Md. Code Regs. 10.27.11.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.27.11.05 - Nursing Functions

A. The following nursing functions require nursing knowledge, judgment, and skill and may not be delegated:

(1) The nursing assessment including, but not limited to, the admission, shift, transfer, or discharge assessment;

(2) Development of the nursing diagnosis;

(3) The establishment of the nursing care goal;

(4) Development of the nursing care plan;

(5) Evaluation of the client's progress, or lack of progress, toward goal achievement; and

(6) Any nursing task which requires nursing knowledge, judgment, and skill.

B. The nurse may delegate treatments of a routine nature if:

(1) The licensed nursing staff of the specific unit of care has identified the function as being routinely performed;

(2) The specific treatments are performed at a high frequency necessary to retain competency;

(3) The treatment has an inherently low risk to the client; as determined by weighing the following factors:

(a) Type of equipment utilized to perform the function;

(b) Nurse staffing ratio that allows for close supervision;

(c) Basic educational preparation of the unlicensed individual or certified nursing assistant performing the delegated function; and

(d) Knowledge and skill set of the nurse delegating and supervising the delegated function; and

(4) There is a quality assurance mechanism in place to assure the function is performed safely and client outcomes meet accepted professional nursing standards including, but not limited to:

(a) An ongoing formalized documented performance appraisal mechanism designed to assure that unlicensed individual or certified nursing assistant's revalidation of continued competency is a component of the quality assurance mechanism; and

(b) Client outcomes meeting accepted professional standards, as reflected by:

(i) Infection rates;

(ii) Rates of adverse events;

(iii) Error rates; and

(iv) Patient satisfaction surveys.

C. The nurse may delegate the obtaining of specific information to an unlicensed individual or certified nursing assistant.

D. When implementing the plan of care, the nurse may delegate a nursing task to an unlicensed individual or certified nursing assistant after the nurse has completed a client assessment and when the delegation of that task does not jeopardize the client's welfare.

E. The nurse may delegate the responsibility to perform a nursing task to an unlicensed individual if:

(1) Acceptance of the delegated nursing task does not become a routine part of the unlicensed individual's job duties; or

(2) An unlicensed individual merely provides assistance with activities of daily living unless the client's needs are such that adverse health consequences are predictable.

F. Administration of medication is a nursing function. As such, the nurse retains full responsibility for medication administration.

G. The following activities related to medication administration may not be delegated except as provided in §H of this regulation:

(1) Calculation of any medication dose;

(2) Administration of medications by injection route;

(3) Administration of medications by way of a tube inserted in a cavity of the body; and

(4) Administration of medication by intravenous route.

H. Delegation of Medication Administration.

(1) The administration of medication as listed in §H(3) of this regulation may be delegated to certified medicine aides and medication technicians only in compliance with §H(2) of this regulation and when clients meet the requirements of Regulation .03F or .04D of this chapter in the following situations:

(a) Supervised group living settings;

(b) Supervised or sheltered work settings;

(c) Independent living settings;

(d) Schools;

(e) Correctional institutions;

(f) Hospice care;

(g) Adult medical day care centers; and

(h) Child care centers established for children with health or medical conditions or both.

(2) A nurse may delegate to a medication technician or certified medicine aide under this section when:

(a) The nurse has provided instruction and direction; and

(b) The medication technician or certified medicine aide is on site in the unit of care on a continuing basis to:

(i) Monitor the therapeutic effects of the medication;

(ii) Observe, record, and report untoward effects of the medication;

(iii) Perform monitoring procedures required for each medication;

(iv) Observe for changes in the individual client's behavior and clinical status;

(v) Record and report the changes observed to the delegating nurse; and

(vi) Withhold administration of the medication.

(3) A nurse may delegate administration of the following medications to a medication technician or a certified medicine aide according to Regulations .03F, .04C, and .05H(1) of this chapter:

(a) Medication by metered dose inhalant, nebulizer, and oxygen by nasal cannula or mask;

(b) Medication by gastrostomy tube or rectal tube if the nurse has calculated the dosage;

(c) Oral medication, including:

(i) Measuring as prescribed an amount of liquid medication where the nurse has calculated the dose; and

(ii) Administering a fraction of a tablet if the nurse has cut the tablet;

(d) Medication by subcutaneous injection if the nurse has calculated the dose;

(e) Medication administered by topical route excluding stage III and IV pressure ulcers and wound care;

(f) Medication administered by suppository route;

(g) Medication drops administered by routes involving eye, ear, and nose; and

(h) Where the registered nurse makes an on-site visit at least every 7 days to assess the client status and the performance of the medication technician's or certified medicine aide's administration of topical medication to stage three or four pressure ulcers or wounds.

Md. Code Regs. 10.27.11.05

Regulations .05 amended as an emergency provision effective February 5, 1992 (19:4 Md. R. 468); emergency status expired August 7, 1992
Regulations .05 amended permanently effective August 8, 1992 (19:11 Md. R. 1015)
Regulations .05 amended effective July 4, 1994 (21:13 Md. R. 1158)
Regulations .05 adopted effective May 10, 2004 (31:9 Md. R. 712)
Regulation .05 amended effective February 28, 2005 (32:4 Md. R. 411); January 26, 2009 (36:2 Md. R. 101)
Regulation .05H amended effective September 19, 2011 (38:19 Md. R. 1147)