POLICY:

This Agency will comply with the Florida Health and Safety Codes related to the Delegation of Nursing Tasks in order to ensure the health and safety of all patients receiving care and services provided by this agency.

PROCEDURE:

1. The Registered Nurse will assess the medical needs and care required by the patient.
2. The      Registered Nurse will develop the plan of nursing actions, implement the  plan, and evaluate the components of the plan.
3. The accountability for the delegation of nursing tasks is the responsibility      of the Registered Nurse
4. The  scope of delegation and the intensity of supervision may vary depending on  the setting, complexity of the task, skills of the unlicensed person, patient’s condition and his/her willingness to be involved in the management of his/her own care.
5. The agency will assure that health related services will be provided by      licensed health care professionals or unlicensed persons functioning under      the delegatory authority of the licensed professional, unless explicitly authorized.

DELEGATION IS STABLE AND CONDITIONS PREDICTABLE:

Certain tasks may be delegated when it has been determined by the Registered Nurse that the patient’s status is non-fluctuating and consistent (including settings where the deteriorating condition is expected). The patient’s medical status being stable does not require frequent reassessment by a Registered Nurse.

GENERAL CRITERIA FOR DELEGATION:

1. The Registered Nurse will consult with the client and make an assessment of the nursing care needs prior to delegation.

2. The tasks must be those that can be properly and safety performed by an unlicensed person without jeopardizing the patient’s welfare, based on the skills of the non-licensed individuals.

3. The delegated nursing task shall be a task that a reasonable and prudent nurse would find is within the scope of sound nursing judgment and practice to delegate.

4. The nursing task shall not require the delegatee to exercise independent nursing judgment or intervention.

5. The delegator shall be responsible for assuring that the delegated task is performed in a competent manner by the delegatee.

ADDITIONAL CRITERIA FOR DELEGATION:

1. The Registered Nurse delegating the task must be directly responsible for the nursing care given to the client.

2. The Registered Nurse delegating the task will follow the Agency policy & procedures for the instruction and training of Home Health Aides performing nursing tasks and 

· Will makes sure the instruction addresses the complexity of the delegated task

· Record the manner in which the unlicensed personnel demonstrates competency of the delegated task

· Maintain a mechanism for re-evaluation of the competency

· Maintain a mechanism for identifying those individuals to whom nursing tasks under this subsection may be delegated

· The Agency will make any final decision as to what nursing tasks can be safely delegated in any specific situation & will also ensure the task is within the scope of the RN’s professional judgment.

The qualified unlicensed person may administer oral and typical medications that are regularly administered by the primary caregiver based on specific instructions from the primary caregiver.

The unlicensed person must demonstrate competency based on rules approved by regulatory authorities , Medicare Conditions of Participation and to carry out gastrostomy feedings or medication administration,

These tasks will not include:

• Calculation of any medication dose
• Administration of the initial dose of a medication that has not previously been administered.
• Administer medications by any injection route
• Administer medications used for intermittent positive pressure breathing or other inhalation treatments.
• Administer medication by way of a tube inserted in a body cavity other than a permanently placed gastrostomy tube.

If respite services are required for more than fourteen (14) days and the patient requires medications administration as listed above, then the Registered Nurse must make an assessment to determine that the patient’s condition continues to be stable and that no changes in the delivery of services are required.

OTHER TASKS THAT MAY BE DELEGATED:

Collecting reporting and documentation of data including but not limited to:

• Vital signs, height, weight, intake and output, Clinitest and Hematest results.
• Change from baseline data established by the Registered Nurse
• Environmental situations
• Client and family comments related to client’s care
• Behaviors  related to the Plan of Care
• Ambulation, Positioning, Turning and normal Range of Motion
• Activities of daily living and reinforcement of health teaching planned and provided by the Registered Nurse.
• Socialization activities.
• Personal hygiene

(a) Bed bath

(b) Sponge, tub, or shower bath

(c) Shampoo, sink, tub, or bed

(d) Nail and skin care

(e) Oral hygiene

(f) Toileting and elimination (including vaginal irrigation and cleansing enemas).

Feeding, cutting up food, placing meal trays. (adequate nutrition and fluid intake)

Tasks that May Not Be Delegated:

• Sterile  Procedures
• Non-Sterile  dressing or cleansing of deep burns or penetrating wounds
• Invasive  Procedures
• Care  of broken skin

Medication Aides:

1. A Registered Nurse may delegate the      administration of medications to unlicensed persons working in the home setting when he/she holds a valid Home Health Medication Aide permit issued by the Department of Aging and Disability Services under the health and Safety Code Chapter 142.
2. The Registered Nurse must be knowledgeable regarding the rules and shall ensure that the Home Health Medication Aide is in compliance with the      statute.
3. The Registered Nurse shall make a supervisory visit while the Medication Aide is in the patient’s residence at least weekly or when any change in the medication regimen is ordered.

POLICY:

1st Choice Home Healthshall offer the Home Health Aide Competency Evaluation Program, and will only utilize Home Health Aides (herein referred to as HHA) who have satisfactorily demonstrated the ability to perform the duties and the responsibilities of the Home Health Aide. All HHA used by the agency must meet the requirements of the State and Medicare Conditions of Participation.

PURPOSE:

1. To provide safe and effective care.

2. To comply with State regulations and the Conditions and Participation.

PROCEDURE:

A. To be employed as a Home Health Aide by this agency, the HHA must meet the following requirements:

1. A minimum of one year full-time experience in direct care in an institutional setting (hospital or nursing home);

2. One year full-time experience within the last five years in direct patient care in an agency setting.

3. Satisfactorily completed a training or competency evaluation program, which complies with the requirements of the State of Florida.

4. Submitted to the agency documentation from the Director of Programs or the Dean of a School of Nursingthat states that the individual is a nursing student who had demonstrated competency in providing basic nursing skills in accordance with the school “curriculum”;

5. Be on the Florida Department of Aging and Disability Service’s nurse aide registry with no findings against HHA relating to patient abuse or neglect or misappropriation of patient property.

B. Competency Evaluation:

1. The agency’s competency evaluation shall consist of:

a. Administration of a written and/or oral test and skills, competency evaluation of the OBRA required categories:

• Communication  skills observation, reporting and documentation of patient status, and the care of the services provided reading temperature pulse and respiration.
• Basic Infection Control
• Basic elements of body functioning and changes that must be reported to the HHA  supervisor.
• Maintenance  of a clean, safe and healthy environment.
• Emergency Procedures and Recognition of Emergencies:
• Physical,  emotional and developmental needs of the population served.
• Patient’s rights
• Safety techniques in personal hygiene and grooming including:

1. Bed/bath-sponges, tub or shower

2. Shampoo-sink, tub or bed

3. Nail and skin care

4. Oral hygiene

5. Toileting and elimination

• Safety transfer techniques and ambulation, normal range of motion and positioning.
• Adequate nutrition and hydration
• Other  task as assigned by the agency

(b). The test will be administered by a Registered Nurse who is qualified according to the Conditions of Participation.

1. Two-years experience as a Registered Nurse.

2. At least-one year experience in Home Health Care.

(c). A HHA may only furnish HHA services after successfully completing a Competency Evaluation.

(d). Must achieve a passing score on the written/oral exam of 80% in all required categories.

(e). May be allowed to re-test once (answers will not be discussed prior to re-testing).

(f). Satisfactory demonstration of skills pertaining to the required OBRA categories:

Patient’s Rights, Personal Care and Hygiene, TPR, Range of Motion and Positioning, Transferring and Ambulation, Infection Control and Work Practice Controls.

(g). Home Health Aides who fail to meet the competency requirements will not be scheduled for patient visits.

(h). All Home Health Aides must successfully complete the Competency Evaluation Program Regardless of prior certification or training.

The HHA must be supervised by a qualified Registered Nurse or Therapist at least every 14 days, either on-site while the HHA is present or when the HHA is not present.