For Rule 64B9-12.002, F.A.C., the Board proposes the rule amendment to remove unnecessary language and define “health care practitioner.” For Rule 64B9-12.003, F.A.C., the Board proposes the rule amendment to update language ....

 

DEPARTMENT OF HEALTH

Board of Nursing

RULE NOS.:RULE TITLES:

64B9-12.002Definitions

64B9-12.003Aspects of Intravenous Therapy Outside the Scope of Practice of the LPN

64B9-12.004Authority for the LPN to Administer Limited Forms of Intravenous Therapy

64B9-12.005Competency and Knowledge Requirements Necessary to Qualify the LPN to Administer IV Therapy

PURPOSE AND EFFECT: For Rule 64B9-12.002, F.A.C., the Board proposes the rule amendment to remove unnecessary language and define “health care practitioner.” For Rule 64B9-12.003, F.A.C., the Board proposes the rule amendment to update language regarding the aspects of IV therapy outside the scope of practice of an IV certified LPN. For Rule 64B9-12.004, F.A.C., the Board proposes the rule amendment to update language regarding authority for the LPN to administer limited forms of intravenous therapy. For Rule 64B9-12.005, F.A.C., the Board proposes the rule amendment to update language regarding the competency and knowledge requirements to qualify an LPN to administer IV therapy.

SUMMARY: For Rule 64B9-12.002, F.A.C., unnecessary language will be removed and “health care practitioner” will be defined. For Rule 64B9-12.003, F.A.C., language regarding the aspects of IV therapy outside the scope of practice of an IV certified LPN will be updated. For Rule 64B9-12.004, F.A.C., language regarding authority for an LPN to administer limited forms of intravenous therapy will be updated. For Rule 64B9-12.005, F.A.C., language regarding the competency and knowledge requirements to qualify an LPN to administer IV therapy will be updated.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: During discussion of the economic impact of this rule at its Board meeting, the Board, based upon the expertise and experience of its members, determined that a Statement of Estimated Regulatory Costs (SERC) was not necessary and that the rule will not require ratification by the Legislature. No person or interested party submitted additional information regarding the economic impact at that time.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 456.013(2), 490.004(4), 464.006 FS.

LAW IMPLEMENTED: 456.013(2), 464.003(3)(b), 464.003(19) FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Joe Baker, Jr., Executive Director, Board of Nursing, 4052 Bald Cypress Way, Bin #C02, Tallahassee, Florida 32399; [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

64B9-12.002 Definitions.

(1) No change.

(2) “Under the direction of a registered professional nurse” means that the registered professional nurse has delegated intravenous therapy functions to a qualified licensed practical nurse. The registered professional nurse does not in all instances have to be on the premises in order for the licensed practical nurse to perform the delegated functions.

(3) No change.

(4)  “Health care practitioner” means a physician or physician assistant licensed pursuant to Chapter 458 or 459, F.S.; a dentist licensed pursuant to Chapter 466, F.S.; or a Florida licensed Advanced Practice Registered Nurse (APRN).

Rulemaking Authority 464.006 FS. Law Implemented 464.003(18)(3)(b) FS. History–New 1-16-91, Formerly 21O-21.002, 61F7-12.002, 59S-12.002, Amended, _________.

64B9-12.003 Aspects of Intravenous Therapy Outside the Scope of Practice of an IV certified the LPN.

(1) Aspects of intravenous therapy which are outside the scope of practice of an IV certified the licensed practical nurse unless under the direct supervision of the registered professional nurse or health care practitioner physician and which shall not be performed or initiated by an IV certified licensed practical nurses without direct supervision include the following:

(a) through (d) No change.

(e) Mixing IV solution;

(f) IV pushes, except heparin flushes and saline flushes.

(2) Although this rule limits the scope of an IV certified licensed practical nurse practice, it is appropriate for an IV certified licensed practical nurses to care for patients receiving such therapy.

Rulemaking Authority 464.006 456.013(2), 490.004(4) FS. Law Implemented 464.003(18) 456.013(2) FS. History–New 1-16-91, Formerly 21O-21.003, 61F7-12.003, 59S-12.003, Amended 4-9-98,                         .

64B9-12.004 Authority for the LPN to Administer Limited Forms of Intravenous Therapy.

(1) With the exception of those aspects of intravenous therapy deemed outside the scope of practice of the IV certified licensed practical nurse by Rule 64B9-12.003, F.A.C., above, and subject to the approval of the institution at which the licensed practical nurse is employed, any licensed practical nurse who meets the competency knowledge requirements of Rule 64B9-12.005, F.A.C., below, is authorized to administer intravenous therapy under the direction of a registered professional nurse or other health care practitioner.

(2) Individuals who have completed a Board approved prelicensure practical nursing education program, professional nursing students who qualify as graduate practical nurses, or licensed practical nurses who have not completed the specified course under Rule 64B9-12.005, F.A.C., may engage in a limited scope of intravenous therapy under the direction of a registered nurse or other health care practitioner physician or dentist. This scope includes:

(a) through (d) No change.

Rulemaking Authority 464.006 FS. Law Implemented 464.003(18)(3)(b) FS. History–New 1-16-91, Formerly 21O-21.004, 61F7-12.004, 59S-12.004, Amended                         .

64B9-12.005 Competency and Knowledge Requirements Necessary to Qualify the LPN to Administer IV Therapy.

(1) Contents. The board endorses the Intravenous Therapy Course Guidelines issued by the Education Department of the National Federation of Licensed Practical Nurses, November, 1983. The course necessary to qualify a licensed practical nurse or graduate practical nurse to administer IV therapy shall be not less than a thirty (30) hour post-graduate level course teaching aspects of IV therapy. The didactic intravenous therapy education must contain the following components:

(a) through (q) No change.

(2) Clinical Competence. The course must be followed by supervised clinical practice in intravenous therapy as needed to demonstrate clinical competence. Verification of clinical competence shall be the responsibility of each institution employing a licensed practical nurse based on institutional protocol. Such verification shall be given through a signed statement of a licensed registered nurse.

(3)(2) Central Venous Lines (CVL) and Peripherally Inserted Central Catherer (PICC) Lines. The Board recognizes that through appropriate education and training, a Licensed Practical Nurse is capable of performing intravenous therapy via central and PICC lines under the direction of a registered professional nurse or other health care practitioner as defined in subsection 64B9-12.002(2), F.A.C. Appropriate education and training requires a minimum of four (4) hours of instruction. The requisite four (4) hours of instruction may be included as part of the thirty (30) hours required for intravenous therapy education specified in subsection (4), of this rule. The education and training required in this subsection shall include, at a minimum, didactic and clinical practicum instruction in the following areas:

(a) No change.

(b) CVL and PICC site assessment;

(c) CVL and PICC dressing and cap changes;

(d) CVL and PICC flushing;

(e) CVL and PICC medication and fluid administration;

(f) CVL and PICC blood drawing; and,

(g) CVL and PICC complications and remedial measures.

Upon completion of the intravenous therapy training via central and PICC lines, the Licensed Practical Nurse shall be assessed on both theoretical knowledge and practice, as well as clinical practice and competence. The clinical practice assessment must be witnessed by a Registered Nurse who shall file a proficiency statement regarding the Licensed Practical Nurse’s ability to perform intravenous therapy via central lines. The proficiency statement shall be kept in the Licensed Practical Nurse’s personnel file.

(4)(3) No change.

(4) Educational Alternatives. The cognitive training shall include one or more of the following:

(a) Post-graduate Level Course. In recognition that the curriculum requirements mandated by Sections 464.019(1)(b), 464.019(1)(f), and 464.019(1)(g), F.S., for practical nursing programs are extensive and that every licensed practical nurse will not administer IV Therapy, the course necessary to qualify a licensed practical nurse or graduate practical nurse to administer IV therapy shall be not less than a thirty (30) hour post-graduate level course teaching aspects of IV therapy containing the components enumerated in subsection 64B9-12.005(1), F.A.C.

(b) Credit for Previous Education. The continuing education provider may credit the licensed practical nurse or graduate practical nurse for previous IV therapy education on a post-graduate level, providing each component of the course content of subsection 64B9-12.005(1), F.A.C., is tested by and competency demonstrated to the provider.

(c) Nontraditional Education. Continuing education providers may select nontraditional education alternatives for acquisition of cognitive content outlined in Rule 64B9-12.005, F.A.C. Such alternatives include:

1. Interactive videos,

2. Self study,

3. Other nontraditional education that may be submitted to the Board for consideration and possible approval. Any continuing education providers using nontraditional education must make provisions for demonstration of and verification of knowledge.

(5) Clinical Competence. The course must be followed by supervised clinical practice in intravenous therapy as needed to demonstrate clinical competence. Verification of clinical competence shall be the responsibility of each institution employing a licensed practical nurse based on institutional protocol. Such verification shall be given through a signed statement of a Florida licensed registered nurse.

Rulemaking Authority 464.006 FS. Law Implemented 464.003(1819) FS. History–New 1-16-91, Formerly 21O-21.005, 61F7-12.005, Amended 7-15-96, Formerly 59S-12.005, Amended 11-17-10,                          .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Nursing

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Nursing

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 3, 2023

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: February 17, 2023