• Adult foster homes.
• Assisted-living facilities.
• 24-hour residential care facilities.
• Child foster homes.
• Private homes.
• Public schools.
• Local corrections facilities.
• Lockups.
• Juvenile detention.
• Youth corrections facilities.
• Detoxification facilities.
• Other settings where a Registered Nurse is not regularly scheduled and is not available for direct supervision.
  
  

• Acute care facilities (hospitals).
• Long-term care facilities.
• Where there is a regularly scheduled Registered Nurse (by rule or statute).

Assessment:

1.  Client’s condition is stable and predictable.

2.  Consider the setting and circumstances.

3.  Assess the task:

     a.  Complexity.

     b.  Risks involved.

     c.  Skills necessary to safely perform.

     d.  How often does the task need to be reassessed?

     e.  Can the task be safely performed without direct RN supervision?

4.  Assess the caregiver:

     a.  Determine whether an unlicensed person can perform the task safely without
          direct supervision of a RN.

     b.  Evaluate the skills, ability and willingness of the unlicensed person (caregiver).

     c.  How often do the caregiver’s skills need to be reassessed?

Teach:

1.  Explain why the task is important to the resident’s well-being.

2.  Teach the proper procedure/technique.

3.  Observe the caregiver perform the task on the resident until you are sure
     competency is achieved.

4.  What are the risks associated with the task?

5.  Observe the resident’s response to the task.

6.  What are the signs and symptoms that the resident may be experiencing side
     affects?

7.  What are the appropriate responses to a side affect?

8.  How is the caregiver to document that he/she has done the task?

Leave procedural guidance as a reference (written directions they can refer to when you’re not there). Include:

1.  A specific, detailed outline of how the task of nursing is to be performed, step-
     by-step.

2.  Signs and symptoms to be observed
3.  Guidelines for what to do if negative signs and symptoms do occur.
4.  That the caregiver understands the risk involved in performing the task and
     knows the plan for dealing with the consequences.
5.  To whom the caregiver reports bad outcomes or concerns.
 
Document your rationale for delegating this task (OAR 851-047-0030(k))
1.  The stability of the client’s condition based on your nursing assessment.
2.  Skill, ability and willingness of unlicensed person.
3.  That the task was taught and the caregiver is competent. (How do you know?
     Was there a return demonstration?)
4.  The written instructions (procedural guidance).
5.  Evidence that the caregiver was instructed that the task is client specific and not
     transferable to other clients or caregivers.
6.  How frequently the resident is to be assessed by the Registered Nurse.
7.  How frequently the caregiver is to be supervised and reevaluated.
8.  That the RN takes responsibility for delegating the task to the caregiver.
 
Periodic Inspection (OAR 851-047-0030(4))
1.  Must periodically observe the competence of the caregiver to perform the task
     on the resident. Is the caregiver still capable and willing to safely perform the
     nursing task?
2.  Initial inspection at 60-days.
3.  Subsequent inspections at the RN’s discretion, but no longer than 180 days
     between inspections

• RN may share delegation and supervision with another RN (OAR 851-047-0030(5)(a,b,c & d)).
• RN may transfer delegation and supervision to another RN (OAR 851-047-0030(6)(a,b,c & d).
• RN has the authority to rescind delegation (OAR 851-047-0030(7) (a,b,c, d & e).

• RN employed by home health, home infusion or hospice.
• RN available 24-hours each day (on call).
• Tasks limited to:
  • Flush the line with routine, pre-measured flushing solutions.
  • Add pre-measured medications.
  • Change bags of pre-measured fluids.
• RN has the right to refuse to delegate administration of medications by IV route.

• A RN (or a LPN at the direction of a RN) may teach an unlicensed caregiver to administer non-injectable medications.
• The instructions taught should include:
  • Proper methods for administration.
  • What the medication is supposed to do for the client/resident (expected outcome).
  • Potential side effects & what to do if they occur.
  • Observe the resident’s response to the medication.
  • How to document administration.
  • How to verify the physician or nurse practitioner order and transcribe the order on the Medication Administration Record (MAR).
• Nurse must write parameters to clarify any PRN orders.