| (a) In addition to meeting the standards in Subchapter
C of this chapter (relating to Minimum Standards for All Home and
Community Support Services Agencies), an agency holding a license
with the category of personal assistance services must meet the standards
of this section.
(b) A person who is not licensed to provide personal
assistance services under this chapter may not indicate or imply that
the person is licensed to provide personal assistance services by
using the words "personal assistance services" or in any other manner.
(c) Personal assistance services, as defined in §558.2
of this chapter (relating to Definitions), may be performed by an
unlicensed person who is at least 18 years of age and has demonstrated
competency, when competency cannot be determined through education
and experience, to perform the tasks assigned by the supervisor. An
unlicensed person who is under 18 years of age, is a high school graduate
or is enrolled in a vocational educational program, and has demonstrated
competency to perform the tasks assigned by the supervisor, may perform
personal assistance services.
(d) The following tasks may be performed under a personal
assistance services category:
(1) personal care as defined in §558.2 of this
chapter;
(2) health-related tasks provided by unlicensed personnel
that may be delegated by an RN, or that an RN determines do not require
delegation, in accordance with the agency's written policy adopted,
implemented, and enforced to ensure compliance with the rules adopted
by the Texas Board of Nursing in 22 TAC Chapter 225 (relating to RN
Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation
in Independent Living Environments for Clients with Stable and Predictable
Conditions);
(3) health-related tasks that are not the practice
of professional nursing under the memorandum of understanding between
HHSC and the Texas Board of Nursing; and
(4) health-related tasks that are delegated by a physician
under the Texas Occupations Code Chapter 157.
(e) The agency must ensure that when developing its
operational policies, the policies are considerate of principles of
individual and family choice and control, functional need, and accessible
and flexible services.
(f) In addition to the client record requirements in §558.301(a)(9)
of this chapter (relating to Client Records), the client file must
include the following:
(1) documentation of determination of services based
on an on-site visit by the supervisor where services will be primarily
delivered and records of supervisory visits, if applicable;
(2) individualized service plan developed, agreed upon,
and signed by the client or family and the agency. The individualized
service plan must include:
(A) types of services, supplies, and equipment to be
provided;
(B) locations of services;
(C) frequency and duration of services;
(D) planned date of service initiation;
(E) charges for services rendered if the charges will
be paid in full or in part by the client or significant other(s),
or on request; and
(F) plan of supervision; and
(3) documentation that the services have been provided
according to the individualized service plan.
(g) In addition to the written policies required by §558.245
of this chapter (relating to Staffing Policies) the agency must adopt
and enforce a written policy addressing the supervision of personnel
with input from the client or family on the frequency of supervision.
(1) Supervision of personnel must be in accordance
with the agency's policies and applicable State laws and rules, including
rules adopted by the Texas Board of Nursing in 22 TAC Chapter 225.
(2) A supervisor must be a licensed nurse or have completed
two years of full-time study at an accredited college or university.
An individual with a high school diploma or general equivalence diploma
(GED) may substitute one year of full-time employment in a supervisory
capacity in a health care facility, agency, or community-based agency
for each required year of college.
(3) The client in a client managed attendant care program
funded by HHSC or the Department of Assistive and Rehabilitative Services
is not required to meet the standard in paragraph (2) of this subsection.
(h) Tube feedings and medication administration through
a permanently placed gastrostomy tube (g-tube) in accordance with
subsection (d)(3) of this section may be performed by an unlicensed
person only after successful completion of the training and competency
program and procedures described in paragraphs (1) - (5) of this subsection.
(1) The training and competency program for the performance
of g-tube feedings by an unlicensed person must be taught by an RN,
physician, physician assistant (PA), or qualified trainer. A qualified
trainer must:
(A) have successfully completed the training and competency
program described in paragraphs (2) and (3) of this subsection taught
by an RN, physician, or PA;
(B) have demonstrated upon return demonstration to
an RN, physician, or PA the performance of the task and the ability
to teach the task; and
(C) have been deemed competent by an RN, physician,
or PA, to train unlicensed personnel in these procedures. Documentation
of competency to perform, train, and teach must be maintained in the
employee's or contractor's file. Competency must be evaluated and
documented annually by an RN, physician, or PA.
(2) The minimum training program must include:
(A) a description of the g-tube placement, including
its purpose;
(B) infection control procedures and universal precautions
to be used when performing g-tube feedings or medication administration
through a g-tube;
(C) a description of conditions that must be reported
to the client or the primary caregiver, or in the absence of the primary
caregiver, to the agency administrator, supervisor, or the client's
physician. The description of conditions must include a plan to be
effected if the g-tube comes out or is not positioned correctly to
ensure medical attention is provided within one hour;
(D) review of a written procedure for g-tube feeding
or medication administration through a g-tube. The written procedure
must be equivalent to current acceptable nursing standards of practice,
including addressing the crushing of medications;
(E) conditions under which g-tube feeding or medication
administration must not be performed; and
(F) demonstration of a g-tube feeding and medication
administration to a client. If the trainee will become a qualified
trainer, the demonstration must be done by the RN, PA, or physician.
If the trainee will not become a qualified trainer, the demonstration
may be done by an RN, PA, physician, or qualified trainer.
(3) The minimum competency evaluation must be documented
and maintained in the employee's file and must include:
(A) a score of 100 percent on a written multiple-choice
test that consists of situational questions to include the criteria
in paragraph (2)(A) - (E) of this subsection and an evaluation of
the trainee's judgment and understanding of the essential skills,
risks, and possible complications of a g-tube feeding or medication
administration through a g-tube;
(B) a skills checklist demonstrating that the trainee
has successfully completed the necessary skills for a g-tube feeding
and medication administration via g-tube, and if the trainee will
become a qualified trainer, the skills checklist must also demonstrate
the ability to teach another person to perform the task. The skills
checklist must be completed by an RN, physician, or PA, if the trainee
will become a qualified trainer. The skills checklist for a trainee
who will not become a qualified trainer may be completed by an RN,
physician, PA, or qualified trainer; and
(C) documentation of an accurate demonstration of the
g-tube feeding and medication administration performed by the trainee
as required by paragraph (2)(F) of this subsection. If the trainee
will become a qualified trainer, documentation of competency to teach
this task must be maintained in the file of the qualified trainer.
The person responsible for the training of the trainee must document
the successful demonstration of the g-tube feeding and medication
administration via g-tube by the trainee and the trainee's competency
to perform this task in the trainee's file.
Cont'd... |
