Section 116.40 Training and Authorization of Non-Licensed Staff by Nurse-Trainers

Section 116

Section 116.40  Training and

Authorization of Non-Licensed Staff by Nurse-Trainers

a)         Only a Nurse-Trainer may delegate, supervise and authorize the

tasks of medication administration to authorized direct care staff.

b)         Prior to training non-licensed staff to administer medication to

an individual, the Nurse-Trainer must have an understanding and knowledge of

the individual's physical and mental status, medical history, medication orders

and medications prescribed to initially train and authorize unlicensed staff to

administer medications and to provide any additional medication related

training of non-licensed authorized staff.  The following is acceptable

evidence of that understanding and knowledge:

1)         The registered nurse completing the assessment of an

individual's health as required by Section 116.90(a) must sign and date the

assessment.  To be valid, this assessment can be no more than one year prior to

the date of the training of the non-licensed staff.

2)         If the Nurse-Trainer initially training and authorizing

unlicensed staff or providing additional training is not the registered professional

nurse who completed the assessment of an individual's health as required by

Section 116.90(a), there must be clear evidence that the Nurse-Trainer has

reviewed an individual's current assessment within the last 365 calendar days

and considered other relevant information before doing any training or

providing direction about medication administration for that individual

registered professional

nurse who completed the assessment of an individual's health as required by

Section 116.90(a), there must be clear evidence that the Nurse-Trainer has

reviewed an individual's current assessment within the last 365 calendar days

and considered other relevant information before doing any training or

providing direction about medication administration for that individual.

c)         Non-licensed direct care staff who are to be authorized to

administer medications under the delegation of Nurse-Trainer shall meet the

following criteria:

1)         be age 18 or older;

2)         complete high school or its equivalency (G.E.D.);

3)         demonstrate functional literacy;

4)         satisfactorily complete the Health and Safety component of the

Direct Support Persons Core Training Program or a DHS approved equivalent

Developmental Disabilities Aide Training Program prior to the beginning of

medication administration training;

5)         be initially trained and evaluated by a Nurse-Trainer in a

competency-based, standardized medication curriculum specified by DHS;

6)         score 80% or above on the written portion of the comprehensive

examination furnished by DHS based on the information conveyed to them during a

medication administration classroom course; and

7)         score 100% on a written or oral competency-based evaluation

specifically pertinent to those medications that these staff are responsible to

administer.

d)         Initial competency-based training toward delegation for

medication administration shall include:

1)         Best practice standards related to the rights of individuals,

legal and ethical responsibilities, agency procedures and communication

pertaining to medication administration.

2)         Best practice nursing techniques associated with medication

administration.

3)         Classes of drugs and their effects and common side-effects

legation for

medication administration shall include:

1)         Best practice standards related to the rights of individuals,

legal and ethical responsibilities, agency procedures and communication

pertaining to medication administration.

2)         Best practice nursing techniques associated with medication

administration.

3)         Classes of drugs and their effects and common side-effects.

4)         Specific information regarding the individuals to whom the

staff will administer medication and the medication the staff will administer.

5)         Techniques to observe, report and document medication effects,

side effects, adverse outcomes and vital signs when those skills are necessary

for the safe administration of medication to that individual.

6)         A final, individual-specific, competency-based evaluation

performed by a Nurse-Trainer for each medication administered to persons at the

program for whom the staff provide supports.

e)         The Nurse-Trainer may delegate the administration of insulin

subcutaneously using an insulin pen pre-filled with insulin by the manufacturer

to authorized staff after the authorized staff has successfully completed a DHS

approved advanced training program specific to diabetes and insulin

administration.

1)         Authorized direct care staff must consult with the

Nurse-Trainer before administering any subcutaneous insulin dosage determined

by a blood glucose test result.

2)         Authorized direct care staff may not calculate the insulin

dosage needed when the dose is dependent upon a blood glucose test report.

3)         Authorized direct care staff may not administer insulin to

individuals who require blood glucose monitoring greater than 3 times daily,

unless directed to do so by the Nurse-Trainer.

f)         Staff, after training, may administer epinephrine by

auto-injector as prescribed by a physician as an emergency measure when an

individual experiences a serious allergic reaction (e.g., anaphylactic shock)

horized direct care staff may not administer insulin to

individuals who require blood glucose monitoring greater than 3 times daily,

unless directed to do so by the Nurse-Trainer.

f)         Staff, after training, may administer epinephrine by

auto-injector as prescribed by a physician as an emergency measure when an

individual experiences a serious allergic reaction (e.g., anaphylactic shock).

The administration of epinephrine by auto-injector by staff is not the

responsibility of the Nurse-Trainer.

1)         The agency is responsible for the training of all staff who

may administer epinephrine by auto-injector.  Training for staff in the use of

epinephrine auto-injectors can be obtained through the American Heart

Association,  American Red Cross, or American Safety and Health Institute, or

from a registered professional nurse or licensed practical nurse, as delegated

by a registered nurse or physician.

2)         Two unexpired epinephrine auto-injectors should be in close

proximity to the individual for whom the medication is prescribed and available

for immediate use at all times.  For the purpose of this Part, close proximity

means:

A)        Within arm's reach of the individual responsible for

administering the epinephrine auto injection when away from the residence; or

B)        In a known location with easy, immediate access when at the

residence.

3)         Emergency medical services must be summoned immediately after the

use of an epinephrine auto-injector.

g)         The Nurse-Trainer may authorize direct care staff  to

administer medications through an enteral tube after the authorized staff has

successfully completed a DHS approved advanced training program specific to

enteral tubes, their maintenance and medication administration.

h)

Authorized direct care staff shall be re-evaluated by a

Nurse-Trainer

at least annually or more frequently at the discretion of the registered

professional nurse

are staff  to

administer medications through an enteral tube after the authorized staff has

successfully completed a DHS approved advanced training program specific to

enteral tubes, their maintenance and medication administration.

h)

Authorized direct care staff shall be re-evaluated by a

Nurse-Trainer

at least annually or more frequently at the discretion of the registered

professional nurse. Any retraining shall be to the extent that is necessary to

ensure competency of

the

authorized direct care staff to administer medication

[20 ILCS 1705/15.4(c)], as judged by a Nurse-Trainer.

i)          Authorized direct care staff shall receive specific

additional competency-based training and assessment by a Nurse-Trainer, as

deemed necessary by the Nurse-Trainer, whenever a change of medication, including,

but not limited to, dosage, time and route, occurs or a new individual who

requires medication enters the program.

j)          Direct care staff who fail to qualify for competency to

administer medications shall be given additional education and testing to meet

criteria for delegation authority to administer medications.

Any direct

care staff person who fails to qualify as an authorized direct care staff after

initial training and testing must, within three months, be given another

opportunity for retraining and retesting.  A direct care staff person who fails

to meet criteria for delegated authority to administer medication, including,

but not limited to, failure of the written test on two occasions, shall be

given consideration for shift transfer or reassignment, if possible.  No

employee shall be terminated for failure to qualify during the three month time

period following initial testing. Refusal to complete training and testing

required by this Section may be grounds for immediate dismissal

[20 ILCS

1705/15.4(h)]

ing,

but not limited to, failure of the written test on two occasions, shall be

given consideration for shift transfer or reassignment, if possible.  No

employee shall be terminated for failure to qualify during the three month time

period following initial testing. Refusal to complete training and testing

required by this Section may be grounds for immediate dismissal

[20 ILCS

1705/15.4(h)].

k)

No authorized direct care staff person delegated to

administer medication shall be subject to suspension or discharge for errors

resulting from the staff person's acts or omissions when performing the

functions unless the staff person's actions or omissions constitute willful and

wanton conduct

[20 ILCS 1705/15.4(i)].

l)

Authorization of staff to administer medication shall be

revoked if, in the opinion of the Nurse-Trainer, the authorized direct care

staff person is no longer competent to administer medication

[20 ILCS

1705/15.4(c)].  The degree of retraining and reassessment of competency should

occur at the discretion of the Nurse-Trainer.

m)        Clear documentation of training, retraining and evaluation

shall be kept in each staff or contractual person's personnel file by each

agency where authorized direct care staff are employed.