[ Search ] [ Legislation ]
[ Home ] [ Back ] [ Bottom ]
| [ Introduced ] |
91_HB3681ham002
LRB9110875MWdvam01
1 AMENDMENT TO HOUSE BILL 3681
2 AMENDMENT NO. . Amend House Bill 3681 by replacing
3 the title with the following:
4 "AN ACT concerning nursing."; and
5 by replacing everything after the enacting clause with the
6 following:
7 "Section 5. The Mental Health and Developmental
8 Disabilities Administrative Act is amended by changing
9 Section 15.4 as follows:
10 (20 ILCS 1705/15.4)
11 Sec. 15.4. Authorization for nursing delegation to
12 permit direct care staff to administer medications.
13 (a) This Section applies to (i) all programs for persons
14 with a developmental disability in settings of 16 persons or
15 fewer that are funded or licensed by the Department of Human
16 Services and that distribute or administer medications and
17 (ii) all intermediate care facilities for the developmentally
18 disabled with 16 beds or fewer that are licensed by the
19 Department of Public Health. The Department of Human
20 Services shall develop a training program for authorized
21 direct care staff to administer oral and topical medications
-2- LRB9110875MWdvam01
1 under the supervision and monitoring of a registered
2 professional nurse. This training program shall be developed
3 in consultation with professional associations representing
4 (i) physicians licensed to practice medicine in all its
5 branches, (ii) registered professional nurses, and (iii)
6 pharmacists.
7 (b) For the purposes of this Section:
8 "Authorized direct care staff" means non-licensed
9 persons who have successfully completed a medication
10 administration training program approved by the Department of
11 Human Services and conducted by a nurse-trainer. This
12 authorization is specific to an individual receiving service
13 in a specific agency and does not transfer to another agency.
14 "Nurse-trainer training program" means a standardized,
15 competency-based medication administration train-the-trainer
16 program provided by the Department of Human Services and
17 conducted by a Department of Human Services master
18 nurse-trainer for the purpose of training nurse-trainers to
19 train persons employed or under contract to provide direct
20 care or treatment to individuals receiving services to
21 administer medications and provide self-administration of
22 medication training to individuals under the supervision and
23 monitoring of the nurse-trainer. The program incorporates
24 adult learning styles, teaching strategies, classroom
25 management, and a curriculum overview, including the ethical
26 and legal aspects of supervising those administering
27 medications.
28 "Self-administration of medications" means an individual
29 administers his or her own medications. To be considered
30 capable to self-administer their own medication, individuals
31 must, at a minimum, be able to identify their medication by
32 size, shape, or color, know when they should take the
33 medication, and know the amount of medication to be taken
34 each time.
-3- LRB9110875MWdvam01
1 "Training program" means a standardized medication
2 administration training program approved by the Department of
3 Human Services and conducted by a registered professional
4 nurse for the purpose of training persons employed or under
5 contract to provide direct care or treatment to individuals
6 receiving services to administer medications and provide
7 self-administration of medication training to individuals
8 under the delegation and supervision of a nurse-trainer. The
9 program incorporates adult learning styles, teaching
10 strategies, classroom management, curriculum overview,
11 including ethical-legal aspects, and standardized
12 competency-based evaluations on administration of medications
13 and self-administration of medication training programs.
14 (c) Training and authorization of non-licensed direct
15 care staff by nurse-trainers must meet the requirements of
16 this subsection.
17 (1) Prior to training non-licensed direct care staff
18 to administer medication, the nurse-trainer shall perform
19 the following for each individual to whom medication will
20 be administered by non-licensed direct care staff:
21 (A) An assessment of the individual's health
22 history and physical and mental status.
23 (B) An evaluation of the medications
24 prescribed.
25 (2) Non-licensed authorized direct care staff shall
26 meet the following criteria:
27 (A) Be 18 years of age or older.
28 (B) Have completed high school or its
29 equivalent (GED), or, on or before the effective
30 date of this amendatory Act of the 91st General
31 Assembly, have at least one year of experience as
32 non-licensed direct care staff.
33 (C) Have demonstrated functional literacy.
34 (D) Have satisfactorily completed the Health
-4- LRB9110875MWdvam01
1 and Safety component of a Department of Human
2 Services authorized direct care staff training
3 program.
4 (E) Have successfully completed the training
5 program, pass the written portion of the
6 comprehensive exam, and score 100% on the
7 competency-based assessment specific to the
8 individual and his or her medications.
9 (F) Have received additional competency-based
10 assessment by the nurse-trainer as deemed necessary
11 by the nurse-trainer whenever a change of medication
12 occurs or a new individual that requires medication
13 administration enters the program.
14 (3) Authorized direct care staff shall be
15 re-evaluated by a nurse-trainer at least annually or more
16 frequently at the discretion of the registered
17 professional nurse. Any necessary retraining shall be to
18 the extent that is necessary to ensure competency of the
19 authorized direct care staff to administer medication.
20 (4) Authorization of direct care staff to
21 administer medication shall be revoked if, in the opinion
22 of the registered professional nurse, the authorized
23 direct care staff is no longer competent to administer
24 medication.
25 (5) The registered professional nurse shall assess
26 an individual's health status at least annually or more
27 frequently at the discretion of the registered
28 professional nurse.
29 (d) Medication self-administration shall meet the
30 following requirements:
31 (1) As part of the normalization process, in order
32 for each individual to attain the highest possible level
33 of independent functioning, all individuals shall be
34 permitted to participate in their total health care
-5- LRB9110875MWdvam01
1 program. This program shall include, but not be limited
2 to, individual training in preventive health and
3 self-medication procedures.
4 (A) Every program shall adopt written policies
5 and procedures for assisting individuals in
6 obtaining preventative health and self-medication
7 skills in consultation with a registered
8 professional nurse, advanced practice nurse,
9 physician assistant, or physician licensed to
10 practice medicine in all its branches.
11 (B) Individuals shall be evaluated to
12 determine their ability to self-medicate by the
13 nurse-trainer through the use of the Department's
14 required, standardized screening and assessment
15 instruments.
16 (C) When the results of the screening and
17 assessment indicate an individual not to be capable
18 to self-administer his or her own medications,
19 programs shall be developed in consultation with the
20 Community Support Team or Interdisciplinary Team to
21 provide individuals with self-medication
22 administration.
23 (2) Each individual shall be presumed to be
24 competent to self-administer medications if:
25 (A) authorized by an order of a physician
26 licensed to practice medicine in all its branches;
27 and
28 (B) approved to self-administer medication by
29 the individual's Community Support Team or
30 Interdisciplinary Team, which includes a registered
31 professional nurse or an advanced practice nurse.
32 (e) Quality Assurance.
33 (1) A registered professional nurse, advanced
34 practice nurse, licensed practical nurse, physician
-6- LRB9110875MWdvam01
1 licensed to practice medicine in all its branches,
2 physician assistant, or pharmacist shall review the
3 following for all individuals:
4 (A) Medication orders.
5 (B) Medication labels, including medications
6 listed on the medication administration record for
7 persons who are not self-medicating to ensure the
8 labels match the orders issued by the physician
9 licensed to practice medicine in all its branches,
10 advanced practice nurse, or physician assistant.
11 (C) Medication administration records for
12 persons who are not self-medicating to ensure that
13 the records are completed appropriately for:
14 (i) medication administered as
15 prescribed;
16 (ii) refusal by the individual; and
17 (iii) full signatures provided for all
18 initials used.
19 (2) Reviews shall occur at least quarterly, but may
20 be done more frequently at the discretion of the
21 registered professional nurse or advanced practice nurse.
22 (3) A quality assurance review of medication errors
23 and data collection for the purpose of monitoring and
24 recommending corrective action shall be conducted within
25 7 days and included in the required annual review.
26 (f) Programs using authorized direct care staff to
27 administer medications are responsible for documenting and
28 maintaining records on the training that is completed.
29 (g) The absence of this training program constitutes a
30 threat to the public interest, safety, and welfare and
31 necessitates emergency rulemaking by the Departments of Human
32 Services and Public Health under Section 5-45 of the Illinois
33 Administrative Procedure Act.
34 (h) Direct care staff who fail to qualify for delegated
-7- LRB9110875MWdvam01
1 authority to administer medications pursuant to the
2 provisions of this Section shall be given additional
3 education and testing to meet criteria for delegation
4 authority to administer medications. Any direct care staff
5 person who fails to qualify as an authorized direct care
6 staff after initial training and testing must within 3 months
7 be given another opportunity for retraining and retesting. A
8 direct care staff person who fails to meet criteria for
9 delegated authority to administer medication, including, but
10 not limited to, failure of the written test on 2 occasions
11 shall be given consideration for shift transfer or
12 reassignment, if possible. No employee shall be terminated
13 for failure to qualify during the 3-month time period
14 following initial testing. Refusal to complete training and
15 testing required by this Section may be grounds for immediate
16 dismissal.
17 (i) No authorized direct care staff person delegated to
18 administer medication shall be subject to suspension or
19 discharge for errors resulting from the staff person's acts
20 or omissions when performing the functions unless the staff
21 person's actions or omissions constitute willful and wanton
22 conduct. Nothing in this subsection is intended to supersede
23 paragraph (4) of subsection (c).
24 (j) A registered professional nurse, advanced practice
25 nurse, physician licensed to practice medicine in all its
26 branches, or physician assistant shall be on duty or on call
27 at all times in any program covered by this Section.
28 (k) The employer shall be responsible for maintaining
29 liability insurance for any program covered by this Section.
30 (l) Any direct care staff person who qualifies as
31 authorized direct care staff pursuant to this Section shall
32 be granted consideration for a one-time additional salary
33 differential. The Department shall determine and provide the
34 necessary funding for the differential in the base. This
-8- LRB9110875MWdvam01
1 subsection (l) is inoperative on and after June 30, 2000.
2 (Source: P.A. 91-630, eff. 8-19-99.)
3 Section 99. Effective date. This Act takes effect upon
4 becoming law.".