BP BHEAD INT H

AN ACT Relating to nurse delegation; adding new sections to chapter 74.13 RCW; and creating a new section.

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

NEW SECTION. Sec. 1. The legislature finds that trained unlicensed persons should be allowed to assist in the care of certain foster children with medical needs.

NEW SECTION. Sec. 2. As used in section 3 of this act:

(1) "Stable condition" means a situation where the child's clinical and behavioral status and nursing care needs are determined to be nonfluctuating, consistent, and do not need frequent reassessment.

(2) "Unlicensed person" means an individual who is not licensed to practice nursing, medicine, or another health occupation requiring a license in Washington state, but who provides the services specified in section 3(1) of this act to children in foster family homes as defined in chapter 74.15 RCW. For the purpose of this section and section 3 of this act, members of the child's immediate family and foster parents licensed under chapter 74.15 RCW are not considered unlicensed persons and may perform nursing tasks without specific delegation.

NEW SECTION. Sec. 3. (1) Unlicensed persons as defined in section 2 of this act are allowed to administer the following tasks at the discretion of the delegating registered nurse based upon the registered nurse's assessment of the person's skills.

(a) Oral medication;

(b) Topical medication, including ear, nose, and eye drops;

(d) Suppositories and unit dose enemas;

(e) Home blood glucose testing and monitoring;

(f) Injectable insulin;

(g) Gastrostomy tube feedings;

(h) Clean intermittent catheterization;

(i) Inhalants;

(j) Oro-pharyngeal suctioning;

(k) Intravenous therapy; and

(l) Prescribed emergency procedures to treat identified anaphylactic reactions.

(2) The department of social and health services in conjunction with the department of health shall adopt rules to implement this section. Such rules shall include the following requirements:

(a) Treatment authorized by this section must be prescribed by a health care practitioner licensed under Title 18 RCW who has prescriptive authority, acting within the scope of his or her license. If the delegating registered nurse obtains verbal orders from the health care practitioner amending the existing treatment plan, the verbal orders shall be provided in writing to the unlicensed person.

(b) Delegation may be made only by a registered nurse.

(d) A registered nurse shall perform an assessment of the child's condition including a plan of risk management, and provide written delegation to the unlicensed person.

(e) Appropriate training for each case shall be provided using standards established jointly by the department of health and the department of social and health services.

(f) There shall be written instructions and appropriate supervision of the trained unlicensed person. Supervision may be indirect.

(g) Unlicensed persons shall be allowed to perform delegated tasks only for a child for whom they have been trained; such training shall not be transferable, but shall be specific to each child.

(h) The trained unlicensed person shall follow directions, or take appropriate corrective action upon notice of inappropriate care to comply with the care plan and directions of the delegating nurse in charge.

(i) Each delegating nurse shall keep a record of each person to whom tasks have been delegated, the training provided, and the results of each follow-up visit; such record shall be distinct from any clinical record.

(j) An appropriate quality assurance system shall be established, including regular evaluation of the program, individual children, and outcomes, and a method to make regular adjustments in the program or level of care of children, and training of unlicensed persons.

NEW SECTION. Sec. 4. Sections 2 and 3 of this act are each added to chapter 74.13 RCW.