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91_SB1948
LRB9113376JMmb
1 AN ACT concerning nursing.
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
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 by the
16 Department of Public Health. The Department of Human
17 Services shall develop a training program for authorized
18 direct care staff to administer oral and topical medications
19 under the supervision and monitoring of a registered
20 professional nurse. This training program shall be developed
21 in consultation with professional associations representing
22 (i) physicians licensed to practice medicine in all its
23 branches, (ii) registered professional nurses, and (iii)
24 pharmacists.
25 (b) For the purposes of this Section:
26 "Authorized direct care staff" means non-licensed
27 persons who have successfully completed a medication
28 administration training program approved by the Department of
29 Human Services and conducted by a nurse-trainer. This
30 authorization is specific to an individual receiving service
31 in a specific agency and does not transfer to another agency.
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1 "Nurse-trainer training program" means a standardized,
2 competency-based medication administration train-the-trainer
3 program provided by the Department of Human Services and
4 conducted by a Department of Human Services master
5 nurse-trainer for the purpose of training nurse-trainers to
6 train persons employed or under contract to provide direct
7 care or treatment to individuals receiving services to
8 administer medications and provide self-administration of
9 medication training to individuals under the supervision and
10 monitoring of the nurse-trainer. The program incorporates
11 adult learning styles, teaching strategies, classroom
12 management, and a curriculum overview, including the ethical
13 and legal aspects of supervising those administering
14 medications.
15 "Self-administration of medications" means an individual
16 administers his or her own medications. To be considered
17 capable to self-administer their own medication, individuals
18 must, at a minimum, be able to identify their medication by
19 size, shape, or color, know when they should take the
20 medication, and know the amount of medication to be taken
21 each time.
22 "Training program" means a standardized medication
23 administration training program approved by the Department of
24 Human Services and conducted by a registered professional
25 nurse for the purpose of training persons employed or under
26 contract to provide direct care or treatment to individuals
27 receiving services to administer medications and provide
28 self-administration of medication training to individuals
29 under the delegation and supervision of a nurse-trainer. The
30 program incorporates adult learning styles, teaching
31 strategies, classroom management, curriculum overview,
32 including ethical-legal aspects, and standardized
33 competency-based evaluations on administration of medications
34 and self-administration of medication training programs.
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1 (c) Training and authorization of non-licensed direct
2 care staff by nurse-trainers must meet the requirements of
3 this subsection.
4 (1) Prior to training non-licensed direct care staff
5 to administer medication, the nurse-trainer shall perform
6 the following for each individual to whom medication will
7 be administered by non-licensed direct care staff:
8 (A) An assessment of the individual's health
9 history and physical and mental status.
10 (B) An evaluation of the medications
11 prescribed.
12 (2) Non-licensed authorized direct care staff shall
13 meet the following criteria:
14 (A) Be 18 years of age or older.
15 (B) Have completed high school or its
16 equivalent (GED), or have at least one year of
17 experience as non-licensed direct care staff.
18 (C) Have demonstrated functional literacy.
19 (D) Have satisfactorily completed the Health
20 and Safety component of a Department of Human
21 Services authorized direct care staff training
22 program.
23 (E) Have successfully completed the training
24 program, pass the written portion of the
25 comprehensive exam, and score 100% on the
26 competency-based assessment specific to the
27 individual and his or her medications.
28 (F) Have received additional competency-based
29 assessment by the nurse-trainer as deemed necessary
30 by the nurse-trainer whenever a change of medication
31 occurs or a new individual that requires medication
32 administration enters the program.
33 (3) Authorized direct care staff shall be
34 re-evaluated by a nurse-trainer at least annually or more
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1 frequently at the discretion of the registered
2 professional nurse. Any necessary retraining shall be to
3 the extent that is necessary to ensure competency of the
4 authorized direct care staff to administer medication.
5 (4) Authorization of direct care staff to
6 administer medication shall be revoked if, in the opinion
7 of the registered professional nurse, the authorized
8 direct care staff is no longer competent to administer
9 medication.
10 (5) The registered professional nurse shall assess
11 an individual's health status at least annually or more
12 frequently at the discretion of the registered
13 professional nurse.
14 (d) Medication self-administration shall meet the
15 following requirements:
16 (1) As part of the normalization process, in order
17 for each individual to attain the highest possible level
18 of independent functioning, all individuals shall be
19 permitted to participate in their total health care
20 program. This program shall include, but not be limited
21 to, individual training in preventive health and
22 self-medication procedures.
23 (A) Every program shall adopt written policies
24 and procedures for assisting individuals in
25 obtaining preventative health and self-medication
26 skills in consultation with a registered
27 professional nurse, advanced practice nurse,
28 physician assistant, or physician licensed to
29 practice medicine in all its branches.
30 (B) Individuals shall be evaluated to
31 determine their ability to self-medicate by the
32 nurse-trainer through the use of the Department's
33 required, standardized screening and assessment
34 instruments.
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1 (C) When the results of the screening and
2 assessment indicate an individual not to be capable
3 to self-administer his or her own medications,
4 programs shall be developed in consultation with the
5 Community Support Team or Interdisciplinary Team to
6 provide individuals with self-medication
7 administration.
8 (2) Each individual shall be presumed to be
9 competent to self-administer medications if:
10 (A) authorized by an order of a physician
11 licensed to practice medicine in all its branches;
12 and
13 (B) approved to self-administer medication by
14 the individual's Community Support Team or
15 Interdisciplinary Team, which includes a registered
16 professional nurse or an advanced practice nurse.
17 (e) Quality Assurance.
18 (1) A registered professional nurse, advanced
19 practice nurse, licensed practical nurse, physician
20 licensed to practice medicine in all its branches,
21 physician assistant, or pharmacist shall review the
22 following for all individuals:
23 (A) Medication orders.
24 (B) Medication labels, including medications
25 listed on the medication administration record for
26 persons who are not self-medicating to ensure the
27 labels match the orders issued by the physician
28 licensed to practice medicine in all its branches,
29 advanced practice nurse, or physician assistant.
30 (C) Medication administration records for
31 persons who are not self-medicating to ensure that
32 the records are completed appropriately for:
33 (i) medication administered as
34 prescribed;
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1 (ii) refusal by the individual; and
2 (iii) full signatures provided for all
3 initials used.
4 (2) Reviews shall occur at least quarterly, but may
5 be done more frequently at the discretion of the
6 registered professional nurse or advanced practice nurse.
7 (3) A quality assurance review of medication errors
8 and data collection for the purpose of monitoring and
9 recommending corrective action shall be conducted within
10 7 days and included in the required annual review.
11 (f) Programs using authorized direct care staff to
12 administer medications are responsible for documenting and
13 maintaining records on the training that is completed.
14 (g) The absence of this training program constitutes a
15 threat to the public interest, safety, and welfare and
16 necessitates emergency rulemaking by the Departments of Human
17 Services and Public Health under Section 5-45 of the Illinois
18 Administrative Procedure Act.
19 (h) Direct care staff who fail to qualify for delegated
20 authority to administer medications pursuant to the
21 provisions of this Section shall be given additional
22 education and testing to meet criteria for delegation
23 authority to administer medications. Any direct care staff
24 person who fails to qualify as an authorized direct care
25 staff after initial training and testing must within 3 months
26 be given another opportunity for retraining and retesting. A
27 direct care staff person who fails to meet criteria for
28 delegated authority to administer medication, including, but
29 not limited to, failure of the written test on 2 occasions
30 shall be given consideration for shift transfer or
31 reassignment, if possible. No employee shall be terminated
32 for failure to qualify during the 3-month time period
33 following initial testing. Refusal to complete training and
34 testing required by this Section may be grounds for immediate
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1 dismissal.
2 (i) No authorized direct care staff person delegated to
3 administer medication shall be subject to suspension or
4 discharge for errors resulting from the staff person's acts
5 or omissions when performing the functions unless the staff
6 person's actions or omissions constitute willful and wanton
7 conduct. Nothing in this subsection is intended to supersede
8 paragraph (4) of subsection (c).
9 (j) A registered professional nurse, advanced practice
10 nurse, physician licensed to practice medicine in all its
11 branches, or physician assistant shall be on duty or on call
12 at all times in any program covered by this Section.
13 (k) The employer shall be responsible for maintaining
14 liability insurance for any program covered by this Section.
15 (l) Any direct care staff person who qualifies as
16 authorized direct care staff pursuant to this Section shall
17 be granted consideration for a one-time additional salary
18 differential. The Department shall determine and provide the
19 necessary funding for the differential in the base. This
20 subsection (l) is inoperative on and after June 30, 2000.
21 (Source: P.A. 91-630, eff. 8-19-99.)
22 Section 99. Effective date. This Act takes effect upon
23 becoming law.