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