State Laws and Regulations Specific to Dialysis: An Overview

1 NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 131 State laws and Regulations Specific to Dialysis: An OverviewCathleen O KeefeCathleen O Keefe, JD, RN,is Executive Director, Regulatory, Government Affairs, and Compliance, Spectra, Laboratory Division of Fresenius at Fresenius MedicalCare North America, Lexington, : The author would like to thank Kasia Januszewski Bartos, Esq., and Mary B. Snyder, MA, JD, Regulatory Affairs Manager, both of Fresenius MedicalCare North America, for conducting much of the initial State -by- State research on which this final document is based. Disclaimer: The information contained in the document is limited to the information published on Board of Nursing (BoN) websites, BoN advisory opinions, and the acces-sibility of other communications, rules and Regulations .

2 It is intended as a general reference tool to facilitate State - Specific research, is current only through December 2004, doesnot constitute legal advice, and should not be used as a substitute for review of the actual statutes and Regulations governing scope of practice in any : Copyright 2005, Fresenius Medical Care North America. Published with permission in Nephrology Nursing Journal, Volume 32, Number 1, pages 31-37. The renal community has longhad need for a thorough com-pilation of information on lawsand Regulations Specific to dial-ysis on a State by State basis to guidethe clinical practice of dialysis and forcompliance purposes. In recognitionof that need, Fresenius Medical CareNorth America (FMCNA) undertookthe process of gathering such informa-tion.

3 The final product has beenoffered to the community throughthe American Nephrology Nurses'Association since much of the infor-mation relates to the scope of practiceand delegation authority of registerednurses and the licensed practical/voca-tional nurses and unlicensed dialysistechnicians they supervise. FMCNAhas made a commitment to update thisinformation on a regular basis for pub-lication annually. ANNA is grateful toFresenius for this contribution to toAdministerHeparin andSalineDialysisTechnicianLegislationDi alysis FacilityLegislationDelegation authority of RNs/Limitations on LPN/LVNs or UAPALABAMAALASKAARKANSASARIZONACALIFORNI ANONONOYESYESNONONOYES Included with facility licensurelawYESCON and LicensureLicensureLicensureTasks that may not be delegated to UAPinclude administration of medications.

4 Limitson IV therapy by LPN - no direct IV tasks that shall not be delegated fromRNs to LPNs include Administer IV pushmedications RNs Only. tasks that shall not be Administration of any medications or IV thera-py, including blood or blood products. technician certification through anational organization (NANT) or have comple-tion of minimum training hemodialysis technician traineesmay administer local anesthetic, anticoagu-lants, or replacement , administration of local anesthet-ics, heparin, and sodium chloride solutionsallowed for technicians. Certification may not access central line NURSING JOURNAL January-February 2005 Vol. 32, No. 132 State laws and Regulations Specific to dialysis : An OverviewStatePCTsAllowed toAdministerHeparin andSalineDialysisTechnicianLegislationDi alysis FacilityLegislationDelegation authority of RNs/Limitations on LPN/LVNs or UAPCOLORADOCONNECTICUTDELAWAREDISTRICT ofCOLUMBIA FLORIDAGEORGIAHAWAIIIDAHOILLINOISNo ExpressProhibitionNONONo ExpressProhibitionNo HeparinYes SalineNo HeparinYes SalineNo ExpressProhibitionNONONOYESNONONONONONOL icensureLicensureCONL icensureCONNOL icensure lawpassed; no rules promulgatedBroad delegation requirements include 50% licensednurses.

5 PCTs may initiate, monitor, and terminate dialysis by RNs only. RNs may not dele-gate administration of meds to of Practice for LPNs includes adminis-tering RN delegation for Healthcare Administration positionstatement prohibits heparin training program for hemodialysisPCTs. National certification exam notrequired. LPNs required to meet the sametraining and competency requirements # delegation of IV meds unless criteria fordelegation is met. delegation thedelegating RN shall teach UAP special tasksof nursing care and verify the UAP s compe-tency to perform the tasks. not delegate to UAPs preparation oradministration of injections, or start, stop, oradjust any IV : The transfer of responsibility forthe performance of selected tasks by the reg-istered nurse (RN) to qualified, competentassistive personnel in a selected situation,based upon the RN s plan of NURSING JOURNAL January-February 2005 Vol.

6 32, No. 133 StatePCTsAllowed toAdministerHeparin andSalineDialysisTechnicianLegislationDi alysis FacilityLegislationDelegation authority of RNs/Limitations on LPN/LVNs or UAPINDIANAIOWAKANSASKENTUCKYLOUISIANAMAI NEMARYLANDNo ExpressProbibitionNo ExpressProhibition YESYESNo IV PushNo ExpressProhibitionYESYESL icensureLicensureCONL icensureRNs can delegate if task does not exceed thescope of practice of delegatee. Nurses mustbalance with ethical duty where there can beno delegation if the nurse knows/should knowit is detrimental to patient s a dialysis unit, RN may delegate heparinand saline administration to an LPN. RN can-not delegate to UAP anything beyond thescope of practice of nursing procedures, including, but not limit-ed to, the administration of medication, dele-gated by a licensed nurse to a designatedunlicensed person shall be Tech Credentialing.

7 PCTs may can-nulate,and administer heparin (specifieddoses), normal saline, intradermal Opinion allows LPN administration ofIV heparin for mention UAPs and CNAs. Nothing spe-cific on dialysis PCTs. Certified NursingAssistants may administer meds, but only if amed course is taken, certain meds only, andno IV technicians are listed as a specificcategory of certified nursing assistant, CNA -DT. Approved training program is required;two year renewal #Subtitle27 NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 134 State laws and Regulations Specific to dialysis : An OverviewStatePCTsAllowed toAdministerHeparin andSalineDialysisTechnicianLegislationDi alysis FacilityLegislationDelegation authority of RNs/Limitations on LPN/LVNs or UAPMASSACHU-SETTSMICHIGANMINNESOTAMISSIS SIPPIMISSOURIMONTANANEBRASKANEVADAYESNo ExpressProhibitionNo ExpressProhibitionNONo ExpressProhibitionNo ExpressProhibitionYESYESYESL icensureCONCOND ialysis technicianlanguage in pro-posed delagtionrules as of 1 to Unlicensed Personnel.

8 Nursingadvisory # Nurses Organization delegation Dpt=CH&RngHigh=In a nursing home setting, medications byinjection can be given only by physician,physician s assistant, RN, LPN. Nothing of meds can be delegated onlyto licensed nurses, either an RN or rules allow LPNs to cannulate andadminister IV heparin or IV saline. Techniciansmay not allowed to administer IV heparin. Nospecific language regarding delegating to dial-ysis cannot delegate administration hemodialysis functions allowed forLPNs and PCTs include cannulation andadministration of heparin and #DELEGATIONA drug or medicine referred to in NRS , inclusive, may be possessed andadministered by: A dialysis technician, underthe direction or supervision of a physician orregistered nurse only if the drug or medicine isused for the process of renal dialysis .

9 NURSING JOURNAL January-February 2005 Vol. 32, No. 135 StatePCTsAllowed toAdministerHeparin andSalineDialysisTechnicianLegislationDi alysis FacilityLegislationDelegation authority of RNs/Limitations on LPN/LVNs or UAPNEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOYESNo ExpressProhibitionYESNONOYESNOYESYESYESY ESL icensureLicensureLicensureCONL icensureCONCON RNs only can delegate IV administration ofmeds. delegation of a task of client care involv-ing the administration of medication shall speci-fy the med, dosage, route. Pharmacy rulesallow PCTs to administer saline and #nur400An RN may delegate selected nursing tasks tothe LPN and ancillary nursing personnel(including aids, assistants, attendants andtechnicians). Nothing Specific as to administra-tion of medications or dialysis Technician can cannulate andadminister heparin bolus.

10 Training and testingrequired for certified hemodialysis trained dialysis technicians areallowed to flush IV lines with pre-determineddoses of heparin when initiating on LPNs administering IV IV push except saline or dialysis technician may administerheparin, lidocaine, and normal may be done by licensed nurse orcompetent dialysis rules for UAPs do not allow IV - dialysis Technicians can adminis-ter IV heparin. Tech rules require NURSING JOURNAL January-February 2005 Vol. 32, No. 136 State laws and Regulations Specific to dialysis : An OverviewStatePCTsAllowed toAdministerHeparin andSalineDialysisTechnicianLegislationDi alysis FacilityLegislationDelegation authority of RNs/Limitations on LPN/LVNs or UAPOKLAHOMAOREGONPENNSYLVANIARHODE ISLANDSOUTHCAROLINASOUTH DAKOTA TENNESSEENOYESYESNo Express ProhibitionNOYESNOYESYESNOP roposedLicensure LawLicensureLicensureLicensure LicensureAdministration of meds may not be Paper on LPN administration of IVmeds, May IV therapy and medicationadministration may be within the scope of practiceof LPN who has appropriate educational trainingand under supervision.