HB4486 EngrossedLRB098 17632 RLC 53149 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Mental Health and Developmental
5Disabilities Administrative Act is amended by changing Section
615.4 as follows:
 
7    (20 ILCS 1705/15.4)
8    Sec. 15.4. Authorization for nursing delegation to permit
9direct care staff to administer medications.
10    (a) This Section applies to (i) all programs for persons
11with a developmental disability in settings of 16 persons or
12fewer that are funded or licensed by the Department of Human
13Services and that distribute or administer medications and (ii)
14all intermediate care facilities for the developmentally
15disabled with 16 beds or fewer that are licensed by the
16Department of Public Health. The Department of Human Services
17shall develop a training program for authorized direct care
18staff to administer oral and topical medications under the
19supervision and monitoring of a registered professional nurse.
20This training program shall be developed in consultation with
21professional associations representing (i) physicians licensed
22to practice medicine in all its branches, (ii) registered
23professional nurses, and (iii) pharmacists.

 

 

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1    (b) For the purposes of this Section:
2    "Authorized direct care staff" means non-licensed persons
3who have successfully completed a medication administration
4training program approved by the Department of Human Services
5and conducted by a nurse-trainer. This authorization is
6specific to an individual receiving service in a specific
7agency and does not transfer to another agency.
8    "Medications" means oral and topical medications, insulin
9in an injectable form, oxygen, epinephrine auto-injectors, and
10vaginal and rectal creams and suppositories. "Oral" includes
11inhalants and medications administered through enteral tubes,
12utilizing aseptic technique. "Topical" includes eye, ear, and
13nasal medications. Any controlled substances must be packaged
14specifically for an identified individual.
15    "Insulin in an injectable form" means a subcutaneous
16injection via an insulin pen pre-filled by the manufacturer.
17Authorized direct care staff may administer insulin, as ordered
18by a physician, advanced practice nurse, or physician
19assistant, if: (i) the staff has successfully completed a
20Department-approved advanced training program specific to
21insulin administration developed in consultation with
22professional associations listed in subsection (a) of this
23Section, and (ii) the staff consults with the registered nurse,
24prior to administration, of any insulin dose that is determined
25based on a blood glucose test result. The authorized direct
26care staff shall not (i) calculate the insulin dosage needed

 

 

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1when the dose is dependent upon a blood glucose test result, or
2(ii) administer insulin to individuals who require blood
3glucose monitoring greater than 3 times daily, unless directed
4to do so by the registered nurse.
5    "Nurse-trainer training program" means a standardized,
6competency-based medication administration train-the-trainer
7program provided by the Department of Human Services and
8conducted by a Department of Human Services master
9nurse-trainer for the purpose of training nurse-trainers to
10train persons employed or under contract to provide direct care
11or treatment to individuals receiving services to administer
12medications and provide self-administration of medication
13training to individuals under the supervision and monitoring of
14the nurse-trainer. The program incorporates adult learning
15styles, teaching strategies, classroom management, and a
16curriculum overview, including the ethical and legal aspects of
17supervising those administering medications.
18    "Self-administration of medications" means an individual
19administers his or her own medications. To be considered
20capable to self-administer their own medication, individuals
21must, at a minimum, be able to identify their medication by
22size, shape, or color, know when they should take the
23medication, and know the amount of medication to be taken each
24time.
25    "Training program" means a standardized medication
26administration training program approved by the Department of

 

 

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1Human Services and conducted by a registered professional nurse
2for the purpose of training persons employed or under contract
3to provide direct care or treatment to individuals receiving
4services to administer medications and provide
5self-administration of medication training to individuals
6under the delegation and supervision of a nurse-trainer. The
7program incorporates adult learning styles, teaching
8strategies, classroom management, curriculum overview,
9including ethical-legal aspects, and standardized
10competency-based evaluations on administration of medications
11and self-administration of medication training programs.
12    (c) Training and authorization of non-licensed direct care
13staff by nurse-trainers must meet the requirements of this
14subsection.
15        (1) Prior to training non-licensed direct care staff to
16    administer medication, the nurse-trainer shall perform the
17    following for each individual to whom medication will be
18    administered by non-licensed direct care staff:
19            (A) An assessment of the individual's health
20        history and physical and mental status.
21            (B) An evaluation of the medications prescribed.
22        (2) Non-licensed authorized direct care staff shall
23    meet the following criteria:
24            (A) Be 18 years of age or older.
25            (B) Have completed high school or its equivalent
26        (GED).

 

 

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1            (C) Have demonstrated functional literacy.
2            (D) Have satisfactorily completed the Health and
3        Safety component of a Department of Human Services
4        authorized direct care staff training program.
5            (E) Have successfully completed the training
6        program, pass the written portion of the comprehensive
7        exam, and score 100% on the competency-based
8        assessment specific to the individual and his or her
9        medications.
10            (F) Have received additional competency-based
11        assessment by the nurse-trainer as deemed necessary by
12        the nurse-trainer whenever a change of medication
13        occurs or a new individual that requires medication
14        administration enters the program.
15        (3) Authorized direct care staff shall be re-evaluated
16    by a nurse-trainer at least annually or more frequently at
17    the discretion of the registered professional nurse. Any
18    necessary retraining shall be to the extent that is
19    necessary to ensure competency of the authorized direct
20    care staff to administer medication.
21        (4) Authorization of direct care staff to administer
22    medication shall be revoked if, in the opinion of the
23    registered professional nurse, the authorized direct care
24    staff is no longer competent to administer medication.
25        (5) The registered professional nurse shall assess an
26    individual's health status at least annually or more

 

 

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1    frequently at the discretion of the registered
2    professional nurse.
3    (d) Medication self-administration shall meet the
4following requirements:
5        (1) As part of the normalization process, in order for
6    each individual to attain the highest possible level of
7    independent functioning, all individuals shall be
8    permitted to participate in their total health care
9    program. This program shall include, but not be limited to,
10    individual training in preventive health and
11    self-medication procedures.
12            (A) Every program shall adopt written policies and
13        procedures for assisting individuals in obtaining
14        preventative health and self-medication skills in
15        consultation with a registered professional nurse,
16        advanced practice nurse, physician assistant, or
17        physician licensed to practice medicine in all its
18        branches.
19            (B) Individuals shall be evaluated to determine
20        their ability to self-medicate by the nurse-trainer
21        through the use of the Department's required,
22        standardized screening and assessment instruments.
23            (C) When the results of the screening and
24        assessment indicate an individual not to be capable to
25        self-administer his or her own medications, programs
26        shall be developed in consultation with the Community

 

 

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1        Support Team or Interdisciplinary Team to provide
2        individuals with self-medication administration.
3        (2) Each individual shall be presumed to be competent
4    to self-administer medications if:
5            (A) authorized by an order of a physician licensed
6        to practice medicine in all its branches; and
7            (B) approved to self-administer medication by the
8        individual's Community Support Team or
9        Interdisciplinary Team, which includes a registered
10        professional nurse or an advanced practice nurse.
11    (e) Quality Assurance.
12        (1) A registered professional nurse, advanced practice
13    nurse, licensed practical nurse, physician licensed to
14    practice medicine in all its branches, physician
15    assistant, or pharmacist shall review the following for all
16    individuals:
17            (A) Medication orders.
18            (B) Medication labels, including medications
19        listed on the medication administration record for
20        persons who are not self-medicating to ensure the
21        labels match the orders issued by the physician
22        licensed to practice medicine in all its branches,
23        advanced practice nurse, or physician assistant.
24            (C) Medication administration records for persons
25        who are not self-medicating to ensure that the records
26        are completed appropriately for:

 

 

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1                (i) medication administered as prescribed;
2                (ii) refusal by the individual; and
3                (iii) full signatures provided for all
4            initials used.
5        (2) Reviews shall occur at least quarterly, but may be
6    done more frequently at the discretion of the registered
7    professional nurse or advanced practice nurse.
8        (3) A quality assurance review of medication errors and
9    data collection for the purpose of monitoring and
10    recommending corrective action shall be conducted within 7
11    days and included in the required annual review.
12    (f) Programs using authorized direct care staff to
13administer medications are responsible for documenting and
14maintaining records on the training that is completed.
15    (g) The absence of this training program constitutes a
16threat to the public interest, safety, and welfare and
17necessitates emergency rulemaking by the Departments of Human
18Services and Public Health under Section 5-45 of the Illinois
19Administrative Procedure Act.
20    (h) Direct care staff who fail to qualify for delegated
21authority to administer medications pursuant to the provisions
22of this Section shall be given additional education and testing
23to meet criteria for delegation authority to administer
24medications. Any direct care staff person who fails to qualify
25as an authorized direct care staff after initial training and
26testing must within 3 months be given another opportunity for

 

 

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1retraining and retesting. A direct care staff person who fails
2to meet criteria for delegated authority to administer
3medication, including, but not limited to, failure of the
4written test on 2 occasions shall be given consideration for
5shift transfer or reassignment, if possible. No employee shall
6be terminated for failure to qualify during the 3-month time
7period following initial testing. Refusal to complete training
8and testing required by this Section may be grounds for
9immediate dismissal.
10    (i) No authorized direct care staff person delegated to
11administer medication shall be subject to suspension or
12discharge for errors resulting from the staff person's acts or
13omissions when performing the functions unless the staff
14person's actions or omissions constitute willful and wanton
15conduct. Nothing in this subsection is intended to supersede
16paragraph (4) of subsection (c).
17    (j) A registered professional nurse, advanced practice
18nurse, physician licensed to practice medicine in all its
19branches, or physician assistant shall be on duty or on call at
20all times in any program covered by this Section.
21    (k) The employer shall be responsible for maintaining
22liability insurance for any program covered by this Section.
23    (l) Any direct care staff person who qualifies as
24authorized direct care staff pursuant to this Section shall be
25granted consideration for a one-time additional salary
26differential. The Department shall determine and provide the

 

 

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1necessary funding for the differential in the base. This
2subsection (l) is inoperative on and after June 30, 2000.
3(Source: P.A. 91-630, eff. 8-19-99.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.