Fla. Admin. Code Ann. R. 59A-18.0081 - Certified Nursing Assistant and Home Health Aide
The certified nursing assistant (CNA) and the home health aide shall:
(1) Be limited to assisting
a patient in accordance with Section
400.506(6)(b),
F.S.;
(2) Be responsible for
documenting services provided to the patient or client and for filing said
documentation with the nurse registry on a regular basis. These service logs
will be stored by the nurse registry in the client's file. The service logs
shall include the name of the patient or client and a listing of the services
provided;
(3) Be responsible for
observing appearance and gross behavioral changes in the patient and reporting
these changes to the patient's health care surrogate or other person designated
by the patient and the nurse registry or to the responsible facility employee
if staffing in a facility;
(4) Be
responsible to maintain a clean, safe and healthy environment, which may
include light cleaning and straightening of the bathroom, straightening the
sleeping and living areas, washing the patient's dishes or laundry, and such
tasks to maintain cleanliness and safety for the patient;
(5) Perform other activities as taught and
documented by a registered nurse, concerning activities for a specific patient
and restricted to the following:
(a) Assisting
with the placement or removal of a colostomy bag, excluding the removal of the
flange or manipulation of the stoma's site;
(b) Assisting with the application and
removal of anti-embolism stockings and hosiery prescribed for therapeutic
treatment of the legs.
(c)
Assisting with the use of devices for aid to daily living such as a wheelchair
or walker;
(d) Assisting with
prescribed range of motion exercises;
(e) Assisting with prescribed ice cap or
collar;
(f) Administer simple urine
tests for sugar, acetone or albumin;
(g) Assisting with the use of a glucometer to
perform blood glucose testing;
(h)
Measuring and preparing special diets;
(i) Measuring intake and output of
fluids;
(j) Measuring vital signs,
including temperature, pulse, respiration or blood pressure;
(k) Assisting with oxygen nasal cannulas and
continuous positive airway pressure (CPAP) devices, excluding the titration of
the prescribed oxygen levels; and
(l) Assisting with the reinforcement of
dressing.
(6) A home
health aide or CNA shall not perform the following activities:
(a) Administer any nursing or therapeutic
service that requires licensure as a health care professional;
(b) Change sterile dressings.
(c) Irrigate body cavities such as giving an
enema;
(d) Perform irrigation of
any wounds (such as vascular ulcers, diabetic ulcers, pressure ulcers, surgical
wounds) or apply agents used in the debridement of necrotic tissues in wounds
of any type;
(e) Perform a gastric
irrigation or enteral feeding;
(f)
Catheterize a patient;
(g)
Administer medications;
(h) Apply
heat by any method;
(i) Care for a
tracheotomy tube;
(j) Provide any
service which has not been included in the plan of treatment; or,
(k) Providing assistance with a pill
organizer, such as removing medication from a pill organizer and placing the
medication in the patient's hand or filling a pill organizer with the patient's
medication(s).
(7) CNA
Qualifications.
(a) For every CNA, a nurse
registry shall have on file a copy of the person's State of Florida
certification.
(b) Individuals who
earn their CNA certificate in another state must contact the Florida Department
of Health, Board of Nursing to inquire about taking the written examination
prior to working as a CNA in Florida, pursuant to chapter 464, part II,
F.S.
(c) A CNA may work as a home
health aide.
(8) Home
Health Aide Qualifications.
(a) For every home
health aide registered with the nurse registry since May 4, 2015, a nurse
registry shall have on file a certificate or documentation of successful
completion of at least forty hours of home health aide training, pursuant to
section 400.506(6)(a),
F.S., from a public vocational technical school or a nonpublic post-secondary
educational institution approved by the Florida Department of Education,
Commission for Independent Education.
(b) Home health aides registered with the
nurse registry since May 4, 2015 who complete their training in another state
must provide a certificate of completion of home health aide training from a
vocational technical school or a post-secondary educational institution
licensed in that state.
(9) CNAs and home health aides referred by
nurse registries must maintain a current cardiopulmonary resuscitation (CPR)
certification from an instructor or training provider that is approved to
provide training by the American Heart Association, the American Red Cross, or
the Health and Safety Institute, and that provides CPR training in which the
student is required to demonstrate, in person, that he or she is able to
perform cardiopulmonary resuscitation.
(10) Licensed practical nurses and registered
nurses that are licensed in Florida or another state may work as home health
aides. Also, persons who have completed the licensed practical nurse or
registered nurse training from a public school, college, or university or a
nonpublic post-secondary educational institution approved by the Florida
Department of Education, Commission for Independent Education but are not yet
licensed may work as home health aides.
(11) CNAs and home health aides referred by
nurse registries may assist with self-administration of medication as described
in Section 400.488, F.S.
(a) Home health aides and CNAs assisting with
self-administered medication, as described in Section
400.488, F.S., shall have
received a minimum of 2 hours of training covering the following content:
1. Training shall cover state law and rule
requirements with respect to the assistance with self-administration of
medications in the home, procedures for assisting the resident with
self-administration of medication, common medications, recognition of side
effects and adverse reactions and procedures to follow when patients appear to
be experiencing side effects and adverse reactions. Training must include
verification that each CNA and home health aide can read the prescription label
and any instructions.
2.
Individuals who cannot read shall not be permitted to assist with prescription
medications.
(b)
Documentation of training on assistance with self-administered medication from
one of the following sources is acceptable:
1.
Documentation of 2 hours of training in compliance with subsection
59A-8.0095(5),
F.A.C., from a home health agency if the home health aide or CNA previously
worked for the home health agency;
2. A training certificate for assisted living
facility staff in compliance with Section
429.52(6),
F.S.;
3. A training certificate for
at least 2 hours of training from a post-secondary educational institution
approved by the Florida Department of Education;
4. Documentation of at least 2 hours of
training by a provider approved by the Florida Department of Health, Board of
Nursing.
(c)
Documentation of the training must be maintained in the file of each home
health aide and CNA. who assists patients with self-administered
medication.
(d) In cases where a
home health aide or a CNA will provide assistance with self-administered
medications as described in Section
400.488, F.S., and paragraph (e)
below, an RN shall conduct an assessment of the patient and patient's
medications for which assistance is to be provided to ensure that a patient
receiving such assistance is medically stable and has regularly scheduled
medications that are intended to be self administered as required in s.
400.488(2),
F.S. and the CNA and home health aide are able to assist in accordance with
their training and with the medication prescription. If the patient will not
consent to a visit by the nurse to conduct an assessment, a written list with
the dosage, frequency and route of administration shall be provided by the
patient or the patient's health care surrogate, family member, or person
designated by the patient to the home health aide or CNA to have reviewed by
the nurse. The patient or the patient's surrogate, guardian, or attorney in
fact must give written consent for a home health aide or C.N.A. to provide
assistance with self-administered medications, as required in Section
400.488(2),
F.S.
(e) The trained home health
aide and CNA may also provide the following assistance with self-administered
medication, as needed by the patient and as described in Section
400.488, F.S.:
1. Prepare necessary items such as juice,
water, cups, or spoons to assist the patient in the self-administration of
medication,
2. Open and close the
medication container or tear the foil of prepackaged medications,
3. Assist the resident in the
self-administration process. Examples of such assistance include the steadying
of the arm, hand, or other parts of the patient's body so as to allow the
self-administration of medication,
4. Assist the patient by placing unused doses
of solid medication back into the medication
container.
(12)
Pursuant to section 400.506(19),
F.S., a nurse registry may not monitor, supervise, manage, or train a
registered nurse, licensed practical nurse, certified nursing assistant,
companion or homemaker, or home health aide referred for contract under this
chapter. In the event of violation of state laws that comes to the attention of
the nurse registry, the nurse registry shall take action in accordance with
section 400.506(19),
F.S. A nurse registry is not prohibited from reviewing records and may do so
per section 400.506(20),
F.S.
Notes
Rulemaking Authority 400.488, 400.497, 400.506 FS. Law Implemented 400.488, 400.497, 400.506 FS.
New 1-27-94, Amended 12-24-00, 8-10-06, 3-15-07, 5-4-15, 2-8-16, 1-11-24.
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