55 Pa. Code § 6600.4 - Medication administration and training-statement of policy
(a)
Background. Section
6600.3 (relating to requirements)
incorporates by reference Federal regulations for intermediate care facilities
for the mentally retarded (ICFs/MR) at
42 CFR
483.400 -
483.480. This section interprets
that portion of the regulations found at
42 CFR
483.460(k)(3), which reads
as follows: "Unlicensed personnel are allowed to administer drugs only if state
law permits." Inasmuch as the administration of drugs is within the scope of
practice of nursing, the applicable State law is The Professional Nursing Law
(law) (63 P. S. §§
211-225.5). The law specifically
does not prohibit home care of the sick by unlicensed persons (see section 4(1)
of the law (63 P. S. §
214(1)). The State Board of
Nursing interprets the home care exemption as applying to ICFs/MR that serve no
more than eight individuals.
(b)
Purpose. This section sets forth guidelines for the
administration of medications in ICF's for eight or fewer individuals with
mental retardation. The guidelines were developed in consultation with the
State Board of Nursing to ensure that unlicensed staff who administer
medications do so safely and lawfully. Compliance with these guidelines will be
considered as part of the annual licensing inspection carried out by the
Department of Health, Division of Long Term Care, ICF/MR Program.
(c)
Applicability. This
section applies to ICF's in which eight or fewer individuals with mental
retardation live. For purposes of this section, the following clarifications
apply:
(1) A facility is a distinct,
individual residential building operating as an ICF/MR, or as part of an
ICF/MR.
(2) Each apartment unit
within an apartment building is considered a separate facility.
(3) Each half of a duplex if there is
physical separation between two distinct and complete living areas, is
considered a separate facility.
(4)
A wing of a building, or an attached building unit, does not constitute a
separate facility.
(5) Eight or
fewer individuals means the total number of individuals living at the facility
and not the licensed capacity of the ICF/MR.
(6) Eight or fewer individuals means the
total number of individuals living at the facility, regardless of whether the
individuals are currently taking medications.
(d)
Medications administration
guidelines.
(1) Prescription
medications and injections of a substance not self-administered by individuals
may be administered by only one of the following:
(i) A licensed physician, licensed dentist,
licensed physician's assistant, registered nurse or licensed practical
nurse.
(ii) A graduate of an
approved nursing program functioning under the direct supervision of a
professional nurse who is present in the facility.
(iii) A student nurse of an approved nursing
program functioning under the direct supervision of a member of the nursing
school faculty who is present in the facility.
(iv) A staff person who meets the criteria
specified in paragraph (2) for the administration of oral, topical, eye and ear
drop, suppository and enema prescription medications, or who meets the criteria
specified in paragraph (3) for the administration of insulin
injections.
(2) A staff
person who has completed and passed the Department of Public Welfare's
(Department) Medications Administration Course may administer oral, topical,
eye and ear drop, suppository and enema prescription medications.
(3) A staff person who has completed and
passed the Department's Medications Administration Course and who has completed
and passed a diabetes patient education program within the past 12 months that
meets the National Standards for Diabetes Patient Education Programs of the
National Diabetes Advisory Board, 7550 Wisconsin Avenue, Bethesda, Maryland
20205, may administer insulin injections to an individual who is under the care
of a licensed physician who is monitoring the diabetes.
(4) Medications administration training of a
staff person shall be conducted by a trainer who has completed the Department's
Medications Administration Course for trainers and is certified by the
Department to train staff. Licensed, certified or registered medical personnel
who serve as trainers shall also complete the Department's Medications
Administration Course for trainers and be certified by the Department prior to
training staff.
(5) Trainers may
not train other individuals to become trainers.
(6) Two trainers may jointly administer the
Medications Administration Course, as long as both trainers are certified and
sign-off on the Module Exam Data Summary Sheet and the Medications Training
Verification Form.
(7) The facility
shall keep a copy of each trainer's training certificate issued by the
Department.
(8) A certified trainer
may administer medications. If a trainer has a training certificate from the
Department, no further documentation is required in order for the trainer to
administer medications.
(9) The
only acceptable medication training course is the Medications Administration
Course developed by the Office of Mental Retardation.
(10) A staff person who administers
prescription medications or insulin injections to an individual shall complete
and pass the Medications Administration Course Practicum annually.
(11) The facility shall keep the following
documentation for each nonmedically licensed staff person who administers
medication:
(i) The Written Module Examination
of Medications Training Manual.
(ii) The Module Examination Data Summary
Sheet of the Medications Training Manual.
(iii) A signed and dated copy of the Training
Verification Form, including the name and signature of the person who gave the
training and the date and location of the training.
(iv) Evidence of a percentage score of 90% or
above for each of the three test sections. If the percentage score falls below
90%, for one or more of the following sections, that test section shall be
retested:
(A) Written examination.
(B) Practicum.
(C) Practicum.
(v) A copy of the Practicum Summary completed
within the past year.
(12) Staff medications training documentation
may be transferred from one agency to another. The Practicum Summary shall be
completed at the new agency prior to administering medication.
(13) Injections of a substance other than
insulin shall be administered by medically licensed personnel specified in
paragraph (1)(i)-(iii).
(14) The
specialized insulin administration training specified in paragraph (3) is
required prior to administering insulin injections, and every 12 months
thereafter. A staff person may not take the Diabetes Patient Education training
and then teach other staff. Training shall be provided directly by the
organization that offers the patient education program that meets the National
standards.
Notes
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