AGING AND DISABILITY SERVICES ADMINISTRATION

Washington State Nursing Care Quality Assurance Commission

RESPONSE TO REQUEST FOR ADVISORY OPINION
January 10, 2003

Question
Can a nursing assistant, registered or certified, help an individual/resident with their medications (provide medication assistance), including legend drugs, controlled substances, and over the counter preparations, in community based care settings (adult family homes, boarding homes, homes for developmentally disabled) and in-home settings?

Requesters
Department of Health (DOH) Nursing Assistant Program, Facilities and Services Licensing, and Board of Pharmacy; Department of Social and Health Services (DSHS) Aging and Disability Services Administration and Nurse Delegation Program; Home Care Association of Washington; Washington State Hospice and Palliative Care Association

Answer
Yes, nursing assistants, registered and certified, may help an individual/resident in the self-administration of their medications (medication assistance), as defined in WAC 246-888, without the supervision of a nurse.

In care settings where supervision is required for nursing assistants (registered or certified) by nurses, the nurse will supervise, direct and instruct the nursing assistant under a plan of care.

The Nursing Care Quality Assurance Commission (NCQAC) has considerable legislative authority over the scope of practice of nursing assistants. NCQAC sought legal advice and reviewed applicable statues and rules, including RCW 69.41.085, Medication Assistance - Community-Based Settings, in making its determination. WAC 246-888-010 through 246-888-110, Medication Assistance, is attached for reference. RCW 69.41.010, “medication assistance” is defined as assistance rendered by a non-practitioner. The statute further lists the professionals who are considered “practitioners.” Nursing assistants are not included in the list and thus able to function as a non-practitioner under this statute giving medication assistance as outlined.

Rationale
Individuals/residents of community based care settings and in-home settings may need assistance with self-administration of their medications, legend drugs and controlled substances, due to physical limitations and have the right to request assistance. Nurses, as practitioners, may determine if self-administration of medications with assistance is appropriate. Nursing assistants, registered and certified, and non-practitioners working in community based care settings and individual homes are acting in accordance with WAC 246-888-020 and may assist the individual/resident in the self-administration of their medications by:

1. communicating appropriate information regarding self-administration;
2. reminding/coaching the individual/resident to take a medication as prescribed;
3. reading the medication label;
4. handing the medication container to the individual/resident;
5. using an enabler or placing the medication in the hand of the individual/resident;
6. opening the medication container; and,
7. Altering or preparing medications for self administration (e.g., crushing or cutting tablets, opening capsules, mixing tablets, capsules or powdered medications with foods or liquids) with documentation of the consultation regarding the appropriateness of the alteration and preparation.

These critical concepts need to be clearly understood by all who provide self-administration of medication with assistance in community settings and individual homes:

• Administration of injections of any kind and intravenous medications by nursing assistants (registered and certified) is strictly prohibited.

• Nursing assistants (registered and certified) may not administer (including apply, instill and insert) legend drugs and controlled substances unless it is under RCW 18.79.260.
• Nothing in this advisory opinion prohibits a home health or hospice agency from including self-administration of medication with assistance (referring to a - g above) in a plan of care. An RN working for a licensed home health or hospice agency may supervise, direct and instruct the nursing assistant (registered and certified) in providing medication assistance.