AN
ACT Relating to the credentialing of hemodialysis technicians; amending RCW
18.135.020 and 18.135.060; creating new sections; and providing an effective
date.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. There
are concerns about the quality of care dialysis patients are receiving due to
the lack of uniform training standards for hemodialysis clinical personnel
working in renal dialysis facilities in this state. Currently, hemodialysis
technicians are trained by the facilities, and most facilities have established
training programs providing from six to eight weeks of ongoing training.
Training is not standardized and varies among facilities. Some facilities
offer no on-site training. National studies indicate that renal dialysis facilities
avoid costs by reducing staffing levels and substituting untrained technicians
for professional nurses generally in response to inadequate medicare
reimbursements. These studies also suggest a resulting increase in patient
morbidity and mortality.
The
legislature finds that the regulation of hemodialysis technicians will increase
the level of professionalism in the state's renal dialysis facilities,
providing increased quality assurance for patients, health care providers,
third-party payers, and the public in general. The legislature declares that
this act furthers the public health, safety, and welfare of the people of the
state.
Sec.
2. RCW
18.135.020 and 1997 c 133 s 1 are each amended to read as follows:
As
used in this chapter:
(1)
"Secretary" means the secretary of health.
(2)
"Health care assistant" means an unlicensed person who assists a
licensed health care practitioner in providing health care to patients pursuant
to this chapter. However persons trained by a federally approved end-stage
renal disease facility who perform end-stage renal dialysis in the home
setting are exempt from certification under this chapter.
(3)
"Health care practitioner" means:
(a)
A physician licensed under chapter 18.71 RCW;
(b)
An osteopathic physician or surgeon licensed under chapter 18.57 RCW; or
(c)
Acting within the scope of their respective licensure, a podiatric physician
and surgeon licensed under chapter 18.22 RCW, a registered nurse or advanced
registered nurse practitioner licensed under chapter 18.79 RCW, or a naturopath
licensed under chapter 18.36A RCW.
(4)
"Supervision" means supervision of procedures permitted pursuant to
this chapter by a health care practitioner who is physically present and is
immediately available in the facility during the administration of injections,
as defined in this chapter, but need not be present during procedures to
withdraw blood.
(5)
"Health care facility" means any hospital, hospice care center,
licensed or certified health care facility, health maintenance organization
regulated under chapter 48.46 RCW, federally qualified health maintenance
organization, renal dialysis center or facility federally approved under 42
C.F.R. 405.2100, blood bank federally licensed under 21 C.F.R. 607, or clinical
laboratory certified under 20 C.F.R. 405.1301‑16.
(6)
"Delegation" means direct authorization granted by a licensed health
care practitioner to a health care assistant to perform the functions
authorized in this chapter which fall within the scope of practice of the
delegator and which are not within the scope of practice of the delegatee.
Sec.
3. RCW
18.135.060 and 2000 c 171 s 30 are each amended to read as follows:
(1)
Except as provided in subsection (2) of this section:
(a)
Any health care assistant certified pursuant to this chapter shall perform the
functions authorized in this chapter only by delegation of authority from the
health care practitioner and under the supervision of a health care
practitioner acting within the scope of his or her license. In the case of
subcutaneous, intradermal and intramuscular and intravenous injections, a
health care assistant may perform such functions only under the supervision of
a health care practitioner having authority, within the scope of his or her
license, to order such procedures.
(b)
The health care practitioner who ordered the procedure or a health care
practitioner who could order the procedure under his or her license shall be
physically present in the immediate area of a hospital or nursing home where
the injection is administered. Sensitivity agents being administered
intradermally or by the scratch method are excluded from this requirement.
(2)
A health care assistant trained by a federally approved end-stage renal disease
facility may perform venipuncture for blood withdrawal, administration of
oxygen as necessary by cannula or mask, venipuncture for placement of fistula
needles, connect to vascular catheter for hemodialysis, intravenous
administration of heparin and sodium chloride solutions as an integral part of
dialysis treatment, and intradermal, subcutaneous, or topical administration of
local anesthetics in conjunction with placement of fistula needles, and
intraperitoneal administration of sterile electrolyte solutions and heparin for
peritoneal dialysis: (a) In the center or health care facility if a registered
nurse licensed under chapter 18.79 RCW is physically present and immediately
available in such center or health care facility; or (b) in the patient's home
if a physician and a registered nurse are available for consultation during the
dialysis.
NEW
SECTION. Sec. 4. The
secretary of health is authorized to establish a task force to assist in the
development of core competencies and minimum training standards for mandatory
training programs to be utilized by renal dialysis facilities for training
hemodialysis technicians as health care assistants pursuant to this act. The
secretary shall appoint to the task force persons knowledgeable in renal
dialysis practice, including nephrologists, dialysis nurses, patient care
hemodialysis technicians, dialysis patients, and other individuals with
expertise. The secretary may appoint succeeding advisory task forces for
reviewing and updating future requirements as necessary.
NEW
SECTION. Sec. 5.
Section 2 of this act takes effect March 1, 2002.
