Legal Nurse Consultant Job Opportunity by pje14554

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									            Alabama Department of Mental Health and Mental Retardation




                             John Houston, Commissioner
                                                                    1




9/23/2010                     Vanessa B. Prater, BSN, RN                 1
Nurse Delegation 101

Why, What, Who, How and When
of the Nurse Delegation Program
              OBJECTIVES
Upon completion, participants will know:

1.    Why DMH developed NDP
2.    What NDP requires
3.    Who is impacted by NDP
4.    How to get more information
5.    When agencies must be in compliance

9/23/2010        Vanessa B. Prater, BSN, RN   3
            WHY???

9/23/2010    Vanessa B. Prater, BSN, RN   4
            DMH AND NDP, WHY?

 Federal Law requires that State Agencies,
 such as the Department of Mental Health
(DMH), that receive Federal funds MUST be
     in compliance with all State Laws.




9/23/2010        Vanessa B. Prater, BSN, RN   5
            DMH AND NDP, WHY?
The Alabama Board of Pharmacy (ABOP) and the
Alabama Board of Nursing (ABON) direct and
control the provision, storage and administration of
medications.

Programs regulated by DMH must comply with not only
DMH regulations, but also those of the ABOP and ABON
with respect to their specific guidelines for the handling
and administration of medications by individuals
other than the consumers who receive the medications.


9/23/2010             Vanessa B. Prater, BSN, RN             6
            DMH AND NDP, WHY?
    Alabama Board of Nursing (ABON) Regulation
      Code of Alabama (1975) Section 34-21-20
                         (Statutory Law)
      Any person practicing or offering to practice
       professional/practical nursing in Alabama for
         compensation shall be required to submit
      evidence that he/she is qualified so to practice
       and shall be licensed. It shall be unlawful for
      any person not licensed to practice or offer to
         practice professional/practical nursing for
                compensation in this State.
9/23/2010            Vanessa B. Prater, BSN, RN          7
            DMH AND NDP, WHY?
       Alabama Board of Nursing Regulation
     Code of Alabama (1975) Section 34-21-26
  The Practice of professional/practical nursing by
    any person who has not been issued a license
   or whose license has been suspended, revoked
   or has expired, is hereby declared to be inimical
    to the public welfare and to constitute a public
   nuisance. The ABON may apply to any court of
   competent jurisdiction for any injunction to enjoin
   any person from practicing professional/practical
      nursing who has not been issued a license.
9/23/2010          Vanessa B. Prater, BSN, RN        8
            DMH AND NDP, WHY?
       Alabama Board of Nursing Regulation
       Administrative Code 610-X-6-.02(10)

 The RN/LPN shall accept responsibility and
  accountability for timely reporting of illegal,
      substandard, unethical, unsafe or
   incompetent nursing practice directly to
            the Board of Nursing
9/23/2010         Vanessa B. Prater, BSN, RN    9
            DMH AND NDP, WHY?
                      SB 428
     Under existing law, the ABON employs
        investigators who investigate alleged
       violations involving drugs or controlled
     substances. This bill grants investigators
     of the ABON the authority to exercise the
      powers of peace officers in investigating
      alleged violations of the Nurse Practice
       Act by persons licensed by the ABON.

9/23/2010         Vanessa B. Prater, BSN, RN   10
            DMH AND NDP, WHY?
       Alabama Board of Nursing Regulation
        Administrative Code 610-X-6-.15(1)

      The RN/LPN who provides care in
       residential community mental health
        programs certified by the ADMH is
       accountable and responsible for the
    nursing care delivered to patients in those
                     settings
9/23/2010         Vanessa B. Prater, BSN, RN   11
            DMH AND NDP, WHY?
            Alabama Board of Nursing Regulation
             Administrative Code 610-X-6-.15(2)

   RN/LPNs who provide nursing in the residential
       community mental health setting and the
    community extensions including day habilitation
   programs, may delegate specific limited tasks to
      designated unlicensed assistive personnel.


9/23/2010             Vanessa B. Prater, BSN, RN   12
            DMH AND NDP, WHY?
 Department of Mental Health Administrative
             Code Regulations

Intellectual Disabilities 580-5-32-.16
Mental Illness 580-2-12(6)
Substance Disorders 580-9-46(14)

            All require 24/7 nursing coverage
9/23/2010             Vanessa B. Prater, BSN, RN   13
            DMH AND NDP, WHY?
                ABOP and NDP

             NAKED PILL SYNDROME

                                Carter English, R. Ph.




9/23/2010         Vanessa B. Prater, BSN, RN        14
            DMH AND NDP, WHY?
                 ABOP and NDP
Pillboxes
Blister Packs – type (labeled at top; each blister
  labeled
Stock medications
OTCs
Controlled Substances
Current Pharmaceutical Companies assisting with
  NDP Requirements
9/23/2010         Vanessa B. Prater, BSN, RN     15
             DMH AND NDP, WHY?
New DMH NDP Administrative Code Regulations
     Anticipated completion:   2009

Will address at a minimum the 4 components of
                       NDP:
         Administrative Requirements
              Education/Training
               Quality Assurance
                  Compliance

 9/23/2010        Vanessa B. Prater, BSN, RN    16
            WHAT???

9/23/2010    Vanessa B. Prater, BSN, RN   17
                ACRONYMS
NDP –       Nurse Delegation Program
DMH –       Department of Mental Health
MAC –       Medication Assistant Certified
            Unlicensed Nursing Individuals

MAS –  Medication Assistance Supervisor
       (RN/LPN)
MATT – Medication Assistance Train-
       The-Trainer (RN ONLY)
9/23/2010            Vanessa B. Prater, BSN, RN   18
            ACRONYMS



MAR – Medication Administration Record




9/23/2010     Vanessa B. Prater, BSN, RN   19
               Definitions
Delegation

The act of authorizing a competent
individual to perform acts supportive to
RN/LPNs in selected situations.

                  ABON Administrative Code

9/23/2010       Vanessa B. Prater, BSN, RN   20
               Definitions
Competency

Outcomes assessed through academic
standing, clinical performance and
certification examination that demonstrates
the ability to perform a particular task.


9/23/2010       Vanessa B. Prater, BSN, RN    21
               Definitions
Supervision

Periodic monitoring by direct observation on
site, by the MAS Nurse to visualize MAC
Workers’ skill and ability to perform
delegated task(s).


9/23/2010       Vanessa B. Prater, BSN, RN   22
                      LPN Supervision
610-X-6-.04 Practice of Practical Nursing

     (1) The practice of practical nursing includes, but is not limited to:

            • (a) Acts designed to promote and maintain health;

            • (b) Prevention of illness and injury;

            • (c) Provision of care using standardized procedures including
              administering medications and treatments under the direction of a
              licensed professional nurse or a licensed or otherwise legally
              authorized prescriber; and


            • (d) Exercise of appropriate nursing judgment.

9/23/2010                       Vanessa B. Prater, BSN, RN                        23
                Supervision


    Physically present or accessible within a
     reasonable time to the immediate area
    and is available to intervene if necessary




9/23/2010         Vanessa B. Prater, BSN, RN   24
                     Definitions
Self Administration

A consumer can self administer if he/she is
able to:
     – Recognize medication(s)
     – Understands purpose/reason for taking the of
       medication(s)
     – Ability to report major side effects and knows when to
       notify nurse, doctor, etc.
            (RN MUST PERFORM ASSESSMENT)

9/23/2010              Vanessa B. Prater, BSN, RN           25
            Consumer Assessment

                 Self Administration
             Limited Self Administration
             Unable to Self Administer




9/23/2010           Vanessa B. Prater, BSN, RN   26
               Definitions
Drug/Medication
Substances recognized as drugs in the
official US pharmacopoeia….

Substances intended for use in the
diagnosis, cure, mitigation, treatment or
prevention of disease in man or animals

9/23/2010       Vanessa B. Prater, BSN, RN   27
               Definitions
Drug/Medication

Substances other than food intended to
 affect the structure or any function of the
 body of man or animals

                    Code of AL Section 20-2-2

9/23/2010       Vanessa B. Prater, BSN, RN     28
               Definitions
Medication Administration
Removal of an individual dose of
medication, from a previously dispensed,
properly labeled container, verifying it with
the M.D./CRNP’s order, giving the individual
dose to the proper consumer at the proper
time by the proper route and promptly
recording the time and dose given.
9/23/2010       Vanessa B. Prater, BSN, RN   29
                 Definitions
Administer

The direct application of a controlled
substance, whether by injection, inhalation,
ingestion or any other means to the body of
a recipient.

            Administrative Code Section 20-2-2
9/23/2010         Vanessa B. Prater, BSN, RN   30
                 Definitions
    Assisting with Medication Administration

             Helping the consumer
     with one or more steps in the process of
             administering medication




9/23/2010         Vanessa B. Prater, BSN, RN    31
               What is NDP?
     The Nurse Delegation Program (NDP) was
     developed by the Department of Mental Health
     (DMH), with guidance from the Alabama Board
     of Nursing (ABON), in response to changes
     made to the Alabama Nurse Practice Act, which
     allows non-licensed persons to assist with
     medication administration in residential
     programs, day programs and other community
     extensions in programs regulated by DMH.

9/23/2010          Vanessa B. Prater, BSN, RN    32
             What is NDP?

   The NDP defines the respective authority
   and responsibility for agencies and nurses
       related to delegation of medication
    administration in DMH certified programs.




9/23/2010        Vanessa B. Prater, BSN, RN   33
            What is NDP?

NDP is managed by the DMH in conjunction
      with the ABON to assure that all
   individuals who receive services from
  programs certified by the DMH receive
              appropriate care.



9/23/2010     Vanessa B. Prater, BSN, RN   34
            What is NDP?
“Consumers have a right to health care that
meets legal standards of care regardless of
the setting. The Safety and well-being of the
consumer must be the central focus of all
decisions regarding delegation of nursing
tasks to MAC Workers (unlicensed
personnel)”
                              NCSBN, 1997
9/23/2010       Vanessa B. Prater, BSN, RN   35
             What is NDP?

  “Let whoever is in charge keep this simple
       question in her head, not, how can I
    always do this right thing myself, but how
      can I provide for this right thing to be
                  always done”?
                           Florence Nightingale


9/23/2010        Vanessa B. Prater, BSN, RN   36
                  What is NDP?
             • Four Components of the NDP
•   1.      Administrative Requirements
•   2.      Education/Training
•   3.      Quality Assurance
•   4.      Compliance




9/23/2010            Vanessa B. Prater, BSN, RN   37
     Administrative Requirements
   There is both individual accountability and
   organizational accountability for delegation.

   Organizational accountability relates to providing
   sufficient resources, staffing, appropriate staff
   mix, implementation of policies and position
   descriptions, opportunity for continuing
   education and creating an environment
   conducive to teamwork, collaboration and client-
   centered care.

9/23/2010          Vanessa B. Prater, BSN, RN       38
     Administrative Requirements
   The organization is accountable for
   assuring that documentation of
   competencies for ALL personnel is
   maintained
   The organization is responsible for the
   development and enforcement of policies
   on delegation with active participation from
   nurses

9/23/2010        Vanessa B. Prater, BSN, RN   39
     Administrative Requirements
   Organizations are responsible for assuring
   that educational needs/requirements are
   met through the implementation of the
   NDP

   Organizations are responsible for assuring
   compliance with all DMH Regulations


9/23/2010        Vanessa B. Prater, BSN, RN   40
            Personnel Issues
MAC Workers Must :
• Have a HS Diploma/GED
• Be responsible
• Be able to read with understanding
• Be knowledgeable of agency operations
• Be respectful
• Be able to work independently
• Be able to monitor consumers
9/23/2010      Vanessa B. Prater, BSN, RN   41
            Personnel Issues
MAS Nurse Must:
• Be an LPN/RN in good standing
• Attend MAS Training and pass competency test
• Understand disease and symptoms
  management related to MI/MR/SA
• Be able to teach and supervise others
• Practice according to the Nursing Standards of
  Practice
• Practice within the NDP guidelines
9/23/2010        Vanessa B. Prater, BSN, RN    42
            Documentation
Job Descriptions
Training – MAC, MAS, MATT
Supervision – MAC, LPN
MAR
Communications
Observations/Actions
Self Administration Assessment

9/23/2010      Vanessa B. Prater, BSN, RN   43
               Documentation


            IF IT IS NOT DOCUMENTED;
                 IT WAS NOT DONE!




9/23/2010          Vanessa B. Prater, BSN, RN   44
            Policies and Procedures
• Compliance with ABON Regulations
• Compliance with NDP
• Documentation – MAR, communications,
  observation, actions
• MAC Supervision – quarterly
• LPN Supervision
• Training and Updates – MAC, MAS
• Self Administration Assessment - annually
9/23/2010          Vanessa B. Prater, BSN, RN   45
            Policies and Procedures
• How to handle medications when on home
  visits, MD visits, trips
• How to handle telephone orders
• Reporting a Nurse to the NDP
  Director/ABON
• Medication Errors – documentation,
  reporting
• Medication security/disposal
9/23/2010          Vanessa B. Prater, BSN, RN   46
     Administrative Requirements


   The DMH Certification Process includes
   NDP Regulations. Certification Surveyors
   will assess compliance with NDP
   Regulations.



9/23/2010       Vanessa B. Prater, BSN, RN   47
            Education and Training
                    MAC Worker
24 hours of training
12 hours Level I – classroom education
Take a written test and pass with 90%
Three attempts

12 hours Level ll – assessment of competencies

4 hours update/refresher annually

9/23/2010         Vanessa B. Prater, BSN, RN     48
            Education and Training
                  MAS RN/LPN

   Any RN/LPN licensed in Alabama,
   employed or contracted by an Agency
   certified by DMH is eligible for training and
   certification as a MAS Nurse



9/23/2010         Vanessa B. Prater, BSN, RN   49
            Education and Training
                    MAS RN/LPN
A four (4) hour training program, taught by a MATT
RN is required

The RN/LPN must pass a written test with a score
of 90 or better

Three (3) attempts to pass written test

Certification updated every two (2) years

9/23/2010         Vanessa B. Prater, BSN, RN       50
            Education and Training
                          MATT RN
RN ONLY

At least one (1) year residential/community experience

Specific trainers certified by the DMH to train MAS
Nurses

Must complete a self study module and take a written test
passing with a score of 90 or better


9/23/2010            Vanessa B. Prater, BSN, RN             51
            Education and Training
                MATT RN
Two attempt to pass test

Update every two (2) years

Appointed to DMH NDP Advisory Council


9/23/2010         Vanessa B. Prater, BSN, RN   52
            Education and Training

                   NEXT SCHEDULED MAS TRAINING
                             JANUARY 2009
              (Watch for announcement of date and location)



               NEXT SCHEDULED MAS UPDATE TRAINING
                  DECEMBER 5, 2008 – Montgomery
                  DECEMBER 17, 2008 – Tuscaloosa
                     JANUARY 14, 2009 - Mobile




9/23/2010              Vanessa B. Prater, BSN, RN             53
            Education and Training


    2nd Annual Update for MAC Workers due
             prior to April 1, 2009




9/23/2010         Vanessa B. Prater, BSN, RN   54
            Quality Assurance
                Medication Errors
   A medication error occurs when the
   correct/incorrect recipient receives an
   incorrect drug, dose, form, quantity, route,
   at the incorrect time.

   Failure to administer a drug (missed dose)
   at the scheduled time constitutes a
   medication error
9/23/2010        Vanessa B. Prater, BSN, RN   55
            Quality Assurance
                 Medication Errors
   Medications may be given one (1) hour before
   OR one (1) hour after the scheduled/ordered
   time. Administration within this acceptable
   range does not constitute a medication error.

   Medication errors by licensed and unlicensed
   personnel must be reported to the DMH.


9/23/2010         Vanessa B. Prater, BSN, RN       56
             Quality Assurance
            Severity of Medication Errors

   Level I – incidents in which the recipient
   experienced NO or MINIMAL adverse
   consequences AND NO TREATMENT or
   INTERVENTION other than monitoring or
   observation was required.


9/23/2010           Vanessa B. Prater, BSN, RN   57
             Quality Assurance
            Severity of Medication Errors

   Level II – incidents in which the recipient
   experienced SHORT TERM,
   REVERSIBLE adverse consequences
   AND
   TREATMENT(S)/INTERVENTION(S) in
   addition to monitoring and observation
   was required.
9/23/2010           Vanessa B. Prater, BSN, RN   58
             Quality Assurance
            Severity of Medication Errors

   Level III – incidents in which the recipient
   experienced LIFE THREATENING and/or
   PERMANENT adverse consequences




9/23/2010           Vanessa B. Prater, BSN, RN   59
              Quality Assurance
            ABON DATA REQUIREMENTS

    # of programs with 24/7 on call coverage

       Programs that participate in NDP
    Programs that do not participate in NDP
          Programs with Nurses 24/7
         Programs with Nurses on call
9/23/2010         Vanessa B. Prater, BSN, RN   60
              Quality Assurance
            ABON DATA REQUIREMENTS

 Method used to comply with 24/7 coverage
                 Turnover
                 Training
            Medication Errors
         Areas of non-compliance
   How non-compliance was addressed
9/23/2010         Vanessa B. Prater, BSN, RN   61
     Data Collection Suggestions

        Nurse Case Load (#MAC/MAS)
           #Calls received after 5P
    #Calls received on weekends/holidays
                Times of Calls
               Location of calls
   #Self Medication Assessments completed

9/23/2010       Vanessa B. Prater, BSN, RN   62
               Compliance

   ABON requires that the DMH provide an
   Annual Report addressing the required
   data

   Failure to comply with all NDP Regulations
   may result in decertification

9/23/2010        Vanessa B. Prater, BSN, RN   63
                    MAR
• All medications must be listed on the MAR
• The MAR must be recopied by a licensed
  nurse if not pre printed by the pharmacy
• MAC Workers CANNOT change, add or
  deleted any medications from the MAR
• MAC Workers CANNOT take verbal
  orders

9/23/2010      Vanessa B. Prater, BSN, RN   64
                  PRNs
• MAC Workers CAN give PRNs
• MAC Workers MUST call the MAS Nurse
  prior to giving a PRN
• Effectiveness of the PRN MUST be
  documented
• MAS Nurse MUST be notified of outcome



9/23/2010     Vanessa B. Prater, BSN, RN   65
            WHO???

9/23/2010    Vanessa B. Prater, BSN, RN   66
            Who is Impacted?

   This regulation applies to any DMH
   certified residential program, day
   programs and/or other community
   extensions that provide services to minors
   UNLESS ALL medications are
   administered by nurses licensed in the
   State of Alabama

9/23/2010       Vanessa B. Prater, BSN, RN   67
            Who is Impacted?
   This regulation applies to any DMH
   certified residential program, day
   programs and/or other community
   extensions that provide services to
   individuals who are unable to self
   medicate as defined and assessed by a
   RN according to NDP guidelines.


9/23/2010       Vanessa B. Prater, BSN, RN   68
            Who is Impacted?

   This regulation does not apply to
   programs where ALL INDIVIDUALS SELF
   MEDICATE as defined and assessed by
   an RN as required by NDP




9/23/2010       Vanessa B. Prater, BSN, RN   69
            Who is Impacted?

   This regulation does not apply to
   individuals residing at home and receiving
   CARE FROM FAMILY/SIGNIFICANT
   OTHER(S)




9/23/2010        Vanessa B. Prater, BSN, RN   70
            HOW???

9/23/2010    Vanessa B. Prater, BSN, RN   71
    How can I get a MAS Nurse?
            Employ a RN/LPN licensed in Alabama

            Discuss Delegation with the nurse and
                 review Position Description

     Contact me for training dates and scheduling
                   (334)242-3217

             Contact me with problems/questions
              Vanessa.Prater@mh.alabama.gov

9/23/2010              Vanessa B. Prater, BSN, RN   72
    How can I get more information?
                 DMH Website
             www.mh.alabama.gov
             Click on the NDP link
                      OR
CONTACT:      Vanessa B. Prater, BSN, RN, Director,
              Nurse Delegation Program
              RSA Union Building
              100 S. Union Street
              P. O. Box 301410
              Montgomery, AL 36130-1410
              (334)242-3217 Office
              Vanessa.Prater@mh.alabama.gov

9/23/2010      Vanessa B. Prater, BSN, RN         73
            How can I get Technical
                 Assistance?
CONTACT:
              Vanessa B. Prater, BSN, RN,
              Director, Nurse Delegation Program
              RSA Union Building
              100 S. Union Street
              P. O. Box 301410
              Montgomery, AL 36130-1410
              (334)242-3217 Office

              Vanessa.Prater@mh.alabama.gov


9/23/2010            Vanessa B. Prater, BSN, RN    74
                 ABON
Practice Consultant
• Carolyn Morgan, MSN, RN
  cmorgan@abn.state.al.us

Executive Officer
• Genell Lee, MSN, RN, JD
  Genell.Lee@abn.alabama.gov

9/23/2010     Vanessa B. Prater, BSN, RN   75
            WHEN???

9/23/2010    Vanessa B. Prater, BSN, RN   76
       When do I have to comply?



              NOW!

9/23/2010      Vanessa B. Prater, BSN, RN   77
            Historical Overview

• Regulation initially effective: December 05
• Program Development/Training:
              • Jan 06-Apr 1, 07
• Full Implementation began: April 1, 07
• Certification Compliance:       Nov 1, 07


9/23/2010        Vanessa B. Prater, BSN, RN   78
            QUESTIONS




9/23/2010    Vanessa B. Prater, BSN, RN   79

								
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