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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsMay 2017

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16 DE Admin. Code 3220
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in March 01, 2017 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by March 31, 2017, at which time the Department would receive information, factual evidence and public comment to the said proposed regulations.
29 Del.C. Chap. 79, “Department of Health and Social Services.”
16 Del.C §3220, “Training and Qualifications for Certified Nursing Assistants.”
Comment: 1. In §2.3.10, their appears to be an extraneous comma after the “CNA.”
Response: The DLTCRP disagrees; the comma is appropriate.
Comment 2: In Appendix A, Psychosocial Needs Module. Competencies Section, 6th bullet, there is a reference to “self?care”.
Response: DLTCRP agrees. Revised as recommended.
Comment 3: In Appendix A, Physical Needs Module, Competencies Section, 15th bullet from the end, there is a reference to “self?help”.
Response: Revised as recommended.
Comment 4: The qualifications of trainers may benefit from enhancement. An RN with only 2 years of overall experience and 1 year of clinical experience (§3.2.1) and supplemental personnel (e.g. occupational, physical or speech therapist) with only 1 year of experience (§3.6.1) are authorized to serve as CNA training program instructors. These are relatively weak credentials to teach a wide array of skills to CNA trainees. While a nurse with 1 year of clinical experience in an NSF may have been exposed to many types of needs, a nurse with more years of experience would generally have greater exposure to a variety of patients and treatment modalities.
Response: The DLTCRP disagrees; the requirements/qualifications are adequate.
Comment 5: § 3.10 lists minimum equipment to be available for training. It would benefit from some additions.
Response: The DLTCRP disagrees; the lists of equipment required include equipment that is regularly used by CNAs. Facilities must take responsibility for teaching CNAs how to use specialized instruments for residents with special needs and it becomes included in the resident-centered care plan.
Comment 6: Appendix A, Physical Needs Module, Competencies Section, includes the following recital: “Assist the resident/patient with ambulation aids, including, but not limited to cane, quad-cane, walker, crutches, wheelchair and transfer aids, such as a mechanical lift.” These forms of AT are included in §3.10 with the exception of the mechanical lift. DMMA may wish to consider adding a mechanical lift to the list of minimum equipment.
Response: The DLTCRP disagrees; mechanical lift is listed at 3.10.19.
Comment 7: Appendix A, Physical Needs Module, Competencies Section, includes the following recitals: “Assist the resident /patient with oral hygiene, including prosthetic devices” and “Administer oral hygiene for the unconscious resident/patient.” In contrast, §3.10 omits all oral hygiene devices, including water flossers, electric toothbrushes, and ultrasonic denture cleaners.
Response: The DLTCRP disagrees; minimum oral hygiene needs are addressed at 3.10.17.
Comment 8: Appendix A, Physical Needs Module, Competencies Section, includes the following recital: “Accurately measure and record with a variety of commonly used devices; blood pressure, height and weight, and temperature, pulse, respiration. Section 3.10 would benefit from the addition of a pulse oximeter.
Response: The DLTCRP disagrees; pulse oximetry is used by nurses not CNAs, therefore, it is not included in the list of devises.
Comment 9: Per Section 2.3.7, CNAs are exempt from fulfilling recertification requirements if on active military duty in a “theater of hostilities.” This may be unduly narrow and could be expanded to cover active duty military not in a “theater of hostilities.” Furthermore, granting such individuals only 30 days to complete 24 hours of community education post deployment is seemingly too short a timeframe.
Response: The DLTCRP disagrees as the timeframe is directly in line with requirements with nurse license renewal when a nurse is on active military duty.
Comment 10: Section 3.3.2 requires instructors to have “experience teaching adults in a group classroom/clinical setting.” There are two concerns with this provision. First, experience teaching in a classroom versus a clinical setting should not be treated as interchangeable. Second, the Division may wish to adopt a more precise experience standard than the “open ended” provision in (§3.3.2)
Response: The DLTCRP disagrees. This requirement was developed by a group of nurse educators and determined appropriate for teaching CNAs.
Comment 11: §4.3.1 could be clarified to note that it only applies to CNAs who have previously worked in a facility. Otherwise, the 80 hour orientation requirement in §4.1.1 would apparently apply.
Response: The DLTCRP disagrees. Temporary agency staff are not facility employees and may never be assigned or choose to work at a facility after only one shift.
Comment 12: §5.3.6 could be improved by clarifying an individual’s option to be represented by an attorney of the individual’s choice.
Response: Revised as recommended.
IT IS SO ORDERED this 12th day of April 2017 by the Delaware Department of Health and Social Services.
Advanced Practice Nurse means an individual whose education and licensure meet the criteria outlined in 24 Del.C. Ch. 19 and who is certified in at least one of the following specialty areas: (1) Adult nurse practitioner; (2) Gerontological clinical nurse specialist; (3) Gerontological nurse practitioner; (4) Psychiatric/mental health clinical nurse specialist; (5) Family nurse practitioner.
Assisted Living Facility” means a residential arrangement for fee licensed pursuant to 16 Del.C. Ch. 11.
CE Track means the Division’s website www.CNADECE.org used for recording and tracking CNA continuing education hours counted toward CNA recertification requirements.
CE Hour” means continuing education offered by an education provider consisting of 60 minutes of instruction. For formal college nursing courses completed, one (1) semester hour is equivalent to five (5) CE hours.
Certified Nursing Assistant (CNA) means a duly certified individual under the supervision of a licensed nurse, who provides care which does not require the judgment and skills of a licensed nurse. The care may include, but is not limited to, the following: bathing, dressing, grooming, toileting, ambulating, transferring and feeding, observing and reporting the general well‑being of the person(s) to whom they are providing care.
Department means the Department of Health and Social Services.
"Direct Supervision" means actually observing students performing tasks.
Division means the Division of Long Term Care Residents Protection.
Education Provider” means a facility, agency or other entity that offers continuing education courses approved by the Division. Education Provider approval is contingent upon the education provider recording attendance, confirming participant identity and otherwise ensuring that CE hours are accurately recorded in CE Track.
"General Supervision" means providing necessary guidance for the program and maintaining ultimate responsibility.
Intermediate Care Facility means a facility licensed pursuant to 16 Del.C. Ch. 11 with a license designated for intermediate care beds.
Licensed Nurse means a licensed practical nurse, registered nurse and/or advanced practice nurse whose education and licensure meet the criteria in 24 Del.C. Ch. 19.
"Licensed Nursing Facility" means a residential institution, as defined in 16 Del.C., §1102(4), which provides services to residents which include resident beds, continuous nursing services, and health and treatment services for individuals who do not currently require continuous hospital care. Care is given in accordance with physician's orders and requires the competences of a registered nurse (RN).
Licensed Practical Nurse (LPN) means a nurse who is licensed as a practical nurse in Delaware or whose license is recognized to practice in the State of Delaware, and who may supervise LPN’s, CNA’s, NA’s and other unlicensed personnel.
Nursing Assistant (NA) means an individual who has completed the requisite training to become a Certified Nursing Assistant but is awaiting certification.
Nursing Related Services means those health related services that include supervision of, and direct assistance to, individuals in their activities of daily living and/or those physical and psychosocial basic skills encompassed in the certified nursing assistant curriculum.
Nursing Services Direct Caregivers means those individuals, as defined in 16 Del.C., §1161(e), assigned to the direct care of nursing facility residents.
Physicianmeans a physician licensed to practice in the State of Delaware.
Registered Nurse (RN) means a nurse who is a graduate of an approved school of professional nursing and who is licensed in Delaware or whose license is recognized to practice in the State of Delaware.
Rehabilitation means the restoration or maintenance of an ill or injured person to self‑sufficiency at his or her highest attainable level.
Resident means a person admitted to a nursing facility or similar facility licensed pursuant to 16 Del.C. Ch 11.
Restraint” “Chemical Restraints mean psychopharmacologic drugs that are used for discipline or convenience and not required to treat medical symptoms.
Physical Restraints mean any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.
Senior Certified Nursing Assistant means a Certified Nursing Assistant who has met the requirements and training specified in Section 4 of these regulations.
Skilled Care Facility means a facility licensed pursuant to 16 Del.C. Ch. 11 with a license designated for skilled care beds.
Student means a person enrolled in a course offering certification as a CNA.
Training Materials Developermeans an agency or other entity which markets Division approved continuing education training materials and courses to education providers.
Each Nursing Assistant/Certified Nursing Assistant employed by any nursing facility either as contract/ agency or facility staff shall be required to meet the following:
2.4.3 Training Materials Developers shall enter courses in CE Track for Division approval prior to offering courses to education providers.
"Activities of Daily Living (ADLs)" means normal daily activities including but not limited to ambulating, transferring, range of motion, grooming, bathing, dressing, eating and toileting.
"Advanced Practice Nurse" means an individual whose education and licensure meet the criteria outlined in 24 Del.C. Ch. 19.
"Certified Nursing Assistant (CNA)" means a duly certified individual under the supervision of a nurse, who provides care which does not require the judgment and skills of a nurse.
"Chemical Restraint" means psychopharmacologic drugs that are used for discipline or convenience and not required to treat medical symptoms.
"Department" means the Department of Health and Social Services.
"Direct Supervision" means actually observing students performing tasks.
"Division" means the Division of Long Term Care Residents Protection.
Facility" means a Nursing Facility, Assisted Living Facility or Intermediate Care Facility for Persons with Intellectual Disabilities licensed pursuant to 16 Del.C. Ch. 11.
"Full-Time" means working a minimum of 35 clock hours per week.
"General Supervision" means providing necessary guidance for the program and maintaining ultimate responsibility.
"Nurse" means a licensed practical nurse (LPN), registered nurse (RN) and/or advanced practice nurse (APRN) whose education and licensure meet the criteria in 24 Del.C. Ch. 19.
"Nursing Related Services" means services that include but are not limited to the following: bathing, dressing, grooming, toileting, ambulating, transferring and feeding, observing and reporting the general well-being of the person(s) to whom a qualified person is providing care.
"Physical Restraint" means any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's/patient's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body.
"Resident/Patient" means a person residing in a facility licensed pursuant to 16 Del.C. Ch. 11 or a person receiving care in a licensed acute or outpatient healthcare setting.
"Student" means a person enrolled in a course offering certification as a CNA.
Provide training in, and the opportunity for, [self?care self-care] according to the resident's/patient's capabilities.
Last Updated: December 31 1969 19:00:00.
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