The Board proposes the rule amendments for the purpose of implementing Chapter 2023-250, Laws of Florida (2023) (Senate Bill 558).

 

DEPARTMENT OF HEALTH

Board of Nursing

RULE NOS.:RULE TITLES:

64B9-15.001Definitions

64B9-15.002Certified Nursing Assistant Authorized Duties.

64B9-15.0025CNA Medication Administration

64B9-15.0026Medication Administration Outside the Scope of Practice of a CNA

PURPOSE AND EFFECT: The Board proposes the rule amendments for the purpose of implementing Chapter 2023-250, Laws of Florida (2023) (Senate Bill 558).

SUMMARY: The rules will be amended to implement Chapter 2023-250, Laws of Florida (2023).

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: 464.202, 464.203, 464.2035(3) FS.

LAW IMPLEMENTED: 464.0156, 464.202, 464.203, 464.2035, 464.2085 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:

 

64B9-15.001 Definitions.

(1) No change.

(2) “Nursing home facility” means a long-term care facility or a nursing home facility as defined in Chapter 400, Part II, F.S.

(3) “Professional nursing” means nursing functions performed by an individual licensed as a registered nurse or advanced practice registered nurse practitioner.

(4) through (5) No change.

(6) “General Supervision” means a registered nurse or a licensed practical nurse currently licensed under Chapter 464, F.S., to the extent allowed under Section 400.23(3), F.S., authorizing procedures being carried out by a certified nursing assistant but who need not be present when such procedures are performed. The certified nursing assistant must be able to contact the registered nurse or licensed practical nurse acting in accordance with Section 400.23(3), F.S., when needed for consultation and advice either in person or by communication devices. This definition is not applicable to a certified nursing assistant providing services in accordance with Section 400.506(10)(b) and (c), F.S., or Part III of Chapter 400, F.S.; or, to a certified nursing assistant who is providing services as a qualified medication aide in accordance with Sections 400.211(5) and 464.2035, F.S.

(7)  “Direct Supervision” means the nurse supervisor or program instructor is on the premises but not necessarily immediately physically present where the tasks and activities are being performed by the certified nursing assistant and the nurse supervisor or physical presence within the patient care unit of a healthcare facility or physical presence within a healthcare agency of a program instructor who assumes responsibility for the practice of the certified nursing assistant.

(8) “Qualified medication aide” is a certified nursing assistant who meets the requirements in Sections 400.211(5) and 464.2035, F.S., and who has completed training and demonstrated competency to administer medications and perform associated tasks for residents of a nursing home facility.

Rulemaking Authority 400.211(5), 464.202, 464.203 FS. Law Implemented 400.211(5), 464.203, 464.2085 FS. History–New 8-31-03, Amended 9-21-06,                                                                                                       .

 

64B9-15.002 Certified Nursing Assistant Authorized Duties.

(1) A certified nursing assistant shall provide care and assist residents with the following tasks related to the activities of daily living only under the general supervision of a registered nurse or licensed practical nurse:

(a) through (n) No change.

(o) Medication administration:

1. A cCertified nursing assistants that meets the training requirements of Section 464.2035(1), F.S., may be delegated medication administration to patients of a home health agency by a licensed registered nurse.

2. A certified nursing assistant who meets the requirements of Sections 464.2035(1) and 400.211(5), F.S. and is designated as a qualified medication aide, may be delegated the administration of medication and associated tasks to residents of a nursing home facility by a licensed registered nurse; however direct supervision by a nurse is required when providing these services.

(p) Tasks prior to medication administration to a patient of a home health agency by a certified nursing assistant that meets the training requirements of  Section 464.2035(1), F.S., or to a resident of a nursing home facility by a qualified medication aide, who has been delegated such tasks by a licensed registered nurse:

1. through 5. No change.

6. Contacting a registered nurse with any questions or concerns regarding ordered medications or administration. A qualified medication aide may also contact a licensed practical nurse with any questions or concerns regarding ordered medications or administration.

(q) Tasks at the time of medication administration to a patient of a home health agency by a certified nursing assistant that meets the training requirements of Section 464.2035(1), F.S., or to a resident of a nursing home facility by a qualified medication aide, who has been delegated such tasks by a licensed registered nurse:

1. through 3. No change.

(r) Tasks following medication administration to a patient of a home health agency by a certified nursing assistant that meets the training requirements of Section 464.2035(1), F.S., or to a resident of a nursing home facility by a qualified medication aide, who has been delegated such tasks by a licensed registered nurse:

1. through 5. No change.

(s) Tasks associated with out of date or discontinued medication delegated deligated to a certified nursing assistants for a patient of a home health agency or delegated to a qualified medication aide for a resident of a nursing home facility:

1. through 2. No change.

3. Returning expired or discontinued prescription medications to the home health agency for disposal or destruction per the agency’s medication policy and procedure protocol or for the qualified medication aide, following nursing home facility policies and procedures with regard to pharmacy requirements for expired or discontinued prescription medications.

4. Disposing of  non-prescription, over the counter medication per the agency’s medication policy and procedure protocol, or for the qualified medication aide, following nursing home facility policies and procedures.

5. No change.

(t) No change.

(2) through (5) No change.

Rulemaking Authority 400.211(5), 464.202, 464.203 FS. Law Implemented 400.211(5), 464.202, 464.203, 464.2085 FS. History-New 9-21-06, Amended 9-11-14, 7-15-21,____________.

 

64B9-15.0025 CNA Medication Administration.

(1) With the exception of those aspects of medication administration deemed outside the scope of practice of the certified nursing assistant by Rule 64B9-15.0026, F.A.C., and subject to the approval of the home health agency with whom the certified nursing assistant is employed or the approval of the nursing home facility with whom the certified nursing assistant is employed as a qualified medication aide, any certified nursing assistant who meets the requirements of this rule is authorized to administer medications to a patient of a home health agency or to a resident of a nursing home facility, respectively, as delegated by a registered nurse and as further described in this rule.

(2) through (3) renumbered and (1) through (2) No change.

(3)(4) For a certified nursing assistant to be eligible to administer medications to a patient of a home health agency, uUpon completion of the initial six-hour training course, the certified nursing assistant 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 validate the competency regarding the certified nursing assistant’s ability to safely administer medications.

(4) For a certified nursing assistant to be designated as a qualified medication aide and eligible to administer medications and perform associated tasks to a resident of a nursing home facility, the following is required:

(a) Holding a clear and active certification as a nursing assistant from the state for a minimum of 1 year immediately preceding delegation by a registered nurse;

(b) Completion of the initial six-hour training course in subsection 64B9-15.0025(2), F.A.C., with the substitution of training in nursing home facility policies and procedures for the training in home health care agency policies and procedures in paragraph (2)(f);

(c) Completion of an additional 34-hour training course curriculum which shall include:

1. An overview of the laws and regulations governing medication administration in nursing home facilities.

2. Infection control practices related to medication administration including application of principles to prevent spread of infection, hand hygiene, standard precautions and use of personal protective equipment, transmission-based precautions, bloodborne pathogens and diseases, multi-drug resistant organisms, and antibiotic stewardship.

3. Anatomy and physiology in relation to health and disease with commonly prescribed medications.

4. Additional information on safe administration of oral, transdermal, opthalmic, otic, inhaled, and topical prescription and over-the-counter medications including terminology and abbreviations, measurement and dosage preparations, and the rights of medication administration.

5. Additional information on documentation and the legal aspects of record keeping.

6. Controlled substances.

7. Oxygen administration, continuous positive airway pressure tasks, blood glucose monitoring, and insulin administration.

(d) Upon completion of the initial six-hour training course and the additional 34-hour training course, which may be combined into a single 40-hour course, the certified nursing assistant 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 validate the competency regarding the certified nursing assistant’s ability to safely administer medications and complete associated tasks. Upon validation, the certified nursing assistant may be designated as a qualified medication aide.

(e) Medication administration and performance of associated tasks may only be performed by a qualified medication aide under the direct supervision of a licensed registered nurse or a licensed practical nurse. The licensed practical nurse must be qualified to supervise in accordance with Rule Chapter 64B9-16, F.A.C.

(5) Education Providers: The initial six-hour certified nursing assistant medication administration training courses in subsection 64B9-15.0025(2) and (4), F.A.C., must be sponsored by a provider of continuing education courses approved by the Board pursuant to Rule 64B9-5.005, F.A.C. To be qualified to teach any such course, the instructor must be a currently licensed registered nurse in good standing in this state, have at least one year of experience teaching adults, and at least one year of professional nursing experience, including one year home health care or one year nursing home facility experience, as appropriate, and the supervision of certified nursing assistants. The provider will be responsible for issuing a certificate verifying completion of the requisite number of hours and course content. In addition, all of the training under subsection 64B9-15.0025(2) and (4), F.A.C., must be through in-person instruction.

(6) Nontraditional Education. Continuing education providers may utilize select nontraditional education alternatives for teaching the acquisition of theoretical content in subsections 64B9-15.0025 (3) and (8), F.A.C. Nontraditional education Such alternatives include:

(a) through (c) No change.

(7) Clinical Competence. The courses must be followed by supervised clinical practice in medication administration as needed to demonstrate clinical competence. Initial and annual vVerification of clinical competence shall be the responsibility of each institution employing a certified nursing assistant based on institutional protocol. Such verification shall be given through a signed statement of a Florida licensed registered nurse with knowledge of the certified nursing assistant’s competence. Annual validation of clinical competency must be completed on or before the anniversary date of the initial validation.

(8) No change.

Rulemaking Authority 400.211(5), 464.2035(3) FS. Law Implemented 400.211(5), 464.0156, 464.2035 FS. History–New 7-15-21, Amended         .

 

64B9-15.0026 Medication Administration Outside the Scope of Practice of a CNA.

(1) Aspects of medication administration tasks which have been delegated by a licensed registered nurse and are associated with medication administration to a patient of a home health agency by a certified nursing assistant or to a resident of a nursing home facility by a certified nursing assistant who is providing services as a qualified medication aide, who has been delegated such a task by a licensed registered nurse which are outside the scope of practice of the certified nursing assistant and which shall not be performed by the certified nursing assistant include the following:

(a) No change.

(b) Administration by subcutaneous, intramuscular, or intravenous injection except for an insulin syringe prefilled with the proper dosage by a pharmacist or an insulin pen prefilled by the manufacturer;

(c) through (e) No change.

(2) Although this rule limits the scope of practice of certified nursing assistants who meet the requirements of Rule 64B9-15.0025, F.A.C., authorized to administer medications to a patient of a home health agency or resident of a nursing home facility as delegated by a registered nurse, it is appropriate for certified nursing assistants who are not authorized to administer medications to care for patients receiving such medications.

Rulemaking Authority 400.211(5), 464.2035(3), FS. Law Implemented 400.211(5), 464.0156, FS., 464.2035. History–New 7-15-21, Amended                 .

 

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: December 08, 2023

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 27, 2023