Chapter 5123:2-6 | Performance of Health-Related Activities and Administration of Medication

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

• Effective: November 6, 2017
• Promulgated Under: 119.03

The following definitions shall apply to this chapter:

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

(B) "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 under section 5123.045 of the Revised Code.

(E) "Certified supported living provider" means a person or government entity certified under 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.

(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 his or her 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;

(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) Pulse oximetry reading;

(9) Use of continuous positive airway pressure machines, including biphasic positive airway 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 plan" or "individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(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 shall address:

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

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

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

(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 5123:2-17-02 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 failure to ensure the medication/treatment, equipment, or supplies needed to administer or perform the medication/treatment are available at the prescribed time;

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

(11) Administration 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 his or her health, safety, and medication.

(BB) "Metabolic glycemic disorders" means medical conditions specifically related to metabolism 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 for himself or herself.

(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 5123:2-6-07 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 5123:2-6-04 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 5123:2-6-04 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 5123:2-5-02 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 his or her 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 5123:2-17-02 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.

Supplemental Information

Authorized By: 5123.04, 5123.42, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 5/5/2023
Prior Effective Dates: 2/14/2000, 10/22/2003 (Emer.), 6/1/2016

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

• Effective: November 6, 2017
• Promulgated Under: 119.03

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

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

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

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

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

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

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

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

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

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

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

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

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

(3) Assist, on request by or with the consent of, a physically impaired but mentally alert individual, with removal of oral prescribed medication or topical prescribed medication from the container and 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.

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

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: 5/5/2023
Prior Effective Dates: 2/14/2000, 10/22/2003 (Emer.)

Rule 5123:2-6-03 | Authorization of developmental disabilities personnel to perform health-related activities and administer prescribed medication.

• Effective: November 6, 2017
• Promulgated Under: 119.03

(A) Individuals for whom developmental disabilities personnel may perform health-related activities and administer prescribed medication

Developmental disabilities personnel who are not specifically authorized by other provisions of the Revised Code to perform health-related activities or administer prescribed medication may do so pursuant to section 5123.42 of the Revised Code and rules adopted by the department under this chapter as part of the specialized services the developmental disabilities personnel provide to individuals who:

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

(2) Are receiving adult services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code 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 (A)(1) to (A)(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.

(B) 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 (A)(1) to (A)(9) of this rule, developmental disabilities personnel, without nursing delegation and without certification issued in accordance with rule 5123:2-6-06 of the Administrative Code, may:

(1) Activate a vagus nerve stimulator or use an epinephrine auto-injector for urgent or emergency treatment of allergic reaction and anaphylaxis if all provisions of paragraphs (A) and (B) of rule 5123:2-6-05 of the Administrative Code are being followed;

(2) 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 5123:2-6-05 of the Administrative Code and paragraph (C) of this rule are being followed.

(C) 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 (A)(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 (A)(2), (A)(7), and (A)(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 (A)(3), (A)(4), (A)(5), (A)(6), and (A)(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 an 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.

(D) 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 shall successfully complete, initially and annually thereafter, a training course or courses as specified in rule 5123:2-6-05 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 shall 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 shall prohibit the developmental disabilities personnel from continuing or commencing to do so.

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

(E) 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 (A)(1) to (A)(9) of this rule and in accordance with paragraph (C) of this rule:

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

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

(c) Developmental disabilities personnel shall 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 (C) of this rule, developmental disabilities personnel shall 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 shall:

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

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

(i) Are certified pursuant to rule 5123:2-6-06 of the Administrative Code; 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 5123:2-6-06 of the Administrative Code, the delegating nurse shall train and verify the skills of developmental disabilities personnel in accordance with Chapter 4723-13 of the Administrative Code.

(4) The employer of developmental disabilities personnel or the county board for independent providers shall 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 shall 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 shall 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 shall:

(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 5123:2-17-02 of the Administrative Code; if applicable, the county board shall notify the quality assessment registered nurse; and

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

(e) Enter a notation in the certification record of the developmental disabilities personnel in the medication administration information system database described in rule 5123:2-6-07 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 shall:

(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 5123:2-17-02 of the Administrative Code; if applicable, the county board shall 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 5123:2-6-07 of the Administrative Code.

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

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

(a) Nursing delegation continues to be necessary;

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

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

Supplemental Information

Authorized By: 5123.46, 5123.42, 5123.04
Amplifies: 5123.04, 5126.36, 5123.41 to 5123.47
Five Year Review Date: 5/5/2023
Prior Effective Dates: 12/29/1993, 2/14/2000, 1/8/2004

Rule 5123:2-6-04 | Qualifications, training, and certification of registered nurse instructors and registered nurse trainers.

• Effective: November 6, 2017
• Promulgated Under: 119.03

(A) Requirements for registered nurse instructors

(1) Only a registered nurse certified by the department as a registered nurse instructor may plan, develop, coordinate, and deliver the registered nurse train-the-trainer program that prepares registered nurses to train developmental disabilities personnel to:

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

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

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

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

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

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

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

(4) Registered nurse instructors shall make entries in the medication administration information system database described in rule 5123:2-6-07 of the Administrative Code in accordance with procedures established by the department for renewal of registered nurse instructor certification.

(B) Requirements for registered nurse trainers

(1) Only a registered nurse certified by the department as a registered nurse trainer may plan, develop, coordinate, and train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (A)(1)(a) to (A)(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 in good standing with the Ohio board of nursing to practice as a registered nurse.

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

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

(d) Computer and internet access and computer literacy sufficient for entering data in the medication administration information system database described in rule 5123:2-6-07 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 evaluation to the registered nurse instructor.

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

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

(5) When a registered nurse fails to meet or cannot show proof of meeting the requirements set forth in paragraph (B)(4) of this rule, he or she shall be required to repeat the registered nurse train-the-trainer program in its entirety. Until such time that the registered nurse successfully repeats the registered nurse train-the-trainer program in its entirety, he or she shall not plan, develop, or coordinate the program of instruction for developmental disabilities personnel to perform or administer the functions set forth in paragraphs (A)(1)(a) to (A)(1)(h) of this rule.

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

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

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

(b) Review of all components required when teaching developmental disabilities personnel to perform or administer the functions set forth in paragraphs (A)(1)(a) to (A)(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 (A)(1)(a) to (A)(1)(h) of this rule.

(h) Responsibility and accountability pursuant to rule 5123:2-6-07 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 (A)(1)(a) to (A)(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 5123:2-6-07 of the Administrative Code, including required entry of data regarding developmental disabilities personnel trained.

(m) Instruction that only a department-approved curriculum shall be used to train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (A)(1)(a) to (A)(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.

Supplemental Information

Authorized By: 5123.04, 5123.44, 5123.45, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 5/5/2023
Prior Effective Dates: 9/30/1993 (Emer.), 8/6/1994, 10/22/2003 (Emer.), 6/1/2016

Rule 5123:2-6-05 | 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: November 6, 2017
• Promulgated Under: 119.03

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

(1) Developmental disabilities personnel shall 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 list 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 5123:2-6-06 of the Administrative Code may provide the training for activation of a vagus nerve stimulator and only according to the department-approved curriculum.

(B) 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 shall 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 5123:2-17-02 of the Administrative Code.

(b) Demonstration by the developmental disabilities personnel of the skills and information on the department-approved skills list 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 5123:2-6-06 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 (B)(1) of this rule.

(C) 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 shall complete training prior to administering topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, 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 shall only be administered by developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123:2-6-06 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 5123:2-6-06 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 list 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 5123:2-6-06 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.

Supplemental Information

Authorized By: 5123.04, 5123.43, 5123.46
Amplifies: 5123.04, 5123.41 to 5123.47
Five Year Review Date: 5/5/2023