2676‑S AMS MART 01

ESHB 2676 - S AMD - 000567

By Senators McAuliffe, West, Moyer and Haugen

                              RULED OUTSIDE SCOPE & OBJECT 3/11/94

    On page 66, after line 33, insert the following:

    "NEW SECTION. Sec. 432.  A new section is added to chapter 18.88A RCW to read as follows:

    For the purposes of maintaining a registry of qualified persons and becoming subject to the provisions of chapter 18.130 RCW, an unlicensed person authorized to administer medications or treatments under section 433 of this act shall register with the state nursing care quality assurance commission as a nursing assistant-registered, providing services to persons with developmental disabilities.

NEW SECTION. Sec. 433.  A new section is added to chapter 71A.10 RCW to read as follows:

    (1) Community residential programs certified by the department of social and health services under chapter 71A.12 RCW and adult family homes licensed under chapter 70.128 RCW and also certified by the department of social and health services under chapter 71A.12 RCW may permit certain staff who are employed as direct care staff who have been trained and have registered as a nursing assistant-registered, providing services to persons with developmental disabilities as defined in RCW 18.88A.020(5) to administer the following medications or treatments to persons with developmental disabilities:

    (a) Oral medication;

    (b) Topical medication;

    (c) Nose, ear, and eye drops;

    (d) Suppositories;

    (e) Home glucose testing and monitoring procedures if the glucometer is recalibrated daily;

    (f) Enemas packaged in unit doses only;

    (g) Prescribed emergency procedures, which shall be limited to activating emergency services, specifically, calling 911 and notifying the attending physician and/or the supervising nurse; and

    (h) Gastrostomy tube feedings, under conditions provided in subsection (4) of this section.

    (2) Treatment authorized by this section must be prescribed by a health care practitioner licensed under Title 18 RCW and who has prescriptive authority, acting within the scope of his or her license, and may be administered only after proper training as specified in subsection (3) of this section.

    (3) The nursing assistant defined in RCW 18.88A.020(5) shall receive the training specified in this subsection.  The person conducting the training must be a registered nurse licensed under chapter 18.88 RCW.  A registered nurse shall not be subject to any reprisal or disciplinary action for refusing to provide the training required under this section.  Training shall include the following:

    (a) Teaching of the nursing assistant defined in RCW 18.88A.020(5) the task, including the nature of the condition requiring treatment, risks of the treatment, side effects, and interaction of prescribed medications;

    (b) Observation of the nursing assistant defined in RCW 18.88A.020(5) performing the task to assure that the nursing assistant defined in RCW 18.88A.020(5) does the task safely and accurately;

    (c) Written instructions for performance of the task for the nursing assistant defined in RCW 18.88A.020(5) to use as a reference;

    (d) Instructions to the nursing assistant defined in RCW 18.88A.020(5) that the task being taught is specific to this client only and is not transferable to other clients or taught to other care providers;

    (e) Documentation of how the task was taught, the teaching outcome, the content and type of instructions left for the nursing assistant defined in RCW 18.88A.020(5), evidence that the nursing assistant defined in RCW 18.88A.020(5) understands risks involved in performing the task and has a plan for how to respond to the consequences, and evidence that the nursing assistant defined in RCW 18.88A.020(5) was instructed that the task is client-specific and not transferable to other clients or providers;

    (f) Performance of the administration of medications or treatments by nursing assistants defined in RCW 18.88A.020(5) authorized in this section shall be reviewed at least annually by a registered nurse.

    (4) A registered nurse may delegate administration of gastrostomy, but not nasogastric, tube feedings to a nursing assistant defined in RCW 18.88A.020(5) specific to one client under the following conditions:

    (a) The registered nurse shall consider the nature of the task to be provided, its complexity, risk involved, and the necessary skill needed;

    (b) The registered nurse shall assess the client's condition and determine that there is not a significant risk to the client if the nursing assistant defined in RCW 18.88A.020(5) performs the task in the absence of direct supervision;

    (c) The registered nurse shall determine how frequently the client's condition shall be reassessed to determine the appropriateness of the continued delegation of the task to a nursing assistant defined in RCW 18.88A.020(5);

    (d) If there is some risk involved to the client, the registered nurse shall determine that the nursing assistant defined in RCW 18.88A.020(5) is prepared to respond effectively to the consequences;

    (e) The registered nurse shall assess the ability of the nursing assistant defined in RCW 18.88A.020(5) to perform the task;

    (f) The registered nurse shall determine the frequency of supervision of the nursing assistant defined in RCW 18.88A.020(5);

    (g) The registered nurse shall document the process for deciding that the task can be safely delegated for the specific client to the specific nursing assistant defined in RCW 18.88A.020(5);

    (h) The registered nurse shall document how frequently the client should be reassessed by a registered nurse regarding continued delegation of the task to the nursing assistant defined in RCW 18.88A.020(5);

    (i) The responsibility, accountability, and authority of the registered nurse shall be limited to teaching and delegation of administration of gastrostomy tube feeding to the nursing assistant defined in RCW 18.88A.020(5), and the determination of which nursing assistants defined in RCW 18.88A.020(5) and the number of nursing assistants defined in RCW 18.88A.020(5) that must be taught and delegated the task of administration of gastrostomy tube feedings shall remain with the registered nurse;

    (j) The number of persons to whom the tasks are taught and delegated shall be limited to the number that can be safely supervised by the registered nurse; and

    (k) The registered nurse shall assure that the nursing assistant defined in RCW 18.88A.020(5) maintains proficiency in performing the tasks through periodic supervision, and reviews conducted at least annually, by the registered nurse.

    (5) The delegating registered nurse has a responsibility to determine that the nursing assistant defined in RCW 18.88A.020(5) is indeed competent to perform the delegated act.  Nonnursing and managerial persons shall not coerce the registered nurse into compromising client safety by requiring the registered nurse to delegate.  Both the delegating registered nurse and the nursing assistant defined in RCW 18.88A.020(5) are accountable for their own actions in the delegation process.

    (6) Verification of the current registration of a person holding himself or herself out to be a nursing assistant defined in RCW 18.88A.020(5) and any restrictions relating to the registration shall be the responsibility of the employer of the nursing assistant defined in RCW 18.88A.020(5).

    (7) Development of rules implementing subsections (2), (3), (4), and (5) of this section shall be jointly adopted by the department of social and health services and the state nursing care quality assurance commission.

    (8) A basic core training curriculum on providing care in residential settings for people with developmental disabilities shall be in addition to the specific nursing assistant training specified in this section.  Such additional training shall be developed and adopted by rule by the secretary of the department of social and health services.

    (9) This section may not be construed to apply to persons who are not developmentally disabled or to persons who are living in residential habilitation centers, nor to any setting or facility other than community residential programs certified by the department of social and health services under chapter 71A.12 RCW and adult family homes licensed under chapter 70.128 RCW and also certified by the department of social and health services under chapter 71A.12 RCW.

    Sec. 434.  RCW 71A.10.020 and 1988 c 176 s 102 are each amended to read as follows:

    As used in this title, the following terms have the meanings indicated unless the context clearly requires otherwise.

    (1) "Department" means the department of social and health services.

    (2) "Developmental disability" means a disability attributable to mental retardation, cerebral palsy, epilepsy, autism, or another neurological or other condition of an individual found by the secretary to be closely related to mental retardation or to require treatment similar to that required for individuals with mental retardation, which disability originates before the individual attains age eighteen, which has continued or can be expected to continue indefinitely, and which constitutes a substantial handicap to the individual.  By January 1, 1989, the department shall promulgate rules which define neurological or other conditions in a way that is not limited to intelligence quotient scores as the sole ((determinate [determinant])) determinant of these conditions, and notify the legislature of this action.

    (3) "Eligible person" means a person who has been found by the secretary under RCW 71A.16.040 to be eligible for services.

    (4) "Habilitative services" means those services provided by program personnel to assist persons in acquiring and maintaining life skills and to raise their levels of physical, mental, social, and vocational functioning.  Habilitative services include education, training for employment, and therapy.

    (5) "Legal representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of the limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.

    (6) "Notice" or "notification" of an action of the secretary means notice in compliance with RCW 71A.10.060.

    (7) "Residential habilitation center" means a state-operated facility for persons with developmental disabilities governed by chapter 71A.20 RCW.

    (8) "Secretary" means the secretary of social and health services or the secretary's designee.

    (9) "Service" or "services" means services provided by state or local government to carry out this title.

(10) "Delegation" means direct authorization granted by a registered nurse to an unlicensed nursing assistant defined in RCW 18.88A.020(5) to perform the functions authorized in this chapter that fall within the scope of practice of the delegator and that are not within the scope of practice of the delegatee.

(11) "Supervision of nursing assistant defined in RCW 18.88A.020"  means the provision of guidance and evaluation by a qualified registered nurse for the accomplishment of the specific tasks enumerated in section 433 of this act with the initial direction of the task or activity, periodic inspection of the actual act of accomplishing the task or activity, and the authority to require corrective action.  The licensed registered nurse is not required to be on the premises but has given oral and written instructions relating to the specific task or activity and the client has been assessed by the licensed registered nurse prior to authority or delegation being granted to perform the task or activity.

NEW SECTION. Sec. 435.  The secretary of health in consultation with the state nursing care quality assurance commission and the department of social and health services shall monitor the implementation of sections 432 through 434 this act and shall make an interim report by December 31, 1995, and a final report by December 31, 1996, to the legislature on the effectiveness of sections 432 through 434 of this act, including whether registration provides sufficient safeguards for protecting the health and safety of persons with developmental disabilities, and with any recommendations for improvements.  The report shall be based on direct observation, documentation, and interviews, and shall specifically include a recommendation on whether a change in the level of credentialing is appropriate relating to patient care and safety."

    Renumber the remaining sections consecutively and correct internal references accordingly.

    On page 98, line 30, strike "(6))) and insert ")) "Nursing assistant-registered, providing services to persons with developmental disabilities" means an individual employed as direct care staff in a community residential program certified by the department of social and health services under chapter 71A.12 RCW or an adult family home licensed under chapter 70.128 RCW and who has been trained by a registered nurse licensed under chapter 18.88 RCW to administer the specific medications or treatments authorized in section 433 of this act. (6)"

ESHB 2676 - S AMD

    By Senators McAuliffe, West, Moyer and Haugen

                              RULED OUTSIDE SCOPE & OBJECT 3/22/94

    On page 2, line 1 of the title amendment, after "71.24.025," insert "71A.10.020,"

    On page 2, line 16 of the title amendment, after "88.46 RCW;" insert "adding a new section to chapter 71A.10 RCW; adding a new section to chapter 18.88A RCW;"

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