Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 2200 - State Board of Nursing › Chapter 6 - Intravenous Infusion Treatment Administration › Section 20 CSR 2200-6.030 - Intravenous Infusion Treatment Administration by Qualified Practical Nurses; Supervision by a Registered Professional Nurse

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This emergency amendment will lift the IV
				  push or bolus medication administration restriction on qualified practical
				  nurses and list two (2) additional types of IV medication that qualified
				  practical nurses will not administer. The need for these changes was determined
				  after the Board of Nursing reviewed a petition for rule review sent by a
				  practicing Licensed Practical Nurse (LPN). It has been determined that
				  restricting qualified practical nurses from utilizing the IV push or bolus
				  route of medication administration places an undue interruption and delay in
				  patient care.
EMERGENCY STATEMENT: Pursuant to 536.041, RSMo, any
				  person may file a written petition with an agency requesting the adoption,
				  amendment, or repeal of any rule. On November 30, 2023, during an open public
				  meeting, an LPN presented a petition to the Missouri State Board of Nursing
				  explaining the patient safety risk with the current restrictive rule. He
				  described that when one of his patients requires an IV push medication for
				  pain, for example, he must stop his care of all his patients and locate a
				  registered nurse (RN) to administer the IV push pain medication. This causes a
				  tremendous delay in patient care. The RN then must leave his or her patients
				  and administer the medication to the LPN's patient. Often the RN does not know
				  any history about the patient and may have to ask the LPN for information about
				  the patient in order to better understand the patient's needs. This activity
				  may occur multiple times during a shift and with multiple qualified practical
				  nurses and patients. Missouri, like most other states across the country, is
				  experiencing a nursing and healthcare workforce shortage. The Missouri State
				  Board of Nursing understands that qualified practical nurses and other health
				  care providers need to be permitted to practice to the fullest extent of their
				  education, skill, and ability.
Pursuant to the criteria in section
				  536.175, RSMo, the Missouri
				  State Board of Nursing approved the petition for the proposed amendment to
				  20 CSR
				  2200-6.030(6) and (7). Regulations
				  impacting patient care that have been longstanding, obsolete, and not based
				  upon evidence should be removed.
The Board of Nursing believes this emergency
				  amendment will permit facilities who employ qualified practical nurses to
				  immediately develop their educational program and begin educating their nurses
				  on this practice in order to address the interruption and delay in patient care
				  related to the above-described practice issue. As a result, the Board of
				  Nursing finds a compelling governmental interest, which requires this emergency
				  action. A proposed amendment, which covers the same material, is published in
				  this issue of the Missouri Register. The scope of this emergency amendment is
				  limited to the circumstances creating the emergency and complies with the
				  protections extended in the Missouri and United States Constitutions. The Board
				  of Nursing believes this emergency amendment is fair to all interested persons
				  and parties under the circumstances. This emergency amendment was filed January
				  5, 2024, becomes effective January 22, 2024, and expires July 19,
				  2024.
(1) Qualified practical
				nurses shall only perform venous access and intravenous (IV) infusion treatment
				modalities according to the specific provisions of section
				335.016, RSMo,
				20 CSR 2200-5.010,
				and this chapter. A qualified practical nurse shall only perform such
				activities under the direction and supervision of a registered professional
				nurse or a person licensed by a state regulatory board to prescribe medications
				and intravenous infusion treatments (hereinafter the "licensed
				prescriber").
(2) Qualified
				practical nurses who perform venous access and intravenous infusion treatment
				modalities shall:
(A) Maintain accountability
				to the registered professional nurse or licensed prescriber who is directing
				and supervising the individual's practical nursing care acts involving venous
				access and intravenous infusion treatment modalities;
(B) Maintain ongoing, documented, specialized
				knowledge, education, skills, training, judgment, and experience related to
				practical nursing care acts involving venous access and intravenous infusion
				treatment modalities;
(C) Ensure
				that appropriate, authorized prescriber orders for patient care involving
				venous access and intravenous infusion treatment modalities are in place before
				patient care is begun;
(D) Only
				engage in practical nursing care acts involving venous access and intravenous
				infusion treatment modalities that are within the individual's authorized scope
				of practice as specified in section
				335.016, RSMo,
				20 CSR 2200-5.010,
				and this chapter; and
(E) Only
				engage in practice consistent with lawful written policies and procedures of
				the individual's employer as well as any state or federal laws applicable to
				the individual's employer.