No. 32212: R156-31b. Nurse Practice Act Rule

DAR File No.: 32212
Filed: 03/02/2009, 03:19
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

Following a public hearing held by the Division on 01/08/2009 and additional written comments received, the Division and the Nursing Board are proposing additional amendments to this rule.

Summary of the rule or change:

Subsections R156-31b-102(2) and (5)(c) are changed to remove the language that limited the recognized accrediting bodies and added the more inclusive federal government agency. In Section R156-31b-601, amendments are made to recognize any regional or national accrediting body recognized by the U.S. Department of Education. Also in Subsection R156-31b-601(3), the percent of funding derived from sources that are not derived from funds provided under Title IV, HEA (Health Education Act) program funds, or student fees is decreased to 10% for proprietary schools which is the requirement established by the U.S. Department of Education. In Section R156-31b-802, updated information with respect to a "train the trainer" program. In Section R156-31b-803, The Medication Aide-Certified (MA-C) model curriculum adopted by the 2007 Delegate Assembly of the National Council of State Boards of Nursing is adopted and incorporated by reference as the model curriculum that must be followed by associations or facilities who want to offer the MA-C training. The previously listed modules are being deleted. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed amendment that was published in the January 1, 2009, issue of the Utah State Bulletin, on page 13. Underlining in the rule below indicates text that has been added since the publication of the proposed rule mentioned above; strike out indicates text that has been deleted. You must view the change in proposed rule and the proposed amendment together to understand all of the changes that will be enforceable should the agency make this rule effective.)

State statutory or constitutional authorization for this rule:

Section 58-31b-101 and Subsections 58-5-106(1)(a) and 58-1-202(1)(a)

This rule or change incorporates by reference the following material:

Deletes the "Accredited Institutions of Postsecondary Education", 2006-2007 edition, published by the American Council on Education; and adds the "Medication Assistant-Certified (MA-C) Model Curriculum", adopted by the National Council of State Boards of Nursing's Delegate Assembly on August 9, 2007

Anticipated cost or savings to:

the state budget:

No additional costs are anticipated to the Division beyond those previously identified in the original rule filing. A state school desiring to offer the MA-C training program will need to follow the model curriculum and have the necessary human and fiscal resources necessary to offer the program. The cost to operate an MA-C training program is unknown at this time. However, the schools who have indicated an interest in offering a program currently offer the certified nurse assistant program and can use the same facilities, supplies and faculty currently involved in the aide program so the costs should be minimal.

local governments:

The Division anticipates there should be little or no effect on local government as a result of these additional proposed amendments. Local governments do not operate nursing education programs and few operate any kind of health care facilities. However, if a local government ran a regulated facility, the use of an MA-C may save money because the MA-C could administer medications under the supervision of a nurse and the facility would not be required to hire another nurse to administer medications.

small businesses and persons other than businesses:

A regulated facility may use the MA-C in addition to existing staff, thus lessening the burden on the nurses. Given there is a shortage of nurses throughout the state, the utilization of an MA-C under appropriate nurse supervision could save facilities personnel costs. If a regulated facility chooses to cover the costs of the training and examination as a benefit to their staff or as a recruitment/retention incentive, the facility would be responsible for those costs. Otherwise, the MA-C would be responsible to pay the costs incurred to become certified. It is estimated that the cost of the MA-C training and examination will be similar to that of the certified nurse assistant. Training programs offered within educational institutions and associations/organizations charge between $280 and $400 for the course. The examination is estimated to cost between $58 and $70 per applicant. By allowing a parent educational institution to be regionally or nationally accredited by an accrediting body recognized by the U.S. Department of Education and the nurse accrediting body, more proprietary schools would qualify to seek approval to begin a nursing education program in Utah. Although the training and examination to become a MA-C will cost approximately $360 - $470, the ability to utilize this type of provider to help with the administration of medications will more than offset any of the certification costs.

Compliance costs for affected persons:

As indicated above, the MA-C training and examination is expected to cost between $360 - $470 per person. The Division's MA-C application fee is $89 and the 2-year renewal fee is $42. However, a person certified as an MA-C is expected to make at least $1.00/hour more than a certified nursing assistant. Hence the costs could be recouped within a 2-month period of time.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing implements H.B. 399 passed during the 2008 Legislative Session regarding MA-C. The implementation of the MA-C provisions create no fiscal impact to businesses beyond those anticipated by the Legislature in passing H.B. 399; such costs are addressed in the original proposed amendment rule filing. The rule change now recognizes a parent academic institution accredited by the U.S. Department of Education, thus allowing more schools to qualify for approval as a nursing education program. No fiscal impact to businesses is anticipated from this change. Francine A. Giani, Executive Director (DAR NOTE: H.B. 399 (2008) is found at Chapter 214, Laws of Utah 2008, and was effective 05/05/2008.)

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

04/14/2009

This rule may become effective on:

04/21/2009

Authorized by:

F. David Stanley, Director

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-31b. Nurse Practice Act Rule.

R156-31b-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 31b, as defined or used in this rule:

(1) "Academic year", as used in Section R156-31b-601, means three quarters or two semesters or 900 clock hours. A quarter is defined to be equal to ten weeks and a semester is defined to be equal to 14 or 15 weeks.

(2) "Affiliated with an institution of higher education", as used in Subsection 58-31b-601(1), means the general and science education courses required as part of a nursing education program are provided by an educational institution which is approved by the Board of Regents or an equivalent governmental agency in another state or a private educational institution which is regionally accredited by an accrediting board recognized by the [Council for Higher Education Accreditation of the American Council on Education]U.S. Department of Education; and the nursing program and the institution of higher education are affiliated with each other as evidenced by a written contract or memorandum of understanding.

(3) "APRN" means an advanced practice registered nurse.

(4) "APRN-CRNA" means an advanced practice registered nurse specializing and certified as a certified registered nurse anesthetist.

(5) "Approved continuing education" in Subsection R156-31b-303(3) means:

(a) continuing education that has been approved by a professional nationally recognized approver of health related continuing education;

(b) nursing education courses taken from an approved education program as defined in Subsection R156-31b-102(6); and

(c) health related course work taken from an educational institution accredited by a regional or national institutional accrediting body [identified in the "Accredited Institutions of Postsecondary Education", 2006-2007 edition, published by the American Council on Education]recognized by the U.S. Department of Education.

(6) "Approved education program" as defined in Subsection 58-31b-102(3) is further defined to include any nursing education program located within the state of Utah which meets the standards established in Sections R156-31b-601, 602 and 603; and any nursing education program located outside of Utah which meets the standards established in Section R156-31b-607.

(7) "CCNE" means the Commission on Collegiate Nursing Education.

(8) "CGFNS" means the Commission on Graduates of Foreign Nursing Schools.

(9) "COA", as used in this rule, means the Council of Accreditation of Nurse Anesthesia Education Programs.

(10) "Clinical preceptor", as used in Section R156-31b-608, means an individual who is employed by a clinical health care facility and is chosen by that agency, in collaboration with the Parent Nursing Education-Program, to provide direct, on-site supervision and direction to a nursing student who is engaged in a clinical rotation, and who is accountable to both the clinical agency and the supervisory clinical faculty member.

(11) "Comprehensive nursing assessment", as used in Section R156-31b-704, means an extensive data collection (initial and ongoing) for individuals, families, groups and communities addressing anticipated changes in patient conditions as well as emergent changes in patient's health status; recognizing alterations to previous patient conditions; synthesizing the biological, psychological, spiritual and social aspects of the patient's condition; evaluating the impact of nursing care; and using this broad and complete analysis to make independent decisions and identification of health care needs; plan nursing interventions, evaluate need for different interventions and the need to communicate and consult with other health team members.

(12) "Contact hour" means 60 minutes.

(13) "Delegatee", as used in Sections R156-31b-701 and 701a, means one or more competent persons receiving a delegation who acts in a complementary role to the delegating nurse, who has been trained appropriately for the task delegated, and whom the delegating nurse authorizes to perform a task that the delegates is not otherwise authorized to perform.

(14) "Delegation" means transferring to delegates the authority to perform a selected nursing task in a selected situation. The delegating nurse retains accountability for the delegation.

(15) "Delegator", as used in Sections R156-31b-701 and 701a, means the nurse making the delegation.

(16) "Diabetes medical management plan (DMMP), as used in this rule, means an individualized plan that describes the health care services that the student is to receive at school. The plan is developed and signed by the student's parent or guardian and health care team. It provides the school with information regarding how the student will manage diabetes at school on a daily basis. The DMMP shall be incorporated into and shall become a part of the student's IHP.

(17) "Direct supervision" is the supervision required in Subsection 58-31b-306(1)(a)(iii) and means:

(a) the person providing supervision shall be available on the premises at which the supervisee is engaged in practice; or

(b) if the supervisee is specializing in psychiatric mental health nursing, the supervisor may be remote from the supervisee if there is personal direct voice communication between the two prior to prescribing a prescription drug.

(18) "Disruptive behavior", as used in this rule, means conduct, whether verbal or physical, that is demeaning, outrageous, or malicious and that places at risk patient care or the process of delivering quality patient care. Disruptive behavior does not include criticism that is offered in good faith with the aim of improving patient care.

(19) "Equivalent to an approved practical nursing education program", as used in Subsection 58-31b-302(2)(e), means the applicant for licensure as an LPN by equivalency is currently enrolled in an RN education program with full approval status, and has completed course work which is equivalent to the course work of an NLNAC accredited practical nursing program.

(20) "Focused nursing assessment", as used in Section R156-31b-703, means an appraisal of an individual's status and situation at hand, contributing to the comprehensive assessment by the registered nurse, supporting ongoing data collection and deciding who needs to be informed of the information and when to inform.

(21) "Individualized healthcare plan (IHP), as used in Section R156-31b-701a, means a plan for managing the health needs of a specific student, written and reviewed at least annually by a school nurse. The IHP is developed by a nurse working in a school setting in conjunction with the student and the student's parent or guardian to guide school personnel in the care of a student with medical needs. The plan shall be based on the student's practitioner's orders for the administration of medications or treatments for the student, or the student's DMMP.

(22) "Licensure by equivalency" as used in this rule means licensure as a licensed practical nurse after successful completion of course work in a registered nurse program which meets the criteria established in Sections R156-31b-601 and R156-31b-603.

(23) "LPN" means a licensed practical nurse.

(24) "MA-C" means a medication aide - certified.

(25) "Medication", as used in Sections R156-31b-701 and 701a, means any prescription or nonprescription drug as defined in Subsections 58-17b-102(39) and (61) of the Pharmacy Practice Act.

(26) "NLNAC" means the National League for Nursing Accrediting Commission.

(27) "NCLEX" means the National Council Licensure Examination of the National Council of State Boards of Nursing.

(28) "Non-approved education program" means any foreign nurse education program.

(29) "Nurse", as used in this rule, means an individual licensed under Title 58, Chapter 31b as a licensed practical nurse, registered nurse, advanced practice registered nurse, or advanced practice registered nurse-certified registered nurse anesthetist, or a certified nurse midwife licensed under Title 58, Chapter 44a.

(30) "Nurse accredited", as used in this rule, means accreditation issued by NLNAC, CCNE or COA.

(31) "Other specified health care professionals", as used in Subsection 58-31b-102(15), who may direct the licensed practical nurse means:

(a) advanced practice registered nurse;

(b) certified nurse midwife;

(c) chiropractic physician;

(d) dentist;

(e) osteopathic physician;

(f) physician assistant;

(g) podiatric physician;

(h) optometrist;

(i) naturopathic physician; or

(j) mental health therapist as defined in Subsection 58-60-102(5).

(32) "Parent academic institution", as used in this rule, means the educational institution which grants the academic degree or awards the certificate of completion.

(33) "Parent nursing education-program", as used in Section R156-31b-607, means a nationally accredited, Board of Nursing approved nursing education program that is providing nursing education (didactic, clinical or both) to a student and is responsible for the education program curriculum, and program and student policies.

(34) "Patient", as used in this rule, means a recipient of nursing care and includes students in a school setting or clients of a health care facility, clinic, or practitioner.

(35) "Patient surrogate", as used in Subsection R156-31b-502(1)(d), means an individual who has legal authority to act on behalf of the patient when the patient is unable to act or decide for himself, including a parent, foster parent, legal guardian, or a person designated in a power of attorney.

(36) "Psychiatric mental health nursing specialty", as used in Subsection 58-31b-302(4)(g), includes psychiatric mental health nurse specialists and psychiatric mental health nurse practitioners.

(37) "Practitioner", as used in Sections R156-31b-701 and 701a, means a person authorized by law to prescribe treatment, medication, or medical devices, and who acts within the scope of such authority.

(38) "RN" means a registered nurse.

(39) "School", as used in Section R156-31b-701a, means any private or public institution of primary or secondary education, including charter schools, pre-school, kindergarten, and special education programs.

(40) "Supervision", as used in this rule, means the provision of guidance and review by a licensed nurse for the accomplishment of a nursing task or activity, including the provision for the initial direction of the task, periodic inspection of the actual act of accomplishing the task or activity, and evaluation of the outcome.

(41) "Supervisory clinical faculty", as used in Section R156-31b-608, means one or more individuals employed by an approved nursing education program who meet the accreditation and Board of Nursing specific requirements to be a faculty member and are responsible for the overall clinical experiences of nursing students and may supervise and coordinate clinical preceptors who provide the actual direct clinical experience.

(42) "Unprofessional conduct" as defined in Title 58, Chapters 1 and 31b, is further defined in Section R156-31b-502.

 

. . . . . . .

 

R156-31b-601. Standards for Parent Academic Institution Offering Nursing Education Program.

In accordance with Subsection 58-31b-601(2), the minimum standards that a parent academic institution offering a nursing education program must meet to qualify graduates for licensure under this chapter are as follows.

(1) The parent academic institution shall be legally authorized by the State of Utah to provide a program of education beyond secondary education.

(2) The parent academic institution shall admit as students only persons having a certificate of graduation from a school providing secondary education or the recognized equivalent of such a certificate.

(3) At least [20]10 percent of the parent academic institution's revenue shall be from sources that are not derived from funds provided under title IV, HEA program funds or student fees, including tuition if a proprietary school.

(4) In addition to the standards established in Subsections (1), (2), and (3) above, a parent education institution offering a nursing education program leading toward licensure as an LPN shall:

(a) be accredited or preaccredited by a regional or national professional accrediting body approved by the [Council for Higher Education Accreditation of the American Council on Education]U.S. Department of Education, and recognized by the nurse accrediting body from which the nursing program will seek nurse accreditation; and

(b) provide not less than one academic year program of study that leads to a certificate or recognized educational credential.

(5) In addition to the standards established in Subsections (1), (2), and (3) above, a parent education institution offering a nursing education program leading toward licensure as an RN shall:

(a) be accredited or preaccredited by a regional or national professional accrediting body approved by the [Council for Higher Education Accreditation of the American Council on Education]U.S. Department of Education, and recognized by the nurse accrediting body from which the nursing program will seek nurse accreditation; and

(b) provide or require not less than a two academic year program of study that awards a minimum of an associate degree.

(6) In addition to the standards established in Subsections (1), (2), and (3) above, a parent education institution offering a nursing education program leading toward licensure as an APRN or APRN-CRNA shall:

(a) be accredited or preaccredited by a regional or national professional accrediting body approved by the [Council for Higher Education Accreditation of the American Council on Education]U.S. Department of Education and recognized by the nurse accrediting body from which the nursing program will seek nurse accreditation;

(b) admit as students, only persons having completed at least an associate degree in nursing or baccalaureate degree in a related discipline; and

(c) provide or require not less than a two academic year program of study that awards a minimum of a master's degree.

 

. . . . . . .

 

R156-31b-802. Medication Aide - Certified - Approval of Training Programs.

In accordance with Subsection 58-31b-601(3), the minimum standards for an MA-C training program to be approved by the Division in collaboration with the Board and the process to obtain approval are established as follows.

(1) All training programs shall be approved by the Division in collaboration with the Board and shall obtain approval prior to implementing the program.

(2) Training programs may be offered by an educational institution, a health care facility, or a health care association.

(3) The program shall consist of a minimum of 60 clock hours of didactic (classroom) training which is consistent with the model curriculum in Section R156-31b-803, and at least 40 hours of practical training within a long-term care facility.

(4) The classroom instructor shall:

(a) have a current, active, unencumbered LPN, RN or APRN license or multistate privilege to practice nursing in Utah;

(b) be a faculty member of an approved nursing education program, or an approved certified nurse aide (CNA) instructor who has completed [the Department of Health's]a "Train the Trainer" program recognized by the Utah Nurse Aide Registry; and

(c) have at least two years of clinical experience and at least one year of experience in long-term care in the past five years.

(5) The on-site practical training experience instructor shall be available at all times during the practical training experience and shall meet the following criteria:

(a) have a current, active, unencumbered LPN, RN or APRN license or multistate privilege to practice nursing in Utah;

(b)(i) be a faculty member of an approved nursing education program with at least one year of experience in long-term care nursing; or

(ii) be an approved CNA instructor who has completed [the Department of Health's]a "Train the Trainer" program recognized by the Utah Nurse Aide Registry, with at least one year of experience in long-term care, and at least three months experience in the specific training facility;

(c) shall not delegate supervisory responsibilities when providing practical experience training to a student;

(d) the practical training instructor to student ratio shall be:

(i) 1:2 if the instructor is working one-on-one with the student to administer the medications; or

(ii) 1:8 if the instructor is supervising a student who is working one-on-one with the clinical facility's medication nurse.

(6) An entity desiring to be approved to provide an MA-C training program to qualify a person for certification as a medication aide shall:

(a) submit to the Division an application form prescribed by the Division;

(b) provide evidence of adequate and appropriate trainers and resources to provide the training program including a well-stocked clinical skills lab or the equivalent;

(c) submit a copy of the proposed training curriculum and an attestation that the proposed curriculum is consistent with the model curriculum in Section R156-31b-803;

(d) document minimal admission requirements including, but not limited to:

(i) an earned high school diploma or successful passage of the general educational development (GED) test;

(ii) current certification as a nursing aide, in good standing, from the Utah Nursing Assistant Registry, with at least 2,000 hours of experience within the two years prior to application to the training program, working as a certified nurse aide in a long-term care setting; and

(iii) current cardiopulmonary resuscitation (CPR) certification.

 

R156-31b-803. Medication Aide - Certified - Model Curriculum.

The model curriculum which must be followed by anyone who desires to offer a medication aide certification program is the "Medication Assistant-Certified (MA-C) Model Curriculum" adopted by the National Council of State Boards of Nursing's Delegate Assembly on August 9, 2007, which is hereby adopted and incorporated by reference.[Module 1: Medication Fundamentals, recommend 16 hours classroom instruction and four hours of skills lab.

(1) Objectives - the learner will:

(a) describe the different documents on which medications can be ordered and recorded;

(b) detail the elements of a complete medication order for safe administration;

(c) discuss the various tasks to be performed for medications to be safely stored;

(d) identify conditions necessitating disposal of medications or questioning an incomplete medication order;

(e) state the ways to measure medications;

(f) state the different forms in which medications can be manufactured;

(g) recognize that the same medication may have different names;

(h) identify accepted abbreviations;

(i) recognize the abbreviations that should not be used;

(j) list the different effects medications can cause, locally and systemically;

(k) state the types of information that should be known about a specific medication prior to giving that medication;

(l) list the three safety checks of medication administration;

(m) identify the six rights of medication administration; and

(n) describe basic steps of medication preparation prior to administration.

(2) Content Outline - medication orders, documentation, storage and disposal:

(a) medication prescription or order:

(i) recorded on patient record;

(ii) complete order must be signed, legible, and include the drug name, dose, route, time, and frequency;

(iii) MA-C should not take verbal or telephone orders; and

(iv) questioning an incomplete medication order;

(b) medication documentation system:

(i) documentation of orders onto agency's medication document;

(ii) medication administration record (MAR); and

(iii) controlled substance medication log;

(c) medication storage:

(i) storage area;

(ii) medication room;

(iii) medication cart; and

(iv) medication tray; and

(d) disposal of outdated, contaminated or unused medication.

(3) Content Outline - mathematics, weights and measures:

(a) MA-C does not convert medications dosages; and

(b) systems of measurement:

(i) apothecaries' system;

(ii) metric system;

(iii) common household measures;

(iv) roman numerals - drams or grains;

(v) weight is grain; and

(vi) volume is minim.

(4) Content Outline - forms of medication:

(a) liquid:

(i) aerosol;

(ii) inhalant;

(iii) drops;

(iv) elixir;

(v) spray;

(vi) solution;

(vii) suspension (needs mixing or shaking);

(viii) syrup; and

(ix) tincture; and

(b) solid and semi-solids:

(i) capsules;

(ii) tablet (dissolve);

(iii) scored versus unscored;

(iv) caplets;

(v) time-released;

(vi) covered with a special coating (not to be crushed);

(vii) lozenges (dissolve);

(viii) ointment;

(ix) paste;

(x) powder;

(xi) cream;

(xii) lotion; and

(xiii) linament.

(5) Content Outline - medication basics:

(a) terminology:

(i) medication names:

(A) generic; and

(B) brand or trade name;

(b) abbreviations:

(i) use standardized abbreviations, acronyms and symbols; and

(ii) do not use abbreviations that should no longer be in use;

(c) dosage range;

(d) actions (how drug causes chemical changes in body);

(e) implications for administration (what medical conditions are treated by the drug);

(f) therapeutic effects (desired effect);

(g) side effects (reaction not part of main effect desired);

(h) precautions (anticipate or prepare for conditions that may change effect of drug);

(i) contraindications (condition making drug dangerous to use);

(j) allergic reactions (life threatening - anaphylaxis);

(k) adverse reactions (unpleasant or serious side effects, other than desired);

(l) tolerance (body adapts to drug and may be resistant or less effective);

(m) interactions:

(i) specific administration information such as do not take with grapefruit juice; and

(ii) certain classes of medications that should not be prescribed at the same time;

(n) additive (synergistic) or antagonist effect;

(o) idiosyncratic effect (drug has unusual effect); and

(p) paradoxical effect (drug works in opposite way).

(6) Content Outline - safety and rights of medication administration:

(a) three safety checks:

(i) when removing the medication package from storage (drawer or shelf);

(ii) when removing medication from the package or container it is kept in; and

(iii) when returning the package to where it is stored; and

(b) six rights of medication administration:

(i) right client;

(ii) right drug;

(iii) right dose;

(iv) right route;

(v) right time; and

(vi) right documentation.

(7) Content Outline - preparation and actual medication administration:

(a) wash hands;

(b) review medications that require checking of pulse or blood pressure before administering;

(c) identify the patient;

(d) introduce yourself;

(e) explain what you are going to do;

(f) glove if necessary;

(g) position the client;

(h) do what you explained;

(i) wash your hands;

(j) special considerations; and

(k) document.

Module 2: Safety, recommend six hours of classroom instruction and one hour of skills lab.

(1) Objectives - the learner will:

(a) identify information needed about the patient and the medication prior to medication administration;

(b) identify common causes of medication errors; and

(c) state what steps should be taken when a medication error occurs.

(2) Content Outline - prevention of medication errors:

(a) know the following before administering medications:

(i) name, generic and trade;

(ii) purpose;

(iii) effect;

(iv) length of time to take effect;

(v) side effects;

(vi) adverse effects;

(vii) interactions;

(viii) special instructions; and

(ix) where to get help.

(3) Content Outline - causes and reporting of medication errors:

(a) failure to follow prescriber's orders exactly;

(b) failure to follow manufacturer's specifications or directions for use;

(c) failure to follow accepted standards for medication administration;

(d) failure to listen to a patient's or family's concerns;

(e) notify the agency's nurse, supervisor, pharmacist, physician or other prescriber, according to the agency policy; and

(f) complete a medication error or incident report.

Module 3: Communication and documentation, recommend six hours of classroom instruction and two hours of skills lab:

(1) Objectives - the learner will:

(a) discuss building relationships (review from CNA training);

(b) state when the nurse must be notified of a change in the patient's normal condition;

(c) discuss when the nurse should be notified about vital sign changes;

(d) state when the nurse should be notified of a patient's pain;

(e) identify other alterations or conditions that should be reported to the nurse;

(f) state documentation requirements for medication administration; and

(g) explain the responsibilities of the delegating nurse when delegating medication administration to the MA-C.

(2) Content Outline - building relationships:

(a) review the communication process;

(b) review barriers to effective listening and communication;

(c) setting boundaries; and

(d) review team building.

(3) Content Outline - reporting of symptoms or side effects:

(a) observe, monitor and report any change that is different from the patient's normal condition;

(b) notify the nurse as soon as possible with as much information as available; and

(c) record changes.

(4) Content Outline - report any change from the patient's normal condition:

(a) temperature;

(b) pulse;

(c) respirations;

(d) blood pressure;

(e) observe and report complaints of pain; and

(f) other changes in condition such as urinary output, mental status, and activity.

(5) Content Outline - documentation of medication administration:

(a) identifying initials and time on the medication administration record (MAR);

(b) circle and document the reasons that a patient may not take a medication; and

(c) prn medication, delegated by the licensed nurse, per facility or agency policy.

(6) Content Outline - role of the delegating nurse:

(a) the nurse must determine the level of supervision, monitoring and accessibility he must provide for nursing assistive personnel;

(b) the nurse continues to have responsibility for the overall nursing care;

(c) to delegate effectively, nurses need to be able to rely on nursing assistive personnel's credentials and job descriptions, especially for a first time assignment;

(d) nursing administration has the responsibility for validating credentials and qualifications of employees;

(e) both nurse and MA-C need the appropriate interpersonal and communication skills and organizational support to successfully resolve delegation issues; and

(f) trust is central to the working relationships between nurses and assistive personnel; good relationships have two-way communication, initiative, appreciation, and willingness to help each other.

Module 4 - Medication administration, recommend 18 hours of classroom instruction and two hours of skills lab:

(1) Objectives - the learner will:

(a) identify common methods of medication administration;

(b) identify factors that may affect how the body uses medication; and

(c) identify the classifications of medications, state common effects of medications on the body, and identify resource materials and professionals to contact for clarification of medication questions.

(2) Content Outline - routes of administration:

(a) oral;

(b) buccal;

(c) sublingual;

(d) inhaler (metered dose);

(e) nebulizer;

(f) nasal;

(g) eye (ophthalmic);

(h) ear (otic);

(i) topical;

(j) dressings;

(k) soaks;

(l) transdermal such as patches; and

(m) suppositories, rectal and vaginal.

(3) Content Outline - factors affecting how the body uses medication:

(a) age;

(b) size;

(c) family traits;

(d) diet;

(e) disease;

(f) psychological issues;

(g) gender and basic metabolic rate; and

(h) dosage.

(4) Content Outline - classes of medications related to body systems and common actions:

(a) antimicrobials control or prevent growth of bacteria, fungus, virus or other microorganisms;

(b) cardiovascular:

(i) corrects an irregular, fast or slow heart rate;

(ii) prevents blood from clotting; and

(iii) lowers blood pressure;

(c) dermatological:

(i) antiinfective; and

(ii) anti-inflammatory;

(d) endocrine:

(i) antidiabetic;

(ii) reduces inflammation; and

(iii) hormones;

(e) gastrointestinal:

(i) promotes bowel movements;

(ii) antacids;

(iii) antidiarrheal; and

(iv) reduces gastric acid;

(f) musculoskeletal relaxes muscles;

(g) neurological:

(i) prevents seizures;

(ii) relieves pain;

(iii) lowers body temperature;

(iv) anti-parkinsonian;

(v) antidepressants;

(vi) promotes sleep;

(vii) relieves anxiety;

(viii) antipsychotics; and

(ix) mood stabilizer;

(h) nutrients, vitamins, and minerals replace chemicals missing or low in the body;

(i) respiratory:

(i) decreases mucus production;

(ii) broncholilation;

(iii) cough depressant or expectorant; and

(iv) decongestant;

(j) sensory:

(i) antiglaucoma;

(ii) artificial terms; and

(iii) earwax emulsifiers; and

(k) urinary increases water loss through kidneys.

(5) Content Outline - location of resources and references:

(a) nurse;

(b) pharmacist;

(c) physician;

(d) package or drug insert; and

(e) drug reference manuals.

Module 5 - Ethical and Legal, recommend four hours classroom instruction and one hour skills lab:

(1) Objectives - the learner will:

(a) identify when a delegated task should or should not be performed by the MA-C;

(b) recognize when and how to report errors;

(c) recognize what should be reported to the licensed nurse;

(d) distinguish between the tasks an MA-C can and cannot accept;

(e) define redelegation;

(f) identify skills that enhance the delegation process;

(g) describe the rights of the client;

(h) discuss the types of abuse that must be reported;

(i) describe examples of the types of legal problems that can occur;

(j) list the three steps to take before medication is safe to give; and

(k) recognize the numerous rights that must be followed before and after medication is administered.

(2) Content Outline - role of the MA-C:

(a) MA-C may perform a task involving administration of medications if:

(i) MA-C's assignment is to administer medications under the supervision of a licensed nurse in accordance with provisions of the Nurse Practice Act and Rule; and

(ii) the delegation is not prohibited by any provision of this act and rule;

(b) role of the MA-C includes medication administration as a delegated nursing function under nursing supervision. The following shall not be delegated to an MA-C:

(i) conversion or calculation of medication dosage;

(ii) assessment of patient need for or response to medications;

(iii) nursing judgment regarding the administration of PRN medications; or

(iv) medications to be given via parenteral routes and through nasogastric, gastrostomy, or jejunostomy routes;

(c) MA-C shall not perform a task involving the administration of medications if:

(i) the medication administration requires an assessment of the patient's need for medication, a calculation of the dosage of the medication or the conversion of the dosage;

(ii) the supervising nurse is unavailable to monitor the progress of the patient and the effect of the medication on the patient; or

(iii) the patient is not stable or has changing needs;

(d) any MA-C who has any reason to believe that he has made an error in the administration of medication shall follow facility policy and procedure to report the possible or known error to the appropriate superior and shall assist in completing any required documentation of the medication error; and

(e) medication administration policies:

(i) MA-C shall report to the supervising nurse:

(A) signs or symptoms that appear life-threatening;

(B) events that appear health-threatening; and

(C) medications that produce no results or undesirable effects as reported by the patient;

(ii) a licensed nurse shall supervise an MA-C; and

(iii) a licensed nurse shall review periodically the following:

(A) authorized provider orders; and

(B) patient medication records.

(3) Content Outline - the responsibility of the MA-C when accepting delegation tasks:

(a) the MA-C has the responsibility not to accept a delegation that he knows is beyond his knowledge and skills;

(b) delegation is patient specific; having done a task for one patient does not automatically mean assistive personnel can do the task for all patients, additionally, delegation is also situation specific, doing a task for one patient in one situation does not mean the nursing assistive personnel may perform that task for this patient in all situations;

(c) a task delegated to assistive personnel cannot be redelegatd by the nursing assistive personnel;

(d) the MA-C is expected to speak up and ask for training and assistance in performing the delegation, or request not to be delegated a particular task, function, or activity; and

(e) both nurse and MA-C need the appropriate interpersonal and communication skills and organizational support to successfully resolve delegation issues.

(4) Content Outline - rights of individuals:

(a) maintain confidentiality;

(b) respect patient's rights;

(c) respect patient's privacy;

(d) respect patient's individuality and autonomy;

(e) communicate respectfully;

(f) respect patient's wishes whenever possible;

(g) right to refuse medication; and

(h) right to be informed.

(5) Content Outline - specific legal and ethical issues:

(a) abuse or neglect:

(i) identify types of abuse:

(A) physical;

(B) verbal;

(C) psychological;

(D) sexual; and

(E) financial;

(ii) preventive measures; and

(iii) duty to report;

(b) exposure to medical malpractice, negligence claims, or lawsuits;

(c) fraud;

(d) theft; and

(e) diversion.

(6) Content Outline - safety and rights of medication administration:

(a) review the three safety checks; and

(b) review the six rights of medication administration.

Module 6 - Practicum:

(1) Objective - the learner will demonstrate safe administration of medications to patients in a clinical setting.

(2) Content Outline - forty hours of supervised clinical practicum, which should be progressive, where the instructor observes medication administration, and gradually, the instructor increases the number of patients to whom the student administers medications.]

 

KEY: licensing, nurses

Date of Enactment or Last Substantive Amendment: 2009

Notice of Continuation: April 1, 2008

Authorizing, and Implemented or Interpreted Law: 58-31b-101; 58-1-106(1)(a); 58-1-202(1)(a)