Missouri Code of State Regulations
Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES
Division 30 - Division of Regulation and Licensure
Chapter 84 - Training Program for Nursing Assistants
Section 19 CSR 30-84.030 - Level I Medication Aide Training Program

Universal Citation: 19 MO Code of State Regs 30-84.030

Current through Register Vol. 49, No. 18, September 16, 2024

PURPOSE: This rule sets forth the requirements for a Level I Medication Aide (LIMA) Training Program.

PUBLISHER'S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

(1) Definitions.

(A) Certifying agency-shall mean a long term care association, area vocational technical school, career center, comprehensive high school, community college, or four- (4-) year institution of higher learning approved by the Department of Health and Senior Services (the department) to issue Level I Medication Aide (LIMA) certification.

(B) Challenge the final examination-shall mean taking the final examination of the course without enrolling in and taking the entire course.

(C) Department of Mental Health (DMH) facility-shall mean a residential setting or day program funded, licensed, operated, or certified by the Department of Mental Health to provide services to persons with developmental disabilities and/or mental illness.

(D) Level I medication aide (LIMA) instructor (instructor)-shall mean a nurse approved to instruct the LIMA course.

(E) Long term care (LTC) association- shall mean a trade association with the primary purpose of representing or advocating for long-term care providers and/or professionals.

(F) Registered nurse presenter-shall mean a registered nurse approved to teach the Train the Trainer Workshops and prepare instructors to teach the LIMA course.

(G) Simulated training setting-shall mean a combined practical and verbal process that simulates all aspects of actual medication administration, including, at a minimum, reading a medication order, setting up the medication, verbally explaining how to administer the medication to a resident, and recording the administration of the medication.

(H) Train the Trainer Workshop-shall mean a training program conducted by a certifying agency to prepare instructors for the LIMA training program.

(I) Training agency-shall mean the entity that sponsors the department-approved training program.

(2) The LIMA Training Program shall be administered by the department in order to prepare individuals for employment as LIMAs in residential care facilities (RCFs) and assisted living facilities (ALFs). The program shall be designed to teach skills in medication administration by the following routes: oral, rectal, vaginal, otic, ophthalmic, nasal, topical, transdermal, buccal, sublin-gual, aerosol/nebulizer, and oral metered dose inhalers.

(3) The objective of the LIMA Training Program shall be to ensure that the LIMA will be able to define the role, limitations, and responsibilities of a LIMA; prepare, administer, and document administration of medications by those routes listed in section (2) of this rule; observe, report, and record unusual responses to medications; identify responsibilities associated with acquiring, storing, and securing medications; utilize appropriate medication reference materials; and identify what constitutes a medication error.

(4) The course shall include a minimum of sixteen (16) hours of integrated formal instruction and practice sessions directly supervised by an approved instructor and shall include a final written examination and a final practicum examination.

(5) Course Manual Requirements.

(A) The course manual must be approved by the department. A list of approved LIMA training manuals may be accessed through the department's website or by telephone at (573) 526-5686.

(B) The manual content shall include procedures and instructions in the following areas: residents' rights; fundamental human body systems; common medical terminology and abbreviations; medication classifications and their implications; observing and reporting possible medication reactions; techniques of medication administration by all routes listed in section (2) of this rule; documentation, including telephone orders, medication administration records (MARs), and leaves of absence; acquiring, storing, and securing medications; medication reference resources; and infection control.

(6) Training Agency Requirements.

(A) The following entities are eligible to be training agencies: area vocational-technical schools, career centers, comprehensive high schools, community colleges, four- (4-) year institutions of higher learning, RCFs or ALFs licensed by the department, DMH facilities, or LTC associations.

(B) The training agency is responsible for obtaining an approved instructor, providing training materials for each student, including a copy of a department-approved course manual, and presenting a class schedule for approval by an approved certifying agency.

(C) Prior to beginning the class the following information must be provided in writing to the certifying agency along with the class schedule: the approved instructor's legal name, Social Security number, nursing license number, current address, and telephone number; each student's legal name, address, telephone number, Social Security number, date of birth, and employer's name and address, if applicable; the date and location of each class to be held; and the date and location of the final examination. The certifying agency which approved the class shall be notified in advance if there are any changes in dates or locations.

(D) Training locations shall contain sufficient space, equipment, and teaching aids to meet the course objectives and accommodate the number of students.

(E) If the instructor is not directly employed by the training agency, there shall be a signed written agreement between the training agency and the instructor, which specifies the roles, responsibilities, and liabilities of each party.

(F) If the training agency is not an RCF or ALF licensed by the department or a DMH facility, the agency must have a written agreement of cooperation currently in effect with the RCF, ALF, or DMH facility where the final practicum examination portion of the course will be conducted.

(G) Within thirty (30) days following the examination date, the training agency must provide in writing to the certifying agency that approved the class the following: each student's legal name, address, date of birth, Social Security number, test booklet and test sheet, class beginning date and completion date, whether certified by a challenge or full course, and form MO 580-2531 (12/10) LIMA Examination Score Sheet (examination score sheet), incorporated by reference in this rule and available by mail at: Department of Health and Senior Services, Section for Long Term Care Regulation, Health Education Unit, PO Box 570, Jefferson City, MO 65102-0570 or by telephone at: (573) 526-5686. This rule does not incorporate any sub-sequent amendments or additions to the materials incorporated by reference. (H) Records Requirements.
1. The training agency shall maintain records for a minimum of two (2) years for those individuals who have completed the LIMA course.

2. The training agency shall provide a copy of the examination score sheet to any individual who completes the course.

3. The training agency may release an examination score sheet with written permission from the student, in accordance with the provisions of the Family Education Rights and Privacy Act of 1974, 20 U.S.C. Section 1232g.

(7) Student Requirements.

(A) Any individual employable by an RCF or ALF to be involved in direct resident care shall be eligible to enroll as a student in the course. Employable shall mean an individual who is at least eighteen (18) years of age and meets the employability criteria pursuant to the provisions of 19 CSR 30-86.042, 19 CSR 30-86.043, or 19 CSR 30-86.047.

(B) Any individual employable in a DMH facility to be involved in direct resident care shall be eligible to enroll as a student in the course. Employable shall mean an individual who meets the employability criteria pursuant to the provisions of 9 CSR 10-5.190.

(C) Individuals either enrolled in or who have been enrolled in a professional nursing school or in a practical nursing program who have completed the medication administration or pharmacology course and who have letters of endorsement from the directors of their respective programs may qualify as a LIMA by successfully challenging the final examination.
1. Those persons wanting to challenge the final examination shall submit a request in writing to the department's Health Education Unit, enclosing documentation required by this rule. If approved to challenge the examination, a letter so stating will be sent from the department to present to an approved instructor so that arrangements can be made for testing.

2. Individuals requesting approval for challenging the examination shall meet the employability criteria in subsection (7)(A) or (B) of this rule.

(D) A student shall not administer medications without the instructor present until s/he successfully completes the course and obtains a copy of the examination score sheet.

(E) Biennial Training.
1. LIMAs shall participate in a minimum of four (4) hours of medication administration training every two (2) years in order to administer medications in an RCF or ALF via the routes set forth in section (2) of this rule. The training shall be completed by the biennial anniversary date of the original issue of the LIMA certificate. The training shall be-
A. Offered by an approved instructor as outlined in section (8) of this rule; and

B. Documented on form MO 580-2973 (12/10), LIMA Biennial Training, incorporated by reference in this rule and available through the department's website or by mail at: Department of Health and Senior Services, Section for Long Term Care Regulation, Health Education Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: (573) 526-5686, and kept in the employee's personnel file. The department will also accept DMH's Medication Aide BiAnnual Training Form MO 650-8730 (12/00) incorporated by reference in this rule as acceptable documentation and available through the department's website or by mail at: Department of Health and Senior Services, Section for Long Term Care Regulation, Health Education Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: (573) 526-5686, and kept in the employee's personnel file. This rule does not incorporate any subsequent amendments or additions to the materials incorporated by reference.

2. At a minimum the training shall address the following:
A. Medication ordering and storage;

B. Medication administration and documentation;

C. Use of generic drugs;

D. Infection control;

E. Observing and reporting possible medication reactions;

F. New medications and/or new procedures;

G. Medication errors;

H. Individual rights and refusal of medications and treatments;

I. Issues specific to the facility/program as indicated by the needs of the residents and the medications and treatments currently being administered; and

J. Corrective actions based on identified problems.

3. LIMAs are responsible to ensure that the department is provided with the documentation required in subparagraph (7)(E)1.B. of this rule by the biennial anniversary date of the original LIMA certificate.
A. LIMAs who fail to submit to the department the documentation required by this rule by the biennial anniversary date of issue of their original LIMA certification will be removed from the LIMA active registry and will not be eligible to be employed as a LIMA in an RCF or ALF.

B. Any LIMA, after having been removed from the active registry for failing to provide to the department the documentation required by this rule, may be reinstated to the active registry by providing proof of a completed biennial training update at any time except any individual who has been off the active registry for more than five (5) years shall retake the course or s/he may challenge the examination if s/he meets the requirements of subsection (C) of this section.

4. LIMAs certified on or before September 30, 2012, shall have until September 30, 2014, to comply with the biennial training requirements required by this section.

(8) Instructor Requirements.

(A) An instructor shall be currently licensed to practice as either a registered nurse or practical nurse in Missouri, shall hold a current temporary permit from the Missouri State Board of Nursing, or shall hold a multi-state or single state registered nurse license from a jurisdiction that is party to the Nurse Licensure Compact. The licensee shall not be subject to current disciplinary action such as probation, suspension, or revocation and shall not be listed on the department's Employee Disqualification List (EDL).

(B) In order to be qualified as an instructor, the individual shall have had one (1) year's experience working as a nurse and shall have attended and successfully completed a "Train the Trainer" workshop to instruct the LIMA course conducted by an approved registered nurse presenter.

(C) A person who has been approved as an instructor shall have that status revoked if, after an investigation by the department or by DMH, it is found that the instructor-
1. Accepted money from a student and did not complete instruction of the class or upon successful completion of the class and final written and practicum examination did not complete the examination score sheet and provide it to the training agency;

2. Falsified information on the examination score sheet or any other required documentation;

3. Failed to administer the course in accordance with the provisions of this rule; or

4. Administered the final examination incorrectly and not in accordance with section (9) of this rule.

(D) Once an instructor's status is revoked, only the department's Section for Long Term Care Regulation Administrator or his/her designee may reinstate the individual and only after the individual has made a written request for reinstatement documenting new circumstances. If an instructor's status is revoked or reinstated, the department shall make such information available to all approved certifying agencies.

(9) Testing Requirements.

(A) The final examination shall consist of a written and a practicum examination administered by an approved instructor.
1. A department-approved written examination which includes twenty-five (25) questions based on the course objectives shall be used.

2. The practicum examination shall be conducted in an RCF or ALF licensed by the department or a DMH facility and shall include the preparation, administration, and documentation of a minimum of ten (10) medications, with no more than five (5) being oral, administered to residents by routes listed in section (2) of this rule. The practicum examination shall be conducted under the direct supervision of the instructor. Testing on routes not available in the facility shall be conducted in a simulated training setting.

(B) The final examination may be retaken one (1) time within ninety (90) days of the first fail date without repeating the course. A minimum score of eighty percent (80%) for the final written examination and one hundred percent (100%) accuracy for the practicum examination is required to pass.

(C) An individual challenging the final examination who does not successfully pass the examination during the challenge process shall be required to complete the course in order to retake the examination.

(D) The instructor shall complete the examination score sheets and provide them to the training agency within fifteen (15) days of administering the examination.

(10) Registered Nurse Presenter Requirements.

(A) A registered nurse presenter shall have the following qualifications:
1. Registered nurse licensed in Missouri or hold a multi-state or single state registered nurse license from a jurisdiction that is party to the Nurse Licensure Compact;

2. Approved LIMA instructor;

3. Has instructed at least one (1) LIMA course and conducted the final examination; and

4. Approved by a certifying agency.

(11) Certifying Agency Requirements.

(A) In order for a certifying agency to be approved by the department, the agency shall enter into an agreement of cooperation with the department which shall be renewable annually and shall carry out the following responsibilities:
1. Verify eligibility requirements and approve registered nurse presenters;

2. Administer Train the Trainer Workshops;

3. Verify eligibility requirements for the Train the Trainer Workshops' participants;

4. Provide instructors, who have successfully completed a Train the Trainer Workshop conducted by an approved registered nurse presenter, with a certificate documenting approval to teach the LIMA course;

5. Within one (1) week of issuing the LIMA instructor certificate, provide in writing to the department after each workshop held: legal names, Social Security numbers, addresses, telephone numbers, and date of birth of approved instructors. The department shall maintain a list of all instructors approved to teach the LIMA course. The list of approved instructors may be accessed through the department's website.

6. Approve training agencies' LIMA course schedules;

7. Verify that the instructor is listed on the department's LIMA-approved instructor list;

8. Verify that the instructor's nursing license is in good standing. A license search is available through the Missouri Division of Professional Registration website;

9. Review information provided by training agencies to ensure that the training program meets the requirements of the LIMA training program included in this rule;

10. Provide training agencies with the department-approved LIMA test booklets and test sheets prior to the final examination date for approved classes;

11. Issue certificates to individuals who successfully complete the LIMA course or successfully challenge the final examination;

12. Within one (1) week of issuing a LIMA certificate, provide in writing to the department the LIMA's legal name, date of birth, address, telephone number, Social Security number, class beginning date and completion date, location of practicum examination, and whether certified by challenge or full course;

13. Issue a LIMA certificate to any DMH certified Medication Aide who applies for LIMA certification, pays the necessary fee, and provides all of the documentation and identifying information required by this rule.
A. The certifying agency shall verify with DMH that the individual is on the Medication Aide registry and has maintained current biennial training updates before issuing the certificate. Verification may be made by contacting DMH; and

14. Maintain records for a minimum of two (2) years for all requirements established in this section.

(B) The certifying agency may release an examination score sheet with written permission from the student, in accordance with the provisions of the Family Education Rights and Privacy Act of 1974, 20 U.S.C. Section 1232g.

*Original authority: 198.073, RSMo 1974, amended 1984, 1992, 1999, 2006 and 198.076, RSMo 1979, amended 1984.

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