BILL REQ. #:  S-4135.2 

Read first time 01/26/10.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to wound care management in occupational therapy; amending RCW 18.59.020 and 18.59.160; and adding a new section to chapter 18.59 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 18.59.020 and 1999 c 333 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) "Board" means the board of occupational therapy practice.
     (2) "Occupational therapy" is the scientifically based use of purposeful activity with individuals who are limited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, or the aging process in order to maximize independence, prevent disability, and maintain health. The practice encompasses evaluation, treatment, and consultation. Specific occupational therapy services include but are not limited to: Using specifically designed activities and exercises to enhance neurodevelopmental, cognitive, perceptual motor, sensory integrative, and psychomotor functioning; administering and interpreting tests such as manual muscle and sensory integration; teaching daily living skills; developing prevocational skills and play and avocational capabilities; designing, fabricating, or applying selected orthotic and prosthetic devices or selected adaptive equipment; wound care management to include sharp debridement as provided in section 3 of this act; and adapting environments for ((the handicapped)) persons with disabilities. These services are provided individually, in groups, or through social systems.
     (3) "Occupational therapist" means a person licensed to practice occupational therapy under this chapter.
     (4) "Occupational therapy assistant" means a person licensed to assist in the practice of occupational therapy under the supervision or with the regular consultation of an occupational therapist.
     (5) "Occupational therapy aide" means a person who is trained to perform specific occupational therapy techniques under professional supervision as defined by the board but who does not perform activities that require advanced training in the sciences or practices involved in the profession of occupational therapy.
     (6) "Occupational therapy practitioner" means a person who is credentialed as an occupational therapist or occupational therapy assistant.
     (7) "Person" means any individual, partnership, unincorporated organization, or corporate body, except that only an individual may be licensed under this chapter.
     (8) "Department" means the department of health.
     (9) "Secretary" means the secretary of health.
     (10) "Sharp debridement" means the removal of devitalized tissue from a wound with scissors, scalpel, and tweezers without anesthesia. "Sharp debridement" does not mean surgical debridement.

Sec. 2   RCW 18.59.160 and 2009 c 68 s 1 are each amended to read as follows:
     An occupational therapist licensed under this chapter may purchase, store, and administer topical and transdermal medications such as hydrocortisone, dexamethasone, fluocinonide, topical anesthetics, lidocaine, magnesium sulfate, and other similar medications for the practice of occupational therapy as prescribed by a health care provider with prescribing authority as authorized in RCW 18.59.100. Administration of medication must be documented in the patient's medical record. Some medications may be applied by the use of iontophoresis and phonophoresis. An occupational therapist may not purchase, store, or administer controlled substances. A pharmacist who dispenses such drugs to a licensed occupational therapist is not liable for any adverse reactions caused by any method of use by the occupational therapist. ((Application of a prescribed medication to a wound as authorized in this statute does not constitute wound care management.)) Application of a topical medication to a wound is subject to section 3 of this act.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.59 RCW to read as follows:
     (1)(a) An occupational therapist licensed under this chapter may provide wound care management in the course of occupational therapy treatment to return patients to functional performance in their everyday occupations under the referral and direction of a physician or other authorized healthcare provider listed in RCW 18.59.100 in accordance with their scope of practice. The referring provider must evaluate the patient prior to referral to an occupational therapist for wound care.
     (b) For the purposes of this section, "wound care management" means a part of occupational therapy treatment that facilitates healing, prevents edema, infection, and excessive scar formation, and minimizes wound complications. Treatment may include: Assessment of wound healing status, patient education, selection and application of dressings, cleansing of the wound and surrounding areas, application of topical medications, as provided under subsection (2) of this section, use of physical agent modalities, application of pressure garments and nonweight-bearing orthotic devices, excluding high-temperature custom foot orthotics made from a mold, and pressure garments, sharp debridement of devitalized tissue, debridement of devitalized tissue with other agents; and adapting activities of daily living to promote independence during wound healing.
     (c) For the purposes of this section, "wound care services" may only be provided by occupational therapy assistants under the direct supervision of occupational therapists. For the purposes of this section, "direct supervision" means supervision of an occupational therapy assistant by an occupational therapist that is on the premises and is quickly and easily available, and where the patient has been examined by the occupational therapist at such time as acceptable occupational therapy practice requires, consistent with the delegated health care task. Wound care services are limited to: Patient education; application of dressings; cleansing of the wound and surrounding areas; application of topical medications, as provided under subsection (2) of this section; use of physical agent modalities; application of pressure garments and nonweight bearing orthotic devices, excluding high-temperature custom foot orthotics made from a mold; and adapting activities of daily living to promote independence during wound healing. Occupational therapists may not delegate sharp debridement.
     (2)(a) Debridement is not an entry-level skill and requires specialized training, which must include: Indications and contraindications for the use of debridement; appropriate selection and use of clean and sterile techniques; selection of appropriate tools, such as scissors, forceps, or scalpel; identification of viable and devitalized tissues; and conditions which require referral back to the referring provider. Training may be provided through entry-level or continuing education, mentoring, cotreatment, and observation. Consultation with the referring provider is required if the wound exposes anatomical structures underlying the skin, such as tendon, muscle, or bone, or if there is an obvious worsening of the condition, or signs of infection.
     (b)(i) Occupational therapists may perform wound care, including sharp debridement, upon showing evidence of adequate education and training by submitting an affidavit to the department attesting to their education and training as follows:
     (A) For occupational therapists performing wound care, including the use of scissors and tweezers for the removal of loosely adherent tissue, a minimum of fifteen hours of mentored training is required to be documented in the affidavit. Mentored training includes observation, cotreatment, and supervised treatment. Fifteen hours mentored training in a clinical setting must include a case mix similar to the occupational therapist's expected practice. In addition, the training must include conditions which necessitate referral back to the referring provider;
     (B) For occupational therapists performing sharp debridement with a scalpel, an additional minimum of fifteen hours of mentored sharp debridement training, to include the use of a scalpel, is required to be documented in the affidavit. Mentored training includes observation, cotreatment, and supervised treatment. Fifteen hours mentored training in a clinical setting must include a case mix similar to the occupational therapist's expected practice. In addition, the training must include conditions which necessitate referral back to the referring provider.
     (ii) Certification as a certified hand therapist by the hand therapy certification commission or as a wound care specialist by the American academy of wound management, the national alliance of wound care, or equivalent organization approved by the board is sufficient to meet the requirements of (b)(i) of this subsection.
     (c) Therapists whose current practice meets the requirement for the affidavit shall submit the affidavit to the department by July 1, 2011.