Full Text of HB3746 103rd General Assembly
HB3746 103RD GENERAL ASSEMBLY |
| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 HB3746 Introduced 2/17/2023, by Rep. Natalie A. Manley SYNOPSIS AS INTRODUCED: |
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Amends the Mental Health and Developmental Disabilities Administrative Act. In provisions requiring the Department of Human Services to develop a medication administration training program for authorized directed staff at certain facilities for persons with a developmental disability, provides that non-licensed authorized direct care staff must, in addition to other specified requirements, (i) score 100% on the competency-based
assessment demonstrating proficiency in the skill of
passing medication and (ii) have received additional competency-based
assessment by the nurse-trainer as deemed necessary by
the nurse-trainer whenever it is determined that
additional skill development and training is needed to
administer a medication. Provides that every facility health care program shall adopt written policies and procedures for assisting individuals who choose to obtain preventative health and self-medication skills in consultation with a professional nurse or other medical personnel as specified. Provides that if an individual desires to gain independence in self-medication administration the individual shall be evaluated to determine the individual's
ability to self-medicate by the nurse-trainer through the use of
the Department's required, standardized screening and assessment
instruments.
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| | A BILL FOR |
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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 residential programs | 11 | | for persons
with a
developmental disability in settings of 16 | 12 | | persons or fewer that are funded or
licensed by the Department | 13 | | of Human
Services and that distribute or administer | 14 | | medications, (ii) all
intermediate care
facilities for persons | 15 | | with developmental disabilities with 16 beds or fewer that are
| 16 | | licensed by the
Department of Public Health, and (iii) all day | 17 | | programs certified to serve persons with developmental | 18 | | disabilities by the Department of Human Services. The | 19 | | Department of Human Services shall develop a
training program | 20 | | for authorized direct care staff to administer
medications | 21 | | under the
supervision and monitoring of a registered | 22 | | professional nurse.
The training program for authorized direct | 23 | | care staff shall include educational and oversight components |
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| 1 | | for staff who work in day programs that are similar to those | 2 | | for staff who work in residential programs. This training | 3 | | program shall be developed in consultation with professional
| 4 | | associations representing (i) physicians licensed to practice | 5 | | medicine in all
its branches, (ii) registered professional | 6 | | nurses, and (iii) pharmacists.
| 7 | | (b) For the purposes of this Section:
| 8 | | "Authorized direct care staff" means non-licensed persons | 9 | | who have
successfully completed a medication administration | 10 | | training program
approved by the Department of Human Services | 11 | | and conducted by a nurse-trainer.
This authorization is | 12 | | specific to an individual receiving service in
a
specific | 13 | | agency and does not transfer to another agency.
| 14 | | "Medications" means oral and topical medications, insulin | 15 | | in an injectable form, oxygen, epinephrine auto-injectors, and | 16 | | vaginal and rectal creams and suppositories. "Oral" includes | 17 | | inhalants and medications administered through enteral tubes, | 18 | | utilizing aseptic technique. "Topical" includes eye, ear, and | 19 | | nasal medications. Any controlled substances must be packaged | 20 | | specifically for an identified individual. | 21 | | "Insulin in an injectable form" means a subcutaneous | 22 | | injection via an insulin pen pre-filled by the manufacturer. | 23 | | Authorized direct care staff may administer insulin, as | 24 | | ordered by a physician, advanced practice registered nurse, or | 25 | | physician assistant, if: (i) the staff has successfully | 26 | | completed a Department-approved advanced training program |
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| 1 | | specific to insulin administration developed in consultation | 2 | | with professional associations listed in subsection (a) of | 3 | | this Section, and (ii) the staff consults with the registered | 4 | | nurse, prior to administration, of any insulin dose that is | 5 | | determined based on a blood glucose test result. The | 6 | | authorized direct care staff shall not: (i) calculate the | 7 | | insulin dosage needed when the dose is dependent upon a blood | 8 | | glucose test result, or (ii) administer insulin to individuals | 9 | | who require blood glucose monitoring greater than 3 times | 10 | | daily, unless directed to do so by the registered nurse. | 11 | | "Nurse-trainer training program" means a standardized, | 12 | | competency-based
medication administration train-the-trainer | 13 | | program provided by the
Department of Human Services and | 14 | | conducted by a Department of Human
Services master | 15 | | nurse-trainer for the purpose of training nurse-trainers to
| 16 | | train persons employed or under contract to provide direct | 17 | | care or
treatment to individuals receiving services to | 18 | | administer
medications and provide self-administration of | 19 | | medication training to
individuals under the supervision and | 20 | | monitoring of the nurse-trainer. The
program incorporates | 21 | | adult learning styles, teaching strategies, classroom
| 22 | | management, and a curriculum overview, including the ethical | 23 | | and legal
aspects of supervising those administering | 24 | | medications.
| 25 | | "Self-administration of medications" means an individual | 26 | | administers
his or her own medications , or a portion of his or |
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| 1 | | her own medications . To be considered capable to | 2 | | self-administer
their own medication, individuals must, at a | 3 | | minimum, be able to identify
their medication by size, shape, | 4 | | or color, know when they should take
the medication, and know | 5 | | the amount of medication to be taken each time. The use of | 6 | | assistive or enabling technologies can be used to demonstrate | 7 | | a person's capability to administer his or her own | 8 | | medications.
| 9 | | "Training program" means a standardized medication | 10 | | administration
training program approved by the Department of | 11 | | Human Services and
conducted by a registered professional | 12 | | nurse for the purpose of training
persons employed or under | 13 | | contract to provide direct care or treatment to
individuals | 14 | | receiving services to administer medications
and provide | 15 | | self-administration of medication training to individuals | 16 | | under
the delegation and supervision of a nurse-trainer. The | 17 | | program incorporates
adult learning styles, teaching | 18 | | strategies, classroom management,
curriculum overview, | 19 | | including ethical-legal aspects, and standardized
| 20 | | competency-based evaluations on administration of medications | 21 | | and
self-administration of medication training programs.
| 22 | | (c) Training and authorization of non-licensed direct care | 23 | | staff by
nurse-trainers must meet the requirements of this | 24 | | subsection.
| 25 | | (1) Prior to training non-licensed direct care staff | 26 | | to administer
medication, the nurse-trainer shall perform |
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| 1 | | the following for each
individual to whom medication will | 2 | | be administered by non-licensed
direct care staff:
| 3 | | (A) An assessment of the individual's health | 4 | | history and
physical and mental status.
| 5 | | (B) An evaluation of the medications prescribed.
| 6 | | (2) Non-licensed authorized direct care staff shall | 7 | | meet the
following criteria:
| 8 | | (A) Be 18 years of age or older.
| 9 | | (B) Have completed high school or have a State of | 10 | | Illinois High School Diploma.
| 11 | | (C) Have demonstrated functional literacy.
| 12 | | (D) Have satisfactorily completed the Health and | 13 | | Safety
component of a Department of Human Services | 14 | | authorized
direct care staff training program.
| 15 | | (E) Have successfully completed the training | 16 | | program,
pass the written portion of the comprehensive | 17 | | exam, and score
100% on the competency-based | 18 | | assessment demonstrating proficiency in the skill of | 19 | | passing medication specific to the
individual and his | 20 | | or her medications .
| 21 | | (F) Have received additional competency-based | 22 | | assessment
by the nurse-trainer as deemed necessary by | 23 | | the nurse-trainer
whenever it is determined that | 24 | | additional skill development and training is needed to | 25 | | administer a medication a change of medication occurs | 26 | | or a new individual
that requires medication |
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| 1 | | administration enters the program .
| 2 | | (3) Authorized direct care staff shall be re-evaluated | 3 | | by a
nurse-trainer at least annually or more frequently at | 4 | | the discretion of
the registered professional nurse. Any | 5 | | necessary retraining shall be
to the extent that is | 6 | | necessary to ensure competency of the authorized
direct | 7 | | care staff to administer medication.
| 8 | | (4) Authorization of direct care staff to administer | 9 | | medication
shall be revoked if, in the opinion of the | 10 | | registered professional nurse,
the authorized direct care | 11 | | staff is no longer competent to administer
medication.
| 12 | | (5) The registered professional nurse shall assess an
| 13 | | individual's health status at least annually or more | 14 | | frequently at the
discretion of the registered | 15 | | professional nurse.
| 16 | | (d) Medication self-administration shall meet the | 17 | | following
requirements:
| 18 | | (1) As part of the normalization process, in order for | 19 | | each
individual to attain the highest possible level of | 20 | | independent
functioning, all individuals shall be | 21 | | permitted to participate in their
total health care | 22 | | program. This program shall include, but not be
limited | 23 | | to, individual training in preventive health and | 24 | | self-medication
procedures.
| 25 | | (A) Every program shall adopt written policies and
| 26 | | procedures for assisting individuals who choose to |
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| 1 | | obtain in obtaining preventative
health and | 2 | | self-medication skills in consultation with a
| 3 | | registered professional nurse, advanced practice | 4 | | registered nurse,
physician assistant, or physician | 5 | | licensed to practice medicine
in all its branches.
| 6 | | (B) If an individual desires to gain independence | 7 | | in self-medication administration the individual | 8 | | Individuals shall be evaluated to determine the | 9 | | individual's their
ability to self-medicate by the | 10 | | nurse-trainer through the use of
the Department's | 11 | | required, standardized screening and assessment
| 12 | | instruments.
| 13 | | (C) (Blank). When the results of the screening and | 14 | | assessment
indicate an individual not to be capable to | 15 | | self-administer his or her
own medications, programs | 16 | | shall be developed in consultation
with the Community | 17 | | Support Team or Interdisciplinary
Team to provide | 18 | | individuals with self-medication
administration.
| 19 | | (2) Each individual shall be presumed to be competent | 20 | | to self-administer
medications if:
| 21 | | (A) authorized by an order of a physician licensed | 22 | | to
practice medicine in all its branches, an advanced | 23 | | practice registered nurse, or a physician assistant; | 24 | | and
| 25 | | (B) approved to self-administer medication by the
| 26 | | individual's Community Support Team or
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| 1 | | Interdisciplinary Team, which includes a registered
| 2 | | professional nurse or an advanced practice registered | 3 | | nurse.
| 4 | | (e) Quality Assurance.
| 5 | | (1) A registered professional nurse, advanced practice | 6 | | registered nurse,
licensed practical nurse, physician | 7 | | licensed to practice medicine in all
its branches, | 8 | | physician assistant, or pharmacist shall review the
| 9 | | following for all individuals:
| 10 | | (A) Medication orders.
| 11 | | (B) Medication labels, including medications | 12 | | listed on
the medication administration record for | 13 | | persons who are not
self-medicating to ensure the | 14 | | labels match the orders issued by
the physician | 15 | | licensed to practice medicine in all its branches,
| 16 | | advanced practice registered nurse, or physician | 17 | | assistant.
| 18 | | (C) Medication administration records for persons | 19 | | who
are not self-medicating to ensure that the records | 20 | | are completed
appropriately for:
| 21 | | (i) medication administered as prescribed;
| 22 | | (ii) refusal by the individual; and
| 23 | | (iii) full signatures provided for all | 24 | | initials used.
| 25 | | (2) Reviews shall occur at least quarterly, but may be | 26 | | done
more frequently at the discretion of the registered |
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| 1 | | professional nurse
or advanced practice registered nurse.
| 2 | | (3) A quality assurance review of medication errors | 3 | | and data
collection for the purpose of monitoring and | 4 | | recommending
corrective action shall be conducted within 7 | 5 | | days and included in the
required annual review.
| 6 | | (f) Programs using authorized direct care
staff to | 7 | | administer medications are responsible for documenting and | 8 | | maintaining
records
on the training that is completed.
| 9 | | (g) The absence of this training program constitutes a | 10 | | threat to the
public interest,
safety, and welfare and | 11 | | necessitates emergency rulemaking by
the Departments of Human | 12 | | Services and
Public Health
under Section 5-45
of
the
Illinois | 13 | | Administrative Procedure Act.
| 14 | | (h) Direct care staff who fail to qualify for delegated | 15 | | authority to
administer medications pursuant to the provisions | 16 | | of this Section shall be
given
additional education and | 17 | | testing to meet criteria for
delegation authority to | 18 | | administer medications.
Any direct care staff person who fails | 19 | | to qualify as an authorized direct care
staff
after initial | 20 | | training and testing must within 3 months be given another
| 21 | | opportunity for retraining and retesting. A direct care staff | 22 | | person who fails
to
meet criteria for delegated authority to | 23 | | administer medication, including, but
not limited to, failure | 24 | | of the written test on 2 occasions shall be given
| 25 | | consideration for shift transfer or reassignment, if possible. | 26 | | No employee
shall be terminated for failure to qualify during |
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| 1 | | the 3-month time period
following initial testing. Refusal to | 2 | | complete training and testing required
by this Section may be | 3 | | grounds for immediate dismissal.
| 4 | | (i) No authorized direct care staff person delegated to | 5 | | administer
medication shall be subject to suspension or | 6 | | discharge for errors
resulting from the staff
person's acts or | 7 | | omissions when performing the functions unless the staff
| 8 | | person's actions or omissions constitute willful and wanton | 9 | | conduct.
Nothing in this subsection is intended to supersede | 10 | | paragraph (4) of subsection
(c).
| 11 | | (j) A registered professional nurse, advanced practice | 12 | | registered nurse,
physician licensed to practice medicine in | 13 | | all its branches, or physician
assistant shall be on
duty or
on | 14 | | call at all times in any program covered by this Section.
| 15 | | (k) The employer shall be responsible for maintaining | 16 | | liability insurance
for any program covered by this Section.
| 17 | | (l) Any direct care staff person who qualifies as | 18 | | authorized direct care
staff pursuant to this Section shall be | 19 | | granted consideration for a one-time
additional
salary | 20 | | differential. The Department shall determine and provide the | 21 | | necessary
funding for
the differential in the base. This | 22 | | subsection (l) is inoperative on and after
June 30, 2000.
| 23 | | (Source: P.A. 102-1100, eff. 1-1-23 .)
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