WSR 02-14-062



(Aging and Adult Services Administration)

[ Filed June 27, 2002, 3:11 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 02-09-047.

Title of Rule: WAC 388-78A-265 Limited nursing services.

Purpose: The Department of Health proposed legislation during the 2000 legislative session designed to improve nurse delegation in the community setting. Passage of SHB 1218 (chapter 95, Laws of 2000) resulted in changes to chapter 18.79 RCW, Registered nurse -- Activities allowed -- Delegation of tasks. In the boarding home WAC 388-78A-265 there is reference to nursing activities that needs to be amended in order to be in compliance with the revisions made by the Department of Health to chapter 18.79 RCW and chapter 246-840 WAC.

Statutory Authority for Adoption: RCW 18.20.090.

Statute Being Implemented: Chapter 18.79 RCW; chapter 95, Laws of 2000.

Summary: To clarify that general delegation by unlicensed staff may still occur in community settings, but only for nursing tasks that do not require substantial skill. The tasks listed in current WAC 388-78A-265(3) require "substantial skill" and should not be delegated to unlicensed staff. Deleting this subsection and providing reference to nursing/delegation statutes and regulations is appropriate and gives providers clear information on the subject.

Reasons Supporting Proposal: To be in compliance with other existing statute and regulations.

Name of Agency Personnel Responsible for Drafting: Sherri Wills, PPDT Program Manager, P.O. Box 45600, Lacey, WA 98504, (360) 725-2348; Implementation: BH Quality Assurance, P.O. Box 45600, Lacey, WA 98504; and Enforcement: Department of Health.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The rule change has been proposed to bring WAC 388-78A-265 Limited nursing services, into compliance with recently revised RCW 18.79.260 Registered nurse--Allowed activities -- Delegation of tasks, as well as update the outdated references to RCW.

Proposal Changes the Following Existing Rules: The rule change has been proposed to bring WAC 388-78A-265 Limited nursing services, into compliance with recently revised RCW 18.79.260.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule is being amended solely to conform with existing statute and is exempt from filing a small business economic impact statement according to RCW 19.85.025(3), which exempts rules described in RCW 34.05.310(4). The proposed rule adopts and incorporates by reference and without material change Washington state statutes and rules of another Washington state agency. See RCW 34.05.310 (4)(c).

RCW 34.05.328 applies to this rule adoption. Under RCW 34.05.328, this rule is determined a "significant legislative rule" however; the amendment incorporates by reference without material change the applicable state statute (chapter 18.79 RCW), and the rules of the Department of Health (chapter 246-840 WAC). Therefore, a cost benefit analysis is not required per RCW 34.05.328 (5)(b)(iii).

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on August 6, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by August 2, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail, by 5:00 p.m., August 6, 2002.

Date of Intended Adoption: No sooner than August 7, 2002.

June 19, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION(Amending WSR 99-15-067, filed 7/19/99, effective 8/19/99)

WAC 388-78A-265   Limited nursing services.   This section applies only to licensees who choose to provide limited nursing services. This section does not apply when residents care for themselves or arrange for independent nursing or health care services pursuant to WAC 388-78A-268.

(1) The licensee shall employ or contract directly or indirectly with a RN or physician to:

(a) Provide or supervise limited nursing services;

(b) Assess, or supervise a LPN's assessment of each resident needing limited nursing services upon admittance, and develop the nursing component of the individual's resident plan;

(c) Reassess, or supervise a LPN's reassessment of the resident's nursing needs when staff notice a change in the resident's functional ability or health status, and amend the nursing component of the individual's resident plan accordingly; and

(d) Be available in person, by pager, or by telephone during hours of limited nursing services.

(2) A licensee shall ensure the following services are only provided by a RN, or a LPN under the supervision of a RN:

(a) Insertion of urethral catheters, including indwelling;

(b) Any other nursing service requested by the licensee and approved in writing by the department.

(3) The licensee may ((allow unlicensed staff to provide the following services under the delegation and supervision of a RN:

(a) Routine ostomy care that is well-established, with no breakdown or maintenance care;

(b) Enema;

(c) Uncomplicated routine colostomy and urethral care when the resident is unable to supervise these activities;

(d) Care of wounds that are superficial without drainage or infection; and

(e) Assistance with glucometer testing if the resident can perform the finger stick)) provide delegated nursing services pursuant to chapter 18.79 RCW and chapter 246-840 WAC.

(4) The licensee shall not provide the following nursing services on the premises:

(a) Respiratory ventilation;

(b) Intravenous procedures;

(c) Suctioning;

(d) Feeding tube insertion or site maintenance; and

(e) Care of residents who are bed-bound for more than fourteen consecutive days as a result of a medical condition.

(5) A licensee providing limited nursing services shall assure that employed or contracted nursing services are consistent with chapters ((18.78 and 18.88)) 18.79 and 18.88A RCW.

(6) A licensee providing limited nursing services shall provide for safe and sanitary:

(a) Storage and handling of clean and sterile nursing equipment and supplies;

(b) Storage and handling of soiled laundry and linens;

(c) Cleaning and disinfecting soiled equipment; and

(d) Refuse and infectious waste disposal.

(7) In new construction designed for limited nursing services, or upon starting a limited nursing services program within an existing boarding home, the licensee shall provide the following, accessible only by staff:

(a) A clean utility area for the purposes of storing and preparing clean and sterile nursing supplies, equipped with:

(i) A work counter or table; and

(ii) Adjacent handwashing sink, with soap and paper towels or other approved hand-drying device; and

(b) A soiled utility area for the purposes of storing soiled linen, cleaning and disinfecting soiled nursing care equipment, and disposing of refuse and infectious waste, equipped with:

(i) A work counter or table;

(ii) Sinks for handwashing and cleaning/sanitizing, with soap and paper towels or other approved hand-drying device.

[Statutory Authority: RCW 18.20.240. 99-15-067, 388-78A-265, filed 7/19/99, effective 8/19/99; 98-20-021, recodified as 388-78A-265, filed 9/25/98, effective 9/25/98. Statutory Authority: RCW 18.20.090. 94-13-180, 246-316-265, filed 6/21/94, effective 7/22/94.]

Washington State Code Reviser's Office