SLS 18RS-339 ORIGINAL
2018 Regular Session
SENATE BILL NO. 300
BY SENATOR HEWITT
HEALTH CARE. Provides relative to tasks performed by direct service workers. (8/1/18)
1 AN ACT
2 To amend and reenact R.S. 37:1032 and 1033(A), (B), (C), and (D)(1) and to enact R.S.
3 37:292(11), relative to direct service workers; to provide for an exception to the
4 nurse practice act; to provide for authorization to perform medical tasks; to provide
5 authority to direct patient care; and to provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 37:1032 and 1033(A), (B), (C), and (D)(1) are hereby amended and
8 reenacted and R.S. 37:292(11) is hereby enacted to read as follows:
9 §929. Exceptions
10 The provisions of this Part shall not apply to:
11 * * *
12 (11) Nursing services performed by a direct service worker, as defined
13 in R.S. 37:1031 et seq.
14 * * *
15 §1032. Authorized procedures
16 Direct service workers may perform any or all of the following tasks for an
17 individual who is in stable condition only when the task may be performed according
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SLS 18RS-339 ORIGINAL
1 to exact directions and there is no need to alter the standard procedure and the results
2 are predictable:
3 (1) Administration of oral and topical medication, ointments, suppositories,
4 or a pre-measured dosage unit provided by the manufacturer of an oral inhalant
5 aerosol as ordered by an authorized prescriber. Any medication administered by a
6 direct service worker under this Part shall be in a container which meets acceptable
7 pharmaceutical standards and is marked with clear instructions, the prescriber's
8 name, the prescription number, if any, and the name of medication, dosage, and
9 route. Under no condition shall a direct service worker administer medications not
10 in compliance with the provisions of this Section.
11 (2) Provision of routine hydration, nutrition, or medication by way of an
12 established gastro-tube.
13 (3) Other non-complex tasks which may be delegated by the registered nurse
14 to the direct service worker pursuant to rules promulgated pursuant to this Part.
15 A. Direct service workers may perform health related tasks for an
16 individual provided that the attending physician has determined the task could
17 have otherwise been performed safely by the individual if the individual was
18 physically capable or provided by a caretaker of a minor child or incompetent
19 adult for the individual provided the following requirements are met:
20 (1) The individual has been determined to be stable by the attending
21 physician.
22 (2) The attending physician has determined that the results of the task
23 are predictable.
24 (3) The individual receiving the services or the caretaker of a minor child
25 or incompetent adult, that have been trained by the attending physician or his
26 designee, is readily available, in person or via telephone, to answer questions
27 related to the tasks.
28 B. Tasks meeting the above criteria may include but are not limited to
29 the following:
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SLS 18RS-339 ORIGINAL
1 (1) Administration of oral and topical medication, ointments,
2 suppositories, or a premeasured dosage unit provided by the manufacturer of
3 an oral inhalant aerosol as ordered by an authorized prescriber.
4 (2) Postural drainage and percussion.
5 (3) Suctioning of a clean, well-healed, uncomplicated, mature
6 tracheostomy in an individual who has no cardiopulmonary problems and is
7 able to cooperate with the person performing the suctioning.
8 (4) Assisting with incentive spirometer.
9 (5) Ensuring proper placement of a nasal cannula.
10 (6) Care of a mature tracheostomy site.
11 (7) Removing, cleaning, and replacing an inner tracheostomy cannula for
12 a mature tracheostomy.
13 (8) Providing routine hydration, nutrition, or medication by way of an
14 established gastrotomy or jejunostomy tube.
15 (9) Cleansing mature, healed PEG and PEJ tube sites.
16 (10) Measuring intake and output.
17 (11) Capillary blood glucose testing.
18 (12) Cleaning intermittent urinary catherization.
19 (13) Obtaining a urine specimen from a port of an indwelling urinary
20 catheter.
21 (14) Emptying and measuring drains.
22 (15) Emptying colostomy and catheter bags.
23 (16) Changing a colostomy appliance.
24 (17) Administrating over-the-counter enemas.
25 (18) Administrating over the counter saline or vinegar vaginal douches.
26 (19) Simple wound care including nonsterile clean dressing removal and
27 application.
28 (20) Epinephrine pen usage for emergency situations.
29 (21) Venting and checking stomach residuals by way of a gastrotomy.
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SLS 18RS-339 ORIGINAL
1 §1033. Required training
2 A. In order to be authorized to perform the procedures specified in R.S.
3 37:1032, a direct service worker shall be employed by a licensed agency or
4 employed as part of an authorized departmental self-directed program. If the direct
5 service worker is employed as part of an authorized departmental self-directed
6 program, the training he will receive shall be developed by the Louisiana Department
7 of Health in conjunction with the Louisiana State Board of Nursing. If the direct
8 service worker is employed by a licensed agency he shall receive the following
9 training:
10 (1) If the direct service worker is employed by a licensed agency he shall
11 receive the following training:
12 (1) (a) All training required by agency licensing laws or the rules and
13 regulations for participating in Medicaid reimbursement or the requirements of the
14 state or federally funded home or community-based service.
15 (2) (b) In order to administer medications, at least sixteen hours of
16 fundamentals of medication administration training including but not limited to
17 medication administration, handling and storage of medications, side effects, and
18 drug interactions. This training may be a part of the training required in Paragraph
19 (1) Subparagraph (a) of this Subsection Paragraph.
20 (3) (c) In order to administer noncomplex tasks, complete didactic training,
21 and demonstration of competency in accordance with guidelines established and
22 approved by the Louisiana Department of Health and the Louisiana Board of
23 Nursing.
24 (4) (d) Appropriate person-specific training from a registered nurse who has
25 assessed the health status of the individual receiving services and determined that the
26 direct service worker can perform the tasks in a safe, appropriate manner, with
27 additional person-specific training by a registered nurse whenever the tasks to be
28 performed or the types of medications to be administered are changed. Written
29 documentation of training provided by the registered nurse shall be submitted to and
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SLS 18RS-339 ORIGINAL
1 maintained by the direct service worker's employer.
2 (2) If the direct service worker is employed as part of an authorized
3 departmental self-directed program, he shall receive the following training:
4 (a) If providing medication administration, the direct service worker
5 shall complete a training course authorized by the Louisiana Department of
6 Health.
7 (b) Task specific training or any training on specific medications shall
8 be provided to the direct service worker by one of the following:
9 (i) The attending physician or his designee.
10 (ii) The individual receiving care by the direct service worker or the
11 caretaker of a minor child or incompetent adult receiving care by the direct
12 service worker, provided they have been trained by the attending physician or
13 his designee.
14 B. Any unlicensed person employed by a licensed agency who is
15 performing the procedures authorized by this Part shall complete the training
16 required by this Section no later than twelve months after promulgation of the
17 regulations required by this Part. Training specified in Subsection A of this Section
18 shall be repeated if the registered nurse does not certify that the direct service worker
19 has demonstrated a sufficient level of competency in the subject matter.
20 C. A direct service worker employed by a licensed agency shall undergo an
21 annual competency validation, specified in rules adopted by the Louisiana Board of
22 Nursing and the Louisiana Department of Health, performed by a registered nurse,
23 to determine whether the direct service worker continues to perform the authorized,
24 person-specific tasks appropriately. Documentation of the annual competency review
25 provided by the registered nurse shall be submitted to and maintained by the direct
26 service worker's employing agency.
27 D.(1) Any licensed nurse who has properly trained and documented that a
28 direct service worker employed by a licensed agency can perform the prescribed
29 tasks shall not be liable for any civil damages as a result of any act or omission of
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SLS 18RS-339 ORIGINAL
1 the direct service worker.
2 * * *
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 300 Original 2018 Regular Session Hewitt
Present law provides for exceptions to the nurse practice act. Proposed law adds nursing
services performed by a direct service worker as an enumerated exception.
Present law establishes services that may be performed by a direct service worker under
certain oversight and training by a registered nurse. Proposed law repeals present law and
provides that a direct service worker may perform health related tasks that the attending
physician has determined could be done by the individual if they were capable or by a
caretaker of a minor child or an incompetent adult. Proposed law enumerates health care
tasks that a direct service worker may perform if the physician determines that the individual
receiving the service is stable, the results of the tasks are predictable, and the individual has
been trained by the physician or his designee and is available to answer questions regarding
the task.
Present law provides for direct service worker required training for direct services workers
who work for a provider agency and for those who work in a LDH self-direction program.
Proposed law retains present law for direct service workers employed by a provider agency.
Proposed law establishes separate training requirements for direct service workers who work
in a LDH self-direction program. Proposed law establishes training by the attending
physician or the individual receiving the service or the caretaker of a minor child or
incompetent adult receiving the service.
Effective August 1, 2018.
(Amends R.S. 37:1032 and 1033(A), (B), (C) and (D)(1); adds R.S. 37:292(11))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.