DRAFT - Competency-Based Training and Assessment for Rule 116 (RESCINDED)

Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.25.XXX

Purpose

Rule 116 outlines the requirements for an Authorized Direct Support Professional (ADSP) to administer medication to individuals living in settings governed by Rule 116. Included in those requirements is a competency-based training and assessment (CBTA); this Information Bulletin (IB) outlines the CBTA process.

Background

Effective January 1, 2025, Public Act 103-0890 went into effect and amends the administrative act. The new language no longer requires CBTAs to be individualized to the person and his or her medication. This information is the interpretive guidance until Rule 116 is amended to include the legislative changes.

Definitions

Competency-Based Training and Assessment (CBTA): The process in which an ADSP is observed by a nurse trainer (RNT) during a medication administration pass and demonstrates the necessary skills to be approved to administer medication by a specific medication route.

Medication Pass: For purposes of this IB, a medication pass is defined as administering medication to multiple individuals in a Rule 116 setting. There should be at least 4 individuals and/or the largest setting that they will be working in. Additionally, the individuals should receive multiple medications during the medication pass. Medication administration during the medication pass should happen under typical circumstances in the setting.

Medication Routes: Medication is administered in various routes. The most common is orally (by mouth). Other routes include topical, inhalants, and eye drops. Each route must have its own CBTA.

Registered Nurse Trainer (RN Trainer or RNT): An RN Trainer is a registered nurse who has completed the requirements to be a nurse trainer within the Division of Developmental Disabilities (DDD). Only an RN Trainer can train ADSPs or be on-call for ADSPs regarding medication administration questions.

Professional Responsibility of the RN Trainer

RN Trainers are ultimately responsible for determining if the responsibility of administering medication can be delegated to an ADSP. The process in this IB is the minimum standard. RN Trainers should continue completing CBTAs or additional training and observation as they see necessary. RN Trainers have a professional responsibility to ensure that ADSPs continue to demonstrate competency in medication administration.

CBTA Process

ADSPs must receive a 100% on the CBTA that demonstrates proficiency in a medication route. This must be demonstrated on 3 separate occasions. ADSPs demonstrate proficiency by completing the following:

  1. The RN Trainer must observe, in person, the ADSP complete a medication pass for a specific medication route on three separate occasions. The intention is for the RN Trainer to have the opportunity to evaluate the ADSP's ability to manage a high stress environment and medications during a typical day. To be able to effectively evaluate this, the following should be present:
    1. There should be multiple individuals at each medication pass
    2. The individuals receiving medications should have multiple medications
  2. This must be documented on the CBTA form.
  3. A CBTA for oral medications does not authorize an ADSP to administer medications via other routes. Each route must have its own CBTA that is completed on 3 separate occasions.
  4. The Medication Administration Record (MAR) that correlates with the CBTA form needs to be copied and attached to the CBTA form once completed. The MAR will be used during Rule 116 surveys to ensure that the medication was administered properly based on what was prescribed at the time of the CBTA.

Administering Medications to New Individuals

When a staff is scheduled to administer medications to an individual that was not involved in the staff's CBTA process, the RN Trainer must have a process in place to ensure that the ADSP has the competency to administer that medication to that individual. This includes the following:

  1. Communication with the ADSP that explains the medication and its potential side effects in general.
  2. Communication with the ADSP regarding how the individual may react to this medication.
  3. This communication must be documented.

Administering a Medication that is New to an Individual or Has a Dosage Change

When a staff is scheduled to administer a medication that has changed (dosage, route, or frequency) or a new medication for an individual, the RN Trainer must have a process in place to ensure that the ADSP has the competency to administer that medication to that individual. This includes the following: 

  1. Communication with the ADSP that explains the medication and/or any changes to the medication. 
  2. Communication with the ADSP regarding how the individual may react to this medication and its potential side effects.
  3. This communication must be documented. 
  4. RNT should consider the last time the ADSP has demonstrated competency in administering that specific route. For example, if it has been years since the ADSP has administered eye drops, the RNT should consider a more in-depth discussion on how to administer and/or observing the ADSP administering eye drops.

Documentation

Until this IB is finalized, providers can choose to use the guidance in this DRAFT IB (new staff would not be authorized until they have to completed 3 CBTAs for a specific route) or use the previous guidance and continue completing CBTAs on all new individuals. DDD is currently developing route specific CBTA forms. If the provider chooses to use the new guidance, please use the current CBTA form and write which route is completed at the top of the form.

Policies and procedures must be changed/created to reflect the new guidance when this IB is finalized.

Contact:

For questions on this DRAFT IB, please email DHS.DDDComments@illinois.gov. Include "Competency-Based Training and Assessment for Rule 116 " in the subject line.

Effective:

Upon posting as final IB.