HB1822ham001 93rd General Assembly



                                     LRB093 04745 BDD 12953 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  and
16    certified by the Department of Public Health.  The Department
17    of Human  Services  shall  develop  a  training  program  for
18    authorized  direct  care staff to administer oral and topical
19    medications  under  the  supervision  and  monitoring  of   a
20    registered professional nurse. This training program shall be
21    developed  in  consultation  with  professional  associations
22    representing  (i) physicians licensed to practice medicine in
                            -2-      LRB093 04745 BDD 12953 a
 1    all its branches, (ii) registered  professional  nurses,  and
 2    (iii) 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 12953 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 12953 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 12953 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 12953 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 12953 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.".