Some facility laws do address medication refusal. The competent and appropriately trained licensed practical nurse may also perform specific assessments or screening activities, such as mental health status screening, suicidal risk screening, substance use screening, behavioral health screening, oral health screening, growth and developmental screening, neonatal abstinence syndrome scoring system, or nutritional health screening. Yes, licensed nurses (RN, LPN, or ARNP) in Washington state are required to take telemedicine training if the nurse provides telemedicine services. Commission action regarding refresher course programs. The registered nurse delegating the task retains the responsibility and accountability for the nursing care of the patient. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. [Statutory Authority: RCW 18.79.110, 18.79.260, 2012 c 164, and 2012 c 10. Any CLIA waived test involving puncturing the skin requires an order from an authorized health care practitioner. The SNF may allow the licensed practical nurse to initiate the admission assessment within licensed practical nurse's scope of practice including collecting information and data without a registered nurse on the premises with the intent that the registered nurse will complete the comprehensive assessment and care planning. Does the patient have a stable and predictable condition? It is not within the scope of a licensed practical nurse to practice independently. A non-nurse may be a supervisor of a licensed practical nurse. These procedures require a prescription from an authorized health care practitioner. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse, in performing an amniotomy, following clinical practice standards. The full name of the medication being ordered; The total amount of medication to be given in a specified time period; The order should state if the dose can be given in divided doses; The order should state if the dose can be repeated; If repeated, the order should indicate how frequently, and in what time frame; and, The order should include what action should be taken if pain is unrelieved. The patient's care plan should include details specifying actions in the POLST applies in all circumstances, including whether CPR should be initiated if a patient is choking. Telehealth may not be appropriate in some circumstances. In neonatal and pediatric services in hospitals, at least one registered nurse or physician must be trained in infant/pediatric resuscitation; in obstetrics, at least one registered nurse must be trained in neonatal resuscitation when infants are present. In an emergency it may be difficult to determine whether the family member is the legal surrogate. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Have now Craig Ritchie moves to approve the amended language for WAC 246-945-014 and authorize staff to file a CR-103 under joint authority Mitomycin C), and Bacillus Calmette-Gurin (immunotherapy) drugs. If the patient's wishes are not known, the POLST should direct care in the patient's best interest. Medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient's current medications and comparing the list to those in the patient record or medication orders. It is beyond the scope of a licensed practical nurse to independently perform training, performance appraisals, or competency validation related to nursing practice of the registered nurse or advanced registered nurse practitioner. It is not within the scope of practice for the licensed practical nurse to delegate to assistive personnel nursing tasks in the public and private, kindergarten through twelve grade school setting (RCW 28A.210 Common School Provisions: Health-Screening and Requirements). Chapter 28A.210.383 RCWprovides that the Office of the Superintendent of Public Instruction (OSPI) and school districts have the authority to develop anaphylactic policies for schools. The registered nurse delegator makes independent professional decisions of the delegation of a nursing task. RCW 18.20 Assisted Living Facilities and WAC 388-78A Assisted Living Facility Licensing Rules for more information. Reporting and recordkeeping requirements for nursing education programs. Scope of practice remains the same regardless of setting. TheInstitute for Safe Medication Practices (ISMP)is a good resource for determining whether a medication is safe to crush. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse to perform therapeutic phlebotomy for conditions, such as polycythemia vera, under the direction of an authorized health care practitioner or under the direction and supervision of a RN. The licensed practical nurse may perform some activities related to ART within the nurse's scope of practice, such as medication administration, routine laboratory testing, and basic education, under the direction of an authorized health care practitioner, or under the direction and supervision, of the registered nurse. Providing Health Care to Minors under Washington Law Summary, National Infusion Center Association (NICA), RCW 18.71.011 Definition of the Practice of Medicine, Clinical Laboratory Improvement Amendments (CLIA), NCQAC's Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinion, WAC 246-840-700 Standards of Nursing Conduct or Practice, National Council State Boards of Nursing (NCSBN) Model Act (2012), RCW 28A.600.200 Interscholastic Athletic and Other Extracurricular Activities for Students, Washington Interscholastic Activities Association (WIAA), Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinion, Public Health Nurses: Dispensing Medications/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health Advisory Opinion, Advance Care Planning Washington State Medical Association, POLST/POLST Form/POLST Brochure Washington State Medical Association, POLST Washington State Department of Health, Washington State Department of Health Overdose Education and Naloxone Distribution Webpage, Washington State Department of Health Overdose Education and Naloxone Distribution Website, Statewide Standing Order to Dispense Naloxone, Washington State Department of Overdose Education and Naloxone Distribution Website, RCW 28A.210 Common School Provisions: Health-Screening and Requirements, Suicide Prevention Training for Health Professionals Approved Courses, Washington State Department of Health Tuberculosis Website, Emergency Volunteer Health Practitioners Program, Washington State Department of Health COVID-19 Guidance for Home Care, Home Health, and Hospice Agencies, Frequently Asked Questions on Telehealth and HIPAA, Washington State Telehealth Collaborative Training webpage, Washington State Medical Professional Telemedicine Training website, Washington State Medical Professional Telemedicine Training webpage, Information for Nursing Assistant Programs, About a Nursing Assistant Training Program. It is within the scope of an appropriately prepared and competent licensed practical nurse to insert prostaglandin into the vagina for a cervical ripening or induction of labor with a viable fetus under the direction of an authorized health care practitioner, or under the direction and supervision, of the registered nurse, following clinical practice standards. An order from an authorized health care practitioner is required. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. The LPN may determine and pronounce death. The nurse should use theScope of Practice Decision Treeto determine if specific activities are within the nurse's legal and individual scope of practice. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply superficial chemical peels or microdermabrasion under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The Food and Drug Administration (FDA) approves administration by intravenous, intramuscular, or subcutaneous routes; a hand-held auto-injector (Evzio) for intramuscular or subcutaneous injection; and, in 2018, approved the first generic Naloxone Hydrochloride nasal spray. The laws and rules found in Aging and Adult Service Section ofWAC 388-78A(assisted living facilities) and388-76(adult family homes) define the qualifications required for an individual to perform the required pre-admission/resident assessment. The Licensed Practical Nurse should use theScope of Practice Decision Treeto determine if specific activities are within the registered nurse's legal and individual scope of practice. It is not within the scope of practice of a licensed practical nurse to administer or recommend OTC drugs. It may be within a licensed practical nurse's scope of practice to provide routine or basic training to UAP if the licensed practical nurse is competent under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse based on the nursing care plan. Curriculum for graduate nursing education programs. Advanced care planning is thoughtful conversations between health care professionals, the patient and/or surrogate. RCW 7.70.065(1)(c). Internationally educated registered nurse program in an approved nursing education program. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical's legal and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the registered nurse's legal and individual scope of practice. This does not mean the licensed practical nurse may not work in a pharmacy setting administering immunizations. The code, RCW 18.79.260 specifies the process as: 1. The physician rules allow delegation to a properly trained and licensed professional and require a physician to be on the immediate premises during the patient's initial treatment. The licensed practical nurse should make the decision whether or not to crush or split the medication based on patient needs, prescribing information by the provider, and safety of the medication being administered in this form. The facility can be more restrictive. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to perform pulmonary artery pressure monitoring procedures due to the complexity of the procedure. RCW 28A.210.380and28A.210.383regulations stipulate the requirements for epinephrine autoinjector use in public and private schools including the option of having a school stock supply of epinephrine autoinjectors for nurses to give following standing orders approved by an authorized health care practitioner. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to obtain a blood specimen via a capillary or venous blood sample to perform lead screening, hepatitis B screening, or other employee health laboratory tests under the direction of an authorized health care provider or under the direction and supervision of a registered nurse. Inactive and reactivating an ARNP license. The licensed practical nurse should use theScope of Practice Decision Treeto determine if specific activities are within the licensed practical nurse's legal and individual scope of practice. The nursing diagnosis drives interventions and patient outcomes, enabling the registered nurse to develop the nursing care plan. (6) "Immediate supervision" means the registered nurse delegator is on the premises, within audible and visual range of the patient and the patient assessment by the registered nurse delegator occurs prior to the delegation of duties to any care giver. PO Box 47852 Olympia, Washington 98504-7852 . Has the patient or authorized representative given consent to the delegation? In most circumstances, if the patients heartbeat stops during a witnessed choking incident or other accident, the LPN should perform first aid measures. There must be an order from an authorized provider. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. A dentist may prescribe neuromodulators (such as Botox) or dermal fillers when it is used to treat functional esthetic dental conditions and their direct esthetic consequences. Such supervision shall be adequate to prevent an unreasonable risk of harm to clients; (4)(a) Performing or attempting to perform nursing techniques and procedures for which the nurse lacks the appropriate knowledge, experience, and education and failing to obtain instruction, supervision and consultation for client safety; (b) Violating the confidentiality of information or knowledge concerning the client, except where required by law or for the protection of the client; or. Delegating specific nursing tasks as outlined in the plan of care and consistent with nursing delegation laws and rules. If the person has no pulse or becomes nonresponsive, begin cardiopulmonary resuscitation (CPR) even if the POLST indicates DNAR. STATE OF WASHINGTON . POLST should not be written as part of routine admission paperwork without medical professional involvement and extensive discussion. There is no law or rule that prohibits the licensed practical nurse from calling in medication orders except for those restrictions in the Controlled Substances Act. (c) The registered nurse and licensed practical nurse act as client advocates in health maintenance and clinical care. BOX 47864, Olympia, WA 98504-7864, Location: 111 Israel Road SE, Tumwater, WA 98501, Subscribe to receive updates from the Nursing Commission, About | News| Meeting Schedule | Contact, Nursing Care Quality Assurance Commission, Washington Administrative Code (WAC) 246-840, Neonatal Intubation and Related Procedures Advisory Opinion, Standing Orders and Verbal Orders Advisory Opinion, WAC 246-320 Hospital Licensing Regulations, WAC 246-330 Ambulatory Surgical Facilities, WAC 388-112-0260 Adult Family Homes and Assisted Living Facilities, D20-010 Assessment and Person-Centered Service Planning Process during COVID-19 Outbreak Policy (March 17, 2020), D20-028 Delivery of Skilled Nursing, Nurse Delegation, and Private Duty Nursing Services during the COVID-19 Outbreak (April 10, 2020), Medical Quality Assurance Commission WAC 246-919-606 Nonsurgical Medical Cosmetic Procedures, Dentist Scope of Practice - Use of Botulinum Toxin Injections/Dermal Fillers Interpretive Statement, Medical Quality Assurance Commission WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin, Food and Drug Administration's website, Using Eye Cosmetics Safely, NCQAC Standing and Verbal Orders Advisory Opinion, WAC 246-870 Electronic Transmission of Prescription Information, Washington State Department of Health Pharmacies website, Compounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinion, Washington State Tuberculosis Laws and Guidelines, Centers for Disease Control Guidelines for TB Screening and Follow-Up, Medication Organizer Device Letter from Secretary of Health (PDF), Food and Drug Administration Understanding Unapproved Use of Approved Drugs "Off-Label" website, Institute for Safe Medication Practices (ISMP), WAC 388-76 Adult Family Home Minimum Licensing Requirements, Washington State Department of Health Patient Rights Guidelines, Epinephrine Autoinjectors and Anaphylaxis Training and Reporting for Authorized Entities Frequently Asked Questions, NCQAC's Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion, Frequently Asked Questions for Nursing Professionals of the Prevention and Treatment of Opioid-Related Overdoses for more information, WAC 246-865-060 Pharmaceutical Services-Extended Care Facility, WAC 246-874-050 Accountability Requirements for an Automated Drug Dispensing Device (ADDD), WAC 246-840 Practical and Registered Nursing, advisory opinions and interpretive statements, WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin. The nurse shall document 2 . WAC 388-112-0260 Adult Family Homes and Assisted Living Facilitiesalso have specific requirements for CPR and first aid training. This should be noted in the POLST, or a statement should be included in the POLST with any exceptions. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse performing venipuncture to obtain blood samples for laboratory testing in any setting. The nurse providing asynchronous (store-and-forward) VDOT is not required to take the training, but NCQAC recommends all nurses take the training. The licensed practical nurse must be competent and follow the standards for medication administration. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. However, theMedical Quality Assurance Commission WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skinincludes language and requirements for physicians. It is important to consider what types of questions or discussion the patient might have when receiving test results or when a diagnosis is relayed to the patient by the nurse. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. WebChapter 246-841 WAC Nursing Assistants Chapter 246-888 WAC Medication Assistance Nurse delegation services can enhance the viability and quality of support for clients in their as appropriate, by following the rules and regulations of the Washington State Nurse Practice Act. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. 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