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91_SB0965ham001
LRB9104864PTpkam05
1 AMENDMENT TO SENATE BILL 965
2 AMENDMENT NO. . Amend Senate Bill 965 on page 1, by
3 replacing lines 7 through 30 with the following:
4 "(20 ILCS 1705/15.4 new)
5 Sec. 15.4. Authorization for nursing delegation to
6 permit direct care staff to administer medications.
7 (a) This Section applies to (i) all programs for persons
8 with a developmental disability in settings of 16 persons or
9 fewer that are funded or licensed by the Department of Human
10 Services and that distribute or administer medications and
11 (ii) all intermediate care facilities for the developmentally
12 disabled with 16 beds or fewer that are licensed by the
13 Department of Public Health. The Department of Human
14 Services shall develop a training program for authorized
15 direct care staff to administer oral and topical medications
16 under the direction and monitoring of a registered
17 professional nurse. This training program shall be developed
18 in consultation with professional associations representing
19 (i) physicians licensed to practice medicine in all its
20 branches, (ii) registered professional nurses, and (iii)
21 pharmacists.
22 (b) For the purposes of this Section:
23 "Authorized direct care staff" means non-licensed
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1 persons who have successfully completed a medication
2 administration training program approved by the Department of
3 Human Services and conducted by a nurse-trainer. This
4 authorization is specific to an individual receiving service
5 in a specific agency and does not transfer to another agency.
6 "Nurse-trainer training program" means a standardized,
7 competency based medication administration train-the-trainer
8 program provided by the Department of Human Services and
9 conducted by a Department of Human Services master
10 nurse-trainer for the purpose of training nurse-trainers to
11 train persons employed or under contract to provide direct
12 care or treatment to individuals receiving services to
13 administer medications and provide self-administration of
14 medication training to individuals under the direction and
15 monitoring of the nurse-trainer. The program incorporates
16 adult learning styles, teaching strategies, classroom
17 management, and a curriculum overview, including the ethical
18 and legal aspects of supervising those administering
19 medications.
20 "Self-administration of medications" means an individual
21 administers his or her own medications. To be considered
22 capable to self-administer their own medication, individuals
23 must, at a minimum, be able to identify their medication by
24 size, shape, or color, know when they should take the
25 medication, and know the amount of medication to be taken
26 each time.
27 "Training program" means a standardized medication
28 administration training program approved by the Department of
29 Human Services and conducted by a registered professional
30 nurse for the purpose of training persons employed or under
31 contract to provide direct care or treatment to individuals
32 receiving services to administer medications and provide
33 self-administration of medication training to individuals
34 under the delegation and direction of a nurse-trainer. The
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1 program incorporates adult learning styles, teaching
2 strategies, classroom management, curriculum overview,
3 including ethical-legal aspects, and standardized
4 competency-based evaluations on administration of medications
5 and self-administration of medication training programs.
6 (c) Training and authorization of non-licensed direct
7 care staff by nurse-trainers must meet the requirements of
8 this subsection.
9 (1) Prior to training non-licensed direct care staff
10 to administer medication, the nurse-trainer shall perform
11 the following for each individual to whom medication will
12 be administered by non-licensed direct care staff:
13 (A) An assessment of the individual's health
14 history and physical and mental status.
15 (B) An evaluation of the medications
16 prescribed.
17 (2) Non-licensed authorized direct care staff shall
18 meet the following criteria:
19 (A) Be 18 years of age or older.
20 (B) Have completed high school or its
21 equivalent (GED).
22 (C) Have demonstrated functional literacy.
23 (D) Have satisfactorily completed the Health
24 and Safety component of a Department of Human
25 Services authorized direct care staff training
26 program.
27 (E) Have successfully completed the training
28 program, pass the written portion of the
29 comprehensive exam, and score 100% on the
30 competency-based assessment specific to the
31 individual and his or her medications.
32 (F) Have received additional competency-based
33 assessment by the nurse-trainer as deemed necessary
34 by the nurse-trainer whenever a change of medication
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1 occurs or a new individual that requires medication
2 administration enters the program.
3 (3) Authorized direct care staff shall be
4 re-evaluated by a nurse-trainer at least annually or more
5 frequently at the discretion of the registered
6 professional nurse. Any necessary retraining shall be to
7 the extent that is necessary to ensure competency of the
8 authorized direct care staff to administer medication.
9 (4) Authorization of direct care staff to
10 administer medication shall be revoked if, in the opinion
11 of the registered professional nurse, the authorized
12 direct care staff is no longer competent to administer
13 medication.
14 (5) The registered professional nurse shall assess
15 an individual's health status at least annually or more
16 frequently at the discretion of the registered
17 professional nurse.
18 (d) Medication self-administration shall meet the
19 following requirements:
20 (1) As part of the normalization process, in order
21 for each individual to attain the highest possible level
22 of independent functioning, all individuals shall be
23 permitted to participate in their total health care
24 program. This program shall include, but not be limited
25 to, individual training in preventive health and
26 self-medication procedures.
27 (A) Every program shall adopt written policies
28 and procedures for assisting individuals in
29 obtaining preventative health and self-medication
30 skills in consultation with a registered
31 professional nurse, advanced practice nurse,
32 physician assistant, or physician licensed to
33 practice medicine in all its branches.
34 (B) Individuals shall be evaluated to
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1 determine their ability to self-medicate by the
2 nurse-trainer through the use of the Department's
3 required, standardized screening and assessment
4 instruments.
5 (C) When the results of the screening and
6 assessment indicate an individual not to be capable
7 to self-administer his or her own medications,
8 programs shall be developed in consultation with the
9 Community Support Team or Interdisciplinary Team to
10 provide individuals with self-medication
11 administration.
12 (1) Each individual shall be presumed to be
13 competent to self-administer medications if:
14 (A) authorized by an order of a physician
15 licensed to practice medicine in all its branches;
16 and
17 (B) approved to self-administer medication by
18 the individual's Community Support Team or
19 Interdisciplinary Team, which includes a registered
20 professional nurse or an advanced practice nurse.
21 (e) Quality Assurance.
22 (1) A registered professional nurse, advanced
23 practice nurse, licensed practical nurse, physician
24 licensed to practice medicine in all its branches,
25 physician assistant, or pharmacist shall review the
26 following for all individuals:
27 (A) Medication orders.
28 (B) Medication labels, including medications
29 listed on the medication administration record for
30 persons who are not self-medicating to ensure the
31 labels match the orders issued by the physician
32 licensed to practice medicine in all its branches,
33 advanced practice nurse, or physician assistant.
34 (C) Medication administration records for
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1 persons who are not self-medicating to ensure that
2 the records are completed appropriately for:
3 (i) medication administered as
4 prescribed;
5 (ii) refusal by the individual; and
6 (iii) full signatures provided for all
7 initials used.
8 (2) Reviews shall occur at least quarterly, but may
9 be done more frequently at the discretion of the
10 registered professional nurse or advanced practice nurse.
11 (3) A quality assurance review of medication errors
12 and data collection for the purpose of monitoring and
13 recommending corrective action shall be conducted within
14 7 days and included in the required annual review.
15 (f) Programs using authorized direct care staff to
16 administer medications are responsible for documenting and
17 maintaining records on the training that is completed.
18 (g) The absence of this training program constitutes a
19 threat to the public interest, safety, and welfare and
20 necessitates emergency rulemaking by the Departments of Human
21 Services and Public Health under Section 5-45 of the Illinois
22 Administrative Procedure Act."; and
23 on page 5, line 8, by replacing "Direct" with "Delegation to
24 authorized direct".