HOUSE BILL REPORT
2SSB 6220


This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Passed House - Amended:
March 5, 2008

Title: An act relating to delegation of nursing tasks to care for persons with diabetes.

Brief Description: Allowing the delegation of nursing tasks to care for persons with diabetes.

Sponsors: By Senate Committee on Ways & Means (originally sponsored by Senators Keiser, Parlette, Pflug, Prentice and Kohl-Welles).

Brief History:

Health Care & Wellness: 2/25/08, 2/27/08 [DPA].

Floor Activity:

Passed House - Amended: 3/5/08, 96-0.

Brief Summary of Second Substitute Bill
(As Amended by House)
  • Authorizes nursing assistants to administer insulin by injection to people with diabetes in community-based or in-home care settings upon delegation by a registered nurse.
  • Directs the Nursing Care Quality Assurance Commission to develop a monitoring system for insulin administered by injection by nursing assistants and report its findings to the Governor and the Legislature.


HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: Do pass as amended. Signed by 13 members: Representatives Cody, Chair; Morrell, Vice Chair; Hinkle, Ranking Minority Member; Alexander, Assistant Ranking Minority Member; Barlow, Campbell, Condotta, DeBolt, Green, Moeller, Pedersen, Schual-Berke and Seaquist.

Staff: Chris Blake (786-7392).

Background:

Nursing assistants may either be registered or certified by the Department of Health depending on their education and training. Nursing assistants may assist in providing care to individuals as delegated by and under the supervision of a registered nurse. Nursing assistants working in community-based or in-home care settings may provide additional nursing care tasks upon completion of the Department of Social and Health Service's (DSHS) basic core nurse delegation training.

Registered nurses may delegate nursing care tasks that are within the nurse's scope of practice to other individuals where the nurse finds it to be in the patient's best interest. Before delegating a nursing care task, the registered nurse must determine the competency of the person to perform the delegated task and evaluate the appropriateness of the delegation. The registered nurse must supervise the person performing the delegated task.

Registered nurses may not generally delegate acts requiring substantial skill or the administration of medications unless the delegation is to a nursing assistant working in a community-based or in-home care setting. The administration of medications by injection, sterile procedures, and central-line maintenance may never be delegated to a nursing assistant in a community-based or in-home care setting.


Summary of Amended Bill:

The set up of diabetic insulin devices and verbal verification of insulin dosage for sight-impaired individuals are considered "simple care tasks" which do not require delegation from a registered nurse.

Upon delegation by a registered nurse, a nursing assistant may administer insulin by injection to people with diabetes in community-based or in-home care settings. The delegating nurse must provide instruction and a demonstration to the nursing assistant in the use of insulin and proper injection procedures. The delegating nurse must provide regular supervision and evaluation of each nursing assistant's performance.

Prior to providing care to individuals with diabetes who may require the administration of insulin, nursing assistants must, in addition to other delegation training and credentialing requirements, submit a certificate to the delegating nurse that documents completion of specialized diabetes nurse delegation training approved by the DSHS. The training must include instruction regarding diabetes, insulin, sliding scale insulin orders, and proper injection procedures.

The Nursing Care Quality Assurance Commission (Commission), in cooperation with the DSHS, must develop a monitoring system for insulin administered by injection by nursing assistants. The monitoring system must contain information reported by delegating nurses, including the number of nursing assistants administering insulin by injection; the number of patients being served; the number of injections administered; the number, type, and outcome of any inappropriately administered insulin; and other relevant information. The Commission shall report its findings and recommendations to the Governor and the Legislature by November 15, 2012. The act expires on June 1, 2013.

Legislative findings state that over 15 percent of people over 65 years old have diabetes and that current limitations on delegation authority limit the ability of people to remain in their homes or in home-like settings. The stated legislative intent is to authorize registered nurses to delegate the administration of insulin injections for elderly persons so that they may continue to reside in their homes or home-like settings. In addition, it is the intent that delegation of insulin injections for publicly-funded clients only be provided for clients who cannot inject themselves and do not have an informal support system to assist with injections.


Appropriation: None.

Fiscal Note: Not requested.

Effective Date of Amended Bill: The bill takes effect 90 days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony:

(In support) This bill is part of an effort to make it easier for those who are frail and elderly to remain in the places where they live. There is no reason for people to leave home and community-based settings in order to go to a nursing home because they need to receive insulin. Many other states have delegated authority for insulin shots with fewer protections than are included in this bill.

(Opposed) None.

Persons Testifying: Senator Keiser, prime sponsor; Bill Moss, Department of Social and Health Services; and Gary Weeks, Washington Health Care Association.

Persons Signed In To Testify But Not Testifying: None.