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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