Senate Bill No. 558
(By Senators Walker, Bailey, Anderson and Plymale)
[Introduced February 19, 1996; referred to the Committee
on Health and Human Resources; and then to the Committee on
A BILL to amend chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article five-m, relating
to medication administration by unlicensed personnel; short
title; definitions; administration of medications in
facilities; exemption from licensure; instructions and
training; eligibility requirements of facility staff;
delegation and supervision of medication administration;
withdrawal of delegation; fees; limitations on medication
administration; and rules.
Be it enacted by the Legislature of West Virginia:
That chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article five-m, to read
ARTICLE 5M. MEDICATION ADMINISTRATION BY UNLICENSED PERSONNEL.
§16-5M-1. Short title.
This article may be cited as the "Medication Administration
by Unlicensed Personnel Act."
As used in this article, unless a different meaning appears
from the context, the following definitions apply.
"Administration of medication" means assisting a person in
ingesting any medication through the mouth, the application of a
medication to the outer skin, eye or ear, the application of nose
drops, or vaginal or rectal suppositories.
"Authorizing agency" means the department's office of health
facility licensure and certification.
"Delegating nurse" means a licensed registered nurse who is
employed or on contract with a facility to provide direct or
indirect supervision of the administration of medication by
facility staff members.
"Department" means the department of health and human resources.
"Facility" means an ICF/MR, a personal care home, a
residential board and care home or a behavioral health group home
that is licensed by the department.
"Facility staff member" means an individual employed by a
facility but does not include a health care professional acting
within the scope of a professional license or certificate.
"Health care professional" means a physician, podiatrist,
registered nurse, practical nurse, dentist, optometrist or
respiratory care professional licensed under chapter thirty of
"ICF/MR" means an intermediate care facility for the
mentally retarded which is licensed by the department.
"Medication" means a drug, as defined in section one hundred
one, article one, chapter sixty-a of this code, to be taken
orally or applied topically that has been prescribed by a health
care professional authorized by law to prescribe.
"Registered nurse" means a person who holds a valid license
pursuant to article seven, chapter thirty of this code.
"Resident" means a resident of a facility.
"Secretary" means the secretary of the department of health and human resources or his or her designee.
§16-5M-3. Administration of medications in facilities.
(a) The secretary is authorized to establish a program for
the administration of medications in facilities. Said program
will be developed and conducted in cooperation with the office of
health facility licensure and certification and the medicaid
(b) Beginning the first day of July, one thousand nine
hundred ninety-six, as a condition of licensure, the authorizing
agency shall require that any facility that has unlicensed staff
administering medication pursuant to the conditions of this
article shall maintain a written record of each medication
administered to each resident including the medication, dosage,
time, route and the name of the staff member authorized to
administer the medication. The record will be subject to review
by the authorizing agency as a part of its procedure in
authorizing continued licensure of the facility.
§16-5M-4. Exemption from licensure.
Any individual who is not otherwise authorized by law to
administer medication in a facility may administer medication
only after participating in a training program and passing a competency evaluation as prescribed in this article. Any
individual who administers medication in a facility in compliance
with the provisions of this article shall be exempt as to that
administration from the licensing requirements of chapter thirty
of this code and the provisions pertaining to controlled
substances contained in section one hundred one, article one,
chapter sixty-a of this code. All licensed health care
professionals as defined in this article remain subject to the
provisions of their respective licensing laws.
§16-5M-5. Instruction and training.
(a) The department, in cooperation with appropriate
agencies, advisory bodies and boards, shall develop and approve
training curricula and competency evaluation procedures for those
facility staff members who administer medication in facilities.
(b) A facility that implements a procedure under which its
facility staff members may administer medications shall ensure
that they have participated in an approved training program and
successfully passed the approved competency evaluation.
(c) A registered nurse who is authorized to train facility
staff members to administer medications in facilities shall:
(1) Possess a current active West Virginia license in good standing to practice as a registered nurse;
(2) Have practiced as a registered nurse for a minimum of
two years in a capacity requiring knowledge of medications; and
(3) Be familiar with the nursing care needs of residents of
facilities as described in this article.
(d) The curriculum of all programs for training facility
staff to administer medication must comply with applicable rules
and receive approval from the authorizing agency prior to
(e) Facility staff members must annually complete a
specified update of medication-related training which must be
arranged by a registered nurse. This training may occur in the
facility and the facility must maintain records of the formal
on-going hours of training.
§16-5M-6. Eligibility requirements of facility staff.
(a) The facility shall name the individual facility staff
members who may administer medications. The facility may permit
a facility staff member to administer medications in a single
specific facility only after compliance with all of the
(1) The staff member has successfully completed a department approved training program and competency evaluation;
(2) The facility determines there is no statement on the
state administered nurse aide registry indicating that the staff
member has been the subject of a finding of abuse or neglect of
a long-term care facility resident or the misappropriation of
such a resident's property;
(3) The medication to be administered is received by the
facility staff member in the container in which it was dispensed
by a pharmacist or the prescribing health care professional; and
(4) The facility staff member complies with all applicable
requirements established under this section, the rules adopted
pursuant to this article and such other criteria, including
minimum competency requirements, as are specified by the
§16-5M-7. Delegation and supervision of medication
(a) If medication administration is to be provided by
facility staff members to facility residents receiving limited
and intermittent nursing care, as defined in the authorizing
agency's rules, or if such administration is to be provided to
ICF/MR residents who have a medical care plan, the facility or ICF/MR must have a delegating nurse who delegates medication
administration responsibilities to such staff members.
Delegation is not necessary for medication administration to
those facility residents not meeting the above cited criteria for
care. A delegating nurse may delegate to any facility staff
member specified by the facility as authorized to administer
medications. Delegation may occur only after all requirements
established by this section and any rules have been met and after
a delegating nurse has completed an assessment of the conditions
at the facility that pertain to the delegation including an
(1) The residents who need medication and the types of
nursing care they require as it relates to their need for
(2) The amount and nature of any assessments of residents
performed by other health care professionals; and
(3) The training and skills of the facility staff members
who will receive the delegated authority to administer
(b) The delegating nurse shall repeat the assessment of a
resident if there is a change in the resident's health status: Provided, That a repeat of an assessment is not required for
those parts of the assessment that have been completed by the
facility to comply with federal regulations that require
comprehensive functional assessments or nursing health status
reviews, if the nurse determines that the assessment information
is current, valid and accurate.
(c) A delegating nurse may delegate to the facility staff
members specified by the facility authority to administer
medications only if all of the following is available to the
(1) The name of the resident to receive the medication;
(2) The name of the medication and the dosage to be
(3) The time or intervals at which the medication is to be
(4) The date the medication is to begin and cease;
(5) Any special instructions for handling or administering
the medication, including instructions for maintaining sterile
conditions and appropriate storage;
(6) Knowledge of the amount and extent of supervision
necessary for the facility staff members administering medications;
(7) Knowledge that indication of any severe adverse
reactions to the medication should be reported to the health care
professional who prescribed the medication and knowledge of any
other procedures that should be followed in an emergency; and
(8) One or more telephone numbers at which the health care
professional who prescribed the medication can be reached in an
emergency and the telephone number of another health care
professional who should be contacted if the prescribing
professional cannot be located.
(d) The information that is to be available to implement
subsection (c) of this section must be received from one or more
health care professionals acting within the scope of their
professions, unless the information is provided by the facility
from records it maintains to comply with federal regulations
regarding standard drug regimen reviews and a delegating nurse
determines that the information from the facility is current,
valid and accurate.
(d) Facility staff members to whom a delegating nurse has
delegated authority to administer medications shall perform that
administration only pursuant to such nurse's direction and supervision. The direction and supervision may be provided
on-site or, pursuant to some means of telecommunication,
off-site. The nurse shall direct and supervise the facility
staff members in accordance with standards established by this
§16-5M-8. Withdrawal of delegation.
The delegating nurse may withdraw approval for a facility
staff member to administer medication if the nurse determines
that the facility staff member is not performing the delegated
nursing task in accordance with the training and written
instructions. The withdrawal of delegation shall be documented.
The nurse shall notify the facility's management of the
withdrawal of delegation, in accordance with the facility's
The department shall set and collect fees for any training
programs given and a fee for any competency evaluation
administered under the provisions of this article, whether the
department administers such training or evaluation, contracts for
said training and evaluation or the training and evaluation is
provided by a private provider or facility, so that the revenue generated from such fees will offset the costs incurred by the
department in the performance of its duties under this article.
No person shall enroll in a training program or take the
competency evaluation until such person applies and makes payment
of the appropriate fees to the department.
§16-5M-10. Limitations on medication administration.
The following limitations apply to the administration of
medication by facility staff members:
(a) Injections or any parenteral medications may not be
administered: Provided, That insulin may be administered if the
facility staff member administering the insulin injection has
been trained in said administration and the insulin is prescribed
in a stable dose with identified times for administration;
(b) Irrigations or debriding agents used in the treatment of
a skin condition or minor abrasions shall not be administered;
(c) No verbal medication orders shall be accepted, no new
medication orders shall be transcribed and no drug dosages shall
be converted; and
(d) No medications ordered by the physician to be given "as
needed" shall be administered unless the order is written with
specific parameters which preclude independent judgment.
The department shall adopt such rules as may be necessary to
implement this article; said rules are to be submitted on an
emergency basis. The rules shall be adopted in accordance with
the provisions of chapter twenty-nine-a of this code.
NOTE: The purpose of this bill is to permit the restricted
administration of medications by unlicensed personnel in
intermediate care facilities for the mentally retarded, personal
care homes, residential board and care homes and behavioral
health group homes.
This article is new; therefore, strike-throughs and
underscoring have been omitted.