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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.
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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.
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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
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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
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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
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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.
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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
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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
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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.
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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.
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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.
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