Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.4 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
(1) Activities of daily
				living (ADLs)--limited to the following activities: bathing, dressing,
				grooming, routine hair and skin care, meal preparation, feeding, exercising,
				toileting, transfer/ambulation, positioning, range of motion, and assistance
				with self administered medications. The term does not include more specific
				tasks defined as health maintenance activities under paragraph (8) of this
				section (relating to Health Maintenance Activities).
(2) Administration of Medications--removal of
				an individual/unit dose from a previously dispensed, properly labeled
				container; verifying it with the medication order; giving the correct
				medication and the correct dose to the proper client at the proper time by the
				proper route; and accurately recording the time and dose given.
(3) Assistance with self-administered
				medication--any needed ancillary aid provided to a client in the client's
				self-administered medication or treatment regimen, such as reminding a client
				to take a medication at the prescribed time, opening and closing a medication
				container, pouring a predetermined quantity of liquid to be ingested, returning
				a medication to the proper storage area, and assisting in reordering
				medications from a pharmacy.
(4)
				Client--the individual receiving care.
(5) Client's Responsible Adult--an
				individual, 18 or older, normally chosen by the client, who is willing and able
				to participate in decisions about the overall management of the client's health
				care and to fulfill any other responsibilities required under this chapter for
				care of the client. The term includes but is not limited to parent, foster
				parent, family member, significant other, or legal guardian.
(6) Delegation--means that a registered nurse
				authorizes an unlicensed person to perform tasks of nursing care in selected
				situations and indicates that authorization in writing. The delegation process
				includes nursing assessment of a client in a specific situation, evaluation of
				the ability of the unlicensed persons, teaching the task, ensuring supervision
				of the unlicensed persons and re-evaluating the task at regular intervals. It
				does not include situations in which an unlicensed person is directly assisting
				a RN by carrying out nursing tasks in the presence of a RN.
(7) Functional Disability--a mental,
				cognitive, or physical disability that precludes the physical performance of
				self-care tasks, including health maintenance activities and ADLs.
(8) Health Maintenance Activities
				(HMAs)--tasks that may be exempt from delegation based on RN assessment that
				enable the client to remain in an independent living environment and go beyond
				ADLs because of the higher skill level required to perform. HMAs include the
				following:
(A) administering oral medications
				that are normally self-administered, including administration through a
				permanently placed feeding tube with irrigation;
(B) topically applied medications;
(C) insulin or other injectable medications
				prescribed in the treatment of diabetes mellitus administered subcutaneously,
				nasally, or via an insulin pump;
(D) unit dose medication administration by
				way of inhalation (MDIs) including medications administered as nebulizer
				treatments for prophylaxis and/or maintenance;
(E) routine administration of a prescribed
				dose of oxygen;
(F) noninvasive
				ventilation (NIV) such as continuous positive airway pressure (CPAP) and
				bi-level positive airway pressure (BiPAP) therapy;
(G) the administering of a bowel and bladder
				program, including suppositories, enemas, manual evacuation, intermittent
				catheterization, digital stimulation associated with a bowel program, tasks
				related to external stoma care including but not limited to pouch changes,
				measuring intake and output, and skin care surrounding the stoma
				area;
(H) routine preventive skin
				care and care of Stage 1 pressure ulcers;
(I) feeding and irrigation through a
				permanently placed feeding tube inserted in a surgically created orifice or
				stoma;
(J) those tasks that an RN
				may reasonably conclude as safe to exempt from delegation based on an
				assessment consistent with §
										225.6
				of this title (relating to RN Assessment of the Client); and
(K) such other tasks as the Board may
				designate.