Illinois Department of Human Services
Division of Developmental Disabilities
The Division of Developmental Disabilities is providing guidance on how service providers will implement the revisions to Rule 116 related to unlicensed direct support staff administering medications in community day service programs.
Background and Explanation:
As of January 1, 2018, the Mental Health and Developmental Disabilities Administrative Act was amended by changing Section 15.4 allowing authorization by nursing delegation to permit direct support staff to administer medications in community day service programs certified to serve persons with developmental disabilities by the Illinois Department of Human Services (IDHS). This would apply to all CILA residents, regardless of their primary service provider, individuals served in ICF/DD with 16 beds or fewer, and individuals receiving Home-Based Services. This would not apply to individuals receiving services in SODCs since SODC Regulations require licensed staff to administer their medications.
If a service provider decides to utilize unlicensed direct support staff to administer medications in their community day services program the Division is requesting that the service provider complete the attached form indicating these intentions and email the form back to the Division using the email address on the form. The Division must be in receipt of this form prior to the community day service provider allowing unlicensed staff to administer medications. See the following link below:
Process and Procedures:
Although the Division is providing guidance, it is necessary to emphasize that the use of direct support staff to administer medications in community day service programs is NOT required. Any community day service program that decides to have direct support staff administer medication will need to have a RN-Trainer. The Division strongly recommends that the community day service program employ a RN-Trainer specifically for the community day service program due to the possibility of serving individuals from a variety of settings. Only a RN-Trainer may delegate, authorize and supervise the task of medication administration to unlicensed direct care staff. A RN who will be training unlicensed direct support staff at a community day service program (and who is not already an IDHS-approved RN-Trainer) must participate in the "IDHS RN-Trainer Medication Administration in the Community" webinars. A RN can register for these webinars on the IDHS Division of Developmental Disabilities Provider Training website.
Prior to training unlicensed direct support staff to administer medication, the RN-Trainer employed by the community day service program must do a nursing assessment of each individual to whom the direct support staff will administer medications. This includes an assessment of the individual's physical and mental status, medical history, medication orders and medications prescribed. This nursing assessment must be completed on an annual basis by the RN-Trainer employed by the community day service program. The individual's physician, advanced practice nurse or physician assistant would need to provide written orders for the medications to be taken at the community day service program and the medications would need to be packaged and labeled according to the requirements of Rule 116.
The training program for the direct support staff must utilize the competency-based, standardized medication curriculum specified by IDHS. The training programs must be conducted by a RN-Trainer. The assessment of the direct support staff's skills and competency to administer medications and the authorization, which is documented on Competency Based Training Assessment (CBTA) form, must be completed by the community day service program RN-Trainer who is delegating this task to the direct support staff. This CBTA form must be completed prior to staff being able to administer medications.
Unlicensed direct support staff (DSP) who are to be authorized to administer medications in community day service programs under the delegation of the RN- Trainer must meet the following criteria:
- Be age 18 years or older
- High school diploma or its equivalency (GED)
- Demonstrate functional literacy (an 8th grade reading level) as evaluated by administration of a functional literacy test (TABE, ABLE or CASA) approved by the Department of Human Services.
- Satisfactorily complete the Health and Safety component of the Direct Support Persons Core Training Program or an IDHS approved equivalent Developmental Disabilities Aide Training Program prior to beginning of medication administration training.
- Be initially trained and evaluated by a RN-Trainer in a competency-based, standardized medication curriculum specified by IDHS - the classroom portion of this training should be at least 8 hours in length. An Attendance Sheet/Class Roster indicating the training date, the total number of didactic class hours, sign in and sign out by the staff being trained and the dated signature of the RN- Trainer should be documented on this form. If a DSP has already completed the classroom portion of this training, they would not need to repeat it. However, the community day service program must obtain written documentation of dates and times this training was completed.
- Score 80% or above on a written exam furnished by IDHS (If a DSP has already completed this exam, it would not need to be repeated. The community day service program would need to have documentation of the date the exam was completed with score obtained on exam).
- Score 100% on an individual-specific, competency-based evaluation performed by a RN- Trainer for each individual at the community day service program for whom the direct care staff person is responsible for administering medication. The RN-Trainer must document this evaluation on the Competency Based Training Assessment (CBTA) form for Medication Administration. A list of the medications the direct support staff is authorized to administer to each individual must be attached to the CBTA form. The date the evaluation was completed, and the signature of the RN-Trainer must be included on this CBTA form.
- Authorized direct support staff need to be re-evaluated by a RN-Trainer at least annually or more frequently at the discretion of the RN-Trainer to ensure competency of the authorized direct support staff to continue to administer medication.
- Care should be taken to ensure that the number of individuals for whom an authorized direct support staff is responsible to administer medications is limited to a manageable number.
- For the safety of the individuals, community day service program must have a written policy and procedure on how daily communication will occur between authorized direct support staff at the community day service program and the individual's CILA or place of residence regarding PRN medications. Authorized direct support staff at the community day service program would need to know the last time the individual had received a PRN medication at their CILA or place of residence and the staff at the CILA or parent/guardian/host family at place of residence would need to know last time the individual received a PRN medication at the community day service program.
If a community day service program is utilizing direct support staff to administer medications - the program must follow all Administration Rule 116 Requirements. The RN-Trainer employed by the community day service program must be available (either on-site or on-call) at all times individuals are present at the community day program site to provide direction regarding medication issues.
March 22, 2019