FAQ - Delegation & Practice - Employer Policies

​Question: I am hoping you can point me in to the right direction. I need some general information on assisted living and their rules and regulations. My questions are:

1. Is there a ratio with LPN/CMT regulation regarding medications, treatments, injections of insulin?

2. How many residents that take medications can be assigned to one LPN/CMT? For instance, the assisted living facility I work for has 38 residents on the Assisted Living and 16 in the Memory Care Unit.

Out of the 54 residents, 52 receive medication.

It is one (1) person passing medication, doing treatments, administering insulin, eye drops, TENS machine, administering medicated creams, removal and applying TED hose, finger sticks for diabetics, plus handling any falls, physician orders, or emergencies with residents. We also need to receive daily medication from our outside pharmacy for the 45+ residents.

As well as charting, and each evening shift nurse/CMT is responsible for medication cart audit. 

Our medication carts are stationary and do not move.

If you could help me with my questions I would appreciate it.

Response: Thank you for contacting the Maryland Board of Nursing with a request for general information on assisted living and the applicable rules and regulations. The MBON does not regulate facilities, assisted living or otherwise. Please review the website for the Office of Health Care Quality (OHCQ) Regulations on Assisted Living.  
As to your questions that are related to the regulation of nurses and certified medication technicians, and decisions on delegation of treatments, medications, and general nursing cares that you identified in this case (or any other), you will need to carefully review the available evidence. In this case, that means referring to Chapter 11 Delegation of Nursing Functions COMAR 10.27.11, pages 1-9.
The Nurse Practice Act and Annotated Code of Regulations (COMAR) for Nurses are both available on our website but can be difficult to locate and sort through; we are in the process of revising our website to make it more user-friendly. It is essential to read the entire chapter as no one line or section can stand alone as you address these questions of nursing practice and delegation.
Additionally, for such important and far-reaching decisions, the registered nurse needs to refer to the Joint Statement on Delegation from the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN). One of the attachments to the position statement (attached in this email) is an excellent Decision Tree for reaching a decision in the type of delegation questions you pose.
We realize you may have been hoping for an answer that quoted some Nurse:Patient ratios or a specific number of patients requiring medications that can be assigned to one CMT or nurse, or other quantified or definitive response. However, this type of issue can only be resolved by a thoughtful, evidence-based approach by the nurses and the agency/facility involved. It is not appropriate for someone remote from the situation to dictate specific practice decisions and delegation from afar. Please work with your agency leadership to resolve these questions keeping patient safety as the primary issue. Thank you for your care to the citizens of Maryland and your support of the board's mission: to advance safe quality care in Maryland through licensure, certification, education and accountability for public protection. Most particularly, thank you for allowing us the opportunity to share with you the Board's commitment to evidence-based practice and regulation.
updated 9/21/2016

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