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Ask A Nurse
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while much has been written about delegation, my situation includes delegation to paraprofessionals (which are lay people who are hired to help with the special education students, such as to diaper, feed, etc.).
Our state bills medicaid for services rendered to the special education students. Our district uses the nurses to bill under their license.
The question has come up as to whether we want to delegate medical services to paraprofessionals, such as catherizations, GT feedings, etc. I would like to know how liable are we? Our district also wants us to bill for the service when it has been delegated, either to a substitute nurse, paraprofessional, or layperson during our absence (for medication administration).
You have presented two questions;
Regarding delegation
Regarding billing for Medicaid
I will respond to the delegation piece first, delegation of nursing
practice is thoroughly defined in the Nursing Practice Act. It is
important to always keep in mind that a nurse (RN) does not delegate to
another nurse, a RN may supervise or make assignments to an LVN, but that
LVN is responsible for his/her own 'practice' of nursing, just as a RN is
responsible for his/her practice. Therefore, a substitute nurse is
responsible for the care of the students, but the prudent School Nurse
would leave thorough orders, care plans and pertinent information for the
substitute nurse should the school nurse be absent.
Chapter 224 addresses: "Delegation of Nursing Tasks to Unlicensed Personnel
for Clients with Acute Conditions or in Acute Care Environments" which
describes delegation for clients who are unstable or unpredictable or who
are in acute care environments. This usually does not include students and
their care in the 'normal' school setting, although, it is understood that
their condition may change from moment to moment.
Chapter 225 addresses: "RN Delegation to Unlicensed Personnel and Tasks Not
Requiring Delegation in Independent Living Environments for Clients with
Stable and Predictable Conditions, which describes delegation for clients
in independent living environments; where the client age 16 or older and/or
their parent or guardian, participates in decision relating to management
of health care; where the task is for a stable, predictable condition". The
information in this chapter most closely describes the care of the student
while they are in school; including a description of: RN Accountability,
RN Assessment of the Client, Activities of Daily Living Not Requiring
Delegation, Health Maintenance Activities Not Requiring Delegation,
Delegation Criteria and Tasks That May Be Delegated, Tasks Prohibited From
Delegation and Supervising Unlicensed Personnel Performing Tasks Delegated
by Other Practitioners.
The Nursing Practice Act and additional information can be found on-line
at: http://www.bne.state.tx.us
In regards to the billing for Medicaid, I can address this in a global
manner, but then you will have to determine the system/protocol for your
district.
When a nurse delegates a billable procedure or treatment, there is a method
to bill Medicaid for that service. The school nurse for that campus should
have a 'service ticket' for the student, on that ticket, there should be a
place to indicate if the nurse carried out the procedure/treatment or if
the same was delegated. The person completing the task (under delegation)
should initial the ticket and sign the ticket, indicating that they are a
staff member, clinic aide or whatever is their title. So, it is legal to
bill for treatments, procedures or tasks that the nurse has appropriately
delegated to another person to complete.
I hope this information offers you some assistance and best of luck to you,
Pam Burke, BSN, RN
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