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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 557MEDICATION AIDES--PROGRAM REQUIREMENTS
RULE §557.128Home Health Medication Aides

(a) General.

  (1) A person may not administer medication to a client unless the person:

    (A) holds a current license under state law that authorizes the licensee to administer medication;

    (B) holds a current permit issued under this section and acts under the delegated authority of an RN to administer medication;

    (C) administers a medication to a client in accordance with rules of the BON that permit delegation of the administration of medication to a person not holding a permit under this section; or

    (D) administers noninjectable medication under circumstances authorized by the memorandum of understanding between the BON and HHSC.

  (2) A HCSSA that provides licensed and certified home health services, licensed home health services, hospice services, or personal assistance services may use a home health medication aide. If there is a direct conflict between the requirements of this chapter and federal regulations, the requirements that are more stringent apply to the licensed and certified HCSSA.

  (3) Exemptions are as follows.

    (A) A person may administer medication to a client without the license or permit as required in paragraph (1) of this subsection if the person is:

      (i) a graduate nurse holding a temporary permit issued by the BON;

      (ii) a student enrolled in an accredited school of nursing or program for the education of RNs who is administering medications as part of the student's clinical experience;

      (iii) a graduate vocational nurse holding a temporary permit issued by the BON;

      (iv) a student enrolled in an accredited school of vocational nursing or program for the education of vocational nurses who is administering medications as part of the student's clinical experience; or

      (v) a trainee in a medication aide training program approved by HHSC under this chapter who is administering medications as part of the trainee's clinical experience.

    (B) Supervision of an exempt person described in subparagraph (A) of this paragraph is as follows.

      (i) A person described in:

        (I) subparagraph (A)(i) of this paragraph shall be supervised by an RN;

        (II) subparagraph (A)(ii) or (iv) of this paragraph shall be supervised by the student's instructor; or

        (III) subparagraph (A)(iii) of this paragraph shall be supervised by an RN or LVN.

      (ii) Supervision must be on-site.

    (C) An exempt person described in this subsection may not be used in a supervisory or charge position.

(b) Required actions.

  (1) If a HCSSA provides home health medication aide services, the HCSSA must employ a home health medication aide to provide the home health medication aide services. The HCSSA must employ or contract with an RN to perform the initial health assessment, prepare the client care plan, establish the medication list, medication administration record, and medication aide assignment sheet, and supervise the home health medication aide. The RN must be available to supervise the home health medication aide when home health medication aide services are provided.

  (2) The clinical records of a client using a home health medication aide must include a statement signed by the client or family acknowledging receipt of the list of permitted and prohibited acts of a home health medication aide.

  (3) The RN must be knowledgeable of HHSC rules governing home health medication aides and must ensure that the home health medication aide is in compliance with the Texas Health and Safety Code, Chapter 142, Subchapter B.

  (4) A home health medication aide must:

    (A) function under the supervision of an RN;

    (B) comply with applicable law and this chapter relating to administration of medication and operation of the HCSSA;

    (C) comply with HHSC rules applicable to personnel used in a HCSSA; and

    (D) comply with this section and §558.701 of this title (relating to Home Health Aides) if the person will be used as a home health aide and a home health medication aide.

  (5) The RN must make a supervisory visit while the medication aide is in the client's residence in accordance with §558.298 of this title (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel and Tasks Not Requiring Delegation).

(c) Permitted actions. A home health medication aide is permitted to:

  (1) observe and report to the HCSSA RN and document in the clinical record any reactions and side effects to medication shown by a client;

  (2) take and record vital signs of a client before administering medication that could affect or change the vital signs;

  (3) administer regularly prescribed medication to a client if the medication aide:

    (A) is trained to administer the medication;

    (B) personally prepares the medication or sets up the medication to be administered; and

    (C) documents the administration of the medication in the client's clinical record;

  (4) administer oxygen per nasal cannula or a non-sealing face mask only in an emergency, after which the medication aide must verbally notify the supervising RN and appropriately document the action and notification;

  (5) apply specifically ordered ophthalmic, otic, nasal, vaginal, topical, and rectal medication unless prohibited by subsection (d)(10) of this section;

  (6) administer medications only from the manufacturer's original container or the original container in which the medication had been dispensed and labeled by the pharmacy with all information mandated by the Texas State Board of Pharmacy;

  (7) administer previously ordered PRN medication if:

    (A) the HCSSA's RN authorizes the medication;

    (B) the medication aide documents in the client's clinical notes the symptoms indicating the need for medication and the time the symptoms occurred;

    (C) the medication aide documents in the client's clinical notes that the HCSSA's RN was contacted, symptoms were described, and the HCSSA's RN granted permission to administer the medication, including the time of contact;

    (D) the medication aide obtains authorization to administer the medication each time the symptoms occur; and

    (E) the medication aide ensures that the client's clinical record is co-signed by the RN who gave permission within seven days after the notes are incorporated into the clinical record;

  (8) measure a prescribed amount of a liquid medication to be administered;

  (9) break a tablet for administration to a client if:

    (A) the client's medication administration record accurately documents how the tablet must be altered before administration; and

    (B) the licensed nurse on duty or on call has calculated the dosage;

  (10) crush medication, if:

    (A) authorization has been given in the original physician's order or the medication aide obtains authorization from the HCSSA's RN; and

    (B) the medication aide documents the authorization on the client's medication administration record.

(d) Prohibited actions. A home health medication aide must not:

  (1) administer a medication by any injectable route, including:

    (A) intramuscular route;

    (B) intravenous route;

    (C) subcutaneous route;

    (D) intradermal route; and

    (E) hypodermoclysis route;

  (2) administer medication used for intermittent positive pressure breathing treatment or any form of medication inhalation treatments;

  (3) administer previously ordered PRN medication except in accordance with subsection (c)(7) of this section;

  (4) administer medication that, according to the client's clinical records, has not been previously administered to the client;

  (5) calculate a client's medication doses for administration;

  (6) crush medication, except in accordance with subsection (c)(10) of this section;

  (7) administer medications or feedings by way of a tube inserted in a cavity of the body except as specified in §558.404(h) of this title (relating to Standards Specific to Agencies Licensed to Provide Personal Assistance Services);

  (8) receive or assume responsibility for reducing to writing a verbal or telephone order from a physician, dentist, podiatrist or advanced practice nurse;

  (9) order a client's medication from a pharmacy;

  (10) apply topical medications that involve the treatment of skin that is broken or blistered when a specified aseptic technique is ordered by the attending physician;

  (11) administer medications from any container other than the manufacturer's original container or the original container in which the medication had been dispensed and labeled by the pharmacy with all information mandated by the Texas State Board of Pharmacy;

  (12) steal, divert, or otherwise misuse medications;

  (13) violate any provision of the statute or of this chapter;

  (14) fraudulently procure or attempt to procure a permit;

  (15) neglect to administer appropriate medications, as prescribed, in a responsible manner; or

  (16) administer medications if the person is unable to do so with reasonable skill and safety to clients by reasons of drunkenness, inappropriate use of drugs, narcotics, chemicals, or any other type of material.

(e) Applicant qualifications. Each applicant for a permit issued under Texas Health and Safety Code, Chapter 142, Subchapter B must complete a training program. Before enrolling in a training program and applying for a permit under this section, all applicants:

  (1) must be able to read, write, speak, and understand English;

  (2) must be at least 18 years of age;

  (3) must be free of communicable diseases and in suitable physical and emotional health to safely administer medications;

  (4) must be a graduate of an accredited high school or have proof of successfully passing a general educational development test;

  (5) must have satisfactorily completed a home health aide training and competency evaluation program or a competency evaluation program under §558.701 of this title;

  (6) must not have a criminal history that HHSC determines is a basis for denying the permit under §557.121 of this chapter (relating to Permitting of Persons with Criminal Backgrounds);

  (7) must not be listed as unemployable on the EMR; and

  (8) must not be listed with a revoked or suspended status on the NAR.

(f) Nursing graduates. A person who is a graduate of an accredited school of nursing and who does not hold a license to practice professional or vocational nursing meets the training requirements for issuance of a permit under this section if the date of graduation from the nursing school was no earlier than January 1 of the year immediately preceding the year of application for a permit under this section.

  (1) The applicant must submit an HHSC application form to HHSC. The applicant must meet the requirements of subsection (e)(1) - (6) of this section.

  (2) The application must be accompanied by the combined permit application and examination fee.

  (3) The applicant must include an official transcript documenting graduation from an accredited school of nursing.

  (4) HHSC acknowledges receipt of the application by sending the applicant a copy of this chapter and HHSC open book examination.

  (5) The applicant must complete the open book examination and return it to HHSC by the date given in the examination notice.

  (6) The applicant must complete HHSC written examination. HHSC determines the site of the examination. HHSC denies the application of an applicant failing to schedule and take the examination by the date given in the examination notice.

  (7) An open book or written examination may not be retaken if the applicant fails.

  (8) Upon successful completion of the two examinations, HHSC evaluates all application documents submitted by the applicant.

  (9) HHSC notifies the applicant in writing of the examination results.

(g) Nursing students. A person who is attending or has attended an accredited school of nursing and who does not hold a license to practice professional or vocational nursing meets the training requirements for issuance of a permit under this section if the person:

  (1) attended the nursing school no earlier than January 1 of the year immediately preceding the year of application for a permit under this section;

  (2) successfully completed courses at the nursing school that cover HHSC curriculum for a home health medication aide training program;

Cont'd...

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