Chapter 5123:2-6 Administration of Medication

5123:2-6-01 Definitions.

The following definitions shall apply to Chapter 5123:2-6 of the Administrative Code:

(A) "Abuse" has the same meaning as in section 5123.50 of the Revised Code, except that it includes a misappropriation, as defined in that section.

(B) "Adult services" has the same meaning as in section 5126.01 of the Revised Code.

(C) "Certified home and community-based services provider" means a person or government entity certified under section 5123.045 of the Revised Code.

(D) "Certified supported living provider" means a person or government entity certified under section 5126.431 of the Revised Code.

(E) "Contact hour" has the same meaning as in Chapter 4723-14 of the Administrative Code.

(F) "County board" means a county board of mental retardation and developmental disabilities established under Chapter 5126. of the Revised Code or a regional council of government formed under section 5126.13 of the Revised Code by two or more county boards.

(G) "Delegable nursing task" means a nursing task, which a licensed nurse has determined meets the provisions listed in Chapter 4723-13 of the Administrative Code.

(H) "Department" means the Ohio department of developmental disabilities as established by section 121.02 of the Revised Code.

(I) "Drug" has the same meaning as in section 4729.01 of the Revised Code.

(J) "Early intervention, preschool or school-age services" means those services offered or provided under Chapter 5123. or Chapter 5126. of the Revised Code.

(K) "Family support services" has the same meaning as in section 5126.01 of the Revised Code.

(L) "Health-related activities" means the following:

(1) Taking vital signs;

(2) Application of clean dressings that do not require health assessment;

(3) Basic measurement of bodily intake and output;

(4) Oral suctioning;

(5) Use of glucometers;

(6) External urinary catheter care;

(7) Emptying and replacing colostomy bags;

(8) Collection of specimens by noninvasive means.

(M) "ICF/MR" means an intermediate care facility for people with mental retardation.

(N) "Individual" means a person with mental retardation and/or developmental disabilities.

(O) "Licensed health professional authorized to prescribe drugs" has the same meaning as in section 4729.01 of the Revised Code.

(P) "Licensed nurse" means a registered nurse or a licensed practical nurse who holds a current valid license to practice nursing in Ohio.

(Q) "Major unusual incident" has the same meaning as in rule 5123:2-17-02 of the Administrative Code.

(R) "Medicaid" has the same meaning as in section 5111.01 of the Revised Code.

(S) "MR/DD personnel" means the employees and the workers under contract who provide specialized services to individuals with mental retardation and developmental disabilities. "MR/DD personnel" includes those who provide the services as follows:

(1) Through direct employment with the department of developmental disabilities or a county board of mental retardation and developmental disabilities;

(2) Through an entity under contract with the department of developmental disabilities or a county board of mental retardation and developmental disabilities; or

(3) Through direct employment or being under contract with private entities, including private entities that operate residential facilities.

(T) "Neglect" has the same meaning as in section 5123.50 of the Revised Code.

(U) "Nursing delegation" means the process established in rules adopted by the Ohio board of nursing pursuant to Chapter 4723. of the Revised Code under which a registered nurse or licensed practical nurse acting at the direction of a registered nurse transfers the performance of a particular nursing activity, task, or prescribed medication administration to another person who is not otherwise authorized to perform the activity, task, or prescribed medication administration.

(V) "Oral prescribed medication" means any prescribed medication that can be ingested through the mouth.

(W) "Prescribed medication" means a drug that is to be administered according to the instructions of a licensed health professional authorized to prescribe drugs.

(X) "Prescribed medication error" means the administration of the wrong prescribed medication (which includes outdated prescribed medication and prescribed medication not stored in accordance with the instructions of the manufacturer or the pharmacist), administration of the wrong dose of prescribed medication, administration of prescribed medication at the wrong time, administration of prescribed medication by the wrong route, or administration of prescribed medication to the wrong person.

(Y) "Prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube" means administration of an oral prescribed medication to an individual through a stable labeled gastrostomy tube or a stable labeled jejunostomy tube.

(Z) "Residential facility" means a facility licensed under section 5123.19 of the Revised Code or subject to section 5123.19 2 of the Revised Code.

(AA) "Self-administration or assistance with self-administration of prescribed medication" has the same meaning as in rule 5123:2-6-02 of the Administrative Code.

(BB) "Specialized services" has the same meaning as in section 5123.50 of the Revised Code.

(CC) "Subcutaneous insulin injection" includes injection of prescribed insulin by syringe and needle subcutaneous injection, and by insulin pump injection.

(DD) "Task" means a task that is prescribed, ordered, delegated, or otherwise directed by a health care professional acting within the scope of the professional's practice.

(EE) "Topical prescribed medication" means any prescribed medication that is applied to the outer skin, and eye, ear, or nose drops. "Topical medication" may include transdermal prescribed medication or vaginal or rectal suppositories.

(FF) "Train the instructor program" means the program for training registered nurses to train MR/DD personnel and for training registered nurses to train other registered nurses to train MR/DD personnel in the administration of oral and topical prescribed medications and health-related activities, administration of food and prescribed medication via stable labeled gastrostomy tube or jejunostomy tube, administration of subcutaneous insulin injections, or performance of delegable nursing tasks pursuant to Chapter 4723-13 of the Administrative Code.

(GG) "Tube feeding" means the provision of prescribed nutrition to an individual through a stable labeled gastrostomy tube or a stable labeled jejunostomy tube.

(HH) "Unusual incident" has the same meaning as in rule 5123:2-17-02 of the Administrative Code.

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.42 , 5123.46
Rule Amplifies: 5123.04 , 5123.41 to 5123.47
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004

5123:2-6-02 Self-administration or assistance with the self-administration of prescribed medication.

(A) An individual who can safely self-administer medication or receive assistance with self-administration of medication has the right to self-administer medication or receive assistance with the self-administration of medication.

(B) Based on an assessment prescribed or approved by the department, the individual's service plan shall document when the individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication. The assessment used to determine when an individual cannot safely self-administer or receive assistance with self-administration of prescribed medication shall be reviewed annually, and a new assessment shall be conducted at least every three years.

(C) MR/DD personnel who are not specifically authorized by other provisions of the Revised Code to provide assistance in the self-administration of prescribed medication may, under section 5123.651 of the Revised Code and this rule, provide that assistance as part of the services they provide to individuals. To provide assistance with self-administration of prescribed medication, MR/DD personnel are not required to be trained or certified in accordance with section 5123.42 of the Revised Code and rules 5123:2-6-05 and 5123:2-6-06 of the Administrative Code.

(D) When assisting in the self-administration of prescribed medication, MR/DD personnel shall take only the following actions:

(1) Remind an individual when to take the medication and observe the individual to ensure that the individual follows the directions on the container;

(2) Assist an individual by taking the medication in its container from the area where it is stored, handing the container with the medication in it to the individual, and opening the container, if the individual is physically unable to open the container;

(3) Assist, on request by or with the consent of, a physically impaired but mentally alert individual, with removal of oral or topical medication from the container and with the individual's taking or applying of the medication. If an individual is physically unable to place a dose of oral medication to the individual's mouth without spilling or dropping it, MR/DD personnel may place the dose in another container and place that container to the individual's mouth.

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.42 , 5123.46 , 5123.65
Rule Amplifies: 5123.04 , 5123.41 to 5123.47 , 5123.65 , 5123.651 , 5126.36
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004

5123:2-6-03 Authorization of MR/DD personnel to administer prescribed medications, perform health-related activities, or perform tube feedings.

(A) Effective December 31, 2003, MR/DD personnel who are not specifically authorized by other provisions of the Revised Code to administer prescribed medications, perform health-related activities, or perform tube feedings may do so pursuant to section 5123.42 of the Revised Code and rules adopted by the department under this chapter as part of the specialized services the MR/DD personnel provide to individuals in the following categories:

(1) Individuals receiving early intervention, preschool, and school age services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(2) Individuals receiving adult services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(3) Individuals receiving family support services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(4) Individuals receiving services from certified supported living providers, if the services are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(5) Individuals receiving residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes not more than four individuals and the services are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(6) Individuals receiving services not included in paragraphs (A) (1) to (A)(5) of this rule that are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(7) Individuals residing in a residential facility with five or fewer beds;

(8) Individuals residing in a residential facility with at least six but not more than sixteen beds;

(9) Individuals residing in a residential facility with seventeen or more beds who are on a field trip from the facility, if all of the following are the case:

(a) The field trip is sponsored by the facility for purposes of complying with federal medicaid statutes and regulations, state medicaid statutes and rules, or other federal or state statutes, regulations, or rules that require the facility to provide habilitation, community integration, or normalization services to its individuals.

(b) Not more than five field trip participants are individuals who have health needs requiring the administration of prescribed medications, excluding participants who self-administer prescribed medications or receive assistance with self-administration of prescribed medications.

(c) The facility staffs the field trip with MR/DD personnel in such a manner that one person will administer prescribed medications, perform health-related activities, or perform tube feedings for not more than two participants if one or both of those participants have health needs requiring the person to administer prescribed medications through a gastrostomy or jejunostomy tube.

(d) According to the instructions of a health care professional acting within the scope of the professional's practice, the health needs of the participants who require administration of prescribed medications by MR/DD personnel are such that the participants must receive the prescribed medications during the field trip to avoid jeopardizing their health and safety.

(B) Authorization of MR/DD personnel to administer prescribed medications, perform health-related activities, or perform tube feedings by the categories specified in paragraphs

(A)(1) to (A)(9) of this rule

(1) In the case of individuals receiving early intervention, preschool, and school-age services, offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code, all of the following apply:

(a) With nursing delegation, MR/DD personnel may perform health-related activities.

(b) With nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(2) In the case of individuals receiving adult services, offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code, all of the following apply:

(a) With nursing delegation, MR/DD personnel may perform health-related activities.

(b) With nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(3) In the case of individuals receiving family support services, offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code, all of the following apply:

(a) Without nursing delegation, MR/DD personnel may perform health-related activities.

(b) Without nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(e) With nursing delegation, MR/DD personnel may administer routine doses of insulin through subcutaneous injections and insulin pumps.

(4) In the case of individuals receiving services from certified supported living providers, if the services are offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code, all of the following apply:

(a) Without nursing delegation, MR/DD personnel may perform health-related activities.

(b) Without nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(e) With nursing delegation, MR/DD personnel may administer routine doses of insulin through subcutaneous injections and insulin pumps.

(5) In the case of individuals receiving residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes not more than four individuals and the services are offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code, all of the following apply:

(a) Without nursing delegation, MR/DD personnel may perform health-related activities.

(b) Without nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(e) With nursing delegation, MR/DD personnel may administer routine doses of insulin through subcutaneous injections and insulin pumps.

(6) In the case of individuals receiving services not included in paragraphs (A) (1) to

(A)(5) of this rule that are offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code, all of the following apply:

(a) With nursing delegation, MR/DD personnel may administer health-related activities.

(b) With nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(7) In the case of individuals residing in a residential facility with five or fewer beds, all of the following apply:

(a) Without nursing delegation, MR/DD personnel may perform health-related activities.

(b) Without nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(e) With nursing delegation, MR/DD personnel may administer routine doses of insulin through subcutaneous injections and insulin pumps.

(8) In the case of individuals residing in a residential facility with at least six but not more than sixteen beds, all of the following apply:

(a) With nursing delegation, MR/DD personnel may perform health-related activities.

(b) With nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(9) In the case of individuals residing in a residential facility with seventeen or more beds who are on a field trip from the facility, all of the following apply during the field trip, subject to the limitations specified in paragraph (A)(9) of this rule:

(a) With nursing delegation, MR/DD personnel may perform health-related activities.

(b) With the nursing delegation, MR/DD personnel may administer oral and topical prescribed medications.

(c) With nursing delegation, MR/DD personnel may administer prescribed medications through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(d) With nursing delegation, MR/DD personnel may perform routine tube feedings, if the gastrostomy and jejunostomy tubes being used are stable and labeled.

(C) The authority of MR/DD personnel to administer prescribed medications, perform health-related activities, and perform tube feedings pursuant to section 5123.42 of the Revised Code and this rule is subject to all of the following:

(1) To administer prescribed medications, perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube or administer subcutaneous insulin injection for individuals in the categories specified under paragraphs (A)(1) to (A)(8) and (B)(1) to (B)(8) of this rule, MR/DD personnel shall obtain the certificate or certificates required by the department and issued under 5123.45 of the Revised Code and rule 5123:2-6-06 of the Administrative Code. MR/DD personnel shall administer prescribed medication, perform health-related activities, and perform tube feedings only as authorized by the certificate or certificates held.

(2) To administer prescribed medications, perform health-related activities, or administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube for individuals in the category specified under paragraphs (A)(9) and (B)(9) of this rule, MR/DD personnel shall successfully complete the training course or courses developed under section 5123.43 of the Revised Code and rule 5123:2-6-05 of the Administrative Code for MR/DD personnel, or obtain the certificate or certificates required by the department and issued under section 5123.45 of the Revised Code and rule 5123:2-6-06 of the Administrative Code. MR/DD personnel shall administer prescribed medication, perform health-related activities, and perform tube feedings only as authorized by the training completed.

(3) If nursing delegation is required under paragraph (B) of this rule, MR/DD personnel shall not act without nursing delegation or in a manner that is inconsistent with the delegation.

(4) Prior to delegating under this rule, the delegating licensed nurse shall:

(a) Assess the individual and complete an evaluation of the conditions under which the delegated task(s) or delegated prescribed medication(s) administration will be done; and

(b) Select MR/DD personnel that have current training in the MR/DD personnel training pursuant to rule 5123:2-6-05 of the Administrative Code and do individual specific training; or select MR/DD personnel that have current certification in the MR/DD personnel training pursuant to rule 5123:2-6-06 of the Administrative Code and do individual specific training; or if the delegating licensed nurse is qualified as a registered nurse instructor pursuant to rule 5123:2-6-05 of the Administrative Code provide training to the MR/DD personnel pursuant to rule 5123:2-6-05 of the Administrative Code and do individual specific training; and

(c) Document assessment and training.

(5) The employer of MR/DD personnel shall ensure that MR/DD personnel have been trained specifically with respect to each individual for whom they administer prescribed medications, perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube or administer subcutaneous insulin injections. MR/DD personnel shall not administer prescribed medications, perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube or administer subcutaneous insulin injection for any individual for whom they have not been specifically trained.

(6) In situations in which nursing delegation is required, the delegating licensed nurse shall also ensure that MR/DD personnel have been trained specifically with respect to each individual for whom they administer prescribed medications, perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube or administer subcutaneous insulin injections. MR/DD personnel shall not administer prescribed medications, perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube or administer subcutaneous insulin injection for any individual for whom they have not been specifically trained.

(7) If the employer of MR/DD personnel believes or is notified by the county board, the department, a delegating licensed nurse or the registered nurse responsible for quality assessment pursuant to rule 5123:2-6-07 of the Administrative Code that MR/DD personnel have not safely administered or will not safely administer prescribed medications, have not safely performed or will not safely perform health-related activities, have not safely administered or will not safely administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, or have not safely administered or will not safely administer subcutaneous insulin injections, the employer shall:

(a) Prohibit the action from continuing or commencing;

(b) Immediately make other staffing arrangements so that administration of prescribed medication, performance of health-related activities, administration of food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, and administration of subcutaneous insulin injections are completed as prescribed, including compliance with the requirements of this chapter of the Administrative Code;

(c) If applicable, immediately notify the county board via the major unusual incident reporting system pursuant to rule 5123:2-17-02 of the Administrative Code, and, if applicable, the county board shall notify the registered nurse responsible for quality assessment oversight pursuant to rule 5123:2-6-07 of the Administrative Code; and

(d) If applicable, immediately notify the delegating licensed nurse.

(8) MR/DD personnel shall not engage in the action or actions subject to an employer's prohibition or a delegating licensed nurse's prohibition.

(9) If the licensed nurse delegating to MR/DD personnel believes that MR/DD personnel have not safely administered or will not safely administer delegated prescribed medications, the delegating licensed nurse shall not authorize the action to commence and shall withdraw authorization for the action to continue. The delegating licensed nurse shall immediately notify the MR/DD personnel's employer and if applicable the registered nurse responsible for quality assessment pursuant to rule 5123:2-6-07 of the Administrative Code. MR/DD personnel shall not engage in the prescribed medication administration requiring nurse delegation without specific authorization from the delegating licensed nurse.

(10) A registered nurse shall reassess delegation and the needs of the individual on an on-going basis, but at least annually, including determination that delegation continues to be necessary and appropriate, determination that the individual continues to be stable, and determination that the MR/DD personnel continue to have the skills to perform the nursing task(s), activity(ies), or prescribed medication administration that have been delegated. The reassessment may be more frequent if necessary in the judgment of the delegating registered nurse.

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.42 , 5123.46
Rule Amplifies: 5123.04 , 5123.41 to 5123.47 , 5126.36
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004

5123:2-6-04 Qualifications, training, and certification of registered nurses to train MR/DD personnel in the administration of prescribed medications, performance of health-related activities, and performance of tube feedings.

(A) Qualifications of instructional personnel for the train the instructor program

(1) A registered nurse, who shall meet the following qualifications, may teach the train the instructor program, or any portion thereof, for a registered nurse:

(a) Current valid licensure in Ohio to practice as a registered nurse;

(b) At least sixty months experience in the practice of nursing, of which at least twenty-four months have been in the field of mental retardation and developmental disabilities;

(c) Knowledge of the laws and rules regulating the practice of nursing, and the laws and rules of the department that address delegation by a licensed nurse to MR/DD personnel and the training of MR/DD personnel pursuant to this chapter;

(d) Knowledge of and experience with the principles of adult education;

(e) Successful completion of the train the instructor program and maintenance of the train the instructor program certification pursuant to this rule; and

(f) Authorization from the department to teach the train the instructor program.

(2) The department's nurse consultant or other department registered nurse designee may teach the train the instructor program, or any portion thereof, for a registered nurse.

(B) Qualifications to plan, develop, and coordinate an MR/DD personnel program of instruction

(1) Only a registered nurse who meets the following requirements shall plan, develop, and coordinate a program of instruction that prepares MR/DD personnel to give or apply oral or topical medications, perform health-related activities, perform subcutaneous insulin injections, or administer food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube:

(a) Current valid licensure in Ohio to practice nursing as a registered nurse;

(b) A minimum of eighteen months experience in the practice of nursing as a registered nurse;

(c) Previous experience caring for an individual with mental retardation and developmental disabilities;

(d) Successful completion of the train the instructor program as evidenced by a certificate from an approved department trainer who is an authorized Ohio board of nursing approver.

(2) The registered nurse certified instructor may utilize other licensed health care professionals to assist with conducting the training as long as the other health care professionals have received instruction on the material and are acting within the professional's scope of practice as outlined in the Revised Code. None of the other licensed health care professionals shall teach the class in its entirety, but may serve as a guest instructor at the direction of the registered nurse certified instructor.

(3) Licensed practical nurses may choose to participate in the train the instructor program. Upon completion, they will receive a certificate of participation offering them continuing education credits, but they may not become a certified instructor.

(C) Minimum curriculum for the train the instructor program

(1) A train the instructor program for registered nurses trained on or after the effective date of this rule, which prepares a registered nurse to teach MR/DD personnel to give oral or apply topical prescribed medication and perform health-related activities, administer food and prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube, or perform subcutaneous insulin injections shall be at a minimum eight hours and include at a minimum the following:

(a) Review of section 4723.071 of the Revised Code and review of sections 5123.41 to 5123.47 of the Revised Code and rules adopted under this chapter and applicable Revised Code and Administrative Code relating to the functioning of a county board, nursing delegation and MR/DD personnel;

(b) Review of all components required when teaching MR/DD personnel to give oral or apply topical prescribed medications and perform health-related activities, administer food and prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube, or perform subcutaneous insulin injections, including general principles of delegation by a licensed nurse to MR/DD personnel;

(c) Quality measures and quality assessment requirements pursuant to this chapter;

(d) MR/DD personnel and licensed nurse documentation requirements;

(e) Principles of nursing delegation supervision including direct and indirect supervision and determination of the appropriate type of supervision pursuant to this chapter;

(f) How to provide indirect supervision, including methods for remaining accessible, and training MR/DD personnel how and when to access help;

(g) How to evaluate the MR/DD personnel's skills including developing and using a skills check list for use in the program of instruction that teaches MR/DD personnel to give oral or apply topical prescribed medications and perform health-related activities, administer food and prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube, or perform subcutaneous insulin injections;

(h) Liability issues pursuant to rule 5123:2-6-07 of the Administrative Code;

(i) General principles of adult basic education.

(2) A train the instructor program for registered nurses trained prior to the effective date of this rule, and already certified under the delegation train the instructor program (DTTI) pursuant to requirements in effect prior to the effective date of this rule, which prepares a registered nurse to teach MR/DD personnel to give or apply oral or topical prescribed medication and perform delegable nursing tasks or administer food and prescribed medication via gastrostomy tube and jejunostomy tube shall be at a minimum two and one half hours and include at a minimum the following:

(a) Review of sections 5123.42 to 5123.47 of the Revised Code and rules adopted under this chapter;

(b) Update on MR/DD personnel administration of oral and topical prescribed medication, performance of health-related activities, administration of food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or performance subcutaneous insulin injections;

(c) Quality measures and quality assessment requirements;

(d) MR/DD personnel and nurse documentation requirements;

(e) Prescription receiving and transcription by MR/DD personnel requirements;

(f) Introduction to internet accessible database for certified registered nurses and certified MR/DD personnel.

(3) The registered nurse coordinator of the train the instructor program shall ensure that the train the instructor program for a registered nurse shall be planned, developed and taught in accordance with requirements set forth in this rule.

(4) The training of nursing task delegation shall be completed as described in rules adopted by the Ohio board of nursing under Chapter 4723-13 of the Administrative Code.

(5) The department must approve a train the instructor program course not developed by the department prior to use in the train the instructor program.

(D) Certificate of training

Successful completion of the train the instructor program provided to prepare the registered nurse to train MR/DD personnel to give oral or apply topical prescribed medications, perform health-related activities, administer food or prescribed medication via stabled labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injection is required to receive a certificate of training. To receive certification, the registered nurse must submit to the course instructor the required application, attend the entire program of required training, participate in class discussions and activities, and complete and submit the evaluation of the train the instructor program.

(E) Renewing certification and maintaining qualifications to teach MR/DD personnel

To maintain the certification to teach MR/DD personnel to give oral or apply topical prescribed medications, perform health-related activities, administer food or prescribed medication via stabled labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injection, the registered nurse shall complete, at a minimum, four contact hours of continuing education per licensure renewal period that relate to the information taught in the train the instructor program or that will enhance the role of the registered nurse who has completed the train the instructor program. Cardiopulmonary resuscitation (CPR), first aid or universal precautions training shall not make up any part of the four contact hours. These contact hours may be a part of the twenty-four hours required by the Ohio board of nursing during each licensure renewal period.

(F) The requirements for registered nurses who will be teaching MR/DD personnel in the administration of prescribed medications and the performance of tube feedings for individuals of a residential facility with seventeen or more beds who are on a field trip from the facility as specified in paragraph (A)(9) of rule 5123:2-6-03 of the Administrative Code are established under rule 5123:2-6-05 of the Administrative Code.

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.44 , 5123.45 , 5123.46
Rule Amplifies: 5123.04 , 5123.41 to 5123.47
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004

5123:2-6-05 Qualifications and training for registered nurses to train MR/DD personnel and for MR/DD.

(A) Qualifications and training requirements of registered nurses

(1) Qualifications of instructional personnel for the train the instructor program

A registered nurse, who shall meet the following qualifications, may teach the train the instructor program, or any portion thereof, for a registered nurse:

(a) Current valid licensure in Ohio to practice as a registered nurse;

(b) At least sixty months experience in the practice of nursing, of which at least twenty-four months have been in the field of mental retardation and developmental disabilities;

(c) Knowledge of the laws and rules regulating the practice of nursing, and the laws and rules of the department that address delegation by a licensed nurse to MR/DD personnel and the training of MR/DD personnel pursuant to this chapter;

(d) Knowledge of and experience with the principles of adult education;

(e) Successful completion of the train the instructor program and maintenance of the train the instructor program continuing education pursuant to this rule; and

(f) Authorization from the department to teach the train the instructor program.

(2) The department's nurse consultant or other department registered nurse who is duly authorized by the department may teach the train the instructor program, or any portion thereof, for a registered nurse.

(3) Qualifications to plan, develop, and coordinate an MR/DD personnel program of instruction

(a) Only a registered nurse who meets the following requirements shall plan, develop, and coordinate a program of instruction that prepares MR/DD personnel to give or apply oral or topical prescribed medications and administer food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube to or for individuals of a residential facility with seventeen or more beds who are on a field trip from the facility, as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code:

(i) Current valid licensure in Ohio to practice nursing as a registered nurse;

(ii) A minimum of eighteen months experience in the practice of nursing as a registered nurse;

(iii) Previous experience caring for an individual with mental retardation and developmental disabilities;

(iv) Successful completion of the train the instructor program pursuant to this rule.

(b) The registered nurse may utilize other licensed health care professionals to assist with conducting the training as long as the other health care professionals have received instruction on the material and are acting within the professional's scope of practice as outlined in the Revised Code. None of the other licensed health care professionals shall teach the class in its entirety, but may serve as a guest instructor at the direction of the registered nurse instructor.

(c) Licensed practical nurses may choose to participate in the train the instructor program. Upon completion, they will receive a certificate of participation offering them continuing education credits, but they may not become an instructor.

(4) Minimum curriculum for the train the instructor program

(a) A train the instructor program for registered nurses trained on or after the effective date of this rule, which prepares a registered nurse to teach MR/DD personnel to give oral or apply topical prescribed medication and administer food or prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube for individuals of a residential facility with seventeen or more beds who are on a field trip, as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code, shall be at a minimum four hours and include at a minimum the following:

(i) Review of section 4723.071 of the Revised Code and review of sections 5123.41 to 5123.47 of the Revised Code and rules adopted under this chapter and applicable Revised Code and Administrative Code relating to the functioning of a county board, nursing delegation and MR/DD personnel;

(ii) Review of all components required when teaching MR/DD personnel to give oral or apply topical prescribed medications and administer food or prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube, including general principles of delegation by a licensed nurse to MR/DD personnel;

(iii) Quality measures and quality assessment requirements pursuant to this chapter;

(iv) MR/DD personnel and licensed nurse documentation requirements;

(v) How to provide indirect supervision, including methods for remaining accessible, and training MR/DD personnel how and when to access help;

(vi) How to evaluate the MR/DD personnel's skills including developing and using a skills check list for use in the program of instruction that teaches MR/DD personnel to give oral or apply topical prescribed medications and administer food or prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube;

(vii) Liability issues pursuant to rule 5123:2-6-07 of the Administrative Code;

(viii) Instruction that nursing delegation instruction is for a specific individual; that nursing delegation instruction must occur for each individual the MR/DD personnel are being delegated to; and that nursing delegation for a specific individual does not confer certification in any other course;

(ix) Instruction that MR/DD personnel being trained to administer prescribed medication and administer food or prescribed medication via a stable labeled gastrostomy tube and a stable labeled jejunostomy tube only to individuals residing in a residential facility with seventeen or more beds who are participating in a field trip, as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code, shall not receive or transcribe physician orders and prescriptions.

(b) The registered nurse coordinator of the train the instructor program shall ensure that the train the instructor program for individuals of a residential facility with seventeen or more beds who are on a field trip, as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code, for a registered nurse shall be planned, developed and taught in accordance with requirements set forth in this rule.

(c) The department must approve a train the instructor program course for individuals of a residential facility with seventeen or more beds who are on a field trip, as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code not developed by the department prior to use in the train the instructor program.

(5) Successful completion of training

The following is required for successful completion of the train the instructor program provided to prepare the registered nurse to train MR/DD personnel to give oral or apply topical prescribed medications and administer food or prescribed medication via stabled labeled gastrostomy tube or stable labeled jejunostomy tube for individuals of a residential facility with seventeen or more beds who are on a field trip, as specified in paragraphs (A)(9) and

(B)(9) of rule 5123:2-6-03 of the Administrative Code:

(a) Submission of the required application to the course instructor;

(b) Attendance at the entire program of required training;

(c) Participation in class discussions and activities; and

(d) Completion and submission of the evaluation of the train the instructor program.

(6) Maintaining qualifications to teach MR/DD personnel

To maintain qualifications to teach MR/DD personnel to give oral or apply topical prescribed medications and administer food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, the registered nurse shall complete, at a minimum, two contact hours of continuing education per licensure renewal period that relate to the information taught in the train the instructor program or that will enhance the role of the registered nurse who has completed the train the instructor program. Cardiopulmonary resuscitation (CPR), first aid or universal precautions training shall not make up any part of the four contact hours. These contact hours may be a part of the twenty-four hours required by the Ohio board of nursing during each licensure renewal period.

(B) MR/DD personnel qualifications and training requirements

(1) MR/DD personnel who are at least eighteen years of age are eligible to receive training in giving oral or applying topical prescribed medication and administering food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals of a residential facility with seventeen or more beds who are on a field trip from the facility as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code.

(2) Prior to permitting MR/DD personnel to take a program of instruction set forth in this rule, the employer of MR/DD personnel shall do the following:

(a) Determine whether the state nurse aide registry created under section 3721.32 of the Revised Code contains a statement included pursuant to division (B)(1) of that section regarding the MR/DD personnel's alleged abuse or neglect of a long-term care facility resident or misappropriation of resident property;

(b) Verify that the MR/DD personnel's name does not appear on the abuser registry created under sections 5123.50 to 5123.54 of the Revised Code as having committed alleged abuse or neglect of an individual or misappropriation of an individual's property; and

(c) Verify compliance with the applicable criminal background check requirements established under sections 5126.28 and 5126.281 of the Revised Code and rules 5123:2-1-05 , 5123:2-1-05.1, and 5123:2-3-06 of the Administrative Code.

(3) MR/DD personnel training program

A training program provided pursuant to this paragraph on or after the effective date of this rule, to train MR/DD personnel to give oral or apply topical prescribed medication and administer food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals of a residential facility with seventeen or more beds who are on a field trip from the facility as specified in paragraphs (A)(9) and (B)(9) of rule 5123:2-6-03 of the Administrative Code shall be taught by a licensed registered nurse instructor qualified pursuant to this rule. The length of the training course shall be determined by the licensed registered nurse instructor qualified pursuant to this rule. The content of this training shall include all of the following:

(a) Instruction that the authority to give prescribed oral medication or apply prescribed topical medication and administer prescribed medications or food via stable labeled gastrostomy tube or stable labeled jejunostomy tube is only granted by licensed nurse delegation, and this authority must be delegated by a licensed nurse to a specific MR/DD personnel who is trained pursuant to paragraph (B) of this rule or who has obtained the certificate or certificates required and issued by the department pursuant to rule 5123:2-6-06 of the Administrative Code.

(b) Instruction that the MR/DD personnel must be provided individual specific training and that the delegating licensed nurse shall be responsible for the individual specific training. The individual specific training shall occur prior to administration of prescribed oral or topical medication or administration of food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(c) Instruction that a registered nurse shall reassess delegation and the needs of the individual on an on-going basis but at least annually, including determination that delegation continues to be necessary and appropriate, determination that the individual continues to be stable, and determination that the MR/DD personnel continue to have the skills to perform the nursing task(s), activity(ies), or prescribed medication administration that have been delegated. The reassessment may be more frequent if necessary in the judgment of the delegating registered nurse.

(d) Infection control and universal precautions. The registered nurse course instructor may waive the infection control and universal precautions instruction material and instruction time of the program of instruction if the MR/DD personnel can document training on that topic within the previous year.

(e) A review of applicable federal and state drug laws and rules.

(f) For MR/DD personnel who will be delegated by the licensed nurse the authority to give prescribed oral medication or apply prescribed topical medication, the training shall, in addition to paragraphs (B)(3)(a) to (B)(3)(e) of this rule, include the following:

(i) Information and instruction on the concepts underlying each step for giving oral or applying topical prescribed medications and how to correctly give oral or apply topical prescribed medications according to current standards of safe practice, including correct and safe practices, procedures, and techniques for administering prescribed oral or topical prescribed medication to train the MR/DD personnel to administer the right medication, at the right dose, to the right individual, by the right route, at the right time.

(ii) Written instructions that should be provided for giving prescribed oral medications or applying topical prescribed medications to a particular individual.

(iii) Instruction in quality measures, including but not limited to, procedures for reporting and documenting all prescribed medication errors that may occur when giving prescribed oral medications or applying topical prescribed medications, procedures in case of emergency, and procedures on when and how to contact the trained MR/DD personnel's employer or designee or the supervising licensed nurse when performing a delegable nursing task.

(iv) Information about what MR/DD personnel may be authorized to perform with respect to giving oral or applying topical prescribed medications.

(v) Instruction that as needed prescribed medication or PRN prescribed medication must have specific parameters for administration which preclude independent judgment.

(vi) Information about what MR/DD personnel are prohibited from giving, which includes but is not limited to the following:

(a) An intramuscular injection;

(b) An intravenous injection;

(c) A subcutaneous injection;

(d Any debriding agent used in the treatment of a skin condition or minor abrasion.

(vii) When applicable, instruction in the use of commercially packaged epinephrine auto-injector for treatment of anaphylactic allergic reaction as prescribed by a licensed health professional authorized to prescribe drugs.

(viii) When applicable, instruction in the use of commercially packaged rectal diazepam gel for the treatment of epilepsy as prescribed by a licensed health professional authorized to prescribe drugs.

(ix) When applicable, instruction in the use of commercially packaged glucagon for the treatment of hypoglycemia as prescribed by a licensed health professional authorized to prescribe drugs. Teaching must be completed and nursing delegation must be in place prior to administration of glucagon.

(x) Instruction in potential drug reactions, including known side effects, interactions, and the proper course of action if a side effect occurs.

(xi) The requirements for documentation of prescribed medications administered, applied, missed, held or refused to, by or for each individual.

(xii) The requirements for documentation and notification of prescribed medication errors.

(xiii) Information regarding the proper storage and care of prescribed medications.

(xiv) Information and instruction that MR/DD personnel may not receive or transcribe physician orders and prescriptions onto a prescribed medication administration record and a treatment administration record.

(xv) Performance of a successful return demonstration for each route of prescribed medication administration MR/DD personnel are being trained in.

(xvi) Successful completion of training in administration of prescribed oral medication and prescribed topical medication and the requirements of this paragraph shall be determined by the licensed registered nurse instructor qualified pursuant to this rule.

(g) For MR/DD personnel who will be delegated by the licensed nurse the authority to administer prescribed medication or food via stable labeled gastrostomy tube or stable labeled jejunostomy tube, the training shall, in addition to paragraphs (B)(3)(a) to (B)(3)(e) of this rule, include the following:

(i) Instruction in quality measures, including but not limited to, procedures for reporting and documenting errors that may occur when administering prescribed medication or food via stable labeled gastrostomy tube or stable labeled jejunostomy tube, procedures in case of emergency, and procedures on when and how to contact the trained MR/DD personnel's employer or designee or the supervising licensed nurse.

(ii) Written instructions that should be provided for administering prescribed medication or food via stable labeled gastrostomy tube or stable labeled jejunostomy tube to a particular individual.

(iii) Correct and safe practices, procedures and techniques for administering food or prescribed medication via a stable labeled gastrostomy tube or a stable labeled jejunostomy tube including possible signs and symptoms of gastrostomy tube or jejunostomy tube malfunction or tube problems, complication or intolerance of food or prescribed medication by the individual, and appropriate response to gastrostomy tube or jejunostomy tube that becomes dislodged.

(iv) The requirements for documentation of food and prescribed medications administered, missed, held or refused to, by or for each individual via gastrostomy tube or jejunostomy tube.

(v) Requirements for documentation and notification of prescribed medication errors or feeding errors via gastrostomy tube or jejunostomy tube.

(vi) Information regarding the proper storage, care, and preparation of food and prescribed medications to be given via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(vii) Information regarding the proper storage and care of tube feeding equipment.

(viii) Instruction in drug reactions and interactions, including common side effects and the proper course of action to be taken if a side effect occurs, and instruction that the delegating licensed nurse will provide specific potential drug reactions and interactions and potential side effects.

(ix) Information about what MR/DD personnel are prohibited from giving, which includes but is not limited to the following: any prescribed medication administered through a nasogastric tube or any unstable or unlabeled gastrostomy tube or unstable or unlabeled jejunostomy tube.

(x) Instruction that as needed prescribed medication or PRN prescribed medication must have specific parameters for administration which preclude independent judgment.

(xi) Instruction that only the delegating licensed nurse shall receive prescriptions for food or prescribed medication to be administered by stable labeled gastrostomy tube or stable labeled jejunostomy tube and only the delegating nurse shall transcribe these prescriptions into an individual's prescribed medication administration record or treatment record.

(xii) Performance of successful return demonstration for administering prescribed medication and food via a stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(xiii) Successful completion of training in administering prescribed medication and food via stable labeled gastrostomy tube and stable labeled jejunostomy tube and the requirements of this paragraph shall be determined by the licensed registered nurse instructor qualified pursuant to this rule.

(4) MR/DD personnel may forego any instruction material and corresponding instruction time of the training outlined in paragraph (B)(3) of this rule by providing the qualified registered nurse instructor with documentation of having received training provided by a registered nurse as part of nursing delegation prior to the effective date of this rule. Documentation must be by the qualified registered nurse instructor who taught the delegation. Such MR/DD personnel must still complete those portions of the training program required in paragraph (B)(3) of this rule that they have not been trained on. The delegating licensed nurse shall determine if the MR/DD personnel continues to have the skills to perform the nursing task(s), activity(ies), or prescribed medication administration.

(C) The standards established by the Ohio board of nursing under Chapter 4723-13 of the Administrative Code shall apply when an unlicensed person is performing delegable nursing tasks, including the performance of health-related activities.

Replaces: part of 5123:2-1-07

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.43 , 5123.44 , 5123.45 , 5123.46
Rule Amplifies: 5123.04 , 5123.41 to 5123.47
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004

5123:2-6-06 Qualifications, training, and certification of MR/DD personnel in the administration of prescribed medications, performance of health-related activities, and performance of tube feedings.

(A) MR/DD personnel who meet the following qualifications are eligible to receive training in giving oral or applying topical prescribed medication, performing health-related activities, or administering food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube:

(1) At least age eighteen years;

(2) Earned a high school diploma or a certificate of high school equivalency (GED). MR/DD personnel who, pursuant to rule 4723-21-16 of the Administrative Code, were employed on or before February 1, 2000 and determined eligible to give oral or apply topical prescribed medication without having earned a high school diploma or GED by demonstrating to a nurse instructor sufficient skills in writing, reading, and mathematics to be able to safely give oral or apply topical prescribed medications are not required to have a high school diploma or certificate of high school equivalency(GED).

(B) Prior to permitting MR/DD personnel to take a program of instruction set forth in this rule, the employer of MR/DD personnel shall do the following:

(1) Determine whether the state nurse aide registry created under section 3721.32 of the Revised Code contains a statement included pursuant to division (B)(1) of that section regarding the MR/DD personnel's alleged abuse or neglect of a long-term care facility resident or misappropriation of resident property;

(2) Verify that the MR/DD personnel's name does not appear on the abuser registry created under sections 5123.50 to 5123.54 of the Revised Code as having committed alleged abuse or neglect of an individual or misappropriation of an individual's property; and

(3) Verify compliance with the applicable criminal background check requirements established under sections 5126.28 and 5126.281 of the Revised Code and rules 5123:2-1-05 , 5123:2-1-05.1, and 5123:2-3-06 of the Administrative Code.

(C) MR/DD personnel: Prescribed medication administration and health-related activities training program

(1) A prescribed medication administration and health-related activities training program provided pursuant to this paragraph on or after the effective date of this rule, to allow MR/DD personnel to give oral or apply topical prescribed medication and perform health-related activities shall be at a minimum a fourteen-hour course. The content of a training course or part of a training course that trains MR/DD personnel in the administration of prescribed oral and topical prescribed medications and performance of health-related activities shall include all of the following:

(a) Infection control and universal precautions.

The registered nurse course instructor may waive the infection control and universal precautions instruction material and instruction time of the program of instruction if the MR/DD personnel can document training on that topic within the previous year.

(b) A review of applicable federal and state drug laws and rules.

(c) Information and instruction on the concepts underlying each step for giving oral or applying topical prescribed medications and how to correctly give oral or apply topical prescribed medications according to current standards of safe practice, including correct and safe practices, procedures, and techniques for administering prescribed oral or topical prescribed medication to train the MR/DD personnel to administer the right medication, at the right dose, to the right individual, by the right route, at the right time.

(d) Written step-by-step directions on how to give oral or apply topical prescribed medications.

(e) Instruction in quality measures, including but not limited to, procedures for reporting and documenting all prescribed medication errors that may occur when giving oral or applying topical prescribed medications or errors that may occur when performing health-related activities, procedures in case of emergency, and procedures on when and how to contact the trained MR/DD personnel's employer or designee or the supervising licensed nurse when medication is administered or a nursing task is performed pursuant to nurse delegation.

(f) Information about what MR/DD personnel may be authorized to perform with respect to giving oral or applying topical prescribed medications.

(g) Limitations with respect to as needed prescribed medications or PRN, which state that MR/DD personnel shall not give or apply a prescribed medication ordered by a physician or other licensed health care professional authorized by the Revised Code to prescribe medications when the prescribed medication is to be given as needed, unless the order is written with specific parameters which preclude independent judgment.

(h) Information about what MR/DD personnel are prohibited from giving, which includes but is not limited to the following:

(i) An intramuscular injection;

(ii) An intravenous injection;

(iii) A subcutaneous injection, except an injection of subcutaneous insulin providing the MR/DD personnel are trained in the subcutaneous injection of insulin pursuant to section 5123.42 of the Revised Code and paragraph (E) of this rule and the subcutaneous injection of insulin is delegated to a specific person by a licensed nurse pursuant to section 5123.42 of the Revised Code and this chapter;

(iv) Any prescribed medication administered through a nasogastric tube or any unstable or unlabeled gastrostomy tube or unstable or unlabeled jejunostomy tube; or

(v) Any debriding agent used in the treatment of a skin condition or minor abrasion.

(i) Instruction in the use of commercially packaged epinephrine auto-injector for treatment of anaphylactic allergic reaction as prescribed by a licensed health professional authorized to prescribe drugs.

(j) Instruction in the use of commercially packaged rectal diazepam gel for the treatment of epilepsy as prescribed by a licensed health professional authorized to prescribe drugs.

(k) Instruction in the use of commercially packaged glucagon for the treatment of hypoglycemia as prescribed by a licensed health professional authorized to prescribe drugs. Teaching must be completed and nursing delegation must be in place prior to administration of glucagon.

(l) Instruction in potential drug reactions, including known side effects, interactions, and the proper course of action if a side effect occurs, and sources for prescribed medication information (such as pharmacist, physician, nurse, or poison control).

(m) The requirements for documentation of prescribed medications administered, applied, missed, held or refused to, by or for each individual.

(n) Information regarding the proper storage and care of prescribed medications.

(o) Information and instruction about who may receive and who may transcribe physician orders and prescriptions onto a prescribed medication administration record and a treatment administration record specific to each category pursuant to rule 5123:2-6-03 of the Administrative Code.

(p) Performance of a successful return demonstration for each route of prescribed medication administration MR/DD personnel are being trained in;

(q) Information that health-related activities are performed only pursuant to nurse delegation except for individuals receiving family support services or services from certified supported living providers, if the services are offered or provided pursuant to Chapter 5123. or 5126. of the Revised Code; individuals receiving residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes no more than four individuals; or individuals residing in a residential facility with five or fewer beds.

(r) Information and instruction on the concepts underlying each step for performing health-related activities according to current standards of safe practice, including instruction in the correct and safe practices, procedures, and techniques for performing health-related activities.

(s) Instruction in the usual parameters of health-related activities including vital signs, signs of possible wound infection and complications, bodily intake and output, and glucometer readings and instruction in the course of action to be taken when parameters of health-related activities are above or below those taught.

(t) The requirements for documentation of health-related activities done, missed, held or refused to, by or for each individual.

(u) The requirements for documentation and notification of health-related activity errors.

(v) Performance of successful return demonstration for each health-related activity MR/DD personnel are being trained to perform;

(w) Completion of written examination pursuant to paragraph (C)(6)(d) of this rule.

(x) Requirements for individual-specific training including the individual's needs, a summary of the individual's relevant health care information, and implementation of the individual's health care plan as part of the individual service plan. The individual-specific training shall occur after certification and prior to administration of prescribed medication or performance of health-related activities. The employer of MR/DD personnel and the delegating licensed nurse shall ensure that MR/DD personnel receive individual specific training pursuant to paragraphs (C)(5) and (C)(6) of rule 5123:2-6-03 of the Administrative Code.

(2) Except as specified in paragraph (C)(3) of this rule, a prescribed medication administration and health-related activities training program provided pursuant to this paragraph for MR/DD personnel already trained prior to the effective date of this rule to receive nursing delegation to give oral prescribed medication or apply topical prescribed medication shall be at a minimum a three-hour course and include at a minimum the following:

(a) Update of applicable federal and state drug laws and rules.

(b) Review of correct and safe practices, procedures, and techniques for administering prescribed oral or topical prescribed medication to train MR/DD personnel to administer the right prescribed medication, at the right dose, to the right individual, by the right route, at the right time.

(c) Instruction in quality measures including, but not limited to, procedures for reporting and documenting all prescribed medication errors that may occur when giving oral or applying topical prescribed medications or errors that may occur when performing health-related activities, procedures in case of emergency, and procedures on when and how to contact the trained MR/DD personnel's employer or designee, or the supervising licensed nurse when performing a delegable nursing task.

(d) Limitations with respect to as needed or PRN prescribed medications, which state that MR/DD personnel shall not give or apply a prescribed medication ordered by a physician or other licensed health care professional authorized by the Revised Code to prescribe medications when the prescribed medication is to be given as needed, unless the order is written with specific parameters which preclude independent judgment.

(e) Information about what MR/DD personnel are prohibited from giving, which includes but is not limited to the following:

(i) An intramuscular injection;

(ii) An intravenous injection;

(iii) A subcutaneous injection, except an injection of subcutaneous insulin providing the MR/DD personnel is trained in the subcutaneous injection of insulin pursuant to section 5123.42 of the Revised Code and paragraph (E) of this rule and the subcutaneous injection of insulin is delegated to a specific person by a licensed nurse pursuant to section 5123.42 of the Revised Code and this chapter;

(iv) Any prescribed medication administered through a nasogastric tube or any unstable or unlabeled gastrostomy tube or unstable or unlabeled jejunostomy tube; or

(v) Any debriding agent used in the treatment of a skin condition or minor abrasion.

(f) Instruction in the use of commercially packaged epinephrine auto-injector for treatment of anaphylactic allergic reaction as prescribed by a licensed health professional authorized to prescribe drugs.

(g) Instruction in the use of commercially packaged diazepam rectal gel for the treatment of acute repetitive seizures or cluster seizures as prescribed by a licensed health professional authorized to prescribe drugs.

(h) Instruction in the use of commercially packaged glucagon for the treatment of hypoglycemia as prescribed by a licensed health professional authorized to prescribe drugs. Teaching must be completed and nursing delegation must be in place prior to administration of glucagon.

(i) Reminder of proper course of action if a side effect occurs, and sources for prescribed medication information (such as pharmacist, physician, nurse, or poison control).

(j) Update in the requirements for documentation of prescribed medications administered, applied, missed, held or refused to, by or for each individual.

(k) Update in the requirements for documentation and notification of prescribed medication errors.

(l) Update in information regarding the proper storage and care of prescribed medications.

(m) Information and instruction about who may receive and who may transcribe physician orders and prescriptions onto a prescribed medication administration record and a treatment administration record specific to each category pursuant to rule 5123:2-6-03 of the Administrative Code.

(n) Performance of a successful return demonstration for each route of prescribed medication administration MR/DD personnel are being trained in.

(o) Instruction in the correct and safe practices, procedures, and techniques for performing health-related activities.

(p) Instruction in the usual parameters of health-related activities including vital signs, signs of possible wound infection and complications, bodily intake and output, and glucometer readings and instruction in the course of action to be taken when parameters of health-related activities are above or below those taught.

(q) The requirements for documentation of health-related activities done, missed, held or refused to, by or for each individual.

(r) The requirements for documentation and notification of health-related activity errors.

(s) Performance of successful return demonstration for each health-related activity MR/DD personnel are being trained to perform.

(t) Completion of written examination pursuant to paragraph (C)(6)(d) of this rule.

(u) Requirements for individual specific training including the individual's needs, a summary of the individual's relevant health care information, and implementation of the individual's health care plan as part of the individual service plan. The individual specific training shall occur after certification and prior to administration of prescribed medication or performance of health-related activities. The employer of MR/DD personnel and the delegating licensed nurse shall ensure that MR/DD personnel receive individual specific training pursuant to paragraphs (C)(5) and (C)(6) of rule 5123:2-6-03 of the Administrative Code.

(3) MR/DD personnel may forego any instruction material and corresponding instruction time of the training outlined in paragraph (C)(2) of this rule by providing the certified registered nurse instructor with documentation of having received training provided by a registered nurse as part of nursing delegation prior to the effective date of this rule. Documentation must be by the registered nurse who taught the delegation. Such MR/DD personnel must still complete those portions of the prescribed medication and health-related activities training program required in paragraph (C)(2) of this rule that they have not been trained on and meet the certification requirements outlined in paragraphs (C)(6)(b) to (C)(6)(d) of this rule.

(4) The registered nurse coordinator of the prescribed medication administration and health-related activities training program shall ensure that the prescribed medication administration and health-related activities training program shall be planned, developed, and taught in accordance with requirements set forth in this chapter. The registered nurse certified instructor may utilize other licensed health care professionals to assist with conducting the training as long as the other health care professionals have received instruction on the material and are acting within the professional's scope of practice as outlined in the Revised Code. None of the other licensed health care professionals shall teach the class in its entirety, but may serve as a guest instructor at the direction of the registered nurse certified instructor.

(5) A prescribed medication administration and health-related activities training program course not developed by the department must be approved by department prior to use in the prescribed medication administration and health-related activities training program.

(6) Certification

Successful completion of the prescribed medication administration and health-related activities training program is required to receive a certificate of training. To receive certification, MR/DD personnel shall do the following:

(a) Attend the entire program of required training;

(b) Participate in class discussions, activities, and return demonstration of proficiency in administering prescribed medications and performing health-related activities;

(c) Complete and submit to the registered nurse certified instructor the evaluation of the prescribed medication administration and health-related activities training program; and

(d) Complete the final closed book written examination with a score of at least eighty per cent. MR/DD personnel scoring less than eighty per cent on the final written examination shall retake the program of training in its entirety to be eligible to retake the final written examination. The final written examination shall be developed and maintained by the department, and only this final written examination shall be used in this program.

(7) Renewal of certification

(a) To maintain certification in the prescribed medication administration and health-related activities training program, trained MR/DD personnel shall complete at a minimum two hours of continuing education annually that relate to the information taught in the prescribed medication administration and health-related activities training program or that will enhance the role of MR/DD personnel who have completed the prescribed medication administration and health-related activities training program. MR/DD personnel shall provide documentation of such hours to the certified registered nurse trainer. Cardiopulmonary resuscitation (CPR), universal precautions, and first aid training shall not make up any part of these two hours.

(b) If the minimum two hours of continuing education are not completed by the annual anniversary date of certification, the MR/DD personnel's certification shall be temporarily suspended for a maximum period of sixty days, during which time the required continuing education shall be completed, and during which time the MR/DD personnel may not administer prescribed medication or perform health-related activities. If the required continuing education is not completed within this sixty-day-period, the MR/DD personnel's certification will be revoked, and the MR/DD personnel shall be required to retake the course in prescribed medication administration and health-related activities in total to become recertified.

(D) MR/DD personnel: Feeding tube by nursing delegation training program

(1) The training provided pursuant to this paragraph to allow MR/DD personnel to provide prescribed medication administration or feeding via stable labeled gastrostomy tube or stable labeled jejunostomy tube feedings by nursing delegation shall be at a minimum four hours and shall be in addition to the prescribed medication and health-related activities training required in paragraph (C) of this rule. MR/DD personnel shall successfully complete the prescribed medication administration and health-related activities training required in paragraph (C) of this rule prior to participating in training for feeding or prescribed medication administration via stable labeled gastrostomy or stable labeled jejunostomy tube. The content of the training course that trains MR/DD personnel in the administration of food or prescribed medications via stable labeled gastrostomy or stable labeled jejunostomy tubes shall include all of the following:

(a) Correct and safe practices, procedures and techniques for administering food or prescribed medication via a stable labeled gastrostomy tube or a stable labeled jejunostomy tube including possible signs and symptoms of gastrostomy tube or jejunostomy tube malfunction or tube problems, complication or intolerance of food or prescribed medication by the individual, and appropriate response to gastrostomy tube or jejunostomy tube that becomes dislodged.

(b) The requirements for documentation of food and prescribed medications administered, missed, held or refused to, by or for each individual via a stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(c) Requirements for documentation and notification of prescribed medication errors or feeding errors via a stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(d) Information regarding the proper storage, care, and preparation of food and prescribed medications to be given via a stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(e) Information regarding the proper storage and care of tube feeding equipment.

(f) Requirements for nursing delegation of prescribed medication or food administration via a stable labeled gastrostomy tube or a stable labeled jejunostomy tube.

(g) Instruction that only the delegating licensed nurse shall receive prescriptions for food or prescribed medication to be administered by stable labeled gastrostomy tube or stable labeled jejunostomy tube and only the delegating nurse shall transcribe these prescriptions into an individual's prescribed medication administration record or treatment record.

(h) Completion of written examination pursuant to paragraph (D)(5)(d) of this rule.

(i) Requirements for individual-specific training including the individual's needs, a summary of the individual's relevant health care information, and implementation of the individual's health care plan as part of the individual service plan. The delegating licensed nurse shall be responsible for the individual-specific training. The individual-specific training shall occur after certification and prior to administration or feeding via a stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(2) MR/DD personnel who prior to the effective date of this rule were receiving nursing delegation and performing prescribed medication administration or provision of food via stable labeled gastrostomy tube or stable labeled jejunostomy tube may forego the training outlined in paragraph (D)(1) of this rule by performing a return demonstration of these skills to the delegating registered nurse. The delegating registered nurse shall update MR/DD personnel who are being delegated to on sections 5123.41 to 5123.47 of the Revised Code and rules adopted under this chapter.

(3) The registered nurse coordinator of the feeding tube by nursing delegation training program shall ensure that the feeding tube by nursing delegation training program shall be planned, developed and taught in accordance with requirements set forth in this chapter. The registered nurse certified instructor may utilize other licensed health care professionals to assist with conducting the training as long as the other health care professionals have received instruction on the material and are acting within the professional's scope of practice as outlined in the Revised Code. None of the other licensed health care professional shall not teach the class in its entirety, but may serve as a guest instructor at the direction of the registered nurse certified instructor.

(4) A feeding tube by nursing delegation training program course not developed by the department must be approved by the department prior to use in the feeding tube by nursing delegation training program.

(5) Certification

Successful completion of the feeding tube by nursing delegation training program is required to receive a certificate of training. To receive certification, the MR/DD personnel must do the following:

(a) Attend the entire program of required training;

(b) Participate in class discussions, activities, and return demonstration of proficiency in administering prescribed medications and food via stable labeled gastrostomy tube and stable labeled jejunostomy tube;

(c) Complete and submit to the registered nurse certified trainer the evaluation of the feeding tube by nursing delegation training program; and

(d) Complete the final closed book written examination with a score of at least eighty per cent. MR/DD personnel scoring less than eighty per cent on the final written examination shall retake the program of training in its entirety to be eligible to retake the final written examination. The final written examination shall be developed and maintained by the department, and only this final written examination shall be used in this program.

(6) Renewal of certification

(a) To maintain certification in the feeding tube by nursing delegation training program, trained MR/DD personnel shall complete one hour of continuing education annually that is planned or coordinated by a registered nurse certified pursuant to rule 5123:2-6-04 of the Administrative Code and that relates to the information taught in the feeding tube by nursing delegation training program or that will enhance the role of MR/DD personnel who have completed the feeding tube by nursing delegation training program. MR/DD personnel shall provide documentation of such hours to the certified registered nurse trainer. Cardiopulmonary resuscitation (CPR), first aid, and universal precautions training shall not make up any part of this one hour.

(b) If the minimum one hour of continuing education is not completed by the annual anniversary date of certification, the MR/DD personnel's certification shall be temporarily suspended for a maximum period of sixty days, during which time the required continuing education shall be completed, and during which time the MR/DD personnel may not administer prescribed medication or food via stable labeled gastrostomy tube or stable labeled jejunostomy tube, and may not receive nursing delegation to perform administer prescribed medication or food via stable labeled gastrostomy tube or stable labeled jejunostomy tube. If the required continuing education is not completed within this sixty-day-period, the MR/DD personnel's certification shall be revoked, and the MR/DD personnel shall be required to retake the course in feeding tube by nursing delegation in total to become recertified.

(E) MR/DD personnel: Subcutaneous insulin injection by nursing delegation training program

(1) The training provided pursuant to this rule to allow MR/DD personnel to provide subcutaneous insulin injection by nursing delegation shall be at least four hours and in addition to the prescribed medication administration and health-related activities training required in paragraph (C) of this rule. MR/DD personnel shall successfully complete the prescribed medication administration and health-related activities training required in paragraph (C) of this rule prior to participating in training for subcutaneous insulin injection. The content of the training course that trains MR/DD personnel in the administration of insulin by subcutaneous injection shall include all of the following:

(a) Information on the basic pathophysiology of diabetes mellitus.

(b) Correct and safe practices, procedures and techniques for administering subcutaneous insulin injection, possible signs and symptoms of subcutaneous insulin injection complication, and instruction in safe handling and disposal of sharps.

(c) The requirements for documentation of subcutaneous insulin injection administered, missed, held or refused to, by or for each individual

(d) Requirements for documentation and notification of subcutaneous insulin injection or insulin pump errors.

(e) Information regarding the proper storage, care, and preparation of insulin to be given by subcutaneous injection or insulin pump.

(f) Signs and symptoms of hypoglycemia and hyperglycemia and procedure for intervention and notification of nurse, physician, or emergency medical services.

(g) Instruction in the use of commercially packaged glucagon for the treatment of hypoglycemia as prescribed by a licensed health professional authorized to prescribe drugs. Teaching must be completed and nursing delegation must be in place prior to administration of glucagon.

(h) Instruction that only a licensed nurse shall transcribe an insulin prescription into an individual's prescribed medication administration record.

(i) Completion of written examination pursuant to paragraph (E)(4)(d) of this rule.

(j) Requirements for nursing delegation of subcutaneous insulin injection.

(k) Requirements for individual-specific training including the individual's needs, a summary of the individual's relevant health care information, and implementation of the individual's health care plan as part of the individual service plan. The delegating licensed nurse shall be responsible for the individual-specific training. The individual-specific training shall occur after certification and prior to administration of subcutaneous insulin injection.

(2) The registered nurse coordinator of the subcutaneous insulin injection by nursing delegation training program shall ensure that the subcutaneous insulin injection by nursing delegation training program is planned and developed in accordance with requirements set forth in this chapter. The registered nurse certified instructor may utilize other licensed health care professionals to assist with conducting the training as long as the other health care professionals have received instruction on the material and are acting within the professional's scope of practice as outlined in the Revised Code. None of the other licensed health care professionals shall teach the class in its entirety, but may serve as a guest instructor at the direction of the registered nurse certified instructor.

(3) A subcutaneous insulin injection by nursing delegation training program course not developed by the department must be approved by the department prior to use in the subcutaneous insulin injection by nursing delegation training program.

(4) Certification

Successful completion of the subcutaneous insulin injection by nursing delegation training program is required to receive a certificate of training. To receive certification, MR/DD personnel shall do the following:

(a) Attend the entire program of required training;

(b) Participate in class discussions, activities, and return demonstration of proficiency in administering subcutaneous insulin injection;

(c) Complete and submit to the registered nurse certified trainer the evaluation of the subcutaneous insulin injection by nursing delegation training program; and

(d) Complete the final closed book written examination with a score of at least eighty per cent. MR/DD personnel scoring less than eighty per cent on the final written examination shall retake the program of training in its entirety to be eligible to retake the final written examination. The final written examination shall be developed and maintained by the department, and only this final written examination shall be used in this program.

(5) Renewal of certification

(a) To maintain certification in the subcutaneous insulin injection by nursing delegation training program, trained MR/DD personnel shall complete one hour of continuing education annually that is planned or coordinated by a registered nurse certified pursuant to rule 5123:2-6-04 of the Administrative Code and that relates to the information taught in the subcutaneous insulin injection by nursing delegation training program, and that will enhance the role of MR/DD personnel who have completed the subcutaneous insulin injection by nursing delegation training program. MR/DD personnel shall provide documentation of such hours to the certified registered nurse trainer. Cardiopulmonary resuscitation (CPR), first aid, and universal precautions training shall not make up any part of this one hour.

(b) If the minimum one hour of continuing education is not completed by the annual anniversary date of certification, the MR/DD personnel's certification shall be temporarily suspended for a maximum period of sixty days, during which time the required continuing education shall be completed, and during which time the MR/DD personnel may not administer subcutaneous insulin injection, and may not receive nursing delegation to perform subcutaneous insulin injection. If the required continuing education is not completed within this sixty-day-period, the MR/DD personnel's certification shall be revoked, and the MR/DD personnel shall be required to retake the course in subcutaneous insulin injection by nursing delegation in total to become recertified.

(F) The standards established by the Ohio board of nursing under Chapter 4723-13 of the Administrative Code shall apply when an unlicensed person is performing delegable nursing tasks that are not defined as health-related activities.

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.42 , 5123.43 , 5123.45 , 5123.46
Rule Amplifies: 5123.04 , 5123.41 to 5123.47
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004

5123:2-6-07 General provisions and compliance in the administration of prescribed medications, performance of health-related activities, and performance of tube feedings.

(A) List of certified MR/DD personnel and certified registered nurses

The department shall establish an online Internet-based database listing registered nurses holding valid certification issued under rule 5123:2-6-04 of the Administrative Code and for listing MR/DD personnel holding valid certification issued under section 5123.45 of the Revised Code and rule 5123:2-6-06 of the Administrative Code in prescribed medication administration and health-related activities, nursing delegation of administration of food and prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, and nursing delegation of subcutaneous insulin injection.

(1) The department shall operate the registered nurse certification database list and the MR/DD personnel certification database list.

(2) The department shall provide read and write access to the database to all certified registered nurses teaching registered nurses pursuant to rule 5123:2-6-04 of the Administrative Code. Certified registered nurse trainers shall be responsible for maintaining current information on trained registered nurses on said database list.

(3) The department shall provide read and write access to the database to all certified registered nurses teaching MR/DD personnel pursuant to rule 5123:2-6-06 of the Administrative Code. The certified registered nurse trainers teaching registered nurses shall be responsible for maintaining current information on trained MR/DD personnel on said database.

(4) The department shall provide read only public access to the database.

(B) MR/DD personnel documentation requirements in the categories specified under paragraphs (A)(1) to (A)(9) of rule 5123:2-6-03 of the Administrative Code

(1) Documentation of all prescribed medications, health-related activities, subcutaneous insulin injections, or delegated tube feedings given, applied, missed, held, or refused shall be done on a prescribed medication administration record or treatment administration record indicating the name or initials of the MR/DD personnel administering a prescribed medication or treatment, time and date, and, when appropriate, observations or difficulties noted.

(2) The employer of MR/DD personnel shall maintain a means of identifying initials and signatures of MR/DD personnel making entries in the prescribed medication administration record and treatment administration record.

(C) All prescribed medications administered pursuant to this chapter shall be administered according to the written direction of an appropriately licensed health care professional and according to the training received by MR/DD personnel pursuant to section 5123.43 of the Revised Code and rules 5123:2-6-05 and 5123:2-6-06 of the Administrative Code.

(D) MR/DD personnel requirements for reporting errors in the categories specified under paragraphs (A)(1) to (A)(9) of rule 5123:2-6-03 of the Administrative Code

(1) Any error by MR/DD personnel in the administration of oral or application of topical prescribed medications, performance of health-related activities, or performance of delegable tube feedings that results in physical harm to the individual shall be immediately reported to an appropriate licensed health care professional.

(2) Any error by MR/DD personnel in the administration of oral or application of topical prescribed medications, performance of health-related activities, or performance of delegable tube feedings shall be reported in accordance with rule 5123:2-17-02 of the Administrative Code if the error meets the definition of major unusual incident or unusual incident as those terms are defined in that rule.

(E) Compliance and quality assessment reviews of individuals receiving services from certified supported living providers; individuals receiving residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes not more than four individuals; or individuals residing in residential facilities of five or fewer beds, excluding ICFs/MR

(1) A registered nurse, employed by or under contract with the county board, shall assist with consultation and quality assessment oversight.

(2) The quality assessment registered nurse, employed by or under contract with the county board, shall complete quality assessment reviews in a format prescribed by the department so that a review of each individual receiving administration of prescribed medications or performance of health-related activities by MR/DD personnel pursuant to this rule in the county is conducted at least once every three years. The quality assessment registered nurse, employed by or under contract with the county board, may conduct more frequent reviews if the registered nurse or county board, provider, or department determines there are issues to warrant such.

(3) In settings where the county board directly provides supported living or home and community-based services in a community living arrangement that includes not more than four individuals or operates a residential facility of five or fewer beds, excluding an ICF/MR, a registered nurse who is not directly employed by the county board and is a disinterested party of the board shall complete quality assessment reviews in a format prescribed by the department so that a review of each individual receiving administration of prescribed medications or performance of health-related activities by MR/DD personnel pursuant to this rule in the county is conducted at least once every three years. The registered nurse may conduct more frequent reviews if the registered nurse, county board, provider, or department determines there are issues to warrant such.

(4) Quality assessment reviews shall be completed in a format prescribed by the department.

(5) Quality assessment reviews shall include, but are not limited to, the following:

(a) Observation of administering prescribed medication or performing health-related activities;

(b) Review of documentation of prescribed medication administration and health-related activities for completeness of documentation and for documentation of appropriate actions taken based on parameters provided in prescribed medication administration and health-related activities training;

(c) Review of all prescribed medication errors from the past twelve months;

(d) Review of the system used by the employer or provider to monitor and document completeness and correct techniques used during oral and topical prescribed medication administration and performance of health-related activities.

(6) The quality assessment registered nurse shall provide a copy of the quality assessment review to the county board and the provider of services in which the site is located within ten business days of the quality assessment review and shall recommend to the county board and the provider of services steps to take to improve the functioning of the trained MR/DD personnel and maintain compliance with this chapter.

(7) The quality assessment registered nurse shall maintain a copy of each quality assessment review performed by the quality assessment nurse or by the registered nurse as specified in paragraphs (E)(2) and (E)(3) of this rule.

(8) The quality assessment registered nurse, employed by or under contract with the county board, as specified under paragraph (E) of this rule shall act as a resource for the county board and related program and service providers concerning health management issues and may serve to assist in expanding health care services in the community.

(F) If the employer of MR/DD personnel believes or is notified by the county board, the department, a delegating licensed nurse or the registered nurse responsible for quality assessment pursuant to this rule that MR/DD personnel have not safely administered or will not safely administer prescribed medications, have not safely performed or will not safely perform health-related activities, have not safely administered or will not safely administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, or have not safely administered or will not safely administer subcutaneous insulin injections, the employer shall prohibit the action from continuing or commencing. MR/DD personnel shall not engage in the action or actions subject to an employer's prohibition.

(1) When the employer prohibits the action from continuing or commencing, the employer shall do the following:

(a) Notify the MR/DD personnel of the prohibition and immediately make other staffing arrangements so that administration of prescribed medication, performance of health-related activities, administration of food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, or administration of subcutaneous insulin injections are completed as prescribed, including compliance with the requirements of this chapter of the Administrative Code;

(b) Immediately notify the department;

(c) If applicable, immediately notify the county board via the major unusual incident reporting system pursuant to rule 5123:2-17-02 of the Administrative Code; and the county board, as applicable, shall notify the registered nurse responsible for quality assessment oversight under paragraph (E) of this rule;

(d) If applicable, immediately notify the delegating licensed nurse.

(2) The employer shall ensure all corrective action is taken prior to allowing the MR/DD personnel to resume the administration of prescribed medication, performance of health-related activities, administration of food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, or administration of subcutaneous insulin injections.

(3) The employer shall notify the department and, as applicable, the county board, the registered nurse responsible for quality assessment under paragraph (E) of this rule, or the delegating licensed nurse of the corrective action taken.

(G) Procedures for suspending the certification of MR/DD personnel without a hearing pending the outcome of an investigation

(1) The department may suspend a certificate issued to MR/DD personnel under rule 5123:2-6-06 of the Administrative Code without a hearing pending the outcome of an investigation if the MR/DD personnel has not or will not safely administer prescribed medication or perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(2) Immediately following the suspension of certification, the department shall notify the MR/DD personnel and the employer of the MR/DD personnel and, as applicable, the county board superintendent or designee, the registered nurse responsible for quality assessment oversight under paragraph (E) of this rule, and the delegating licensed nurse.

(3) When the department has suspended a certificate without a hearing, the department shall expedite the investigation and any revocation proceedings. If the department determines as a result of its investigation or at any other time that the suspension is not warranted, the department shall immediately revoke its suspension and reinstate the suspended certificate. Upon reinstatement, the department shall immediately notify the MR/DD personnel and all entities notified under paragraph (G)(2) of this rule of the reinstatement.

(H) Procedures for revoking a certificate issued to MR/DD personnel under rule 5123:2-6-06 of the Administrative Code

(1) The department shall revoke the certification of MR/DD personnel to administer prescribed medication or perform health-related activities, administer food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer insulin by subcutaneious injection if there is evidence after an investigation that MR/DD personnel:

(a) Have failed to comply with the applicable criminal background check requirements of sections 5126.28 and 5126.281 of the Revised Code and rules 5123:2-1-05 , 5123:2-1-05.1, and 5123:2-3-06 of the Administrative Code;

(b) Have failed to exercise proper regard for the health, safety and welfare of the individual;

(c) Have failed to maintain continued certification requirements pursuant to rule 5123:2-6-06 of the Administrative Code; or

(d) Have failed to take corrective action to maintain compliance with this chapter.

(2) Prior to revoking the MR/DD personnel's certification, the department shall notify the MR/DD personnel and the employer of the MR/DD personnel, in writing, of its intent to revoke the MR/DD personnel's certification and specify a reason for such finding. The department shall also provide notice, as applicable, to the county board superintendent or designee, the registered nurse responsible for quality assessment under paragraph (E) of this rule, and the delegating licensed nurse.

(3) The MR/DD personnel may appeal the department's decision to revoke certification by requesting a hearing within seven days of receiving the notification issued under paragraph

(H)(2) of this rule.

(4) A hearing shall be held within twenty-one calendar days of receiving the request for a hearing. The hearing officer shall hold a hearing at a site mutually agreed upon by the MR/DD personnel and the department. Any person shall have the opportunity to present evidence at the hearing. The hearing officer shall determine whether the department's decision to revoke the certification was based upon the MR/DD personnel's noncompliance with this chapter. The hearing officer shall issue a written recommendation to the director or the director's designee within ten calendar days of the hearing.

(5) The director or the director's designee shall issue a written decision to the MR/DD personnel, the employer of the MR/DD personnel, and any entities notified under paragraph (H)(2) of this rule within five calendar days of receipt of the hearing officer's recommendations.

(I) Procedures for accepting complaints and conducting investigations

(1) Any complaint regarding the administration of prescribed medication, performance of health-related activities, and performance of tube feedings by MR/DD personnel pursuant to the authority granted under section 5123.42 of the Revised Code or compliance with rules adopted under this chapter shall be made to the department using the process established under rule 5123:2-17-01 of the Administrative Code. This paragraph shall not be construed to allow MR/DD personnel, a representative of MR/DD personnel, or an employee organization as defined in Chapter 4117. of the Revised Code to make a complaint to the department regarding a personnel action.

(2) Any complaints related to the scope of nursing practice shall be referred to the Ohio board of nursing, which regulates nursing practice in accordance with Chapter 4723. of the Revised Code.

(3) When a quality assessment registered nurse under paragraph (E) of this rule receives a complaint or identifies concerns based on a quality assurance review conducted pursuant to paragraph (E) of this rule related to the performance or qualifications of MR/DD personnel, that registered nurse shall do an initial investigation including a discussion with the MR/DD personnel and his/her employer. After completing the initial investigation, the quality assessment registered nurse under paragraph (E) of this rule shall contact and work with the nurse consultant or a designee of the department to assure that the cases are handled in a consistent manner statewide

(J) Corrective action

(1) In the event that an investigation conducted pursuant to paragraph (I) of this rule results in a finding of failure to comply with the requirements of this chapter, the county board shall work with the MR/DD personnel's employer to assure immediate action is taken to correct the issue to assist the county board or the MR/DD personnel's employment agency in meeting compliance with this chapter.

(2) The department shall review alleged county board violations of this chapter pursuant to MR/DD personnel performing oral and topical prescribed medication administration, performing health-related activities, or administering food or prescribed medication via a stable labeled gastrostomy tube or a stable labeled jejunostomy tube. The department may make recommendations to assist the county board in achieving compliance.

(3) If the provider is found to be in violation of this chapter pursuant to MR/DD personnel performing prescribed medication administration, performing health-related activities, or administering food or prescribed medication via a stable labeled gastrostomy tube or a stable labeled jenunostomy tube, the department may make recommendations to assist the provider in achieving compliance.

(4) The department shall review compliance within thirty days of the corrective action. If the department determines that corrective action does not bring the county board, program or any other provider into substantial compliance with this chapter, the department may revoke a certificate obtained pursuant to rule 5123:2-6-06 of the Administrative Code, or take other actions as allowed by the Revised Code or Administrative Code.

(5) The county board program or any other provider of services may appeal the findings of the department within seven days of receipt of notification by the department.

(a) The request to appeal shall be made in writing to the director of the department and shall explain the basis for the appeal.

(b) The director or the director's designee shall review the appeal within fourteen days of the receipt of the request. The purpose of the review shall be to determine if the findings were based upon the county board's or other provider's of service including the MR/DD personnel's employer's noncompliance with this chapter.

(c) Within seven days of the date of review of the appeal by the director or the director's designee, the decision of the director or the director's designee shall be made in writing to the county board or other providers of service including the MR/DD personnel's employer(s). The decision of the director or the director's designee shall be final and shall be based on the review of evidence.

(K) Immunity from liability

MR/DD personnel who administer prescribed medications, perform health-related activities or perform tube feedings pursuant to the authority granted under section 5123.42 of the Revised Code and rule 5123:2-6-03 of the Administrative Code are not liable for any injury caused by administering the prescribed medications, performing the tasks, or performing the tube feedings if both the following apply:

(1) The MR/DD personnel acted in accordance with the methods taught in training completed in compliance with section 5123.42 of the Revised Code and rules 5123:2-6-05 and 5123:2-6-06 of the Administrative Code; and

(2) The MR/DD personnel did not act in a manner that constitutes wanton or reckless misconduct.

R.C. 119.032 review dates: 07/05/2012 and 07/05/2015
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.421 , 5123.45 , 5123.46
Rule Amplifies: 5123.04 , 5123.41 to 5123.47 , 5126.36
Prior Effective Dates: 09/30/1993 (Emer.), 12/29/1993, 05/16/1994 (Emer.), 08/06/1994, 06/30/1995, 02/14/2000, 10/22/2003 (Emer.), 01/08/2004