A patient needs nurse delegation when a licensed caregiver must administer medication. It's also needed when a patient can self-administer medication but doesn't know it. Washington State rule (WAC 246-840-910 to 920). This includes OTC and Rx drugs.

Medications must be administered by a nurse if a medical expert determines a patient has cognitive impairment or is frail. Washington law protects older persons who lack the mental or physical competence to recognize what medications they're taking or to take them without assistance. This needs a doctor's order.

Nurse Delegation allows a person who needs nursing care to stay in an AFH, ALF, or at home. A person may need daily RN support with medications, wound care, tube feedings, or insulin injections. Previously, patients may choose between a nursing home or private nurse visits. A registered nurse teaches a non-medically educated caregiver proper patient care techniques under the Nurse Delegation Program.

The nursing assistant must be state-licensed. Once able to handle nurse-delegated responsibilities, daily visits or extended nursing home stays are no longer needed, decreasing care expenditures. Not all nursing abilities are delegable.

RNs can only delegate qualified caregivers. A delegating nurse must assume official client delegation duty. A home health RN who isn't the delegator can't delegate a caregiver. LPNs cannot delegate. An RN delegated a client's assignment to a community-based nursing assistant.

Washington's Nursing Care Quality Assurance Commission oversees delegating RNs. The delegating RN and nursing assistant are responsible for their own conduct. No one can force an RN to delegate and compromise patient safety. Not all licensed caregivers can perform these responsibilities. A caregiver must be a licensed CNA, HCA, HCA-C, or NAR. They must have a 9-hour nurse delegation certificate. If the client needs insulin, the caregiver needs a 3-hour diabetes certificate. They must have 40 hours of the 75-hour basic training or prove exemption.

Community nurses delegate. Certified community residential programs for the developmentally handicapped, licensed adult family homes, boarding houses, licensed assisted living facilities or At home

Family nursing delegation isn't required. Educating family members about medications is not delegation. Again, it's not a state rule but a terrific method to learn about your loved one's care and keep them safe.

Currently, 4 tasks CANNOT be delegated:

• Non-insulin injections
• Sterilization
• Linemaintenance
•  Nursing judgment/assessment

Before getting nurse delegation in Washington, a patient must be "stable and predictable." A Revamp nurse will complete a head-to-toe assessment of the client before delegating. If the client's last comprehensive nursing evaluation has changed significantly, they will need a new one before delegation. You'll need written doctor orders to outsource drugs and responsibilities.

Revamp nurses do initial comprehensive visits. If a client gets insulin carers, visits will be weekly for 4 weeks. For other responsibilities, visits will be at least every 90 days. Changes in drugs or client condition will prompt a visit. A new caregiver will be visited if hired.

Medicaid, Labor and Industries, and The Veterans Association cover Nurse Delegation. If the patient isn't enrolled, the service is private pay.