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 Finance.]

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 as follows:
§16-5M-1. Short title.
This article may be cited as the "Medication Administration by Unlicensed Personnel Act."
§16-5M-2. Definitions.
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 this code.
"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 program.
(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 implementation.
(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 following:
(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 authorizing agency.
§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 assessment of:
(1) The residents who need medication and the types of nursing care they require as it relates to their need for medication;
(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 medications.
(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 nurse:
(1) The name of the resident to receive the medication;
(2) The name of the medication and the dosage to be administered;
(3) The time or intervals at which the medication is to be administered;
(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 article.
§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 policy.
§16-5M-9. Fees.
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.
§16-5M-11. Rules.
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.