093_HB3033

 
                                     LRB093 08668 AMC 08898 b

 1        AN ACT concerning nursing homes.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5.  The Nursing  Home  Care  Act  is  amended  by
 5    adding Section 3-202.3 as follows:

 6        (210 ILCS 45/3-202.3 new)
 7        Sec.  3-202.3.   Authorization  for nursing delegation to
 8    permit direct care staff to administer medications.
 9        (a)  The Department of  Public  Health  shall  develop  a
10    training   program   for  authorized  direct  care  staff  to
11    administer oral and topical medications under the supervision
12    and  monitoring  of  a  registered  professional   nurse   in
13    facilities  licensed  under  this  Act. This training program
14    shall  be  developed  in   consultation   with   professional
15    associations representing (i) physicians licensed to practice
16    medicine  in  all  its branches, (ii) registered professional
17    nurses, and (iii) pharmacists.
18        (b)  For the purposes of this Section:
19        "Authorized  direct  care  staff"    means   non-licensed
20    persons   who   have   successfully  completed  a  medication
21    administration training program approved  by  the  Department
22    and conducted by a nurse-trainer.
23        "Nurse-trainer  training  program"  means a standardized,
24    competency-based medication administration  train-the-trainer
25    program  provided by the Department and conducted by a master
26    nurse-trainer for the purpose of training  nurse-trainers  to
27    train  persons  employed  or under contract to provide direct
28    care  or  treatment  to  individuals  receiving  services  to
29    administer medications  and  provide  self-administration  of
30    medication  training to individuals under the supervision and
31    monitoring of the nurse-trainer.   The  program  incorporates
 
                            -2-      LRB093 08668 AMC 08898 b
 1    adult   learning   styles,   teaching  strategies,  classroom
 2    management, and a curriculum overview, including the  ethical
 3    and   legal   aspects   of  supervising  those  administering
 4    medications.
 5        "Training  program"  means  a  standardized    medication
 6    administration  training  program  approved by the Department
 7    and conducted by a  registered  professional  nurse  for  the
 8    purpose  of  training  persons  employed or under contract to
 9    provide direct care or  treatment  to  individuals  receiving
10    services  to  administer medications under the delegation and
11    supervision of a nurse-trainer.
12        (c)  Training and authorization  of  non-licensed  direct
13    care  staff  by  nurse-trainers must meet the requirements of
14    this subsection.
15             (1)  Prior  to  training  non-licensed  direct  care
16        staff to administer medication, the  nurse-trainer  shall
17        perform   the  following  for  each  individual  to  whom
18        medication will be administered  by  non-licensed  direct
19        care staff:
20                  (A)  An  assessment  of the individual's health
21             history and physical and mental status.
22                  (B)  An   evaluation   of    the    medications
23             prescribed.
24             (2)  Non-licensed authorized direct care staff shall
25        meet the following criteria:
26                  (A)  Be 18 years of age or older.
27                  (B)  Have   completed   high   school   or  its
28             equivalent (GED).
29                  (C)  Have demonstrated functional literacy.
30                  (D)  Have satisfactorily completed  the  Health
31             and  Safety  component  of  a  Department authorized
32             direct care staff training program.
33                  (E)  Have successfully completed  the  training
34             program,   passed   the   written   portion  of  the
 
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 1             comprehensive  exam,  and   scored   100%   on   the
 2             competency-based    assessment   specific   to   the
 3             individual and his or her medications.
 4                  (F)  Have received additional  competency-based
 5             assessment  by the nurse-trainer as deemed necessary
 6             by the nurse-trainer whenever a change of medication
 7             occurs or a new individual that requires  medication
 8             administration enters the program.
 9             (3)  Authorized   direct   care   staff   shall   be
10        re-evaluated by a nurse-trainer at least annually or more
11        frequently   at   the   discretion   of   the  registered
12        professional nurse.  Any necessary retraining shall be to
13        the extent that is necessary to ensure competency of  the
14        authorized direct care staff to administer medication.
15             (4)  Authorization   of   direct   care   staff   to
16        administer medication shall be revoked if, in the opinion
17        of  the  registered  professional  nurse,  the authorized
18        direct care staff is no longer  competent  to  administer
19        medication.
20             (5)  The  registered professional nurse shall assess
21        an individual's health status at least annually  or  more
22        frequently   at   the   discretion   of   the  registered
23        professional nurse.
24        (d)  Quality Assurance.
25             (1)  A  registered  professional   nurse,   advanced
26        practice   nurse,  licensed  practical  nurse,  physician
27        licensed  to  practice  medicine  in  all  its  branches,
28        physician  assistant,  or  pharmacist  shall  review  the
29        following for all individuals:
30                  (A)  Medication orders.
31                  (B)  Medication labels  to  ensure  the  labels
32             match the orders issued by the physician licensed to
33             practice  medicine  in  all  its  branches, advanced
34             practice nurse, or physician assistant.
 
                            -4-      LRB093 08668 AMC 08898 b
 1                  (C)  Medication   administration   records   to
 2             ensure that the records are completed  appropriately
 3             for:
 4                       (i)  medication       administered      as
 5                  prescribed;
 6                       (ii)  refusal by the individual; and
 7                       (iii)  full signatures  provided  for  all
 8                  initials used.
 9             (2)  Reviews shall occur at least quarterly, but may
10        be   done  more  frequently  at  the  discretion  of  the
11        registered professional nurse or advanced practice nurse.
12             (3)  A quality assurance review of medication errors
13        and data collection for the  purpose  of  monitoring  and
14        recommending  corrective action shall be conducted within
15        7 days and included in the required annual review.
16        (e)  Facilities using authorized  direct  care  staff  to
17    administer  medications  are  responsible for documenting and
18    maintaining records on the training that is completed.
19        (f)  The absence of this training program  constitutes  a
20    threat  to  the  public  interest,  safety,  and  welfare and
21    necessitates emergency rulemaking by the Department of Public
22    Health under Section  5-45  of  the  Illinois  Administrative
23    Procedure Act.
24        (g)  Direct  care staff who fail to qualify for delegated
25    authority  to  administer   medications   pursuant   to   the
26    provisions   of   this  Section  shall  be  given  additional
27    education  and  testing  to  meet  criteria  for   delegation
28    authority  to  administer  medications. Any direct care staff
29    person who fails to qualify  as  an  authorized  direct  care
30    staff after initial training and testing must within 3 months
31    be given another opportunity for retraining and retesting.  A
32    direct  care  staff  person  who  fails  to meet criteria for
33    delegated authority to administer medication, including,  but
34    not  limited  to,  failure of the written test on 2 occasions
 
                            -5-      LRB093 08668 AMC 08898 b
 1    shall  be  given  consideration   for   shift   transfer   or
 2    reassignment,  if  possible.  No employee shall be terminated
 3    for  failure  to  qualify  during  the  3-month  time  period
 4    following initial testing.  Refusal to complete training  and
 5    testing required by this Section may be grounds for immediate
 6    dismissal.
 7        (h)  No  authorized direct care staff person delegated to
 8    administer medication  shall  be  subject  to  suspension  or
 9    discharge  for  errors resulting from the staff person's acts
10    or omissions when performing the functions unless  the  staff
11    person's  actions  or omissions constitute willful and wanton
12    conduct. Nothing in this subsection is intended to  supersede
13    paragraph (4) of subsection (c).
14        (i)  A  registered  professional nurse, advanced practice
15    nurse, physician licensed to practice  medicine  in  all  its
16    branches,  or physician assistant shall be on duty or on call
17    at all times in any facility covered by this Section.
18        (j)  The facility shall be  responsible  for  maintaining
19    liability insurance for any program covered by this Section.