AGING AND DISABILITY SERVICES ADMINISTRATION
May 13, 2002
AASA: BH #2002-011
SUBJECT: NEW NURSE DELEGATION WACS
Dear Boarding Home Provider:
The requirements for Nurse Delegation were changed during the 2000 legislative session. The statutory authority that governs Nurse Delegation now includes both Chapter 18.79 Revised Code of Washington (RCW) and Chapter 18.88A RCW. As a result, the Washington Administrative Code (WAC) for Nurse Delegation, established in 1996, has been revised by the Department of Health (DOH).
The new Nurse Delegation WAC 246-840-910 through 970 became effective on January 27, 2002. These WACs and RCW 18.79.260, the section outlining nurse delegation, are enclosed. As a result of these rules, Boarding Home Interim Guideline #18: Nurse Delegation in Boarding Homes, dated February 26, 1999, is rescinded.
This letter is written to provide you with an overview of the revisions and how these changes impact boarding homes.
How do these changes affect our Boarding Home?
The new rule expands the settings in which nurse delegation may be performed
to include all boarding homes, not just those with assisted living contracts.
Does this change the way boarding homes have performed “general”
delegation under WAC 388-78A-265(3)(a), (b), (c), (d) and (e)?
Yes. The new Nurse Delegation WAC supersedes the previous “general”
delegation WAC. If your boarding home decides to offer Nurse Delegation
as an available service, you must meet the requirements of WAC 246-840-910
through 970.
What are the important features of WAC 246-840-910 through 970?
In addition to expanding community settings where nurse delegation is allowed,
the areas that directly impact the boarding home provider include the following:
- The previous list of allowed delegated tasks has been eliminated. The new WAC allows the delegating registered nurse (RN) to determine what is appropriate to delegate using professional judgment.
- Administration of medications by injection, central line maintenance (intravenous), and sterile procedures cannot be delegated.
- Individuals receiving nurse delegation must give consent prior to the delegation. Verbal consent is allowed provided that it is documented and followed up by obtaining written consent within 30 days.
- The time frame for re-evaluation and documentation by the delegating nurse has been extended to every 90 days.
- When frequency of staff turnover in the boarding home makes delegation impractical to continue in that setting, the delegating nurse has the option to rescind delegation.
Who can do nurse delegated tasks?
A nursing assistant who is either a nursing assistant-certified (NAC) or
a nursing assistant-registered (NAR) per chapter 18.88A RCW. The NAR must
have successfully completed the basic caregiver training. Both the NAR and
CNA must complete the core delegation training and have a certificate of
completion for nurse delegation issued by DSHS.
What do I do if we are having problems with nurse delegation in
our boarding home?
Report any complaints with nurse delegation to the Complaint Resolution
Unit (CRU) toll-free hotline at 1-800-562-6078. All complaints will be referred
to the nursing care quality assurance commission for investigation.
Are all boarding homes required to provide nurse delegation?
No. However, if you provide any type of nursing service in your boarding
home, consult with your registered nurse as to whether nurse delegation
would be appropriate.
Should you have any further questions about the new Nurse Delegation RCW or WAC, please contact the DOH Nursing Care Quality Assurance Commission by telephone at (360) 236-4700 or online at http://www.doh.wa.gov .
Sincerely,
Patricia K. Lashway, Director
Residential Care Services
