Full Text of SB3169 099th General Assembly
SB3169 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 SB3169 Introduced 2/19/2016, by Sen. Julie A. Morrison SYNOPSIS AS INTRODUCED: |
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Amends the Mental Health and Developmental Disabilities Administrative Act. Permits authorized direct care staff to administer
certain medications under the
supervision and monitoring of a registered professional nurse in all developmental training settings that are funded or licensed by the Department of Human Services. Effective immediately.
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| | A BILL FOR |
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| | | SB3169 | | LRB099 18301 RLC 42673 b |
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| 1 | | AN ACT concerning State government.
| 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 Section | 6 | | 15.4 as follows:
| 7 | | (20 ILCS 1705/15.4)
| 8 | | Sec. 15.4. Authorization for nursing delegation to permit | 9 | | 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 persons with | 15 | | developmental disabilities with 16 beds or fewer that are
| 16 | | licensed by the
Department of Public Health , and (iii) all | 17 | | developmental training settings that are funded or licensed by | 18 | | the Department of Human Services . The Department of Human | 19 | | Services shall develop a
training program for authorized direct | 20 | | care staff to administer
medications under the
supervision and | 21 | | monitoring of a registered professional nurse.
This training | 22 | | program shall be developed in consultation with professional
| 23 | | associations representing (i) physicians licensed to practice |
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| 1 | | medicine in all
its branches, (ii) registered professional | 2 | | nurses, and (iii) pharmacists.
| 3 | | (b) For the purposes of this Section:
| 4 | | "Authorized direct care staff" means non-licensed persons | 5 | | who have
successfully completed a medication administration | 6 | | training program
approved by the Department of Human Services | 7 | | and conducted by a nurse-trainer.
This authorization is | 8 | | specific to an individual receiving service in
a
specific | 9 | | agency and does not transfer to another agency.
| 10 | | "Medications" means oral and topical medications, insulin | 11 | | in an injectable form, oxygen, epinephrine auto-injectors, and | 12 | | vaginal and rectal creams and suppositories. "Oral" includes | 13 | | inhalants and medications administered through enteral tubes, | 14 | | utilizing aseptic technique. "Topical" includes eye, ear, and | 15 | | nasal medications. Any controlled substances must be packaged | 16 | | specifically for an identified individual. | 17 | | "Insulin in an injectable form" means a subcutaneous | 18 | | injection via an insulin pen pre-filled by the manufacturer. | 19 | | Authorized direct care staff may administer insulin, as ordered | 20 | | by a physician, advanced practice nurse, or physician | 21 | | assistant, if: (i) the staff has successfully completed a | 22 | | Department-approved advanced training program specific to | 23 | | insulin administration developed in consultation with | 24 | | professional associations listed in subsection (a) of this | 25 | | Section, and (ii) the staff consults with the registered nurse, | 26 | | prior to administration, of any insulin dose that is determined |
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| 1 | | based on a blood glucose test result. The authorized direct | 2 | | care staff shall not: (i) calculate the insulin dosage needed | 3 | | when the dose is dependent upon a blood glucose test result, or | 4 | | (ii) administer insulin to individuals who require blood | 5 | | glucose monitoring greater than 3 times daily, unless directed | 6 | | to do so by the registered nurse. | 7 | | "Nurse-trainer training program" means a standardized, | 8 | | competency-based
medication administration train-the-trainer | 9 | | program provided by the
Department of Human Services and | 10 | | conducted by a Department of Human
Services master | 11 | | nurse-trainer for the purpose of training nurse-trainers to
| 12 | | train persons employed or under contract to provide direct care | 13 | | or
treatment to individuals receiving services to administer
| 14 | | medications and provide self-administration of medication | 15 | | training to
individuals under the supervision and monitoring of | 16 | | the nurse-trainer. The
program incorporates adult learning | 17 | | styles, teaching strategies, classroom
management, and a | 18 | | curriculum overview, including the ethical and legal
aspects of | 19 | | supervising those administering medications.
| 20 | | "Self-administration of medications" means an individual | 21 | | administers
his or her own medications. To be considered | 22 | | capable to self-administer
their own medication, individuals | 23 | | must, at a minimum, be able to identify
their medication by | 24 | | size, shape, or color, know when they should take
the | 25 | | medication, and know the amount of medication to be taken each | 26 | | time.
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| 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 nurse | 4 | | for the purpose of training
persons employed or under contract | 5 | | to provide direct care or treatment to
individuals receiving | 6 | | 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 care | 15 | | staff by
nurse-trainers must meet the requirements of this | 16 | | subsection.
| 17 | | (1) Prior to training non-licensed direct care staff to | 18 | | administer
medication, the nurse-trainer shall perform the | 19 | | following for each
individual to whom medication will be | 20 | | 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 prescribed.
| 24 | | (2) Non-licensed authorized direct care staff shall | 25 | | meet the
following criteria:
| 26 | | (A) Be 18 years of age or older.
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| 1 | | (B) Have completed high school or have a high | 2 | | school equivalency certificate.
| 3 | | (C) Have demonstrated functional literacy.
| 4 | | (D) Have satisfactorily completed the Health and | 5 | | Safety
component of a Department of Human Services | 6 | | authorized
direct care staff training program.
| 7 | | (E) Have successfully completed the training | 8 | | program,
pass the written portion of the comprehensive | 9 | | exam, and score
100% on the competency-based | 10 | | assessment specific to the
individual and his or her | 11 | | medications.
| 12 | | (F) Have received additional competency-based | 13 | | assessment
by the nurse-trainer as deemed necessary by | 14 | | the nurse-trainer
whenever a change of medication | 15 | | occurs or a new individual
that requires medication | 16 | | administration enters the program.
| 17 | | (3) Authorized direct care staff shall be re-evaluated | 18 | | by a
nurse-trainer at least annually or more frequently at | 19 | | the discretion of
the registered professional nurse. Any | 20 | | necessary retraining shall be
to the extent that is | 21 | | necessary to ensure competency of the authorized
direct | 22 | | care staff to administer medication.
| 23 | | (4) Authorization of direct care staff to administer | 24 | | medication
shall be revoked if, in the opinion of the | 25 | | registered professional nurse,
the authorized direct care | 26 | | staff is no longer competent to administer
medication.
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| 1 | | (5) The registered professional nurse shall assess an
| 2 | | individual's health status at least annually or more | 3 | | frequently at the
discretion of the registered | 4 | | professional nurse.
| 5 | | (d) Medication self-administration shall meet the | 6 | | following
requirements:
| 7 | | (1) As part of the normalization process, in order for | 8 | | each
individual to attain the highest possible level of | 9 | | independent
functioning, all individuals shall be | 10 | | permitted to participate in their
total health care | 11 | | program. This program shall include, but not be
limited to, | 12 | | individual training in preventive health and | 13 | | self-medication
procedures.
| 14 | | (A) Every program shall adopt written policies and
| 15 | | procedures for assisting individuals in obtaining | 16 | | preventative
health and self-medication skills in | 17 | | consultation with a
registered professional nurse, | 18 | | advanced practice nurse,
physician assistant, or | 19 | | physician licensed to practice medicine
in all its | 20 | | branches.
| 21 | | (B) Individuals shall be evaluated to determine | 22 | | their
ability to self-medicate by the nurse-trainer | 23 | | through the use of
the Department's required, | 24 | | standardized screening and assessment
instruments.
| 25 | | (C) When the results of the screening and | 26 | | assessment
indicate an individual not to be capable to |
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| 1 | | self-administer his or her
own medications, programs | 2 | | shall be developed in consultation
with the Community | 3 | | Support Team or Interdisciplinary
Team to provide | 4 | | individuals with self-medication
administration.
| 5 | | (2) Each individual shall be presumed to be competent | 6 | | to self-administer
medications if:
| 7 | | (A) authorized by an order of a physician licensed | 8 | | to
practice medicine in all its branches; and
| 9 | | (B) approved to self-administer medication by the
| 10 | | individual's Community Support Team or
| 11 | | Interdisciplinary Team, which includes a registered
| 12 | | professional nurse or an advanced practice nurse.
| 13 | | (e) Quality Assurance.
| 14 | | (1) A registered professional nurse, advanced practice | 15 | | nurse,
licensed practical nurse, physician licensed to | 16 | | practice medicine in all
its branches, physician | 17 | | assistant, or pharmacist shall review the
following for all | 18 | | individuals:
| 19 | | (A) Medication orders.
| 20 | | (B) Medication labels, including medications | 21 | | listed on
the medication administration record for | 22 | | persons who are not
self-medicating to ensure the | 23 | | labels match the orders issued by
the physician | 24 | | licensed to practice medicine in all its branches,
| 25 | | advanced practice nurse, or physician assistant.
| 26 | | (C) Medication administration records for persons |
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| 1 | | who
are not self-medicating to ensure that the records | 2 | | are completed
appropriately for:
| 3 | | (i) medication administered as prescribed;
| 4 | | (ii) refusal by the individual; and
| 5 | | (iii) full signatures provided for all | 6 | | initials used.
| 7 | | (2) Reviews shall occur at least quarterly, but may be | 8 | | done
more frequently at the discretion of the registered | 9 | | professional nurse
or advanced practice nurse.
| 10 | | (3) A quality assurance review of medication errors and | 11 | | data
collection for the purpose of monitoring and | 12 | | recommending
corrective action shall be conducted within 7 | 13 | | days and included in the
required annual review.
| 14 | | (f) Programs using authorized direct care
staff to | 15 | | administer medications are responsible for documenting and | 16 | | maintaining
records
on the training that is completed.
| 17 | | (g) The absence of this training program constitutes a | 18 | | threat to the
public interest,
safety, and welfare and | 19 | | necessitates emergency rulemaking by
the Departments of Human | 20 | | Services and
Public Health
under Section 5-45
of
the
Illinois | 21 | | Administrative Procedure Act.
| 22 | | (h) Direct care staff who fail to qualify for delegated | 23 | | authority to
administer medications pursuant to the provisions | 24 | | of this Section shall be
given
additional education and testing | 25 | | to meet criteria for
delegation authority to administer | 26 | | medications.
Any direct care staff person who fails to qualify |
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| 1 | | as an authorized direct care
staff
after initial training and | 2 | | testing must within 3 months be given another
opportunity for | 3 | | retraining and retesting. A direct care staff person who fails
| 4 | | to
meet criteria for delegated authority to administer | 5 | | medication, including, but
not limited to, failure of the | 6 | | written test on 2 occasions shall be given
consideration for | 7 | | shift transfer or reassignment, if possible. No employee
shall | 8 | | be terminated for failure to qualify during the 3-month time | 9 | | period
following initial testing. Refusal to complete training | 10 | | and testing required
by this Section may be grounds for | 11 | | immediate dismissal.
| 12 | | (i) No authorized direct care staff person delegated to | 13 | | administer
medication shall be subject to suspension or | 14 | | discharge for errors
resulting from the staff
person's acts or | 15 | | omissions when performing the functions unless the staff
| 16 | | person's actions or omissions constitute willful and wanton | 17 | | conduct.
Nothing in this subsection is intended to supersede | 18 | | paragraph (4) of subsection
(c).
| 19 | | (j) A registered professional nurse, advanced practice | 20 | | nurse,
physician licensed to practice medicine in all its | 21 | | branches, or physician
assistant shall be on
duty or
on call at | 22 | | all times in any program covered by this Section.
| 23 | | (k) The employer shall be responsible for maintaining | 24 | | liability insurance
for any program covered by this Section.
| 25 | | (l) Any direct care staff person who qualifies as | 26 | | authorized direct care
staff pursuant to this Section shall be |
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| 1 | | granted consideration for a one-time
additional
salary | 2 | | differential. The Department shall determine and provide the | 3 | | necessary
funding for
the differential in the base. This | 4 | | subsection (l) is inoperative on and after
June 30, 2000.
| 5 | | (Source: P.A. 98-718, eff. 1-1-15; 98-901, eff. 8-15-14; 99-78, | 6 | | eff. 7-20-15; 99-143, eff. 7-27-15.)
| 7 | | Section 99. Effective date. This Act takes effect upon | 8 | | becoming law.
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