(20 ILCS 1705/15.4)
Authorization for nursing delegation to permit direct care
(a) This Section applies to (i) all residential programs for persons
developmental disability in settings of 16 persons or fewer that are funded or
licensed by the Department of Human
Services and that distribute or administer medications, (ii) all
facilities for persons with developmental disabilities with 16 beds or fewer that are
licensed by the
Department of Public Health, and (iii) all day programs certified to serve persons with developmental disabilities by the Department of Human Services. The Department of Human Services shall develop a
training program for authorized direct care staff to administer
medications under the
supervision and monitoring of a registered professional nurse.
The training program for authorized direct care staff shall include educational and oversight components for staff who work in day programs that are similar to those for staff who work in residential programs. This training program shall be developed in consultation with professional
associations representing (i) physicians licensed to practice medicine in all
its branches, (ii) registered professional nurses, and (iii) pharmacists.
(b) For the purposes of this Section:
"Authorized direct care staff" means non-licensed persons who have
successfully completed a medication administration training program
approved by the Department of Human Services and conducted by a nurse-trainer.
This authorization is specific to an individual receiving service in
specific agency and does not transfer to another agency.
"Medications" means oral and topical medications, insulin in an injectable form, oxygen, epinephrine auto-injectors, and vaginal and rectal creams and suppositories. "Oral" includes inhalants and medications administered through enteral tubes, utilizing aseptic technique. "Topical" includes eye, ear, and nasal medications. Any controlled substances must be packaged specifically for an identified individual.
"Insulin in an injectable form" means a subcutaneous injection via an insulin pen pre-filled by the manufacturer. Authorized direct care staff may administer insulin, as ordered by a physician, advanced practice registered nurse, or physician assistant, if: (i) the staff has successfully completed a Department-approved advanced training program specific to insulin administration developed in consultation with professional associations listed in subsection (a) of this Section, and (ii) the staff consults with the registered nurse, prior to administration, of any insulin dose that is determined based on a blood glucose test result. The authorized direct care staff shall not: (i) calculate the insulin dosage needed when the dose is dependent upon a blood glucose test result, or (ii) administer insulin to individuals who require blood glucose monitoring greater than 3 times daily, unless directed to do so by the registered nurse.
"Nurse-trainer training program" means a standardized, competency-based
medication administration train-the-trainer program provided by the
Department of Human Services and conducted by a Department of Human
Services master nurse-trainer for the purpose of training nurse-trainers to
train persons employed or under contract to provide direct care or
treatment to individuals receiving services to administer
medications and provide self-administration of medication training to
individuals under the supervision and monitoring of the nurse-trainer. The
program incorporates adult learning styles, teaching strategies, classroom
management, and a curriculum overview, including the ethical and legal
aspects of supervising those administering medications.
"Self-administration of medications" means an individual administers
his or her own medications. To be considered capable to self-administer
their own medication, individuals must, at a minimum, be able to identify
their medication by size, shape, or color, know when they should take
the medication, and know the amount of medication to be taken each time.
"Training program" means a standardized medication administration
training program approved by the Department of Human Services and
conducted by a registered professional nurse for the purpose of training
persons employed or under contract to provide direct care or treatment to
individuals receiving services to administer medications
and provide self-administration of medication training to individuals under
the delegation and supervision of a nurse-trainer. The program incorporates
adult learning styles, teaching strategies, classroom management,
curriculum overview, including ethical-legal aspects, and standardized
competency-based evaluations on administration of medications and
self-administration of medication training programs.
(c) Training and authorization of non-licensed direct care staff by
nurse-trainers must meet the requirements of this subsection.
(1) Prior to training non-licensed direct care staff
to administer medication, the nurse-trainer shall perform the following for each individual to whom medication will be administered by non-licensed direct care staff:
(A) An assessment of the individual's health
history and physical and mental status.
(B) An evaluation of the medications prescribed.
(2) Non-licensed authorized direct care staff shall
meet the following criteria:
(A) Be 18 years of age or older.
(B) Have completed high school or have a high
school equivalency certificate.
(C) Have demonstrated functional literacy.
(D) Have satisfactorily completed the Health and
Safety component of a Department of Human Services authorized direct care staff training program.
(E) Have successfully completed the training
program, pass the written portion of the comprehensive exam, and score 100% on the competency-based assessment specific to the individual and his or her medications.
(F) Have received additional competency-based
assessment by the nurse-trainer as deemed necessary by the nurse-trainer whenever a change of medication occurs or a new individual that requires medication administration enters the program.
(3) Authorized direct care staff shall be
re-evaluated by a nurse-trainer at least annually or more frequently at the discretion of the registered professional nurse. Any necessary retraining shall be to the extent that is necessary to ensure competency of the authorized direct care staff to administer medication.
(4) Authorization of direct care staff to administer
medication shall be revoked if, in the opinion of the registered professional nurse, the authorized direct care staff is no longer competent to administer medication.
(5) The registered professional nurse shall assess
an individual's health status at least annually or more frequently at the discretion of the registered professional nurse.
(d) Medication self-administration shall meet the following
(1) As part of the normalization process, in order
for each individual to attain the highest possible level of independent functioning, all individuals shall be permitted to participate in their total health care program. This program shall include, but not be limited to, individual training in preventive health and self-medication procedures.
(A) Every program shall adopt written policies
and procedures for assisting individuals in obtaining preventative health and self-medication skills in consultation with a registered professional nurse, advanced practice registered nurse, physician assistant, or physician licensed to practice medicine in all its branches.
(B) Individuals shall be evaluated to determine
their ability to self-medicate by the nurse-trainer through the use of the Department's required, standardized screening and assessment instruments.
(C) When the results of the screening and
assessment indicate an individual not to be capable to self-administer his or her own medications, programs shall be developed in consultation with the Community Support Team or Interdisciplinary Team to provide individuals with self-medication administration.
(2) Each individual shall be presumed to be
competent to self-administer medications if:
(A) authorized by an order of a physician
licensed to practice medicine in all its branches, an advanced practice registered nurse, or a physician assistant; and
(B) approved to self-administer medication by
the individual's Community Support Team or Interdisciplinary Team, which includes a registered professional nurse or an advanced practice registered nurse.
(e) Quality Assurance.
(1) A registered professional nurse, advanced
practice registered nurse, licensed practical nurse, physician licensed to practice medicine in all its branches, physician assistant, or pharmacist shall review the following for all individuals:
(A) Medication orders.
(B) Medication labels, including medications
listed on the medication administration record for persons who are not self-medicating to ensure the labels match the orders issued by the physician licensed to practice medicine in all its branches, advanced practice registered nurse, or physician assistant.
(C) Medication administration records for
persons who are not self-medicating to ensure that the records are completed appropriately for:
(i) medication administered as prescribed;
(ii) refusal by the individual; and
(iii) full signatures provided for all
(2) Reviews shall occur at least quarterly, but may
be done more frequently at the discretion of the registered professional nurse or advanced practice registered nurse.
(3) A quality assurance review of medication errors
and data collection for the purpose of monitoring and recommending corrective action shall be conducted within 7 days and included in the required annual review.
(f) Programs using authorized direct care
staff to administer medications are responsible for documenting and maintaining
on the training that is completed.
(g) The absence of this training program constitutes a threat to the
safety, and welfare and necessitates emergency rulemaking by
the Departments of Human Services and
under Section 5-45
Illinois Administrative Procedure Act.
(h) Direct care staff who fail to qualify for delegated authority to
administer medications pursuant to the provisions of this Section shall be
additional education and testing to meet criteria for
delegation authority to administer medications.
Any direct care staff person who fails to qualify as an authorized direct care
after initial training and testing must within 3 months be given another
opportunity for retraining and retesting. A direct care staff person who fails
meet criteria for delegated authority to administer medication, including, but
not limited to, failure of the written test on 2 occasions shall be given
consideration for shift transfer or reassignment, if possible. No employee
shall be terminated for failure to qualify during the 3-month time period
following initial testing. Refusal to complete training and testing required
by this Section may be grounds for immediate dismissal.
(i) No authorized direct care staff person delegated to administer
medication shall be subject to suspension or discharge for errors
resulting from the staff
person's acts or omissions when performing the functions unless the staff
person's actions or omissions constitute willful and wanton conduct.
Nothing in this subsection is intended to supersede paragraph (4) of subsection
(j) A registered professional nurse, advanced practice registered nurse,
physician licensed to practice medicine in all its branches, or physician
assistant shall be on
on call at all times in any program covered by this Section.
(k) The employer shall be responsible for maintaining liability insurance
for any program covered by this Section.
(l) Any direct care staff person who qualifies as authorized direct care
staff pursuant to this Section shall be granted consideration for a one-time
salary differential. The Department shall determine and provide the necessary
the differential in the base. This subsection (l) is inoperative on and after
June 30, 2000.
(Source: P.A. 99-78, eff. 7-20-15; 99-143, eff. 7-27-15; 99-581, eff. 1-1-17; 100-50, eff. 1-1-18; 100-513, eff. 1-1-18; 100-863, eff. 8-14-18.)