Texas Register, Volume 38, Number 47, Pages 8313-8478, November 22, 2013 Page: 8,356
8313-8478 p. ; 28 cm.View a full description of this periodical.
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and the unlicensed person to include, but not limited to proper tech-
nique for determination of the client's blood sugar prior to each ad-
ministration of insulin or other medication, proper injection technique,
risks, side effects and the correct response(s). The RN must leave writ-
ten instructions for the performance of administering insulin or other
injectable medications prescribed in the treatment of diabetes mellitus
subcutaneously, nasally, or via insulin pump, including a copy of the
physician's order or instructions, for the unlicensed person, client, or
client's responsible adult to use as a reference;
(3) delegate the administration of insulin or other injectable
medication prescribed in the treatment of diabetes mellitus subcuta-
neously, nasally, or via insulin pump to an unlicensed person, specific
to one client. The RN must teach that the administration of insulin
or other injectable medication prescribed in the treatment of diabetes
mellitus subcutaneously, nasally, or via insulin pump is to be performed
only for the patient 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;
(4) delegate the administration of insulin or other injectable
medication prescribed in the treatment of diabetes mellitus subcuta-
neously, nasally, or via insulin pump to additional unlicensed persons
providing care to the specific client provided the registered nurse lim-
its the number of unlicensed persons to the number who will remain
proficient in performing the task and can be safely supervised by the
registered nurse;
(5) 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 days) to evaluate the proper
medication administration of insulin by the unlicensed person(s). After
the initial 60 days, the RN, 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
person(s). Separate visits shall be made for each unlicensed person
administering insulin;
(6) make supervisory visits in the event there are changes
in the client's status; and
(7) ensure that the client or client's responsible adult ac-
knowledges in writing that the administration of medication(s) under
this section will be delegated to an unlicensed person.
225.13. Tasks Prohibited From Delegation.
The following are nursing tasks that are not within the scope of sound
professional nursing judgment to delegate:
(1) physical, psychological, and social assessment, which
requires professional nursing judgment, intervention, referral, or fol-
low-up;
(2) formulation of the nursing care plan and evaluation of
the client's response to the care rendered;
(3) specific tasks involved in the implementation of the
care plan that require professional nursing judgment or intervention;
(4) the responsibility and accountability for client or
client's responsible adult health teaching and health counseling which
promotes client or client's responsible adult education and involves
the client's responsible adult in accomplishing health goals; and
(5) the following tasks related to medication administra-
tion:
(A) calculation of any medication doses except for mea-
suring a prescribed amount of liquid medication and breaking a tablet
for administration, provided the RN has calculated the dose;(B) administration of medications by an injectable route
except for subcutaneous injectable insulin or other injectable medica-
tion prescribed in the treatment of diabetes mellitus as permitted by
225.12 of this title (relating to Delegation of Administration of In-
sulin) or other injectable medication prescribed in the treatment of dia-
betes mellitus and in emergency situations as permitted by 224.6(4) of
this title (relating to General Criteria for Delegation) and 225.10(13)
of this title (relating to Tasks That May Be Delegated);
(C) administration of medications by way of a tube in-
serted in a cavity of the body except as permitted by 225.10(10) of
this title;
(D) responsibility for receiving or requesting verbal or
telephone orders from a physician, dentist, or podiatrist; and
(E) administration of the initial dose of a medication
that has not been previously administered to the client unless the RN
documents in the client's medical record the rationale for authorizing
the unlicensed person to administer the initial dose.
225.14. Supervising Unlicensed Personnel Performing Tasks Dele-
gated by Other Practitioners.
(a) The following applies to the registered nurse who practices
in a collegial relationship with another licensed practitioner who has
delegated tasks to an unlicensed person over whom the RN has su-
pervisory responsibilities. The RN's accountability to the BON, with
respect to its taking disciplinary action against the RN's license, is met
if the RN:
(1) verifies the training of the unlicensed person;
(2) verifies that the unlicensed person can properly and ad-
equately perform the delegated task without jeopardizing the client's
welfare; and
(3) adequately supervises the unlicensed person.
(b) If the RN cannot verify the unlicensed person's capability
to perform the delegated task, the RN must communicate this fact to
the licensee who delegated the task.
225.15. Application of Other Laws and Regulations.
BON 217.11(1) of this title (relating to Standards of Professional
Nursing Practice) requires RNs to know and conform to all laws and
regulations affecting their area of practice. The RN authorizing an
unlicensed person to perform tasks in independent living environ-
ments should be aware that, in addition to this chapter, various laws
and regulations may apply including, but not limited to, laws and
regulations governing home and community support service agencies
and Medicare and Medicaid regulations. In situations where a RN's
practice is governed by multiple laws and regulations that impose
different requirements, the RN must comply with them all and if in-
consistent, the most restrictive requirement(s) governs. For example,
if one regulation requires a RN to make a supervisory visit every 14
days and another leaves it to the RN's professional judgment, the RN
would have to visit at least every 14 days or more frequently, if that is
what the RN's professional judgment indicated.
The agency certifies that legal counsel has reviewed the pro-
posal and found it to be within the state agency's legal authority
to adopt.
Filed with the Office of the Secretary of State on November 8,
2013.
TRD-20130516938 TexReg 8356 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/m1/44/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.