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