093_HB3033 LRB093 08668 AMC 08898 b 1 AN ACT concerning nursing homes. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Nursing Home Care Act is amended by 5 adding Section 3-202.3 as follows: 6 (210 ILCS 45/3-202.3 new) 7 Sec. 3-202.3. Authorization for nursing delegation to 8 permit direct care staff to administer medications. 9 (a) The Department of Public Health shall develop a 10 training program for authorized direct care staff to 11 administer oral and topical medications under the supervision 12 and monitoring of a registered professional nurse in 13 facilities licensed under this Act. This training program 14 shall be developed in consultation with professional 15 associations representing (i) physicians licensed to practice 16 medicine in all its branches, (ii) registered professional 17 nurses, and (iii) pharmacists. 18 (b) For the purposes of this Section: 19 "Authorized direct care staff" means non-licensed 20 persons who have successfully completed a medication 21 administration training program approved by the Department 22 and conducted by a nurse-trainer. 23 "Nurse-trainer training program" means a standardized, 24 competency-based medication administration train-the-trainer 25 program provided by the Department and conducted by a master 26 nurse-trainer for the purpose of training nurse-trainers to 27 train persons employed or under contract to provide direct 28 care or treatment to individuals receiving services to 29 administer medications and provide self-administration of 30 medication training to individuals under the supervision and 31 monitoring of the nurse-trainer. The program incorporates -2- LRB093 08668 AMC 08898 b 1 adult learning styles, teaching strategies, classroom 2 management, and a curriculum overview, including the ethical 3 and legal aspects of supervising those administering 4 medications. 5 "Training program" means a standardized medication 6 administration training program approved by the Department 7 and conducted by a registered professional nurse for the 8 purpose of training persons employed or under contract to 9 provide direct care or treatment to individuals receiving 10 services to administer medications under the delegation and 11 supervision of a nurse-trainer. 12 (c) Training and authorization of non-licensed direct 13 care staff by nurse-trainers must meet the requirements of 14 this subsection. 15 (1) Prior to training non-licensed direct care 16 staff to administer medication, the nurse-trainer shall 17 perform the following for each individual to whom 18 medication will be administered by non-licensed direct 19 care staff: 20 (A) An assessment of the individual's health 21 history and physical and mental status. 22 (B) An evaluation of the medications 23 prescribed. 24 (2) Non-licensed authorized direct care staff shall 25 meet the following criteria: 26 (A) Be 18 years of age or older. 27 (B) Have completed high school or its 28 equivalent (GED). 29 (C) Have demonstrated functional literacy. 30 (D) Have satisfactorily completed the Health 31 and Safety component of a Department authorized 32 direct care staff training program. 33 (E) Have successfully completed the training 34 program, passed the written portion of the -3- LRB093 08668 AMC 08898 b 1 comprehensive exam, and scored 100% on the 2 competency-based assessment specific to the 3 individual and his or her medications. 4 (F) Have received additional competency-based 5 assessment by the nurse-trainer as deemed necessary 6 by the nurse-trainer whenever a change of medication 7 occurs or a new individual that requires medication 8 administration enters the program. 9 (3) Authorized direct care staff shall be 10 re-evaluated by a nurse-trainer at least annually or more 11 frequently at the discretion of the registered 12 professional nurse. Any necessary retraining shall be to 13 the extent that is necessary to ensure competency of the 14 authorized direct care staff to administer medication. 15 (4) Authorization of direct care staff to 16 administer medication shall be revoked if, in the opinion 17 of the registered professional nurse, the authorized 18 direct care staff is no longer competent to administer 19 medication. 20 (5) The registered professional nurse shall assess 21 an individual's health status at least annually or more 22 frequently at the discretion of the registered 23 professional nurse. 24 (d) Quality Assurance. 25 (1) A registered professional nurse, advanced 26 practice nurse, licensed practical nurse, physician 27 licensed to practice medicine in all its branches, 28 physician assistant, or pharmacist shall review the 29 following for all individuals: 30 (A) Medication orders. 31 (B) Medication labels to ensure the labels 32 match the orders issued by the physician licensed to 33 practice medicine in all its branches, advanced 34 practice nurse, or physician assistant. -4- LRB093 08668 AMC 08898 b 1 (C) Medication administration records to 2 ensure that the records are completed appropriately 3 for: 4 (i) medication administered as 5 prescribed; 6 (ii) refusal by the individual; and 7 (iii) full signatures provided for all 8 initials used. 9 (2) Reviews shall occur at least quarterly, but may 10 be done more frequently at the discretion of the 11 registered professional nurse or advanced practice nurse. 12 (3) A quality assurance review of medication errors 13 and data collection for the purpose of monitoring and 14 recommending corrective action shall be conducted within 15 7 days and included in the required annual review. 16 (e) Facilities using authorized direct care staff to 17 administer medications are responsible for documenting and 18 maintaining records on the training that is completed. 19 (f) The absence of this training program constitutes a 20 threat to the public interest, safety, and welfare and 21 necessitates emergency rulemaking by the Department of Public 22 Health under Section 5-45 of the Illinois Administrative 23 Procedure Act. 24 (g) Direct care staff who fail to qualify for delegated 25 authority to administer medications pursuant to the 26 provisions of this Section shall be given additional 27 education and testing to meet criteria for delegation 28 authority to administer medications. Any direct care staff 29 person who fails to qualify as an authorized direct care 30 staff after initial training and testing must within 3 months 31 be given another opportunity for retraining and retesting. A 32 direct care staff person who fails to meet criteria for 33 delegated authority to administer medication, including, but 34 not limited to, failure of the written test on 2 occasions -5- LRB093 08668 AMC 08898 b 1 shall be given consideration for shift transfer or 2 reassignment, if possible. No employee shall be terminated 3 for failure to qualify during the 3-month time period 4 following initial testing. Refusal to complete training and 5 testing required by this Section may be grounds for immediate 6 dismissal. 7 (h) No authorized direct care staff person delegated to 8 administer medication shall be subject to suspension or 9 discharge for errors resulting from the staff person's acts 10 or omissions when performing the functions unless the staff 11 person's actions or omissions constitute willful and wanton 12 conduct. Nothing in this subsection is intended to supersede 13 paragraph (4) of subsection (c). 14 (i) A registered professional nurse, advanced practice 15 nurse, physician licensed to practice medicine in all its 16 branches, or physician assistant shall be on duty or on call 17 at all times in any facility covered by this Section. 18 (j) The facility shall be responsible for maintaining 19 liability insurance for any program covered by this Section.