NH BOARD OF NURSING Medication Administration

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NH BOARD OF NURSINGMedication Administration

• The role of the LNA and MNA in Assisted Living
  Residences
• Dee Houle, M.S., R.N.
• Program Specialist IV

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Board of Nursing Licensure

• Licensed Nursing Assistants
• RSA 326-B14
• Medication Nursing Assistants
• RSA 326-B27

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Licensed Nursing Assistants (LNAs) and the Law

• RSA 326-B14 An LNA shall, with or without
  compensation or personal profit, practice under
  the supervision of an RN, ARNP, or LPN and
  Provide safe nursing-related activities under
  the supervision of an RN or an LPN.
• Scope of practice based on activities taught
  during initial educational program, Nur 704.09

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LNA Scope of Practice

• Additional activities may be added based on
  specific BON approval, Nur 404.12, such as
• Straight urinary catheters, application of TENS
  unit, feeding tubes, phlebotomy, wound care,
  vagus nerve stimulation, pulse oximetry,
  incentive spirometry, oral suctioning, oxygen
  mask placement/cannula placement, chest
  physiotherapy, peripheral vein IV removal,
  colostomy irrigations, medicated lotions,
  ointments and creams, blood glucose monitoring,
  fingerstick PT/INR testing, reminding clients to
  take their medications and transcribing medical
  orders.

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LNA Scope of Practice

• The LNA may also assist in oxygen as a treatment
  therapy and change the collar that holds a
  tracheostomy tube in place as delegated by the
  nurse.
• It is not within the scope of practice for a
  Licensed Nursing Assistant to engage in the
  following activities
• Insertion of intravenous catheters,
• Calling in Prescribing Practitioner orders to the
  Pharmacy
• Insertion of indwelling catheters

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Medication Nursing Assistants

• A Medication Nursing Assistant (MNA) is a
  Licensed Nursing Assistant (LNA) with a NH Board
  Approved Certificate to administer medications
  under the supervision of a RN/LPN to stable
  clients living in facilities and in the
  community.

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Whats the definition of stable?

• The client whose health status is under control
  and raises no expectations that the clients
  symptoms, vital signs or reactions to medications
  will suddenly change.
• There are predictable outcomes to care.

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The BON definition of supervision

• October 20, 2005 Clinical Practice Advisory
• Question
• How does the Board define direct vs. indirect
  supervision?
• Board Response
• The board affirmed a previous definition that
  direct supervision refers to having the
  supervisor in close proximity to the licensee
  either in the same room or the same building.
  Indirect supervision requires the supervisor to
  be readily accessible but not necessarily on the
  floor or in the building. Thus, having telephone
  communication with a supervisor who is available
  to assist in an identified problem would meet the
  definition of indirect supervision.

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Nursing Delegation Rules Nur 404

• Nurse Practice Act revised in 2005 and Nursing
  Rules updated in 2001
• Pertains to delegation among licensees as well as
  to delegation to unlicensed assistive personnel
• Must be in keeping with Nur 404
• RSA-B33 III No person may coerce a licensed
  nurse into compromising patient safety by
  requiring the licensed nurse to delegate if the
  license nurse determines it is inappropriate to
  do so.

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What is Delegation?

• Nur 401.01(f) The transfer, at the discretion of
  the nurse, of authority for the performance of a
  task of client care from the licensed nurse with
  the authority to perform the task to someone who
  does not otherwise have such authority

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Nur 404.05

• A MNA shall NOT perform a task involving the
  administration of medication if
• -the task requires the determination of the
  clients need for the medication, the calculation
  of the dosage or the conversion of the dosage
• -the delegating nurse is unavailable to monitor
  the progress of the client and the effect of the
  medication
• -the client is not stable or has changing
  needs.

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Can LNAs administer medications?

• The short answer is no!
• but it has been opined to be within the LNA
  scope of practice to apply medicated lotions,
  ointments and creams.

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What about He-P 805.17?

• (af) If a resident self-administers medication
  with supervision, as defined in He-P 805.03 (bc),
  personnel may be permitted to
• (1) Remind the resident to take the correct dose
  of his or her medication at the correct time
• (2) Place the medication container within reach
  of the resident
• (3) Remain with the resident to observe the
  resident taking the appropriate amount and type
  of medication as ordered by the licensed
  practitioner
• (4) Record on the resident's daily medication
  record that they have supervised the resident
  taking his or her medication and
• (5) Document in the residents record any
  observed or reported side effects, adverse
  reactions, and refusal to take medications and or
  medications not taken.

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What can the LNA do under He-P 805.17 (af)?

• Special Notation from 2/15/07 board meeting
  Numerous questions have come to the Board
  regarding the New Assisted Living Rules HeP-805.
• Specific issues addressed by the board at its
  2/15/07 meeting included the LNA scope of
  practice. The board opined the following
• Board consensus that issue with self-directed
  medication for cognitively intact individuals
  with physical disabilities is within the scope of
  LNA practice.
• Board further agreed that HeP 805.17 (af) (1-3
  5) are within LNA scope. Board reinforced that
  (4) is NOT within LNA scope LNA cannot supervise
  medications consumed or tell patient what to
  consume.
• The He-P 800 Residential Care and Health Facility
  rules may be accessed via this link
  http//gencourt.state.nh.us/rules/he-p800.html

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Medication AdministrationHand-over-Hand

• From BON Clinical Practice Advisory 1998-1999
• QUESTION Can a LNA assist clients with
  medication administration using a hand over hand
  approach?
• ANSWER Yes, the LNA can place hands over clients
  hands to assist client with medication
  administration is within the scope of the LNA
  practice when the client has cognitive abilities
  to determine medication needs. This process is
  utilized for the motor process or becomes the
  hands of an individual who is physically
  impaired.

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Medication AdministrationHand-over-Hand

• The client
• must have a care plan specific to their
  impairment with hand over hand details,
• must be self directed,
• can be prompted or reminded of medication needs

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LNA Scope of Practice

• There has been a blurring of LNA and MNA roles
  in the healthcare community
• LNA Scope of Practice has not changed and remains
  consistent within the Nurse Practice Act and
  Nursing Administrative rules across all practice
  areas

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Contact us
Telephone [phone] mwalker_at_nursing.st
ate.nh.us dhoule_at_nursing.state.nh.us web site
www. state.nh.us/nursing email
boardquestions_at_nursing.state.nh.us