1. SB 1857Training Follow-up Grace White Director of Nursing MHMR of Tarrant County

2. Trainings occurred • January 1, 2012 deadline for HCS • Implementation plans • LVN’s must have RN supervisor • Written plan for comprehensive nursing assessments by 9/1/2012 • Provider advocate committee • March 1, 2012 • LVN on call pilot begins Where are we now???

3. Change really isn’t because of SB 1857, but because traditionally providers and DADS weren’t following the TAC rules mandated by the BON • Allows providers to continue to use unlicensed staff to give medication • Allows providers to continue to use LVN’s on call Why these issues?

4. Nursing process toolkit • http://www.dads.state.tx.us/providers/nschanges/index.html • Nursing comprehensive assessment and nursing care plan • RN delegation worksheet • Nursing supervision form • Nursing special needs form for Unlicensed Assistive Personnel Comprehensive assessments

5. DADS doesn’t mandate the form, just the elements in the form • This is Nursing 101 • 9/1/2012 – DADS - plan reasonable to your program • Initial comprehensive assessment/ annual update – don’t re-do the entire assessment each time • Reassess for significant change • Define – significant change - Comprehensive assessment

6. Nursing care plan IS the nursing service plan • An example of a completed nursing service plan is in the training materials at the end of the presentations • The nursing service plan is the IP for HCS • What the RN uses to guide care, also specific details in the plan are required for LVN on call pilot Nursing service plan

7. Provider advocate committee acting as the Client Responsible Adult • Develop as part of implementation plan • Nurse/service coordinator/CEO designee • Mandated form on DADS website PAC as the CRA

8. RN’s must do initial and annual comprehensive assessments • RN’s must do IDT meetings pertaining to above assessments and nursing service plans • Quarterly nursing physical exams • LVN supervision • Training of individuals and staff by nurses • Different timeframe for assessments ICF changes

9. RN responsible for medication training of unlicensed staff • RN responsible for competency of unlicensed staff to give medications under SB1857 • RN responsible for ongoing oversight and training and competency of the staff • Re-do SAMS training - Example: Medication Management Training • Policies – update!!! Training

10. March 1, 2012 • Everyone must participate in data collection component • March data entered into CARE April 30, 2012 • Listing of what should be in place by March 1 to start pilot LVN pilot

11. More Information letters are coming out for ICF • The FAQs and the notebooks for the training are good things to review for answers • DADS is gathering answers to questions submitted and will be getting those to us… Questions???