Texas Register, Volume 38, Number 47, Pages 8313-8478, November 22, 2013 Page: 8,355
8313-8478 p. ; 28 cm.View a full description of this periodical.
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(B) environmental situations/living conditions that af-
fect the client's health status; [;]
(C) client or significant other's comments relating to the
client's care;[;] and
(D) (No change.)
(5) - (6) (No change.)
(7) ventilator care to include tracheal care and [to include]
instilling normal saline and suctioning of a tracheostomy with routine
supplemental oxygen administration;
(8) - (9) (No change.)
(10) administration of medications that are administered:
(A) - (D) (No change.)
(E) vaginal or rectal gels or suppositories;
(F) - (G) (No change.)
(11) administration of oral unit dose medications from
the client's daily pill reminder [pill] container in accordance with
225.11 [(a)] of this title (relating to Delegation of Administration of
Medications From Pill Reminder Container [and Administration of
Insulin]);
(12) administration of insulin or other injectable medica-
tions prescribed in the treatment of diabetes mellitus administered sub-
cutaneously, nasally, or via an insulin pump in [subcutaneously, nasally
or via insulin pump in] accordance with 225.12 [225.11 ,)] of this
title (relating to Delegation of Insulin or Other Injectable Medications
Prescribed in the Treatment of Diabetes Mellitus); [and]
(13) certain emergency measures as defined in 224.6(4)
of this title (relating to General Criteria for Delegation);
(14) those tasks that an RN may reasonably conclude as
safe to delegate based on an assessment consistent with 225.6 of this
title; and
(15) [(-3)] other such tasks as the Board may designate.
225.11. Delegation ofAdministration of Medications From Pill Re-
minder Container [and Administration of Insulin].
[(a)] In addition to all previous criteria listed, when delegating
the administration of oral unit dose medications from the client's daily
pill reminder container, the RN must:
(1) ensure that the unit dose medication(s) are placed in
the client's daily pill reminder [pill] container, from properly dispensed
prescription bottle(s), by the RN or a person mutually agreed upon by
the RN and client or client's responsible adult who has demonstrated
the ability to complete the task properly;
(2) instruct the client or client's responsible adult and the
unlicensed person involved in such delegation activity about each med-
ication placed in such a container with regard to distinguishing char-
acteristics of each medication, proper time, dose, route and adverse
effects which may be associated with the medication;
(3) provide to the client, client's responsible adult if ap-
plicable, and the unlicensed person(s) instructions to contact the RN
before the medication is administered when there are questions con-
cerning the medications or changes in the client's status related to the
medication being given. An example is when the medications appear
to be rearranged or missing.
(4) make supervisory visits in the event there are changes
in the client's status related to the medication being given and determine
the frequency of supervisory visits in consultation with the client or theclient's responsible adult to assure that safe and effective services are
being provided; and
(5) ensure the client or client's responsible adult acknowl-
edges in writing that the administration of medication(s) under this sec-
tion will be delegated to an unlicensed person.
b) tn addition to complying with afl pious ce a liste
Then dating administration of insulin subcutaneously, nasally or
via insulin pump the RN must:}
((t) arrange for a RN to be available on eatt for eonsulta-
tion/intervention 24 hours each dayi
f(2) provide tein of all aspects of insulin administra-
tion- subcutaneously nasall or via insulin pump to the client and the
ticsed person to ,,, bt not pr to proper diqe for
determination of the client's blood sugar prior to each administration
of insuin proper injection teenique- ri sid e effects and the correct
response(s) The RN must leave written instructions for the perfor-
mance of the administration of insulin subcutaneously, nasay or via
insulin pt mp including a eopy of the physician's order or instructions
for the unlicensed person eient, or e1ient's responsible adult to use as
a reference.]
I(3 dIel , , the administration of insulin subcutaneously
.nasat or via insulin pump to an unlicensed person, specific to one
client. The RN must teach that the administration of insulin subeuta-
neoes nasly , or via insulin pump is to be performed only for the pa-
tient for whom the instructions are provided and instruct the unlicensed
person that the task is client specific and not transferable to other clients
or providers;]
1(4) del, te the administration of insulin subcutaneously,
nasa11T or via insulin pump to additional unlicensed persons provid-
ing care to the specific client provided the registered nurse limits the
number funlicensed persons to the number who wi remain proficient
in pMf ming- the task and can be safely Superised by the registered
nurse;;4
{(75) make supervisory visits to the client's location at least 3
times within the first 60 days (one within the first two weeks one within
the second two weeks and one in the last 30 ays) to evaluate the proper
,medication administration of insulin by the unlicensed person(s7)7 After
the initial 60 days the RKN in consultation with the client or client's
responsible adult shall determine the frequency for supervisory visits
to assure the proper and safe administration of insulin by the unlicensed
persons Separate vi ts shall be made for each unlicensed person
administering i nsim
(6) make supervisory visits in the event there are changes
in the e~ient's status and}
(7) ensure that the client or client's responsible adult ae-
knowledges in writing that the administration of medication(s) under
this section will be delegated to an unlicensed person
225.12. Delegation of Insulin or Other Injectable Medications Pre-
scribed in the Treatment of Diabetes Mellitus.
In addition to all previous criteria listed, when delegating administra-
tion of insulin or other injectable medications prescribed in the treat-
ment of diabetes mellitus administered subcutaneously, nasally, or via
insulin pump the RN must:
(1) arrange for a RN to be available on call for consulta-
tion/intervention 24 hours each day;
(2) provide teaching of all aspects of insulin or other in-
jectable medications prescribed in the treatment of diabetes mellitus
administered subcutaneously, nasally, or via insulin pump to the clientPROPOSED RULES November 22, 2013 38 TexReg 8355
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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/m1/43/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.