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 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 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
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 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
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 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
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 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
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 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.".