| (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;
Cont'd... |
