On December 4, the Agency for Health Care Administration (AHCA) presented a webinar to help answer some of the questions that were received and not easily answered during the AHCA Joint Training for Assisted Living Facilities. The update was given that the Department of Elder Affairs (DOEA) rule making process that was challenged concerning 58A-5 is still in litigation, so AHCA is enforcing the rule that went into effect on May 10, 2018, until settled.
Questions arose from the new extended assistance with self-administration of medication duties. The trained, unlicensed staff member must read the medication label aloud; however, it is not necessary to read items such as the address of the pharmacy that dispensed the medication. The intent of the rule is to reduce medication errors and to have the resident participate in the process of taking his or her medications. Reading the medication label aloud should focus on the right resident, right medication, right dosage, right time and right route to have the resident participate in safe assistance with self-administration of medication.
In the process of assistance with self-administration, a resident whose ordered medication requires it be given by a nebulizer must have it observed by a trained staff who has completed the additional two hours of training that are specific to the added skills which took effect May 10, 2018, for this to be accomplished. It was clarified that the staff member must stay with the resident during the medication being delivered via nebulizer to meet the requirement of observing the resident taking his/her medication. This will require a staff member to spend 10-15 minutes with the resident while this process takes place. Note that if you have a significant number of residents with orders that require nebulizers, this could greatly impact the ability to assist residents in a specific time frame. Consider this for staffing purposes to meet resident needs.
One theme mentioned several times during the webinar was that the resident must be a participant in the assistance with self-administration of medications. This would include a resident who is declining. Evaluations must be done when a resident’s health is changing to determine if a resident needs administration of medications by a licensed nurse or if the unlicensed staff member can continue to assist.
A clarification was made as to whether a hold or waive order be written to remove the requirement of reading a medication aloud for a resident. The simple answer to the question is “No.” The requirement is written in the statute and a physician’s order cannot override the statute requirement to read a label aloud for assistance with medications with an unlicensed staff member. While some residents with a diagnosis of dementia are resistant to medications, that does not change the requirement. This clarification will cause you to review the residents under your care to ensure accurate placement in your facility.
If a resident has sliding scale insulin, the assist can be done by a trained unlicensed staff member if the correct orders are in place and the resident is doing his or her part.
429.256 (4) (g)(h) states – Assistance with self-administration does not include:
(g) Medications ordered by the physician or health care professional with prescriptive authority to be given “as needed,” unless the order is written with specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent resident.
(h) Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person.
Therefore, obtaining clarification of a sliding scale order related to the glucometer reading might be necessary to ensure the parameters are clear and appropriate for an unlicensed staff member to assist.
Regarding over-the-counter (OTC) medications provided from the facility as a stock supply, ensure the staff keep the medications securely locked so when a competent resident asks for an OTC, it is provided and documented. It is not for the staff to provide judgment about whether or not a resident needs an OTC medication. Additionally, it’s not required for a facility to provide a stock of OTC medications, but there are provisions for it in 58A-5.0185(8) FAC.
Another area clarified related to background screening requirements. The question was whether facilities were required to have background screens for contractors and outside vendors doing work on the building or the property (such as maintenance, construction, etc.) since they may have access to residents or resident living areas? The answer was clarified by referencing 408.809 which states, “Any person, as required by authorizing statutes, contracting with a licensee or provider whose responsibilities require him or her to provide personal care or personal services directly to clients, or contracting with a licensee or provider to work 20 hours a week or more who will have access to client funds, personal property, or living areas. Evidence of contractor screening may be retained by the contractor’s employer or the licensee.
While the webinar helped clarify several areas of the Rule, more questions may come up in the future. If your facility has a circumstance that unclear, make sure to contact the right people, be it FHCA, AHCA, your legal counsel or clinical advisor, for example – and review the right regulation to get the correct answer.