Full Text of SB0860 103rd General Assembly
SB0860eng 103RD GENERAL ASSEMBLY | | | SB0860 Engrossed | | LRB103 03319 KTG 48325 b |
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| 1 | | AN ACT concerning State government. | 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly: | 4 | | Section 5. The Mental Health and Developmental | 5 | | Disabilities Administrative Act is amended by changing Section | 6 | | 15.4 as follows: | 7 | | (20 ILCS 1705/15.4) | 8 | | Sec. 15.4. Authorization for nursing delegation to permit | 9 | | direct care staff to administer medications. | 10 | | (a) This Section applies to (i) all residential programs | 11 | | for persons with a developmental disability in settings of 16 | 12 | | persons or fewer that are funded or licensed by the Department | 13 | | of Human Services and that distribute or administer | 14 | | medications, (ii) all intermediate care facilities for persons | 15 | | with developmental disabilities with 16 beds or fewer that are | 16 | | licensed by the Department of Public Health, and (iii) all day | 17 | | programs certified to serve persons with developmental | 18 | | disabilities by the Department of Human Services. The | 19 | | Department of Human Services shall develop a training program | 20 | | for authorized direct care staff to administer medications | 21 | | under the supervision and monitoring of a registered | 22 | | professional nurse. The training program for authorized direct | 23 | | care staff shall include educational and oversight components |
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| 1 | | for staff who work in day programs that are similar to those | 2 | | for staff who work in residential programs. This training | 3 | | program shall be developed in consultation with professional | 4 | | associations representing (i) physicians licensed to practice | 5 | | medicine in all its branches, (ii) registered professional | 6 | | nurses, and (iii) pharmacists. | 7 | | (b) For the purposes of this Section: | 8 | | "Authorized direct care staff" means non-licensed persons | 9 | | who have successfully completed a medication administration | 10 | | training program approved by the Department of Human Services | 11 | | and conducted by a nurse-trainer. This authorization is | 12 | | specific to an individual receiving service in a specific | 13 | | agency and does not transfer to another agency. | 14 | | "Medications" means oral and topical medications, | 15 | | auto-injectors, insulin in an injectable form, oxygen, | 16 | | epinephrine auto-injectors, and vaginal and rectal creams and | 17 | | suppositories. "Oral" includes inhalants and medications | 18 | | administered through enteral tubes, utilizing aseptic | 19 | | technique. "Topical" includes eye, ear, and nasal medications. | 20 | | Any controlled substances must be packaged specifically for an | 21 | | identified individual. | 22 | | "Insulin in an injectable or auto-injectable form" means a | 23 | | subcutaneous injection , auto-injection, or other technologies | 24 | | available including, but not limited to, insulin pumps, | 25 | | insulin pods, or via an insulin pen pre-filled by the | 26 | | manufacturer. |
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| 1 | | "GLP-1 receptor agonists in an injectable or | 2 | | auto-injectable form" means an anti-diabetic medication used | 3 | | for the treatment of type 1 and type 2 diabetes. Authorized | 4 | | direct care staff may administer insulin or GLP-1 receptor | 5 | | agonists via auto-injection or pen pre-filled by the | 6 | | manufacturer as delegated by the registered professional nurse | 7 | | and , as ordered by a physician, advanced practice registered | 8 | | nurse, or physician assistant, if: (i) the staff has | 9 | | successfully completed a Department-approved advanced training | 10 | | program specific to insulin or GLP-1 receptor agonist | 11 | | administration developed in consultation with professional | 12 | | associations listed in subsection (a) of this Section, and | 13 | | (ii) the staff consults with the registered nurse, prior to | 14 | | administration, of any insulin or GLP-1 receptor agonist dose | 15 | | that is determined based on a blood glucose test result. The | 16 | | authorized direct care staff shall not: (i) calculate the | 17 | | insulin or GLP-1 receptor agonist dosage needed when the dose | 18 | | is dependent upon a blood glucose test result, or (ii) | 19 | | administer insulin or GLP-1 receptor agonists to individuals | 20 | | who require blood glucose monitoring greater than 3 times | 21 | | daily, unless directed to do so by the registered nurse. An | 22 | | individual may self-administer insulin or GLP-1 receptor | 23 | | agonists in any form if the individual is deemed independent | 24 | | by the nurse-trainer through the use of the Department's | 25 | | required standardized screening and assessment instruments. | 26 | | "Nurse-trainer training program" means a standardized, |
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| 1 | | competency-based medication administration train-the-trainer | 2 | | program provided by the Department of Human Services and | 3 | | conducted by a Department of Human Services master | 4 | | nurse-trainer for the purpose of training nurse-trainers to | 5 | | train persons employed or under contract to provide direct | 6 | | care or treatment to individuals receiving services to | 7 | | administer medications and provide self-administration of | 8 | | medication training to individuals under the supervision and | 9 | | monitoring of the nurse-trainer. The program incorporates | 10 | | adult learning styles, teaching strategies, classroom | 11 | | management, and a curriculum overview, including the ethical | 12 | | and legal aspects of supervising those administering | 13 | | medications. | 14 | | "Self-administration of medications" means an individual | 15 | | administers his or her own medications or a portion of his or | 16 | | her own medications . To be considered capable to | 17 | | self-administer their own medication, individuals must, at a | 18 | | minimum, be able to identify their medication by size, shape, | 19 | | or color, know when they should take the medication, and know | 20 | | the amount of medication to be taken each time. The use of | 21 | | assistive or enabling technologies can be used to demonstrate | 22 | | a person's capability to administer his or her own | 23 | | medications. | 24 | | "Training program" means a standardized medication | 25 | | administration training program approved by the Department of | 26 | | Human Services and conducted by a registered professional |
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| 1 | | nurse for the purpose of training persons employed or under | 2 | | contract to provide direct care or treatment to individuals | 3 | | receiving services to administer medications and provide | 4 | | self-administration of medication training to individuals | 5 | | under the delegation and supervision of a nurse-trainer. The | 6 | | program incorporates adult learning styles, teaching | 7 | | strategies, classroom management, curriculum overview, | 8 | | including ethical-legal aspects, and standardized | 9 | | competency-based evaluations on administration of medications | 10 | | and self-administration of medication training programs. | 11 | | (c) Training and authorization of non-licensed direct care | 12 | | staff by nurse-trainers must meet the requirements of this | 13 | | subsection. | 14 | | (1) Prior to training non-licensed direct care staff | 15 | | to administer medication, the nurse-trainer shall perform | 16 | | the following for each individual to whom medication will | 17 | | be administered by non-licensed direct care staff: | 18 | | (A) An assessment of the individual's health | 19 | | history and physical and mental status. | 20 | | (B) An evaluation of the medications 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 have a State of | 25 | | Illinois High School Diploma. | 26 | | (C) Have demonstrated functional literacy. |
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| 1 | | (D) Have satisfactorily completed the Health and | 2 | | Safety component of a Department of Human Services | 3 | | authorized direct care staff training program. | 4 | | (E) Have successfully completed the training | 5 | | program, pass the written portion of the comprehensive | 6 | | exam, and score 100% on the competency-based | 7 | | assessment demonstrating proficiency in the skill of | 8 | | administering medication specific to the individual | 9 | | and his or her medications . | 10 | | (F) Have received additional competency-based | 11 | | assessment by the nurse-trainer as deemed necessary by | 12 | | the nurse-trainer whenever it is determined that | 13 | | additional skill development and training is needed to | 14 | | administer a medication a change of medication occurs | 15 | | or a new individual that requires medication | 16 | | administration enters the program . | 17 | | (3) Authorized direct care staff shall be re-evaluated | 18 | | by a nurse-trainer at least annually or more frequently at | 19 | | the discretion of the registered professional nurse. Any | 20 | | necessary retraining shall be to the extent that is | 21 | | necessary to ensure competency of the authorized direct | 22 | | care staff to administer medication. | 23 | | (4) Authorization of direct care staff to administer | 24 | | medication shall be revoked if, in the opinion of the | 25 | | registered professional nurse, the authorized direct care | 26 | | staff is no longer competent to administer medication. |
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| 1 | | (5) The registered professional nurse shall assess an | 2 | | individual's health status at least annually or more | 3 | | frequently at the discretion of the registered | 4 | | professional nurse. | 5 | | This subsection only applies to settings where the | 6 | | registered professional nurse has jurisdiction. If direct care | 7 | | staff move to other settings, they shall consult with the | 8 | | registered professional nurse who has jurisdiction of that | 9 | | setting. | 10 | | (d) Medication self-administration shall meet the | 11 | | following requirements: | 12 | | (1) As part of the normalization process, in order for | 13 | | each individual to attain the highest possible level of | 14 | | independent functioning, all individuals shall be | 15 | | permitted to participate in their total health care | 16 | | program. This program shall include, but not be limited | 17 | | to, individual training in preventive health and | | | | 18 | | self-administration of medication self-medication | 19 | | procedures. | 20 | | (A) Every program shall adopt written policies and | 21 | | procedures for assisting individuals who choose to | 22 | | obtain in obtaining preventative health and | 23 | | self-administration of medication self-medication | 24 | | skills in consultation with a registered professional | 25 | | nurse, advanced practice registered nurse, physician | 26 | | assistant, or physician licensed to practice medicine |
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| 1 | | in all its branches. | 2 | | (B) If an individual desires to gain independence | 3 | | in self-administration of medication, the individual | 4 | | Individuals shall be evaluated to determine the | 5 | | individual's their ability to self-administer | 6 | | medication self-medicate by the nurse-trainer through | 7 | | the use of the Department's required, standardized | 8 | | screening and assessment instruments. | 9 | | (C) (Blank). When the results of the screening and | 10 | | assessment indicate an individual not to be capable to | 11 | | self-administer his or her own medications, programs | 12 | | shall be developed in consultation with the Community | 13 | | Support Team or Interdisciplinary Team to provide | 14 | | individuals with self-medication administration. | 15 | | (2) Each individual shall be presumed to be competent | 16 | | to self-administer medications if: | 17 | | (A) authorized by an order of a physician licensed | 18 | | to practice medicine in all its branches, an advanced | 19 | | practice registered nurse, or a physician assistant; | 20 | | and | 21 | | (B) approved to self-administer medication by the | 22 | | individual's Community Support Team or | 23 | | Interdisciplinary Team, which includes a registered | 24 | | professional nurse or an advanced practice registered | 25 | | nurse. | 26 | | (e) Quality Assurance. |
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| 1 | | (1) A registered professional nurse, advanced practice | 2 | | registered nurse, licensed practical nurse, physician | 3 | | licensed to practice medicine in all its branches, | 4 | | physician assistant, or pharmacist shall review the | 5 | | following for all individuals: | 6 | | (A) Medication orders. | 7 | | (B) Medication labels, including medications | 8 | | listed on the medication administration record for | 9 | | persons who are not self-administering medication | 10 | | self-medicating to ensure the labels match the orders | 11 | | issued by the physician licensed to practice medicine | 12 | | in all its branches, advanced practice registered | 13 | | nurse, or physician assistant. | 14 | | (C) Medication administration records for persons | 15 | | who are not self-administering medication | 16 | | self-medicating to ensure that the records are | 17 | | completed appropriately for: | 18 | | (i) medication administered as prescribed; | 19 | | (ii) refusal by the individual; and | 20 | | (iii) full signatures provided for all | 21 | | initials used. | 22 | | (2) Reviews shall occur at least quarterly, but may be | 23 | | done more frequently at the discretion of the registered | 24 | | professional nurse or advanced practice registered nurse. | 25 | | (3) A quality assurance review of medication errors | 26 | | and data collection for the purpose of monitoring and |
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| 1 | | recommending corrective action shall be conducted within 7 | 2 | | days and included in the required annual review. | 3 | | (f) Programs using authorized direct care staff to | 4 | | administer medications are responsible for documenting and | 5 | | maintaining records on the training that is completed. | 6 | | (g) The absence of this training program constitutes a | 7 | | threat to the public interest, safety, and welfare and | 8 | | necessitates emergency rulemaking by the Departments of Human | 9 | | Services and Public Health under Section 5-45 of the Illinois | 10 | | Administrative Procedure Act. | 11 | | (h) Direct care staff who fail to qualify for delegated | 12 | | authority to administer medications pursuant to the provisions | 13 | | of this Section shall be given additional education and | 14 | | testing to meet criteria for delegation authority to | 15 | | administer medications. Any direct care staff person who fails | 16 | | to qualify as an authorized direct care staff after initial | 17 | | training and testing must within 3 months be given another | 18 | | opportunity for retraining and retesting. A direct care staff | 19 | | person who fails to meet criteria for delegated authority to | 20 | | administer medication, including, but not limited to, failure | 21 | | of the written test on 2 occasions shall be given | 22 | | consideration for shift transfer or reassignment, if possible. | 23 | | No employee shall be terminated for failure to qualify during | 24 | | the 3-month time period following initial testing. Refusal to | 25 | | complete training and testing required by this Section may be | 26 | | grounds for immediate dismissal. |
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| 1 | | (i) No authorized direct care staff person delegated to | 2 | | administer medication shall be subject to suspension or | 3 | | discharge for errors resulting from the staff person's acts or | 4 | | omissions when performing the functions unless the staff | 5 | | person's actions or omissions constitute willful and wanton | 6 | | conduct. Nothing in this subsection is intended to supersede | 7 | | paragraph (4) of subsection (c). | 8 | | (j) A registered professional nurse, advanced practice | 9 | | registered nurse, physician licensed to practice medicine in | 10 | | all its branches, or physician assistant shall be on duty or on | 11 | | call at all times in any program covered by this Section. | 12 | | (k) The employer shall be responsible for maintaining | 13 | | liability insurance for any program covered by this Section. | 14 | | (l) Any direct care staff person who qualifies as | 15 | | authorized direct care staff pursuant to this Section shall be | 16 | | granted consideration for a one-time additional salary | 17 | | differential. The Department shall determine and provide the | 18 | | necessary funding for the differential in the base. This | 19 | | subsection (l) is inoperative on and after June 30, 2000. | 20 | | (Source: P.A. 102-1100, eff. 1-1-23 .) |
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