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DMH Nurse Delegation 101

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Vanessa B. Prater, BSN, RN. 1. Nurse Delegation 101 ... Vanessa B. Prater, BSN, RN. 6. DMH AND NDP, WHY? The Alabama Board of Pharmacy (ABOP) and the ... – PowerPoint PPT presentation

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Title: DMH Nurse Delegation 101


1
(No Transcript)
2
Nurse Delegation 101
  • Why, What, Who, How and When of the Nurse
    Delegation Program

3
OBJECTIVES
  • Upon completion, participants will know
  • Why DMH developed NDP
  • What NDP requires
  • Who is impacted by NDP
  • How to get more information
  • When agencies must be in compliance

4
WHY???
5
DMH AND NDP, WHY?
  • Federal Law requires that State Agencies,
  • such as the Department of Mental Health
  • (DMH), that receive Federal funds MUST be in
    compliance with all State Laws.

6
DMH AND NDP, WHY?
  • The Alabama Board of Pharmacy (ABOP) and the
  • Alabama Board of Nursing (ABON) direct and
  • control the provision, storage and administration
    of
  • medications.
  • Programs regulated by DMH must comply with not
    only
  • DMH regulations, but also those of the ABOP and
    ABON
  • with respect to their specific guidelines for the
    handling
  • and administration of medications by individuals
  • other than the consumers who receive the
    medications.

7
DMH AND NDP, WHY?
  • Alabama Board of Nursing (ABON) Regulation
  • Code of Alabama (1975) Section 34-21-20
  • (Statutory Law)
  • Any person practicing or offering to practice
    professional/practical nursing in Alabama for
    compensation shall be required to submit evidence
    that he/she is qualified so to practice and shall
    be licensed. It shall be unlawful for any person
    not licensed to practice or offer to practice
    professional/practical nursing for compensation
    in this State.

8
DMH AND NDP, WHY?
  • Alabama Board of Nursing Regulation
  • Code of Alabama (1975) Section 34-21-26
  • The Practice of professional/practical nursing by
    any person who has not been issued a license or
    whose license has been suspended, revoked or has
    expired, is hereby declared to be inimical to the
    public welfare and to constitute a public
    nuisance. The ABON may apply to any court of
    competent jurisdiction for any injunction to
    enjoin any person from practicing
    professional/practical nursing who has not been
    issued a license.

9
DMH AND NDP, WHY?
  • Alabama Board of Nursing Regulation
  • Administrative Code 610-X-6-.02(10)
  • The RN/LPN shall accept responsibility and
    accountability for timely reporting of illegal,
    substandard, unethical, unsafe or incompetent
    nursing practice directly to the Board of Nursing

10
DMH AND NDP, WHY?
  • SB 428
  • Under existing law, the ABON employs
    investigators who investigate alleged violations
    involving drugs or controlled substances. This
    bill grants investigators of the ABON the
    authority to exercise the powers of peace
    officers in investigating alleged violations of
    the Nurse Practice Act by persons licensed by the
    ABON.

11
DMH AND NDP, WHY?
  • Alabama Board of Nursing Regulation
  • Administrative Code 610-X-6-.15(1)
  • The RN/LPN who provides care in residential
    community mental health programs certified by the
    ADMH is accountable and responsible for the
    nursing care delivered to patients in those
    settings

12
DMH AND NDP, WHY?
  • Alabama Board of Nursing Regulation
  • Administrative Code 610-X-6-.15(2)
  • RN/LPNs who provide nursing in the residential
    community mental health setting and the community
    extensions including day habilitation programs,
    may delegate specific limited tasks to designated
    unlicensed assistive personnel.

13
DMH AND NDP, WHY?
  • Department of Mental Health Administrative Code
    Regulations
  • Intellectual Disabilities 580-5-32-.16
  • Mental Illness 580-2-12(6)
  • Substance Disorders 580-9-46(14)
  • All require 24/7 nursing coverage

14
DMH AND NDP, WHY?
  • ABOP and NDP
  • NAKED PILL SYNDROME
  • Carter English, R. Ph.

15
DMH AND NDP, WHY?
  • ABOP and NDP
  • Pillboxes
  • Blister Packs type (labeled at top each
    blister labeled
  • Stock medications
  • OTCs
  • Controlled Substances
  • Current Pharmaceutical Companies assisting with
    NDP Requirements

16
DMH AND NDP, WHY?
  • New DMH NDP Administrative Code Regulations
  • Anticipated completion 2009
  • Will address at a minimum the 4 components of
    NDP
  • Administrative Requirements
  • Education/Training
  • Quality Assurance
  • Compliance

17
WHAT???
18
ACRONYMS
  • NDP Nurse Delegation Program
  • DMH Department of Mental Health
  • MAC Medication Assistant Certified
  • Unlicensed Nursing Individuals
  • MAS Medication Assistance Supervisor
  • (RN/LPN)
  • MATT Medication Assistance Train-
  • The-Trainer (RN ONLY)

19
ACRONYMS
  • MAR Medication Administration Record

20
Definitions
  • Delegation
  • The act of authorizing a competent
  • individual to perform acts supportive to
  • RN/LPNs in selected situations.
  • ABON Administrative Code

21
Definitions
  • Competency
  • Outcomes assessed through academic
  • standing, clinical performance and
  • certification examination that demonstrates
  • the ability to perform a particular task.

22
Definitions
  • Supervision
  • Periodic monitoring by direct observation on
  • site, by the MAS Nurse to visualize MAC
  • Workers skill and ability to perform
  • delegated task(s).

23
LPN Supervision
  • 610-X-6-.04 Practice of Practical Nursing
  • (1) The practice of practical nursing includes,
    but is not limited to
  • (a) Acts designed to promote and maintain health
  • (b) Prevention of illness and injury
  • (c) Provision of care using standardized
    procedures including administering medications
    and treatments under the direction of a licensed
    professional nurse or a licensed or otherwise
    legally authorized prescriber and
  • (d) Exercise of appropriate nursing judgment.

24
Supervision
  • Physically present or accessible within a
    reasonable time to the immediate area and is
    available to intervene if necessary

25
Definitions
  • Self Administration
  • A consumer can self administer if he/she is
  • able to
  • Recognize medication(s)
  • Understands purpose/reason for taking the of
    medication(s)
  • Ability to report major side effects and knows
    when to notify nurse, doctor, etc.
  • (RN MUST PERFORM ASSESSMENT)

26
Consumer Assessment
  • Self Administration
  • Limited Self Administration
  • Unable to Self Administer

27
Definitions
  • Drug/Medication
  • Substances recognized as drugs in the
  • official US pharmacopoeia….
  • Substances intended for use in the
  • diagnosis, cure, mitigation, treatment or
  • prevention of disease in man or animals

28
Definitions
  • Drug/Medication
  • Substances other than food intended to affect the
    structure or any function of the body of man or
    animals
  • Code of AL Section 20-2-2

29
Definitions
  • Medication Administration
  • Removal of an individual dose of
  • medication, from a previously dispensed,
  • properly labeled container, verifying it with
  • the M.D./CRNPs order, giving the individual
  • dose to the proper consumer at the proper
  • time by the proper route and promptly
  • recording the time and dose given.

30
Definitions
  • Administer
  • The direct application of a controlled
  • substance, whether by injection, inhalation,
  • ingestion or any other means to the body of
  • a recipient.
  • Administrative Code Section 20-2-2

31
Definitions
  • Assisting with Medication Administration
  • Helping the consumer
  • with one or more steps in the process of
    administering medication

32
What is NDP?
  • The Nurse Delegation Program (NDP) was
  • developed by the Department of Mental Health
  • (DMH), with guidance from the Alabama Board
  • of Nursing (ABON), in response to changes
  • made to the Alabama Nurse Practice Act, which
  • allows non-licensed persons to assist with
  • medication administration in residential
  • programs, day programs and other community
  • extensions in programs regulated by DMH.

33
What is NDP?
  • The NDP defines the respective authority and
    responsibility for agencies and nurses related to
    delegation of medication administration in DMH
    certified programs.

34
What is NDP?
  • NDP is managed by the DMH in conjunction with the
    ABON to assure that all individuals who receive
    services from programs certified by the DMH
    receive appropriate care.

35
What is NDP?
  • Consumers have a right to health care that
  • meets legal standards of care regardless of
  • the setting. The Safety and well-being of the
  • consumer must be the central focus of all
  • decisions regarding delegation of nursing
  • tasks to MAC Workers (unlicensed
  • personnel)
  • NCSBN, 1997

36
What is NDP?
  • Let whoever is in charge keep this simple
    question in her head, not, how can I always do
    this right thing myself, but how can I provide
    for this right thing to be always done?
  • Florence Nightingale

37
What is NDP?
  • Four Components of the NDP
  • 1. Administrative Requirements
  • 2. Education/Training
  • 3. Quality Assurance
  • 4. Compliance

38
Administrative Requirements
  • There is both individual accountability and
    organizational accountability for delegation.
  • Organizational accountability relates to
    providing sufficient resources, staffing,
    appropriate staff mix, implementation of policies
    and position descriptions, opportunity for
    continuing education and creating an environment
    conducive to teamwork, collaboration and
    client-centered care.

39
Administrative Requirements
  • The organization is accountable for assuring
    that documentation of competencies for ALL
    personnel is maintained
  • The organization is responsible for the
    development and enforcement of policies on
    delegation with active participation from nurses

40
Administrative Requirements
  • Organizations are responsible for assuring that
    educational needs/requirements are met through
    the implementation of the NDP
  • Organizations are responsible for assuring
    compliance with all DMH Regulations

41
Personnel Issues
  • MAC Workers Must
  • Have a HS Diploma/GED
  • Be responsible
  • Be able to read with understanding
  • Be knowledgeable of agency operations
  • Be respectful
  • Be able to work independently
  • Be able to monitor consumers

42
Personnel Issues
  • MAS Nurse Must
  • Be an LPN/RN in good standing
  • Attend MAS Training and pass competency test
  • Understand disease and symptoms management
    related to MI/MR/SA
  • Be able to teach and supervise others
  • Practice according to the Nursing Standards of
    Practice
  • Practice within the NDP guidelines

43
Documentation
  • Job Descriptions
  • Training MAC, MAS, MATT
  • Supervision MAC, LPN
  • MAR
  • Communications
  • Observations/Actions
  • Self Administration Assessment

44
Documentation
  • IF IT IS NOT DOCUMENTED
  • IT WAS NOT DONE!

45
Policies and Procedures
  • Compliance with ABON Regulations
  • Compliance with NDP
  • Documentation MAR, communications, observation,
    actions
  • MAC Supervision quarterly
  • LPN Supervision
  • Training and Updates MAC, MAS
  • Self Administration Assessment - annually

46
Policies and Procedures
  • How to handle medications when on home visits, MD
    visits, trips
  • How to handle telephone orders
  • Reporting a Nurse to the NDP Director/ABON
  • Medication Errors documentation, reporting
  • Medication security/disposal

47
Administrative Requirements
  • The DMH Certification Process includes NDP
    Regulations. Certification Surveyors will assess
    compliance with NDP Regulations.

48
Education and Training
  • MAC Worker
  • 24 hours of training
  • 12 hours Level I classroom education
  • Take a written test and pass with 90
  • Three attempts
  • 12 hours Level ll assessment of competencies
  • 4 hours update/refresher annually

49
Education and Training
  • MAS RN/LPN
  • Any RN/LPN licensed in Alabama, employed or
    contracted by an Agency certified by DMH is
    eligible for training and certification as a MAS
    Nurse

50
Education and Training
  • MAS RN/LPN
  • A four (4) hour training program, taught by a
    MATT
  • RN is required
  • The RN/LPN must pass a written test with a score
  • of 90 or better
  • Three (3) attempts to pass written test
  • Certification updated every two (2) years

51
Education and Training
  • MATT RN
  • RN ONLY
  • At least one (1) year residential/community
    experience
  • Specific trainers certified by the DMH to train
    MAS
  • Nurses
  • Must complete a self study module and take a
    written test
  • passing with a score of 90 or better

52
Education and Training
  • MATT RN
  • Two attempt to pass test
  • Update every two (2) years
  • Appointed to DMH NDP Advisory Council

53
Education and Training
  • NEXT SCHEDULED MAS TRAINING
  • JANUARY 2009
  • (Watch for announcement of date and location)
  • NEXT SCHEDULED MAS UPDATE TRAINING
  • DECEMBER 5, 2008 Montgomery
  • DECEMBER 17, 2008 Tuscaloosa
  • JANUARY 14, 2009 - Mobile

54
Education and Training
  • 2nd Annual Update for MAC Workers due
  • prior to April 1, 2009

55
Quality Assurance
  • Medication Errors
  • A medication error occurs when the
    correct/incorrect recipient receives an incorrect
    drug, dose, form, quantity, route, at the
    incorrect time.
  • Failure to administer a drug (missed dose) at
    the scheduled time constitutes a medication error

56
Quality Assurance
  • Medication Errors
  • Medications may be given one (1) hour before OR
    one (1) hour after the scheduled/ordered time.
    Administration within this acceptable range does
    not constitute a medication error.
  • Medication errors by licensed and unlicensed
    personnel must be reported to the DMH.

57
Quality Assurance
  • Severity of Medication Errors
  • Level I incidents in which the recipient
    experienced NO or MINIMAL adverse consequences
    AND NO TREATMENT or INTERVENTION other than
    monitoring or observation was required.

58
Quality Assurance
  • Severity of Medication Errors
  • Level II incidents in which the recipient
    experienced SHORT TERM, REVERSIBLE adverse
    consequences AND TREATMENT(S)/INTERVENTION(S) in
    addition to monitoring and observation was
    required.

59
Quality Assurance
  • Severity of Medication Errors
  • Level III incidents in which the recipient
    experienced LIFE THREATENING and/or PERMANENT
    adverse consequences

60
Quality Assurance
  • ABON DATA REQUIREMENTS
  • of programs with 24/7 on call coverage
  • Programs that participate in NDP
  • Programs that do not participate in NDP
  • Programs with Nurses 24/7
  • Programs with Nurses on call

61
Quality Assurance
  • ABON DATA REQUIREMENTS
  • Method used to comply with 24/7 coverage
  • Turnover
  • Training
  • Medication Errors
  • Areas of non-compliance
  • How non-compliance was addressed

62
Data Collection Suggestions
  • Nurse Case Load (MAC/MAS)
  • Calls received after 5P
  • Calls received on weekends/holidays
  • Times of Calls
  • Location of calls
  • Self Medication Assessments completed

63
Compliance
  • ABON requires that the DMH provide an Annual
    Report addressing the required data
  • Failure to comply with all NDP Regulations may
    result in decertification

64
MAR
  • All medications must be listed on the MAR
  • The MAR must be recopied by a licensed nurse if
    not pre printed by the pharmacy
  • MAC Workers CANNOT change, add or deleted any
    medications from the MAR
  • MAC Workers CANNOT take verbal orders

65
PRNs
  • MAC Workers CAN give PRNs
  • MAC Workers MUST call the MAS Nurse prior to
    giving a PRN
  • Effectiveness of the PRN MUST be documented
  • MAS Nurse MUST be notified of outcome

66
WHO???
67
Who is Impacted?
  • This regulation applies to any DMH certified
    residential program, day programs and/or other
    community extensions that provide services to
    minors UNLESS ALL medications are administered by
    nurses licensed in the State of Alabama

68
Who is Impacted?
  • This regulation applies to any DMH certified
    residential program, day programs and/or other
    community extensions that provide services to
    individuals who are unable to self medicate as
    defined and assessed by a RN according to NDP
    guidelines.

69
Who is Impacted?
  • This regulation does not apply to programs where
    ALL INDIVIDUALS SELF MEDICATE as defined and
    assessed by an RN as required by NDP

70
Who is Impacted?
  • This regulation does not apply to individuals
    residing at home and receiving CARE FROM
    FAMILY/SIGNIFICANT OTHER(S)

71
HOW???
72
How can I get a MAS Nurse?
  • Employ a RN/LPN licensed in Alabama
  • Discuss Delegation with the nurse and
  • review Position Description
  • Contact me for training dates and scheduling
  • (334)242-3217
  • Contact me with problems/questions
  • Vanessa.Prater_at_mh.alabama.gov

73
How can I get more information?
  • DMH Website
  • www.mh.alabama.gov
  • Click on the NDP link
  • OR
  • CONTACT Vanessa B. Prater, BSN, RN, Director,
    Nurse Delegation Program
  • RSA Union Building
  • 100 S. Union Street
  • P. O. Box 301410
  • Montgomery, AL 36130-1410
  • (334)242-3217 Office
  • Vanessa.Prater_at_mh.alabama.gov

74
How can I get Technical Assistance?
  • CONTACT
  • Vanessa B. Prater, BSN, RN, Director,
    Nurse Delegation Program
  • RSA Union Building
  • 100 S. Union Street
  • P. O. Box 301410
  • Montgomery, AL 36130-1410
  • (334)242-3217 Office
  • Vanessa.Prater_at_mh.alabama.gov

75
ABON
  • Practice Consultant
  • Carolyn Morgan, MSN, RN
  • cmorgan_at_abn.state.al.us
  • Executive Officer
  • Genell Lee, MSN, RN, JD
  • Genell.Lee_at_abn.alabama.gov

76
WHEN???
77
When do I have to comply?
  • NOW!

78
Historical Overview
  • Regulation initially effective December 05
  • Program Development/Training
  • Jan 06-Apr 1, 07
  • Full Implementation began April 1, 07
  • Certification Compliance Nov 1, 07

79
QUESTIONS
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