Public Act 098-0901
 
HB4486 EnrolledLRB098 17632 RLC 53149 b


  
    AN ACT concerning State government.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 5. The Mental Health and Developmental 
Disabilities Administrative Act is amended  by changing Section 
15.4 as follows:
 



    (20 ILCS 1705/15.4)



    Sec. 15.4. 
Authorization for nursing delegation to permit 
direct care
staff to
administer medications.

    (a) This Section applies to (i) all programs for persons

with a
developmental disability in settings of 16 persons or 
fewer that are funded or
licensed by the Department of Human

Services and that distribute or administer medications and (ii) 
all
intermediate care
facilities for the developmentally 
disabled with 16 beds or fewer that are
licensed by the

Department of Public Health.  The Department of Human Services 
shall develop a
training program for authorized direct care 
staff to administer oral and
topical
medications under the

supervision and monitoring of a registered professional nurse.

This training program shall be developed in consultation with 
professional
associations representing (i) physicians licensed 
to practice medicine in all
its branches, (ii) registered 
professional nurses, and (iii) pharmacists.

    (b) For the purposes of this Section:

    "Authorized direct care staff"  means non-licensed persons 
who have
successfully completed a medication administration 
training program
approved by the Department of Human Services 
and conducted by a nurse-trainer.
This authorization is 
specific to an individual receiving service in
a
specific 
agency and does not transfer to another agency.

    "Medications" means oral and topical medications, insulin 
in an injectable form, oxygen, epinephrine auto-injectors, and 
vaginal and rectal creams and suppositories.  "Oral" includes 
inhalants and medications administered through enteral tubes, 
utilizing aseptic technique.  "Topical" includes eye, ear, and 
nasal medications.  Any controlled substances must be packaged 
specifically for an identified individual.
    "Insulin in an injectable form" means a subcutaneous 
injection via an insulin pen pre-filled by the manufacturer.  
Authorized direct care staff may administer insulin, as ordered 
by a physician, advanced practice nurse, or physician 
assistant,  if:   (i) the staff  has successfully completed a 
Department-approved advanced training program specific to 
insulin administration developed in consultation with 
professional associations listed in subsection (a) of this 
Section, and (ii) the staff consults with the registered nurse, 
prior to administration, of  any insulin dose that is determined 
based on a blood glucose test result.  The authorized direct 
care staff shall not (i) calculate the insulin dosage needed 
when the dose is dependent upon a blood glucose test result, or 
(ii) administer insulin to individuals who require blood 
glucose monitoring greater than 3 times daily, unless directed 
to do so by the registered nurse. 
    "Nurse-trainer training program" means a standardized, 
competency-based
medication administration train-the-trainer 
program provided by the
Department of Human Services and 
conducted by a Department of Human
Services master 
nurse-trainer for the purpose of training nurse-trainers to

train persons employed or under contract to provide direct care 
or
treatment to individuals receiving services to administer

medications and provide self-administration of medication 
training to
individuals under the supervision and monitoring of 
the nurse-trainer.  The
program incorporates adult learning 
styles, teaching strategies, classroom
management, and a 
curriculum overview, including the ethical and legal
aspects of 
supervising those administering medications.

    "Self-administration of medications" means an individual 
administers
his or her own medications.  To be considered 
capable to self-administer
their own medication, individuals 
must, at a minimum, be able to identify
their medication by 
size, shape, or color, know when they should take
the 
medication, and know the amount of medication to be taken each 
time.

    "Training program" means a standardized  medication 
administration
training program approved by the Department of 
Human Services and
conducted by a registered professional nurse 
for the purpose of training
persons employed or under contract 
to provide direct care or treatment to
individuals receiving 
services to administer medications
and provide 
self-administration of medication training to individuals 
under
the delegation and supervision of a nurse-trainer.  The 
program incorporates
adult learning styles, teaching 
strategies, classroom management,
curriculum overview, 
including ethical-legal aspects, and standardized

competency-based evaluations on administration of medications 
and
self-administration of medication training programs.

    (c) Training and authorization of non-licensed direct care 
staff by
nurse-trainers must meet the requirements of this 
subsection.


        (1) Prior to training non-licensed direct care staff to 
    administer
medication, the nurse-trainer shall perform the 
    following for each
individual to whom medication will be 
    administered by non-licensed
direct care staff:


            (A)  An assessment of the individual's health 
        history and
physical and mental status.


            (B)  An evaluation of the medications prescribed.


        (2)  Non-licensed authorized direct care staff shall 
    meet the
following criteria:


            (A)  Be 18 years of age or older.


            (B)  Have completed high school or its equivalent 
        (GED).


            (C)  Have demonstrated functional literacy.


            (D)  Have satisfactorily completed the Health and 
        Safety
component of a Department of Human Services 
        authorized
direct care staff training program.


            (E)  Have successfully completed the training 
        program,
pass the written portion of the comprehensive 
        exam, and score
100% on the competency-based 
        assessment specific to the
individual and his or her 
        medications.


            (F)  Have received additional competency-based 
        assessment
by the nurse-trainer as deemed necessary by 
        the nurse-trainer
whenever a change of medication 
        occurs or a new individual
that requires medication 
        administration enters the program.


        (3)  Authorized direct care staff shall be re-evaluated 
    by a
nurse-trainer at least annually or more frequently at 
    the discretion of
the registered professional nurse.  Any 
    necessary retraining shall be
to the extent that is 
    necessary to ensure competency of the authorized
direct 
    care staff to administer medication.


        (4)  Authorization of direct care staff to administer 
    medication
shall be revoked if, in the opinion of the 
    registered professional nurse,
the authorized direct care 
    staff is no longer competent to administer
medication.


        (5)  The registered professional nurse shall assess an

    individual's health status at least annually or more 
    frequently at the
discretion of the registered 
    professional nurse.

    (d)  Medication self-administration shall meet the 
following
requirements:


        (1)  As part of the normalization process, in order for 
    each
individual to attain the highest possible level of 
    independent
functioning, all individuals shall be 
    permitted to participate in their
total health care 
    program.  This program shall include, but not be
limited to, 
    individual training in preventive health and 
    self-medication
procedures.


            (A)  Every program shall adopt written policies and

        procedures for assisting individuals in obtaining 
        preventative
health and self-medication skills in 
        consultation with a
registered professional nurse, 
        advanced practice nurse,
physician assistant, or 
        physician licensed to practice medicine
in all its 
        branches.


            (B)  Individuals shall be evaluated to determine 
        their
ability to self-medicate by the nurse-trainer 
        through the use of
the Department's required, 
        standardized screening and assessment
instruments.


            (C)  When the results of the screening and 
        assessment
indicate an individual not to be capable to 
        self-administer his or her
own medications, programs 
        shall be developed in consultation
with the Community 
        Support Team or Interdisciplinary
Team to provide 
        individuals with self-medication
administration.


        (2)  Each individual shall be presumed to be competent 
    to self-administer
medications if:


            (A)  authorized by an order of a physician licensed 
        to
practice medicine in all its branches; and


            (B)  approved to self-administer medication by the

        individual's Community Support Team or

        Interdisciplinary Team, which includes a registered

        professional nurse or an advanced practice nurse.

    (e)  Quality Assurance.


        (1)  A registered professional nurse, advanced practice 
    nurse,
licensed practical nurse, physician licensed to 
    practice medicine in all
its branches, physician 
    assistant, or pharmacist shall review the
following for all 
    individuals:


            (A)  Medication orders.


            (B)  Medication labels, including medications 
        listed on
the medication administration record for 
        persons who are not
self-medicating to ensure the 
        labels match the orders issued by
the physician 
        licensed to practice medicine in all its branches,

        advanced practice nurse, or physician assistant.


            (C)  Medication administration records for persons 
        who
are not self-medicating to ensure that the records 
        are completed
appropriately for:


                (i)  medication administered as prescribed;


                (ii)  refusal by the individual; and


                (iii)  full signatures provided for all 
            initials used.


        (2)  Reviews shall occur at least quarterly, but may be 
    done
more frequently at the discretion of the registered 
    professional nurse
or advanced practice nurse.


        (3)  A quality assurance review of medication errors and 
    data
collection for the purpose of monitoring and 
    recommending
corrective action shall be conducted within 7 
    days and included in the
required annual review.

    (f)  Programs using authorized direct care
staff to 
administer medications are responsible for documenting and 
maintaining
records
on the training that is completed.

    (g) The absence of this training program constitutes a 
threat to the
public interest,
safety, and welfare and 
necessitates emergency rulemaking by
the Departments of Human 
Services and
Public Health
under Section 5-45
of
the
Illinois 
Administrative Procedure Act.

    (h) Direct care staff who fail to qualify for delegated 
authority to
administer medications pursuant to the provisions 
of this Section shall be
given
additional education and testing 
to meet criteria for
delegation authority to administer 
medications.
Any direct care staff person who fails to qualify 
as an authorized direct care
staff
after initial training and 
testing must within 3 months be given another
opportunity for 
retraining and retesting.  A direct care staff person who fails

to
meet criteria for delegated authority to administer 
medication, including, but
not limited to, failure of the 
written test on 2 occasions shall be given
consideration for 
shift transfer or reassignment, if possible.  No employee
shall 
be terminated for failure to qualify during the 3-month time 
period
following initial testing.  Refusal to complete training 
and testing required
by this Section may be grounds for 
immediate dismissal.

    (i) No authorized direct care staff person delegated to 
administer
medication shall be subject to suspension or 
discharge for errors
resulting from the staff
person's acts or 
omissions when performing the functions unless the staff

person's actions or omissions constitute willful and wanton 
conduct.
Nothing in this subsection is intended to supersede 
paragraph (4) of subsection
(c).

    (j) A registered professional nurse, advanced practice 
nurse,
physician licensed to practice medicine in all its 
branches, or physician
assistant shall be on
duty or
on call at 
all times in any program covered by this Section.

    (k) The employer shall be responsible for maintaining 
liability insurance
for any program covered by this Section.

    (l) Any direct care staff person who qualifies as 
authorized direct care
staff pursuant to this Section shall be 
granted consideration for a one-time
additional
salary 
differential.  The Department shall determine and provide the 
necessary
funding for
the differential in the base.  This 
subsection (l) is inoperative on and after
June 30, 2000.

(Source: P.A. 91-630, eff. 8-19-99.)

 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.