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91_SB0965enr SB965 Enrolled LRB9104864PTpk 1 AN ACT concerning nursing. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Mental Health and Developmental 5 Disabilities Administrative Act is amended by adding Section 6 15.4 as follows: 7 (20 ILCS 1705/15.4 new) 8 Sec. 15.4. Authorization for nursing delegation to 9 permit direct care staff to administer medications. 10 (a) This Section applies to (i) all programs for persons 11 with a developmental disability in settings of 16 persons or 12 fewer that are funded or licensed by the Department of Human 13 Services and that distribute or administer medications and 14 (ii) all intermediate care facilities for the developmentally 15 disabled with 16 beds or fewer that are licensed by the 16 Department of Public Health. The Department of Human 17 Services shall develop a training program for authorized 18 direct care staff to administer oral and topical medications 19 under the supervision and monitoring of a registered 20 professional nurse. This training program shall be developed 21 in consultation with professional associations representing 22 (i) physicians licensed to practice medicine in all its 23 branches, (ii) registered professional nurses, and (iii) 24 pharmacists. 25 (b) For the purposes of this Section: 26 "Authorized direct care staff" means non-licensed 27 persons who have successfully completed a medication 28 administration training program approved by the Department of 29 Human Services and conducted by a nurse-trainer. This 30 authorization is specific to an individual receiving service 31 in a specific agency and does not transfer to another agency. SB965 Enrolled -2- LRB9104864PTpk 1 "Nurse-trainer training program" means a standardized, 2 competency-based medication administration train-the-trainer 3 program provided by the Department of Human Services and 4 conducted by a Department of Human Services master 5 nurse-trainer for the purpose of training nurse-trainers to 6 train persons employed or under contract to provide direct 7 care or treatment to individuals receiving services to 8 administer medications and provide self-administration of 9 medication training to individuals under the supervision and 10 monitoring of the nurse-trainer. The program incorporates 11 adult learning styles, teaching strategies, classroom 12 management, and a curriculum overview, including the ethical 13 and legal aspects of supervising those administering 14 medications. 15 "Self-administration of medications" means an individual 16 administers his or her own medications. To be considered 17 capable to self-administer their own medication, individuals 18 must, at a minimum, be able to identify their medication by 19 size, shape, or color, know when they should take the 20 medication, and know the amount of medication to be taken 21 each time. 22 "Training program" means a standardized medication 23 administration training program approved by the Department of 24 Human Services and conducted by a registered professional 25 nurse for the purpose of training persons employed or under 26 contract to provide direct care or treatment to individuals 27 receiving services to administer medications and provide 28 self-administration of medication training to individuals 29 under the delegation and supervision of a nurse-trainer. The 30 program incorporates adult learning styles, teaching 31 strategies, classroom management, curriculum overview, 32 including ethical-legal aspects, and standardized 33 competency-based evaluations on administration of medications 34 and self-administration of medication training programs. SB965 Enrolled -3- LRB9104864PTpk 1 (c) Training and authorization of non-licensed direct 2 care staff by nurse-trainers must meet the requirements of 3 this subsection. 4 (1) Prior to training non-licensed direct care staff 5 to administer medication, the nurse-trainer shall perform 6 the following for each individual to whom medication will 7 be administered by non-licensed direct care staff: 8 (A) An assessment of the individual's health 9 history and physical and mental status. 10 (B) An evaluation of the medications 11 prescribed. 12 (2) Non-licensed authorized direct care staff shall 13 meet the following criteria: 14 (A) Be 18 years of age or older. 15 (B) Have completed high school or its 16 equivalent (GED). 17 (C) Have demonstrated functional literacy. 18 (D) Have satisfactorily completed the Health 19 and Safety component of a Department of Human 20 Services authorized direct care staff training 21 program. 22 (E) Have successfully completed the training 23 program, pass the written portion of the 24 comprehensive exam, and score 100% on the 25 competency-based assessment specific to the 26 individual and his or her medications. 27 (F) Have received additional competency-based 28 assessment by the nurse-trainer as deemed necessary 29 by the nurse-trainer whenever a change of medication 30 occurs or a new individual that requires medication 31 administration enters the program. 32 (3) Authorized direct care staff shall be 33 re-evaluated by a nurse-trainer at least annually or more 34 frequently at the discretion of the registered SB965 Enrolled -4- LRB9104864PTpk 1 professional nurse. Any necessary retraining shall be to 2 the extent that is necessary to ensure competency of the 3 authorized direct care staff to administer medication. 4 (4) Authorization of direct care staff to 5 administer medication shall be revoked if, in the opinion 6 of the registered professional nurse, the authorized 7 direct care staff is no longer competent to administer 8 medication. 9 (5) The registered professional nurse shall assess 10 an individual's health status at least annually or more 11 frequently at the discretion of the registered 12 professional nurse. 13 (d) Medication self-administration shall meet the 14 following requirements: 15 (1) As part of the normalization process, in order 16 for each individual to attain the highest possible level 17 of independent functioning, all individuals shall be 18 permitted to participate in their total health care 19 program. This program shall include, but not be limited 20 to, individual training in preventive health and 21 self-medication procedures. 22 (A) Every program shall adopt written policies 23 and procedures for assisting individuals in 24 obtaining preventative health and self-medication 25 skills in consultation with a registered 26 professional nurse, advanced practice nurse, 27 physician assistant, or physician licensed to 28 practice medicine in all its branches. 29 (B) Individuals shall be evaluated to 30 determine their ability to self-medicate by the 31 nurse-trainer through the use of the Department's 32 required, standardized screening and assessment 33 instruments. 34 (C) When the results of the screening and SB965 Enrolled -5- LRB9104864PTpk 1 assessment indicate an individual not to be capable 2 to self-administer his or her own medications, 3 programs shall be developed in consultation with the 4 Community Support Team or Interdisciplinary Team to 5 provide individuals with self-medication 6 administration. 7 (2) Each individual shall be presumed to be 8 competent to self-administer medications if: 9 (A) authorized by an order of a physician 10 licensed to practice medicine in all its branches; 11 and 12 (B) approved to self-administer medication by 13 the individual's Community Support Team or 14 Interdisciplinary Team, which includes a registered 15 professional nurse or an advanced practice nurse. 16 (e) Quality Assurance. 17 (1) A registered professional nurse, advanced 18 practice nurse, licensed practical nurse, physician 19 licensed to practice medicine in all its branches, 20 physician assistant, or pharmacist shall review the 21 following for all individuals: 22 (A) Medication orders. 23 (B) Medication labels, including medications 24 listed on the medication administration record for 25 persons who are not self-medicating to ensure the 26 labels match the orders issued by the physician 27 licensed to practice medicine in all its branches, 28 advanced practice nurse, or physician assistant. 29 (C) Medication administration records for 30 persons who are not self-medicating to ensure that 31 the records are completed appropriately for: 32 (i) medication administered as 33 prescribed; 34 (ii) refusal by the individual; and SB965 Enrolled -6- LRB9104864PTpk 1 (iii) full signatures provided for all 2 initials used. 3 (2) Reviews shall occur at least quarterly, but may 4 be done more frequently at the discretion of the 5 registered professional nurse or advanced practice nurse. 6 (3) A quality assurance review of medication errors 7 and data collection for the purpose of monitoring and 8 recommending corrective action shall be conducted within 9 7 days and included in the required annual review. 10 (f) Programs using authorized direct care staff to 11 administer medications are responsible for documenting and 12 maintaining records on the training that is completed. 13 (g) The absence of this training program constitutes a 14 threat to the public interest, safety, and welfare and 15 necessitates emergency rulemaking by the Departments of Human 16 Services and Public Health under Section 5-45 of the Illinois 17 Administrative Procedure Act. 18 (h) Direct care staff who fail to qualify for delegated 19 authority to administer medications pursuant to the 20 provisions of this Section shall be given additional 21 education and testing to meet criteria for delegation 22 authority to administer medications. Any direct care staff 23 person who fails to qualify as an authorized direct care 24 staff after initial training and testing must within 3 months 25 be given another opportunity for retraining and retesting. A 26 direct care staff person who fails to meet criteria for 27 delegated authority to administer medication, including, but 28 not limited to, failure of the written test on 2 occasions 29 shall be given consideration for shift transfer or 30 reassignment, if possible. No employee shall be terminated 31 for failure to qualify during the 3-month time period 32 following initial testing. Refusal to complete training and 33 testing required by this Section may be grounds for immediate 34 dismissal. SB965 Enrolled -7- LRB9104864PTpk 1 (i) No authorized direct care staff person delegated to 2 administer medication shall be subject to suspension or 3 discharge for errors resulting from the staff person's acts 4 or omissions when performing the functions unless the staff 5 person's actions or omissions constitute willful and wanton 6 conduct. Nothing in this subsection is intended to supersede 7 paragraph (4) of subsection (c). 8 (j) A registered professional nurse, advanced practice 9 nurse, physician licensed to practice medicine in all its 10 branches, or physician assistant shall be on duty or on call 11 at all times in any program covered by this Section. 12 (k) The employer shall be responsible for maintaining 13 liability insurance for any program covered by this Section. 14 (l) Any direct care staff person who qualifies as 15 authorized direct care staff pursuant to this Section shall 16 be granted consideration for a one-time additional salary 17 differential. The Department shall determine and provide the 18 necessary funding for the differential in the base. This 19 subsection (l) is inoperative on and after June 30, 2000. 20 Section 10. The Nursing and Advanced Practice Nursing 21 Act is amended by changing Section 5-15 as follows: 22 (225 ILCS 65/5-15) 23 Sec. 5-15. Policy; application of Act. For the protection 24 of life and the promotion of health, and the prevention of 25 illness and communicable diseases, any person practicing or 26 offering to practice professional and practical nursing in 27 Illinois shall submit evidence that he or she is qualified to 28 practice, and shall be licensed as provided under this Act. 29 No person shall practice or offer to practice professional or 30 practical nursing in Illinois or use any title, sign, card or 31 device to indicate that such a person is practicing 32 professional or practical nursing unless such person has been SB965 Enrolled -8- LRB9104864PTpk 1 licensed under the provisions of this Act. 2 This Act does not prohibit the following: 3 (a) The practice of nursing in Federal employment in the 4 discharge of the employee's duties by a person who is 5 employed by the United States government or any bureau, 6 division or agency thereof and is a legally qualified and 7 licensed nurse of another state or territory and not in 8 conflict with Sections 10-5, 10-30, and 10-45 of this Act. 9 (b) Nursing that is included in their program of study 10 by students enrolled in programs of nursing or in current 11 nurse practice update courses approved by the Department. 12 (c) The furnishing of nursing assistance in an 13 emergency. 14 (d) The practice of nursing by a nurse who holds an 15 active license in another state when providing services to 16 patients in Illinois during a bonafide emergency or in 17 immediate preparation for or during interstate transit. 18 (e) The incidental care of the sick by members of the 19 family, domestic servants or housekeepers, or care of the 20 sick where treatment is by prayer or spiritual means. 21 (f) Persons from being employed as nursing aides, 22 attendants, orderlies, and other auxiliary workers in private 23 homes, long term care facilities, nurseries, hospitals or 24 other institutions. 25 (g) The practice of practical nursing by one who has 26 applied in writing to the Department in form and substance 27 satisfactory to the Department, for a license as a licensed 28 practical nurse and who has complied with all the provisions 29 under Section 10-30, except the passing of an examination to 30 be eligible to receive such license, until: the decision of 31 the Department that the applicant has failed to pass the next 32 available examination authorized by the Department or has 33 failed, without an approved excuse, to take the next 34 available examination authorized by the Department or until SB965 Enrolled -9- LRB9104864PTpk 1 the withdrawal of the application, but not to exceed 3 2 months. No applicant for licensure practicing under the 3 provisions of this paragraph shall practice practical nursing 4 except under the direct supervision of a registered 5 professional nurse licensed under this Act or a licensed 6 physician, dentist or podiatrist. In no instance shall any 7 such applicant practice or be employed in any supervisory 8 capacity. 9 (h) The practice of practical nursing by one who is a 10 licensed practical nurse under the laws of another U.S. 11 jurisdiction and has applied in writing to the Department, in 12 form and substance satisfactory to the Department, for a 13 license as a licensed practical nurse and who is qualified to 14 receive such license under Section 10-30, until (1) the 15 expiration of 6 months after the filing of such written 16 application, (2) the withdrawal of such application, or (3) 17 the denial of such application by the Department. 18 (i) The practice of professional nursing by one who has 19 applied in writing to the Department in form and substance 20 satisfactory to the Department for a license as a registered 21 professional nurse and has complied with all the provisions 22 under Section 10-30 except the passing of an examination to 23 be eligible to receive such license, until the decision of 24 the Department that the applicant has failed to pass the next 25 available examination authorized by the Department or has 26 failed, without an approved excuse, to take the next 27 available examination authorized by the Department or until 28 the withdrawal of the application, but not to exceed 3 29 months. No applicant for licensure practicing under the 30 provisions of this paragraph shall practice professional 31 nursing except under the direct supervision of a registered 32 professional nurse licensed under this Act. In no instance 33 shall any such applicant practice or be employed in any 34 supervisory capacity. SB965 Enrolled -10- LRB9104864PTpk 1 (j) The practice of professional nursing by one who is a 2 registered professional nurse under the laws of another 3 state, territory of the United States or country and has 4 applied in writing to the Department, in form and substance 5 satisfactory to the Department, for a license as a registered 6 professional nurse and who is qualified to receive such 7 license under Section 10-30, until (1) the expiration of 6 8 months after the filing of such written application, (2) the 9 withdrawal of such application, or (3) the denial of such 10 application by the Department. 11 (k) The practice of professional nursing that is 12 included in a program of study by one who is a registered 13 professional nurse under the laws of another state or 14 territory of the United States or foreign country, territory 15 or province and who is enrolled in a graduate nursing 16 education program or a program for the completion of a 17 baccalaureate nursing degree in this State, which includes 18 clinical supervision by faculty as determined by the 19 educational institution offering the program and the health 20 care organization where the practice of nursing occurs. The 21 educational institution will file with the Department each 22 academic term a list of the names and origin of license of 23 all professional nurses practicing nursing as part of their 24 programs under this provision. 25 (l) Any person licensed in this State under any other 26 Act from engaging in the practice for which she or he is 27 licensed. 28 (m) Delegation to authorized direct care staff trained 29 under Section 15.4 of the Mental Health and Developmental 30 Disabilities Administrative Act. 31 An applicant for license practicing under the exceptions 32 set forth in subparagraphs (g), (h), (i), and (j) of this 33 Section shall use the title R.N. Lic. Pend. or L.P.N. Lic. 34 Pend. respectively and no other. SB965 Enrolled -11- LRB9104864PTpk 1 (Source: P.A. 90-61, eff. 12-30-97; 90-248, eff. 1-1-98; 2 90-655, eff. 7-30-98; 90-742, eff. 8-13-98.) 3 Section 99. Effective date. This Act takes effect upon 4 becoming law.