Responsibilities of the Registered Nurse in Home and ...

Responsibilities of the Registered Nurse in Home and ...

RN DELEGATION Sections 9241 through 9253 of the Direct Service Registry rule published December 20, 2012 address delegation of medication administration and noncomplex tasks by the RN to direct service workers working with clients receiving HCBS waiver services. Section 9253 specifically addresses the Responsibilities of the Registered Nurse with regard to these areas of delegation.

WHAT ARE THE RESPONSIBILITIES OF THE RN DURING DELEGATION? 1. assuring that during person-specific trainings and required evaluations, the direct service worker performs the authorized medication administration and non-complex tasks according to exact directions making certain there is no need to alter the standard procedures and the results are predictable; 2. assuring no direct service worker is authorized to perform medication administration and noncomplex tasks if the health status of the person receiving services is not stable and predictable;

3. assuring that the direct service worker demonstrates a sufficient level of competency in the subject matter as set forth in training; 4. assisting in the development of the plan of care for the person receiving assistance or services; 5. assisting the persons planning team to determine the frequency needed for RN assessments of the health status of the person receiving assistance or services;

6. at least annually, completing the competency evaluation of the direct service worker; 7. at least annually and more often as needed, assessing the health status of the client; and 7. completing and submitting the required documentation to the licensed agency employing the direct service worker. WHAT THE RN IS NOT RESPONSIBLE FOR

Assessing every client Training the DSW on the CPOC for their client. If there are aspects of the CPOC that may require the RNs involvement in the training of the DSW, those decisions are made on a case by case basis. Providing the 16 hours of basic training as referenced in Section 5055, Part K of HCBS licensing standards. Monitoring the MAR and re-ordering medications. All providers should have systems in place to assure that clients are receiving medications according to physicians orders. The RN may be involved in assisting the provider to establish and evaluate those systems.

Training on every medication that the client takes. The RN determines whether there is any additional client specific training needed on a particular medication. Examples might be whether the clients pulse or blood pressure need to be taken prior to administration. Are there specific side affects that the DSW should be aware of so that if observed, it will be reported in a timely manner. The provider team makes the initial

determination about whether the client will need health care tasks performed that need to be referred to the RN for assessment. The team may consist of the Support Coordinator, provider and client at a minimum but may also include the clients family members, legal representative, DSW or others that may be chosen by the client. The team reviews and takes into consideration data collected on the CPOC, SIS La Plus, 90L, psychological and/or psychiatric evaluations and other historical

data. If the team determines that the client has no need for the DSW to administer medications or perform any non-complex tasks, referral to the RN is not necessary. The team is also responsible for evaluating changes in a clients condition that may require referral to the RN for assessment. Remember If the client has been deemed to be independent in their ability to self-administer their medications, how did the

team arrive at this determination? There should be documentation of an assessment in the clients record. The link below is for the departments assessment of client capacity to self-administer medication and determination of need for non-complex tasks to be performed developed November 2015: http:// dhh.louisiana.gov/assets/medicaid/hss/docs/DSW/ASSES SMENTOFCLIENTCAPACITYTOSELFADMINISTERMEDICATI ONANDDETERMINATIONOFNEEDFORNONCOMPLEXTASKS TOBEPERFORMED.pdf

For those clients referred to the RN by the provider team, the RN shall conduct an assessment and make a determination whether the clients health status is stable and predictable as required by the State Board of Nursing. If stable and predictable, the RN may proceed with the medication administration training, any client specific training that the RN deems necessary and determination of competency. Stable and predictable is defined by the State Board of Nursing as a situation in which the

persons clinical and behavioral status is determined by a licensed RN to be nonfluctuating and consistent. The RN retains accountability for any task that is delegated. If there are tasks that will be delegated, documentation should reflect that the RN conducted an assessment of the client, trained the worker on the tasks to be delegated and made a determination of competency. State surveyors will ask for this documentation. Providers are also responsible for knowing the

Medicaid policy for the client populations they serve. Medication administration may be delegated by the RN for clients receiving services under the OCDD and OAAS waiver programs. Medication administration is not allowed for clients receiving OAAS Long Term Care Personal Care Services (LT-PCS). Policy for this program only allows prompts or reminders. FREQUENTLY ASKED QUESTIONS Is a doctors order required for OTC drugs?

Yes. Providers might consider obtaining standing orders from the physician for OTC drugs that can be renewed and updated on an annual basis. What if the clients family insists on preparing a pill box or a weekly pill organizer with the clients medications? The regulations require that the direct support staff administer medications from containers that have labeling from the pharmacy that dispensed the medication/s. Can training by the RN be performed over the phone? The 16 hours of medication administration training by the RN cannot be done over the phone however, it is up to the judgment of the RN whether training can be done over the phone whenever

there are changes in medication orders and other client specific training that he/she deems necessary. Is training transferrable between provider agencies? Training is transferrable between provider agencies. The agency that is receiving the training from another agency must have sufficient documentation to determine that the employee successfully completed the required training. The receiving employer must verify the workers competency to perform the duties that will be assigned. Is there an RN delegation form?

There is no RN delegation form that providers are required to use. Do all DSWs need to be trained in medication administration? While it is a good practice, it is only necessary to train DSWs that are required to administer medications as part of the clients plan of care. If a DSW has a certificate as a certified medication attendant (CMA) do they need the 16 hour medication administration training? If a DSW has a current certificate as a CMA, it would not be necessary for them to take the 16 hour medication administration training. A determination of competency would still need to be completed. Does the 16 hour medication administration training have to be

repeated on an annual basis? The training does not have to be repeated on an annual basis. The RN may make a determination that a DSW needs to complete part or all of the training based upon the RNs assessment of competency that must be completed at least annually. Additional resources on RN delegation of medication administration and non-complex tasks may be found on the Health Standards Direct Service Worker web page at: http://dhh.louisiana.gov/index.cfm/directory/detail /713

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