ENSURING QUALITY CARE
RN DELEGATION September 2019 Safety, Oversight and Quality Unit 1
PURPOSE AND KEY TERMS • Lay caregiver The purpose of this section is to help the learner understand the • Periodic inspection basics of RN delegation and the • Rescinding role and responsibilities of the • RN delegation AFH licensee when a task of nursing is delegated. • Supervisory visits • Written instructions September 2019 Safety, Oversight and Quality Unit 2
OBJECTIVES The learner will be able to: Understand the basic RN delegation process Describe why an RN must provide periodic inspection and supervisory visits Describe the role and responsibility of the lay caregiver once a task of nursing has been delegated List the types of situations or conditions when an RN may rescind a delegated task Know what documents the RN must leave at the AFH when a task has been delegated. September 2019 Safety, Oversight and Quality Unit 3
INTRODUCTION AFH residents frequently require nursing tasks such as insulin injections. RN delegation is a tool that allows a caregiver to perform a specific nursing task. Remember: • Not all nursing tasks can be delegated • It is the sole responsibility of the RN to decide if a nursing task can be delegated • RN delegation will not work in all situations September 2019 Safety, Oversight and Quality Unit 4
INTRODUCTION CONTINUED RN delegation is a process that requires a team approach between the RN and all caregivers in the AFH. While the RN is responsible for understanding the rules of RN delegation, it is important the AFH caregiver understand the delegation process as well as what to expect from an RN when a nursing task is delegated. September 2019 Safety, Oversight and Quality Unit 5
WHAT IS RN DELEGATION? RN delegation is a legally defined process that allows an RN to authorize a caregiver (non-licensed caregiver) to perform a nursing task for a resident without the RN being in the foster home each time the task is performed. • The Oregon Nurse Practice Act only authorizes the RN to delegate the performance of the physical task • The RN cannot delegate assessment or evaluation of the resident’s health status September 2019 Safety, Oversight and Quality Unit 6
IMPORTANT NOTE RN delegation requirements do not apply to family members performing nursing tasks for family members. September 2019 Safety, Oversight and Quality Unit 7
RN DELEGATION PROCESS RN delegation is a: • Specific task • For a specific resident • That sets a specific process What this means is that the RN must provide detailed written instructions for each task and each resident in each setting and observe each caregiver performing the nursing task on the resident. September 2019 Safety, Oversight and Quality Unit 8
RN DELEGATION PROCESS CONTINUED The RN can teach several caregivers about the resident’s condition at the same time. • However, for delegation to occur the RN must evaluate each individual caregiver as they perform the nursing task from start to finish. September 2019 Safety, Oversight and Quality Unit 9
RN DELEGATION PROCESS CONTINUED Types of nursing tasks that must be delegated: • There is no list of what nursing tasks must be delegated. It is the individual RN’s responsibility to determine if a nursing task can or should be delegated. The following list is a sample of common delegations that are seen in AFH settings: • Subcutaneous injections, such as insulin • Providing nutrition, fluids and oral medications through a gastrostomy tube (g-tube) or other feeding tubes • Routine trach care and suctioning • Straight urinary catheterization September 2019 Safety, Oversight and Quality Unit 10
RN DELEGATION PROCESS CONTINUED Other nursing tasks may be appropriate to delegate, however, the RN may determine a commonly delegated nursing task cannot be delegated in a specific situation. The RN is solely responsible for making the final decision as to whether the delegation of a nursing task can safely occur in your AFH. September 2019 Safety, Oversight and Quality Unit 11
RN DELEGATION PROCESS CONTINUED What cannot be delegated: • An RN cannot delegate: • Assessment, evaluation or decision making • Any nursing task if the resident’s condition is unstable or requires the RN to assess before and/or after the task is performed • The administration of intramuscular (IM) injections • The administration of intravenous (IV) medications September 2019 Safety, Oversight and Quality Unit 12
RN DELEGATION PROCESS CONTINUED Certain nursing tasks used for anticipatory emergencies cannot be delegated but are taught by an RN, pharmacist or the resident’s primary care practitioner. These include: • Glucagon for diabetics • Epi-pens for allergies September 2019 Safety, Oversight and Quality Unit 13
RN DELEGATION PROCESS CONTINUED The RN must evaluate five components of the RN delegation process before deciding if a nursing task can be delegated. 1. RN must consider: • Their own expertise with the delegation process and the nursing task being considered • If there is time to complete the delegation process in a timely manner • If the RN has the time to provide on-going supervision of the delegated nursing task(s) September 2019 Safety, Oversight and Quality Unit 14
RN DELEGATION PROCESS CONTINUED 2. The RN must evaluate the resident’s health condition related to the nursing task being considered for delegation. • The resident’s condition must be stable and predictable • To determine if the resident is stable and predictable, the RN will do a focused assessment of the resident related to the nursing task being considered • An RN cannot delegate if the resident is displaying symptoms that may be signaling a possible unknown health condition 3. The RN must determine if the task being considered for delegation is appropriate in this specific situation. September 2019 Safety, Oversight and Quality Unit 15
RN DELEGATION PROCESS CONTINUED 4. The RN must assess each caregiver individually and determine if the caregiver is: • Able and willing to perform the task (includes physical ability) • Able follow written instructions and communication; AND • Is able to routinely perform the task • The RN cannot delegate a nursing task if the lay caregiver cannot perform the nursing task frequently enough to maintain the necessary skills 5. The RN must decide if the environment where the nursing task will be performed is appropriate. September 2019 Safety, Oversight and Quality Unit 16
RN DELEGATION PROCESS CONTINUED Once the RN has decided to delegate, the RN must provide the caregiver with information before delegating the nursing task, which includes: • Basic information about the resident’s chronic condition, including why the resident needs a particular nursing task performed • Any potential risks associated with the nursing task and possible side effects the resident may experience when the nursing task is performed • Any signs and symptoms the caregiver needs to observe and/or any actions that need to be taken and documented • How to correctly perform the task September 2019 Safety, Oversight and Quality Unit 17
RN DELEGATION PROCESS CONTINUED The RN must observe the caregiver perform the nursing task from start to finish. • The RN can provide teaching about the task to several caregivers at one time, however the RN must observe each caregiver as they perform the nursing task on the resident . • Depending on the frequency of the nursing task, the RN may need to return to the AFH to finish delegating all caregivers September 2019 Safety, Oversight and Quality Unit 18
RN DELEGATION PROCESS CONTINUED The RN is required to document in the resident’s record the name of each caregiver the RN has delegated to perform the nursing task. • The RN must provide a nursing plan of care that identifies the delegation; and • Details when the RN will return to review the delegation The RN is responsible for providing clear, written step-by-step instructions including when to call 911, the resident’s healthcare practitioner and/or the RN who has delegated the nursing task. September 2019 Safety, Oversight and Quality Unit 19
RN DELEGATION PROCESS CONTINUED The RN is not on call for emergencies however, it is the AFH licensee’s responsibility to notify the RN anytime there is a change in the resident’s medical orders or condition. The RN will need to determine if the changes affect the delegated nursing task. September 2019 Safety, Oversight and Quality Unit 20
RN DELEGATION PROCESS CONTINUED Once the task has been delegated, the RN has a responsibility for on- going periodic inspection, supervision and evaluation. Oregon’s Nurse Practice Act requires the following frequencies: • A new delegation requires the RN to evaluate the lay caregiver and resident between one and sixty days from the date the nursing task was delegated. • Thereafter, the RN is required to evaluate each caregiver and resident no less than 180 days from the last visit. September 2019 Safety, Oversight and Quality Unit 21
RN DELEGATION PROCESS CONTINUED Supervision of RN delegation is limited to the delegated task and is not general supervision of the caregivers or their work. The AFH licensee and/or resident manager must routinely review caregiver records to ensure the caregivers are following the RNs directions as written. September 2019 Safety, Oversight and Quality Unit 22
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