Medication Administration in the Community Administrative Rule 116

Medication Administration in the Community Administrative Rule 116

Medication Administration in the Community Administrative Rule 116 1 HouseKeeping

Webinar 1 from 9:30 to 11:30 am Lunch break 11:30 to 12:45 pm Webinar 2 from 12:45 pm to 2:45 pm. We will be reading and discussing important points. 2 Instructors Master

Nurse Trainer Master Nurse-Trainer: Anne Fitz: [email protected] IDHS, Statewide Nursing Coordinator (Revised 1-12-17) 3

SECTION 1 & 2, PRINT OUTS Request/Approval for RN Nurse-Trainer Status Program evaluation

Complete IL462-4401 Request/Approval for RN Nurse-Trai ner Status entire form after completing all three required webinars. Complete

IL462-4402 - Program Evaluation - RN Nurse - T rainer Training Program form at the end of the course today Email or fax documents above to: Email: [email protected] Fax: (217) 782-9444 4 Nurse Trainer Prerequisites [116.30 b)] RN in Illinois with an unencumbered license

1 year RN clinical experience in last 5 years, preferably in Developmental Disabilities Successfully complete the DHS NurseTraining Program -Attend all three Webinars Complete & send Nurse-Trainer Application Test Completion with 90% or better 5 Overall Purpose of Rule 116 6

Section 116.10 Purpose (1) To ensure the safety of individuals in programs funded by the Department of Human Services by regulating the storage, distribution, and administration of medications in specific settings training of non-licensed staff in the administration of medications

7 Section 116.10 Purpose (2) This applies exclusively to all programs for individuals with a developmental disability in settings of 16 persons or fewer that are funded or licensed by the Department of Human Services and that

distribute or administer medications 8 Section 116.10 Purpose (3) and all intermediate care facilities for the developmentally disabled with 16 beds or fewer that are licensed by the Illinois Department of Public Health.

9 Application Clarification In all cases, the individual must have a DD/ID diagnosis. Licensed and funded by DHS. Licensed by DPH & funded by DHS (ICF-DD-16 & CLFs of 16 or fewer) Licensed by DCFS & funded by DHS (Child Group Homes of 10 or less)

10 POLL Which of the following CANNOT use Rule 116? 1. 2. 3. 4.

CILAs Day Training Programs ICF/DD-16 Child Group Homes < 10 beds Day Training Programs 11 DEFINITIONS 116.20

12 Administer/ Administration An act in which a single dose of medication is instilled into the body of applied to the body of or otherwise given to a person for immediate consumption or use 13

Authorized Direct Care Staff (1) Non-licensed persons who have successfully completed a medication administration training program specified by the Illinois Department of Human Services and conducted by a Nurse-Trainer 14 Authorized Direct Care Staff

(2) This authorization, that can only be conducted by a Nurse-Trainer is specific to an individual receiving services in a specific agency and does not transfer to another agency or individual. 15

Community Residence (1) Any residence funded by DHS and provided by a licensed agency, or a residential setting certified or approved by DHS,

or an intermediate care facility for 16 or fewer persons with developmental disabilities licensed by Illinois Department of Public Health as a ICF/DD 16 Competency-Based that is tied to an identified set of skills and knowledge and requires documentation of an acceptable level of performance of a task or achievement of an

outcome. 17 Delegation (1) The transfer of responsibility for the performance of selected tasks by the registered nurse (RN) to authorized direct care staff in a selected situation, based upon the RNs plan of care. 18 Delegation (2)

The RN retains professional accountability for the outcome of the delegated task and all the nursing care of the individual. No redelegation by authorized direct care staff may occur. 19 Delegation & Nurse Practice Act 20 Delegation & the Nurse Practice Act

(1) Delegation means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. Nursing Activity means any work requiring the use of knowledge acquired by completion of an approved program for

licensure, (Section 50-75 Nursing Delegation) 21 Delegation & the Nurse Practice Act (2) Task

means work not requiring nursing knowledge, judgment, or decision-making, as defined by the Department by rule. (Section 50-75 Nursing Delegation) 22 Delegation & the Nurse Practice Act (3)

A registered professional nurse shall not delegate any nursing activity requiring the specialized knowledge, judgment, and skill of a licensed nurse to an non-licensed person, including medication administration. 23 Delegation & the Nurse Practice Act (4) A registered

professional nurse may delegate nursing activities to other registered professional nurses or licensed practical nurses. 24 POLL

Of the following who can perform a Nursing Activity in a CILA? 1. 2. 3. 4. LPN or RN CNA Specially trained authorized staff Any staff person

LPN or RN 25 Delegation & the Nurse Practice Act (5) A registered nurse may delegate tasks to other licensed and nonlicensed persons. A licensed practical nurse who has been delegated a nursing activity shall not redelegate the nursing activity.

26 POLL Of the following who can perform a medication related Task in a CILA? 1. 2. 3. 4.

LPN RN Specially trained authorized staff Any of the above Any of the above 27 Delegation & the Nurse Practice Act (6) A registered

professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. 28 POLL

A TASK is work: 1. 2. 3. 4. NOT REQUIRING nursing knowledge. REQUIRING nursing or knowledge. commonly done only by long term care RNs. found only in DD agencies.

NOT REQUIRING nursing knowledge or judgment 29 Functional Literacy An individuals ability to read, write, speak, compute and solve problems at levels of proficiency necessary to function on the job, as assessed by standardized

techniques. --------------------------------------- TABE (ABLE, CASAS) @ 8th grade reading level (Attachment A VIII. Special conditions, I. Professional Service Requirement, 6) 30 Medication Error (1) (4/29/10 Memo)

The administration of medication other than as prescribed resulting in the: wrong medication being given medication being given at the wrong time In wrong dosage or via the wrong route, or by the wrong person, or medication omitted entirely. 31 Medication Error (2) Medication Error is meant to include: A lack of documentation of

medication administration or any error in the documentation. 32 Medication Error (3) Medication errors must be documented and are subject to review by DHS or DPH, whichever is

applicable Medication errors that meet the reporting criteria in DHS rules on Office of Inspector General Investigations of Alleged Abuse or Neglect or Deaths in State-Operated and Community Facilities (59III. Adm. Code 50) shall be reported to the Office of Inspector General 33 Non-Licensed Staff Training Program (1) A standardized

competency-based medication administration training program approved by It is conducted by a Nurse-Trainer for the purpose of training persons employed or under contract to provide direct care or treatment to individuals receiving services to: 34 Non-Licensed Staff Training Program (2) administer

medications implement self-administration of medication training to individuals under the supervision and monitoring of the Nurse-Trainer. It incorporates adult learning styles, teaching strategies, classroom management, curriculum overview including: 35 Non-Licensed Staff Training Program (3)

ethical-legal aspects and standardized competency-based evaluations on administration of medications and self-administration of medication training programs. [20 ILCS 1705/15.4 (b)] 36

Normalization A philosophy under which persons with a develop-mental disability are provided or restored to patterns and conditions of everyday life that are as close as possible to norms and patterns of the mainstream of society. 37 Patent or Proprietary Medications Medications and household remedies

that are generally considered and accepted as harmless and nonpoisonous when used according to the directions on the label and for which there are written physician orders for their use. 38 Self-Administration An act in which an individual administers his or her own medications. To be considered capable of self-administering medications, individual

residents must, at a minimum, be able to: identify prescribed medication by size, shape, or color know when it should be taken and in what amount it should be taken each time. [20 ILCS 1705/15.4 (b)] 39 Substantial Compliance (1) Meeting the requirements set forth in this

Part, except for variations from the strict and literal performance of those requirements that result in insignificant omissions and defects, given the particular circumstances and the history of those omissions and defects. 40 Substantial Compliance (2) Omissions that have an adverse

impact on an individuals health and safety shall be considered significant and shall be considered substantial noncompliance. 41 Supervision (1) An

active process in which the Registered Professional Nurse monitors, directs, guides, and evaluates the outcomes of an activity or task. 42 Supervision (2)

The registered professional nurse maintains the accountability for the tasks and responsibilities, as subcomponents of total patient care, delegated to authorized direct care staff 43 POLL

Who can teach medication administration program to nonlicensed staff? 1. 2. 3. 4. Only a RN-Trainer Any RN

Specially trained LPN Any of the choices ONLY A RN-TRAINER 44 116.30 Master Nurse-Trainer and Nurse-Trainers b) All RNs seeking approval to be Nurse-Trainers shall be: 1) Licensed as a registered professional nurse in

Illinois with an unencumbered license 2) Possess one year of clinical registered professional nursing experience within past five years, preferably in developmental disabilities 3) Have successfully completed the DHS NurseTrainer Training Program 45 116.30 Master Nurse-Trainer and Nurse -Trainers c) Requests for approval shall be submitted, in writing, to the DD Medical Director. The DD Medical Director shall approve all

requests that show substantial compliance with the requirements. Previous history as a Nurse-Trainer will be considered during the review process 46 116.30 Master Nurse-Trainers and Nurse-Trainers The decision to approve or deny requests shall be on file with the Department, which will maintain a

list of all approved Nurse-Trainers d) The DD Medical Director shall, upon request, grant conditional approval to a registered professional nurse who fulfills the requirements but has not yet completed the required Nurse-Trainer Training Program 47 116.30 Master Nurse-Trainers and Nurse-Trainers

Conditional approval shall be granted for no more than 90 calendar days following the date of conditional approval. The nurse given conditional approval shall not train or authorized non-licensed staff to administer medications , but may monitor and direct, as well as educate and train, previously authorized direct care staff on new medications or dosage changes as required

48 116.30 Revoking Nurse-Trainer Status e) The DD Medical Director shall revoke the NurseTrainer status if: 1) Nurse-Trainers registered professional nurse license is encumbered or revoked or 2) Nurse-Trainer has one or more substantiated or indicated findings or verified documentation of physical abuse, sexual abuse, egregious neglect or financial exploitation 49

116.30 Revoking Nurse-Trainer Status f) The DD Medical Director shall revoke the Nurse-Trainer status if in the DD Medical Directors professional judgment: 1) the Nurse-Trainer has failed to adequately supervise authorized direct care staff in administering medications; 50 116.30 Revoking Nurse-Trainer Status

2) the Nurse-Trainer has one or more findings as defined in Section 116.20 other than the types of findings listed in Section 116.30 (e) (2) and those findings warrant revocation of the nurses NurseTrainer status 3) the Nurse-Trainer otherwise failed to carry out responsibilities in substantial compliance with this Part 51

116.30 Revoking Nurse-Trainer Status g) If the nurses Nurse-Trainer status is revoked, the DD Medical Director shall notify the nurse of the revocation. The revocation letter will include the basis for the revocation, the effective date, and information about the nurses right to appeal the revocation. 52 116.30 Revoking Nurse-Trainer Status

1) A nurse who receives a revocation letter including notice of an opportunity for an administrative hearing: Must submit a request for a hearing to the Bureau of Clinical Services, as listed in the revocation letter. Request is to be in one of the formats indicated in the revocation letter and must be received by the date identified in the letter. Failure to comply with this request shall constitute a waiver of the nurses right to an administrative hearing.

53 116.30 Revoking Nurse-Trainer Status If the nurse requests an appeal: A) The Department shall be required to establish beyond a preponderance of the evidence that the DD Medical Directors revocation of the Nurse-Trainer status is warranted. B) Hearings shall be conducted in accordance with the

Departments rules on the conduct of the hearings and appeals (89 III. Adm. Code 508). In the event there is a conflict between 89 III. Adm. Code 508 and this Part, the provisions of this Part shall prevail. 54 116.30 Revoking Nurse-Trainer Status C) The nurse may not function as a Nurse-Trainer during the appeal process. 2) If Nurse does not request a hearing or if the hearing

results in a decision that the DD Medical Directors revocation of the nurses Nurse-Trainer status is warranted, the DD Medical Director shall revoke the Nurse-Trainer status and notify the nurse, and any agency known to the Department where the nurse is acting as a Nurse-Trainer 55 POLL

Which criterion is necessary to become a Nurse-Trainer? 1. 2. 3. 4. Advanced Practice Nurse 5 years of experience in DD Licensed RN in Illinois

5 years of RN experience BE LICENSED AS AN RN IN ILLINOIS 56 116.40 Training and Authorization of Non-Licensed Staff by Nurse-Trainers 57 116.40 Training and Authorization of

Non-Licensed Staff (1) a) Only a Nurse-Trainer may delegate supervise and authorize the task of medication administration to authorized direct care staff. b) Prior to training non-licensed staff to administer medication, the Nurse-Trainer must have an understanding and knowledge of the individuals : 58 116.40 Training and Authorization of

Non-Licensed Staff (2) physical and mental status medical history medication orders and medications prescribed, to initially train and authorize unlicensed staff to administer medications and to provide additional medication related training of non-licensed authorized staff 59

116.40 Training and Authorization of Non-Licensed Staff (3) The following is acceptable evidence of that understanding & knowledge: 1) The Nurse-Trainer completing the assessment of the individuals health must sign & date the assessment. To be valid, this assessment can be no more than one year prior to the date of training of the nonlicensed staff. 60 116.40 Training and Authorization of

Non-Licensed Staff (4) 2) If the Nurse-Trainer initially training & authorizing unlicensed staff or providing additional training is not the RN who completed the assessment of the individuals health, there must be clear evidence that the Nurse-Trainer has reviewed an individuals current assessment within the last 365 calendar days and considered other relevant information before doing any training or providing direction about medication administration for that individual.

61 116.40 c) Non-licensed Direct Care Staff Requirements (1) c) Non-licensed direct care staff who are to be authorized to administer medications under the delegation of the Nurse-Trainer shall meet the following criteria: 1) be age 18 or older; 62

116.40 c) Non-Licensed Direct Care Staff Requirements (2) 2) complete high school or its equivalency (G.E.D.); 3) demonstrate functional literacy; 63 116.40 c) Non-licensed Direct Care Staff Requirements (3) 4) satisfactorily complete the Health and Safety component of the Direct Support

Persons Core Training Program or a DHS approved equivalent Developmental Disabilities Aide Training Program prior to beginning of medication administration training 64 116.40 c) Non-Licensed Direct Care Staff Requirements (4) 5) be initially trained and evaluated by a Nurse-Trainer in a competency-based,

standardized medication curriculum specified by DHS 65 116.40 c) Non-Licensed Direct Care Staff Requirements (5) 6) pass the written portion of the comprehensive examination furnished by DHS based on the information conveyed during a medication administration classroom course

66 116.40 c) Non-Licensed Direct Care Staff Requirements (5) 7) Score on a written or oral competency-based evaluation specifically pertinent to those medications that non-licensed direct care staff is responsible to administer.

67 POLL BEFORE staff can administer meds the Nurse-Trainer must assess the: 1. 2. 3. 4.

present physical & mental status medical history medication orders & meds prescribed All the above. ALL THE ABOVE. 68 116.40 d) Initial competency-based training toward delegation for medication administration

shall include: 1) Best practice standards related to the rights of individuals, legal and ethical responsibilities, agency procedures and communication pertaining to medication administration. 2) Best practice nursing techniques associated with medication administration. 69 116.40 d) Initial Competency-Based

Training for Medication Administration 3) Classes of drugs and their effects and common side-effects 4) Specific information regarding: the individuals to whom the staff will administer medications & the medication the staff will administer 70 116.40 d) Initial Competency-Based Training for Medication Administration

5) Techniques to observe, report and document: medication effects side effects adverse outcomes vital signs When those skills are necessary for the safe administration of medication

71 116.40 d) Initial Competency-Based Training for Medication Administration 6) A final, individual-specific, competencybased evaluation performed by a NurseTrainer for each medication administered to persons at the program for whom the staff provide supports. 72 116.40 e) Delegation of Insulin Administration

Nurse-Trainer may delegate the administration of insulin subcutaneously using an insulin pen (pre-filled with insulin by manufacturer) to authorized staff authorized staff must successfully complete a DHS approved advanced training program specific to diabetes & insulin administration 73 116.40 e) Delegation of Insulin Administration 1) Authorized direct care staff must consult with

the Nurse-Trainer before administering any subcutaneous insulin dose determined by a blood glucose test result 2) Authorized direct care staff may not calculate the insulin dose when the dose is dependent on a blood glucose test result 74 116.40 e) Delegation of Insulin Administration 3) Authorized direct care staff may not administer insulin to individuals who require

blood glucose monitoring more than 3 times per day * * unless directed to do so by the NurseTrainer 75 116.40 f) Epinephrine by Auto-Injector Staff, after training, may administer epinephrine by auto-injector as prescribed by a physician as an emergency measure when an individual experiences a serious allergic reaction (anaphylactic shock).

The administration of epinephrine by autoinjector by staff is not the responsibility of the Nurse-Trainer 76 116.40 f) Epinephrine by Auto-Injector 1) Agency is responsible for the training of all staff who may administer epinephrine by autoinjector This training can be obtained through the

American Heart Association, American Red Cross, American Safety and Health Association, or from a RN or LPN (as delegated by an RN or physician) 77 116.40 f) Epinephrine by Auto-Injector 2) Two unexpired epinephrine auto-injectors should be in close proximity to the individual for whom the medication is prescribed &

available for immediate use at all times. Close proximity means: A) within arms reach for the individual responsible for administering the epinephrine auto-injection when away from the residence: or 78 116.40 f) Epinephrine by Auto-Injector

B) In a known location with easy, immediate access to individual and staff when at the residence. 3) Emergency medical services must be summoned immediately after the use of epinephrine auto-injector 79 116.40 g) Medications & Enteral Tubes Nurse-Trainer may authorized direct care staff to

administer medications through an enteral tube after authorized staff has successfully completed: DHS approved advanced training program specific to enteral tubes, their maintenance, and medication administration 80 116.40 Training and Authorization of NonLicensed Staff h) Authorized direct care staff shall be reevaluated by a Nurse-Trainer at least annually or more frequently at the discretion of the registered professional nurse. Any retraining

shall be to the extent that is necessary to ensure competency of the authorized direct care staff to administer medication [20 ILCS 1705/15.4 (c)], as judged by a Nurse-Trainer. 81 116.40 Training and Authorization of NonLicensed Staff i) Authorized direct care staff shall receive specific additional competency-based training and assessment by a Nurse-Trainer, as deemed necessary by the Nurse-Trainer, Whenever a change of medication, including

dosage, time or route occurs Or a new individual who requires medications enters the program 82 116.40 Training and Authorization of Non-Licensed Staff j) Direct care staff who fail to qualify for competency to administer medications shall be given additional education and testing to meet criteria for delegation authority to administer medications. Any direct care staff

person who fails to qualify as an authorized direct care staff after initial training and testing must, within 3 months be given another 83 116.40 Training and Authorization of NonLicensed Staff j) opportunity for retraining and retesting. A direct care staff person who fails to meet criteria for delegated authority to administer medication, including, but not limited to, failure of the written test on two occasions, shall be given consideration for shift transfer or

reassignment, if possible. 84 116.40 Training and Authorization of Non-Licensed Staff j) No employee shall be terminated for failure to qualify during the three month time period following initial testing. Refusal to complete training and retesting required by this Section may be grounds for immediate dismissal. [20ILCS 1705/15.4(h)]

85 116.40 Training and Authorization of NonLicensed Staff k) No authorized direct care staff person delegated to administer medication shall be subject to suspension or discharge for errors resulting from the staff persons acts or omissions when performing the functions unless the staff persons actions or omissions constitute willful and wanton conduct. 86

116.40 Training and Authorization of NonLicensed Staff l) Authorization of staff to administer medication shall be revoked if, in the opinion of the Nurse-Trainer, the authorized direct care staff person is no longer competent to administer medication [20 ILCS 1705/15.4 (c)] The degree of retraining and reassessment of competency should occur at the discretion of the Nurse-Trainer 87 116.40 Training and Authorization of NonLicensed Staff

m) Clear documentation of training, retraining, and evaluation shall be kept in each staff or contractual persons personnel file by each agency 88 POLL How often should staff be evaluated?

1. 2. 3. 4. At least yearly At least monthly Only when they make a mistake Once authorized, no more evaluations are required. At least yearly.

89 POLL Can authorization be revoked by the Nurse-Trainer? 1. 2.

Yes No Yes. 90 116.40 Training and Authorization of Non-Licensed Staff i) Clear documentation of training, retraining, and evaluation shall be kept in each staff or contractual persons

personnel file by each agency where authorized direct care staff are employed. 91 116.50 Administration of Medications 92 116.50 a) Administration of Medications a) Medications shall be administered in accordance with the Mental Health and

Developmental Disabilities Administrative Act [20 ILCS 1705] and the Illinois Nurse Practice Act 93 116.50 b)Administration of Medications b) With the exception of insulin administration by insulin pen & emergency epinephrine administration by auto-injector, non-licensed staff shall not administer medication in an injectable form

94 116.50 c)Administration of Medications c) Medications that are regularly available without a prescription at a commercial pharmacy may be purchased for stock, when they are prescribed by a physician or any other person licensed to prescribe medication in Illinois. Can be prescribed as a PRN or Regularly scheduled (such as daily, weekly, monthly)

95 115.50 c) Administration of Medications The following conditions shall apply: 1) The medication must be stored in original container, with the original label intact 2) No labeling other than the original container labeling is allowed. This labeling may not be obscured in any way 96

116.50 c) Administration of Medications 3) The prescription instructions will be placed on the MAR as required by Section 116.70 (b) and followed as written. 4)Providers may not repackage medications 5) Providers shall communicate with all appropriate parties regarding regularly prescribed stock medications during an individuals absence from agency 97 POLL

How are stock prn medications stored? 1. 2. 3. 4. Divided into vials for each individual In their original containers In medication envelopes

In pill minders as necessary. In their original containers. 98 116.50 d) Administration of Medications d) Medications that are regularly available without prescription at a commercial pharmacy, such as: uncontrolled cough syrups, laxatives, and analgesics shall be given to an individual only upon the written

order of the physician or other person licensed to prescribe medications in Illinois 99 116.50 Administration of Medications e) Over-the-counter substances such as skin care lotion, lip balm, sunscreen, mouthwash, nonmedicated foot powder & cough drops, are generally considered comfort treatments. They would not be subject to Rule 116 requirements. If these substances are prescribed by a physician or other person licensed to prescribe medications, then

these substances become subject to Rule 116 requirements. 100 116.50 Administration of Medications f) PRN medications shall be administered within one hour after the need is identified. g) A registered professional nurse, advanced practice nurse, physician, or physician assistant shall be on duty or on-call at all times in any program covered by this Part [20ILCS 1705/15.4(j)]

101 116.60 Medication Self-Administration 102 116.60 Medication Self-Administration a) As part of the normalization process, in order for each individual to attain the highest possible level of independent functioning, all individuals shall be

permitted to participate in their total health care program [20 ILCS 1705/15.4(d)]. 103 116.60 Medication Self-Administration a) Every program shall include, but not be limited to, individual training in promoting wellness, prevention of disease and medication self-administration procedures.

104 116.60 Medication Self-Administration a) (1) 1) Every program shall adopt written policies and procedures for assisting individuals in obtaining preventative health and medication self-administration skills in consultation with the registered professional nurse [20 ILCS 1705/15.4 (d)]. 105

116.60 Medication Self-Administration a) (1) 2) Individuals shall be evaluated to determine their self-administration of medication capabilities by a NurseTrainer through the use of DHS required, standardized screening and assessment instruments (SAMA) 106 116.60 Medication Self-Administration a) (2) 3) When the results of the screening and

assessment indicate an individual not to be independently capable to self-administer his or her own medications, programs shall be developed in consultation with the Community Support Team (CST) or Interdisciplinary Team (IDT) to provide individuals with 107 116.60 Medication Self-Administration a) (2) medication self-administration training as identified in each individuals

treatment/service plan 108 116.60 Medication Self-Administration b) Each individual shall be presumed to be competent to self-administer medications if he or she has been determined to be: 1) capable by a registered professional nurse or advanced practice nurse. 2) approved to self-administer medication by the individuals Community Support Team (CST) or

Interdisciplinary Team (IDT); and 3) Authorized by a written order of a physician 109 POLL Who decides if an individual can independently administer their own medication? 1.

2. 3. 4. Nurse Interdisciplinary Team or Community Support Team Doctor All the above. All the above.

110 116.60 Medication Self-Administration c) Training of individuals to self-administer medication shall minimally include instruc-tion, for each medication prescribed, in the following areas: 1) Identification of a medication by any of the following methods A) name B) purpose 111

116.60 Medication Self-Administration C) size D) shape E) color F) or other distinguishing feature 2) dosage or quantity to be taken 3) route of administration 112 116.60 Medication Self-Administration 4) frequency or times of administration

5) purpose of medication, special instructions, common side-effects & potential consequences of not taking the medication properly and 6) when to seek medical assistance 113 POLL

Individuals training to take their own medications must include: 1. 2. 3. 4. What normalization is. The doctors name. The drug cost. Medication purpose.

Medication purpose 114 116.60 Medication Self-Administration d) When requested to do so by an individual, authorized direct care staff may assist an individual in the self-administration of medications by taking the medication from the locked area where it is stored and handing it to the individual. If the individual is physically unable to open the container, a staff member

may open the container for the individual. 115 116.60 Medication Self-Administration d) Agency staff may also assist physically impaired individuals, such as those who have arthritis, cerebral palsy, or Parkinsons disease, in the removal of the medication from the container and in consuming or applying the

medication. 116 116.60 Medication Self-Administration e) Each individual shall remain under observation by authorized direct care staff and be assisted by the staff to correct or prevent medication errors and to safeguard against adverse drug reactions. Observation frequency shall be determined by the Nurse-Trainer and the individuals CST or IDT to maintain an individuals safety when

117 116.60 Medication Self-Administration independently self-administering his or her own medications. All observation and assistance shall be noted in the individuals file. 118 116.60 Medication Self-Administration f) Individuals specifically determined to be

competent, by a physician who has issued a written order, to self-administer their own medications may maintain possession of the key or combination of the lock to their own medication storage area. 119 116.60 Medication Self-Administration f) A duplicate key or a copy of the combination shall be kept in a secure location for emergency use by licensed personnel or

authorized direct care staff, if the individual should lose or misplace the key forget the combination. 120 116.60 Medication Self-Administration g) A medication administration record need not be kept for those individuals for whom the attending physician has given permission to have access to their own medications and to be fully responsible for taking their own

medications. 121 116.60 Medication Self-Administration However, each agency shall develop and implement a quality assurance procedure to ensure that self-administered medications are taken in accordance with prescribed orders. Documentation must include: medication name, dosage & frequency, and the identity of the prescribing physician or other person

licensed to prescribe medication in Illinois 122 POLL When can staff assist with selfadministration? 1. 2. 3. 4.

Only when directed by the RN When asked by the individual Any time. Never. When asked by the individual. 123 116.70 Medication Administration Record and Required Documentation

124 116.70 Medication Administration Record and Required Documentation (1) a) All medications, including patent or proprietary medications (e.g., cathartics, headache remedies, or vitamins, but not limited to those) shall be given only upon the written order of a physician, advanced practice nurse, or physician assistant.

125 116.70 Medication Administration Record and Required Documentation (2) a) All orders shall be given as prescribed by the physician, advanced practice nurse or physician assistant and at the designated time. Telephone orders may be taken by a

registered professional nurse or licensed practical nurse. 126 116.70 Medication Administration Record and Required Documentation (3) a) All orders shall be immediately written on the individuals record or a telephone order form

and signed by the nurse taking the order. These orders shall be countersigned or documented by facsimile prescription or electronically signed by the physician within 10 working days. 127 116.70 Medication Administration Record and Required Documentation (1) b) Medication Administration Record 1) Except as provided in Section 116.60(g), an individualized MAR shall be kept for

each individual for medications administered including PRN medications, and shall contain at least the following: A) the individuals name; 128 116.70 Medication Administration Record and Required Documentation b) 1) MAR contain: B) the name and dosage form of the

medication; C) the name of the prescribing physician, advanced practice nurse, physician assistant, dentist, podiatrist, or certified optometrist; 129 116.70 Medication Administration Record and Required Documentation (3) b) 1) MAR shall contain:

D) dose or quantity to be taken E) frequency or times of administration F) route of administration; G) date and time given; H) most recent date of the order I) allergies to medication; and 130 116.70 Medication Administration Record and Required Documentation J)

special considerations, including special directions and precautions for the medications preparation & administration and contraindications for the medication. 131 116.70 Medication Administration Record and Required Documentation 2) PRN medications must be documented on the MAR in accordance with Section 116.70(b) (1). In addition the following must be included

on the MAR: A) conditions for which the medication may given; and B) maximum or stop dosage 132 POLL Do OTC medications need a physician order?

1. 2. Yes No Yes 133 116.70 Medication Administration Record and Required Documentation

3) The MAR for the current month shall be kept with the medications or in the individuals record. 4) The MAR shall be completed and initialed immediately after medication is administered by the RN, LPN or authorized direct care staff. 134 116.70 Medication Administration Record and Required Documentation 4 contd).

Each MAR shall have a section that contains the full signature and title of each individual who initials MAR. 5) All changes in medication shall be noted on the MAR by a licensed practical nurse, registered professional nurse, advanced practice nurse, pharmacist, 135 116.70 Medication Administration Record and Required Documentation 5 contd).

physician assistant, dentist, podiatrist, or certified optometrist and reported to the Nurse-Trainer prior to the next dose. Upon the direct instruction of a Nurse-Trainer, authorized direct care staff may indicate on the MAR completion of the 136 116.70 Medication Administration Record and Required Documentation following actions: A) discontinuation of medication;

B) change in medication schedule; and/or C) application of a medication information label with a medication by a licensed pharmacy 137 POLL Where should the MAR be kept? 1.

2. 3. 4. With the individuals clinical record. In the individuals room. In the Nurse-Trainers possession. With the medications With the medications 138

116.70 Medication Administration Record and Required Documentation 6) Individual refusal to take medications shall be noted on the MAR. Authorized direct care staff shall document in the individuals record the reasons for refusal and notify the registered professional nurse, NurseTrainer, or person licensed to prescribe medication in Illinois to receive direction on 139 116.70 Medication Administration Record

and Required Documentation on any action to be taken. Refusal of medication by an individual is not considered a medication error. 7) For individuals who are independently selfadministering medications, no MAR is required. However, any medication that individuals take shall be listed in their records, including 140 116.70 Medication Administration Record and Required Documentation 7) contd

dosage, frequency, and identity of the prescribing physician, advanced practice nurse, physician assistant, podiatrist, or certified optometrist. 141 116.70 Medication Administration Record and Required Documentation 7) contd Each agency shall develop and implement a quality assurance system to ensure that

self-administered medications are taken in accordance with prescribed orders. 142 116.70 Medication Administration Record and Required Documentation (1) c) In the event of a medication error, authorized direct care staff shall immediately report the error to the registered professional nurse, Nurse-Trainer or person licensed to prescribe medication in Illinois to receive direction on

any action to be taken. 143 116.70 Medication Administration Record and Required Documentation (2) c) All medication errors shall be documented in the individuals record and a medication error report shall be completed within eight hours or before the end of the shift in which the error was discovered, whichever is earlier. The medication error report shall be sent to

the Nurse-Trainer for review and further action within 7 calendar days after the occurrence. 144 116.70 Medication Administration Record and Required Documentation (3) c) . A copy of the medications error report shall be maintained as part of the agencys quality assurance program. Medication errors must documented and are subject to review by DHS or DPH, whichever is

applicable. 145 116.70 Medication Administration Record and Required Documentation (4) c) . Medication errors that meet the reporting criteria of DHS rules on Office of Inspector General Investigations of Alleged

Abuse or Neglect or Deaths in StateOperated and Community Agency Facilities (59 III. Adm. Code 50) shall be reported to the Office of Inspector General. 146 116.70 Medication Administration Record and Required Documentation(1) d) In the event of a suspected drug reaction, authorized direct care staff shall immediately report the signs and symptoms to the registered professional nurse, advanced practice nurse, physician, physician assistant,

dentist, podiatrist, or certified optometrist to receive direction on any action to be taken. 147 116.70 Medication Administration Record and Required Documentation(2) d) . All adverse drug reactions shall be documented in the individuals record and an adverse drug reaction report shall be completed within eight hours or before the end of the shift in which the reaction was discovered, whichever is earlier.

148 116.70 Medication Administration Record and Required Documentation (3) d). The adverse drug reaction report shall be sent to the prescriber and Nurse-Trainer for review and further action. A copy of the adverse drug reaction report shall be maintained as part of the agencys quality assurance program.

149 116.70 Medication Administration Record and Required Documentation (1) e) An inventory and a record of use of controlled substances shall be maintained by the registered professional nurse in the program, and each sub-stance shall require a separate sheet indicating the: 1) name of the individual; 2) name of the prescriber; 150

116.70 Medication Administration Record and Required Documentation (2) e) inventory . indicating: 3) prescription number; 4) name of the drug and strength; 5) amount used; 6) amount remaining; 7) time and date administered; 8) name of the individual who administered the medication; and

151 116.70 Medication Administration Record and Required Documentation (3) e) inventory . indicating the: 9) documentation of a shift count done by authorized direct care staff. Any discrepan-ies shall be reported to the Nurse-Trainer for review and action in accordance with written policy. 152

116.70 Medication Administration Record and Required Documentation 9) A) A shift count must be completed when the responsibility for administering medications changes from one authorized direct care staff or nurse to another authorized direct care staff or nurse 153 116.70 Medication Administration Record

and Required Documentation 9) B) The authorized direct care staff or nurse passing on responsibility for medication administration will count the controlled substances with the authorized direct care staff or nurse assuming responsibility for medication administration. 154 116.70 Medication Administration Record and Required Documentation

9) C) The count completed when a controlled substance is administered is not considered a shift count. f) Host Family Community Integrated Living Arrangements as described in 59 III. Adm. Code 115 must develop a quality assurance procedure to ensure accurate inventory & record of use of controlled substances. 155 POLL

How many staff persons are required for a shift count? 1. 2. 3. 4. One Two Three

No shift count is required One 156 Storage and Disposal of Medications 116.80 157

116.80 Storage and Disposal of Medications a) All medications shall be stored in locked compartments or within the locked medicine container, cabinet or closet. b) Access to medications shall be limited to licensed personnel and authorized direct care staff. Each program shall maintain an up-todate list of authorized direct care staff. 158 116.80 Storage and Disposal of Medications c) Each program shall have a written procedure

for safeguarding medications kept in an individuals room or possession and shall require medications to be stored when individual safety cannot otherwise be assured. d) All medications shall be stored in their original containers. 159 116.80 Storage and Disposal of Medications e) All prescription medications that are given to individuals at the direction of the

physician, registered professional nurse, advanced practice nurse, pharmacist, physician assistant, dentist, podiatrist, or certified optometrist shall have a label with the same information as would appear on 160 116.80 Storage and Disposal of Medications e) a pharmacy label in accordance with Section 22 of the Illinois Pharmacy Practice Act [225 ILCS 85] to show: 1) the name and address of the pharmacy

where the prescription is sold or dispensed; 161 116.80 Storage and Disposal of Medications e) 2) the name or initials of the person authorized to practice pharmacy; 3) the date on which the prescription was filled; 4) the name of the patient; 162

116.80 Storage and Disposal of Medications e) 5) the prescription number as filled in the prescription files; 6) the last name of the practitioner who prescribed the prescription; 7) the directions for use as contained in the prescription; and 163 116.80 Storage and Disposal of Medications

e) 8) the proprietary name or names or the established name of the medications, the dosage and the quantity. f) Disposal of all medication shall be in accordance with federal and state laws. 164 116.80 Storage and Disposal of Medications www.EPA.state.il.us/medication disposal/faq.html www.DisposeMyMeds.org

www.drug-buster.com/home.html www.rxdestroyer.com 165 116.90 Individual Health Supports and Assessment a) The registered professional nurse shall assess an individuals health status at least annually or more frequently at the discretion of the

registered professional nurse. 166 116.90 Individual Health Supports and Assessment b) A physician, advance practice nurse or physician assistant shall assess an individuals health status at least annually or more frequently at the discretion of the physician or at the request of the agency or the registered professional nurse.

167 116.100 Quality Assurance 168 116.100 Quality Assurance (1) a) A registered professional nurse, advanced practice nurse, licensed practical nurse, pharmacist or physician shall review the following for all individuals: 1) medication orders;

2) Medication labels & medications listed on the MAR to ensure that they match the physician orders; and 169 116.100 Quality Assurance (2) 3) MAR (for persons who are not selfmedicating to ensure that they are completed appropriately for: A) Medication administer as prescribed B) refusal by the individual; and C) full signatures provided for all initials used

170 116.100 Quality Assurance b) Reviews, as described in subsection (a) shall occur at least quarterly, but may be done more frequently at the discretion of the registered professional nurse and/or advanced practice nurse. 171 116.100 Quality Assurance c) At least annually, the agency, inclusive of the NurseTrainer, shall summarize & analyze all medication

errors to identify patterns & trends and establish corresponding corrective action. The analysis & corrective action must be documented Documentation should be retained by agency for at least 5 years 172 116.100 Quality Assurance d) All quality assurance records shall be confidential and may only be disclosed in accordance with Article VIII, Part 21 of the

code of Civil Procedure [735 ILCS 5/8-2101 through 8-2105]. 173 116.100 Quality Assurance f) Nothing in this Part shall limit or restrict the reporting of medication errors as possible abuse or neglect or the investigation by the Office of Inspector General of possible abuse or neglect in accordance with the Departments rules

174 116.100 Quality Assurance f) . on Office of Inspector General Investigations of Alleged Abuse or Neglect and Deaths in State-Operated and Community Agency Facilities (59 Ill. Adm. Code 50) 175

116.110 Administrative Requirements 176 116.110 Administrative Requirements a) Written policies and procedures shall be developed by each agency that include: 1) Provisions for on-going supervision and monitoring of authorized direct care staff. 2) Provisions for annual review and any necessary retraining of authorized direct

care staff in theory and practice of medication administration. 177 116.110 Administrative Requirements a) policies and procedures...include: 3) Provisions for a systematic review of all medication errors, adverse drug reactions, and incidents to identify contributing factors and plan corrective action.

178 116.110 Administrative Requirements a) policies and procedures ...include: 4) Provisions for recording and reporting of all instances of retraining and retesting for failure to qualify as an authorized direct care staff. 179

116.110 Administrative Requirements (1) b) Each program shall have written policies and procedures to include the governing of: 1) distribution of medications, including controlled substances, and persons authorized to distribute medications; 2) administration of medications; 3) quality assurance medication review; 180 116.110 Administrative Requirements (2)

b) Each program written policies and procedures to include the governing of: 4) Storage and safekeeping of medications; 5) Disposal of medication including controlled substances; and 6) training, review and necessary retraining of authorized direct care staff. 181 116.110 Administrative Requirements c) Policies and procedures shall be

consistent with applicable rules regulations, and federal and State law. d) Each program shall have a copy of all policies and procedures related to medication administration on file and readily available to all programs at all times. 182 183 184

185 186 187 188 Changes in Rule 116 (1) Public Act 98-0901 was passed August

15, 2014. Amended Section 15.4 of the Mental Health and Developmental Disabilities Act This is the section that requires the development of a training program for authorized direct care staff to administer medications under the supervision of a RN. 189

Changes in Rule 116 (2) Staff are no longer limited to administration of just oral and topical medications. Medications has been modified to include: oral and topical medications, insulin in an injectable form, oxygen, epinephrine auto-injectors, and vaginal and rectal creams and suppositories.

190 Changes in Rule 116 (3) Oral includes inhalants and medication administered through enteral tubes, using aseptic technique. Insulin in an injectable form means a

subcutaneous injection via an insulin pen pre-filled by the manufacturer. 191 Changes in Rule 116 (4) Authorized staff CAN administer insulin

with an insulin pen if: they successfully complete Department approved advanced training. Consults with the RN prior to administration any insulin dose determined by blood sugar result. 192 Changes in Rule 116

(5) Authorized staff shall NOT administer insulin by insulin pen if: Calculation of the insulin dose needed when the dose is blood glucose dependent or The individual requires blood glucose

monitoring greater than 3 times daily unless directed to do so by the registered nurse. 193 Changes in Rule 116 (6) Rule 116 changes are happening but the

Division must consider both public and government in rewriting the Rule and implementing the changes. Please be patient. YOU CANNOT IMPLEMENT ANY RULE 116 CHANGE UNTIL EVERYTHING IS FINALIZED. 194 Poll

I can practice as a Nurse-Trainer as soon as this class is over. 1. True 2. False 195 Testing Email Request/Approval for RN Nurse-Trainer to:

[email protected] or fax to: Sandra Bancroft, (217) 782-9444. You will receive email notification for taking Post-Test from Division of Developmental Disabilities. OPEN Give BOOK TEST but do it alone.

the BEST answer. Dont argue with the test questions. Stick to Rule 116 and the class materials/discussion. Take

your time, USE RULE! (Revised 5-4-16) 196 Testing You cannot practice as a Nurse-Trainer until test completion with a score of 90% or better and receive documentation of your NurseTrainer approval. Upon Nurse-Trainer approval, your name will

be added to the state Nurse-Trainer database. Those who are already Nurse-Trainers will not take the test. Any communication about test is through [email protected] (Revised 5-4-16) 197

Helpful Website Illinois Department of Human Services http://www.dhs.state.il.us/page.aspx?item=27893 Illinois Nurse Practice Act and Administrative Rule 116 http://www.ilga.gov/commission/jcar/admincode/059/059 00116sections.html

Training Requirements Manual http://www.dhs.state.il.us/page.aspx?item=48120 Office of the Inspector General (OIG)

http://www.dhs.state.il.us/page.aspx?item=29410 198 Continuing Education Credit (CEs) Five (5) hours of documented Continuing Education (CE) Credit are awarded for attendance at all three webinars. To document your viewing of the pre-recorded Webinar see #7 under Documenting CEs link at: http://www.dhs.state.il.us/page.aspx?item=45329

To document your attendance at the live Webinars 1 and 2, see #6 under Documenting CEs link at: http://www.dhs.state.il.us/page.aspx?item=45329 CEs will not be added to the DHS OneNet Training Module system transcripts. For RNs only, after completing the IDHS CBL exam your exam score and CEs will be added to the DHS OneNet Training Module system transcript. Upon request to an RN transcript can be emailed. (Revised 5-4-16)

199 THANK YOU for your attention and attendance. Have a good week. 200

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