Objectives At the completion of today s presentation, you will be able to: 1. Identify principles used in nursing delegation according to the nursing process Consent of person receiving nursing care Consent of person completing delegated nursing task Initial and on-going training Competency testing, return demonstration Supervision Documentation 2. Describe working with school administrators when nurse delegation is not successful 3. Building the system of needs per individual and building Resources necessary to safely care for students Staff development around the healthcare concerns in schools 4. End of year report how to use this to influence and the benefit of students 1
5. Access resources to implement House bill 2247 expansion of medications that can be delegated: eye drops, ear drops and topical medications (3) A registered nurse may delegate tasks of nursing care to other individuals where the registered nurse determines that it is in the best interest of the patient. (a) The delegating nurse shall: (i) Determine the competency of the individual to perform the tasks; (ii) Evaluate the appropriateness of the delegation; (iii) Supervise the actions of the person performing the delegated task; and (iv) Delegate only those tasks that are within the registered nurse's scope of practice. (3) A registered nurse may delegate tasks of nursing care to other individuals where the registered nurse determines that it is in the best interest of the patient. (a) The delegating nurse shall: (i) Determine the competency of the individual to perform the tasks; (ii) Evaluate the appropriateness of the delegation; (iii) Supervise the actions of the person performing the delegated task; and (iv) Delegate only those tasks that are within the registered nurse's scope of practice. 2
The 2012 legislature passed House Bill 2247. School employees may administer 1. Oral medications 2. Eye drops 3. Ear drops 4. Topical medications Nurse may delegate these medications. School administrators must provide for medical treatment of students Nurses assure delegation is safe for the student and the school employee models the nursing process Assess the student and the school employee s competency Plan documentation of the training and nursing care Implement - supervision requirements Evaluate changes in student needs, changes in school personnel, activities, change the plan or continue 3
(d) No person may coerce a nurse into compromising patient safety by requiring the nurse to delegate if the nurse determines that it is inappropriate to do so. Nurses shall not be subject to any employer reprisal or disciplinary action by the nursing care quality assurance commission for refusing to delegate tasks or refusing to provide the required training for delegation if the nurse determines delegation may compromise patient safety. Use the five rights Right student identification of student; are the right consents from the parents on file Right medication in an original container labeled for the student Right dosage Right route oral medication, eye drops, ear drops, topical medications Right time (s) You work with school personnel of varying skills, abilities and willingness to administer medications You will be assessing the competency of the school personnel Able to safely administer the medications Willing to administer the medications Available when the student needs and medications scheduled All three criteria must be met in order for the school personnel to be competent 4
Initial and on-going training and supervision 1. Five rights 2. Side effects and reactions to medications that must be reported 3. Demonstration of administration if needed and return demonstration 4. If the school personnel are not competent, the nurse does not delegate to this person Nursing judgment is not delegated this is the decision to delegate and assessing student safety The school nurse delegates the task, not the judgment or responsibility The initial training needs to include what to do in case of emergency: anaphyllaxis skin reactions choking Plan Documentation in the nursing care plan of training plan, competency assessment, student assessment emergency preparedness: 911, parents, etc. 5
Implement On going training and supervision as needed Evaluate Adequate and well trained personnel to assure safety Ongoing education related to emergencies, drug storage, medications, side effects Capture data in annual school report on medication administration, volume and type, hours in training and supervision, incident reporting Describe working with school administrators when nurse delegation is not successful Cannot be coerced Resources needed to safety administer medications Immunities in the law protect the school personnel 6
Working under my RN license? Not really. If you document the training and assessment of competency, supervision, plan, evaluation, you are delegating properly. If the school personnel do not follow the plan nor direction, you met your responsibilities. OSPI Oral Medications bulletin Revising to include eye drops, ear drops and topical medications Recruiting for a school nurse to revise the memo OSPI circulating the announcement Memo from OSPI to cover until bulletin revised Effective date of HB 2247: June 7, 2012 Questions 7