093_HB1822ham002 LRB093 04745 BDD 13494 a 1 AMENDMENT TO HOUSE BILL 1822 2 AMENDMENT NO. . Amend House Bill 1822 by replacing 3 everything after the enacting clause with the following: 4 "Section 5. The Mental Health and Developmental 5 Disabilities Administrative Act is amended by changing 6 Section 15.4 as follows: 7 (20 ILCS 1705/15.4) 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 or12 fewerthat 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 fewerthat are licensed or certified 16 by the 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 -2- LRB093 04745 BDD 13494 a 1 branches, (ii) registered professional nurses, and (iii) 2 pharmacists. 3 (b) For the purposes of this Section: 4 "Authorized direct care staff" means non-licensed 5 persons who have successfully completed a medication 6 administration training program approved by the Department of 7 Human Services and conducted by a nurse-trainer. This 8 authorization is specific to an individual receiving service 9 in a specific agency and does not transfer to another agency. 10 "Nurse-trainer training program" means a standardized, 11 competency-based medication administration train-the-trainer 12 program provided by the Department of Human Services and 13 conducted by a Department of Human Services master 14 nurse-trainer for the purpose of training nurse-trainers to 15 train persons employed or under contract to provide direct 16 care or treatment to individuals receiving services to 17 administer medications and provide self-administration of 18 medication training to individuals under the supervision and 19 monitoring of the nurse-trainer. The program incorporates 20 adult learning styles, teaching strategies, classroom 21 management, and a curriculum overview, including the ethical 22 and legal aspects of supervising those administering 23 medications. 24 "Self-administration of medications" means an individual 25 administers his or her own medications. To be considered 26 capable to self-administer their own medication, individuals 27 must, at a minimum, be able to identify their medication by 28 size, shape, or color, know when they should take the 29 medication, and know the amount of medication to be taken 30 each time. 31 "Training program" means a standardized medication 32 administration training program approved by the Department of 33 Human Services and conducted by a registered professional 34 nurse for the purpose of training persons employed or under -3- LRB093 04745 BDD 13494 a 1 contract to provide direct care or treatment to individuals 2 receiving services to administer medications and provide 3 self-administration of medication training to individuals 4 under the delegation and supervision of a nurse-trainer. The 5 program incorporates adult learning styles, teaching 6 strategies, classroom management, curriculum overview, 7 including ethical-legal aspects, and standardized 8 competency-based evaluations on administration of medications 9 and self-administration of medication training programs. 10 (c) Training and authorization of non-licensed direct 11 care staff by nurse-trainers must meet the requirements of 12 this subsection. 13 (1) Prior to training non-licensed direct care staff 14 to administer medication, the nurse-trainer shall perform 15 the following for each individual to whom medication will 16 be administered by non-licensed direct care staff: 17 (A) An assessment of the individual's health 18 history and physical and mental status. 19 (B) An evaluation of the medications 20 prescribed. 21 (2) Non-licensed authorized direct care staff shall 22 meet the following criteria: 23 (A) Be 18 years of age or older. 24 (B) Have completed high school or its 25 equivalent (GED). 26 (C) Have demonstrated functional literacy. 27 (D) Have satisfactorily completed the Health 28 and Safety component of a Department of Human 29 Services authorized direct care staff training 30 program. 31 (E) Have successfully completed the training 32 program, pass the written portion of the 33 comprehensive exam, and score 100% on the 34 competency-based assessment specific to the -4- LRB093 04745 BDD 13494 a 1 individual and his or her medications. 2 (F) Have received additional competency-based 3 assessment by the nurse-trainer as deemed necessary 4 by the nurse-trainer whenever a change of medication 5 occurs or a new individual that requires medication 6 administration enters the program. 7 (3) Authorized direct care staff shall be 8 re-evaluated by a nurse-trainer at least annually or more 9 frequently at the discretion of the registered 10 professional nurse. Any necessary retraining shall be to 11 the extent that is necessary to ensure competency of the 12 authorized direct care staff to administer medication. 13 (4) Authorization of direct care staff to 14 administer medication shall be revoked if, in the opinion 15 of the registered professional nurse, the authorized 16 direct care staff is no longer competent to administer 17 medication. 18 (5) The registered professional nurse shall assess 19 an individual's health status at least annually or more 20 frequently at the discretion of the registered 21 professional nurse. 22 (d) Medication self-administration shall meet the 23 following requirements: 24 (1) As part of the normalization process, in order 25 for each individual to attain the highest possible level 26 of independent functioning, all individuals shall be 27 permitted to participate in their total health care 28 program. This program shall include, but not be limited 29 to, individual training in preventive health and 30 self-medication procedures. 31 (A) Every program shall adopt written policies 32 and procedures for assisting individuals in 33 obtaining preventative health and self-medication 34 skills in consultation with a registered -5- LRB093 04745 BDD 13494 a 1 professional nurse, advanced practice nurse, 2 physician assistant, or physician licensed to 3 practice medicine in all its branches. 4 (B) Individuals shall be evaluated to 5 determine their ability to self-medicate by the 6 nurse-trainer through the use of the Department's 7 required, standardized screening and assessment 8 instruments. 9 (C) When the results of the screening and 10 assessment indicate an individual not to be capable 11 to self-administer his or her own medications, 12 programs shall be developed in consultation with the 13 Community Support Team or Interdisciplinary Team to 14 provide individuals with self-medication 15 administration. 16 (2) Each individual shall be presumed to be 17 competent to self-administer medications if: 18 (A) authorized by an order of a physician 19 licensed to practice medicine in all its branches; 20 and 21 (B) approved to self-administer medication by 22 the individual's Community Support Team or 23 Interdisciplinary Team, which includes a registered 24 professional nurse or an advanced practice nurse. 25 (e) Quality Assurance. 26 (1) A registered professional nurse, advanced 27 practice nurse, licensed practical nurse, physician 28 licensed to practice medicine in all its branches, 29 physician assistant, or pharmacist shall review the 30 following for all individuals: 31 (A) Medication orders. 32 (B) Medication labels, including medications 33 listed on the medication administration record for 34 persons who are not self-medicating to ensure the -6- LRB093 04745 BDD 13494 a 1 labels match the orders issued by the physician 2 licensed to practice medicine in all its branches, 3 advanced practice nurse, or physician assistant. 4 (C) Medication administration records for 5 persons who are not self-medicating to ensure that 6 the records are completed appropriately for: 7 (i) medication administered as 8 prescribed; 9 (ii) refusal by the individual; and 10 (iii) full signatures provided for all 11 initials used. 12 (2) Reviews shall occur at least quarterly, but may 13 be done more frequently at the discretion of the 14 registered professional nurse or advanced practice nurse. 15 (3) A quality assurance review of medication errors 16 and data collection for the purpose of monitoring and 17 recommending corrective action shall be conducted within 18 7 days and included in the required annual review. 19 (f) Programs using authorized direct care staff to 20 administer medications are responsible for documenting and 21 maintaining records on the training that is completed. 22 (g) The absence of this training program constitutes a 23 threat to the public interest, safety, and welfare and 24 necessitates emergency rulemaking by the Departments of Human 25 Services and Public Health under Section 5-45 of the Illinois 26 Administrative Procedure Act. 27 (h) Direct care staff who fail to qualify for delegated 28 authority to administer medications pursuant to the 29 provisions of this Section shall be given additional 30 education and testing to meet criteria for delegation 31 authority to administer medications. Any direct care staff 32 person who fails to qualify as an authorized direct care 33 staff after initial training and testing must within 3 months 34 be given another opportunity for retraining and retesting. A -7- LRB093 04745 BDD 13494 a 1 direct care staff person who fails to meet criteria for 2 delegated authority to administer medication, including, but 3 not limited to, failure of the written test on 2 occasions 4 shall be given consideration for shift transfer or 5 reassignment, if possible. No employee shall be terminated 6 for failure to qualify during the 3-month time period 7 following initial testing. Refusal to complete training and 8 testing required by this Section may be grounds for immediate 9 dismissal. 10 (i) No authorized direct care staff person delegated to 11 administer medication shall be subject to suspension or 12 discharge for errors resulting from the staff person's acts 13 or omissions when performing the functions unless the staff 14 person's actions or omissions constitute willful and wanton 15 conduct. Nothing in this subsection is intended to supersede 16 paragraph (4) of subsection (c). 17 (j) A registered professional nurse, advanced practice 18 nurse, physician licensed to practice medicine in all its 19 branches, or physician assistant shall be on duty or on call 20 at all times in any program covered by this Section. 21 (k) The employer shall be responsible for maintaining 22 liability insurance for any program covered by this Section. 23 (l) Any direct care staff person who qualifies as 24 authorized direct care staff pursuant to this Section shall 25 be granted consideration for a one-time additional salary 26 differential. The Department shall determine and provide the 27 necessary funding for the differential in the base. This 28 subsection (l) is inoperative on and after June 30, 2000. 29 (Source: P.A. 91-630, eff. 8-19-99.) 30 Section 99. Effective date. This Act takes effect upon 31 becoming law.".