Commerce, Occupational and Professional Licensing

Section R156-31b-701a

Delegation of Nursing Tasks in a School Setting

Notice of Proposed Rule

(Amendment)

DAR File No.: 33266
Filed: 12/14/2009 01:00:03 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division and the Board of Nursing reviewed this rule and determined that amendments are necessary to amend the rule regarding delegation of medications in the school setting to indicate when delegation is appropriate based on the effects of the medication. The proposed amendments require any unlicensed person who administers medication to be trained annually by a school nurse. Specific requirements for insulin and glucagon were deleted because the information is subsumed in the nonspecific language in the section. Having specifically addressed two drugs, school nurses were unsure how to deal with drugs not mentioned in this section. It was determined that it would be better to address the issue of medications and medication administration in the school setting in general rather than pointing out specific drugs. Also, the language concerning specific requirements for the student health plan were deleted to reflect the move toward a more generalized rule.

Summary of the rule or change:

In Subsection R156-31b-701a(1), the amendment requires any unlicensed person who administers medications in a school setting must have annual training from a school nurse. In Subsection R156-31b-701a(2), the amendment indicates that the action of a medication determines whether or not it can be delegated. In Subsection R156-31b-701a(3), the amendment clarifies that medications that require monitoring a student before, during, or after administration cannot be administered by an unlicensed person. In Subsections R156-31b-701a(5) and (6), the amendment combines current language and allows an unlicensed person to provide a scheduled or corrective dose of insulin. Existing language specific to insulin and glucagon is deleted but additions are made to include all types of medications and also includes current specific information related to insulin and glucagon that is not generalizable to other medications.

State statutory or constitutional authorization for this rule:

• Section 58-31b-101
• Subsection 58-1-106(1)(a)
• Subsection 58-1-202(1)(a)

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $50 to print and distribute the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget.

local governments:

There could be an effect on local school districts if a student needs a medication administered that requires a licensed nurse. The school district could utilize existing school nurses if possible or may need to hire a home health agency or private duty nurse to administer the medication. Exact costs to a school district are unknown. It is generally known that Utah as a whole is experiencing a shortage of school nurses. These proposed amendments could intensify that shortage if more and more students are attending school and requiring medication administration.

small businesses:

There should be no effect on small businesses. If a school qualifies as a small business, it most likely would fall under the exemption in education statutes for private schools and there would be no school nurse involved.

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

There is a potential effect in that a student may need a licensed nurse to administer a medication rather than an unlicensed person. It would be the decision of the school nurse whether or not to delegate the administration of a medication to an unlicensed person based on the effects of the medication, need for monitoring the student and whether or not the administration requires nursing knowledge. The exact costs are unknown. The positive effect is that medications which can be life-threatening cannot be delegated to an unlicensed person to administer and a life may be saved.

Compliance costs for affected persons:

Unlicensed people accepting the delegated task to administer a medication will require annual training to ensure competency. This training should already be in effect; therefore no additional costs are anticipated for the annual training. It is possible a school may have to make arrangements for a medication to be administered by a nurse and not an unlicensed person. The extent of that possibility is unknown to the Division and any resulting cost is also unknown.

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

No fiscal impact to businesses is anticipated from this rule filing beyond those already addressed in the rule summary.

Francine A. Giani, Executive Director

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

Commerce
Occupational and Professional Licensing
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

• Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at lpoe@utah.gov

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:

02/01/2010

This rule may become effective on:

02/08/2010

Authorized by:

Mark Steinagel, Director

R156. Commerce, Occupational and Professional Licensing.

R156-31b. Nurse Practice Act Rule.

R156-31b-701a. Delegation of Nursing Tasks in a School Setting.

In addition to the delegation rule found in Section R156-31b-701, the delegation of nursing tasks in a school setting is further defined, clarified, or established as follows:

(1) Any task being delegated by the school nurse shall be identified within a current IHP. The IHP is limited to a specific delegate e for a specific time frame. Any unlicensed person who administers medication to a student as a delegatee of a school nurse, must receive training from a school nurse at least annually.

(2) [In accordance with Section 53A-11-601 and an IHP, it is appropriate for a nurse to provide training to unlicensed assistive personnel, which training includes the routine, scheduled or correction injection of insulin (via actual injection or pump) or the administration of glucagon in an emergency situation, provided that any training regarding the injection of insulin and the administration of glucagon is updated at least annually. The selection of the type of insulin and dosage levels shall not be delegated.]The action of a medication shall determine if the drug is appropriate to delegate the administration to an unlicensed person. Any medication with known, frequent side effects that can be life threatening shall not be delegated.

(3) [In accordance with an IHP, and except as provided herein and in R156-31b-701, a nurse may not delegate the administration of any medication which requires nursing assessment or judgment prior to injection or administration. The routine provision of scheduled or correction dosage of insulin and the administration of glucagon in an emergency situation, as prescribed by the practitioner's order and specified in the IHP, shall not be considered actions that require nursing assessment or judgment prior to administration and therefore, can be delegated to a delegatee.]Medications that require the student's vital signs or oxygen saturation to be monitored before, during or after administration of the drug shall not be administered by an unlicensed person.

(4) A nurse working in a school setting may not delegate the administration of the first dose of a new medication or a dosage change.

(5) [An IHP shall be developed for any student receiving insulin in a school. By example, but not limited to the following list, the IHP may include:

(a) carbohydrate counting;

(b) glucose testing;

(c) activation, suspension, or bolus of an insulin pump;

(d) usage of insulin pens, syringes, and an insulin pump;

(e) copy of the medical orders; and

(f) emergency protocols related to glucagon administration.]A nurse may not delegate the administration of any medication which requires nursing assessment or judgment prior to or immediately after administration.

(6) The routine provision of scheduled or correction dosage of insulin and the administration of glucagon in an emergency situation, as prescribed by the practitioner's order or specified in the IHP:

(a) are not actions that require nursing assessment or judgment prior to administration; and

(b) may be delegated to a delegatee. Insulin and glucagon injections by the delegatee shall only occur when the delegatee has followed the guidelines of the IHP.[Insulin and glucagon injections by the delegatee shall only occur when the delegatee has followed the guidelines of the IHP.

(a) Dosages of insulin may be injected by the delegatee as designated in the IHP.

(b) Non-routine, correction dosages of insulin may be given by the delegatee only after:

(i) following the guidelines of the IHP; and

(ii) consulting with the delegator, parent or guardian, as designated in the IHP, and verifying and confirming the type and dosage of insulin being injected.

(c) Under Subsection (6), insulin and glucagon injections by the delegatee is limited to a specific delegatee, for a specific student and for a specific time.

(7) A student who is capable of administering his own insulin may self-administer insulin as provided in the IHP. A delegatee may verify the insulin dose of a student who self-administers insulin, if such verification is required in the IHP.

(8) When the student is not capable of self-administration, scheduled and routine correction doses of insulin may be administered, and the administration of glucagon may be performed, by a delegatee as provided in Subsection R156-31b-701a(2).]

 

KEY: licensing, nurses

Date of Enactment or Last Substantive Amendment: [July 9, 2009]2010

Notice of Continuation: April 1, 2008

Authorizing, and Implemented or Interpreted Law: 58-31b-101; 58-1-106(1)(a); 58-1-202(1)(a)