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91_SB0965ccr001
LRB9104864PTmbccr1
1 91ST GENERAL ASSEMBLY
2 CONFERENCE COMMITTEE REPORT
3 ON SENATE BILL 965
4 -------------------------------------------------------------
5 -------------------------------------------------------------
6 To the President of the Senate and the Speaker of the
7 House of Representatives:
8 We, the conference committee appointed to consider the
9 differences between the houses in relation to House Amendment
10 No. 1 to Senate Bill 965, recommend the following:
11 (1) that the House recede from House Amendment No. 1;
12 and
13 (2) that Senate Bill 965 be amended by replacing the
14 title with the following:
15 "AN ACT concerning nursing."; and
16 by replacing everything after the enacting clause with the
17 following:
18 "Section 5. The Mental Health and Developmental
19 Disabilities Administrative Act is amended by adding Section
20 15.4 as follows:
21 (20 ILCS 1705/15.4 new)
22 Sec. 15.4. Authorization for nursing delegation to
23 permit direct care staff to administer medications.
24 (a) This Section applies to (i) all programs for persons
25 with a developmental disability in settings of 16 persons or
26 fewer that are funded or licensed by the Department of Human
27 Services and that distribute or administer medications and
28 (ii) all intermediate care facilities for the developmentally
29 disabled with 16 beds or fewer that are licensed by the
30 Department of Public Health. The Department of Human
31 Services shall develop a training program for authorized
32 direct care staff to administer oral and topical medications
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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.
35 "Training program" means a standardized medication
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1 administration training program approved by the Department of
2 Human Services and conducted by a registered professional
3 nurse for the purpose of training persons employed or under
4 contract to provide direct care or treatment to individuals
5 receiving services to administer medications and provide
6 self-administration of medication training to individuals
7 under the delegation and supervision of a nurse-trainer. The
8 program incorporates adult learning styles, teaching
9 strategies, classroom management, curriculum overview,
10 including ethical-legal aspects, and standardized
11 competency-based evaluations on administration of medications
12 and self-administration of medication training programs.
13 (c) Training and authorization of non-licensed direct
14 care staff by nurse-trainers must meet the requirements of
15 this subsection.
16 (1) Prior to training non-licensed direct care staff
17 to administer medication, the nurse-trainer shall perform
18 the following for each individual to whom medication will
19 be administered by non-licensed direct care staff:
20 (A) An assessment of the individual's health
21 history and physical and mental status.
22 (B) An evaluation of the medications
23 prescribed.
24 (2) Non-licensed authorized direct care staff shall
25 meet the following criteria:
26 (A) Be 18 years of age or older.
27 (B) Have completed high school or its
28 equivalent (GED).
29 (C) Have demonstrated functional literacy.
30 (D) Have satisfactorily completed the Health
31 and Safety component of a Department of Human
32 Services authorized direct care staff training
33 program.
34 (E) Have successfully completed the training
35 program, pass the written portion of the
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1 comprehensive exam, and score 100% on the
2 competency-based assessment specific to the
3 individual and his or her medications.
4 (F) Have received additional competency-based
5 assessment by the nurse-trainer as deemed necessary
6 by the nurse-trainer whenever a change of medication
7 occurs or a new individual that requires medication
8 administration enters the program.
9 (3) Authorized direct care staff shall be
10 re-evaluated by a nurse-trainer at least annually or more
11 frequently at the discretion of the registered
12 professional nurse. Any necessary retraining shall be to
13 the extent that is necessary to ensure competency of the
14 authorized direct care staff to administer medication.
15 (4) Authorization of direct care staff to
16 administer medication shall be revoked if, in the opinion
17 of the registered professional nurse, the authorized
18 direct care staff is no longer competent to administer
19 medication.
20 (5) The registered professional nurse shall assess
21 an individual's health status at least annually or more
22 frequently at the discretion of the registered
23 professional nurse.
24 (d) Medication self-administration shall meet the
25 following requirements:
26 (1) As part of the normalization process, in order
27 for each individual to attain the highest possible level
28 of independent functioning, all individuals shall be
29 permitted to participate in their total health care
30 program. This program shall include, but not be limited
31 to, individual training in preventive health and
32 self-medication procedures.
33 (A) Every program shall adopt written policies
34 and procedures for assisting individuals in
35 obtaining preventative health and self-medication
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1 skills in consultation with a registered
2 professional nurse, advanced practice nurse,
3 physician assistant, or physician licensed to
4 practice medicine in all its branches.
5 (B) Individuals shall be evaluated to
6 determine their ability to self-medicate by the
7 nurse-trainer through the use of the Department's
8 required, standardized screening and assessment
9 instruments.
10 (C) When the results of the screening and
11 assessment indicate an individual not to be capable
12 to self-administer his or her own medications,
13 programs shall be developed in consultation with the
14 Community Support Team or Interdisciplinary Team to
15 provide individuals with self-medication
16 administration.
17 (2) Each individual shall be presumed to be
18 competent to self-administer medications if:
19 (A) authorized by an order of a physician
20 licensed to practice medicine in all its branches;
21 and
22 (B) approved to self-administer medication by
23 the individual's Community Support Team or
24 Interdisciplinary Team, which includes a registered
25 professional nurse or an advanced practice nurse.
26 (e) Quality Assurance.
27 (1) A registered professional nurse, advanced
28 practice nurse, licensed practical nurse, physician
29 licensed to practice medicine in all its branches,
30 physician assistant, or pharmacist shall review the
31 following for all individuals:
32 (A) Medication orders.
33 (B) Medication labels, including medications
34 listed on the medication administration record for
35 persons who are not self-medicating to ensure the
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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
35 direct care staff person who fails to meet criteria for
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1 delegated authority to administer medication, including, but
2 not limited to, failure of the written test on 2 occasions
3 shall be given consideration for shift transfer or
4 reassignment, if possible. No employee shall be terminated
5 for failure to qualify during the 3-month time period
6 following initial testing. Refusal to complete training and
7 testing required by this Section may be grounds for immediate
8 dismissal.
9 (i) No authorized direct care staff person delegated to
10 administer medication shall be subject to suspension or
11 discharge for errors resulting from the staff person's acts
12 or omissions when performing the functions unless the staff
13 person's actions or omissions constitute willful and wanton
14 conduct. Nothing in this subsection is intended to supersede
15 paragraph (4) of subsection (c).
16 (j) A registered professional nurse, advanced practice
17 nurse, physician licensed to practice medicine in all its
18 branches, or physician assistant shall be on duty or on call
19 at all times in any program covered by this Section.
20 (k) The employer shall be responsible for maintaining
21 liability insurance for any program covered by this Section.
22 (l) Any direct care staff person who qualifies as
23 authorized direct care staff pursuant to this Section shall
24 be granted consideration for a one-time additional salary
25 differential. The Department shall determine and provide the
26 necessary funding for the differential in the base. This
27 subsection (l) is inoperative on and after June 30, 2000.
28 Section 10. The Nursing and Advanced Practice Nursing
29 Act is amended by changing Section 5-15 as follows:
30 (225 ILCS 65/5-15)
31 Sec. 5-15. Policy; application of Act. For the protection
32 of life and the promotion of health, and the prevention of
33 illness and communicable diseases, any person practicing or
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1 offering to practice professional and practical nursing in
2 Illinois shall submit evidence that he or she is qualified to
3 practice, and shall be licensed as provided under this Act.
4 No person shall practice or offer to practice professional or
5 practical nursing in Illinois or use any title, sign, card or
6 device to indicate that such a person is practicing
7 professional or practical nursing unless such person has been
8 licensed under the provisions of this Act.
9 This Act does not prohibit the following:
10 (a) The practice of nursing in Federal employment in the
11 discharge of the employee's duties by a person who is
12 employed by the United States government or any bureau,
13 division or agency thereof and is a legally qualified and
14 licensed nurse of another state or territory and not in
15 conflict with Sections 10-5, 10-30, and 10-45 of this Act.
16 (b) Nursing that is included in their program of study
17 by students enrolled in programs of nursing or in current
18 nurse practice update courses approved by the Department.
19 (c) The furnishing of nursing assistance in an
20 emergency.
21 (d) The practice of nursing by a nurse who holds an
22 active license in another state when providing services to
23 patients in Illinois during a bonafide emergency or in
24 immediate preparation for or during interstate transit.
25 (e) The incidental care of the sick by members of the
26 family, domestic servants or housekeepers, or care of the
27 sick where treatment is by prayer or spiritual means.
28 (f) Persons from being employed as nursing aides,
29 attendants, orderlies, and other auxiliary workers in private
30 homes, long term care facilities, nurseries, hospitals or
31 other institutions.
32 (g) The practice of practical nursing by one who has
33 applied in writing to the Department in form and substance
34 satisfactory to the Department, for a license as a licensed
35 practical nurse and who has complied with all the provisions
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1 under Section 10-30, except the passing of an examination to
2 be eligible to receive such license, until: the decision of
3 the Department that the applicant has failed to pass the next
4 available examination authorized by the Department or has
5 failed, without an approved excuse, to take the next
6 available examination authorized by the Department or until
7 the withdrawal of the application, but not to exceed 3
8 months. No applicant for licensure practicing under the
9 provisions of this paragraph shall practice practical nursing
10 except under the direct supervision of a registered
11 professional nurse licensed under this Act or a licensed
12 physician, dentist or podiatrist. In no instance shall any
13 such applicant practice or be employed in any supervisory
14 capacity.
15 (h) The practice of practical nursing by one who is a
16 licensed practical nurse under the laws of another U.S.
17 jurisdiction and has applied in writing to the Department, in
18 form and substance satisfactory to the Department, for a
19 license as a licensed practical nurse and who is qualified to
20 receive such license under Section 10-30, until (1) the
21 expiration of 6 months after the filing of such written
22 application, (2) the withdrawal of such application, or (3)
23 the denial of such application by the Department.
24 (i) The practice of professional nursing by one who has
25 applied in writing to the Department in form and substance
26 satisfactory to the Department for a license as a registered
27 professional nurse and has complied with all the provisions
28 under Section 10-30 except the passing of an examination to
29 be eligible to receive such license, until the decision of
30 the Department that the applicant has failed to pass the next
31 available examination authorized by the Department or has
32 failed, without an approved excuse, to take the next
33 available examination authorized by the Department or until
34 the withdrawal of the application, but not to exceed 3
35 months. No applicant for licensure practicing under the
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1 provisions of this paragraph shall practice professional
2 nursing except under the direct supervision of a registered
3 professional nurse licensed under this Act. In no instance
4 shall any such applicant practice or be employed in any
5 supervisory capacity.
6 (j) The practice of professional nursing by one who is a
7 registered professional nurse under the laws of another
8 state, territory of the United States or country and has
9 applied in writing to the Department, in form and substance
10 satisfactory to the Department, for a license as a registered
11 professional nurse and who is qualified to receive such
12 license under Section 10-30, until (1) the expiration of 6
13 months after the filing of such written application, (2) the
14 withdrawal of such application, or (3) the denial of such
15 application by the Department.
16 (k) The practice of professional nursing that is
17 included in a program of study by one who is a registered
18 professional nurse under the laws of another state or
19 territory of the United States or foreign country, territory
20 or province and who is enrolled in a graduate nursing
21 education program or a program for the completion of a
22 baccalaureate nursing degree in this State, which includes
23 clinical supervision by faculty as determined by the
24 educational institution offering the program and the health
25 care organization where the practice of nursing occurs. The
26 educational institution will file with the Department each
27 academic term a list of the names and origin of license of
28 all professional nurses practicing nursing as part of their
29 programs under this provision.
30 (l) Any person licensed in this State under any other
31 Act from engaging in the practice for which she or he is
32 licensed.
33 (m) Delegation to authorized direct care staff trained
34 under Section 15.4 of the Mental Health and Developmental
35 Disabilities Administrative Act.
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1 An applicant for license practicing under the exceptions
2 set forth in subparagraphs (g), (h), (i), and (j) of this
3 Section shall use the title R.N. Lic. Pend. or L.P.N. Lic.
4 Pend. respectively and no other.
5 (Source: P.A. 90-61, eff. 12-30-97; 90-248, eff. 1-1-98;
6 90-655, eff. 7-30-98; 90-742, eff. 8-13-98.)
7 Section 99. Effective date. This Act takes effect upon
8 becoming law.".
9 Submitted on May 26, 1999
10 s/Sen. Dave Syverson s/Rep. Dan Reitz
11 s/Sen. Kathleen Parker s/Rep. Sara Feigenholtz
12 s/Sen. Laura Kent Donahue s/Rep. Barbara Flynn Currie
13 s/Sen. Barack Obama s/Rep. Dan Rutherford
14 s/Sen. Antonio Munoz s/Rep. Renee Kosel
15 Committee for the Senate Committee for the House