The state Legislature has amended RCW 18.135.130 to limit the administration of certain drugs to only those health care assistants certified in category(s) C and/or E. This change is effective on July 22, 2011. The law is formally known as Substitute House Bill (SHB) 1304.
Health care assistants category C and/or Ecan administer certain drugs via the following routes: topical, rectal, otic, oral, ophthalmic or inhaled.
Section 1 specifies the types of drugs that may be administered. This section expires on July 1, 2013.
Health care assistants working under this expanded scope of practice must have sufficient training, experience and supervision to administer medicines with reasonable skill and safety.
- Maintain a list of specific medications/diagnostic agents and the route of administration for each HCA. This list must be submitted to the Department of Health and be available for review.
- Ensure that HCAs authorized to administer medicines demonstrate initial and ongoing competency.
- Not allow an HCA to administer a medicine if:
- The patient is unable to physically ingest or safely apply a medicine independently or with assistance.
or
- The patient is unable to indicate awareness that he or she is taking a medicine.
What are the different classifications or levels of health care assistants, and what is each level permitted to do as far as patient care?
Can a health care assistant start an IV? If not, what are their duties relating to IVs?
Can a facility set up dosing guidelines for a health care assistant to use without consulting the provider?
Can a health care assistant assist in colonoscopies, use the biopsy forceps and snares to cut and obtain tissue samples at the direction of the MD?
Can a health care assistant access, flush, and withdraw blood for an Implanted Venous Access device (port-a-cath)?
Can a health care assistant insert urinary catheters?
Who can supervise a health care assistant?
Can a health care assistant be a part of the controlled substance count at the beginning and end of the day and sign for the count?
Can a health care assistant sign out and administer a controlled substance that has been ordered by a supervising practitioner? This includes obtaining the narcotic cabinet keys, opening the cabinet, removing the narcotic ordered and then administering it intramuscularly.
Can a health care assistant work at the facility before he/she receives the health care certification in the mail?
What types of drugs can a health care assistant administer by injection?
How many health care assistants can a delegator supervise?
Is telephone triage and advice using a Barton Schmitt, MD protocol book within the scope of practice for a credentialed health care assistant?
Is a health care assistant credential transferable to other hospitals?
Can a registered nurse supervise a health care assistant to administer vaccines?
What are the different classifications or levels of health care assistants, and what is each level permitted to do as far as patient care?
WAC 246-826-100 outlines the different classification and levels of a health care assistant. Here is a link to that information -
http://apps.leg.wa.gov/wac/default.aspx?cite=246-826-100.
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Can a health care assistant start an IV? If not, what are their duties relating to IVs?
No. A health care assistant may not start an IV. Health care assistants in categories D and F may interrupt an IV, administer an injection, and restart at the same rate. Line draws may only be performed by a category B assistant if the IV is stopped and restarted by a licensed practitioner. The rule does not say a health care assistant can discontinue the IV, so it is not in their scope of practice to do so. (WAC 246-826-210 (1))
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Can a facility set up dosing guidelines for a health care assistant to use without consulting the provider?
No.
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Can a health care assistant assist in colonoscopies, use the biopsy forceps and snares to cut and obtain tissue samples at the direction of the MD?
No.
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Can a health care assistant access, flush, and withdraw blood for an Implanted Venous Access device (port-a-cath)?
No.
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Can a health care assistant insert urinary catheters?
No.
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Who can supervise a health care assistant?
A health care assistant can only be supervised by licensed medical doctors, osteopathic doctors, physician assistants, podiatric doctors, advanced registered nurse practitioners, registered nurses, and naturopathic doctors.
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Can a health care assistant be a part of the controlled substance count at the beginning and end of the day and sign for the count?
No.
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Can a health care assistant sign out and administer a controlled substance that has been ordered by a supervising practitioner? This includes obtaining the narcotic cabinet keys, opening the cabinet, removing the narcotic ordered and then administering it intramuscularly.
No. A health care assistant cannot sign out a controlled substance, have the narcotic cabinet keys or open the cabinet. A health care assistant certified in Category C or Category E can give an intramuscular injection. He or she can only do this if the supervising practitioner is physically present and immediately available in the facility during the administration of the injection.
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Can a health care assistant work at the facility before he/she receives the health care certification in the mail?
The health care assistant can work and perform the duties of his or her category while waiting for the actual certification document. This is considered a training period. The assistant can work during the application process.
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What types of drugs can a health care assistant administer by injection?
Class C, D, E, or F health care assistants working in a hospital or nursing home may administer by injection the drugs listed below. They may do so only as authorized and directed by a delegator. They are also limited by what is allowed by their category of certification.
Antihistamines, Anti-infective agents, Antineoplastic agents, Autonomic drugs, Blood derivatives, Blood formation and coagulation, Cardiovascular drugs, CNS agents, Diagnostic agents, Electrolytic, caloric and water balance, Gastrointestinal drugs, Gold compounds, Heavy metal antagonists, Hormones/synthetic substitutes, Local anesthetics, Oxytocics, Radioactive agents, Serums toxoids, vaccines, Skin and mucous membrane agents, Smooth muscle relaxants, Vitamins, Unclassified therapeutic agents.
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How many health care assistants can a delegator supervise?
There are no limitations on how many health care assistants a delegator can supervise.
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Is telephone triage and advice using a Barton Schmitt, MD protocol book within the scope of practice for a credentialed health care assistant?
No.
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Is a health care assistant credential transferable to other hospitals?
No. Certification at one health care faculty or health care practitioner is not transferable to another health care facility or health care practitioner.
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Can a registered nurse supervise a health care assistant to administer vaccines?
Yes, a registered nurse can supervise a health care assistant to administer vaccines at the facility which has certified the health care assistant. The registered nurse must be physically present and immediately available in the building.
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