Texas 2011 - 82nd Regular

Texas House Bill HB3611 Compare Versions

The same version is selected twice. Please select two different versions to compare.

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	82R23113 AJZ-D
2	2	By: Truitt H.B. No. 3611
3	3	Substitute the following for H.B. No. 3611:
4	4	By: Kolkhorst C.S.H.B. No. 3611
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the administration of medication for persons with
10	10	intellectual and developmental disabilities.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 161, Human Resources Code, is amended by
13	13	adding Subchapter D-1 to read as follows:
14	14	SUBCHAPTER D-1. ADMINISTRATION OF MEDICATION FOR CLIENTS WITH
15	15	INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
16	16	Sec. 161.091. DEFINITIONS. In this subchapter:
17	17	(1) "Administration of medication" means:
18	18	(A) removing a unit or dose of medication from a
19	19	previously dispensed, properly labeled container;
20	20	(B) verifying the medication with the medication
21	21	order;
22	22	(C) giving the proper medication in the proper
23	23	dosage to the proper client at the proper time by the proper
24	24	administration route; and
25	25	(D) recording the time of administration and
26	26	dosage administered.
27	27	(2) "Client" means a person with an intellectual and
28	28	developmental disability who is receiving services from a facility
29	29	or program listed in Section 161.092.
30	30	(3) "Unlicensed person" means an individual not
31	31	licensed as a health care provider who provides services at or for a
32	32	facility or program listed in Section 161.092, including:
33	33	(A) a nurse aide, orderly, assistant, attendant,
34	34	technician, home health aide, medication aide with a permit issued
35	35	by a state agency, or other individual who provides personal health
36	36	care-related services;
37	37	(B) a person who is monetarily compensated to
38	38	perform certain health-related tasks and functions in a
39	39	complementary or assistive role to a licensed nurse who provides
40	40	direct client care or performs common nursing functions;
41	41	(C) a person who performs those tasks and
42	42	functions as a volunteer but does not qualify as a friend providing
43	43	gratuitous nursing care of the sick under Section 301.004,
44	44	Occupations Code; or
45	45	(D) a person who is a professional nursing
46	46	student who provides care for monetary compensation and not as part
47	47	of a formal educational program.
48	48	Sec. 161.092. APPLICABILITY. This subchapter applies only
49	49	to administration of medication provided to certain persons with
50	50	intellectual and developmental disabilities who are served:
51	51	(1) in a small facility with not less than one and not
52	52	more than eight beds that is licensed or certified under Chapter
53	53	252, Health and Safety Code;
54	54	(2) in a medium facility with not less than nine and
55	55	not more than 13 beds that is licensed or certified under Chapter
56	56	252, Health and Safety Code; or
57	57	(3) by one of the following Section 1915(c) waiver
58	58	programs administered by the Department of Aging and Disability
59	59	Services to serve persons with intellectual and developmental
60	60	disabilities:
61	61	(A) the Home and Community-Based Services waiver
62	62	program; or
63	63	(B) the Texas Home Living waiver program.
64	64	Sec. 161.093. ADMINISTRATION OF MEDICATION. (a)
65	65	Notwithstanding other law, an unlicensed person may provide
66	66	administration of medication to a client without the requirement
67	67	that a registered nurse delegate or oversee each administration if:
68	68	(1) the medication is:
69	69	(A) an oral medication;
70	70	(B) a topical medication; or
71	71	(C) a metered dose inhaler;
72	72	(2) the medication is administered to the client for a
73	73	stable or predictable condition;
74	74	(3) the client has been personally assessed by a
75	75	registered nurse initially and in response to significant changes
76	76	in the client's health status, and the registered nurse has
77	77	determined that the client's health status permits the
78	78	administration of medication by an unlicensed person; and
79	79	(4) the unlicensed person has been:
80	80	(A) trained by a registered nurse or licensed
81	81	vocational nurse under the direction of a registered nurse
82	82	regarding proper administration of medication; or
83	83	(B) determined to be competent by a registered
84	84	nurse or licensed vocational nurse under the direction of a
85	85	registered nurse regarding proper administration of medication,
86	86	including through a demonstration of proper technique by the
87	87	unlicensed person.
88	88	(b) The administration of medication other than the
89	89	medications described by Subsection (a)(1) is subject to the rules
90	90	of the Texas Board of Nursing regarding the delegation of nursing
91	91	tasks to unlicensed persons in independent living environments such
92	92	as the facilities and programs listed in Section 161.092.
93	93	Sec. 161.094. DEPARTMENT DUTIES. (a) The department shall
94	94	ensure that:
95	95	(1) administration of medication by an unlicensed
96	96	person under this subchapter is reviewed at least annually and
97	97	after any significant change in a client's condition by a
98	98	registered nurse or a licensed vocational nurse under the
99	99	supervision of a registered nurse; and
100	100	(2) a facility or program listed in Section 161.092
101	101	has policies to ensure that the determination of whether an
102	102	unlicensed person may provide administration of medication to a
103	103	client under Section 161.093 may be made only by a registered nurse.
104	104	(b) The department shall verify that:
105	105	(1) each client is assessed to identify the client's
106	106	needs and abilities regarding the client's medications;
107	107	(2) the administration of medication by an unlicensed
108	108	person to a client is performed only by an unlicensed person who is
109	109	authorized to perform that administration under Section 161.093;
110	110	and
111	111	(3) the administration of medication to each client is
112	112	performed in such a manner as to ensure the greatest degree of
113	113	independence, including the use of an adaptive or assistive aid,
114	114	device, or strategy as allowed under program rules.
115	115	(c) The department shall enforce this subchapter.
116	116	Sec. 161.095. LIABILITY. (a) A registered nurse
117	117	performing a client assessment required under Section 161.093, or a
118	118	registered nurse or licensed vocational nurse training an
119	119	unlicensed person or determining whether an unlicensed person is
120	120	competent to perform administration of medication under Section
121	121	161.093, may be held accountable or civilly liable only in relation
122	122	to whether the nurse properly:
123	123	(1) performed the assessment;
124	124	(2) conducted the training; and
125	125	(3) determined whether the unlicensed person is
126	126	competent to provide administration of medication to clients.
127	127	(b) The Texas Board of Nursing may take disciplinary action
128	128	against a registered nurse or licensed vocational nurse under this
129	129	subchapter only in relation to whether:
130	130	(1) the registered nurse properly performed the client
131	131	assessment required by Section 161.093;
132	132	(2) the registered nurse or licensed vocational nurse
133	133	properly trained the unlicensed person in the administration of
134	134	medication; and
135	135	(3) the registered nurse or licensed vocational nurse
136	136	properly determined whether an unlicensed person is competent to
137	137	provide administration of medication to clients.
138	138	(c) A registered nurse or licensed vocational nurse may not
139	139	be held accountable or civilly liable for the acts or omissions of
140	140	an unlicensed person performing administration of medication.
141	141	Sec. 161.096. CONFLICT WITH OTHER LAW. This subchapter
142	142	controls to the extent of a conflict with other law.
143	143	SECTION 2. (a) The Texas Board of Nursing and the Texas
144	144	Department of Aging and Disability Services shall conduct a pilot
145	145	program to evaluate licensed vocational nurses providing on-call
146	146	services by telephone to clients, as defined by Section 161.091,
147	147	Human Resources Code, as added by this Act, who are under the care
148	148	of the licensed vocational nurses. The licensed vocational nurses
149	149	shall use standardized and validated protocols or decision trees in
150	150	performing telephone on-call services in the pilot program. The
151	151	department shall collect data to evaluate the efficacy of licensed
152	152	vocational nurses performing telephone on-call services in the
153	153	pilot program. The pilot program must begin not later than
154	154	September 1, 2011, and must end on August 31, 2012.
155	155	(b) The Texas Board of Nursing and the Department of Aging
156	156	and Disability Services, in consultation with affected
157	157	stakeholders, including public and private providers, registered
158	158	and licensed vocational nurses employed by the facilities or
159	159	providers of services listed in Section 161.092, Human Resources
160	160	Code, as added by this Act, and other persons or entities the
161	161	executive director of the board and the commissioner of the
162	162	department consider appropriate, shall:
163	163	(1) develop the goals and measurable outcomes of the
164	164	pilot program;
165	165	(2) review the outcomes of the pilot program and make
166	166	recommendations regarding potential regulatory or statutory
167	167	changes; and
168	168	(3) on notice of unsafe or ineffective nursing care
169	169	discovered in the pilot program, review the data or the outcomes and
170	170	make recommendations for corrective action.
171	171	(c) Not later than December 1, 2012, the Texas Board of
172	172	Nursing and the Department of Aging and Disability Services shall
173	173	submit a report detailing the findings of the pilot program and any
174	174	jointly developed recommendations to the Senate Committee on Health
175	175	and Human Services and the House Committee on Public Health.
176	176	(d) This section expires September 1, 2013.
177	177	SECTION 3. In developing any policies, processes, or
178	178	training curriculum required by Subchapter D-1, Chapter 161, Human
179	179	Resources Code, as added by this Act, the Texas Department of Aging
180	180	and Disability Services shall convene an advisory committee of
181	181	affected stakeholders, including public and private providers and
182	182	registered and licensed vocational nurses employed by the
183	183	facilities or providers of services listed in Section 161.092,
184	184	Human Resources Code, as added by this Act, and other persons or
185	185	entities the department considers appropriate.
186	186	SECTION 4. This Act takes effect immediately if it receives
187	187	a vote of two-thirds of all the members elected to each house, as
188	188	provided by Section 39, Article III, Texas Constitution. If this
189	189	Act does not receive the vote necessary for immediate effect, this
190	190	Act takes effect September 1, 2011.