093_HB3033
LRB093 08668 AMC 08898 b
1 AN ACT concerning nursing homes.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Nursing Home Care Act is amended by
5 adding Section 3-202.3 as follows:
6 (210 ILCS 45/3-202.3 new)
7 Sec. 3-202.3. Authorization for nursing delegation to
8 permit direct care staff to administer medications.
9 (a) The Department of Public Health shall develop a
10 training program for authorized direct care staff to
11 administer oral and topical medications under the supervision
12 and monitoring of a registered professional nurse in
13 facilities licensed under this Act. This training program
14 shall be developed in consultation with professional
15 associations representing (i) physicians licensed to practice
16 medicine in all its branches, (ii) registered professional
17 nurses, and (iii) pharmacists.
18 (b) For the purposes of this Section:
19 "Authorized direct care staff" means non-licensed
20 persons who have successfully completed a medication
21 administration training program approved by the Department
22 and conducted by a nurse-trainer.
23 "Nurse-trainer training program" means a standardized,
24 competency-based medication administration train-the-trainer
25 program provided by the Department and conducted by a master
26 nurse-trainer for the purpose of training nurse-trainers to
27 train persons employed or under contract to provide direct
28 care or treatment to individuals receiving services to
29 administer medications and provide self-administration of
30 medication training to individuals under the supervision and
31 monitoring of the nurse-trainer. The program incorporates
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1 adult learning styles, teaching strategies, classroom
2 management, and a curriculum overview, including the ethical
3 and legal aspects of supervising those administering
4 medications.
5 "Training program" means a standardized medication
6 administration training program approved by the Department
7 and conducted by a registered professional nurse for the
8 purpose of training persons employed or under contract to
9 provide direct care or treatment to individuals receiving
10 services to administer medications under the delegation and
11 supervision of a nurse-trainer.
12 (c) Training and authorization of non-licensed direct
13 care staff by nurse-trainers must meet the requirements of
14 this subsection.
15 (1) Prior to training non-licensed direct care
16 staff to administer medication, the nurse-trainer shall
17 perform the following for each individual to whom
18 medication will be administered by non-licensed direct
19 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 authorized
32 direct care staff training program.
33 (E) Have successfully completed the training
34 program, passed the written portion of the
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1 comprehensive exam, and scored 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) Quality Assurance.
25 (1) A registered professional nurse, advanced
26 practice nurse, licensed practical nurse, physician
27 licensed to practice medicine in all its branches,
28 physician assistant, or pharmacist shall review the
29 following for all individuals:
30 (A) Medication orders.
31 (B) Medication labels to ensure the labels
32 match the orders issued by the physician licensed to
33 practice medicine in all its branches, advanced
34 practice nurse, or physician assistant.
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1 (C) Medication administration records to
2 ensure that the records are completed appropriately
3 for:
4 (i) medication administered as
5 prescribed;
6 (ii) refusal by the individual; and
7 (iii) full signatures provided for all
8 initials used.
9 (2) Reviews shall occur at least quarterly, but may
10 be done more frequently at the discretion of the
11 registered professional nurse or advanced practice nurse.
12 (3) A quality assurance review of medication errors
13 and data collection for the purpose of monitoring and
14 recommending corrective action shall be conducted within
15 7 days and included in the required annual review.
16 (e) Facilities using authorized direct care staff to
17 administer medications are responsible for documenting and
18 maintaining records on the training that is completed.
19 (f) The absence of this training program constitutes a
20 threat to the public interest, safety, and welfare and
21 necessitates emergency rulemaking by the Department of Public
22 Health under Section 5-45 of the Illinois Administrative
23 Procedure Act.
24 (g) Direct care staff who fail to qualify for delegated
25 authority to administer medications pursuant to the
26 provisions of this Section shall be given additional
27 education and testing to meet criteria for delegation
28 authority to administer medications. Any direct care staff
29 person who fails to qualify as an authorized direct care
30 staff after initial training and testing must within 3 months
31 be given another opportunity for retraining and retesting. A
32 direct care staff person who fails to meet criteria for
33 delegated authority to administer medication, including, but
34 not limited to, failure of the written test on 2 occasions
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1 shall be given consideration for shift transfer or
2 reassignment, if possible. No employee shall be terminated
3 for failure to qualify during the 3-month time period
4 following initial testing. Refusal to complete training and
5 testing required by this Section may be grounds for immediate
6 dismissal.
7 (h) No authorized direct care staff person delegated to
8 administer medication shall be subject to suspension or
9 discharge for errors resulting from the staff person's acts
10 or omissions when performing the functions unless the staff
11 person's actions or omissions constitute willful and wanton
12 conduct. Nothing in this subsection is intended to supersede
13 paragraph (4) of subsection (c).
14 (i) A registered professional nurse, advanced practice
15 nurse, physician licensed to practice medicine in all its
16 branches, or physician assistant shall be on duty or on call
17 at all times in any facility covered by this Section.
18 (j) The facility shall be responsible for maintaining
19 liability insurance for any program covered by this Section.