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Nurse Delegation Program

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  1. Nurse Delegation Program WHAT’S NEW?

  2. OBJECTIVES Upon completion of this training, participants will: • Learn at least one change that occurred with the Nurse Delegation Program during the last two years • Verbalize at least two changes that will occur within the near future Vanessa B. Prater, BSN, RN

  3. OBJECTIVES • State at least one change made to the nurse practice act for Alabama during 2009 Vanessa B. Prater, BSN, RN

  4. In Review 2008-2009 Vanessa B. Prater, BSN, RN

  5. OUR NEW NUMBER Vanessa B. Prater, BSN, RN

  6. 610-X-7-.06 Effective, December 2009, the ABON revised their regulations • The ABON Regulation that applies to ADMH Residential Programs was: • 610-X-6-.15 Vanessa B. Prater, BSN, RN

  7. 610-X-7-.06 The current number for the ABON Regulation that applies to ADMH Residential Programs is 610-X-7-.06 The title of the regulation remains the same ADMH Residential Community Programs Vanessa B. Prater, BSN, RN

  8. 610-X-7-.06(9) The Commissioner of the ADMH shall submit a report(s) to the ABON in a format specified but the Board upon request to include but not limited to: • Total # or residential programs (Contractors should include subcontractors) • Total # of consumers served • Total # of RNs • Total # of LPNs Vanessa B. Prater, BSN, RN

  9. 610-X-7-.06 • Total # of MAC Workers trained (current # of MAC Workers at agency) • Total # of MAC Workers trained during the reporting period (April 1 previous year – March 31, current year) • Total # of medication errors in each category (Address each personnel category – RN, LPN, MAC, Pharmacist AND each error type – Wrong med, person, time, reason, route, documentation, dose, missed dose or other (explain) Vanessa B. Prater, BSN, RN

  10. 7 Rights of Medication Administration610-X-6-.07(1)(j) Vanessa B. Prater, BSN, RN

  11. 7 Rights • Right person • Right medication • Right time • Right dose • Right route • Right reason • Right documentation Vanessa B. Prater, BSN, RN

  12. RIGHT REASON What is the medical condition requiring the medication? Ex. • For “severe” agitation • For sleep • For glaucoma • For temp > 101 Vanessa B. Prater, BSN, RN

  13. Right Reason In the future, all medication orders will include the “purpose” or “expected therapeutic benefit of the medication, however, it is currently best practice for all “as needed” (PRN) medications to include a specific purpose The precise circumstances for which the drug is to be given. Vanessa B. Prater, BSN, RN

  14. Right Reason • SAFETY TIPS • Medication • Important information you need to know • WHAT YOU NEED TO KNOW • ABOUT EACH MEDICINE YOU TAKE • What is the name of each • medication? • What is it for? • What time should you take it? • How much of it should you take • each time? • How should you take it? • Should you take it with food? • How long should you take it? • What should you do if you miss a • dose? • Are there any side effects? What • should you do if you have any? • Is it safe to take with other • medications you are taking, • including over-the-counter • medication, vitamins or herbals? • What food, drink or activities • should you avoid while taking it? • Alabama Hospital Association • 500 North East Blvd. Montgomery, AL 36117 • (334) 272-8781 Vanessa B. Prater, BSN, RN

  15. Right Reason • All PRN prescriptions should specify: • dose (not a range of doses), • frequency, • maximum daily dose and • the precise circumstances for which the drug is to be given. A time period for the prescription must also be stated (stop order) Vanessa B. Prater, BSN, RN

  16. Right Reason All PRN medication administered should be documented in the clinical notes with details of the name of • Name of drug administered, • Date and time of administration, • dose of drug, • the specific symptoms and conditions which resulted in the drug being administered and • a description of the patients response to the medication. Vanessa B. Prater, BSN, RN

  17. Right Reason Universal Medication Form • Date • Name of medication/dose • Directions • Date stopped • Reason for taking • Name of MD Vanessa B. Prater, BSN, RN

  18. RIGHT DOCUMENTATION IF IT IS NOT DOCUMENTED; IT DID NOT HAPPEN! Vanessa B. Prater, BSN, RN

  19. RIGHT DOCUMENTATION BLANKS ON THE MARs ARE NOW LEVEL I MEDICATION ERRORS (PE/PI NOTE: What percentage of your agency’s Level I medication errors are due to “lack of documentation” on the MAR?) Vanessa B. Prater, BSN, RN

  20. REPORTING MEDICATION ERRORS Vanessa B. Prater, BSN, RN

  21. 2008 1st ADMH Report to the ABON Study Period: April 1, 07-April 1, 2008 Reporting according to Levels ADMH Totals Level 1 1535 Level II 13 Level III 0 Vanessa B. Prater, BSN, RN

  22. 2009 2nd ADMH Report to the ABON Study Period: April 1, 2008-April 1, 2009 Reporting requirements: • Levels • Personnel • RN • LPN • MAC Vanessa B. Prater, BSN, RN

  23. 2009 Level I ADMH Total 2945 RN 70 LPN 133 MAC 2742 Vanessa B. Prater, BSN, RN

  24. 2009 Level II ADMH Total 14 RN 1 LPN 1 MAC 12 Vanessa B. Prater, BSN, RN

  25. 2009 Level III ADMH Total 0 Vanessa B. Prater, BSN, RN

  26. 2010 3rd ADMH Report to the ABON Study Period: April 1, 2009-March 31, 2010 Reporting Requirements: • Med error per Level • Med error per personnel • Med error per type: Wrong med Wrong dose Wrong person Wrong route Wrong time Missed dose Wrong purpose Other Documentation error Vanessa B. Prater, BSN, RN

  27. 2010 Letter delineating report requirements will be emailed and slow mailed during the week of May 17-21, 2010 Due Date: June 18, 2010 Vanessa B. Prater, BSN, RN

  28. OTC Medications Vanessa B. Prater, BSN, RN

  29. OTCs 610-X-7-.06(5) “The task of assisting with the delivery of prescribed eye, ear, nose, oral, topical, inhalant, rectal or vaginal medication s may only be delegated to a mental health worker……………” Vanessa B. Prater, BSN, RN

  30. OTCs All medications, including “as needed” medication (PRN) shall be ordered by a legal prescriber specifying the reason for which the medication any be given. Vanessa B. Prater, BSN, RN

  31. OTCs A MAS RN/LPN may place a prescribed, factory labeled and sealed, single dose, over-the-counter, as needed (PRN) medications in a plastic bag with a closure. The bag shall be labeled with the consumers’ name, facility/program name; date single dose meds were placed in the bag by the MAS RN/LPN. The MAS RN/LPN shall check expiration dates on all single dose packages, initial the plastic bag and enclose a copy of the MD standing orders inside the bag with the factory sealed single dose over-the-counter medications Vanessa B. Prater, BSN, RN

  32. MAS TRAINING Vanessa B. Prater, BSN, RN

  33. MAS Training In November 2009 the MAS Training Program was revised • Length of training changed from 4 hours to 6.5 hours • Standardized agenda developed • Training points to re-enforce developed • PowerPoint Presentation Developed • Level II/III Med Error Report Form Vanessa B. Prater, BSN, RN

  34. MAS Training If your agency has a MATT RN, he/she must utilize the following at a minimum • Standardized agenda, • Evaluation form, • List of training points to re-enforce, • Training/testing form to be sent to NDP Office, • Training DVDs and PowerPoint Presentation • Level II/III Med Error Form Vanessa B. Prater, BSN, RN

  35. MAS Training 1st MATT RN UPDATE DEVELOPED AND PRESENTED NOVEMBER 2009 Quarterly MATT RN meetings open to other nurses/persons Vanessa B. Prater, BSN, RN

  36. MAS Training ANNUAL MATT RN UPDATE PLANNED FOR EACH YEAR, WITH RNs WHO WILL BE INSTRUCTING OTHER NURSES, IN NOVEMBER TO FOCUS ON THE CHANGES THAT HAVE OCCURRED OR CHANGES THAT ARE ANTICIPATED Vanessa B. Prater, BSN, RN

  37. FUTURE CHANGES Vanessa B. Prater, BSN, RN

  38. FUTURE CHANGES • NDP Regulations • MAC DVD • Question Board • Standardized Forms • All Manuals revised/update • All test revised/updated • Updated Website Vanessa B. Prater, BSN, RN

  39. OTHER CANGES to the ALBAMA NURSE PRACTICE ACT Vanessa B. Prater, BSN, RN

  40. DEFINITIONS Vanessa B. Prater, BSN, RN

  41. Definitions Accountability Answerable or responsible for action Responsibility The charge to do something that is expected performance Vanessa B. Prater, BSN, RN

  42. Definitions Delegation The act of authorizing a competent individual to perform selected nursing activities supportive to RNs or LPNs in selected situations while retaining the accountability for the outcome if the delegation is to an unlicensed individual Vanessa B. Prater, BSN, RN

  43. Definitions Legally Authorized Prescriber • Licensed physician (MD), • Dentist (DDS), • Certified Registered Nurse Practitioner (CRNP), • Certified Nurse Midwife (CNM) and • Physician Assistant (PA) Vanessa B. Prater, BSN, RN

  44. Definitions • May Power, privilege or right retained by the Board • May not Prohibition • Shall Duty, requirement or condition precedent Vanessa B. Prater, BSN, RN

  45. Definitions Direct Supervision Responsible licensed nurse physically present in facility and readily accessible to designate or prescribe a course of action or to give procedural guidance, direction and periodic evaluation. Vanessa B. Prater, BSN, RN

  46. Definitions Indirect Supervision Responsible licensed nurse is available for periodic inspection and evaluation through physical presence, electronic or telephonic communication for direction, consultation and collaboration. Vanessa B. Prater, BSN, RN

  47. Definitions Assessments Comprehensive The systematic collection and analysis of data including the physical, psychological, social, cultural and spiritual aspects of the patient by the RN for the purpose of judging a patient’s health and illness status and actual or potential health needs. Comprehensive assessment includes patient history, physical examination, analysis of the data collected, development of the patient plan of care, implementation and evaluation of the plan of care. Vanessa B. Prater, BSN, RN

  48. Assessment Standards 610-X-6-.09(2)(a)-(d) The RN shall conduct and document comprehensive and focused nursing assessments of the health status of patients by: • Collecting objective and subjective data from: • observations, • physical examinations, • interviews and • written records in an accurate and timely manner as appropriate to the patient’s health care needs Vanessa B. Prater, BSN, RN

  49. Assessment Standards 2. Analysis and reporting of data collected 3. Developing plan of care based upon the patient assessment Vanessa B. Prater, BSN, RN