Louisiana Administrative Code › Title 46 - PROFESSIONAL AND OCCUPATIONAL STANDARDS › Part XLVII - Nurses: Practical Nurses and Registered Nurses › Subpart 2 - Registered Nurses › Chapter 37 - Nursing Practice › Section XLVII-3709 - Delegation of Medication Administration to Unlicensed Assistive Personnel in Outpatient Clinic Settings

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Introduction. Registered nurses and advanced practice registered nurses may
				  delegate medication administration in outpatient clinic settings for patients
				  with stable and predictable health conditions under specific provisos as
				  provided for in this Subpart. When delegating to unlicensed assistive
				  personnel, the registered nurse or advanced practice registered nurse is
				  authorizing the unlicensed assistive personnel to perform a task that is
				  normally within the registered nurses or advanced practice registered nurses
				  scope of practice. Prior to agreeing to delegate tasks including medication
				  administration, the registered nurse or advanced practice registered nurse is
				  responsible for understanding rules relative to delegating nursing care and for
				  achieving the competence to delegate and supervise.
B. Definitions
Administration of Medication
-removal of an
					 individual dose from a previously dispensed or distributed, properly labeled
					 container, verifying the dose and medication with the prescribers order, giving
					 the individual dose to the proper patient at the proper time by the proper
					 route and promptly recording the time and dose given.
Delegation
-entrusting the performance of
					 selected nursing tasks by the registered nurse to other competent nursing
					 personnel in selected situations. The registered nurse or advanced practice
					 registered nurse retains the accountability for the total nursing care of the
					 individual. The registered nurse and advanced practice registered nurse is
					 responsible for and accountable to each consumer of nursing care for the
					 quality of nursing care he or she receives, regardless of whether the care is
					 provided solely by the registered nurse/advanced practice registered nurse or
					 by the registered nurse/advanced practice registered nurse in conjunction with
					 other licensed or unlicensed assistive personnel.
Direct Supervision
-the registered nurse or
					 advanced practice registered nurse is physically present in the office or suite
					 where the procedure, including medication administration, is being performed at
					 all times that the unlicensed assistive personnel is on duty providing
					 services. Direct supervision also includes ongoing oversight, follow-up and
					 evaluation of the individual patient and the ongoing oversight, follow-up and
					 evaluation of competency of the unlicensed assistive personnel.
Outpatient Clinic Setting
-nonresidential
					 facilities, that provides treatment for health conditions that is obtained on
					 an outpatient basis which allows patients to return to and function in their
					 usual environment. Outpatient clinic settings for the purpose of this subpart
					 do not include facilities such as hospitals, emergency rooms, and ambulatory
					 surgical centers.
Person-Specific
-health care needs and
					 related factors in order to meet the unique needs of the specific person
					 receiving care.
Stable and Predictable
-a situation in
					 which the persons clinical and behavioral status is determined by a licensed
					 registered nurse or advanced practice registered nurse to be non-fluctuating
					 and consistent. A stable and predictable condition involves long term health
					 care needs which are recuperative in nature, do not require the regular
					 scheduled presence or reassessment of a licensed nurse, and is not
					 characterized by rapid changes.
Unlicensed Assistive Personnel
-an
					 unlicensed individual who is trained to function in an assistive role to the
					 licensed nurse in the provision of patient activities as delegated by the
					 nurse. Unlicensed assistive personnel have no authority to provide nursing
					 care, despite any education or training, without the delegation of such care
					 and tasks from registered nurses or advanced practice registered
					 nurses.
C. Responsibilities.
				  Registered nurses and advanced practice registered nurses may delegate
				  medication administration in outpatient clinic settings provided the following
				  conditions are met.
1. The registered nurse
				  or advanced practice registered nurse has assessed the health status of the
				  individual immediately prior to the delegation, and the patients health
				  condition is determined to be stable and predictable.
2. The registered nurse or advanced practice
				  registered nurse provides direct supervision and retains the accountability for
				  the total nursing and advanced practice nursing care of the individual and
				  retains the responsibility to:
i. assess the
				  patient;
ii. develop and implement
				  the plan of care;
iii. determine
				  that the medication administration can be safely and legally
				  delegated;
iv. ensure the
				  medication administration is properly documented in the patients
				  record;
v. ascertain the training
				  and competency of the unlicensed assistive personnel to whom the registered
				  nurse or advanced practice registered nurse delegates the administration of
				  medication;
vi. rescind the
				  delegation if the patients condition changes, it is determined that the
				  unlicensed assistive personnel is not safe or competent to administer the
				  medication, or as otherwise determined by the registered nurse or advanced
				  practice registered nurse.
3. The delegation of medication
				  administration to unlicensed assistive personnel must be person-specific, and
				  the unlicensed assistive personnel must:
i.
				  be adequately trained for the task;
ii. have demonstrated that the task has been
				  learned;
iii. be able to perform
				  the task safely in the given nursing situation;
iv. be safe for the person to carry out the
				  task;
v. have appropriate
				  supervision available during the task implementation.
4. The delegation of medication
				  administration by the unlicensed assistive personnel must be an established
				  policy of the practice setting and include all aspects of LAC 46:XLVII.3709.G
				  at a minimum. The policy must be written, recorded, and available to
				  all.
5. The registered nurse or
				  advanced practice registered nurse and the unlicensed assistive personnel must
				  be employed by the same organization or otherwise be formally accountable to
				  the same institution or organization.