Wa
H09-006 – Information
February 17, 2009
|TO: |Home and Community Services (HCS) Division Regional Administrators |
| |Area Agency on Aging (AAA) Directors |
| |Division of Developmental Disabilities (DDD) Regional Administrators |
|FROM: |Bill Moss, Director, Home and Community Services Division |
| |Linda Rolfe, Director, Division of Developmental Disabilities |
|SUBJECT: |Nurse Delegation for Insulin Injections and Other Diabetic Care Information |
|Purpose: |To update field staff on the process and requirements for delegating insulin injections and other diabetic care |
|Background: |Nurse delegation for insulin injections has been prohibited since the initiation of the program in 1996. In the |
| |past few years, field staff have reported numerous clients who are unable to stay in, or return to, their own homes|
| |or other community-based settings because they were unable to perform their own insulin injections and were not |
| |allowed to receive them in community-based settings. The 2008 Legislature enacted new legislation to allow the |
| |delegation of insulin injections. The new law also includes details about what can now be done without nurse |
| |delegation. |
|What’s new, changed, or |The Nurse Delegation Program RCW now allows registered nurses to delegate insulin injections. No other types of |
|Clarified |injections may be delegated. |
| | |
| |In order to be qualified to administer insulin injections, caregivers must meet the same education and registration|
| |requirements necessary for other tasks in nurse delegation. In addition, caregivers must also have a certificate |
| |for a new 3-hour training developed by DSHS called “Nurse Delegation: Special Focus on Diabetes”. This training is|
| |offered in self-study and classroom formats and will be taught by the network of community trainers and AAA |
| |staff/training contractors who already teach the 9-hour “Nurse Delegation for Nursing Assistants” class. |
| | |
| |Once the caregiver has completed the required training courses, the nurse delegator will provide one-on-one, |
| |hands-on training to specific caregivers as they deem competent to provide this task for the client needing insulin|
| |delegation. The nurse delegator is also required to supervise caregivers giving insulin injections more frequently|
| |for the first four weeks they are giving injections. |
| | |
| |The referral and payment authorization process currently used by case/resource managers/social workers for nurse |
| |delegation will not change. However, they must confirm that caregivers have completed the required training |
| |classes and are registered or certified nursing assistants before referring to a delegating nurse. Delegating |
| |nurses and case/resource managers/social workers will work in collaboration to assure that the client receives the |
| |highest quality care in a timely manner. |
| | |
| |The new law clarifies what can be done for diabetic clients without nurse delegation. |
| | |
| |RCW 18.79.260(3)(e) clarifies tasks that do not need delegation. These include: diabetic insulin device set up and|
| |verbal verification of insulin dosage for sight-impaired individuals. Insulin device set up includes inserting a |
| |medication cartridge and placing a needle on an insulin pen or “clicking” the correct insulin dose based on a |
| |written physician order for a client. This does not include drawing up insulin into a syringe which can only be |
| |done under nurse delegation. The client must be able to self inject. |
|ACTION: |None, information only. |
|Related |RCW 18.79.260(3)(e)(i-viii) |
|REFERENCES: |WAC 246-840-910 through 970 |
|ATTACHMENT(S): |Nurse Delegation handout summarizing new law: |
| |[pic] |
| |Engrossed Second Substitute House Bill 6228 (Sections 11 & 12 apply to ND): |
| |[pic] |
|CONTACT(S): |Kay Sievers, RN, Nurse Delegation Program Manager |
| |(360) 651-6828 |
| |sievek@dshs. |
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