(1) Medication Administration. The supervising or delegating nurse maintains responsibility for any medication administration task delegated to a home health aide or CNA pursuant to Sections 464.0156, 464.2035, 400.489, and 400.490, F.S.
    (a) Medication administration includes conducting any examination, including vital signs (temperature, blood pressure, heart rate, and/or respirations) for the proper administration of medication that the patient cannot perform personally and that can be performed by a licensed health care practitioner, or a home health aide or CNA as delegated by an RN.
    (b) A home health aide or CNA may not administer medication to patients unless they have successfully completed a medication administration training course and obtained a current validation for the route by which the medication is administered in accordance with Fl. Admin. Code R. 59A-8.0097
    (c) In cases wherein a home health aide or a CNA is delegated to administer medications, an assessment of the medications for which administration is to be provided shall be conducted by the registered nurse (RN) who delegated the task prior to the home health aide or CNA performing the task and upon any change in the patient’s medication regiment. The assessment shall be documented in the patient’s medical record for patients receiving medication administration from a home health aide or CNA.
    1. The delegating nurse must ensure the home health aide or CNA administers the medication in accordance with their training and competency, and with the medication prescription.
    2. Home health aides and CNAs who are validated to administer whole (not crushed) oral medication may give the medication in any dietary or nutritional food substance that facilitates swallowing, is tolerated by the patient and is not contrary to any prescribed diet, label warnings or known contraindications for the medication being given.
    3. The home health aide or CNA must notify the supervising or delegating nurse of changes in the dosage, frequency or route of a medication. The nurse must verify the change and update the Medication Administration Record (MAR).
    4. The supervising or delegating nurse is required to review the MAR every 60 days, or more frequently if needed, for each patient receiving medication administration from a home health aide or CNA. The MAR must be kept on record by the home health agency.
    5. The home health aide and/or CNA must communicate changes in a patient’s condition to the supervising or delegating nurse. The nurse must assess for unusual reactions to the medication or a significant change in the patient’s health or behavior that may be caused by the medication, and must document such in the patient’s record to be reported immediately to the patient’s health care provider. Contact with the health care provider must also be documented in the patient’s medical record.
    (2) Medication Administration Procedures. Home health aides and CNAs must:
    (a) Only administer medication as prescribed or ordered by the patient’s health care practitioner and which are properly labeled and dispensed in accordance with Chapters 465 and 499, F.S.;
    (b) Comply with new or changed orders for a specific medication, which override the previous orders for that medication. No order to discontinue the previous order is necessary;
    (c) Comply with the time limit as provided for in time-limited orders (i.e. those that are ordered for a specific number of doses or days). Such orders do not require an order to discontinue at the completion of the time allotted in the time-limit;
    (d) Before administering medication to any patient initially, review the patient’s medical history and medication background with the delegating RN, and again thereafter as determined by the delegating RN.
    (e) Perform appropriate hand hygiene measures consistent with current guidence from the Centers for Disease Control and Prevention (CDC) before administering medication to the patient.
    (f) Immediately report torn, damaged, illegible, or mislabeled prescription labels to the dispensing pharmacist and, if a patient is residing in a residential facility, notify the facility supervisor;
    (g) Check the directions and expiration date of each medication to ensure that expired medications (those which are no longer current) or those no longer prescribed are not administered;
    (h) Administer medication as prescribed and via the route instructed by the patient’s prescribing health care professional. Each time medication is administered:
    1. Verify the correct medication is administered to the correct patient, at the correct time, dosage, route, and for the correct reason, as prescribed by the health care practitioner.
    2. Observe complete ingestion of oral medication before leaving the patient and before recording or documenting the administration of the medication on the MAR.
    (i) PRN medications. The supervising or delegating nurse maintains responsibility for the appropriate administration of PRN medications based on the patient’s health condition and prescribing health care practitioner orders.
    1. Prior to the administration of an “”as needed”” or “”PRN”” medication to a patient, the home health aide or CNA must consult with the supervising or delegating nurse to determine the appropriateness of administration of the PRN medication.
    2. Administration of medications which require nursing judgement or assessment to evaluate the effectiveness of the medication shall not be delegated, including medications for pain and psychotropic medications. PRN medications must include specific written instructions with specific parameters for administration as prescribed by the patient’s health care practitioner.
    3. Administration of PRN medication must be documented on the MAR with the reason for the administration of the PRN medication, monitoring of the patient, and outcome of the medication.
    (j) Ensure that the prescription for a medication is promptly refilled so that a patient does not miss a prescribed dosage of medication. If the home health aide or CNA is not responsible for routine refills of a medication, they must notify the individual responsible for refilling the patient’s prescriptions and document this notification;
    (3) In the administration of medications, a home health aide or CNA must not:
    (a) Administer medications, including PRN and OTC medications or medication samples without a written order and instructions for preparation and use from the patient’s physician, PA, or APRN.
    (b) Administer medications for which the health care provider’s prescription or order does not specify the medication schedule, medication amount, dosage, route of administration, purpose for the medication, or with medication that would require professional medical judgment by the home health aide or CNA.
    (c) Crush, dilute, or mix crushed medications without written instructions from the delegating RN as prescribed by the patient’s health care provider.
    (d) Administer medications via a medication route for which the home health aide or CNA has not been validated.
    (e) Prepare syringes for a patient’s use during the self-administration of medication via a parenteral, subcutaneous, intra-dermal, intra-muscular or intravenous route.
    (f) Administer medications by injection via a parenteral, subcutaneous, intra-dermal, intra-muscular or intravenous route, with the exception of an epi-pen administered in an emergency situation. This prohibition does not include the administration of prefilled insulin syringes.
    (g) Administer medication that is inserted vaginally, or administered via a tracheostomy.
    (h) Administer medications for which the health care provider’s prescription or order does not specify the medication schedule, medication amount, dosage, route of administration, purpose for the medication, or with medication that would require professional medical judgment by the home health aide or CNA.
    (4) Home health aides and CNAs must not:
    (a) Continue to provide services as a home health aide or CNA if they fail to maintain required validation.
    (b) Provide services as a home health aide or CNA while not currently authorized to do so by the State of Florida.
    (c) Provide services as a home health aide or CNA after the home health agency has determined the home health aide or CNA must not continue to provide assistance with medication administration or administer medication as delegated by an RN.
    (5) If a home health aide or CNA violates any provision of Section 400.489, 400.490, 464.0156 or 464.2035, F.S. or this rule, the home health agency must:
    (a) Prohibit the home health aide or CNA from providing medication administration services to patients of the agency;
    (b) Require the home health aide or CNA to:
    1. Successfully complete the Basic Medication Administration Course and corresponding validation;
    2. Participate in and successfully complete a corrective action plan; and
    3. Comply with remediation requests.
    (6) Medication Errors.
    (a) The RN must document medication errors and all interventions in the patient’s medical record.
    (b) The home health agency must incorporate documented medication errors into their Quality Assurance program for systemic analysis in order to prevent a future occurrence and improve provision of services to patients.
    (7) Medication Storage and Disposal.
    (a) Home health aides and CNAs must:
    1. Maintain medications in their original containers labeled by the dispensing health care practitioner or pharmacy with the patient’s name, the practitioner’s name, and the directions for administering the medication;
    2. Maintain OTC medications in their original containers;
    3. Ensure medications in a patient’s residence are organized and returned to the patient’s preferred location for storage and retrieval following administration.
    (b) A home health aide or CNA may not transport medications away from the patient’s residence or dispose of the patient’s medications.
    (c) Disposal of medications must be conducted by licensed health care professional and consistent with applicable federal, state, and local regulations.
Rulemaking Authority 400.489, 464.0156, 464.2035 FS. Law Implemented 400.489, 400.490, 464.0156, 464.2035 FS. History-New 5-24-23.