Nurse Delegation 101

1. Vanessa B. Prater, BSN, RN

2. Nurse Delegation 101 Why, What, Who, How and When of the Nurse Delegation Program

3. OBJECTIVES Upon completion, participants will know: • Why DMH developed NDP • What NDP requires • Who is impacted by NDP • How to get more information • When agencies must be in compliance Vanessa B. Prater, BSN, RN

4. WHY??? Vanessa B. Prater, BSN, RN

5. DMH AND NDP, WHY? Federal Law requires that State Agencies, such as the Department of Mental Health (DMH), that receive Federal funds MUST be in compliance with all State Laws. Vanessa B. Prater, BSN, RN

6. DMH AND NDP, WHY? The Alabama Board of Pharmacy (ABOP) and the Alabama Board of Nursing (ABON) direct and control the provision, storage and administration of medications. Programs regulated by DMH must comply with not only DMH regulations, but also those of the ABOP and ABON with respect to their specific guidelines for the handling and administration of medications by individuals other than the consumers who receive the medications. Vanessa B. Prater, BSN, RN

7. DMH AND NDP, WHY? Alabama Board of Nursing (ABON) Regulation Code of Alabama (1975) Section 34-21-20 (Statutory Law) Any person practicing or offering to practice professional/practical nursing in Alabama for compensation shall be required to submit evidence that he/she is qualified so to practice and shall be licensed. It shall be unlawful for any person not licensed to practice or offer to practice professional/practical nursing for compensation in this State. Vanessa B. Prater, BSN, RN

8. DMH AND NDP, WHY? Alabama Board of Nursing Regulation Code of Alabama (1975) Section 34-21-26 The Practice of professional/practical nursing by any person who has not been issued a license or whose license has been suspended, revoked or has expired, is hereby declared to be inimical to the public welfare and to constitute a public nuisance. The ABON may apply to any court of competent jurisdiction for any injunction to enjoin any person from practicing professional/practical nursing who has not been issued a license. Vanessa B. Prater, BSN, RN

9. DMH AND NDP, WHY? Alabama Board of Nursing Regulation Administrative Code 610-X-6-.02(10) The RN/LPN shall accept responsibility and accountability for timely reporting of illegal, substandard, unethical, unsafe or incompetent nursing practice directly to the Board of Nursing Vanessa B. Prater, BSN, RN

10. DMH AND NDP, WHY? SB 428 Under existing law, the ABON employs investigators who investigate alleged violations involving drugs or controlled substances. This bill grants investigators of the ABON the authority to exercise the powers of peace officers in investigating alleged violations of the Nurse Practice Act by persons licensed by the ABON. Vanessa B. Prater, BSN, RN

11. DMH AND NDP, WHY? Alabama Board of Nursing Regulation Administrative Code 610-X-6-.15(1) The RN/LPN who provides care in residential community mental health programs certified by the ADMH is accountable and responsible for the nursing care delivered to patients in those settings Vanessa B. Prater, BSN, RN

12. DMH AND NDP, WHY? Alabama Board of Nursing Regulation Administrative Code 610-X-6-.15(2) RN/LPNs who provide nursing in the residential community mental health setting and the community extensions including day habilitation programs, may delegate specific limited tasks to designated unlicensed assistive personnel. Vanessa B. Prater, BSN, RN

13. DMH AND NDP, WHY? Department of Mental Health Administrative Code Regulations Intellectual Disabilities 580-5-32-.16 Mental Illness 580-2-12(6) Substance Disorders 580-9-46(14) All require 24/7 nursing coverage Vanessa B. Prater, BSN, RN

14. DMH AND NDP, WHY? ABOP and NDP NAKED PILL SYNDROME Carter English, R. Ph. Vanessa B. Prater, BSN, RN

15. DMH AND NDP, WHY? ABOP and NDP Pillboxes Blister Packs – type (labeled at top; each blister labeled Stock medications OTCs Controlled Substances Current Pharmaceutical Companies assisting with NDP Requirements Vanessa B. Prater, BSN, RN

16. New DMH NDP Administrative Code Regulations Anticipated completion: 2009 Will address at a minimum the 4 components of NDP: Administrative Requirements Education/Training Quality Assurance Compliance DMH AND NDP, WHY? Vanessa B. Prater, BSN, RN

17. WHAT??? Vanessa B. Prater, BSN, RN

18. ACRONYMS NDP – Nurse Delegation Program DMH – Department of Mental Health MAC – Medication Assistant Certified Unlicensed Nursing Individuals MAS – Medication Assistance Supervisor (RN/LPN) MATT – Medication Assistance Train- The-Trainer (RN ONLY) Vanessa B. Prater, BSN, RN

19. ACRONYMS MAR – Medication Administration Record Vanessa B. Prater, BSN, RN

20. Definitions Delegation The act of authorizing a competent individual to perform acts supportive to RN/LPNs in selected situations. ABON Administrative Code Vanessa B. Prater, BSN, RN

21. Definitions Competency Outcomes assessed through academic standing, clinical performance and certification examination that demonstrates the ability to perform a particular task. Vanessa B. Prater, BSN, RN

22. Definitions Supervision Periodic monitoring by direct observation on site, by the MAS Nurse to visualize MAC Workers’ skill and ability to perform delegated task(s). Vanessa B. Prater, BSN, RN

23. LPN Supervision 610-X-6-.04 Practice of Practical Nursing (1) The practice of practical nursing includes, but is not limited to: • (a) Acts designed to promote and maintain health; • (b) Prevention of illness and injury; • (c) Provision of care using standardized procedures including administering medications and treatments under the direction of a licensed professional nurse or a licensed or otherwise legally authorized prescriber; and • (d) Exercise of appropriate nursing judgment. Vanessa B. Prater, BSN, RN

24. Supervision Physically present or accessible within a reasonable time to the immediate area and is available to intervene if necessary Vanessa B. Prater, BSN, RN

25. Definitions Self Administration A consumer can self administer if he/she is able to: • Recognize medication(s) • Understands purpose/reason for taking the of medication(s) • Ability to report major side effects and knows when to notify nurse, doctor, etc. (RN MUST PERFORM ASSESSMENT) Vanessa B. Prater, BSN, RN

26. Consumer Assessment Self Administration Limited Self Administration Unable to Self Administer Vanessa B. Prater, BSN, RN

27. Definitions Drug/Medication Substances recognized as drugs in the official US pharmacopoeia…. Substances intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or animals Vanessa B. Prater, BSN, RN

28. Definitions Drug/Medication Substances other than food intended to affect the structure or any function of the body of man or animals Code of AL Section 20-2-2 Vanessa B. Prater, BSN, RN

29. Definitions Medication Administration Removal of an individual dose of medication, from a previously dispensed, properly labeled container, verifying it with the M.D./CRNP’s order, giving the individual dose to the proper consumer at the proper time by the proper route and promptly recording the time and dose given. Vanessa B. Prater, BSN, RN

30. Definitions Administer The direct application of a controlled substance, whether by injection, inhalation, ingestion or any other means to the body of a recipient. Administrative Code Section 20-2-2 Vanessa B. Prater, BSN, RN

31. Definitions Assisting with Medication Administration Helping the consumer with one or more steps in the process of administering medication Vanessa B. Prater, BSN, RN

32. What is NDP? The Nurse Delegation Program (NDP) was developed by the Department of Mental Health (DMH), with guidance from the Alabama Board of Nursing (ABON), in response to changes made to the Alabama Nurse Practice Act, which allows non-licensed persons to assist with medication administration in residential programs, day programs and other community extensions in programs regulated by DMH. Vanessa B. Prater, BSN, RN

33. What is NDP? The NDP defines the respective authority and responsibility for agencies and nurses related to delegation of medication administration in DMH certified programs. Vanessa B. Prater, BSN, RN

34. What is NDP? NDP is managed by the DMH in conjunction with the ABON to assure that all individuals who receive services from programs certified by the DMH receive appropriate care. Vanessa B. Prater, BSN, RN

35. What is NDP? “Consumers have a right to health care that meets legal standards of care regardless of the setting. The Safety and well-being of the consumer must be the central focus of all decisions regarding delegation of nursing tasks to MAC Workers (unlicensed personnel)” NCSBN, 1997 Vanessa B. Prater, BSN, RN

36. What is NDP? “Let whoever is in charge keep this simple question in her head, not, how can I always do this right thing myself, but how can I provide for this right thing to be always done”? Florence Nightingale Vanessa B. Prater, BSN, RN

37. What is NDP? • Four Components of the NDP • 1. Administrative Requirements • 2. Education/Training • 3. Quality Assurance • 4. Compliance Vanessa B. Prater, BSN, RN

38. Administrative Requirements There is both individual accountability and organizational accountability for delegation. Organizational accountability relates to providing sufficient resources, staffing, appropriate staff mix, implementation of policies and position descriptions, opportunity for continuing education and creating an environment conducive to teamwork, collaboration and client-centered care. Vanessa B. Prater, BSN, RN

39. Administrative Requirements The organization is accountable for assuring that documentation of competencies for ALL personnel is maintained The organization is responsible for the development and enforcement of policies on delegation with active participation from nurses Vanessa B. Prater, BSN, RN

40. Administrative Requirements Organizations are responsible for assuring that educational needs/requirements are met through the implementation of the NDP Organizations are responsible for assuring compliance with all DMH Regulations Vanessa B. Prater, BSN, RN

41. Personnel Issues MAC Workers Must : • Have a HS Diploma/GED • Be responsible • Be able to read with understanding • Be knowledgeable of agency operations • Be respectful • Be able to work independently • Be able to monitor consumers Vanessa B. Prater, BSN, RN

42. Personnel Issues MAS Nurse Must: • Be an LPN/RN in good standing • Attend MAS Training and pass competency test • Understand disease and symptoms management related to MI/MR/SA • Be able to teach and supervise others • Practice according to the Nursing Standards of Practice • Practice within the NDP guidelines Vanessa B. Prater, BSN, RN

43. Documentation Job Descriptions Training – MAC, MAS, MATT Supervision – MAC, LPN MAR Communications Observations/Actions Self Administration Assessment Vanessa B. Prater, BSN, RN

44. Documentation IF IT IS NOT DOCUMENTED; IT WAS NOT DONE! Vanessa B. Prater, BSN, RN

45. Policies and Procedures • Compliance with ABON Regulations • Compliance with NDP • Documentation – MAR, communications, observation, actions • MAC Supervision – quarterly • LPN Supervision • Training and Updates – MAC, MAS • Self Administration Assessment - annually Vanessa B. Prater, BSN, RN

46. Policies and Procedures • How to handle medications when on home visits, MD visits, trips • How to handle telephone orders • Reporting a Nurse to the NDP Director/ABON • Medication Errors – documentation, reporting • Medication security/disposal Vanessa B. Prater, BSN, RN

47. Administrative Requirements The DMH Certification Process includes NDP Regulations. Certification Surveyors will assess compliance with NDP Regulations. Vanessa B. Prater, BSN, RN

48. Education and Training MAC Worker 24 hours of training 12 hours Level I – classroom education Take a written test and pass with 90% Three attempts 12 hours Level ll – assessment of competencies 4 hours update/refresher annually Vanessa B. Prater, BSN, RN

49. Education and Training MAS RN/LPN Any RN/LPN licensed in Alabama, employed or contracted by an Agency certified by DMH is eligible for training and certification as a MAS Nurse Vanessa B. Prater, BSN, RN

50. Education and Training MAS RN/LPN A four (4) hour training program, taught by a MATT RN is required The RN/LPN must pass a written test with a score of 90 or better Three (3) attempts to pass written test Certification updated every two (2) years Vanessa B. Prater, BSN, RN