DAR File No. 41323

Health, Family Health and Preparedness, Licensing

Rule R432-700

Home Health Agency Rule

Notice of Proposed Rule

(Amendment)

DAR File No.: 41323
Filed: 02/15/2017 03:23:58 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule amendment is to add requirements to allow for a Licensed Health Care Professional to delegate medication administration to unlicensed personnel in accordance with the Nurse Practice Act and Section R156-31B-701, as well as to amend incorrect references and wording. The Health Facility Committee reviewed and approved these rule amendments on 02/08/2017.

Summary of the rule or change:

The rule amendment is to add requirements to allow for a licensed health care professional working for a home health agency to delegate medication administration to unlicensed personnel in accordance with the Nurse Practice Act and Section R156-31B-701, as well as to amend incorrect references and wording.

Statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because there will be no change in current practice.

local governments:

There is no impact to local government budgets because there will be no change in current practice.

small businesses:

There is no impact to small business budgets because there will be no change in current practice.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to businesses, individuals, local governments, and persons that are not small businesses because there will be no change in current practice.

Compliance costs for affected persons:

There is no impact to affected persons because there will be no change in current practice.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no fiscal impact to business because the amendment does not change current practice as allowed by law.

Joseph Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-273-2804, by FAX at 801-274-0658, or by Internet E-mail at [email protected]
• Carmen Richins at the above address, by phone at 801-273-2802, by FAX at 801-274-0658, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/31/2017

This rule may become effective on:

04/07/2017

Authorized by:

Joseph Miner, Executive Director

R432. Health, Family Health and Preparedness, Licensing.

R432-700. Home Health Agency Rule.

R432-700-4. Definitions.

(1) See common definitions rule R432-1-3.

(2) Special definitions:

(a) "Branch Office" means a location from which a home health agency provides services within a portion of the total geographic area served by the parent agency. The branch office is a part of the parent home health agency and shares administration and services.

(b) "Licensed health care professional" means a registered nurse, physician assistant, advanced practice registered nurse, or physician licensed by the Utah Department of Commerce who has education and experience to assess and evaluate the health care needs of the resident.

(c) "Parent Home Health Agency" means the agency that has administrative control of branch offices.

([c]d) "Service Agreement" means a written agreement for services between the client and the personal care provider which outlines how the services are to be provided according to the requirements of R432-700-[30]24.

 

R432-700-8. Governing Body and Policies.

(1) The home health agency shall be organized under a governing body that assumes full legal responsibility for the conduct of the agency.

(2) The administrative structure of the agency must be shown by an organization chart.

(3) The governing body shall assume responsibility to:

(a) Comply with all federal regulations, state rules, and local laws;

(b) Adopt policies and procedures which describe functions or services of the home health agency and protect patient rights;

(c) Adopt a statement that there is no discrimination because of race, color, sex, religion, ancestry, or national origin[ (Sections 13-7-1 through 4)];

(d) Develop and implement bylaws which shall include at least:

(i) A statement of purpose;

(ii) A statement of qualifications for membership and methods to select members of the governing board;

(iii) A provision for the establishment, selection, and term of office for committee members and officers;

(iv) A description of functions and duties of the governing body, officers, and committees;

(v) A statement of the authority and responsibility delegated to the administrator;

(vi) A policy statement relating to conflict of interest of members of the governing body or employees who may influence agency decisions;

(vii) Meet as stated in bylaws, at least annually;

(viii) Appoint by name and in writing a qualified administrator who is responsible for the agency's overall functions.

(4) [Notify the licensing agency the name of a new administrator in writing no later than five days after hire.

(5) ]Review the written annual evaluation report from the administrator and make recommendations as necessary. Documentation of this review shall be available to the Department.

([6]5) Make provision for resources and equipment to provide a safe working environment for personnel.

([7]6) Establish a system of financial management and accountability.

 

R432-700-10. Personnel.

(1) The administrator shall employ qualified personnel who are competent to perform their respective duties, services, and functions.

(2) The agency shall develop written policies and procedures that address at least the following:

(a) Job descriptions, qualifications, validation of licensure or certificates of completion for each position held;

(b) Orientation for direct and contract employees;

(c) Criteria for, and frequency of, performance evaluations;

(d) Work schedules; method and period of payment; fringe benefits such as sick leave, vacation, insurance, etc.;

(e) Frequency and documentation of in-service training;

(f) Contents of personnel files.

(3) Each employee shall be licensed, certified or registered as required by the Utah Department of Commerce, Division of Occupational and Professional Licensing.

(4) Failure to ensure that all staff are licensed, certified or registered may result in sanctions to the agency license.

(5) [Copies shall be maintained for Department review that all staff have a current license, certificate, or registration. New employees shall have 45 days to present the original document.

(6) ]An annual in-service shall be documented that staff have been trained in the reporting requirements for suspected abuse, neglect and exploitation.

 

R432-700-11. Health Surveillance.

(1) The agency shall establish and implement a policy and procedure for health screening of all agency health care workers (persons with direct patient contact) to identify any situation which would prevent the employee from performing assigned duties in a satisfactory manner.

(2) Employee health screening and immunization components of personnel health programs shall be developed in accordance with R386-702, Communicable Disease Rules.

(3) Employee skin testing by the Mantoux Method or other FDA approved in-vitro serologic test and follow up for tuberculosis shall be done in accordance with R388-804, Special Measures for Control of Tuberculosis.

(a) The licensee shall ensure that all employees are skin-tested for tuberculosis within two weeks of:

(i) initial hiring;

(ii) suspected exposure to a person with active tuberculosis; and

(iii) development of symptoms of tuberculosis.

(b) Skin testing shall be exempted for all employees with known positive reaction to skin tests.

(4) All infections and communicable diseases reportable by law shall be reported by the facility to the local health department in accordance with R386-702-[2]3.

 

R432-700-21. Nursing Services.

(1) Nursing services provided through a home health agency shall be under the supervision of a director of nursing services.

(2) Nursing services shall be provided by or under the supervision of a registered nurse and according to the plan of care.

(3) When an agency provides or contracts for services, the service shall be provided according to the plan of care and supervised by designated, qualified personnel.

(4) Nursing staff shall observe, report, and record written clinical notes.

(5) Nursing services should recognize and use opportunities to teach health concepts to the patient and family.

(6) All registered nurses or licensed practical nurses employed by, or on contract with, the agency shall have a valid license from the Utah Department of Commerce, Title 58, Chapter 31b.

(7) Licensed nurses shall have the following responsibilities:

(a) Administer prescribed medications and treatments according to law and as permitted within the scope of the individual's license;

(b) Perform nursing care according to the needs of the patient and as indicated in the written plan of care;

(c) Inform the physician and other personnel of changes in the patient's condition and needs;

(d) Write clinical notes in the individual patient record for each visit or contact;

(e) Teach self-care techniques to the patient or family, or both;

(f) Develop plans of care;

(g) Participate in in-service programs.

(8) The director of nursing services shall be responsible for and shall be accountable for the following functions:

(a) Designate a registered nurse to act as director of nursing services during his absence;

(b) Assume responsibility for the quality of nursing services provided by the agency;

(c) Develop nursing service policies and procedures that must be reviewed annually and revised as necessary;

(d) Establish work schedules for nursing personnel according to patient needs;

(e) Assist in development of job descriptions for nursing personnel;

(f) Complete performance evaluations for nursing personnel according to agency policy;

(g) Direct in-service programs for all nursing personnel.

(9) In addition to the general responsibilities, a registered nurse shall have the following responsibilities:

(a) Make the initial nursing evaluation visit;

(b) Re-evaluate nursing needs based on the patient's status and condition;

(c) Initiate the plan of care and make necessary revisions;

(d) Provide services which require specialized nursing skill;

(e) Initiate appropriate preventive and rehabilitative nursing procedures;

(f) Supervise staff assignments based on specific patient needs, family capabilities, staff training and experience, and degree o[t]f supervision needed;

(g) Assist in coordinating all services provided;

(h) Prepare termination of services statements;

(i) Supervise and consult with licensed practical nurses as necessary;

(j) Provide written instructions for certified nursing aide to ensure provision of required services written in the plan of care;

(k) Supervise certified nursing aide in the patient's home as necessary, and be readily available for consultation by telephone;

(l) Make supervisory visits with or without the certified nursing aide's presence as follows:

(i) Initial assessment;

(ii) Every two weeks to patients who receive skilled services;

(iii) Every three months to patients who require long-term maintenance services;

(iv) Any time there is a question of change in the patient's condition.

(10) The licensed practical nurse shall have the following responsibilities:

(a) Work under the supervision of a registered nurse;

(b) Observe, record, and report to the immediate supervisor the general physical or mental condition of the patient;

(c) Assist the registered nurse in performing specialized procedures;

(d) Assist in development of the plan of care.

 

R432-700-22. Certified Nursing Aide.

(1) [The c]Certified nursing aides [shall]may have the following responsibilities:

([1]a) Provide only those services written in the plan of care and received as written instructions from the registered nurse supervisor. If the service is an extension of therapy, the instructions shall be written by the licensed therapist;

([2]b) Perform normal household services essential to health care at home;

([3]c) Make occupied or unoccupied beds;

([4]d) [The certified nursing aide may ]S[s]upervise the patient's self-administration of medication by:

([a]i) Reminding the patient it is time to take medications;

([b]ii) Opening the bottle cap;

([c]iii) Reading the medication label to patients;

([d]iv) Checking the self-administered dosage against the label of the container;

([e]v) Reassuring the patient that [he is taking the correct]the dose being taken is correct;

([f]vi) Observing the patient taking [his ]the medication.

([5]e) [Perform simple diagnostic activities]Observe, record and/or report basic patient status;

([6]f) Perform activities of daily living as written in plan of care;

([7]g) Give nail care as described in the plan of care;

([8]h) Observe and record food and fluid intake when ordered;

([9]i) Change dry dressings according to written instructions from the supervisor;

([10]j) Administer emergency first aid;

([11]k) Provide escort and transportation to doctor's appointments and elsewhere as part of patient-care services;

([12]l) Provide social interaction and reassurance to the patient and family in accordance with the plan of care;

([13]m) Write clinical notes in individual patient records.

([14]2) Certified Nursing Aides shall be at least 18 years old.

([15]3) Certified Nursing Aides shall have received a certificate of completion for the employment position[:

(a) The curriculum or the comparable challenge exam shall be offered under the direction of the Utah Board of Education;

(b) If the employee does not have a certificate of completion for the position at the time of employment, completion of the course of study or challenge exam shall occur] within six months of the date of hire.

(4) Certified Nursing Aides must be certified in cardiopulmonary resuscitation and emergency procedures.

 

R432-700-25. Medication and Treatment.

(1) [Medications or s]Skilled treatments shall be administered only by licensed personnel to comply with signed orders from a person lawfully authorized to give the order. This order may be remotely given[over the telephone] but shall be subsequently signed by the person giving the order within 31 days.

(2) Medications shall be administered according to signed orders from a person lawfully authorized to give the order. This order may be remotely given but shall be subsequently signed by the person giving the order within 31 days.

(3) All[telephone] orders remotely given shall be received and verified only by licensed personnel lawfully authorized to accept the order. [Telephone]Remotely given orders shall be recorded in the patient's record.

([3]4) If medications are administered by agency personnel, the orders and subsequent changes in orders, shall be signed by the physician and included in the patient's record.

(5) Unlicensed staff may administer medications only after delegation by a licensed health care professional under the professional scope of practice.

(i) If a licensed health care professional delegates the task of medication administration to unlicensed assistive personnel, the delegation shall be in accordance with the Nurse Practice Act and R156-31B-701;

(ii) The medications must be administered according to the prescribing order;

(iii) The delegating authority must provide and document supervision, evaluation, and training of unlicensed assistive personnel assisting with medication administration;

(iv) The delegating authority or another registered nurse shall be readily available either in person or by telecommunication; and

(v) Delegation to unlicensed staff shall not include delegating medication set up for subsequent medication administration.

([4]6) Orders for therapy services shall include the procedures to be used, the frequency of therapy, and the duration of therapy.

([5]7) Orders for skilled services shall be reviewed or renewed by the attending physician at intervals not to exceed 63 days. Physician's signature and date shall be evidence of this review or renewal.

([6]8) Physician orders may be transmitted by facsimile machine. The agency must be able to obtain the original signature, upon request, if verification of the signature is requested.

 

R432-700-27. Medical Supplies and Equipment.

(1) The agency shall develop and follow written policies and procedures which describe:

([1]a) Agency provision of or use of durable medical equipment, and disposable and semi-disposable medical supplies;

([2]b) Categories of medical supplies and equipment available through the home health agency;

([3]c) Charges and reimbursement for medical supplies and equipment;

([4]d) Processes for billing medical supplies and equipment to the patient, insurance carrier, or other payment source.

 

R432-700-30. Penalties.

Any person who violates any provision of this rule may be subject to the penalties enumerated in 26-21-11 and R432-3-[6]7 and be punished for violation of a class A misdemeanor as provided in 26-21-16.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [October 1, 2011]2017

Notice of Continuation: September 15, 2016

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-2.1