1、Nurse Delegation in LTCSS Overview,Prepared for Pennsylvania Long Term Care Commission July 2014,Background,State policy surrounding scope of practice and allowable delegation of tasks involved in the provision of LTCSS is a complex public policy issue that involves multiple state agencies with juri
2、sdiction over regulation of professional practice, professional licensure/certification, health care policy and LTCSS service delivery and financing Establishment of nurse delegation models requires a comprehensive approach encompassing statutory and regulatory provisions as well as adequate systems
3、 and resources for training, oversight and quality assurance,Nurse Delegation,State Nurse Practice Acts establish which health maintenance tasks can be delegated to paid direct care workers providing services in a home setting. Key reasons for authorizing nurse delegation with respect to LTCSS inclu
4、de: Supporting family caregivers nurses can train family caregivers to perform tasks but if the family member is employed or away from the home for other reasons (i.e. respite), a paid caregiver often steps in to provide care Service costs costs to public funding sources such as Medicaid is reduced
5、if health maintenance task can be safely performed by direct care worker rather than a nurse,Nurse Delegation,State law and regulations governing nurse delegation typically specify:What tasks can be delegated, to whom, for whom and under what conditions Accountability, responsibility and liability p
6、rovisions Process to modify or rescind a delegation Protections and complaint process,What Tasks, To Whom, For Whom, Conditions,Provisions Specific nursing tasks that can be delegated and those that are prohibited from being delegated Nurse maintains independent professional decision making authorit
7、y over delegation of a nursing task delegation Assessment parameters and decision tree tool often provided Client Condition “stable and predictable” Care setting and circumstances Task complexity and frequency, skills required, safety and risks Skills, ability and willingness of direct care worker,A
8、ccountability, Responsibility, Liability,Provisions Nurse delegator remains responsible for the delegated nursing task and must monitor performance of the task(s) Training requirements for nurse delegators and for direct care workers Level and frequency of direct and indirect supervision of direct c
9、are worker required Regular, periodic review and reevaluation of delegations Documentation requirements Applicable liability/immunity provisions,Modify/Rescind Delegation,Provisions - Modifications Responsibility remains with original nurse delegator Nurse delegator responsible to verify modificatio
10、n with health care provider and to review and reaffirm delegation decision Provisions regarding allowing transfer of delegation to another nurse and if allowed, procedures to do so Provisions - Rescission Criteria/circumstances under which delegation can/should be rescinded Documentation requirement
11、s Nurse delegator initiates and participates in alternative plan to assure continuity of care,Protections and Complaint Process,Provisions - Protections Protections against coercion or employer reprisals related to Requiring a nurse delegator to delegate a task that they have determined in their pro
12、fessional judgment is inappropriate for delegation Direct care worker refusing to accept delegation of a task based on patient safety concerns Provisions Complaints Process to receive and investigate complaints regarding registered nurse delegators Process to receive and investigate complaints regarding performance of delegated tasks by direct care workers,16 Tasks,11-15 Tasks,6-10 Tasks,1-5 Tasks,0 Tasks,Delegation of Health Maintenance Tasks to LTSS Workers - 2014,Source: AARP, State Scorecard on Long-Term Services and Supports, 2014,
