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 Reported by House Committee On:
Health Care & Wellness
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: 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].
Brief Summary of Second Substitute Bill (As Amended by House Committee) |
|
|
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.
Amended Bill Compared to Second Substitute Bill:
The substitute bill requires the Commission to establish a monitoring system for insulin
administered by injection by nursing assistants. The monitoring system shall include
information reported by delegating nurses. The Commission must report to the Governor and
the Legislature on the findings from the monitoring system by November 15, 2012. The act
expires on June 1, 2013.
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.