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Public Act 91-0630
SB965 Enrolled LRB9104864PTpk
AN ACT concerning nursing.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Mental Health and Developmental
Disabilities Administrative Act is amended by adding Section
15.4 as follows:
(20 ILCS 1705/15.4 new)
Sec. 15.4. Authorization for nursing delegation to
permit direct care staff to administer medications.
(a) This Section applies to (i) all programs for persons
with a developmental disability in settings of 16 persons or
fewer that are funded or licensed by the Department of Human
Services and that distribute or administer medications and
(ii) all intermediate care facilities for the developmentally
disabled with 16 beds or fewer that are licensed by the
Department of Public Health. The Department of Human
Services shall develop a training program for authorized
direct care staff to administer oral and topical medications
under the supervision and monitoring of a registered
professional nurse. This training program shall be developed
in consultation with professional associations representing
(i) physicians licensed to practice medicine in all its
branches, (ii) registered professional nurses, and (iii)
pharmacists.
(b) For the purposes of this Section:
"Authorized direct care staff" means non-licensed
persons who have successfully completed a medication
administration training program approved by the Department of
Human Services and conducted by a nurse-trainer. This
authorization is specific to an individual receiving service
in a specific agency and does not transfer to another agency.
"Nurse-trainer training program" means a standardized,
competency-based medication administration train-the-trainer
program provided by the Department of Human Services and
conducted by a Department of Human Services master
nurse-trainer for the purpose of training nurse-trainers to
train persons employed or under contract to provide direct
care or treatment to individuals receiving services to
administer medications and provide self-administration of
medication training to individuals under the supervision and
monitoring of the nurse-trainer. The program incorporates
adult learning styles, teaching strategies, classroom
management, and a curriculum overview, including the ethical
and legal aspects of supervising those administering
medications.
"Self-administration of medications" means an individual
administers his or her own medications. To be considered
capable to self-administer their own medication, individuals
must, at a minimum, be able to identify their medication by
size, shape, or color, know when they should take the
medication, and know the amount of medication to be taken
each time.
"Training program" means a standardized medication
administration training program approved by the Department of
Human Services and conducted by a registered professional
nurse for the purpose of training persons employed or under
contract to provide direct care or treatment to individuals
receiving services to administer medications and provide
self-administration of medication training to individuals
under the delegation and supervision of a nurse-trainer. The
program incorporates adult learning styles, teaching
strategies, classroom management, curriculum overview,
including ethical-legal aspects, and standardized
competency-based evaluations on administration of medications
and self-administration of medication training programs.
(c) Training and authorization of non-licensed direct
care staff by nurse-trainers must meet the requirements of
this subsection.
(1) Prior to training non-licensed direct care staff
to administer medication, the nurse-trainer shall perform
the following for each individual to whom medication will
be administered by non-licensed direct care staff:
(A) An assessment of the individual's health
history and physical and mental status.
(B) An evaluation of the medications
prescribed.
(2) Non-licensed authorized direct care staff shall
meet the following criteria:
(A) Be 18 years of age or older.
(B) Have completed high school or its
equivalent (GED).
(C) Have demonstrated functional literacy.
(D) Have satisfactorily completed the Health
and Safety component of a Department of Human
Services authorized direct care staff training
program.
(E) Have successfully completed the training
program, pass the written portion of the
comprehensive exam, and score 100% on the
competency-based assessment specific to the
individual and his or her medications.
(F) Have received additional competency-based
assessment by the nurse-trainer as deemed necessary
by the nurse-trainer whenever a change of medication
occurs or a new individual that requires medication
administration enters the program.
(3) Authorized direct care staff shall be
re-evaluated by a nurse-trainer at least annually or more
frequently at the discretion of the registered
professional nurse. Any necessary retraining shall be to
the extent that is necessary to ensure competency of the
authorized direct care staff to administer medication.
(4) Authorization of direct care staff to
administer medication shall be revoked if, in the opinion
of the registered professional nurse, the authorized
direct care staff is no longer competent to administer
medication.
(5) The registered professional nurse shall assess
an individual's health status at least annually or more
frequently at the discretion of the registered
professional nurse.
(d) Medication self-administration shall meet the
following requirements:
(1) As part of the normalization process, in order
for each individual to attain the highest possible level
of independent functioning, all individuals shall be
permitted to participate in their total health care
program. This program shall include, but not be limited
to, individual training in preventive health and
self-medication procedures.
(A) Every program shall adopt written policies
and procedures for assisting individuals in
obtaining preventative health and self-medication
skills in consultation with a registered
professional nurse, advanced practice nurse,
physician assistant, or physician licensed to
practice medicine in all its branches.
(B) Individuals shall be evaluated to
determine their ability to self-medicate by the
nurse-trainer through the use of the Department's
required, standardized screening and assessment
instruments.
(C) When the results of the screening and
assessment indicate an individual not to be capable
to self-administer his or her own medications,
programs shall be developed in consultation with the
Community Support Team or Interdisciplinary Team to
provide individuals with self-medication
administration.
(2) Each individual shall be presumed to be
competent to self-administer medications if:
(A) authorized by an order of a physician
licensed to practice medicine in all its branches;
and
(B) approved to self-administer medication by
the individual's Community Support Team or
Interdisciplinary Team, which includes a registered
professional nurse or an advanced practice nurse.
(e) Quality Assurance.
(1) A registered professional nurse, advanced
practice nurse, licensed practical nurse, physician
licensed to practice medicine in all its branches,
physician assistant, or pharmacist shall review the
following for all individuals:
(A) Medication orders.
(B) Medication labels, including medications
listed on the medication administration record for
persons who are not self-medicating to ensure the
labels match the orders issued by the physician
licensed to practice medicine in all its branches,
advanced practice nurse, or physician assistant.
(C) Medication administration records for
persons who are not self-medicating to ensure that
the records are completed appropriately for:
(i) medication administered as
prescribed;
(ii) refusal by the individual; and
(iii) full signatures provided for all
initials used.
(2) Reviews shall occur at least quarterly, but may
be done more frequently at the discretion of the
registered professional nurse or advanced practice nurse.
(3) A quality assurance review of medication errors
and data collection for the purpose of monitoring and
recommending corrective action shall be conducted within
7 days and included in the required annual review.
(f) Programs using authorized direct care staff to
administer medications are responsible for documenting and
maintaining records on the training that is completed.
(g) The absence of this training program constitutes a
threat to the public interest, safety, and welfare and
necessitates emergency rulemaking by the Departments of Human
Services and Public Health under Section 5-45 of the Illinois
Administrative Procedure Act.
(h) Direct care staff who fail to qualify for delegated
authority to administer medications pursuant to the
provisions of this Section shall be given additional
education and testing to meet criteria for delegation
authority to administer medications. Any direct care staff
person who fails to qualify as an authorized direct care
staff after initial training and testing must within 3 months
be given another opportunity for retraining and retesting. A
direct care staff person who fails to meet criteria for
delegated authority to administer medication, including, but
not limited to, failure of the written test on 2 occasions
shall be given consideration for shift transfer or
reassignment, if possible. No employee shall be terminated
for failure to qualify during the 3-month time period
following initial testing. Refusal to complete training and
testing required by this Section may be grounds for immediate
dismissal.
(i) No authorized direct care staff person delegated to
administer medication shall be subject to suspension or
discharge for errors resulting from the staff person's acts
or omissions when performing the functions unless the staff
person's actions or omissions constitute willful and wanton
conduct. Nothing in this subsection is intended to supersede
paragraph (4) of subsection (c).
(j) A registered professional nurse, advanced practice
nurse, physician licensed to practice medicine in all its
branches, or physician assistant shall be on duty or on call
at all times in any program covered by this Section.
(k) The employer shall be responsible for maintaining
liability insurance for any program covered by this Section.
(l) Any direct care staff person who qualifies as
authorized direct care staff pursuant to this Section shall
be granted consideration for a one-time additional salary
differential. The Department shall determine and provide the
necessary funding for the differential in the base. This
subsection (l) is inoperative on and after June 30, 2000.
Section 10. The Nursing and Advanced Practice Nursing
Act is amended by changing Section 5-15 as follows:
(225 ILCS 65/5-15)
Sec. 5-15. Policy; application of Act. For the protection
of life and the promotion of health, and the prevention of
illness and communicable diseases, any person practicing or
offering to practice professional and practical nursing in
Illinois shall submit evidence that he or she is qualified to
practice, and shall be licensed as provided under this Act.
No person shall practice or offer to practice professional or
practical nursing in Illinois or use any title, sign, card or
device to indicate that such a person is practicing
professional or practical nursing unless such person has been
licensed under the provisions of this Act.
This Act does not prohibit the following:
(a) The practice of nursing in Federal employment in the
discharge of the employee's duties by a person who is
employed by the United States government or any bureau,
division or agency thereof and is a legally qualified and
licensed nurse of another state or territory and not in
conflict with Sections 10-5, 10-30, and 10-45 of this Act.
(b) Nursing that is included in their program of study
by students enrolled in programs of nursing or in current
nurse practice update courses approved by the Department.
(c) The furnishing of nursing assistance in an
emergency.
(d) The practice of nursing by a nurse who holds an
active license in another state when providing services to
patients in Illinois during a bonafide emergency or in
immediate preparation for or during interstate transit.
(e) The incidental care of the sick by members of the
family, domestic servants or housekeepers, or care of the
sick where treatment is by prayer or spiritual means.
(f) Persons from being employed as nursing aides,
attendants, orderlies, and other auxiliary workers in private
homes, long term care facilities, nurseries, hospitals or
other institutions.
(g) The practice of practical nursing by one who has
applied in writing to the Department in form and substance
satisfactory to the Department, for a license as a licensed
practical nurse and who has complied with all the provisions
under Section 10-30, except the passing of an examination to
be eligible to receive such license, until: the decision of
the Department that the applicant has failed to pass the next
available examination authorized by the Department or has
failed, without an approved excuse, to take the next
available examination authorized by the Department or until
the withdrawal of the application, but not to exceed 3
months. No applicant for licensure practicing under the
provisions of this paragraph shall practice practical nursing
except under the direct supervision of a registered
professional nurse licensed under this Act or a licensed
physician, dentist or podiatrist. In no instance shall any
such applicant practice or be employed in any supervisory
capacity.
(h) The practice of practical nursing by one who is a
licensed practical nurse under the laws of another U.S.
jurisdiction and has applied in writing to the Department, in
form and substance satisfactory to the Department, for a
license as a licensed practical nurse and who is qualified to
receive such license under Section 10-30, until (1) the
expiration of 6 months after the filing of such written
application, (2) the withdrawal of such application, or (3)
the denial of such application by the Department.
(i) The practice of professional nursing by one who has
applied in writing to the Department in form and substance
satisfactory to the Department for a license as a registered
professional nurse and has complied with all the provisions
under Section 10-30 except the passing of an examination to
be eligible to receive such license, until the decision of
the Department that the applicant has failed to pass the next
available examination authorized by the Department or has
failed, without an approved excuse, to take the next
available examination authorized by the Department or until
the withdrawal of the application, but not to exceed 3
months. No applicant for licensure practicing under the
provisions of this paragraph shall practice professional
nursing except under the direct supervision of a registered
professional nurse licensed under this Act. In no instance
shall any such applicant practice or be employed in any
supervisory capacity.
(j) The practice of professional nursing by one who is a
registered professional nurse under the laws of another
state, territory of the United States or country and has
applied in writing to the Department, in form and substance
satisfactory to the Department, for a license as a registered
professional nurse and who is qualified to receive such
license under Section 10-30, until (1) the expiration of 6
months after the filing of such written application, (2) the
withdrawal of such application, or (3) the denial of such
application by the Department.
(k) The practice of professional nursing that is
included in a program of study by one who is a registered
professional nurse under the laws of another state or
territory of the United States or foreign country, territory
or province and who is enrolled in a graduate nursing
education program or a program for the completion of a
baccalaureate nursing degree in this State, which includes
clinical supervision by faculty as determined by the
educational institution offering the program and the health
care organization where the practice of nursing occurs. The
educational institution will file with the Department each
academic term a list of the names and origin of license of
all professional nurses practicing nursing as part of their
programs under this provision.
(l) Any person licensed in this State under any other
Act from engaging in the practice for which she or he is
licensed.
(m) Delegation to authorized direct care staff trained
under Section 15.4 of the Mental Health and Developmental
Disabilities Administrative Act.
An applicant for license practicing under the exceptions
set forth in subparagraphs (g), (h), (i), and (j) of this
Section shall use the title R.N. Lic. Pend. or L.P.N. Lic.
Pend. respectively and no other.
(Source: P.A. 90-61, eff. 12-30-97; 90-248, eff. 1-1-98;
90-655, eff. 7-30-98; 90-742, eff. 8-13-98.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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