Texas 2011 - 82nd Regular

Texas Senate Bill SB1857 Compare Versions

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1	1	By: Zaffirini S.B. No. 1857
2	2	(Truitt)
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the administration of medication for persons with
8	8	intellectual and developmental disabilities.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 161, Human Resources Code, is amended by
11	11	adding Subchapter D-1 to read as follows:
12	12	SUBCHAPTER D-1. ADMINISTRATION OF MEDICATION FOR CLIENTS WITH
13	13	INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
14	14	Sec. 161.091. DEFINITIONS. In this subchapter:
15	15	(1) "Administration of medication" means:
16	16	(A) removing a unit or dose of medication from a
17	17	previously dispensed, properly labeled container;
18	18	(B) verifying the medication with the medication
19	19	order;
20	20	(C) giving the proper medication in the proper
21	21	dosage to the proper client at the proper time by the proper
22	22	administration route; and
23	23	(D) recording the time of administration and
24	24	dosage administered.
25	25	(2) "Client" means a person with an intellectual and
26	26	developmental disability who is receiving services from a facility
27	27	or program listed in Section 161.092.
28	28	(3) "Unlicensed person" means an individual not
29	29	licensed as a health care provider who provides services at or for a
30	30	facility or program listed in Section 161.092, including:
31	31	(A) a nurse aide, orderly, assistant, attendant,
32	32	technician, home health aide, medication aide with a permit issued
33	33	by a state agency, or other individual who provides personal health
34	34	care-related services;
35	35	(B) a person who is monetarily compensated to
36	36	perform certain health-related tasks and functions in a
37	37	complementary or assistive role to a licensed nurse who provides
38	38	direct client care or performs common nursing functions;
39	39	(C) a person who performs those tasks and
40	40	functions as a volunteer but does not qualify as a friend providing
41	41	gratuitous nursing care of the sick under Section 301.004,
42	42	Occupations Code; or
43	43	(D) a person who is a professional nursing
44	44	student who provides care for monetary compensation and not as part
45	45	of a formal educational program.
46	46	Sec. 161.092. APPLICABILITY. This subchapter applies only
47	47	to administration of medication provided to certain persons with
48	48	intellectual and developmental disabilities who are served:
49	49	(1) in a small facility with not less than one and not
50	50	more than eight beds that is licensed or certified under Chapter
51	51	252, Health and Safety Code;
52	52	(2) in a medium facility with not less than nine and
53	53	not more than 13 beds that is licensed or certified under Chapter
54	54	252, Health and Safety Code; or
55	55	(3) by one of the following Section 1915(c) waiver
56	56	programs administered by the Department of Aging and Disability
57	57	Services to serve persons with intellectual and developmental
58	58	disabilities:
59	59	(A) the Home and Community-Based Services waiver
60	60	program; or
61	61	(B) the Texas Home Living waiver program.
62	62	Sec. 161.093. ADMINISTRATION OF MEDICATION.
63	63	(a) Notwithstanding other law, an unlicensed person may provide
64	64	administration of medication to a client without the requirement
65	65	that a registered nurse delegate or oversee each administration if:
66	66	(1) the medication is:
67	67	(A) an oral medication;
68	68	(B) a topical medication; or
69	69	(C) a metered dose inhaler;
70	70	(2) the medication is administered to the client for a
71	71	stable or predictable condition;
72	72	(3) the client has been personally assessed by a
73	73	registered nurse initially and in response to significant changes
74	74	in the client's health status, and the registered nurse has
75	75	determined that the client's health status permits the
76	76	administration of medication by an unlicensed person; and
77	77	(4) the unlicensed person has been:
78	78	(A) trained by a registered nurse or licensed
79	79	vocational nurse under the direction of a registered nurse
80	80	regarding proper administration of medication; or
81	81	(B) determined to be competent by a registered
82	82	nurse or licensed vocational nurse under the direction of a
83	83	registered nurse regarding proper administration of medication,
84	84	including through a demonstration of proper technique by the
85	85	unlicensed person.
86	86	(b) The administration of medication other than the
87	87	medications described by Subsection (a)(1) is subject to the rules
88	88	of the Texas Board of Nursing regarding the delegation of nursing
89	89	tasks to unlicensed persons in independent living environments such
90	90	as the facilities and programs listed in Section 161.092.
91	91	Sec. 161.094. DEPARTMENT DUTIES. (a) The department shall
92	92	ensure that:
93	93	(1) administration of medication by an unlicensed
94	94	person under this subchapter is reviewed at least annually and
95	95	after any significant change in a client's condition by a
96	96	registered nurse or a licensed vocational nurse under the
97	97	supervision of a registered nurse; and
98	98	(2) a facility or program listed in Section 161.092
99	99	has policies to ensure that the determination of whether an
100	100	unlicensed person may provide administration of medication to a
101	101	client under Section 161.093 may be made only by a registered nurse.
102	102	(b) The department shall verify that:
103	103	(1) each client is assessed to identify the client's
104	104	needs and abilities regarding the client's medications;
105	105	(2) the administration of medication by an unlicensed
106	106	person to a client is performed only by an unlicensed person who is
107	107	authorized to perform that administration under Section 161.093;
108	108	and
109	109	(3) the administration of medication to each client is
110	110	performed in such a manner as to ensure the greatest degree of
111	111	independence, including the use of an adaptive or assistive aid,
112	112	device, or strategy as allowed under program rules.
113	113	(c) The department shall enforce this subchapter.
114	114	Sec. 161.095. LIABILITY. (a) A registered nurse
115	115	performing a client assessment required under Section 161.093, or a
116	116	registered nurse or licensed vocational nurse training an
117	117	unlicensed person or determining whether an unlicensed person is
118	118	competent to perform administration of medication under Section
119	119	161.093, may be held accountable or civilly liable only in relation
120	120	to whether the nurse properly:
121	121	(1) performed the assessment;
122	122	(2) conducted the training; and
123	123	(3) determined whether the unlicensed person is
124	124	competent to provide administration of medication to clients.
125	125	(b) The Texas Board of Nursing may take disciplinary action
126	126	against a registered nurse or licensed vocational nurse under this
127	127	subchapter only in relation to whether:
128	128	(1) the registered nurse properly performed the client
129	129	assessment required by Section 161.093;
130	130	(2) the registered nurse or licensed vocational nurse
131	131	properly trained the unlicensed person in the administration of
132	132	medication; and
133	133	(3) the registered nurse or licensed vocational nurse
134	134	properly determined whether an unlicensed person is competent to
135	135	provide administration of medication to clients.
136	136	(c) A registered nurse or licensed vocational nurse may not
137	137	be held accountable or civilly liable for the acts or omissions of
138	138	an unlicensed person performing administration of medication.
139	139	Sec. 161.096. CONFLICT WITH OTHER LAW. This subchapter
140	140	controls to the extent of a conflict with other law.
141	141	SECTION 2. (a) The Texas Board of Nursing and the
142	142	Department of Aging and Disability Services shall conduct a pilot
143	143	program to evaluate licensed vocational nurses providing on-call
144	144	services by telephone to clients, as defined by Section 161.091,
145	145	Human Resources Code, as added by this Act, who are under the care
146	146	of the licensed vocational nurses. The licensed vocational nurses
147	147	shall use standardized and validated protocols or decision trees in
148	148	performing telephone on-call services in the pilot program. The
149	149	department shall collect data to evaluate the efficacy of licensed
150	150	vocational nurses performing telephone on-call services in the
151	151	pilot program. The pilot program must begin not later than
152	152	September 1, 2011.
153	153	(b) The Texas Board of Nursing and the Department of Aging
154	154	and Disability Services, in consultation with affected
155	155	stakeholders, including public and private providers, registered
156	156	and licensed vocational nurses employed by the facilities or
157	157	providers of services listed in Section 161.092, Human Resources
158	158	Code, as added by this Act, and other persons or entities the
159	159	executive director of the board and the commissioner of the
160	160	department consider appropriate, shall:
161	161	(1) develop the goals and measurable outcomes of the
162	162	pilot program;
163	163	(2) review the outcomes of the pilot program and make
164	164	recommendations regarding potential regulatory or statutory
165	165	changes; and
166	166	(3) on notice of unsafe or ineffective nursing care
167	167	discovered in the pilot program, review the data or the outcomes and
168	168	make recommendations for corrective action.
169	169	(c) Not later than December 1, 2012, the Texas Board of
170	170	Nursing and the Department of Aging and Disability Services shall
171	171	submit a report detailing the findings of the pilot program and any
172	172	jointly developed recommendations to the Senate Committee on Health
173	173	and Human Services and the House Committee on Public Health.
174	174	(d) This section expires September 1, 2015.
175	175	SECTION 3. In developing any policies, processes, or
176	176	training curriculum required by Subchapter D-1, Chapter 161, Human
177	177	Resources Code, as added by this Act, the Department of Aging and
178	178	Disability Services shall convene an advisory committee of affected
179	179	stakeholders, including public and private providers and
180	180	registered and licensed vocational nurses employed by the
181	181	facilities or providers of services listed in Section 161.092,
182	182	Human Resources Code, as added by this Act, and other persons or
183	183	entities the department considers appropriate.
184	184	SECTION 4. This Act takes effect immediately if it receives
185	185	a vote of two-thirds of all the members elected to each house, as
186	186	provided by Section 39, Article III, Texas Constitution. If this
187	187	Act does not receive the vote necessary for immediate effect, this
188	188	Act takes effect September 1, 2011.