Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: The commission is setting an early effective date for this rule under RCW 34.04.380 [34.05.380 (3)(a)] (3)(a) because there was an emergency clause in chapter 140, Laws of 2003. The requirements in this rule have been in place under emergency rules and will expire July 2, 2004.

     Purpose: Adopt rules to implement chapter 140, Laws of 2003, allowing nursing assistants to accept specific delegation in an in-home care setting. These rules also adopt legislative changes allowing nursing assistants to accept more tasks when accepting specific delegation. Emergency rules currently in place are due to expire on July 2, 2004.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-841-405.

     Statutory Authority for Adoption: RCW 18.88A.060 and chapter 140, Laws of 2003.

      Adopted under notice filed as WSR 04-10-079 on May 4, 2004.

     Changes Other than Editing from Proposed to Adopted Version: WAC 246-841-405 (2)(a) and (b). Took out the words, "a copy of." The proposal would have required the nursing assistant to provide the registered nurse with a copy of their certificate of completion but would not require that they present the original certificate of completion to the registered nurse. This is inconsistent with the law as RCW 18.88A.210(3) requires the nursing assistant to present the certificate of completion to the registered nurse. The change makes the rule consistent with the law.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: July 2, 2004.

June 8, 2004

Cheryl Payseno, Chair

Nursing Care Quality

Assurance Commission

OTS-6413.5

AMENDATORY SECTION(Amending WSR 96-06-029, filed 2/28/96, effective 3/30/96)

WAC 246-841-405   Nursing assistant delegation.   Provision for delegation of certain tasks.

     (1) Nursing assistants may perform ((the following)) tasks((,)) when delegated by a registered nurse((,)) for ((residents in certified community residential programs for the developmentally disabled, residents in licensed adult family homes, and to residents of licensed boarding homes contracting to provide assisted living services:

     (a) Oral and topical medications and ointments;

     (b) Nose, ear, eye drops, and ointments;

     (c) Dressing changes and urinary catheterization using clean techniques;

     (d) Suppositories, enemas, and ostomy care in established and healed condition;

     (e) Blood glucose monitoring; and

     (f) Gastrostomy feedings in established and healed condition)) patients in community-based care settings or in-home care settings, each as defined in RCW 18.79.260 (3)(e).

     (2) Any nursing assistant who receives authority to perform ((such)) a delegated nursing task must, before performing any delegated task:

     (a) For nursing assistants-registered, ((complete)) provide to the delegating nurse the certificate of completion of both the basic caregiver training and core delegation training as established by the department of social and health services.

     (b) For nursing assistants-certified, ((complete)) provide to the delegating nurse the certificate of completion of the core delegation training as established by the department of social and health services.

     (c) For all nursing assistants, comply with all applicable requirements and protocol established by the nursing care quality assurance commission in WAC 246-840-910 through ((246-840-980)) WAC 246-840-970.

     (d) For all nursing assistants, meet any additional training requirements identified by the nursing care quality assurance commission. Any exceptions to any such training requirements must adhere to RCW 18.79.260 (3)(e)(v).

     (3) Any nursing assistant performing a delegated nursing care task pursuant to this section, shall perform the task:

     (a) Only for the specific ((resident)) patient who was the subject of the delegation;

     (b) Only with the ((resident's)) patient's consent; and

     (c) In compliance with all applicable requirements and protocols established by the nursing care quality assurance commission in WAC 246-840-910 through ((246-840-980)) WAC 246-840-970.

     (4) A nursing assistant may consent or refuse to consent to perform a delegated nursing care task ((listed in subsection (1) of this section,)) and shall be responsible for their own actions with regard to the decision to consent or refuse to consent and the performance of the delegated nursing care task.

     (5) Nursing assistants shall not accept delegation of, or perform, the following nursing care tasks:

     (a) Administration of medication by injection;

     (b) Sterile procedures;

     (c) Central line maintenance;

     (d) Acts that require nursing judgment.

[Statutory Authority: Chapter 18.88A RCW. 96-06-029, § 246-841-405, filed 2/28/96, effective 3/30/96.]

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