Chapter 5123:2-6 Administration of Medication

5123:2-6-01 Definitions of terms used in Chapter 5123:2-6 of the Administrative Code.

The following definitions shall apply to this chapter:

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

(B) "Business day" means a day of the week, excluding Saturday, Sunday, or a legal holiday as defined in section 1.14 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 5123.161 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 developmental disabilities.

(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) "Delegating nurse" means the licensed nurse who transfers the responsibility for performance of selected nursing tasks and/or medication administration to developmental disabilities personnel who have been trained and/or certified to do so, while retaining accountability of outcome. The delegating nurse determines the level of supervision required to ensure adequate oversight of developmental disabilities personnel to perform nursing tasks and/or administer medication. The delegating nurse is not necessarily the same nurse as the nurse who trains developmental disabilities personnel.

(I) "Department" means the Ohio department of developmental disabilities.

(J) "Department-approved curriculum" means the standards for instruction, training, and performance approved by the Ohio department of developmental disabilities.

(K) "Developmental disabilities personnel" means the employees and workers who provide specialized services to individuals with developmental disabilities:

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

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

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

(L) "Director" means the director of the Ohio department of developmental disabilities or his or her designee.

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

(N) "Employer oversight" means the monitoring of developmental disabilities personnel and ensuring developmental disabilities personnel perform health-related activities and administer medication in accordance with this chapter.

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

(P) "Health-related activities" means only:

(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; and

(8) Collection of specimens by noninvasive means.

(Q) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(R) "Individual" means a person with a developmental disability.

(S) "Individual plan" or "individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(T) "Individual-specific training" means training provided to developmental disabilities personnel by a licensed nurse or by an employer of developmental disabilities personnel through employer oversight, which shall address:

(1) The unique needs of the individual being served;

(2) A summary of the individual's relevant health care information; and

(3) Implementation of the individual's health care plan as part of the individual plan or individual service plan.

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

(V) "Licensed nurse" means a registered nurse or a licensed practical nurse who holds a current valid license to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code.

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

(X) "Medicaid" has the same meaning as in section 5162.03 of the Revised Code.

(Y) "Medication/treatment error" means:

(1) Wrong medication/treatment administered or performed;

(2) Medication/treatment administered or performed at the wrong time;

(3) Medication/treatment administered or performed by a route not prescribed;

(4) Incorrect dose or amount of medication/treatment administered or performed;

(5) Expired medication/treatment administered or performed;

(6) Contaminated medication/treatment administered or performed;

(7) Improperly stored medication/treatment administered or performed;

(8) Medication/treatment administered or performed without corresponding order from a licensed health professional authorized to prescribe drugs;

(9) Not performing or administering a medication/treatment during the prescribed time, including failure to ensure the medication/treatment, equipment, or supplies needed to administer or perform the medication/treatment are available at the prescribed time;

(10) Not documenting a medication/treatment that was administered or performed;

(11) Administration of medication/treatment by developmental disabilities personnel without certification or whose certification has expired; and

(12) Administration of medication/treatment without nursing delegation when nursing delegation is required.

(Z) "Mentally alert" means the ability of an individual to cognitively understand and communicate specific information pertaining to his or her health, safety, and medication.

(AA) "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 responsibility for 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.

(BB) "Nursing task" means those activities that constitute the practice of nursing as a licensed nurse and may include but is not limited to, assistance with activities that are performed to maintain or improve an individual's wellbeing when the individual is unable to perform those activities for himself or herself.

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

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

(EE) "Qualified intellectual disability professional" has the same meaning as in 42 C.F.R. 483.430 in effect on the effective date of this rule.

(FF) "Quality assessment registered nurse" means a registered nurse who is a registered nurse instructor or registered nurse trainer employed by or under contract with a county board and who assists with consultation and quality assessment oversight as set forth in rule 5123:2-6-07 of the Administrative Code.

(GG) "Registered nurse instructor" means a registered nurse who is certified by the Ohio department of developmental disabilities in accordance with rule 5123:2-6-04 of the Administrative Code to plan, develop, coordinate, and deliver a course of instruction (i.e., the registered nurse train-the-trainer program) to prepare other registered nurses to train developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(HH) "Registered nurse trainer" means a registered nurse who is certified by the Ohio department of developmental disabilities in accordance with rule 5123:2-6-04 of the Administrative Code to train developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(II) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(JJ) "Service and support administrator" means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

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

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

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

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

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

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.42, 5123.46
Rule Amplifies: 5123.04, 5123.41to5123.47
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 self-administration of prescribed medication.

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

(B) The service and support administrator or qualified intellectual disability professional, as applicable, shall ensure that a department-approved self-administration assessment is completed for an individual who requires prescribed medication. Based on the outcome of the self-administration assessment, the individual plan or individual service plan, as applicable, shall document when the individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication. The service and support administrator or qualified intellectual disability professional, as applicable, shall ensure that the self-administration assessment is reviewed annually. A new self-administration assessment shall be completed at least once every three years or more often when there is a change that affects the individual's medication routine such as a change in medication route, service setting, service provider, or health status.

(C) Each individual plan or individual service plan shall indicate when the individual is able to safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication including:

(1) When the individual is able to safely self-administer medication independently;

(2) When the individual is able to safely self-administer medication with assistance; and

(3) When the individual is not able to successfully self-administer medication with or without assistance and include a statement of how medication administration will be completed.

(D) When the self-administration assessment indicates an individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication:

(1) Further assessment shall be conducted to determine exactly what specific steps of self-administration of medication or self-administration of medication with assistance the individual is able to safely complete. The individual shall participate in these steps under the supervision of developmental disabilities personnel who have current certification in health-related activities and prescribed medication administration and have received individual-specific training.

(2) The details of the individual's specific abilities and needs for developmental disabilities personnel support shall be noted in the individual plan or individual service plan.

(E) Developmental disabilities 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, developmental disabilities 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.

(F) When assisting in the self-administration of prescribed medication, developmental disabilities personnel shall take only the following actions as needed and identified in the individual plan or individual service plan:

(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; or

(3) Assist, on request by or with the consent of, a physically impaired but mentally alert individual, with removal of oral prescribed medication or topical prescribed 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 prescribed medication to the individual's mouth without spilling or dropping it, developmental disabilities personnel may place the dose in another container and place that container to the individual's mouth.

(G) When an individual has been assessed as able to safely self-administer prescribed medication or self-administer prescribed medication with assistance, developmental disabilities personnel are not authorized to verify accuracy of medication being taken by the individual on a routine basis unless specified in the individual plan or individual service plan. When there is reason to question the individual's self-medication skills, a new self-administration assessment shall be completed.

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
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 developmental disabilities personnel to perform health-related activities and administer prescribed medication.

(A) Individuals for whom developmental disabilities personnel may perform health-related activities and administer prescribed medication Developmental disabilities personnel who are not specifically authorized by other provisions of the Revised Code to perform health-related activities or administer prescribed medication 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 developmental disabilities personnel provide to individuals who:

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

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

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

(4) Are 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) Are 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) Are receiving services not described 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) Reside in a residential facility with five or fewer beds;

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

or

(9) Reside in a residential facility with seventeen or more beds while on a field trip when:

(a) The field trip is sponsored by the residential 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 residential facility to provide habilitation, community integration, or normalization services to individuals;

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

(c) The residential facility staffs the field trip with developmental disabilities personnel in such a manner that one person will perform health-related activities and administer prescribed medication for not more than four field trip participants if one or more of those participants have health needs requiring the person to administer oral prescribed medication through a gastrostomy or jejunostomy tube; and

(d) According to the instructions of a health care professional acting within the scope of his or her professional practice, the health needs of the field trip participants who require administration of prescribed medication by developmental disabilities personnel are such that the participants must receive the prescribed medication during the field trip to avoid jeopardizing their health and safety.

(B) Authorization of developmental disabilities personnel to perform health-related activities and administer prescribed medication by the categories described in paragraphs (A)(1) to (A)(9) of this rule

(1) In the case of individuals receiving services described in paragraphs (A)(1), (A)(2), (A)(6), and (A)(8) of this rule, trained and certified developmental disabilities personnel may, with nursing delegation:

(a) Perform health-related activities;

(b) Administer oral prescribed medication and apply topical prescribed medication; and

(c) Administer oral prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(2) In the case of individuals receiving services described in paragraphs (A)(3), (A)(4), (A)(5), and (A)(7) of this rule:

(a) Without nursing delegation, trained and certified developmental disabilities personnel may:

(i) Perform health-related activities; and

(ii) Administer oral prescribed medication and apply topical prescribed medication.

(b) With nursing delegation, trained and certified developmental disabilities personnel may:

(i) Administer oral prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled; and

(ii) Administer routine doses of insulin through subcutaneous injection.

(3) In the case of individuals receiving services described in paragraph (A)(9) of this rule, trained developmental disabilities personnel may, with nursing delegation:

(a) Perform health-related activities;

(b) Administer oral prescribed medication and apply topical prescribed medication; and

(c) Administer oral prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled.

(C) Requirements that apply when developmental disabilities personnel perform health-related activities and administer prescribed medication pursuant to section 5123.42 of the Revised Code

(1) To perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections for individuals in the categories specified in paragraphs (A)(1) to (A)(8) of this rule and in accordance with paragraph (B) of this rule:

(a) Developmental disabilities personnel shall obtain the certificate or certificates required by the department and issued in accordance with rule 5123:2-6-06 of the Administrative Code;

(b) Developmental disabilities personnel shall perform health-related activities and administer prescribed medication only as authorized by the certificate or certificates held; and

(c) When nursing delegation is required in accordance with paragraph (B) of this rule, developmental disabilities personnel shall not act without nursing delegation or act in a manner that is inconsistent with nursing delegation.

(2) To perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, or administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals in the category specified in paragraph (A)(9) of this rule and in accordance with paragraph (B) of this rule:

(a) Developmental disabilities personnel shall successfully complete the developmental disabilities personnel training program in accordance with paragraph (E) of rule 5123:2-6-05 of the Administrative Code.

(b) Developmental disabilities personnel shall perform health-related activities and administer prescribed medication only as authorized by the training program completed.

(c) When nursing delegation is required in accordance with paragraph (B) of this rule, developmental disabilities personnel shall not act without nursing delegation or act in a manner that is inconsistent with nursing delegation.

(3) Prior to delegating to developmental disabilities personnel under this rule, the delegating nurse shall:

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

(b) Select developmental disabilities personnel that, as applicable:

(i) Are certified pursuant to rule 5123:2-6-06 of the Administrative Code; or

(ii) Have current developmental disabilities personnel training pursuant to rule 5123:2-6-05 of the Administrative Code.

(c) Ensure developmental disabilities personnel have received individual-specific training for each individual for whom they perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections. Developmental disabilities personnel shall not perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections for any individual for whom they have not been specifically trained.

(d) Document the assessment of the individual and individual-specific training.

(e) Comply with all standards and conditions for nursing delegation in accordance with Chapter 4723-13 of the Administrative Code.

(4) When delegating nursing tasks that are not taught as part of the curriculum specified in rule 5123:2-6-05 or 5123:2-6-06 of the Administrative Code, the delegating nurse shall train and verify the skills of developmental disabilities personnel in accordance with Chapter 4723-13 of the Administrative Code.

(5) The employer of developmental disabilities personnel shall ensure that developmental disabilities personnel have received individual-specific training for each individual for whom they perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections. Developmental disabilities personnel shall not perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections for any individual for whom they have not been specifically trained.

(6) In situations in which nursing delegation is required, the delegating nurse shall also ensure that developmental disabilities personnel have been trained specifically with respect to each individual for whom they perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections. Developmental disabilities personnel shall not perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections for any individual for whom they have not been specifically trained.

(7) If the employer of developmental disabilities personnel believes or is notified by the county board, the department, a delegating nurse, or the quality assessment registered nurse that developmental disabilities personnel have not safely performed or will not safely perform health-related activities, have not safely administered or will not safely administer oral prescribed medication, have not safely applied or will not safely apply topical prescribed medication, have not safely administered or will not safely administer oral prescribed medication via stable labeled gastrostomy tube or 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 commencing or continuing;

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

(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; if applicable, the county board shall notify the quality assessment registered nurse; and

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

(8) If the delegating nurse believes that developmental disabilities personnel have not safely performed or will not safely perform health-related activities, have not safely administered or will not safely administer oral prescribed medication, have not safely applied or will not safely apply topical prescribed medication, have not safely administered or will not safely administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or have not safely administered or will not safely administer subcutaneous insulin injections, the delegating nurse shall:

(a) Prohibit the action from commencing or continuing;

(b) Immediately notify the employer of the developmental disabilities personnel; and

(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; if applicable, the county board shall notify the quality assessment registered nurse.

(9) Developmental disabilities personnel shall not engage in an action or actions subject to an employer's prohibition or a delegating nurse's prohibition.

(10) A registered nurse shall reassess nursing delegation and the needs of the individual on an ongoing basis, but at least annually. The reassessment may be more frequent if necessary in the judgment of the delegating registered nurse. The reassessment shall include a determination that:

(a) Nursing delegation continues to be necessary;

(b) The individual and circumstances continue to adhere to standards and conditions for nursing delegation in accordance with Chapter 4723-13 of the Administrative Code; and

(c) The developmental disabilities personnel continue to demonstrate the skill to accurately perform the nursing tasks, health-related activities, and prescribed medication administration being delegated.

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
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 nurse instructors and registered nurse trainers.

(A) Requirements for registered nurse instructors

(1) Only a registered nurse certified by the department as a registered nurse instructor may plan, develop, coordinate, and deliver the registered nurse train-the-trainer program that prepares registered nurses to train developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(2) Only a registered nurse who meets the following requirements may be certified as a registered nurse instructor:

(a) Current valid licensure in good standing with the Ohio board of nursing to practice as a registered nurse.

(b) A minimum of sixty months full-time (or equivalent part-time) experience in the practice of nursing as a registered nurse, of which at least twenty-four months have been in the field of developmental disabilities.

(c) Knowledge of the current laws and rules which regulate the practice of nursing, sections 5123.41 to 5123.47 of the Revised Code, and this chapter.

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

(e) Current certification as a registered nurse trainer in accordance with this rule.

(f) Successful completion of the department-provided registered nurse instructor orientation program and maintenance of registered nurse instructor certification pursuant to this rule.

(3) The department may certify a registered nurse who meets the requirements of this rule as a registered nurse instructor for a period of two years.

(4) Registered nurse instructors shall make entries in the medication administration information system database in accordance with procedures established by the department for renewal of registered nurse instructor certification.

(B) Requirements for registered nurse trainers

(1) Only a registered nurse certified by the department as a registered nurse trainer may plan, develop, coordinate, and train developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(2) Only a registered nurse who meets the following requirements may be certified as a registered nurse trainer:

(a) Current valid licensure in good standing with the Ohio board of nursing to practice as a registered nurse.

(b) A minimum of eighteen months full-time (or equivalent part-time) experience in the practice of nursing as a registered nurse.

(c) Previous experience caring for an individual with developmental disabilities.

(d) Successful completion of a registered nurse train-the-trainer program that has been authorized by an Ohio board of nursing continuing education approver unit. Successful completion of the registered nurse train-the-trainer program requires the registered nurse to:

(i) Submit a completed application to the registered nurse instructor;

(ii) Attend the entire registered nurse train-the-trainer program;

(iii) Participate in registered nurse train-the-trainer program class discussions and activities; and

(iv) Submit a completed evaluation to the registered nurse instructor.

(3) The department shall certify a registered nurse who meets the requirements of this rule as a registered nurse trainer for a period of two years.

(4) To maintain certification as a registered nurse trainer, the registered nurse shall, during the effective period of the certification complete, at a minimum, four contact hours of continuing education related to information addressed in the registered nurse train-the-trainer program or that will enhance the role of the registered nurse trainer. Training in cardiopulmonary resuscitation, first aid, or universal precautions for infection control shall not count toward the four contact hours. The four contact hours may be part of the continuing education required by the Ohio board of nursing to maintain licensure as a registered nurse.

(5) When a registered nurse fails to meet or cannot show proof of meeting the requirements set forth in paragraph (B)(4) of this rule, he or she shall be required to repeat the registered nurse train-the-trainer program in its entirety. Until such time that the registered nurse repeats the registered nurse train-the-trainer program in its entirety, he or she shall not plan, develop, or coordinate a program of instruction for developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(C) Minimum curriculum for the registered nurse train-the-trainer program

(1) The registered nurse train-the-trainer program shall be at a minimum eight hours; one hour equals sixty minutes of classroom instruction. The registered nurse train-the-trainer program shall address:

(a) Review of sections 4723.071 and 5123.41 to 5123.47 of the Revised Code, rules adopted under this chapter, and other applicable sections of the Revised Code and rules of the Administrative Code pertaining to the functioning of a county board, nursing delegation, and developmental disabilities personnel.

(b) Review of all components required when teaching developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, and administer subcutaneous insulin injections, including general principles of nursing delegation by a licensed nurse to developmental disabilities personnel.

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

(d) Documentation requirements for licensed nurses and developmental disabilities personnel.

(e) Principles of developmental disabilities personnel certification and nursing delegation including, but not limited to:

(i) Direct and indirect supervision and determination of the appropriate type of supervision pursuant to this chapter;

(ii) Explanation that nursing delegation requires developmental disabilities personnel to receive individual-specific training for each individual served; and

(iii) Explanation that nursing delegation is expressly authorized for a specific individual served and does not confer nursing delegation authority to or for another individual.

(f) How to provide indirect supervision, including methods for remaining accessible and training developmental disabilities personnel how and when to access help.

(g) How to evaluate the skills of developmental disabilities personnel, including developing and using a skills check list in the training program that teaches developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, and administer subcutaneous insulin injections.

(h) Responsibility and accountability issues pursuant to rule 5123:2-6-07 of the Administrative Code.

(i) General principles of adult basic education.

(j) Instruction that health-related activities and medication administration certification applies only while providing services in settings under the administrative oversight of the department and that such certification does not confer authority or apply in any other setting or course of medication administration.

(k) Requirements for nursing delegation for individuals residing at a residential facility with seventeen or more beds while on a field trip pursuant to rule 5123:2-6-05 of the Administrative Code including instruction that:

(i) Developmental disabilities personnel being trained to administer oral prescribed medication, apply topical prescribed medication, and administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube only to individuals residing at a residential facility with seventeen or more beds while on a field trip, shall not receive or transcribe physician's orders and prescriptions; and

(ii) Only a registered nurse who meets the requirements set forth in rule 5123:2-6-05 of the Administrative Code may train developmental disabilities personnel for receiving nursing delegation for individuals residing at a residential facility with seventeen or more beds while on a field trip.

(l) Information and instruction regarding the department's medication administration information system database, including required entry of data regarding developmental disabilities personnel trained.

(m) Instruction that only a department-approved curriculum shall be used to train developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(2) A registered nurse instructor may engage other licensed health care professionals to assist with instruction of the registered nurse train-the-trainer program as long as the other licensed health care professionals have received instruction on the material and are acting within the scope of their professional practice as outlined in the Revised Code.

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.44, 5123.45, 5123.46
Rule Amplifies: 5123.04, 5123.41to5123.47
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 of registered nurses who train developmental disabilities personnel and developmental disabilities personnel who administer prescribed medication to individuals residing at a residential facility with seventeen or more beds while on a field trip.

(A) Requirements for registered nurse instructors

Only a registered nurse certified by the department as a registered nurse instructor in accordance with rule 5123:2-6-04 of the Administrative Code may plan, develop, coordinate, and deliver the registered nurse training program that prepares registered nurses to train developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, or administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals residing at a residential facility with seventeen or more beds while on a field trip.

(B) Requirements for registered nurses who train developmental disabilities personnel

Only a registered nurse may plan, develop, coordinate, and train developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, or administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals residing at a residential facility with seventeen or more beds while on a field trip. A registered nurse who trains developmental disabilities personnel shall either:

(1) Be a certified registered nurse trainer in accordance with rule 5123:2-6-04 of the Administrative Code; or

(2) Meet the following requirements:

(a) Current valid licensure in good standing with the Ohio board of nursing to practice as a registered nurse;

(b) A minimum of eighteen months full-time (or equivalent part-time) experience in the practice of nursing as a registered nurse;

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

(d) Successful completion of the registered nurse training program pursuant to this rule.

(C) Minimum curriculum for the registered nurse training program

(1) The registered nurse training program which prepares a registered nurse to teach developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, and administer oral prescribed nurs medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals residing at a residential facility with seventeen or more beds while on a field trip, shall be at a minimum four hours; one hour equals sixty minutes of classroom instruction. The registered nurse training program shall address:

(a) Review of sections 4723.071 and 5123.41 to 5123.47 of the Revised Code, rules adopted under this chapter, and other applicable sections of the Revised Code and rules of the Administrative Code pertaining to the functioning of a county board, nursing delegation, and developmental disabilities personnel;

(b) Review of all components required when teaching developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, and administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, including general principles of nursing delegation by a licensed nurse to developmental disabilities personnel;

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

(d) Documentation requirements for licensed nurses and developmental disabilities personnel;

(e) How to provide indirect supervision, including methods for remaining accessible and training developmental disabilities personnel how and when to access help;

(f) How to evaluate the skills of developmental disabilities personnel, including developing and using a skills check list in the training program that teaches developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, and administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube;

(g) Responsibility and accountability issues pursuant to rule 5123:2-6-07 of the Administrative Code;

(h) Instruction that nursing delegation instruction is for a specific individual; that nursing delegation instruction must occur for each individual served by the developmental disabilities personnel; and that nursing delegation for a specific individual does not confer nursing delegation for any other individual; and

(i) Instruction that developmental disabilities personnel being trained to administer oral prescribed medication, apply topical prescribed medication, and administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube only to individuals residing at a residential facility with seventeen or more beds while on a field trip shall not receive or transcribe physician orders and prescriptions.

(2) The registered nurse instructor shall ensure that the training program to prepare registered nurses to train developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, or administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals residing at a residential facility with seventeen or more beds while on a field trip shall be planned, developed, and taught in accordance with requirements set forth in this rule.

(3) Successful completion of the training program to prepare the registered nurse to train developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, and administer oral prescribed medication via stabled labeled gastrostomy tube or stable labeled jejunostomy tube for individuals residing at a residential facility with seventeen or more beds while on a field trip requires:

(a) Submission of the required application to the registered nurse instructor;

(b) Attendance at the entire training program;

(c) Participation in training program discussions and activities; and

(d) Completion and submission of the evaluation of the training program to the registered nurse instructor.

(4) To maintain qualifications to teach developmental disabilities personnel to administer oral prescribed medication, apply topical prescribed medication, and administer oral 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 registered nurse training program or that will enhance the role of the registered nurse trainer. Training in cardiopulmonary resuscitation, first aid, or universal precautions for infection control shall not count toward the two contact hours. The two contact hours may be part of the continuing education required by the Ohio board of nursing to maintain licensure as a registered nurse.

(D) Developmental disabilities personnel qualifications and training requirements

(1) To be eligible to receive training in administering oral prescribed medication, applying topical prescribed medication, and administering oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube for individuals residing at a residential facility with seventeen or more beds while on a field trip, developmental disabilities personnel shall be:

(a) At least eighteen years of age; and

(b) Able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided.

(2) Prior to permitting developmental disabilities personnel to take a training program set forth in this rule, the employer of developmental disabilities personnel shall ensure background investigations on the developmental disabilities personnel have been completed in accordance with rule 5123:2-2-02 of the Administrative Code and requirements to enroll developmental disabilities personnel in the Ohio attorney general's retained applicant fingerprint database ("Rapback") have been met.

(E) Developmental disabilities personnel training program

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

(2) Instruction that the developmental disabilities personnel must be provided individual-specific training and that the delegating nurse shall be responsible for the individual-specific training. The individual-specific training shall occur prior to administering oral prescribed medication, applying topical prescribed medication, or administering oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(3) Instruction that a registered nurse shall reassess nursing delegation and the needs of the individual on an ongoing basis but at least annually, including determination that nursing delegation continues to be necessary and appropriate, determination that the individual continues to be stable, and determination that the developmental disabilities personnel continue to have the skills to perform the nursing tasks, activities, or prescribed medication administration that have been delegated. The reassessment may be more frequent if necessary in the judgment of the delegating registered nurse.

(4) Universal precautions for infection control. The registered nurse may waive the universal precautions for infection control instruction material and instruction time if the developmental disabilities personnel can document training on that topic within the previous year.

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

(6) For developmental disabilities personnel who will be delegated by the licensed nurse the authority to administer oral prescribed medication or apply topical prescribed medication, the training shall, in addition to the content described in paragraphs (E)(1) to (E)(5) of this rule, include:

(a) Information and instruction on the concepts underlying each step for correctly and safely administering oral prescribed medication or applying topical prescribed medication according to current standards of safe practice, procedures, and techniques for administering oral prescribed medication and applying topical prescribed medication to train the developmental disabilities personnel to administer the right medication, at the right dose, to the right individual, by the right route, at the right time.

(b) Written instructions that should be provided for administering oral prescribed medication and applying topical prescribed medication to a particular individual.

(c) Instruction in quality measures, including but not limited to, procedures for reporting and documenting all medication/treatment errors that may occur when administering oral prescribed medication or applying topical prescribed medication, procedures in case of emergency, and procedures on when, why, and how to contact the employer of the developmental disabilities personnel or designee and the supervising licensed nurse when medication is administered or a nursing task is performed pursuant to delegation.

(d) Information about what developmental disabilities personnel may be authorized to perform with respect to administering oral prescribed medication or applying topical prescribed medication.

(e) Limitations with respect to "as needed" (or "PRN") prescribed medication, which state that developmental disabilities personnel shall not administer or apply a prescribed medication ordered by a physician or other licensed health professional authorized to prescribe drugs when the prescribed medication is to be administered or applied as needed, unless the order is written with specific parameters which preclude independent judgment.

(f) Information about what developmental disabilities personnel are prohibited from administering, which includes but is not limited to:

(i) An intramuscular injection;

(ii) An intravenous injection;

(iii) A subcutaneous injection; and

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

(g) 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.

(h) 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.

(i) 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.

(j) 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 center).

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

(l) The requirements for documentation and notification of medication/treatment errors.

(m) Information regarding the appropriate and secure storage and care of prescribed medication.

(n) Information and instruction that developmental disabilities personnel may not receive or transcribe physician orders and prescriptions onto a prescribed medication administration record and a treatment administration record.

(o) Performance of a successful return demonstration for each route of prescribed medication administration in which developmental disabilities personnel are trained.

(7) Successful completion of training in administering oral prescribed medication and applying topical prescribed medication and the content described in paragraph (E)(6) of this rule shall be determined by the registered nurse qualified pursuant to this rule.

(8) For developmental disabilities personnel who will be delegated by the licensed nurse the authority to administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, the training shall, in addition to the content described in paragraphs (E)(1) to (E)(5) of this rule, include:

(a) Instruction in quality measures, including but not limited to, procedures for reporting and documenting errors that may occur when administering oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, procedures in case of emergency, and procedures on when, why, and how to contact the employer of developmental disabilities personnel or designee or the supervising licensed nurse.

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

(c) Correct and safe practices, procedures, and techniques for administering oral 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 prescribed medication by the individual, and appropriate response to gastrostomy tube or jejunostomy tube that becomes dislodged.

(d) The requirements for documentation of oral prescribed medication administered, missed, held, or refused to, by, or for each individual via gastrostomy tube or jejunostomy tube.

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

(f) Information regarding the proper storage, care, and preparation of oral prescribed medication to be administered via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(g) Information regarding the proper storage and care of gastrostomy tubes and jejunostomy tubes.

(h) 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 nurse will provide specific potential drug reactions and interactions and potential side effects.

(i) Information about what developmental disabilities personnel are prohibited from administering, which includes but is not limited to, any prescribed medication administered through a nasogastric tube or an unstable or unlabeled gastrostomy tube or unstable or unlabeled jejunostomy tube.

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

(k) Instruction that only the delegating nurse shall receive prescriptions for oral 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 a prescribed medication administration record or treatment administration record.

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

(9) Successful completion of training in administering oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube and the content described in paragraph (E)(8) of this rule shall be determined by the registered nurse qualified pursuant to this rule.

(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, including the performance of health-related activities.

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.43, 5123.44, 5123.45, 5123.46
Rule Amplifies: 5123.04, 5123.41to5123.47
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 developmental disabilities personnel who perform health-related activities and administer prescribed medication.

(A) To be eligible to receive training in performing health-related activities, administering oral prescribed medication, applying topical prescribed medication, administering oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, and administering subcutaneous insulin injections, developmental disabilities personnel shall:

(1) Be at least eighteen years of age;

(2) Hold a high school diploma or general education development certificate; and

(3) Be able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided.

(B) Prior to permitting developmental disabilities personnel to take a program of instruction set forth in this rule, the employer of developmental disabilities personnel shall verify compliance with requirements for background investigations for developmental disabilities personnel in accordance with rule 5123:2-2-02 of the Administrative Code and requirements to enroll developmental disabilities personnel in the Ohio attorney general's retained applicant fingerprint database ("Rapback").

(C) Training programs for developmental disabilities personnel

(1) Health-related activities and prescribed medication administration training program

(a) A health-related activities and prescribed medication administration training program provided pursuant to this rule, to prepare developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, and apply topical prescribed medication shall be at a minimum a fourteen-hour course; one hour equals sixty minutes of classroom instruction. Relevant agency-specific and/or facility-specific material may be added to the department-approved curriculum described in paragraph (C)(1)(b) of this rule only with additional corresponding classroom instruction time beyond the fourteen-hour course.

(b) The health-related activities and prescribed medication administration training program shall address:

(i) Universal precautions for infection control. The registered nurse trainer may waive the universal precautions for infection control instruction material and instruction time of the program if the developmental disabilities personnel can document training on that topic within the previous year.

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

(iii) Information and instruction on the concepts underlying each step for administering oral prescribed medication and applying topical prescribed medication and how to correctly administer oral prescribed medication and apply topical prescribed medication according to current standards of safe practice, procedures, and techniques to train the developmental disabilities personnel to administer the right medication, at the right dose, to the right individual, by the right route, at the right time.

(iv) Written step-by-step directions on how to administer oral prescribed medication and apply topical prescribed medication.

(v) Instruction in quality measures, including but not limited to, procedures for reporting and documenting medication/treatment errors that may occur when performing health-related activities, administering oral prescribed medication, or applying topical prescribed medication, procedures in case of emergency, and procedures on when, why, and how to contact the employer of the developmental disabilities personnel or designee or the supervising licensed nurse when medication is administered or a nursing task is performed pursuant to nursing delegation.

(vi) Information about what developmental disabilities personnel may be authorized to perform with respect to administering oral prescribed medication or applying topical prescribed medication.

(vii) Limitations with respect to "as needed" (or "PRN") prescribed medication, which state that developmental disabilities personnel shall not administer or apply a prescribed medication ordered by a physician or other licensed health professional authorized to prescribe drugs when the prescribed medication is to be administered or applied as needed, unless the order is written with specific parameters which preclude independent judgment.

(viii) Information about what developmental disabilities personnel are prohibited from administering, which includes but is not limited to:

(a) An intramuscular injection;

(b) An intravenous injection;

(c) A subcutaneous injection, except an injection of subcutaneous insulin provided the developmental disabilities personnel are trained in the subcutaneous injection of insulin pursuant to section 5123.42 of the Revised Code and 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;

(d) Any prescribed medication administered through a nasogastric tube or an unstable or unlabeled gastrostomy tube or unstable or unlabeled jejunostomy tube; and

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

(ix) 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.

(x) 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.

(xi) 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.

(xii) 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 center).

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

(xiv) Information regarding the appropriate and secure storage and care of prescribed medication.

(xv) Instruction that in settings where developmental disabilities personnel are administering prescribed medication, with or without nursing delegation, medication may be administered only from pharmacy-labeled or manufacturer-labeled containers and only by the person who prepared the dosage from those containers.

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

(xvii) Performance of a successful return demonstration for each route of prescribed medication administration in which developmental disabilities personnel are trained.

(xviii) Information that health-related activities are performed only pursuant to nursing delegation except for individuals:

(a) Receiving family support services or services from certified supported living providers, if the services are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(b) 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

(c) Residing in a residential facility with five or fewer beds.

(xix) 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.

(xx) 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.

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

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

(xxiii) Performance of successful return demonstration for each health-related activity in which developmental disabilities personnel are trained.

(xxiv) Completion of written examination pursuant to paragraph (E)(1)(d) of this rule.

(xxv) Requirements for individual-specific training which shall occur after certification and prior to administration of prescribed medication or performance of health-related activities. The employer of developmental disabilities personnel and the delegating nurse shall ensure that developmental disabilities personnel receive individual-specific training.

(2) Oral prescribed medication via feeding tube by nursing delegation training program

(a) An oral prescribed medication via feeding tube by nursing delegation training program provided pursuant to this rule to prepare developmental disabilities personnel to administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube shall be at a minimum a four-hour course and shall be in addition to the health-related activities and prescribed medication administration training program described in paragraph (C)(1) of this rule; one hour equals sixty minutes of classroom instruction. Relevant agency-specific and/or facility-specific material may be added to the department-approved curriculum described in paragraph (C)(2)(b) of this rule only with additional corresponding classroom instruction time beyond the four-hour course. Developmental disabilities personnel shall successfully complete the health-related activities and prescribed medication administration training program described in paragraph (C)(1) of this rule prior to participating in the oral prescribed medication via feeding tube by nursing delegation training program.

(b) The oral prescribed medication via feeding tube by nursing delegation training program shall address:

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

(ii) Requirements for documentation of oral prescribed medication administered, missed, held, or refused to, by, or for each individual via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(iii) Requirements for documentation and notification of oral prescribed medication errors via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(iv) Information regarding the proper storage, care, and preparation of oral prescribed medication to be administered via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(v) Information regarding the proper storage and care of gastrostomy tubes and jejunostomy tubes.

(vi) Requirements for nursing delegation of oral prescribed medication administration via stable labeled gastrostomy tube or stable labeled jejunostomy tube.

(vii) Instruction that only the delegating nurse shall receive prescriptions for oral 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 a prescribed medication administration record or treatment administration record.

(viii) Performance of successful return demonstration of proficiency in administering oral prescribed medication via stable labeled gastrostomy tube and stable labeled jejunostomy tube.

(ix) Completion of written examination pursuant to paragraph (E)(1)(d) of this rule.

(x) Requirements for individual-specific training which shall occur after certification and prior to administration of oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube. The delegating nurse shall be responsible for the individual-specific training.

(3) Subcutaneous insulin injection by nursing delegation training program

(a) A subcutaneous insulin injection by nursing delegation training program provided pursuant to this rule to prepare developmental disabilities personnel to administer subcutaneous insulin injection by nursing delegation shall be a minimum a four-hour course and shall be in addition to the health-related activities and prescribed medication administration training program described in paragraph (C)(1) of this rule; one hour equals sixty minutes of classroom instruction. Relevant agency-specific and/or facility-specific material may be added to the department-approved curriculum described in paragraph (C)(3)(b) of this rule only with additional corresponding classroom instruction time beyond the four-hour course. Developmental disabilities personnel shall successfully complete the health-related activities and prescribed medication administration training program described in paragraph (C)(1) of this rule prior to participating in the subcutaneous insulin injection by nursing delegation training program.

(b) The subcutaneous insulin injection by nursing delegation training program shall address:

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

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

(iii) The requirements for documentation of subcutaneous insulin injections administered, missed, held, or refused to, by, or for each individual.

(iv) Requirements for documentation and notification of subcutaneous insulin injection errors.

(v) Information regarding the proper storage, care, and preparation of insulin to be administered by subcutaneous insulin injection.

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

(vii) 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.

(viii) Instruction that only a licensed nurse shall transcribe an insulin prescription into a prescribed medication administration record.

(ix) Performance of successful return demonstration of proficiency in administering subcutaneous insulin injections.

(x) Completion of written examination pursuant to paragraph (E)(1)(d) of this rule.

(xi) Requirements for nursing delegation of subcutaneous insulin injections.

(xii) Requirements for individual-specific training which shall occur after certification and prior to administration of subcutaneous insulin injections. The delegating nurse shall be responsible for the individual-specific training.

(D) Requirements for training programs

(1) The health-related activities and prescribed medication administration training program, administration of oral prescribed medication via feeding tube by nursing delegation training program, and the subcutaneous insulin injection by nursing delegation training program shall be planned, developed, and delivered by a registered nurse trainer certified by the department in accordance with rule 5123:2-6-04 of the Administrative Code. The registered nurse trainer shall ensure that training programs are conducted in accordance with requirements set forth in this chapter.

(2) A registered nurse trainer shall use only a department-approved curriculum for the health-related activities and prescribed medication administration training program, the administration of oral prescribed medication via feeding tube by nursing delegation training program, or the subcutaneous insulin injection by nursing delegation training program.

(3) A registered nurse trainer shall personally conduct the majority of a training program but may utilize other licensed health professionals to assist with conducting the training program as long as the other licensed health professionals have received instruction on the material and are acting within their professional scope of practice as outlined in the Revised Code.

(E) Initial certification of developmental disabilities personnel

(1) To receive initial certification in health-related activities and prescribed medication administration, administration of oral prescribed medication via feeding tube by nursing delegation, or subcutaneous insulin injection by nursing delegation, developmental disabilities personnel shall:

(a) Attend the entire applicable training program.

(b) Actively participate in the training program class discussions and activities.

(c) Successfully perform a return demonstration of proficiency.

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

(e) Complete and submit to the registered nurse trainer the evaluation of the training program.

(2) Certification in health-related activities and prescribed medication administration is a prerequisite for certification in administration of oral prescribed medication via feeding tube by nursing delegation or certification in subcutaneous insulin injection by nursing delegation.

(3) The registered nurse trainer shall ensure developmental disabilities personnel meet all requirements for initial certification before indicating so in the medication administration information system database.

(F) Maintenance of developmental disabilities personnel certification

(1) To maintain certification in health-related activities and prescribed medication administration, administration of oral prescribed medication via feeding tube by nursing delegation, or subcutaneous insulin injection by nursing delegation, developmental disabilities personnel shall annually complete continuing education that will enhance the role of developmental disabilities personnel who have completed the training program as determined by the registered nurse trainer. Developmental disabilities personnel shall provide documentation of completion of the required continuing education to the registered nurse trainer.

(a) To maintain certification in health-related activities and prescribed medication administration, developmental disabilities personnel shall annually complete at least two hours of continuing education that relates to the information taught in the health-related activities and prescribed medication administration training program (as determined by the registered nurse trainer) and perform a successful return demonstration of skills.

(b) To maintain certification in administration of oral prescribed medication via feeding tube by nursing delegation, developmental disabilities personnel shall annually complete at least one hour of continuing education that relates to the information taught in the administration of oral prescribed medication via feeding tube by nursing delegation training program (as determined by the registered nurse trainer) and perform a successful return demonstration of skills. The continuing education required in this paragraph is in addition to the two hours of continuing education required for health-related activities and prescribed medication administration certification and, if applicable, the one hour of continuing education required for subcutaneous insulin injection by nursing delegation certification.

(c) To maintain certification in subcutaneous insulin injection by nursing delegation, the developmental disabilities personnel shall annually complete at least one hour of continuing education that relates to the information taught in the subcutaneous insulin injection by nursing delegation training program (as determined by the registered nurse trainer) and perform a successful return demonstration of skills. The continuing education required in this paragraph is in addition to the two hours of continuing education required for health-related activities and prescribed medication administration certification and, if applicable, the one hour of continuing education required for oral prescribed medication administration via feeding tube by nursing delegation certification.

(2) Training in cardiopulmonary resuscitation, first aid, or universal precautions for infection control shall not count toward continuing education required by paragraph (F)(1)(a), (F)(1)(b), or (F)(1)(c) of this rule.

(3) Maintaining certification in health-related activities and prescribed medication administration is required to maintain certification in administration of oral prescribed medication via feeding tube by nursing delegation and certification in subcutaneous insulin injection by nursing delegation.

(4) When developmental disabilities personnel fail to complete the required continuing education and return demonstration of skills by the annual certification expiration date, the certification of the developmental disabilities personnel shall be temporarily inactive for a maximum period of sixty calendar days, during which time the developmental disabilities personnel shall complete the required continuing education and return demonstration of skills. While certification is inactive, the developmental disabilities personnel shall not perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, receive nursing delegation to administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, administer subcutaneous insulin injections, or receive nursing delegation to administer subcutaneous insulin injections. If the developmental disabilities personnel fail to complete the required continuing education and return demonstration of skills within the sixty-day suspension period, the developmental disabilities personnel shall be required to repeat each training program in its entirety to become recertified.

(5) The registered nurse trainer shall ensure developmental disabilities personnel meet all requirements for renewal certification before indicating so in the medication administration information system database.

(G) For adequate reasons and when requested in writing, the director may waive a condition or specific requirement of this rule. Approval to waive a condition or specific requirement shall not be contrary to the rights, health, or safety of individuals served. The decision to grant or deny a rule waiver is final and may not be appealed.

(H) 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.

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.42, 5123.43, 5123.45, 5123.46
Rule Amplifies: 5123.04, 5123.41to5123.47
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 for performance of health-related activities and administration of prescribed medication.

(A) Medication administration information system database

(1) The department shall operate and maintain the medication administration information system database of registered nurse instructors and registered nurse trainers holding valid certification issued in accordance with rule 5123:2-6-04 of the Administrative Code and developmental disabilities personnel holding valid certification issued in accordance with rule 5123:2-6-06 of the Administrative Code in health-related activities and prescribed medication administration, oral prescribed medication via feeding tube by nursing delegation, and subcutaneous insulin injection by nursing delegation.

(2) The department shall provide read and write access to the medication administration information system database to all registered nurse instructors. Each registered nurse instructor shall enter in the database initial information about each person he or she trained to be a registered nurse trainer in accordance with rule 5123:2-6-04 of the Administrative Code.

(3) The department shall provide read and write access to the medication administration information system database to all registered nurse trainers. Each registered nurse trainer shall enter in the database current information about developmental disabilities personnel he or she trained in accordance with rule 5123:2-6-06 of the Administrative Code at the time of certification and recertification of the developmental disabilities personnel.

(4) Each registered nurse trainer shall enter in the medication administration information system database, information about himself or herself at the time of recertification and thereafter, within sixty calendar days of any change of information. Each registered nurse trainer shall enter information required for renewal of his or her registered nurse trainer certification prior to expiration of the certification.

(5) The department shall provide read only access to the medication administration information system database to the public.

(B) Documentation of performance of health-related activities and administration of prescribed medication by developmental disabilities personnel

(1) All prescribed medication administered pursuant to this chapter shall be administered according to the written directions of an appropriately licensed health professional authorized to prescribe drugs and according to the training received by developmental disabilities personnel in accordance with rules 5123:2-6-05 and 5123:2-6-06 of the Administrative Code.

(2) Performance of health-related activities and administration of prescribed medication and treatments shall be documented in a medication/treatment administration record indicating the completion of prescribed orders, including the signature or initials of the developmental disabilities personnel administering the prescribed medication or treatment, date, time, and when appropriate, observations or difficulties noted. This written documentation is required for all prescribed medication and treatments performed, administered, applied, missed, held, or refused, including:

(a) Routine and as-needed prescribed medication and treatments;

(b) Health-related activities; and

(c) Subcutaneous insulin injections.

(3) Medication/treatment administration records shall include at a minimum:

(a) Name of individual served;

(b) All allergies of individual served;

(c) Day, month, and year of documentation;

(d) Name of drug or treatment;

(e) Complete dosage and frequency of prescribed medication;

(f) Route of prescribed medication administration;

(g) Scheduled/prescribed time or intervals for administration;

(h) Any special instructions regarding each medication administration or treatment as provided by the pharmacy, physician, or prescriber; and

(i) Parameters provided by the physician or licensed health professional for ordered health-related activities.

(4) The employer of developmental disabilities personnel shall maintain a means of identifying signatures and initials of developmental disabilities personnel making entries in the medication/treatment administration record. Identification shall be included in the medication/treatment administration record or by using a separate master signatures/initials log.

(5) Certified developmental disabilities personnel transcribing changes and/or checking the accuracy of changes entered in the medication/treatment administration record shall document when transcription and/or check has been completed, including date, time, and signature or initials.

(a) Only a licensed nurse or developmental disabilities personnel with health-related activities and prescribed medication administration certification may transcribe changes and/or check the accuracy of changes entered in the medication/treatment administration record.

(b) Checking the accuracy of transcriptions shall include:

(i) Verifying changes are transcribed as specified by the prescriber;

(ii) Verifying special instructions are indicated as instructed by pharmacy or prescriber directives; and

(iii) Ensuring the availability of equipment and/or supplies required to administer medication or perform the task in the setting.

(6) With any change to medication and/or treatment orders, the employer of developmental disabilities personnel or delegating nurse shall ensure the medication/treatment administration record has been checked.

(7) Employers of developmental disabilities personnel and independent providers shall ensure documentation, including the date, time, and signature or initials of certified developmental disabilities personnel who sign the medication/treatment administration record is completed in accordance with this rule.

(C) Requirements for developmental disabilities personnel to report medication/treatment errors

(1) Any medication/treatment error by developmental disabilities personnel in the performance of health-related activities, administration of oral prescribed medication, or application of topical prescribed medication that results in physical harm to the individual shall be immediately reported to an appropriate licensed health care professional. The requirement to immediately report medication/treatment errors applies to errors involving prescribed medication, treatments, over-the-counter medication, and health-related activities.

(2) Any medication/treatment error by developmental disabilities personnel shall be reported in accordance with rule 5123:2-17-02 of the Administrative Code when the medication/treatment error meets the definition of major unusual incident or unusual incident.

(3) Developmental disabilities personnel who observe, identify, or become aware of a medication/treatment error shall report to the delegating nurse and/or supervisory staff immediately in accordance with the employer's written policy and procedure. All medication/treatment errors shall be documented in an unusual incident report in accordance with rule 5123:2-17-02 of the Administrative Code.

(4) The employer of developmental disabilities personnel shall train developmental disabilities personnel in accordance with the employer's written policy and procedure that medication/treatment errors and related plans of prevention shall be documented in an unusual incident report.

(D) Compliance and quality assessment

(1) Each county board shall employ or enter into a contract with a registered nurse instructor or a registered nurse trainer who will serve as a quality assessment registered nurse to assist with consultation and quality assessment oversight.

(2) Quality assessment reviews shall be conducted when developmental disabilities personnel perform health-related activities or administer prescribed medication for individuals who:

(a) Receive services from certified supported living providers;

(b) Receive 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

(c) Reside in residential facilities of five or fewer beds, excluding intermediate care facilities for individuals with intellectual disabilities.

(3) The quality assessment registered nurse shall complete quality assessment reviews so that a review of each individual in the county for whom developmental disabilities personnel perform health-related activities or administer prescribed medication is conducted at least once every three years. The quality assessment registered nurse may conduct more frequent reviews if the quality assessment 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:

(a) Observation of performance of health-related activities and administration of prescribed medication;

(b) Review of the system of communication and supports related to performance of health-related activities and administration of prescribed medication for the individual being assessed to ensure complete and accurate administration of health care directives given by the individual's health care professionals;

(c) Review of documentation of performance of health-related activities and administration of prescribed medication for completeness of documentation and for documentation of appropriate actions taken based on parameters provided in the health-related activities and prescribed medication administration training program described in rule 5123:2-6-06 of the Administrative Code;

(d) Review of all medication/treatment errors from the past twelve months; and

(e) Review of the system of processes and procedures used by the employer of developmental disabilities personnel or independent provider to monitor and document completeness and correct techniques used during performance of health-related activities, administration of oral prescribed medication, and application of topical prescribed medication.

(6) The quality assessment registered nurse shall provide a copy of the quality assessment review report to the county board and the provider of services within ten business days of the quality assessment review and shall recommend to the county board and the provider of services steps to be taken to improve the functioning of the trained developmental disabilities personnel and maintain compliance with this chapter.

(7) The quality assessment registered nurse shall maintain a copy of each quality assessment review he or she performs in accordance with paragraph (D)(3) of this rule.

(8) The quality assessment registered nurse shall coordinate with, as applicable, the county board, the employer of developmental disabilities personnel, or independent provider to ensure that safety concerns are immediately addressed.

(9) The employer of developmental disabilities personnel or the independent provider, as applicable, shall submit a written plan of improvement to the quality assessment registered nurse that addresses specific rule violations identified in the quality assessment review within thirty calendar days of receipt of the quality assessment review report.

(10) The quality assessment registered nurse shall notify the county board and the department when the employer of developmental disabilities personnel or the independent provider fails to:

(a) Submit a written plan of improvement within sixty calendar days of receipt of the quality assessment review report; or

(b) Successfully implement the written plan of improvement within sixty calendar days of submission of the plan to the quality assessment registered nurse.

(11) The quality assessment registered nurse shall act as a resource for the county board and providers of services concerning health management issues and may assist in expanding health care services in the community.

(E) Prohibition on performance of health-related activities and administration of prescribed medication by developmental disabilities personnel

(1) If an employer of developmental disabilities personnel believes or is notified by the county board, the department, a delegating nurse, or the quality assessment registered nurse that developmental disabilities personnel have not safely performed or will not safely perform health-related activities, have not safely administered or will not safely administer oral prescribed medication, have not safely applied or will not safely apply topical prescribed medication, have not safely administered or will not safely administer oral prescribed medication via stable labeled gastrostomy tube or 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. Developmental disabilities personnel shall not engage in the action or actions subject to an employer's prohibition.

(2) When the employer prohibits the action from continuing or commencing, the employer shall:

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

(b) Immediately notify the department by making an entry regarding the prohibition of the developmental disabilities personnel in the medication administration information system database;

(c) If applicable, immediately notify the county board via the major unusual incident reporting system in accordance with rule 5123:2-17-02 of the Administrative Code; the county board, as applicable, shall notify the quality assessment registered nurse; and

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

(3) The employer shall ensure corrective action is taken prior to allowing the developmental disabilities personnel to resume the performance of health-related activities, administration of oral prescribed medication, application of topical prescribed medication, administration of oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administration of subcutaneous insulin injections.

(4) The employer shall notify the department by making an entry regarding the corrective action and end of prohibition of the developmental disabilities personnel in the medication administration information system database and, as applicable, the county board, the quality assessment registered nurse, and/or the delegating nurse of the corrective action taken.

(F) Procedures for suspending certification of developmental disabilities personnel without a hearing pending the outcome of an investigation

(1) The department may suspend the certification of developmental disabilities personnel issued in accordance with rule 5123:2-6-06 of the Administrative Code without a hearing pending the outcome of an investigation if the developmental disabilities personnel has not or will not safely perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer subcutaneous insulin injections.

(2) Immediately following the suspension of certification, the department shall notify the developmental disabilities personnel and the employer of the developmental disabilities personnel and, as applicable, the county board superintendent or designee, the quality assessment registered nurse, and the delegating nurse.

(3) When the department has suspended certification 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 withdraw the suspension and reinstate the suspended certification. Upon reinstatement, the department shall immediately notify the developmental disabilities personnel and all entities notified in accordance with paragraph (F)(2) of this rule of the reinstatement.

(G) Procedures for revoking certification of developmental disabilities personnel

(1) The department shall revoke the certification of developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, apply topical prescribed medication, administer oral prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administer insulin by subcutaneous injections if there is evidence after an investigation that developmental disabilities personnel:

(a) Have been convicted of or plead guilty to a disqualifying offense as set forth in paragraph (E) of rule 5123:2-2-02 of the Administrative Code and the corresponding exclusionary period has not elapsed;

(b) Are included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(e) of rule 5123:2-2-02 of the Administrative Code;

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

(d) Have failed to maintain continued certification requirements in accordance with rule 5123:2-6-06 of the Administrative Code; or

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

(2) Prior to revoking the certification of developmental disabilities personnel, the department shall notify the developmental disabilities personnel and the employer of the developmental disabilities personnel, in writing, of its intent to revoke the certification and specify a reason for such action. The department shall also provide notice, as applicable, to the county board superintendent or designee, the quality assessment registered nurse, and the delegating nurse.

(3) The developmental disabilities personnel may appeal the department's decision to revoke certification by requesting a hearing within seven calendar days of receiving the notification issued in accordance with paragraph (G)(2) of this rule.

(4) If the developmental disabilities personnel timely requests a hearing, the director shall appoint an independent hearing officer to conduct the hearing. The 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 developmental disabilities 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 noncompliance with this chapter by the developmental disabilities personnel. The hearing officer shall issue a written recommendation to the director within ten calendar days of the hearing.

(5) The director shall issue a written decision to the developmental disabilities personnel, the employer of the developmental disabilities personnel, and any entities notified in accordance with paragraph (G)(2) of this rule.

(H) Procedures for revoking certification of a registered nurse instructor or registered nurse trainer

(1) The department shall revoke the certification of a registered nurse instructor or the certification of a registered nurse trainer if there is evidence after an investigation that the registered nurse instructor or registered nurse trainer:

(a) Has been convicted of or plead guilty to a disqualifying offense as set forth in paragraph (E) of rule 5123:2-2-02 of the Administrative Code and the corresponding exclusionary period has not elapsed;

(b) Is included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(e) of rule 5123:2-2-02 of the Administrative Code;

(c) Has failed to maintain valid licensure in good standing with the Ohio board of nursing to practice as a registered nurse;

(d) Has failed to adhere to requirements of this chapter; or

(e) Has falsified documentation or records or falsified entries to the medication administration information system database required by this chapter.

(2) Except as otherwise provided by statute, all hearing and adjudication proceedings shall be conducted in accordance with the requirements set forth in Chapter 119. of the Revised Code.

(3) If the registered nurse instructor or registered nurse trainer timely requests a hearing, the director shall appoint an independent hearing officer to conduct the hearing.

(I) Procedures for accepting complaints and conducting investigations

(1) Any complaint regarding the performance of health-related activities or administration of prescribed medication by developmental disabilities 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 set forth in rule 5123:2-17-01 of the Administrative Code. This paragraph shall not be construed to allow developmental disabilities personnel, a representative of developmental disabilities 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.

(3) Any complaints regarding registered nurses related to training of developmental disabilities personnel shall be referred to the department.

(4) When a quality assessment registered nurse receives a complaint or identifies concerns based on a quality assurance review conducted pursuant to paragraph (D) of this rule related to the performance or qualifications of developmental disabilities personnel, the quality assessment registered nurse shall conduct an initial investigation which shall include a discussion with the developmental disabilities personnel and his or her employer. After completing the initial investigation, the quality assessment registered nurse shall contact and work with the department's designee to ensure 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 employer of developmental disabilities personnel to ensure immediate action is taken to correct the issue and assist the county board or the employer of developmental disabilities personnel in achieving compliance with this chapter.

(2) The department shall review alleged violations of this chapter by a county board. The department may make recommendations to assist the county board in achieving compliance.

(3) If a provider is found to be in violation of this chapter, the department may make recommendations to assist the provider in achieving compliance.

(4) The department shall review compliance within thirty calendar days of the corrective action. If the department determines that corrective action does not bring the county board or provider into substantial compliance with this chapter, the department may revoke a certification issued in accordance with rule 5123:2-6-06 of the Administrative Code, or take other actions as authorized by the Revised Code or Administrative Code.

(5) A county board or other providers of services may appeal the findings of the department within seven calendar days of receipt of notification by the department.

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

(b) The director shall review the appeal within fourteen calendar days of the receipt of the request. The purpose of the review shall be to determine if the findings were based upon noncompliance with this chapter by the county board and/or other providers of services including the employer of developmental disabilities personnel.

(c) Within seven calendar days of the date of review of the appeal by the director, the decision of the director shall be made in writing to the county board or other providers of service including the employer of developmental disabilities personnel. The decision of the director shall be based on his or her review of the evidence and shall be final.

(K) Immunity from liability Developmental disabilities personnel who perform health-related activities or administer prescribed medication 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 performing the health-related activity or administering the prescribed medication when:

(1) The developmental disabilities 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 developmental disabilities personnel did not act in a manner that constitutes wanton or reckless misconduct.

Effective: 6/1/2016
Five Year Review (FYR) Dates: 06/01/2021
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