SB0860 EnrolledLRB103 03319 KTG 48325 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Mental Health and Developmental
5Disabilities Administrative Act is amended by changing Section
615.4 as follows:
 
7    (20 ILCS 1705/15.4)
8    Sec. 15.4. Authorization for nursing delegation to permit
9direct care staff to administer medications.
10    (a) This Section applies to (i) all residential programs
11for persons with a developmental disability in settings of 16
12persons or fewer that are funded or licensed by the Department
13of Human Services and that distribute or administer
14medications, (ii) all intermediate care facilities for persons
15with developmental disabilities with 16 beds or fewer that are
16licensed by the Department of Public Health, and (iii) all day
17programs certified to serve persons with developmental
18disabilities by the Department of Human Services. The
19Department of Human Services shall develop a training program
20for authorized direct care staff to administer medications
21under the supervision and monitoring of a registered
22professional nurse. The training program for authorized direct
23care staff shall include educational and oversight components

 

 

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1for staff who work in day programs that are similar to those
2for staff who work in residential programs. This training
3program shall be developed in consultation with professional
4associations representing (i) physicians licensed to practice
5medicine in all its branches, (ii) registered professional
6nurses, and (iii) pharmacists.
7    (b) For the purposes of this Section:
8    "Authorized direct care staff" means non-licensed persons
9who have successfully completed a medication administration
10training program approved by the Department of Human Services
11and conducted by a nurse-trainer. This authorization is
12specific to an individual receiving service in a specific
13agency and does not transfer to another agency.
14    "Medications" means oral, injectable, auto-injectable, and
15topical medications, insulin in an injectable form, oxygen,
16epinephrine auto-injectors, and vaginal and rectal creams and
17suppositories. "Oral" includes inhalants and medications
18administered through enteral tubes, utilizing aseptic
19technique. "Topical" includes eye, ear, and nasal medications.
20Any controlled substances must be packaged specifically for an
21identified individual.
22    "Insulin in an injectable or auto-injectable form" means a
23subcutaneous injection, auto-injection, or other technology
24including, but not limited to: (i) an insulin pump; (ii) an
25insulin pod; (iii) via an insulin pen pre-filled by the
26manufacturer; and (iv) a syringe.

 

 

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1    "GLP-1 receptor agonists in an injectable or
2auto-injectable form" means medication used for the treatment
3of type 1 and type 2 diabetes and obesity. Authorized direct
4care staff may administer insulin or GLP-1 receptor agonists
5via auto-injection or an insulin pen pre-filled by the
6manufacturer as delegated by the registered nurse and , as
7ordered by a physician, advanced practice registered nurse, or
8physician assistant, if: (i) the staff has successfully
9completed a Department-approved advanced training program
10specific to insulin or GLP-1 receptor agonist administration
11developed in consultation with professional associations
12listed in subsection (a) of this Section, and (ii) the staff
13consults with the registered nurse, prior to administration,
14of any insulin or GLP-1 receptor agonist dose that is
15determined based on a blood glucose test result. The
16authorized direct care staff shall not: (i) calculate the
17insulin or GLP-1 receptor agonist dosage needed when the dose
18is dependent upon a blood glucose test result, or (ii)
19administer insulin or GLP-1 receptor agonists to individuals
20who require blood glucose monitoring greater than 3 times
21daily, without consultation with and unless directed to do so
22by the registered nurse. An individual may self-administer
23insulin or GLP-1 receptor agonists in any form if the
24individual is deemed independent by the nurse-trainer through
25the use of the Department's required standardized screening
26and assessment instruments.

 

 

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1    "Nurse-trainer training program" means a standardized,
2competency-based medication administration train-the-trainer
3program provided by the Department of Human Services and
4conducted by a Department of Human Services master
5nurse-trainer for the purpose of training nurse-trainers to
6train persons employed or under contract to provide direct
7care or treatment to individuals receiving services to
8administer medications and provide self-administration of
9medication training to individuals under the supervision and
10monitoring of the nurse-trainer. The program incorporates
11adult learning styles, teaching strategies, classroom
12management, and a curriculum overview, including the ethical
13and legal aspects of supervising those administering
14medications.
15    "Self-administration of medications" means an individual
16administers his or her own medications or a portion of his or
17her own medications. To be considered capable to
18self-administer their own medication, individuals must, at a
19minimum, be able to identify their medication by size, shape,
20or color, know when they should take the medication, and know
21the amount of medication to be taken each time. The use of
22assistive or enabling technologies can be used to demonstrate
23a person's capability to administer his or her own
24medications.
25    "Training program" means a standardized medication
26administration training program approved by the Department of

 

 

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1Human Services and conducted by a registered professional
2nurse for the purpose of training persons employed or under
3contract to provide direct care or treatment to individuals
4receiving services to administer medications and provide
5self-administration of medication training to individuals
6under the delegation and supervision of a nurse-trainer. The
7program incorporates adult learning styles, teaching
8strategies, classroom management, curriculum overview,
9including ethical-legal aspects, and standardized
10competency-based evaluations on administration of medications
11and self-administration of medication training programs.
12    (c) Training and authorization of non-licensed direct care
13staff by nurse-trainers must meet the requirements of this
14subsection.
15        (1) Prior to training non-licensed direct care staff
16    to administer medication, the nurse-trainer shall perform
17    the following for each individual to whom medication will
18    be administered by non-licensed direct care staff:
19            (A) An assessment of the individual's health
20        history and physical and mental status.
21            (B) An evaluation of the medications prescribed.
22        (2) Non-licensed authorized direct care staff shall
23    meet the following criteria:
24            (A) Be 18 years of age or older.
25            (B) Have completed high school or have a State of
26        Illinois High School Diploma.

 

 

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1            (C) Have demonstrated functional literacy.
2            (D) Have satisfactorily completed the Health and
3        Safety component of a Department of Human Services
4        authorized direct care staff training program.
5            (E) Have successfully completed the training
6        program, pass the written portion of the comprehensive
7        exam, and score 100% on the competency-based
8        assessment demonstrating proficiency in the skill of
9        administering medication specific to the individual
10        and his or her medications.
11            (F) Have received additional competency-based
12        assessment or training by the nurse-trainer when the
13        nurse-trainer determines additional skill development
14        is needed to administer medication by the
15        nurse-trainer as deemed necessary by the nurse-trainer
16        whenever a change of medication occurs or a new
17        individual that requires medication administration
18        enters the program.
19        (3) Authorized direct care staff shall be re-evaluated
20    by a nurse-trainer at least annually or more frequently at
21    the discretion of the registered professional nurse. Any
22    necessary retraining shall be to the extent that is
23    necessary to ensure competency of the authorized direct
24    care staff to administer medication.
25        (4) Authorization of direct care staff to administer
26    medication shall be revoked if, in the opinion of the

 

 

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1    registered professional nurse, the authorized direct care
2    staff is no longer competent to administer medication.
3        (5) The registered professional nurse shall assess an
4    individual's health status at least annually or more
5    frequently at the discretion of the registered
6    professional nurse.
7    This subsection only applies to settings where the
8registered professional nurse has jurisdiction. If direct care
9staff move to other settings, they shall consult with the
10registered professional nurse who has jurisdiction of that
11setting.
12    (d) Medication self-administration shall meet the
13following requirements:
14        (1) As part of the normalization process, in order for
15    each individual to attain the highest possible level of
16    independent functioning, all individuals shall be
17    permitted to participate in their total health care
18    program. This program shall include, but not be limited
19    to, individual training in preventive health and
20    self-administration of medication self-medication
21    procedures.
22            (A) Every program shall adopt written policies and
23        procedures for assisting individuals who choose to
24        obtain in obtaining preventative health and
25        self-administration of medication self-medication
26        skills in consultation with a registered professional

 

 

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1        nurse, advanced practice registered nurse, physician
2        assistant, or physician licensed to practice medicine
3        in all its branches.
4            (B) If an individual desires to gain independence
5        in self-administration of medication, the individual
6        Individuals shall be evaluated to determine the
7        individual's their ability to self-administer
8        medication self-medicate by the nurse-trainer through
9        the use of the Department's required, standardized
10        screening and assessment instruments.
11            (C) (Blank). When the results of the screening and
12        assessment indicate an individual not to be capable to
13        self-administer his or her own medications, programs
14        shall be developed in consultation with the Community
15        Support Team or Interdisciplinary Team to provide
16        individuals with self-medication administration.
17        (2) Each individual shall be presumed to be competent
18    to self-administer medications if:
19            (A) authorized by an order of a physician licensed
20        to practice medicine in all its branches, an advanced
21        practice registered nurse, or a physician assistant;
22        and
23            (B) approved to self-administer medication by the
24        individual's Community Support Team or
25        Interdisciplinary Team, which includes a registered
26        professional nurse or an advanced practice registered

 

 

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1        nurse.
2    (e) Quality Assurance.
3        (1) A registered professional nurse, advanced practice
4    registered nurse, licensed practical nurse, physician
5    licensed to practice medicine in all its branches,
6    physician assistant, or pharmacist shall review the
7    following for all individuals:
8            (A) Medication orders.
9            (B) Medication labels, including medications
10        listed on the medication administration record for
11        persons who are not self-administering medication
12        self-medicating to ensure the labels match the orders
13        issued by the physician licensed to practice medicine
14        in all its branches, advanced practice registered
15        nurse, or physician assistant.
16            (C) Medication administration records for persons
17        who are not self-administering medication
18        self-medicating to ensure that the records are
19        completed appropriately for:
20                (i) medication administered as prescribed;
21                (ii) refusal by the individual; and
22                (iii) full signatures provided for all
23            initials used.
24        (2) Reviews shall occur at least quarterly, but may be
25    done more frequently at the discretion of the registered
26    professional nurse or advanced practice registered nurse.

 

 

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1        (3) A quality assurance review of medication errors
2    and data collection for the purpose of monitoring and
3    recommending corrective action shall be conducted within 7
4    days and included in the required annual review.
5    (f) Programs using authorized direct care staff to
6administer medications are responsible for documenting and
7maintaining records on the training that is completed.
8    (g) The absence of this training program constitutes a
9threat to the public interest, safety, and welfare and
10necessitates emergency rulemaking by the Departments of Human
11Services and Public Health under Section 5-45 of the Illinois
12Administrative Procedure Act.
13    (h) Direct care staff who fail to qualify for delegated
14authority to administer medications pursuant to the provisions
15of this Section shall be given additional education and
16testing to meet criteria for delegation authority to
17administer medications. Any direct care staff person who fails
18to qualify as an authorized direct care staff after initial
19training and testing must within 3 months be given another
20opportunity for retraining and retesting. A direct care staff
21person who fails to meet criteria for delegated authority to
22administer medication, including, but not limited to, failure
23of the written test on 2 occasions shall be given
24consideration for shift transfer or reassignment, if possible.
25No employee shall be terminated for failure to qualify during
26the 3-month time period following initial testing. Refusal to

 

 

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1complete training and testing required by this Section may be
2grounds for immediate dismissal.
3    (i) No authorized direct care staff person delegated to
4administer medication shall be subject to suspension or
5discharge for errors resulting from the staff person's acts or
6omissions when performing the functions unless the staff
7person's actions or omissions constitute willful and wanton
8conduct. Nothing in this subsection is intended to supersede
9paragraph (4) of subsection (c).
10    (j) A registered professional nurse, advanced practice
11registered nurse, physician licensed to practice medicine in
12all its branches, or physician assistant shall be on duty or on
13call at all times in any program covered by this Section.
14    (k) The employer shall be responsible for maintaining
15liability insurance for any program covered by this Section.
16    (l) Any direct care staff person who qualifies as
17authorized direct care staff pursuant to this Section shall be
18granted consideration for a one-time additional salary
19differential. The Department shall determine and provide the
20necessary funding for the differential in the base. This
21subsection (l) is inoperative on and after June 30, 2000.
22(Source: P.A. 102-1100, eff. 1-1-23.)