Chapter 5123-6 | Performance of Health-Related Activities and Administration of Medication

Rule 5123-6-01 | Definitions of terms used in Chapter 5123-6 of the Administrative Code.

• Effective: January 14, 2024
• Promulgated Under: 119.03

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

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

(B) "Annually" means within a three hundred sixty-five-day span of time.

(C) "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.

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

(E) "Certified supported living provider" means a person or government entity certified pursuant to section 5123.161 of the Revised Code.

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

(G) "County board" means a county board of developmental disabilities.

(H) "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.

(I) "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 to perform or administer the functions set forth in paragraphs (KK)(1) to (KK)(8) of this rule.

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

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

(L) "Developmental disabilities personnel" means the 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;

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

(4) As an independent provider.

(M) "Director" means the director of the Ohio department of developmental disabilities or that person's designee.

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

(O) "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.

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

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

(1) Taking vital signs (i.e., temperature, pulse, respiration, and blood pressure);

(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 ostomy bags;

(8) Obtaining pulse oximetry reading;

(9) Use of continuous positive airway pressure machines, including biphasic positive airway pressure machines;

(10) Application of percussion vests;

(11) Use of cough assist devices and insufflators;

(12) Application of prescribed compression hosiery; and

(13) Collection of specimens by noninvasive means.

(R) "Independent provider" has the same meaning as in section 5123.16 of the Revised Code.

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

(T) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual and includes an "individual program plan" as that term is used in 42 C.F.R. 483.440 as in effect on the effective date of this rule.

(U) "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 addresses:

(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 service plan.

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

(W) "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.

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

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

(Z) "Medication/treatment error" means:

(1) Wrong prescribed 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 or in the case of over-the-counter medication, not as indicated by the manufacturer;

(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, other than over-the-counter medication authorized in accordance with section 5123.42 of the Revised Code, administered or performed without corresponding order from a licensed health professional authorized to prescribe drugs;

(9) Not performing or administering a prescribed medication/treatment during the prescribed time, including but not limited to, failure to ensure the medication/treatment, equipment, or supplies needed to administer or perform the medication/treatment are available at the prescribed time or declination of a prescribed medication/treatment by an individual;

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

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

(12) Administration of over-the-counter medication authorized in accordance with section 5123.42 of the Revised Code by developmental disabilities personnel without required training; and

(13) Administration or performance of medication/treatment without nursing delegation when nursing delegation is required.

(AA) "Mentally alert" means the ability of an individual to cognitively understand and communicate specific information pertaining to the individual's health, safety, and medication.

(BB) "Metabolic glycemic disorders" means medical conditions specifically related to metabolism of glucose such as diabetes, pre-diabetes, and metabolic syndrome.

(CC) "Metered dose inhaled medication" means a pre-measured medication administered by inhalation using a hand-held dispenser or aerosol nebulizer.

(DD) "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.

(EE) "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 without assistance.

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

(GG) "Over-the-counter medication" means a drug that may be sold and purchased without a prescription, but that unless specifically authorized in division (B)(1)(c) of section 5123.42 of the Revised Code, requires a prescription for administration by unlicensed personnel to a person who is not able to self-administer.

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

(II) "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.

(JJ) "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 5123-6-07 of the Administrative Code.

(KK) "Registered nurse instructor" means a registered nurse who is certified by the Ohio department of developmental disabilities in accordance with rule 5123-6-04 of the Administrative Code to plan, develop, coordinate, and deliver the registered nurse train-the-trainer program to prepare other registered nurses to train developmental disabilities personnel to:

(1) Perform health-related activities;

(2) Administer oral prescribed medication;

(3) Administer topical prescribed medication;

(4) Administer topical over-the-counter musculoskeletal medication;

(5) Administer oxygen and metered dose inhaled medication;

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

(7) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(8) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(LL) "Registered nurse trainer" means a registered nurse who is certified by the Ohio department of developmental disabilities in accordance with rule 5123-6-04 of the Administrative Code to train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (KK)(1) to (KK)(8) of this rule.

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

(NN) "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 5123-5-02 of the Administrative Code.

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

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

(QQ) "Topical over-the-counter musculoskeletal medication" means an over-the-counter medication that is applied topically or passes through the skin to provide relief from discomfort in the muscles, joints, or bones.

(RR) "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.

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

(TT) "Vagus nerve stimulator" has the same meaning as "vagal nerve stimulator" as that term is used in section 5123.42 of the Revised Code.

Last updated January 17, 2024 at 8:40 AM

Supplemental Information

Authorized By: 5123.04, 5123.42, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 1/14/2029
Prior Effective Dates: 9/30/1993 (Emer.), 12/29/1993, 11/6/2017

Rule 5123-6-02 | Self-administration or assistance with self-administration of prescribed medication.

• Effective: January 14, 2024
• Promulgated Under: 119.03

(A) Purpose

This rule sets forth the right of an individual who can safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication to do so, establishes procedures for determining whether an individual can safely self-administer or receive assistance with self-administration of prescribed medication, and defines parameters for providing assistance with self-administration of prescribed medication.

(B) Right to self-administer or receive assistance with self-administration of prescribed medication

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.

(C) Self-administration assessment

(1) Prior to restriction of an individual's right to self-administer prescribed medication, the service and support administrator or qualified intellectual disability professional, as applicable, will ensure that a department-approved self-administration assessment is completed for an individual who requires prescribed medication administration. Based on the outcome of the self-administration assessment, the individual service plan will 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, will ensure that the self-administration assessment is reviewed annually to confirm continued need for support for medication administration. A new self-administration assessment will 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.

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

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

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

(c) 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.

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

(a) Further assessment will be conducted to determine exactly what specific steps of self-administration of medication the individual is able to safely complete. The individual will 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.

(b) The details of the individual's specific abilities and the specific necessary support from licensed or certified personnel to complete medication administration will be noted in the individual service plan.

(D) Providing assistance with self-administration

(1) 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 5123-6-05 and 5123-6-06 of the Administrative Code.

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

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

(b) 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

(c) 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 physically assist 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.

(3) 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 service plan. When there is reason to question the individual's self-administration skills, a new self-administration assessment will be completed.

Last updated January 17, 2024 at 8:40 AM

Supplemental Information

Authorized By: 5123.04, 5123.42, 5123.46, 5123.65
Amplifies: 5123.04, 5123.41 to 5123.47, 5123.65, 5123.651, 5126.36
Five Year Review Date: 1/14/2029
Prior Effective Dates: 12/29/1993, 5/16/1994 (Emer.), 10/22/2003 (Emer.), 11/6/2017

Rule 5123-6-03 | Authorization of developmental disabilities personnel to perform health-related activities and administer prescribed medication.

• Effective: January 14, 2024
• Promulgated Under: 119.03

(A) Purpose

This rule sets forth conditions under which developmental disabilities personnel may perform health-related activities and administer prescribed medication.

(B) 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 in a setting where seventeen or more individuals are receiving the services;

(3) Are receiving adult services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code in a setting where sixteen or fewer individuals are receiving the services;

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

(5) 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;

(6) 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;

(7) Are receiving services not described in paragraphs (B)(1) to (B)(6) of this rule that are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(8) Reside in a residential facility with five or fewer beds; or

(9) Reside in a residential facility with six or more beds.

(C) Authorization of developmental disabilities personnel to activate a vagus nerve stimulator, use an epinephrine auto-injector, and administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces

In the case of individuals receiving services described in paragraphs (B)(1) to (B)(9) of this rule, developmental disabilities personnel, without nursing delegation and without certification issued in accordance with rule 5123-6-06 of the Administrative Code, may:

(1) Activate a vagus nerve stimulator if all provisions of paragraph (B) of rule 5123-6-05 of the Administrative Code are being followed;

(2) Use an epinephrine auto-injector for urgent or emergency treatment of allergic reaction and anaphylaxis if all provisions of paragraph (C) of rule 5123-6-05 of the Administrative Code are being followed; or

(3) Administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces provided that:

(a) The topical over-the-counter medication is not being applied to an open wound;

(b) The topical over-the-counter medication is not being applied for specific treatment of a condition that requires a medical diagnosis including fungal infections; and

(c) All provisions of rule 5123-6-05 of the Administrative Code and paragraph (D) of this rule are being followed.

(D) Authorization of developmental disabilities personnel to perform health-related activities and administer prescribed medication

(1) In the case of individuals receiving services described in paragraph (B)(1) of this rule, trained and certified developmental disabilities personnel may, with nursing delegation:

(a) Perform health-related activities;

(b) Administer oral prescribed medication, administer topical prescribed medication, and administer topical over-the-counter musculoskeletal medication;

(c) Administer oxygen and metered dose inhaled medication;

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

(e) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump.

(2) In the case of individuals receiving services described in paragraphs (B)(2), (B)(7), and (B)(9) of this rule, trained and certified developmental disabilities personnel may, with nursing delegation:

(a) Perform health-related activities;

(b) Administer oral prescribed medication, administer topical prescribed medication, and administer topical over-the-counter musculoskeletal medication;

(c) Administer oxygen and metered dose inhaled medication;

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

(e) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(f) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(3) In the case of individuals receiving services described in paragraphs (B)(3), (B)(4), (B)(5), (B)(6), and (B)(8) of this rule:

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

(i) Perform health-related activities;

(ii) Administer oral prescribed medication, administer topical prescribed medication, and administer topical over-the-counter musculoskeletal medication; and

(iii) Administer oxygen and metered dose inhaled medication.

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

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

(ii) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(iii) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(4) In the case of individuals living in a family home receiving services from an unlicensed in-home care worker providing the care through employment or other arrangement entered into directly with a family member of the individual and who is not otherwise employed by or under contract with a person or government entity to provide services to individuals with developmental disabilities, the family member living in the home may be able to delegate health care tasks according to the provisions of section 5123.47 of the Revised Code.

(E) Requirements that apply when developmental disabilities personnel activate a vagus nerve stimulator, use an epinephrine auto-injector, or administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces pursuant to section 5123.42 of the Revised Code

(1) Developmental disabilities personnel will successfully complete, initially and annually thereafter, a training course or courses as specified in rule 5123-6-05 of the Administrative Code.

(2) Developmental disabilities personnel may activate a vagus nerve stimulator, use an epinephrine auto-injector, or administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces only as authorized by the training courses completed and according to manufacturer's instructions and individual-specific indications.

(3) If an employer of developmental disabilities personnel or a county board believes the developmental disabilities personnel have not or will not safely activate a vagus nerve stimulator or use an epinephrine auto-injector, the employer or county board will prohibit the developmental disabilities personnel from continuing or commencing to do so and make appropriate arrangements for emergency interventions by another means for individuals who have a specified need for activation of a vagus nerve stimulator or use of an epinephrine auto-injector.

(4) If an employer of developmental disabilities personnel or a county board believes the developmental disabilities personnel have not or will not safely administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces, the employer or county board will prohibit the developmental disabilities personnel from continuing or commencing to do so.

(5) Developmental disabilities personnel will not engage in an action or actions subject to an employer's or county board's prohibition.

(F) 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; administer topical prescribed medication; administer topical over-the-counter musculoskeletal medication; administer oxygen and metered dose inhaled medication; administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes; administer prescribed insulin though subcutaneous injection, inhalation, and insulin pump; and administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection for individuals in the categories specified in paragraphs (B)(1) to (B)(9) of this rule and in accordance with paragraph (D) of this rule:

(a) Developmental disabilities personnel will obtain the certification or certifications required by the department and issued in accordance with rule 5123-6-06 of the Administrative Code;

(b) Developmental disabilities personnel will perform health-related activities and administer prescribed medication only as authorized by the certification or certifications held;

(c) Developmental disabilities personnel will not perform health-related activities or administer prescribed medication for any individual for whom they have not received individual-specific training; and

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

(2) Prior to delegating to developmental disabilities personnel under this rule and in accordance with all standards and conditions set forth in Chapter 4723-13 of the Administrative Code, the delegating nurse will:

(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 5123-6-06 of the Administrative Code; and

(ii) Comply with all standards and conditions set forth in Chapter 4723-13 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; administer topical prescribed medication; administer topical over-the-counter musculoskeletal medication; administer oxygen and metered dose inhaled medication; administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes; administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; or administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(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.

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

(4) The employer of developmental disabilities personnel, or the county board for independent providers, will ensure that developmental disabilities personnel have received individual-specific training for each individual for whom they perform health-related activities or administer prescribed medication. Developmental disabilities personnel will not perform health-related activities or administer prescribed medication for any individual for whom they have not been specifically trained.

(5) In situations in which nursing delegation is required, the delegating nurse will also ensure that developmental disabilities personnel have received individual-specific training provided by the delegating nurse or by another licensed nurse for each individual for whom the developmental disabilities personnel perform health-related activities or administer prescribed medication.

(6) 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, or have not safely administered or will not safely administer prescribed medication, the employer will:

(a) Prohibit the action from commencing or continuing;

(b) Immediately make other staffing arrangements so that performance of health-related activities or administration of prescribed medication 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 5123-17-02 of the Administrative Code; if applicable, the county board will notify the quality assessment registered nurse; and

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

(e) Enter a notation in the certification record of the developmental disabilities personnel in the medication administration information system database described in rule 5123-6-07 of the Administrative Code.

(7) If the delegating nurse believes that developmental disabilities personnel have not safely performed or will not safely perform health-related activities, or have not safely administered or will not safely administer prescribed medication, the delegating nurse will:

(a) Prohibit the action from commencing or continuing;

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

(c) If applicable, immediately notify the county board via the major unusual incident reporting system pursuant to rule 5123-17-02 of the Administrative Code; if applicable, the county board will notify the quality assessment registered nurse; and

(d) Enter a notation in the certification record of the developmental disabilities personnel in the medication administration information system database described in rule 5123-6-07 of the Administrative Code.

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

(9) A registered nurse will 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 will 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.

Last updated January 17, 2024 at 8:41 AM

Supplemental Information

Authorized By: 5123.04, 5123.42, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47, 5126.36
Five Year Review Date: 1/14/2029
Prior Effective Dates: 8/6/1994, 6/30/1995

Rule 5123-6-04 | Qualifications, training, and certification of registered nurse instructors and registered nurse trainers.

• Effective: January 14, 2024
• Promulgated Under: 119.03

(A) Purpose

This rule establishes requirements for registered nurse instructors and registered nurse trainers as well as the curriculum for the registered nurse train-the-trainer program.

(B) 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:

(a) Perform health-related activities;

(b) Administer oral prescribed medication;

(c) Administer topical prescribed medication;

(d) Administer topical over-the-counter musculoskeletal medication;

(e) Administer oxygen and metered dose inhaled medication;

(f) Administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes;

(g) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(h) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

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

(a) Current valid licensure as a registered nurse in good standing to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code.

(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 will 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 will make entries in the medication administration information system database described in rule 5123-6-07 of the Administrative Code in accordance with procedures established by the department for renewal of registered nurse instructor certification.

(C) 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 or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

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

(a) Current valid licensure as a registered nurse in good standing to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code.

(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) Computer and internet access and computer literacy sufficient for entering data in the medication administration information system database described in rule 5123-6-07 of the Administrative Code; receiving and sending electronic mail; and creating, saving, and sending electronic file attachments.

(e) 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;

(iv) Successfully complete the post-program requirements to demonstrate core knowledge and preparedness for teaching; and

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

(3) The department will 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 will, 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 will 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) The department may conduct an audit of proof of completion of continuing education to ensure compliance with paragraph (C)(4) of this rule. When a registered nurse fails to meet or cannot show proof of meeting the requirements set forth in paragraph (C)(4) of this rule, the registered nurse will be required to repeat the registered nurse train-the-trainer program in its entirety. Until such time that the registered nurse successfully repeats the registered nurse train-the-trainer program in its entirety, the registered nurse will not plan, develop, or coordinate the program of instruction for developmental disabilities personnel to perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

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

(1) The registered nurse train-the-trainer program will be at a minimum eight hours; one hour equals sixty minutes of classroom instruction. The registered nurse train-the-trainer program will 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 or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(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) The scope of authority granted to developmental disabilities personnel by certification and the responsibilities of developmental disabilities personnel to acquire and maintain certification as required for medication administration;

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

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

(iv) 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 or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(h) Responsibility and accountability pursuant to rule 5123-6-07 of the Administrative Code related to the use of the medication administration information system database and prohibition of actions by developmental disabilities personnel who the registered nurse or employer believes have not or will not safely perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(i) Responsibility and accountability pursuant to Chapter 4723-4 of the Administrative Code relating to standards of competent nursing practice including but not limited to, demonstration of competence and accountability in all areas of practice in which the nurse is engaged.

(j) General principles of adult basic education.

(k) 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.

(l) Information and instruction regarding the medication administration information system database described in rule 5123-6-07 of the Administrative Code, including required entry of data regarding developmental disabilities personnel trained.

(m) Instruction that only a department-approved curriculum will be used to train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(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.

Last updated January 17, 2024 at 8:41 AM

Supplemental Information

Authorized By: 5123.04, 5123.44, 5123.45, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 1/14/2029
Prior Effective Dates: 8/6/1994, 11/6/2017

Rule 5123-6-05 | Qualifications and training of developmental disabilities personnel to activate a vagus nerve stimulator; use an epinephrine auto-injector; and administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

• Effective: January 14, 2024
• Promulgated Under: 119.03

(A) Purpose

This rule establishes requirements for developmental disabilities personnel to activate a vagus nerve stimulator; use an epinephrine auto-injector; and administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(B) Qualifications for developmental disabilities personnel to activate a vagus nerve stimulator

(1) Developmental disabilities personnel will complete training prior to activating a vagus nerve stimulator and at least annually thereafter that includes:

(a) All content in the department-approved curriculum for activation of a vagus nerve stimulator including:

(i) Signs and symptoms of seizure;

(ii) Seizure first aid;

(iii) Correct care and use of the stimulator magnet;

(iv) Ensuring availability of the stimulator magnet at all times;

(v) Reporting potential side effects and seizure-related problems to a healthcare professional; and

(vi) Documentation of seizure activity and stimulator magnet use.

(b) Demonstration by the developmental disabilities personnel of the skills and information on the department-approved skills checklist for activation of a vagus nerve stimulator.

(c) Individual-specific training about any individuals for whom the developmental disabilities personnel are going to activate a vagus nerve stimulator, including individual-specific indications for use of the stimulator magnet, seizure first aid, and at a minimum the information on the individual-specific training guidelines for individuals with an implanted vagus nerve stimulator.

(2) To be eligible to receive training to activate a vagus nerve stimulator, developmental disabilities personnel must 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.

(3) Only a licensed nurse or developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of the Administrative Code may provide the training for activation of a vagus nerve stimulator and only according to the department-approved curriculum.

(C) Qualifications for developmental disabilities personnel to use an epinephrine auto-injector for urgent or emergency treatment of allergic reaction and anaphylaxis

(1) Developmental disabilities personnel will complete training prior to using an epinephrine auto-injector for urgent or emergency treatment of allergic reaction and anaphylaxis and at least annually thereafter that includes:

(a) All content in the department-approved curriculum for use of an epinephrine auto-injector including:

(i) Signs and symptoms of allergic reaction;

(ii) Correct care and use of the epinephrine auto-injector;

(iii) Ensuring availability of the epinephrine auto-injector at all times;

(iv) Medical follow-up after use of an epinephrine auto-injector; and

(v) Documentation of major unusual incidents and unusual incidents involving use of an epinephrine auto-injector in accordance with rule 5123-17-02 of the Administrative Code.

(b) Demonstration by the developmental disabilities personnel of the skills and information on the department-approved skills checklist for use of an epinephrine auto-injector.

(c) Individual-specific training about any individuals for whom the developmental disabilities personnel are going to use an epinephrine auto-injector, including individual-specific indications for known allergens and symptoms associated with personal history of allergic reactions and at a minimum the information on the individual-specific training guidelines for individuals who have been prescribed an epinephrine auto-injector.

(2) To be eligible to receive training to use an epinephrine auto-injector, developmental disabilities personnel must 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.

(3) Only a licensed nurse or developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of the Administrative Code may provide the training for use of an epinephrine auto-injector and only according to the department-approved curriculum.

(4) Developmental disabilities personnel who have documentation of having received training in the use of an epinephrine auto-injector as part of another recognized certification training (such as "American Red Cross" first aid) may use an epinephrine auto-injector according to that certification while that certification is in effect without the training specified in paragraph (C)(1) of this rule.

(D) Qualifications for developmental disabilities personnel to administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces

(1) Developmental disabilities personnel will complete training prior to administering topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces and at least annually thereafter that includes:

(a) All content in the department-approved curriculum for administration of topical over-the-counter medication including:

(i) That topical over-the-counter medication is not to be applied to an open wound;

(ii) That topical over-the-counter medication is not to be applied for specific treatment of a condition that requires a medical diagnosis including but not limited to, fungal infection;

(iii) That an individual's known allergies must be confirmed as not present in the topical over-the-counter medication each time before the topical over-the-counter medication is administered;

(iv) That the manufacturer's label directions for amount and frequency must be followed unless a prescription to administer at an alternate amount or frequency has been provided by a licensed health professional authorized to prescribe drugs;

(v) That over-the-counter medication for oral consumption requires a prescription from a licensed health professional authorized to prescribe drugs and will only be administered by developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of Administrative Code and section 5123.42 of the Revised Code;

(vi) That topical over-the-counter medication for any purpose other than cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces may be applied only by developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of Administrative Code and section 5123.42 of the Revised Code; and

(vii) Appropriate documentation of the use of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(b) Demonstration by the developmental disabilities personnel of the skills and information on the department-approved skills checklist for administration of topical over-the-counter medication.

(c) Individual-specific training about any individuals for whom the developmental disabilities personnel are going to administer topical over-the-counter medication including individual-specific allergies and history of the use of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces and at a minimum the information on the individual-specific training guidelines for individuals for whom developmental disabilities personnel will be administering topical over-the-counter medication without a prescription.

(2) To be eligible to receive training to administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces, developmental disabilities personnel must 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.

(3) Only a licensed nurse or developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of the Administrative Code may provide the training for administration of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

Last updated January 17, 2024 at 8:42 AM

Supplemental Information

Authorized By: 5123.04, 5123.43, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 1/14/2029
Prior Effective Dates: 11/6/2017

Rule 5123-6-06 | Qualifications, training, and certification of developmental disabilities personnel who perform health-related activities and administer prescribed medication.

• Effective: January 14, 2024
• Promulgated Under: 119.03

(A) Purpose

This rule sets forth eligibility and requirements for three types of training programs and resulting certification held by developmental disabilities personnel:

(1) Health-related activities and prescribed medication administration;

(2) Prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation; and

(3) Administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

(B) Eligibility to take a training program required to perform health-related activities and administer prescribed medication

(1) To be eligible to take a training program described in paragraph (C) of this rule, developmental disabilities personnel will:

(a) Be at least eighteen years of age;

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

(c) 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.

(2) Prior to permitting developmental disabilities personnel to enroll in a training program described in paragraph (C) of this rule, the registered nurse trainer will, as applicable:

(a) Secure an attestation from the employer of developmental disabilities personnel that the developmental disabilities personnel has been subject to a completed background check conducted in accordance with rule 5123-2-02 of the Administrative Code with results received; or

(b) Verify that the developmental disabilities personnel holds independent provider certification issued by the department.

(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, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, and administer oxygen and metered dose inhaled medication, will 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)(c) of this rule only with additional corresponding classroom instruction time beyond the fourteen-hour course.

(b) The department may authorize a registered nurse trainer to provide a portion of the health-related activities and prescribed medication administration training program by audio-visual distance learning. The department's authorization will be based upon review and approval of a training program syllabus and supporting documentation submitted by the registered nurse trainer that demonstrate the audio-visual distance learning meets the following requirements:

(i) The registered nurse trainer will develop a syllabus that:

(a) Outlines specific content and number of hours of the training program to be conducted by audio-visual distance learning and by in-person classroom instruction;

(b) Describes methods for providing students with training manuals and materials;

(c) Reflects incorporation of evidence-based principles of adult learning in the instructional design;

(d) Includes interactive learning activities to achieve student engagement with the registered nurse trainer and other students;

(e) Describes methods to be used by the registered nurse trainer to verify student comprehension of information and skills;

(f) Sets forth that a student will complete the return demonstration of proficiency, including transcription, described in paragraph (E)(1)(c) of this rule, the written examination described in paragraph (E)(1)(d) of this rule, and the evaluation of the training program described in paragraph (E)(1)(e) of this rule during the in-person classroom instruction portion of the training program; and

(g) Provides sufficient detail to demonstrate how the requirements set forth in paragraphs (C)(1)(b)(ii) and (C)(1)(b)(iii) of this rule will be met.

(ii) Audio-visual distance learning will be conducted using conferencing software that provides for:

(a) Two-way audio and video interactive capability by all participants;

(b) All participants to see one another including each participant's face and upper body from the desktop and above;

(c) The registered nurse trainer to share and present materials on screen;

(d) A private chat feature that enables a student to chat with the registered nurse trainer and ask questions if muted;

(e) Authenticated log-on by participants;

(f) An enabled waiting room so that the registered nurse trainer controls admission of students;

(g) The registered nurse trainer to track a student's attendance and presence in the meeting room;

(h) Prevention of anyone other than the registered nurse trainer from recording the training program; and

(i) The registered nurse trainer to control and disable a student's audio and video capability and remove a student when necessary.

(iii) The registered nurse trainer is responsible for ensuring:

(a) A student's video monitor is large enough to allow clear visualization of the registered nurse trainer, the presented materials, and demonstrations. Neither a student nor the registered nurse trainer is permitted to participate in the audio-visual distance learning via a hand-held cellular telephone.

(b) The class size is such that the registered nurse trainer clearly visualizes each student on the registered nurse trainer's video monitor.

(c) A student experiencing technical difficulties with the audio-visual conferencing software is not considered in attendance for that portion of the training program.

(c) The health-related activities and prescribed medication administration training program will address:

(i) A review of an individual's right to self-administer medication, self-administer medication with assistance, and participate in steps of medication administration when not able to self-administer medication or self-administer medication with assistance.

(ii) Concepts of person-centered planning relevant to an individual's consent or declination of prescribed medication.

(iii) 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.

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

(v) Information and instruction on the concepts underlying each step for correctly administering oral prescribed medication, administering topical prescribed medication, administering topical over-the-counter musculoskeletal medication, and administering oxygen and metered dose inhaled medication according to current standards of safe practice, procedures, and techniques.

(vi) Information and instruction 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 and with the right documentation.

(vii) Written step-by-step directions on how to administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, and administer oxygen and metered dose inhaled medication.

(viii) Instruction in safe storage and transport of oxygen.

(ix) Instruction in taking vital signs (i.e., temperature, pulse, respiration, and blood pressure).

(x) Instruction in application of clean dressings that do not require health assessment.

(xi) Instruction in basic measurement of bodily intake and output.

(xii) Instruction in oral suctioning.

(xiii) Instruction in use of glucometers.

(xiv) Instruction in external urinary catheter care.

(xv) Instruction in emptying and replacing ostomy bags.

(xvi) Instruction in application of prescribed compression hosiery.

(xvii) Instruction in collection of specimens by noninvasive means.

(xviii) Instruction in the use of pulse oximetry to accurately record an individual's oxygen saturation as prescribed by a licensed health professional authorized to prescribe drugs.

(xix) Instruction in the use of continuous positive airway pressure machines, including biphasic positive airway pressure machines, for the intermittent delivery of continuous positive airway pressure to treat obstructive sleep apnea or sleep-related hypoventilation as prescribed by a licensed health professional authorized to prescribe drugs.

(xx) Instruction in the application of percussion vests to promote airway secretion clearance as prescribed by a licensed health professional authorized to prescribe drugs.

(xxi) Instruction in the use of cough assist devices and insufflators to promote the removal of airway secretions in those with respiratory muscle weakness as prescribed by a licensed health professional authorized to prescribe drugs.

(xxii) Instruction in the use of metered dose inhaled medication administered by a hand-held dispenser and the use of an aerosol nebulizer to administer a pre-measured medication for the treatment of asthma or other respiratory condition as prescribed by a licensed health professional authorized to prescribe drugs.

(xxiii) Information and instruction in responsibility of developmental disabilities personnel for following the step-by-step procedures for administration of all medication and performance of health-related activities and completing additional training before attempting any action for which the developmental disabilities personnel is not competent.

(xxiv) Information and instruction in responsibility of developmental disabilities personnel for knowing the purpose of medication and health-related activities being performed or administered and facilitating the reporting of problems, including lack of effectiveness and potential side effects, to a healthcare professional.

(xxv) 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, administering topical prescribed medication, administering topical over-the-counter musculoskeletal medication, and administering oxygen and metered dose inhaled medication.

(xxvi) Procedures to be followed in case of medication emergency including when, why, and how to contact the employer of developmental disabilities personnel or designee, a healthcare professional, or the supervising licensed nurse when medication is administered or a nursing task is performed pursuant to nursing delegation.

(xxvii) Information about what developmental disabilities personnel may be authorized to perform with respect to administering oral prescribed medication, administering topical prescribed medication, administering topical over-the-counter musculoskeletal medication, or administering oxygen and metered dose inhaled medication.

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

(xxix) Limitations with respect to over-the-counter medication which include the need for a prescription from a licensed health professional authorized to prescribe drugs to administer all over-the-counter medication not authorized for administration by developmental disabilities personnel pursuant to section 5123.42 of the Revised Code.

(xxx) The requirement for specialized training pursuant to this rule for the administration of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(xxxi) Instruction in the use of topical over-the-counter musculoskeletal medication.

(xxxii) 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 a subcutaneous injection of insulin or prescribed medication for the treatment of metabolic glycemic disorders, provided the developmental disabilities personnel are trained and hold administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation certification in accordance with this rule and the subcutaneous injection of insulin or prescribed medication for the treatment of metabolic glycemic disorders 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 an unstable or unlabeled jejunostomy tube; and

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

(xxxiii) 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.

(xxxiv) 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.

(xxxv) 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).

(xxxvi) The requirements for documentation of prescribed medication administered, missed, held, or declined to, by, or for each individual.

(xxxvii) The definition of a medication/treatment error and requirements for documentation and notification of unusual incidents and major unusual incidents related to medication/treatment errors.

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

(xxxix) 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.

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

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

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

(xliii) 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;

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

(d) Receiving adult day services in a setting where services are provided to sixteen or fewer individuals.

(xliv) 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.

(xlv) Instruction in the usual parameters of health-related activities and instruction in the course of action to be taken when parameters of health-related activities are above or below those taught.

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

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

(2) Prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program

(a) A prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program provided pursuant to this rule to prepare developmental disabilities personnel to administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes will be at a minimum a four-hour course and will 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 will 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 prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program.

(b) The prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program will address:

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

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

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

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

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

(vi) Requirements for nursing delegation of prescribed medication administration through stable labeled gastrostomy and jejunostomy tubes.

(vii) Instruction that only the delegating nurse or a licensed nurse in coordination/communication with the delegating nurse will receive prescriptions for prescribed medication to be administered through stable labeled gastrostomy or jejunostomy tube and only the delegating nurse or a licensed nurse in coordination/communication with the delegating nurse will transcribe these prescriptions on to a medication administration record or treatment administration record.

(viii) Performance of successful return demonstration of proficiency in administering prescribed medication through stable labeled gastrostomy and jejunostomy tubes.

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

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

(3) Administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program

(a) An administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program provided pursuant to this rule to prepare developmental disabilities personnel to administer insulin through subcutaneous injection, inhalation, and insulin pump and administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection by nursing delegation will be a minimum a four-hour course and will 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 will 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 administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program.

(b) The administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program will address:

(i) Information on the basic pathophysiology of metabolic glycemic disorders.

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

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

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

(v) Information regarding the proper storage, care, and preparation of insulin or prescribed medication for treatment of metabolic glycemic disorders to be administered by subcutaneous 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 the delegating nurse or a licensed nurse in coordination/communication with the delegating nurse will transcribe a prescription for insulin or prescribed medication for treatment of metabolic glycemic disorders on to a medication administration record.

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

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

(xi) Requirements for nursing delegation of administration of insulin through subcutaneous injection, inhalation, and insulin pump and administration of prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(xii) Requirements for individual-specific training which will occur after certification and prior to administration of insulin through subcutaneous injection, inhalation, and insulin pump and administration of prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection. The delegating nurse is responsible for the individual-specific training.

(D) Requirements for training programs

(1) The health-related activities and prescribed medication administration training program, the prescribed medication administration through gastrostomy or jejunostomy tube by nursing delegation training program, and the administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program will be planned, developed, and delivered by a registered nurse trainer certified by the department in accordance with rule 5123-6-04 of the Administrative Code. The registered nurse trainer will ensure that training programs are conducted in accordance with requirements set forth in this chapter.

(2) A registered nurse trainer will use only a department-approved curriculum for the health-related activities and prescribed medication administration training program, the prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program, or the administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program.

(3) A registered nurse trainer will 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, prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, or administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation, developmental disabilities personnel will:

(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 will 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 will 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 prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation or certification in administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

(3) The registered nurse trainer will 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, prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, or administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation, developmental disabilities personnel will 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 will 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 will 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 prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, developmental disabilities personnel will annually complete at least one hour of continuing education that relates to the information taught in the prescribed medication administration through gastrostomy and jejunostomy 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 administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation certification.

(c) To maintain certification in administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation, the developmental disabilities personnel will annually complete at least one hour of continuing education that relates to the information taught in the administration of insulin and medication for the treatment of metabolic glycemic disorders 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 prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation certification.

(2) Training in cardiopulmonary resuscitation, first aid, activation of a vagus nerve stimulator, use of an epinephrine auto-injector, administration of topical over-the-counter medication, or universal precautions for infection control will 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 prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation and certification in administration of insulin and medication for the treatment of metabolic glycemic disorders 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 will be temporarily inactive for a maximum period of sixty calendar days, during which time the developmental disabilities personnel will complete the required continuing education and return demonstration of skills. 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 will be required to repeat each training program in its entirety to become recertified.

(5) While the certification of developmental disabilities personnel is temporarily inactive in accordance with paragraph (F)(4) of this rule, the developmental disabilities personnel will not:

(a) Perform health-related activities;

(b) Administer oral prescribed medication;

(c) Administer topical prescribed medication;

(d) Administer topical over-the-counter musculoskeletal medication;

(e) Administer oxygen or metered dose inhaled medication;

(f) Administer prescribed medication through gastrostomy or jejunostomy tubes;

(g) Receive nursing delegation to administer prescribed medication through gastrostomy or jejunostomy tubes;

(h) Administer prescribed insulin through subcutaneous injection, inhalation, or insulin pump;

(i) Receive nursing delegation to administer prescribed insulin through subcutaneous injection, inhalation, or insulin pump;

(j) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection; or

(k) Receive nursing delegation to administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(6) The registered nurse trainer will 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 will not be contrary to the rights, health, or safety of individuals served. The decision to grant or deny a rule waiver is not subject to appeal.

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

Last updated January 17, 2024 at 8:42 AM

Supplemental Information

Authorized By: 5123.04, 5123.42, 5123.43, 5123.45, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 1/14/2029
Prior Effective Dates: 8/6/1994, 6/30/1995, 10/22/2003 (Emer.)

Rule 5123-6-07 | General provisions and compliance for performance of health-related activities and administration of prescribed medication.

• Effective: January 14, 2024
• Promulgated Under: 119.03

(A) Purpose

This rule sets forth requirements for the medication administration information system database, documentation of performance of health-related activities and administration of medication, compliance and quality assessment, and actions that may be taken by the department regarding certification issued pursuant to Chapter 5123-6 of the Administrative Code.

(B) Medication administration information system database

(1) The department will 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 5123-6-04 of the Administrative Code and developmental disabilities personnel holding valid certification issued in accordance with rule 5123-6-06 of the Administrative Code in health-related activities and prescribed medication administration, prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, and administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

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

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

(4) Registered nurse trainers will enter in the medication administration information system database:

(a) Information about themselves at the time of their recertification and thereafter, within sixty calendar days of any change of information.

(b) Information required for renewal of their registered nurse trainer certification prior to expiration of the certification.

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

(C) 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 will be administered according to the written directions of a licensed health professional authorized to prescribe drugs and according to the training received by developmental disabilities personnel in accordance with rule 5123-6-06 of the Administrative Code.

(2) Performance of health-related activities and administration of prescribed medication and treatments will 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, missed, held, or declined, including:

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

(b) Health-related activities; and

(c) Administration of insulin and subcutaneous injections of prescribed medication for the treatment of metabolic glycemic disorders.

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

(5) Certified developmental disabilities personnel transcribing any information in a medication/treatment administration record or checking the accuracy of information transcribed in the medication/treatment administration record will 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 information in a medication/treatment administration record or check the accuracy of information transcribed in the medication/treatment administration record.

(b) Checking the accuracy of transcriptions will 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 will ensure the medication/treatment administration record has been checked.

(7) Employers of developmental disabilities personnel and independent providers will 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.

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

(1) Any medication/treatment error in the performance of health-related activities or administration of medication that results in physical harm to the individual will 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 will be reported in accordance with rule 5123-17-02 of the Administrative Code when the medication/treatment error meets the definition of major unusual incident or unusual incident.

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

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

(E) Compliance and quality assessment

(1) Each county board will 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 will be conducted when certified developmental disabilities personnel perform health-related activities, administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, administer oxygen, or administer metered dose inhaled 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;

(c) Receive adult services in a setting where sixteen or fewer individuals receive services; and

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

(3) The quality assessment registered nurse will complete quality assessment reviews so that a review of each provider location in the county where certified developmental disabilities personnel perform health-related activities, administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, administer oxygen, or administer metered dose inhaled 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 will be completed in a format prescribed by the department.

(5) Quality assessment reviews will 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 provider location being assessed to ensure complete and accurate administration of health care directives given by health care professionals for the individuals being served at the provider location;

(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 5123-6-06 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 administration of topical prescribed medication.

(6) The quality assessment registered nurse will evaluate for patterns of failure to comply or maintain compliance with this chapter.

(7) The quality assessment registered nurse will 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. The quality assessment review report will identify findings specific to provisions of this chapter and may recommend to the county board and the provider of services steps to be taken to improve the systems and procedures used by the provider to support the functioning of the trained developmental disabilities personnel and suggestions for improving quality related to performance of health-related activities and administration of prescribed medication and maintaining compliance with this chapter.

(8) The quality assessment registered nurse will maintain a copy of each quality assessment review performed in accordance with paragraph (E)(3) of this rule.

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

(10) The employer of developmental disabilities personnel or the independent provider, as applicable, will 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.

(11) The quality assessment registered nurse will 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.

(12) The quality assessment registered nurse will serve 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.

(F) 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 or will not safely perform health-related activities or administer prescribed medication, the employer will prohibit the action from continuing or commencing. Developmental disabilities personnel will 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 will:

(a) Notify the developmental disabilities personnel of the prohibition and immediately make other staffing arrangements so that the needs of individuals served are met in a manner that ensures compliance with the requirements of this chapter;

(b) Immediately notify the department by making a notation 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 5123-17-02 of the Administrative Code; the county board, as applicable, will notify the quality assessment registered nurse; and

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

(3) The employer will ensure corrective action is taken prior to allowing the developmental disabilities personnel to resume the performance of health-related activities or the administration of prescribed medication.

(4) The employer will 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.

(G) Denial, suspension, or revocation of certification issued pursuant to this chapter

(1) The department may deny, suspend, or revoke a certificate holder's certification issued pursuant to this chapter for good cause including:

(a) Misfeasance;

(b) Malfeasance;

(c) Nonfeasance;

(d) Substantiated abuse or neglect;

(e) A violation of sections 5123.41 to 5123.45 of the Revised Code or rules adopted pursuant to this chapter;

(f) The conviction or plea of guilty to a disqualifying offense as set forth in paragraph (E) of rule 5123-2-02 of the Administrative Code and the corresponding exclusionary period has not elapsed;

(g) Other conduct the department determines to be injurious to individuals being served; or

(h) The board of nursing has taken disciplinary action against a certificate holder pursuant to Chapter 4723. of the Revised Code.

(2) When denying, suspending, or revoking certification pursuant to this rule, the department will comply with the notice and hearing requirements of Chapter 119. of the Revised Code and section 5123.452 of the Revised Code.

(H) 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 pursuant to section 5123.42 of the Revised Code or compliance with rules adopted pursuant to this chapter will be made to a county board or the department. This paragraph will 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 a county board or the department regarding a personnel action.

(2) Any complaints related to the scope of nursing practice will be referred to the Ohio board of nursing.

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

(4) The department may conduct an audit of a registered nurse's training of developmental disabilities personnel to determine compliance with rule 5123-6-06 of the Administrative Code.

(5) When a quality assessment registered nurse receives a complaint or identifies concerns based on a quality assessment review conducted pursuant to paragraph (E) of this rule related to the performance or qualifications of developmental disabilities personnel, the quality assessment registered nurse will conduct an initial investigation which includes a discussion with the developmental disabilities personnel and the employer. After completing the initial investigation, the quality assessment registered nurse will contact and work with the department's designee to ensure that the cases are handled in a consistent manner statewide.

(I) Immunity from liability

Developmental disabilities personnel who perform health-related activities or administer medication pursuant to the authority granted pursuant to section 5123.42 of the Revised Code and rule 5123-6-03 of the Administrative Code are not liable for any injury caused by performing the health-related activity or administering the 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 5123-6-05 and 5123-6-06 of the Administrative Code; and

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

Last updated January 17, 2024 at 8:42 AM

Supplemental Information

Authorized By: 5123.04, 5123.45, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47, 5126.36
Five Year Review Date: 1/14/2029
Prior Effective Dates: 8/6/1994, 2/14/2000, 11/19/2020