The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if this activity is within the nurse's regulatory and individual scope of practice. Criteria for approval of refresher course program located outside Washington state. Mail: P.O. The licensed practical nurse works under the direction of an authorized health care practitioner within the practitioner's. Patients with chronic pain, including those on high doses, establishing a relationship with a new practitioner. (16) "Supervision" means the guidance and evaluation by a registered nurse delegator for the accomplishment of a nursing task or activity, including the initial direction of the task or activity; periodic inspection at least every ninety days of the actual act of accomplishing the task or activity; and the authority to require corrective action. BOX 47864, Olympia, WA 98504-7864, Location: 111 Israel Road SE, Tumwater, WA 98501, Subscribe to receive updates from the Nursing Commission, About | News| Meeting Schedule | Contact, Nursing Care Quality Assurance Commission, Washington Administrative Code (WAC) 246-840, Neonatal Intubation and Related Procedures Advisory Opinion, Standing Orders and Verbal Orders Advisory Opinion, WAC 246-320 Hospital Licensing Regulations, WAC 246-330 Ambulatory Surgical Facilities, WAC 388-112-0260 Adult Family Homes and Assisted Living Facilities, D20-010 Assessment and Person-Centered Service Planning Process during COVID-19 Outbreak Policy (March 17, 2020), D20-028 Delivery of Skilled Nursing, Nurse Delegation, and Private Duty Nursing Services during the COVID-19 Outbreak (April 10, 2020), Medical Quality Assurance Commission WAC 246-919-606 Nonsurgical Medical Cosmetic Procedures, Dentist Scope of Practice - Use of Botulinum Toxin Injections/Dermal Fillers Interpretive Statement, Medical Quality Assurance Commission WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin, Food and Drug Administration's website, Using Eye Cosmetics Safely, NCQAC Standing and Verbal Orders Advisory Opinion, WAC 246-870 Electronic Transmission of Prescription Information, Washington State Department of Health Pharmacies website, Compounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinion, Washington State Tuberculosis Laws and Guidelines, Centers for Disease Control Guidelines for TB Screening and Follow-Up, Medication Organizer Device Letter from Secretary of Health (PDF), Food and Drug Administration Understanding Unapproved Use of Approved Drugs "Off-Label" website, Institute for Safe Medication Practices (ISMP), WAC 388-76 Adult Family Home Minimum Licensing Requirements, Washington State Department of Health Patient Rights Guidelines, Epinephrine Autoinjectors and Anaphylaxis Training and Reporting for Authorized Entities Frequently Asked Questions, NCQAC's Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion, Frequently Asked Questions for Nursing Professionals of the Prevention and Treatment of Opioid-Related Overdoses for more information, WAC 246-865-060 Pharmaceutical Services-Extended Care Facility, WAC 246-874-050 Accountability Requirements for an Automated Drug Dispensing Device (ADDD), WAC 246-840 Practical and Registered Nursing, advisory opinions and interpretive statements, WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin. Extended or satellite nursing campus of nursing education programs approved in Washington state. Critical thinking is purposeful and reflective judgment in response to events, observations, experiences, and verbal or written expressions. It would be within the scope of practice for the licensed practical nurse to assess lung sounds before and after treatments. Web(a) The delegating nurse shall: (i) Determine the competency of the individual to perform the tasks; (ii) Evaluate the appropriateness of the delegation; (iii) Supervise the actions of the person performing the delegated task; and (iv) Delegate only those tasks that are within the registered nurse's scope of practice. Students enrolled in a nontraditional nursing program. The order may be made using a standing order. Refer to theStanding Order Advisory Opinionfor more information on use of standing orders. Innovation projects or program approach for approved nursing education programs located in Washington state. The patient may want to refuse CPR under all circumstances including choking or accidents. The laws and rules do not prohibit the competent and appropriately trained licensed nurse from implementing a drug order that has a dosage range. Delegation is not required for the NA-R/NA-C or other UAP to follow the cardiopulmonary resuscitation (CPR)/DO NOT ATTEMPT RESUSCITATION (DNAR) POLST in Section A. Invasive procedures require an order from an authorized health care practitioner. Standing orders may also be used to allow a nurse to start more than one intravenous line based on specific criteria. The licensed practical nurse should use nursing judgment and determine whether additional verification or clarification is required. A licensed practical nurse may work in any setting where nursing care is provided. The licensed practical nurse may perform nursing care under the direction of an authorized health care practitioner or at the direction and under the supervision of the registered nurse. However, the Nursing Care Quality Assurance Commission (NCQAC) recommends licensed nurses complete the telemedicine training if they provide services such as; telephone triage, remote patient monitoring (RPM, which enables recording and monitoring health data remotely), asynchronous telehealth (such as Store and Forward technology that allows patient data to be collected, stored, and later retrieved by another professional), Mobile Health (mHealth, using smart devices such as smartphones and smart wearables that allow continuous data collection about a person's behavior or condition) or other types of telehealth. The competent and appropriately trained licensed practical nurse can perform triage under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. Examples of diagnostic imaging procedures include: While the licensed practical nurse may perform routine, diagnostic imaging procedures, because of the complexity, it is not within the scope of the licensed practical nurse to perform interventional radiology procedures. The nursing laws and rules do prohibit the competent and appropriately trained licensed practical nurse from assisting in performing a sports physical examination under the direction of an authorized provider or under the direction and supervision of the registered nurse. Follow the policies and procedures relative to the documentation (paper or electronic) system used by the organization. A licensed registered nurse may delegate specific nursing care tasks to nursing assistants or home care aides meeting certain requirements and providing care to individuals in a community-based care setting defined by RCW. The law, RCW 43.70.495, requires the nurse to sign and retain an attestation of completion. Naloxone(Narcan) is the current standard of treatment for opioid overdose. The licensed practical nurse should make the decision whether or not to crush or split the medication based on patient needs, prescribing information by the provider, and safety of the medication being administered in this form. A SNF may limit the admission of a patient if a registered nurse is not available to perform the admission assessment. There may be other regulations, such as Centers for Medicare and Medicaid Services (CMS) who defines the requirements for supervision (general or direct), and other parameters, for reimbursement of the procedure. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform internal or external electronic fetal monitoring under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. (i) Failure to protect clients from unsafe practices or conditions, abusive acts, and neglect; (3) Failure to adhere to the standards in WAC, (a) Delegating nursing care function or responsibilities to a person the nurse knows or has reason to know lacks the ability or knowledge to perform the function or responsibility, or delegating to unlicensed persons those functions or responsibilities the nurse knows or has reason to know are to be performed only by licensed persons. The general age of majority for health care is eighteen years old in Washington State as defined in . The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing a lumbar puncture, following clinical practice standards. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse due to the complexity of the activity to perform endotracheal intubation. Internationally educated practical nurse program in an approved nursing education program. Does the patient have a stable and predictable condition? WAC 388-112-0260 Adult Family Homes and Assisted Living Facilitiesalso have specific requirements for CPR and first aid training. (1) "Authorized representative" means a person allowed to provide written consent for health care on behalf of a patient who is not competent to consent. The complexity and seriousness of the test results may also determine who gives the results and by what method test results should be given. Implementing nursing interventions and medical orders consistent with nursing rules and within an environment conducive to patient safety; Prioritizing performance of nursing interventions within the assignment; Recognizing responses to nursing interventions; Modifying immediate nursing interventions based on changes in the patient's status; and. Staff must meet the credentialing, training and competency requirements established in the state and federal laws and rules specific to the setting. Must meet all Washington Administrative Code (WAC) requirements related to this position Minimum of 3 years nursing experience preferred Ability to read, write, and speak in English Delegation process experience preferred Must possess strong organizational, time-management, and problem-solving skills The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing compounding medications is within the licensed practical nurse's regulatory and individual scope of practice. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to perform wart removal using liquid nitrogen or topical medications under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. These online courses are on-demand eLearning with virtual proctored final exams. Is the nursing assistant or home care aide trained in diabetes care and insulin injections when delegating insulin? The registered nurse delegator makes independent professional decisions of the delegation of a nursing task. The Food and Drug Administration (FDA) approves cosmetics. The licensed practical nurse (LPN) or registered nurse (RN) should consider what they are trying to accomplish based on the patient needs and safety and within their scope of practice. The licensed practical nurse may document symptoms or other findings and may document using a nursing diagnosis already made by the registered nurse. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in suctioning a fresh tracheostomy stoma; Changing, repositioning, or reinserting a tracheostomy tube in an established tracheostomy tract, (Decannulation before a mature tract is an emergency situation as well as a complex procedure and is not within the scope of the licensed practical nurse. Can the task be performed without requiring judgment based on nursing knowledge? It is recommended that medication orders be patient/condition specific even if prescribed pro re nata (PRN), when needed. While this is specific to public health nurses, the general concepts apply to any setting. These procedures require a prescription from an authorized health care practitioner. The POLST form must be signed by the advanced registered nurse practitioner (ARNP), physician, or physician assistant and the patient or surrogate decision-maker to be valid. Abnormal test results should be communicated by someone who can provide supporting information about the test, implications, and follow-up care. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). Symjepi (https://www.symjepi.com/) is not classified as an EAI. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from administering medications following standing orders. Other alternatives may be necessary such as a liquid medication. RCW 28A.210.370allows self-administration of medications, including epinephrine, if the student meets the requirements under the treatment plan for anaphylaxis, and has a prescription from their health care practitioner. The nursing laws and rules do not require an authorized health care practitioner or registered nurse to be on the premises when a licensed practical nurse provides nursing care or performs medical regimens. WebWashington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. The laws and rules place accountability on the nurse who is implementing the order to implement or clarify that the order is accurate, valid, properly authorized, and is not harmful or potentially harmful to the patient, or is not contraindicated by documented information. Inactive and reactivating an ARNP license. (14) "Registered nurse delegation" means the registered nurse transfers the performance of selected nursing tasks to competent nursing assistants or home care aides in selected situations. Continuing education for ARNP license renewal. Minimum standards for registered nurses include the following: Minimum standards for licensed practical nurses include the following: (A) Delegating selected nursing functions to others in accordance with their education, credentials, and demonstrated competence as defined in WAC, (A) The practical nurse may delegate selected nursing tasks to competent individuals in selected situations, in accordance with their education, credentials and competence as defined in WAC, (B) Supervising others to whom they have delegated nursing functions as defined in WAC. Anursing care assessmentgathers information about the person's health status through the collection of data and/or physical examination. The Food and Drug Administration (FDA) approves administration by intravenous, intramuscular, or subcutaneous routes; a hand-held auto-injector (Evzio) for intramuscular or subcutaneous injection; and, in 2018, approved the first generic Naloxone Hydrochloride nasal spray. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical nurse's legal and individual scope of practice. Itdoes notinclude the use of audio-only telephone, facsimile, or email.. The nursing laws and rules allow the licensed practical to relay test results or a medical diagnosis if already made by an authorized health care practitioner. This procedure requires a prescription from an authorized health care practitioner. See theWAC 246-865-060 Pharmaceutical Services-Extended Care Facilityfor more information. See the Nursing Care Quality Assurance Commission'sNeonatal Intubation and Related Procedures Advisory Opinionfor additional information. No color additives are approved by the FDA for permanent dyeing or tinting of eyelashes or eyebrows. RCW 7.70.065(1)(c). A facility or employer may require a specific certification or training program. The licensed practical nurse administering the medication is responsible for ensuring the medication is safe to crush or split before giving it. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing these activities is within the licensed practical nurse's regulatory and individual scope of practice. (15) "Stable and predictable condition" means the registered nurse delegator determines the patient's clinical and behavioral status is nonfluctuating and consistent. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of the off-label medication is within his or her regulatory and individual scope of practice. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of the off-label medication is within the nurse's regulatory and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. These procedures require a prescription from an authorized health care practitioner. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. It may be within the scope of practice of the competent and appropriately trained licensed practical nurse to perform the following tasks related to a VAD or other infusion devices under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse: It is not within the scope of a licensed practical nurse to perform the following tasks: The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The licensed nurse (RN, LPN, or ARNP) providing telemedicine clinical services licensed prior to January 1, 2021, will need to complete telemedicine training by December 31, 2021. The LPN or RN may provide telehealth nursing services within their scope of practice to patients in Washington state following standing orders approved by an authorized practitioner. Interventional radiology is performed using minimally invasive therapies under imaging guidance. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. The laws states, The system shall provide an audit trail of all prescriptions electronically transmitted that documents for retrieval all actions and persons who have acted on a prescription, including authorized delegation of transmission. The order must be authenticated. Inflation and deflation of cuff in a healed and established stoma. Appropriate documentation of a focused patient assessment and evaluation must substantiate intervention. (2) "Coercion" means to force or compel another, by authority, to do something that he/she would not otherwise choose to do. 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