65G-7.004. Medication Assistance Provider Training and Validation Requirements

(1)(a) Unless otherwise authorized by law in the State of Florida, an individual shall not administer medication or supervise the self-administration of medication to Agency clients unless he or she has successfully completed an Agency-provided medication administration training course and obtained a current validation for the route by which the medication is administered. These requirements are necessary in order for an individual to become or remain a MAP.

(b) Unless otherwise authorized by law in the State of Florida, individuals who are not currently recognized by the Agency as a MAP permitted to administer prescribed enteral formulas or supervise the self-administration of prescribed enteral formulas to Agency clients are prohibited from doing so. MAPs or other unlicensed direct service providers administering prescribed enteral formulas who have previous training in the administration of prescribed enteral formula at the time this rule becomes effective shall have until December 31, 2019 to obtain the training and validation required to continue administering prescribed enteral formulas to clients, during which time they may continue to administer prescribed enteral formulas.

(2) An individual who wishes to obtain authorization as a MAP to administer medication or supervise the self-administration of medication to Agency clients must:

(a) Complete the Agency-approved Basic Medication Administration Training, including validation by simulation for the otic, transdermal, and topical routes as part of the training course. If the individual is not given the opportunity by the Trainer to obtain the required validation by simulation, he or she may obtain on-site validation from the Validation Trainer by either simulation or with an actual client using the client’s medication. A list of available Trainers may be obtained from the Regional Office MCM;

(b) Complete a two-part, Agency-provided exam within three calendar days of completing the Medication Administration Training, achieving a score of at least 85% on the Course Content section of the exam and 100% on the MAR section of the exam. If the individual fails to obtain a passing score, he or she may be permitted by the Trainer to retake the examination once to attempt to obtain a passing score. If the individual fails to obtain a passing score the second time, he or she must retake the Medication Administration Training prior to being permitted to attempt to obtain a passing score. If the individual fails to take the exam within three calendar days, he or she must take the course again in order to sit for the exam; and

(c) Obtain validation pursuant to subsections (4) and (5), prior to being permitted to assist in medication administration. 

(3) A MAP or MAP applicant who wishes to administer or supervise self-administration of prescribed enteral formulas must:

(a) Be authorized as a MAP for the administration or supervision of self-administration of medication, pursuant to subsection (2);

(b) Complete the Agency-provided Prescribed Enteral Formula Administration Training. A list of available Trainers may be obtained from the Regional Office MCM;

(c) Complete a two-part, Agency-provided exam following the Prescribed Enteral Formula Administration training, achieving a score of at least 85% on the course content section of the exam and 100% on the simulated return demonstration. If the individual fails to obtain a passing score, he or she may be permitted by the Trainer to retake the examination once to attempt to obtain a passing score. If the individual fails to obtain a passing score the second time, he or she must retake the Prescribed Enteral Formula Administration Training prior to being permitted to attempt to obtain a passing score;

(d) Obtain validation focused on prescribed enteral formula administration pursuant to subsections (4) and (5), in addition to the Agency-provided medication administration training course and validation; and

(e) MAPs or other unlicensed direct service providers administering prescribed enteral formulas who have previous training in the administration of prescribed enteral formula at the time this rule becomes effective shall have 180 days from the effective date of the rule to obtain the training and validation required to continue administering prescribed enteral formulas to clients, during which time they may continue to administer prescribed enteral formulas.

(4) Validation Requirements:

(a) Any MAP who is validated for otic, transdermal, or topical routes is not required to become revalidated for those three routes, unless the validation for the MAP’s primary route lapses. Any MAP who is validated for administration routes other than otic, transdermal, or topical routes, may obtain validation for these three routes via on-site validation from the Validation Trainer by either simulation or with an actual client using the client’s medication.

(b) MAP applicants must be assessed and validated as competent to administer medication or to supervise the self-administration of medication by an approved Validation Trainer after obtaining a passing score on the training examination. A list of available Validation Trainers may be obtained from the Regional Office MCM.

(c) MAP applicants who wish to administer prescribed enteral formula medication or to supervise the self-administration of prescribed enteral formula medication shall obtain a separate validation specific to prescribed enteral formula administration in addition to the validation required for Basic Medication Administration pursuant to paragraph (4)(a). A list of available Validation Trainers may be obtained from the Regional Office MCM.

(d) The MAP must achieve a score of 100% proficiency in the validation prior to being approved to provide medication administration assistance or prescribed enteral formula administration.

(e) MAP applicants must successfully complete their initial validation for their primary non-simulated medication administration routes within 180 days of completion of the Medication Administration Training, including Basic Medication Administration Training and Prescribed Enteral Formula Training.

(5) Successful assessment and validation require that the applicant demonstrate his or her capability to correctly administer medication and supervise the self-administration of medications in a safe and sanitary manner in an on-site client-setting using the client’s prescribed medications, except for the simulated routes, which include otic, transdermal, and topical administration routes.

(a) Validation for Basic Medication Administration includes a demonstration of the following proficiencies:

1. The ability to comprehend and follow medication instructions on a prescription label, physician’s order, and properly complete a MAR form;

2. The ability to administer medication by oral, transdermal, ophthalmic, otic, rectal, enteral, inhaled, or topical administration routes;

3. The ability to obtain pertinent medication information, including the purpose of the medication, its common side effects, and symptoms of adverse reactions to the medication, either from the package insert that comes from the pharmacy, or other professionally recognized medication resource, and to maintain this information for easy access and future reference;

4. The ability to write legibly, convey accurate information, and communicate with Agency staff and other health care providers through the applicant’s writings in a manner that ensures the health, safety, and well-being of the clients;

5. The ability to comply with medication administration record-keeping requirements;

6. The ability to communicate in a manner that permits health care providers and emergency responders to adequately and quickly respond to emergencies,

7. Knowledge of the proper storage and handling of medications;

8. Knowledge of proper disposal of expired or unused medications;

9. Knowledge of special requirements relating to storage and disposal of controlled medications;

10. Knowledge of requirements for obtaining authorizations for medication administration assistance, authorization for self-administration of medication without supervision, and informed consent for medication administration assistance; and

11. Training on the correct positioning and use of any adaptive equipment or use of special techniques required for the proper administration of medication.

(b) Validation for Prescribed Enteral Formula Administration includes a demonstration of the following proficiencies:

1. The ability to comprehend and follow prescribed enteral formula instructions on a physician’s order and properly complete a MAR form;

2. The ability to administer prescribed enteral formula by the enteral administration route;

3. The ability to write legibly, convey accurate information, and comply with medication administration record-keeping requirements;

4. The ability to communicate in a manner that permits health care providers and emergency responders to adequately and quickly respond to emergencies;

5. Knowledge of the proper storage and handling of prescribed enteral formulas;

6. Adequate training on the correct positioning and use of any adaptive equipment or use of special techniques required for the proper administration of prescribed enteral formulas.

(c) Subsequent validations for additional routes may be completed by the MAP following his or her initial validation(s). If the MAP obtains a subsequent validation, he or she must ensure that the Validation Trainer documents the subsequent validation(s) on the MAP’s original Validation Certificate, in the space provided.

(6) To maintain his or her ability to administer or supervise the self-administration of medication, a MAP must attend an Update Training Course and be revalidated annually, subject to the following qualifications:

(a) Update Training Course (referred to as Annual Inservice Training in section 393.506, F.S.):

1. MAPs that administer or supervise self-administration of medications must attend an annual update training course in Basic Medication Administration provided by the Agency, prior to the expiration of their current validation.  Upon successful completion of the Basic Medication Administration annual update, the MAP shall receive a Certificate of Completion for Basic Medication Administration Annual Update, APD Form 65G-7.004 A, effective December 2018, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10595.

2. MAPs that administer or supervise self-administration of prescribed enteral formulas must attend an annual update training course in Prescribed Enteral Formula Administration provided by the Agency prior to their re-validation. This course is required in addition to the Basic Medication Administration annual update training course. Upon successful completion of the Prescribed Enteral Formula Administration annual update, the MAP shall receive a Certificate of Completion for Prescribed Enteral Formula Administration Annual Update, APD Form 65G-7.004 B, effective December 2018, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10596.

3. MAPs who are required to re-validate on or before October 15, 2019 are permitted to complete the re-validation without completing the Update Training Course prior to re-validation.

(b) Re-Validation Requirements:

1. Effective and Expiration Dates:

a. Primary Routes.

(I) The effective date of a MAP’s primary route validation is the date that the MAP successfully completed the initial validation for that route.

(II) The expiration date for his or her primary route validation is based on the date of his or her initial validation received for a primary route of medication administration. The validation for the primary route of medication administration expires annually on the anniversary date of his or her initial effective date.

b. All Other Routes, Except Otic, Transdermal, and Topical Routes.

(I) The effective date of a MAP’s non-primary route(s), except otic, transdermal, and topical routes, is the date of the most recent validation for that specific route, regardless of when the MAP successfully completed the initial validation for that specific route.

(II) The expiration date for a MAP’s non-primary route(s), except otic, transdermal, and topical routes, is one year from the date of the most recent validation.

c. Otic, Transdermal, and Topical Routes.

(I) The effective date of a MAP’s otic, transdermal, and topical routes is the date that the MAP successfully completed the initial validation by simulation or with an actual client.

(II) Otic, transdermal, and topical routes do not expire.

2.a. If the MAP’s validation for the all administration routes other than the primary route expire, the MAP is not required to complete the required courses provided for in subsection (2). In this case, the MAP may continue to administer medications or supervise the administration of medications for routes for which the MAP maintains a current validation.

b. If the MAP’s validation for the primary routes expires, the MAP must complete the required courses provided for in subsection (2) and be revalidated for the primary route and all other routes, regardless of whether the non-primary route validations have expired, prior to being permitted to continue administering medications or supervising administration of medications.

3. MAPs shall, at least annually, through demonstration, be assessed and revalidated as competent to:

a. Administer medication or supervise the self-administration of medication;

b. Administer prescribed enteral formulas, if previously validated for prescribed enteral formula administration. This revalidation is in addition to the required revalidation for Basic Medication Administration.

4. A MAP must be re-validated annually within the 60 days preceding the expiration of his or her current validation.

5. MAPs who fail to acquire revalidation for the primary route of administration before the expiration of their validation for the primary route must retake the Basic Medication Administration Course and obtain current validation for their primary route within 180 days of completion of the Basic Medication Administration Course, prior to continuing to administer or supervise self-administration of medication;

6. MAPs who fail to acquire revalidation for prescribed enteral formula administration before the expiration of their validation must retake the prescribed enteral formula administration course and successfully revalidate within 180 days of completion of the Prescribed Enteral Formula Administration Course, prior to continuing to administer prescribed enteral formulas.

7. MAPs must successfully complete their re-validation for their primary non-simulated medication administration routes within 60 days of completion of the Update Training Course, including the Update for Basic Medication Administration and Prescribed Enteral Formula.

(7) A MAP may only assist in the administration of medication through an administration route for which the MAP holds a current, active validation.

(a) When a client is prescribed a medication requiring an administration route for which the MAP has not yet been validated or for which his or her validation has expired, the MAP must obtain a validation for that specific administration route before administering the medication to the client via that route.

(b) Temporary Validation.

1. When a client is prescribed a medication requiring an administration route for which the MAP has not been validated, the MAP may obtain a temporary validation for only that specific administration route and only that specific client from any individual licensed or authorized to practice nursing in the State of Florida pursuant to chapter 464, F.S., or licensed to practice medicine as a physician in the State of Florida pursuant to chapter 458 or 459, F.S., if:

a. The prescribed medication is necessary to ensure the health and safety of the client;

b. The MAP or the MAP’s supervisor attempts and is unable to contact a MAP who is able to administer the medication at the appropriate dosage times and who is validated for the specific administrative route;

c. The MAP obtains a validation in that administration route from an Agency-approved Validation Trainer as soon as possible within 30 days of the date the temporary validation was signed by the medical professional;

d. The nurse or physician documents the validation either utilizing Temporary Validation Form, Form 65G-7.004 C, effective April 2019, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10597, or utilizing a document with the nurse or physician’s letterhead on it indicating:

(I) That the nurse or physician validated the MAP;

(II) The date of validation;

(III) The route of administration validated;

(IV) The length of time the validation is necessary in order to ensure the client obtains the medication as prescribed and to provide time for the MAP to either obtain a validation from an Agency-approved Validation Trainer or locate a MAP who is validated in the appropriate administration route to provide the medication. Under no circumstances shall an Temporary Validation last longer than 30 days from the date of validation.

2. If the doctor or nurse utilizes a form with the nurse or physician’s letterhead on it rather than the Temporary Validation Form, the document utilized to record the Temporary Validation must be attached to the Temporary Validation Form. Completed Temporary Validation forms must be maintained by the MAP and his or her employer and be available to the Agency for review upon request.

3. A Temporary Validation can only be obtained for the following routes:

a. Oral;

b. Enteral, except for prescribed enteral formulas;

c. Transdermal;

d. Ophthalmic;

e. Otic;

f. Rectal;

g. Inhaled; and

h. Topical.

(c) If the client is prescribed an enteral formula, the MAP must obtain the required training and validation specific to prescribed enteral formula administration before administering prescribed enteral formula.

(8) Once trained and validated on one nebulizer or intermittent positive pressure breathing machine, a MAP is not required to train on subsequent machines of the same type to qualify as validated for nebulizers or intermittent positive pressure breathing machines.

(9) Trained and validated MAPs must maintain the original certificates indicating successful completion of training and validation. Employers of MAPs must maintain a copy of the training certificate and proof of current validation of each employee providing medication administration assistance at the site where the medication administration assistance is being provided.

(10) Any employer or contractor who offers MAP services is responsible for maintaining a record of the MAP’s training certification and annual validation and for making such records available for Agency review upon request.

Rulemaking Authority 393.501, 393.506 FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19.