Chapter 4761-7 Issuance of License; Scope of Care; Supervision

4761-7-01 Original license or permit, identification card or electronic license verification.

(A) The board shall prepare and provide to each initial license or permit holder a certificate stating the name of the license or limited permit holder, the license or limited permit number assigned and the initial issuance date. Additionally, the board may issue an identification card as proof of current authorization to practice. In lieu of an identification card, the board may permit the electronic verification of the each license or limited permit holder through a web-based verification system. An identification card or electronic verification shall contain the person's name, license or permit number, information as to the type of authorization under which they practice, and date of expiration.

(B) Official license or permit certificates shall be signed by the board president and be affixed with the seal of the board. Official identification cards, if used, shall bear the signature of the board president and/or the executive director. Electronic verification of license or limited permit status shall be considered a primary source verification. For the purpose of conspicuous display as set forth under division (A) of section 4761.05 of the Revised Code, a holder may make a notarized copy of the license or permit certificate. A written statement must be found on the document attesting that the certificate is a true copy.

(C) Neither the holder nor anyone else shall make any alterations on a certificate or identification card issued by the board.

(D) Regardless of the original issue date, all licenses shall expire on June thirtieth of each even numbered year, unless other limitations pursuant to law, board order, or consent agreement are in effect.

(E) Regardless of the original issue date, all limited permits will expire on June thirtieth of each year, unless other limitations pursuant to law, board order, or consent agreement are in effect.

(F) Identification cards or electronic verification are valid proof of current authorization.

(G) In accordance with division (C) of section 4761.05 of the Revised Code, holders of licenses and permits must display in a conspicuous place on their persons the information as to the type of authorization under which they practice. This information shall include the holder's name, title, and the type of authorization under which they practice, which shall state no less than "R.C.P." for a licensed respiratory care professional or "limited permit holder" for a limited permit holder.

R.C. 119.032 review dates: 10/28/2013 and 08/15/2018
Promulgated Under: 119.03
Statutory Authority: 4761.03
Rule Amplifies: 4761.05
Prior Effective Dates: 03/10/1990, 03/14/1991, 01/31/1992, 01/01/1996, 05/02/1996, 09/21/1998, 03/26/2001, 8/15/08, 10/26/2009

4761-7-03 Scope of respiratory care defined.

(A) "Respiratory care" as employed in Chapter 4761. of the Revised Code, means engaging in respiratory care, as defined in division (A) of section 4761.01 of the Revised Code, as a clinician, an educator, a manager, and/or a consultant, excluding activities related to equipment maintenance, cleaning, and delivery.

(B) "Instructing in the use of medical gases" as it is used in division (A)(2) of section 4761.01 of the Revised Code, means the direct or indirect use of educational material, communicated in writing or otherwise, that explains the clinical indications or contraindications concerning a patient's prescription for a medical gas.

(C) "Administering of medical gases" as it is used in division (A)(2) of section 4761.01 of the Revised Code, means the direct application and quantitative adjustment of a medical gas to a patient regardless of the device used to administer the gas.

(D) "Monitoring and recording the results of medical gases" as it is used in division (A)(2) of section 4761.01 of the Revised Code, means assessing, evaluating and documenting the use of a medical gas, including measurements of fractional inspired concentrations, flow and volume; and a patient's physiologic or clinical response to a medical gas, including invasive or noninvasive sampling of blood or gas samples.

(E) "Any service" as it is used in division (A) of section 4761.01 of the Revised Code, means any practice performed by a competently trained licensed respiratory care professional or permit holder involving the evaluation of cardiopulmonary function, the treatment of cardiopulmonary impairment, the assessment of treatment effectiveness and the care of patients with deficiencies and abnormalities associated with the cardiopulmonary system.

(F) "Aspiration" as it is used in division (B)(1) of section 4761.10 of the Revised Code, means to remove bodily fluids or mucous from the pulmonary airway by means of a suction device. Included suctioning procedures are naso-pharyngeal, oral-pharyngeal, tracheal, and bronchial. Oral suctioning and suctioning of secretions external to the airway will not be considered aspiration as this term is defined in this rule.

R.C. 119.032 review dates: 05/06/2010 and 05/06/2015
Promulgated Under: 119.03
Statutory Authority: 4761.03
Rule Amplifies: 4761.01(A) , 4761.10(B)(1)
Prior Effective Dates: 1/1/94, 1/1/96, 9/21/98/ 3/26/01, 7/11/03

4761-7-04 Supervision.

As provided for in division (B) of section 4761.05 of the Revised Code, a limited permit holder must work under the supervision of a respiratory care professional (RCP) and may not be supervised by any other person, including those persons licensed to practice in any other profession.

"To practice under the supervision of a respiratory care professional" as used in division (B) of section 4761.05 of the Revised Code requires that an RCP be readily available in the facility and responsible at all times for the direction and actions of a limited permit holder under their supervision. Three types of limited permits are issued by the board: student-based, employment-based, and graduate-based. The level of supervision and the duties assigned may vary based upon the type of limited permit holder that is being supervised. The RCP shall determine the appropriate level of supervision and assigned respiratory care duties for an employment-based limited permit holder taking into consideration institutional competency reviews and work performance. For student limited permit holders, the appropriate level of supervision and assigned respiratory care duties shall be based, in part, on competencies approved on the verification of education form completed by the student's respiratory care educational program director. At no time shall a supervising RCP assign duties that exceed the approved competencies documented on the verification of education form. Graduate-based limited permit holders may practice a full scope of respiratory care duties, but must still be supervised in accordance with this rule. Regardless of the type of limited permit held, an RCP shall not delegate to a less qualified person any service which requires the skill, knowledge and judgment of an RCP.

R.C. 119.032 review dates: 05/06/2010 and 05/06/2015
Promulgated Under: 119.03
Statutory Authority: 4761.03
Rule Amplifies: 4761.05
Prior Effective Dates: 01/01/1994, 05/02/1996, 09/21/1998, 03/26/2001, 07/11/2003, 05/23/2005, 07/01/2007

4761-7-05 Administration of medications.

(A) Respiratory care professionals and limited permit holders must be able to document appropriate and successful training and proficiency on the route of medication delivery, drug pharmacology, and dosage calculations for any medication for the treatment and testing of cardiopulmonary impairment for which they are authorized to administer pursuant to division (A)(4) of section 4761.01 of the Revised Code. Appropriate training includes, but is not limited to, the following components:

(1) Pharmacology. Subject matter shall include terminology, drug standards, applicable laws and legal aspects, identification of drugs by name and classification, and the principles of pharmacodynamics of medications used in the treatment and testing of cardiopulmonary impairment.

(2) Techniques of drug administration. Subject matter shall include principles of asepsis, safety and accuracy in drug administration, applicable anatomy and physiology, and techniques of administration and any route of administration for any medications for the treatment and testing of cardiopulmonary impairment.

(3) Dosage calculations. Subject matter shall include a review of arithmetic and methods of calculation required in the administration of drug dosages.

(4) The role of the respiratory care professional or limited permit holder in the administration of any medication for the treatment and testing of cardiopulmonary impairment. Subject matter shall include constraints of medication administration under the legal scope of practice for respiratory care, the rationale for specific respiratory care in relation to drug administration; observations and actions associated with desired drug effects, side effects and toxic effects; communication between respiratory care professional or limited permit holder and other members of the health care team; respiratory care provider-client interactions; and the documentation of medication administration for any medication for the treatment and testing of cardiopulmonary impairment.

(5) Clinical experience in the administration of any medication(s) for the treatment and testing of cardiopulmonary impairment, planned under the direction of a qualified respiratory care professional or other qualified health care provider responsible for teaching medication administration for any medication for the treatment and testing of cardiopulmonary impairment.

(B) Respiratory care professionals may administer medications to induce minimal sedation to moderate sedation/analgesia during diagnostic and therapeutic procedures relating to the testing and treatment of cardiopulmonary impairments. It is appropriate for respiratory care professionals to administer these medications if the following criteria are followed:

(1) Only a person authorized to prescribe or write orders pursuant to section 4761.17 of the Revised Code may select and order the drug to be administered to achieve the desired level of sedation/analgesia. The order shall include:

(a) Medication;

(b) Dosage;

(c) Frequency; and

(d) Method of administration.

(2) In addition to the general training requiring for medication administration contained in paragraphs (A)(1) to (A)(5) of this rule, a respiratory care professional shall also do the following:

(a) Complete the education and competency requirements of the employing facility on the administration of sedatives and analgesic medications;

(b) Understand the pharmacology, dosage, routes of administration, and adverse reactions of sedatives, analgesics, and antagonists. Identify the appropriate selection of monitoring equipment and be able to understand and interpret vital signs. Record patient's vital signs and medication in the medical record;

(c) Have current advanced cardiac life support (ACLS) or pediatric advanced life support (PALS) certification as appropriate and be able to perform rescue procedures;

(d) Meet competency guidelines, as determined by the facility, for the insertion and maintenance of artificial airways, assessing and maintaining ventilation, administration of oxygen, and

(e) Be able to insert and maintain an intravenous line when medications are administered by this route.

(3) The administration of medications to induce minimal to moderate sedation/analgesia shall be properly supervised by the authorized prescriber. Respiratory care professional must adhere to the following supervisory guidelines:

(a) Oral administration or aerosolized administration of medications to induce minimal to moderate sedation/analgesia may be performed with off-site supervision of the prescriber and do not require the respiratory care professional to be able to insert or maintain an intravenous line.

(b) Intravenous administration of medications to induce minimal sedation/analgesia for emergency intervention procedures, such as intubation may be performed with off-site supervision of the prescriber.

(c) Intravenous administration of medications to induce moderate sedation/analgesia for respiratory care procedures requires direct supervision of the prescriber.

(4) At no time shall a respiratory care professional administer a medication at a dosage and interval that is reasonably expected to induce deep sedation or general anesthesia.

(5) A respiratory care professional who administers a medication to induce minimal sedation to moderate sedation/analgesia shall have no other assignments during the course of administration, monitoring and recovery of the patient that would leave the patient unattended or unmonitored.

(6) Prior to administering a medication to induce minimal sedation to moderate sedation/analgesia, the respiratory care professional shall review the patient's pertinent medical history, including sedation-oriented aspects. The patient history should include a review of the medical history; current medications, herbal products, or vitamins; medication allergies; use of tobacco, alcohol, or substance abuse; last oral intake; and history of adverse reactions to sedatives, analgesics or anesthetics.

(7) Monitoring parameters shall minimally include:

(a) Baseline vital signs prior to and intermittently during the procedure;

(b) Pulmonary ventilation, including respiratory rate, depth of breathing, auscultation and, if appropriate, end tidal CO2 monitoring;

(c) Oxygenation via pulse oximetry;

(d) Electrocardiography for patient with history of cardiovascular disease or dysrhythmias, or hypertension;

(e) Response to verbal and tactile stimulation and commands;

(C) For each respiratory care professionals and limited permit holdersrespiratory care provider, the organization shall maintain a record that documents training and proficiency reviews. Documentation of periodic competency reviews shall be maintained by the organization. At the request of the board, records may be audited, reviewed, or copied.

R.C. 119.032 review dates: 05/06/2010 and 05/06/2015
Promulgated Under: 119.03
Statutory Authority: 4761.03
Rule Amplifies: 4761.01
Prior Effective Dates: 1/1/1996, 5/2/1996, 3/26/2001, 05/23/2005