms such as
opening containers, handing the container or medication to the
individual, preparing the medication with prior authorization, using
enablers for facilitating the self-administration of medication, and
other means of assisting in the administration of legend drugs or
controlled substances commonly employed in community-based settings))
may receive medication assistance. Nothing in this chapter affects the
right of an individual to refuse medication or requirements relating to
informed consent.
NEW SECTION. Sec. 13 This act is necessary for the immediate
preservation of the public peace, health, or safety, or support of the
state government and its existing public institutions, and takes effect
immediately.