Delegation in community and in-home care settings is defined by WAC 246-840-910 through 246-840-970. An exception exists in the physician rules that require a physician to be on the immediate premises during the patient's initial treatment when a nurse is performing laser therapy:WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin. The nurse must use nursing judgment and consider what aspects of the initial and ongoing assessment, supervision, and evaluation need to be done face-to-face. The licensed practical nurse may assist an authorized provider in replacing a suprapubic catheter in a non-established tract. Student requirements in all approved nursing education programs. Laser treatment requires a prescription from an authorized health care practitioner. Stop Overdose.comoffers education, resources, and technical assistance for individuals, professionals, and communities in Washington State who want to learn to prevent and respond to overdose and improve the health of people who use drugs. It is within the scope of the appropriately prepared and competent LPN to discuss end-of-life care with the patient or surrogate under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse (RN). Standard I Initiating the Nursing Process: Nursing Diagnosis/Problem Identification. 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. ); Tracheostomy site care and dressing changes; and. The laws and rules do not prohibit the licensed practical nurse from accepting an order from an authorized medical provider through another unlicensed or licensed person. 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. To learn more about the different training options available and access additional resources, see theWashington State Telehealth Collaborative Training webpage. Assist an authorized health care practitioner or the registered nurse in changing bottles and/or disposable collection system. It is within the scope of an appropriately prepared and competent licensed practical nurse to follow standing orders to provide routine birth control or to screen for and treat sexually transmitted diseases. It is acceptable for the licensed practical nurse to prepare a medication organizer or individual pill containers under the following conditions: See theAdvisory Opinion on Medisets, theMedication Organizer Device Letter from Secretary of Health (PDF), and theMedication Organizer Device (PDF)for more information. The licensed practical nurse implementing the order is required to see clarification of the order when the licensed practical nurse believes or has any reason to believe one of these contraindications exists, and to take any other action necessary to assure the safety of the patient. Organizational policies may dictate who can perform a sports physical examination. RCW 28A.600.200 Interscholastic Athletic and Other Extracurricular Activities for Studentsprovides authority to the school district board of directors to control, supervise, and regulate the conduct of interschool athletic activities including delegating control, supervision and regulation to theWashington Interscholastic Activities Association (WIAA)or other voluntary nonprofit entity. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations in using standing orders. 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. A prescription or order from an authorized health care practitioner is required. Although a nursing care assessment may include elements of a non-skilled personal care assessment, it is a comprehensive nursing care evaluation and must be performed by the registered nurse. 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. The facility or employer may require a specific certification or training program. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to obtain a blood specimen via a capillary or venous blood sample to perform lead screening, hepatitis B screening, or other employee health laboratory tests under the direction of an authorized health care provider or under the direction and supervision of a registered nurse. Exceptions to nursing faculty degree requirements in prelicensure registered nurse nursing education programs. Violations of standards of nursing conduct or practice. WSR 13-15-063, 246-840-940, filed 7/15/13, effective 8/15/13. Conditions for participants entering the approved substance abuse monitoring program. If the patient's wishes are not known, the POLST should direct care in the patient's best interest. (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. 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 employer may have policies or guidelines about crushing or splitting medications. It is not within the scope of practice for a licensed practical nurse to practice independently. The Licensed Practical Nurse should use theScope of Practice Decision Treeto determine if specific activities are within the registered nurse's legal and individual scope of practice. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. STATE OF WASHINGTON . See the Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionfor additional information. Initial licensure for registered nurses and practical nurses. In an emergency it may be difficult to determine whether the family member is the legal surrogate. Telemedicine as defined inRCW 70.41.020(13)means, the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment [but] does not include the use of audio-only telephone, facsimile, or email.. 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. Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). Extended or satellite nursing campus of nursing education programs approved in Washington state. The delegating physician need not be on the premises during the procedure, but the physician must be reachable by telephone to be able to respond within thirty minutes to treat complications. A non-nurse may be a supervisor of a licensed practical nurse. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionand Verbal Orders provides additional guidance and recommendations. RCW 18.20 Assisted Living Facilities and WAC 388-78A Assisted Living Facility Licensing Rules for more information. CNA may administer in a nursing home setting with a medication assistant endorsement. Web10987 Luddington Street (818) 253-5989 Care provided: Assisted Living, Respite Care Brookdale Vista Grande 2780 Vickers Drive (719) 598-0400 Care provided: Assisted Living, Respite Care American Life Adult Care Center 8849 NW 169 Terrace (305) 827-3100 Care provided: Assisted Living, Respite Care Amor De Jesus Corp 14283 Sw 177 Street The procedure may be performed in a home setting or an in-center setting. Does the patient reside in one of the following settings? 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. Apre-admission/resident assessmentis a needs assessment screening tool used to obtain information about the personal care needs and requests of a potential resident. School registered nurses or licensed practical nurse (LPN) may provide telehealth services to students during the COVID-19 emergency within their legal scope of practice. The laws and rules do not require a special certificate to perform cosmetic procedures. Employer: Washington Department of Labor & Industries - Insurance Services . 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. The nursing laws and rules allow a licensed practical nurse to provide care in an ICU, PCU, or recovery room. Range orders should ideally consist of: The state laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from assisting in providing case management and support for patients in MAT within the licensed practical nurse's scope of practice. See the Nursing Care Quality Assurance Commission's for additional information. The newly licensed RN, LPN, or ARNP or the RN, LPN, or ARNP licensed through the endorsement process who provides clinical services will need to meet the requirement one year after the initial license is issued. This procedure requires a prescription from an authorized health care practitioner. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. The licensed practical nurse should use nursing judgment and determine whether additional verification or clarification is required. The nursing law and rule does not require the registered nurse or an authorized health care practitioner to be on the premises when a licensed practical nurse provides care in any setting. The following conduct may subject a nurse to disciplinary action under the Uniform Disciplinary Act, chapter, (2) Failure to adhere to the standards in WAC. Apply here. The Nursing Care Quality Assurance Commission determines that it is not within the scope of a licensed practical nurse to perform iliac crest bone marrow aspirations and biopsies due to the complexity of the procedure. The licensed practical nurse is required to use critical thinking in clinical problem-solving and decision-making processes relative to scope of practice, knowledge, competency, and experience. Other examples include post-fall and pre-transfer assessments. WebWhat Is Nurse Delegation? It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner, or the registered nurse, in removing trans-thoracic (epicardial) pacing wire following open-heart surgery, following clinical practice standards. It is within the scope of an appropriately prepared and competent licensed practical nurse to apply or remove an external electronic fetal monitor under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. (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. 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. There must be an order from an authorized provider. The licensed practical nurse uses and applies nursing diagnosis (formulated by the registered nurse) as a foundation for implementing interventions. Seeking mental health care is both safe and encouraged. Itdoes notinclude the use of audio-only telephone, facsimile, or email.. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. 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. Follow the policies and procedures relative to the documentation (paper or electronic) system used by the organization. You should contact your legal advisor to obtain advice with respect to any particular issue or problem. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex tracheostomy care under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards including: The licensed practical nurse should use theScope of Practice Decision Treeto determine if the activity is within the nurse's legal and individual scope of practice. The licensed practical nurse may assist in carrying out the assessment process and carrying out these plans. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse follow theWashington State Tuberculosis Laws and Guidelinesand theCenters for Disease Control Guidelines for TB Screening and Follow-Up. 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 telemedicine training provides a valuable overview of the roles, responsibilities, liability, and legal requirements when providing telehealth services. The licensed practical nurse may administer naloxone or other opioid antagonist to anyone at risk for having or witnessing an opioid overdose. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionand Verbal Orders provides additional guidance and recommendations. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex respiratory therapy procedures under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. WebWashington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree. 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 order or prescription may be for a specific patient or through the use of standing orders. Medical regimens require a prescription or order from an authorized health care practitioner. The standing orders are often used to renew medication prescriptions. The nurse providing asynchronous (store-and-forward) VDOT is not required to take the training, but NCQAC recommends all nurses take the training. WebThe registered nurse delegator previously provided written instructions for the care and treatment of the patient. This does not mean the licensed practical nurse may not work in a pharmacy setting administering immunizations. COURSES This order may be written for an individual patient or through a standing order. The nurse shall document 2 . Triaging occurs in various setting such as managed care organization, primary and specialty care, emergency departments, and crisis lines. The licensed practical nurse should use theScope of Practice Decision Treeto determine if any of the activities the licensed practical nurse is assisting with, is within the nurse's legal and individual scope of practice. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to perform bladder instillation therapy under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. WebRCW 18.79 Nursing Care and WAC 246-840 Practical and Registered Nursing. POLST is a portable medical order, and the LPN should follow it within scope of practice and standard of care. The licensed practical nurse should use theScope of Practice Decision Treeto determine if administering medications following a specific standing order within the licensed practical nurse's regulatory and individual scope of practice. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. The licensed practical nurse may assist an authorized health care practitioner, or the registered nurse, in performing a sterile speculum examination, including obtaining cytology specimens, following clinical practice standards. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. This procedure requires a prescription from an authorized health care practitioner. Naloxone has not been shown to produce tolerance or cause physical or psychological pain. 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 Centers for Medicaid and Medicare Services (CMS) and accreditation organizations (such as the Joint Commission) may have specific requirements. The nurse would need to contact the other state(s) to see if they can practice in their state with a Washington state license during the pandemic. Standing orders are certainly not to be used in lieu of medical consultation or intervention. The Licensed Practical Nurse should use theScope of Practice Decision Treeto determine if specific activities are within the registered nurse's legal and individual scope of practice. The Licensed Practical Nurse may administer an opioid antagonist following a standing order from an authorized health care practitioner. WAC 246-840-700allows the licensed practical nurse to make basic observations, gather data and assist in identification of needs and problems relevant to the patient, collect specific data as directed, and, communicate outcomes of the data collection process in a timely manner to the registered nurse or other authorized health care provider. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse from administering stem cell-based products via a peripheral intravenous line, intra-arterial catheter, intradermal technique, or intramuscular technique. WebIf the home identifies that a resident has a need for nursing care and the home is not able to provide the care per chapter 18.79 RCW, the home must contract with a nurse currently licensed in the state of Washington to provide the nursing care and service, or hire or contract with a nurse to provide nurse delegation. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to insert a FSE or IUPC. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. (15) "Stable and predictable condition" means the registered nurse delegator determines the patient's clinical and behavioral status is nonfluctuating and consistent. The patient must be in a stable condition. Other laws do allow exceptions for specific types of treatment: See theProviding Health Care to Minors under Washington Law Summaryfor more information. It may be within the scope of practice of the competent and appropriately trained licensed practical nurse to prepare allergenic extracts as compounded sterile preparations under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. OREGON STATE UNIVERSITY Open search box. An order is required from an authorized health care practitioner for laboratory tests involving puncturing of the skin. The process for reconciliation of medication is the responsibility of the prescriber. To complete the free and publicly available telemedicine training, see theWashington State Medical Professional Telemedicine Training website. Curriculum for prelicensure registered nursing education programs. Can the task be performed without repeated nursing assessments? 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. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing compounding medications and preparing and administering allergenic extracts is within the licensed practical nurse's regulatory and individual scope of practice. It may be within the scope of practice of a competent and appropriately trained licensed practical nurse to perform a focused assessment and monitor the patient collecting the information and data related to pulmonary function. The Nursing Care Quality Assurance Commission supports the use of medication organizers following standards of practice for medication administration. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. Only a registered nurse or advanced registered nurse practitioner may supervise and evaluate the practice of nursing provided by a licensed practical nurse. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to perform an EEG or EMG under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse, following clinical practice standards. Curriculum for graduate nursing education programs. Standing orders may be used. Authorized prescriptions by ARNP with prescriptive authority. The law, RCW 43.70.495, requires the nurse to sign and retain an attestation of completion. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. The patient may want to refuse CPR under all circumstances including choking or accidents. Nurses may carry and administer an opioid antagonist (such as naloxone) in a suspected opioid overdose whether the person is a family member, friend, stranger, or a patient. The NCQAC suggests the following: It may be within the scope of practice of the competent and appropriately trained licensed practical nurse to administer and read the TB skin test under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. This would take away some of the notion of the nurse "prescribing" the medication. 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. Established numerous primary care clinics. 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. A prescription or order from an authorized provider is required. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the registered nurse's legal and individual scope of practice. Can the task be performed without a need for complex observations or critical decisions? WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. A prescription or order from an authorized provider is required for legend drugs, controlled substances, over-the-counter drugs, or for medical treatments.RCW 18.79.270 LPN - Activities Allowed. Clinical judgment (critical thinking) is used throughout all components of the nursing process. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to perform peritoneal dialysis under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. The licensed practical nurse may collect the data and then have the registered nurse review the data and complete the assessment to determine the patient' needs and developing the nursing care plan. 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. Another option is for the facility or employer to become an authorized entity. WebThis CNE activity does not include any unannounced information about off-label use of a product for a purpose other than that for which it was approved by the Food and Drug Administration (FDA). The competent and appropriately trained licensed practical nurse may compound medications under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. 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. Episodic care of chronic opioid patients. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from collecting the information for a pre-anesthesia assessment. Clinical and practice experiences for students in approved nursing education programs. The licensed practical nurse may perform some activities related to ART within the nurse's scope of practice, such as medication administration, routine laboratory testing, and basic education, under the direction of an authorized health care practitioner, or under the direction and supervision, of the registered nurse. See WAC 296-04-045. If you have a question related to nursing practice in the state of Washington, please contactnursingpractice@doh.wa.govorarnppractice@doh.wa.govfor questions about advanced nursing practice. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply superficial chemical peels or microdermabrasion under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. Commission action following commission site visit, complaint investigation, or national accreditation visits of nursing education programs located in Washington state. It is not within the scope of practice of a licensed practical nurse to administer or recommend OTC drugs. No, the telemedicine training requirement doesn't apply to audio-only telephone (telephone triage), facsimile, or email. If a comprehensive nursing assessment is contemplated as part of the care plan, the registered nurse must undertake that portion of the pre-admission assessment. A comprehensive nursing assessment means collection, analysis, and synthesis of data performed by the registered nurse used to establish a health status baseline, plan care and address changes in a patient's condition as defined in theNational Council State Boards of Nursing (NCSBN) Model Act (2012). Health Services Partners Air Quality Allergies Asthma WAC 246-870 Electronic Transmission of Prescription Informationallows electronic prescriptions for legend drugs and controlled substances (except for Schedule II controlled substances). A prescription or order from an authorized provider is required. Off-label use should be done with careful insight and understanding of the risks and benefits to the patient considering high-quality evidence supporting efficacy, effectiveness, and safety. 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