Current through Reg. 49, No. 38; September 20, 2024
(a) A
facility may allow personal care staff to perform a health maintenance activity
(HMA) for a resident, without being delegated, only if:
(1) the activity is performed for a person
with a functional disability as defined in § 553.3 of this chapter
(relating to Definitions);
(2) a
registered nurse (RN) acting on behalf of the facility conducts and documents
an assessment in accordance with subsection (b) of this section, and
determines, based on the assessment, that the activity qualifies as an HMA not
requiring delegation; and
(3) the
facility ensures and documents that all the conditions and requirements of
subsection (c) of this section are met:
(A)
the resident, the resident's legally authorized representative, or other adult
chosen by the resident, as applicable, is willing and able to direct personal
care staff to perform the task without RN supervision; and
(B) the resident, the resident's legally
authorized representative, or other adult chosen by the resident, as
applicable, is willing and able and has agreed in writing, to participate in
directing the personal care staff's actions in carrying out the HMA;
(4) the activity addresses a
condition that is stable and predictable, as defined in § 553.3 of this
chapter; and
(5) the activity is
performed for a resident who could perform the task on his or her own but for a
functional disability that prevents it.
(b) The RN conducting an assessment for
purposes of subsection (a)(1) of this section must conduct it in accordance
with Board of Nursing rules at 22 TAC §
225.6(relating
to RN Assessment of the Client).
(1) The RN's
assessment must consider each element listed in 22 TAC §
225.6,
and all relevant aspects of the resident's environment, to develop an overall
understanding of the resident's health status.
(2) In assessing each element required by
paragraph (1) of this subsection, the RN may consider strength in one element
to compensate for or offset a weakness in another element, as long as the RN
determines that all required conditions in subsection (c) of this section are
met.
(3) The RN is not required to
know the identity of the personal care staff member who will perform the
activity or his or her specific qualifications. The RN is not required to
determine the competency of the personal care staff who will perform the
activity.
(4) The RN must reassess
a resident's status in accordance with this subsection any time there is a
change in the resident's condition that may affect the resident's physical or
cognitive abilities, or the stability or predictability of the resident's
condition and, at a minimum, must reassess the resident's status:
(A) at least once annually; or
(B) at least once every six months if the
resident has been diagnosed with Alzheimer's disease or a related disorder or
resides in an Alzheimer's disease certified facility or
unit.
(c) To
meet the condition of subsection (a)(2) of this section, the RN, in addition to
conducting a resident assessment meeting the requirements of subsections (a)(1)
and (b) of this section, must determine and document that all of the conditions
listed in 22 TAC §
225.8(a)(2)
(relating to Health Maintenance Activities Not Requiring Delegation)
exist.
(d) If the RN determines
under subsection (a)(1) of this section that an activity does not qualify as an
HMA not requiring delegation, personal care staff may perform that activity for
the resident only if:
(1) the RN has
determined in accordance with 22 Texas Administrative Code (TAC) Chapter 225
(relating to RN Delegation to Personnel and Tasks Not Requiring Delegation in
Independent Living Environments for Clients with Stable and Predictable
Conditions) that:
(A) the activity can be
delegated to a personal care staff member; and
(B) the activity constitutes the medication
administration;
(2) the
RN has properly delegated the task to the personal care staff member in
accordance with 22 TAC Chapter 225 and § 553.261(a)(1)(A)(iii) of this
chapter (relating to Coordination of Care); and
(3) the medication and medication
administration requirements of § 553.261(a) of this chapter are otherwise
met.
