Texas Register, Volume 38, Number 47, Pages 8313-8478, November 22, 2013 Page: 8,354
8313-8478 p. ; 28 cm.View a full description of this periodical.
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225.4. Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1) - (5) (No change.)
(6) Delegation--means that a registered nurse authorizes an
unlicensed person to perform tasks of nursing care in selected situations
and indicates that authorization in writing. The delegation process in-
cludes nursing assessment of a client in a specific situation, evaluation
of the ability of the unlicensed persons, teaching the task, ensuring su-
pervision of the unlicensed persons and re-evaluating the task at regular
intervals. [authorizing an unlicensed person to provide nursing services
while retaining ccou ntability for how the unl licensed person performs
the task;] It does not include situations in which an unlicensed person
is directly assisting a RN by carrying out nursing tasks in the presence
of a RN.
(7) (No change.)
(8) Health Maintenance Activities (HMAs)--tasks that may
be exempt from delegation based on RN assessment that enable the
client to remain in an independent living environment and go beyond
ADLs because of the higher skill level required to perform. HMAs
include the following [limited to the following tasks that enable the
client to remain in an independent living environment and that go be-
yond ADLs because of the higher skill leve required to perform :
(A) (No change.)
(B) topically applied medications;
(C) insulin or other injectable medications prescribed
in the treatment of diabetes mellitus administered subcutaneously,
nasally, or via an insulin pump;
(D) unit dose medication administration by way of in-
halation (MDIs) including medications administered as nebulizer treat-
ments for prophylaxis and/or maintenance;
(E) routine administration of a prescribed dose of oxy-
gen;
(F) noninvasive ventilation (NIV) such as continuous
positive airway pressure (CPAP) and bi-level positive airway pressure
(BiPAP) therapy;
(G) [(B)] the administering of a bowel and bladder pro-
gram, including suppositories, enemas, manual evacuation, intermit-
tent catheterization, digital stimulation associated with a bowel pro-
gram, tasks related to external stoma care including but not limited to
pouch changes, measuring intake and output, and skin care surround-
ing the stoma area;
(H) [(0] routine preventive skin care and care of Stage
1 pressure ulcers [decubitus];
(I) [(D)] feeding and irrigation through a permanently
placed feeding tube inserted in a surgically created orifice or stoma;
[and]
(J) those tasks that an RN may reasonably conclude as
safe to exempt from delegation based on an assessment consistent with
225.6 of this title (relating to RN Assessment of the Client); and
(K) [(E)] such other tasks as the Board may designate.
(9) (No change.)
(10) Not Requiring Delegation--a determination by a RN
that the performance of an ADL or HMA may be exempt from delega-
tion for a particular client and does not constitute the practice of profes-
sional nursing based on criteria established by the Board/this chapter.(11) - (12) (No change.)
225.5. RN Accountability.
(a) (No change.)
(b) The RN is responsible for documenting the delegation as-
sessment and delegation decision(s), and must provide the rationale for
the delegation decisions upon request of the client or the client's respon-
sible adult. When delegation decisions conflict or are in disagreement
with the client or the client's responsible adult, the RN should collab-
orate with the client or the client's responsible adult through a dispute
resolution process if available.
(c) [{b)] The RN is not accountable for an unlicensed person's
actual performance of ADLs or HMAs not requiring delegation.
(d) [(-)] The RN's accountability to the BON [BNB] with re-
spect to its taking disciplinary action against the RN's license is met
when the RN can verify compliance with this chapter.
(e) [(4)] This chapter does not change a RN's civil liability.
225.6. RNAssessment of the Client.
(a) The RN, in consultation with the client if 16 or older, and
when appropriate the client's responsible adult, must make an assess-
ment to determine if the care:
(1) - (2) (No change.)
(3) should not be delegated and only performed by a nurse.
(b) - (c) (No change.)
225.8. Health Maintenance Activities Not Requiring Delegation.
(a) (No change.)
(b) Task(s) qualified as HMA(s) not requiring delegation may
not be exempt from delegation in programs utilizing rotating shifts, ex-
cept when the individual client can direct the UAP in the performance
of the task(s).
(c) [(b)] If the above criteria cannot be met, an HMA may still
be performed as a delegated task if it meets the criteria of 225.9 of
this title (relating to Delegation Criteria).
225.9. Delegation Criteria.
(a) - (b) (No change.)
(c) The competency of the unlicensed person to whom the
nursing task is delegated must be adequately documented. The ver-
ification of competency may be by an individual or, if appropriate,
by experience, training, education, and/or certification/permit of the
unlicensed person.
(d) [(c)] If the RN is employed, the employing entity must
have a written policy acknowledging that the final decision to delegate
shall be made by the RN in consultation with client or client's respon-
sible adult.
225.10. Tasks That May Be Delegated.
A RN may delegate the following tasks unless the RN's assessment
under 225.6 of this title (relating to RN Assessment of the Client) and
225.9 of this title (relating to Delegation Criteria) determines that the
task is not a task a reasonable and prudent nurse would delegate. Tasks
include:
(1)- (3) (No change.)
(4) the collecting, reporting, and documentation of data in-
cluding, but not limited to:
(A) vital signs, height, weight, intake and output, cap-
illary blood and urine test;[, for sugar and hematest results]38 TexReg 8354 November 22, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 47, Pages 8313-8478, November 22, 2013, periodical, November 22, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth379965/m1/42/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.