For Rule 64B9-15.002, F.A.C., the Board proposes the rule amendment to update the rule regarding CNA authorized duties. For Rule 64B9-15.0025, F.A.C., the Board proposes the promulgation of the rule to provide instructions ....

 

DEPARTMENT OF HEALTH

Board of Nursing

RULE NOS.:RULE TITLES:

64B9-15.002Certified Nursing Assistant Authorized Duties.

64B9-15.0025CNA Medication Administration

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

64B9-15.005Standards for Certified Nursing Assistant Training Programs

PURPOSE AND EFFECT: For Rule 64B9-15.002, F.A.C., the Board proposes the rule amendment to update the rule regarding CNA authorized duties. For Rule 64B9-15.0025, F.A.C., the Board proposes the promulgation of the rule to provide instructions for medication administration by CNAs. For Rule 64B9-15.0026, F.A.C., the Board proposes the promulgation of the rule to provide medication administration outside the scope of the practice of a CNA. For Rule 64B9-15.005, F.A.C., the Board proposes the rule amendment to include online training programs.

SUMMARY: For Rule 64B9-15.002, F.A.C., the rule will be updated regarding CNA authorized duties. For Rule 64B9-15.0025, F.A.C., instructions will be provided for medication administration by CNAs. For Rule 64B9-15.0026, F.A.C., the rule provides medication administration outside the scope of the practice of a CNA. For Rule 64B9-15.005, F.A.C., the rule amendment will include online training programs.

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:

 

64B9-15.002 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) Tasks associated with medication administration delegated to nursing assistants in home health prior to administration:

1. Reviewing prescription medication orders,

2. Reviewing medication administration records for the time of last previous dose administered,

3. Reviewing prescription medication labels for the prescriber’s name, patient’s name, medication, dose, route of administration, frequency of administration, and expiration date,

4. Reviewing non-prescription, over the counter medication orders and any special instruction from the heath care provider that ordered the medication,

5. Reviewing the manufacturer’s packaging and instructions for medication ingredients, dose, route of administration, frequency, warnings and adverse reactions,

6. Contacting a registered nurse with any questions or concerns regarding ordered medications or administration.

(p) Tasks associated with medication administration delegated to certified nursing assistants in home health at the time of administration:

1. Identifying patient by name,

2. Informing patient of medication and dose being administered,

3. Administering medication as ordered.

(q) Tasks associated with medication administration delegated to certified nursing assistants in home health following administration:

1. Reviewing medication administration record to confirm that the correct medication and dose was adminstered by the correct route, 

2. Documenting name of medication, dose, route of administration, and time of administration immediately following administration,

3.  Documenting medications refused or withheld and the reason for not administering the medication,

4. Reporting any symptoms of adverse effects to registered nurse and documenting reporting,

5. Documenting any adverse effects of medication.

(r) Tasks associated with out of date or discontinued medication deligated to certified nursing assistants in a home health setting:

1. Identifying expired  medication,

2. Reviewing orders to discontinue medication,

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,

4. Disposing of  non-prescription, over the counter medication per the agency’s medication policy and procedure protocol,

5. Documenting return or disposal of medications.

(s)  Any task delegated by a registered nurse to a certified nursing assistant who has satisfactorily completed the training required  by s. 464.2035, F.S., and who has been determined to be competent to perform the assigned task.  

(2) through (5) No change.

Rulemaking Authority 464.202, 464.203 FS. Law Implemented 464.202, 464.203, 464.2085 FS. History-New 9-21-06, Amended 9-11-14,             .

 

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 certfied nursing assistant is employed, any certfied nursing assistant who meets the requirements of this rule is authorized to administer medications as delegated by a registered nurse.

(2) A certified nursing assistant shall complete an initial six-hour Board approved training course on medication administration and be documented to be competent in the safe and sanitary administration of medication by a registered nurse licensed under chapter 464, F.S., a physician licensed under chapter 458, F.S., or an osteopathic physician licensed under chapter 459, F.S.

(3) The initial six-hour training course curriculum shall include:

(a) A glossary of common terminology for labeling of legend medications.

(b) Safe administration of oral, transdermal, ophthalmic, otic, rectal, inhaled, enteral, and topical prescription and over-the-counter medications.

(c) Record keeping and documentation of medication administration.

(d) Safe storage and proper disposal of medications.

(e) Prevention of medication errors.

(f) Home health care agency policies and procedures regarding medications.

(g) Recognizing, documenting and reporting adverse reactions to medications.

(4) Upon 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.

(5) Providers: The initial six-hour certified nursing assistant medication administration training course 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 teaching experience, and have professional nursing experience, including home health care 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.

(6) Nontraditional Education. Continuing education providers may select nontraditional education alternatives for acquisition of theoretical content outlined in Rule 64B9-15.005, F.A.C. Such alternatives include:

(a) Interactive videos,

(b) Self study,

(c) 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.

(7) Clinical Competence. The course must be followed by supervised clinical practice in medication administration as needed to demonstrate clinical competence. Verification 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.

(8) In addition to other inservice training hours required under 64B9-15.011, F.A.C., certified nursing assistants found to be competent to administer medications shall annually and satisfactorily complete two (2) hours of inservice training in medication administration and error prevention approved by the Board.  The initial two (2) hours annual inservice training shall be completed within one year of issuance of the proficiency statement.

Rulemaking Authority 464.2035(3) FS. Law Implemented 464.0156, 464.2035 FS.  History–New_________.

 

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

(1) Aspects of medication administration within a home health agency which are outside the scope of practice of the certfied nursing assistant and which shall not be performed by the certified nursing assistant include the following:

(a) Admintsration of controlled substances listed in Schedule II, Schedule III, or Schedule IV of s. 893.03, F.S., or 21 U.S.C. s. 812;

(b) Administration by subcutaneous, intramuscular, or intravenous injection;

(c) Legend drugs without original labeling identifying the patient, medication, dose, route and frequency of administration, prescriber, and expiration date.

(d) Over-the-counter, non-prescription, medications without an order from a physician licensed under chapter 458, F.S., an osteopathic physician licensed under chapter 459, F.S., a podiatric physician licensed under chapter 461, F.S., or an advanced practice registered nurse licensed under s. 464.012 or 464.0123, F.S.;

(e) Over-the-counter, non-prescription, medications not in the original packaging from the manufacturer.

(2) Although this rule limits the scope of practice of certified nursing assistants, it is appropriate for certified nursing assistants within a home health agency to care for patients receiving such medications.

Rulemaking Authority 464.2035(3), FS. Law Implemented 464.0156, FS., 464.2035. History–New ­­____________.

 

64B9-15.005 Standards for Certified Nursing Assistant Training Programs.

(1) Each training program, including online training programs, shall have a governing body which has authority to conduct the certified nursing assistant training program, determine general policy, and assure adequate financial support.

(a) through (d) No change.

(2) through (5) No change.

(6) A training program must maintain a passing rate on certified nursing assistant examination for its graduates of not less than 10% below the state average as reported annually. If a program’s passing rate drops below the standard for 12 months, the program must be reviewed by the Board. The Board shall place the program on probation, and if the passing rate does not meet the standard within one year, the Board shall rescind the program approval. If a program has no test takers for one calendar year, the program shall be considered abandoned and program approval shall be rescinded. A one year extension of probation for good cause may be granted by the Board.  Good cause may consist of acts of nature, serious illness or death of essential faculty or administrator or any other circumstance which creates an impediment for the program.

(7) through (11) No change.

Rulemaking Authority 464.202, 464.203 FS. Law Implemented 464.203, 464.2085 FS. History–New 5-25-03, Amended 8-10-08, 6-5-12, 9-9-15,                           .

 

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: October 7, 2020

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 22, 2020