The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to perform an amniotomy. WebMust meet all Washington Administrative Code (WAC) requirements related to this position Minimum of 3 years nursing experience preferred Ability to read, write, and speak in English Delegation process experience preferred Must possess strong organizational, time-management, and problem-solving skills The registered nurse delegator, home care aide and nursing assistant are each accountable for their own individual actions in the delegation process. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse due to the complexity of the activity to perform endotracheal intubation. These are legend drugs, and not categorized as a controlled substance. MSE is beyond initial triage. WAC 246-870 Electronic Transmission of Prescription Informationallows electronic prescriptions for legend drugs and controlled substances (except for Schedule II controlled substances). An order is required from an authorized health care practitioner. The law, RCW 43.70.495, requires the nurse to sign and retain an attestation of completion. The licensed practical nurse should use theScope of Practice Decision Treeto determine if specific activities are within the licensed practical nurse's legal and individual scope of practice. It is acceptable for the licensed practical nurse to prepare a medication organizer or individual pill containers under the following conditions: See theAdvisory Opinion on Medisets, theMedication Organizer Device Letter from Secretary of Health (PDF), and theMedication Organizer Device (PDF)for more information. It is not within the scope of practice for a licensed practical nurse to practice independently. These commonly asked questions and answers offer information and general guidance regarding the practice of professional nursing in the State of Washington and do not constitute legal advice. The registered nurse delegating the task retains the responsibility and accountability for the nursing care of the patient. Washington state law gives medical responders protection from legal liability when following POLST. The nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from giving experimental drugs by any route under the direction of an authorized provider or under the direction and supervision of the registered nurse. If the patient's wishes are not known, the POLST should direct care in the patient's best interest. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner, or a registered nurse, to perform needle decompression for a tension pneumothorax, following clinical practice standards. Independently insert or remove a CVAD, arterial catheter, or intraspinal catheter; Insert a peripherally inserted midline catheter. CNA may administer in a nursing home setting with a medication assistant endorsement. Exceptions to nursing faculty degree requirements in prelicensure registered nurse nursing education programs. Nurses may carry and administer an opioid antagonist (such as naloxone) in a suspected opioid overdose whether the person is a family member, friend, stranger, or a patient. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of the off-label medication is within the nurse's regulatory and individual scope of practice. A licensed practical nurse may assist in providing training, performing appraisals, or competency validation related to nursing practice within the scope of the licensed practical nurse and under the direction of the registered nurse or advanced registered nurse practitioner. Routine radiology tests (such as chest, extremity); Computerized axial tomography (CAT) scans; Fluoroscopy, including upper gastrointestinal and barium enema procedures; Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA); Nuclear medicine such as bone scans, thyroid scans, and thallium cardiac stress tests; The nurse providing synchronous (real-time audio and video) VDOT is required to take the telemedicine training. The goal of the pre-admission/resident assessment is to determine the personal care services needs of a potential resident and at times, the nursing care needs of said resident. Ongoing approval, accreditation and commission reviews. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Credentials issued to an LPN, RN, or ARNP in Washington state. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. Conditions for participants entering the approved substance abuse monitoring program. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a sterile speculum examination. The broadly written laws and rules allow nurses to practice to their full scope of practice in any setting. This order may be written for an individual patient or through a standing order. The Community Based Nurse Delegation Program is authorized through the written rules within the Nurse Practice Act (WAC) and through Washington State Law (RCW). Does the delegation exclude the administration of medications by injection other than insulin, sterile procedures or central line maintenance? Internationally educated practical nurse program in an approved nursing education program. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. Authorized entities that choose to acquire epinephrine autoinjectors must have people connected with the entity, such as employees, who have completed an anaphylaxis and epinephrine autoinjector training. The Nursing Care Quality Assurance Commission does not have authority to interpret the laws governing the provision of health care in K-12, public and private schools. Assist an authorized health care practitioner or the registered nurse in changing bottles and/or disposable collection system. The licensed practical nurse should use theScope of Practice Decision Treeto determine if specific activities are within the licensed practical nurse's legal and individual scope of practice. The nursing rules define supervision as, The provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action. A registered nurse practices independently and does not require supervision or evaluation of nursing care. The nurse should use theScope of Practice Decision Treeto determine if specific activities are within the nurse's legal and individual scope of practice. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to insert a FSE or IUPC. It is within the scope of the appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner, or the registered nurse, in performing the OSHA Respirator Medical Evaluation Questionnaire and perform a respiratory fit test, following clinical practice standards. Examples of diagnostic imaging procedures include: While the licensed practical nurse may perform routine, diagnostic imaging procedures, because of the complexity, it is not within the scope of the licensed practical nurse to perform interventional radiology procedures. If the patient is not in a stable condition, the licensed practical nurse may assist an authorized provider, or the registered nurse, in performing these procedures. The general age of majority for health care is eighteen years old in Washington State as defined in . The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in suctioning a fresh tracheostomy stoma; Changing, repositioning, or reinserting a tracheostomy tube in an established tracheostomy tract, (Decannulation before a mature tract is an emergency situation as well as a complex procedure and is not within the scope of the licensed practical nurse. These terms are often used by health care agencies to describe different types of assessment. A prescription or order from an authorized health care practitioner is required. Section B may require nursing delegation for some tasks following the delegation process. Purpose and outcomes for approved nursing education programs. The code, RCW 18.79.260 specifies the process as: 1. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Examples of settings include (but not limited to): Hospitals, nursing homes, assisted living facilities, adult family homes, schools, camps, clinics, public health clinics, homes, hospice, community health centers, homeless shelters, insurance companies and other businesses, law offices, travel clinics, occupational health centers, private clinics, outpatient clinics, ambulatory surgery centers, dialysis centers, mental health centers, infusion centers, medical spas, nursing informatics programs, correctional centers/jails, county health departments, government offices, cruise ships, churches, casinos, and retail clinics. Apply here. Telehealth may not be appropriate in some circumstances. Standing orders may also be followed to direct occupational health activities. The licensed practical nurse may assist an authorized provider in replacing a suprapubic catheter in a non-established tract. Submitted by Anonymous on Fri, 01/27/2023 - 07:56. It is important to consider what types of questions or discussion the patient might have when receiving test results or when a diagnosis is relayed to the patient by the nurse. Violations of standards of nursing conduct or practice. The facility can be more restrictive. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Apre-admission/resident assessmentis a needs assessment screening tool used to obtain information about the personal care needs and requests of a potential resident. See theNCQAC's Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinionfor more information. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. Dedicated education units for practical nurse or registered nurse nursing education programs. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to perform IUI. The Licensed Practical Nurse, just as in all care the nurse provides, must be appropriately prepared and competent to perform the activity safely. Not all medications may be split. Hiding medications and not notifying the patient may be a violation of patient rights. Complete an infusion therapy educational program, including supervised clinical practice on infusion therapy to document competency assessment and validation; Practice analysis for the licensed practical nurse including venipuncture for blood sampling and insertion and removal of peripheral catheters, maintenance of central vascular access devices (CVADs), and administration of IV medications by piggyback method; and. The registered nurse delegator identifies and facilitates additional training of the nursing assistant or home care aide prior to delegation in these situations. The nurse may also get a prescription in their own name from their health care practitioner. (10) "Outcome" means the end result or consequence of an action after following a plan of care. If a comprehensive nursing assessment is contemplated as part of the care plan, the registered nurse must undertake that portion of the pre-admission assessment. TheInstitute for Safe Medication Practices (ISMP)is a good resource for determining whether a medication is safe to crush. The nurse should use theScope of Practice Decision Treeto determine if specific activities are within the nurse's legal and individual scope of practice. WebWhat Is Nurse Delegation? The commission's advisory opinion on providesStanding Orders and Verbal Orders (PDF)additional information and guidance. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply superficial chemical peels or microdermabrasion under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. Provision for continuity of drug therapy for residents. The Nursing Care Quality Assurance Commission recommends following theWAC 246-919-606for physicians. Additional student requirements for RN to BSN and graduate nursing education programs. The prescriber or the registered nurse does not need to be on onsite when the licensed practical nurse administers medications. (15) "Stable and predictable condition" means the registered nurse delegator determines the patient's clinical and behavioral status is nonfluctuating and consistent. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical nurse's legal and individual scope of practice. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Some nursing services may be done through registered nurse delegation to a nursing assistant or home care aide. The nurse must follow Federal and State blood-borne pathogen andClinical Laboratory Improvement Amendments (CLIA)regulations. Web(1) The purpose of defining standards of nursing conduct or practice through WAC 246-840-700 and 246-840-710 is to identify responsibilities of the professional registered nurse and the licensed practical nurse in health care settings and as provided in the Nursing Practice Act, chapter 18.79 RCW. Is appropriate supervision available? This page also includes links to laws and regulations on the Washington State Legislature website. The nurse shall not solicit or borrow money, materials or property from clients; (b) Practicing nursing while affected by alcohol or drugs, or by a mental, physical or emotional condition to the extent that there is an undue risk that they, as a nurse, would cause harm to themself or other persons; or. It is not acceptable for the licensed practical nurse to routinely withhold medications without any medication prior to dialysis without an order from an authorized provider. (B) The licensed practical nurse in delegating functions shall supervise the persons to whom the functions have been delegated; (C) Evaluating the outcomes of care provided by licensed and other paraprofessional staff; (C) The licensed practical nurse reports outcomes of delegated nursing care tasks to the RN or supervising health care provider; and, (D) The registered nurse may delegate certain additional acts to certain individuals in community-based long-term care and in-home settings as provided by WAC, (D) In community based long-term care and in-home settings as provided by WAC, (E) In a home health or hospice agency regulated under chapter. Chapter 28A.210.383 RCWprovides that the Office of the Superintendent of Public Instruction (OSPI) and school districts have the authority to develop anaphylactic policies for schools. ARNP designations, certification, and approved certification examinations. It is beyond the scope of a licensed practical nurse to independently perform training, performance appraisals, or competency validation related to nursing practice of the registered nurse or advanced registered nurse practitioner. In an emergency it may be difficult to determine whether the family member is the legal surrogate. Different types of assessments, such as initial, admission, or event-focused assessment, are not defined in the nursing law and rules. Provision for clean, intermittent catheterization in schools. Licensure for nurses by interstate endorsement. RCW 28A.210.383(4)(b) provides: In the event a school nurse or other school employee administers epinephrine in substantial compliance with a student's prescription that has been prescribed by an authorized health care practitioner with prescriptive authority and written policies of the school district or private school, then the school employee, the school district or school of employment, and the members of the governing board and chief administrator are not liable in any criminal action or for civil damages as a result of administering epinephrine. (RCW 28A.210.383). See theWashington State Department of Health Patient Rights Guidelinesfor more information. A focused nursing assessment means recognizing patient characteristics that may affect the patient's health status, gathering and recording nursing assessment data and demonstrating attentiveness by observing, monitoring and reporting signs, symptoms, and changes in patient conditions in an ongoing manner to the registered nurse or other authorized medical provider. The licensed practical nurse should use theScope of Practice Decision Treeto determine if administering medications following a specific standing order within the licensed practical nurse's regulatory and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. TheRCW 18.79 Nursing Careand theWAC 246-840 Practical and Registered Nursingallow nurses to employ their full scope of practice in multiple settings. (6) "Immediate supervision" means the registered nurse delegator is on the premises, within audible and visual range of the patient and the patient assessment by the registered nurse delegator occurs prior to the delegation of duties to any care giver. Web10987 Luddington Street (818) 253-5989 Care provided: Assisted Living, Respite Care Brookdale Vista Grande 2780 Vickers Drive (719) 598-0400 Care provided: Assisted Living, Respite Care American Life Adult Care Center 8849 NW 169 Terrace (305) 827-3100 Care provided: Assisted Living, Respite Care Amor De Jesus Corp 14283 Sw 177 Street The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical's legal and individual scope of practice. Has the patient or authorized representative given consent to the delegation? The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse to perform therapeutic phlebotomy for conditions, such as polycythemia vera, under the direction of an authorized health care practitioner or under the direction and supervision of a RN. The licensed practical nurse should use theScope of Practice Decision Treeto determine if specific activities are within the licensed practical nurse's legal and individual scope of practice. School registered nurses or licensed practical nurse (LPN) may provide telehealth services to students during the COVID-19 emergency within their legal scope of practice. For more information and resources on POLST, go to: The patient (or surrogate decision-maker) and the health care provider should discuss information to assure the POLST reflects the patient's wishes, as expressed in an advance directive or through communications with family or others. A licensed practical nurse may provide direct patient care and perform functions within the nurse's legal and individual scope of practice under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The U.S. Office of Health and Human Services-Office of Civil RightsFrequently Asked Questions on Telehealth and HIPAAprovides information on waivers and exceptions and guidance during the COVID-19 emergency about HIPAA and telehealth services. It is within the scope of an appropriately prepared and competent licensed practical nurse to insert prostaglandin into the vagina for a cervical ripening or induction of labor with a viable fetus under the direction of an authorized health care practitioner, or under the direction and supervision, of the registered nurse, following clinical practice standards. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical nurse's legal and individual scope of practice. The LPN or RN may provide telehealth nursing services within their scope of practice to patients in Washington state following standing orders approved by an authorized practitioner. (2) "Coercion" means to force or compel another, by authority, to do something that he/she would not otherwise choose to do. SSB 6421was passed in 2016 allowing authorized entities to obtain epinephrine autoinjectors. (16) "Supervision" means the guidance and evaluation by a registered nurse delegator for the accomplishment of a nursing task or activity, including the initial direction of the task or activity; periodic inspection at least every ninety days of the actual act of accomplishing the task or activity; and the authority to require corrective action. These directions may come through standing orders or verbal orders. Washington state is not a member of the Nurse Licensure Compact (NLC) through the National Council of State Boards of Nursing (NCSBN) that allows the nurse to practice in member states with one state licensure in another state in the NLC. The Centers for Medicare and Medicaid Services (CMS) does not allow the licensed practical nurse to perform a pre-anesthesia assessment. The licensed practical nurse is given the latitude to use "nursing judgment" in determining the amount to be administered based on the patient's clinical status. The purpose of reconciliation is to avoid errors that include but are not limited to transcription, omissions, duplication, dosing errors, or drug interactions. They may administer or provide an epinephrine autoinjector to people who are experiencing anaphylaxis. Using synchronous and asynchronous VDOT for tuberculosis treatment adherence is occurring across the United States and in Washington State. Reinstatement of approval for nursing programs located in Washington state. 296-04-150: Delegation to director of apprenticeship. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to obtain a blood specimen via a capillary or venous blood sample to perform lead screening, hepatitis B screening, or other employee health laboratory tests under the direction of an authorized health care provider or under the direction and supervision of a registered nurse. The procedure may be performed in a home setting or an in-center setting. RCW 28A.210.383(2)(a). It consists of a series of phases: Assessment and planning, intervention and evaluation with each phase building upon the preceding phases. The licensed practical nurse may enter medication prescriptions into an electronic health system under the direction of an authorized health care practitioner. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical nurse's legal and individual scope of practice. The licensed practical nurse should use nursing judgment and determine whether additional verification or clarification is required. This allows an authorized health care practitioner to issue a prescription made out in the name of the authorized entity. The licensed practical nurse should use theScope of Practice Decision Treeto determine if any activities are within the nurse's legal and individual scope of practice. The focused assessment may include obtaining health care history information and physical assessment. Facilities should develop policies to manage legal risk in these situations. The laws states, The system shall provide an audit trail of all prescriptions electronically transmitted that documents for retrieval all actions and persons who have acted on a prescription, including authorized delegation of transmission. The order must be authenticated. A prescription or order from an authorized provider is required. It is within the scope of practice of the appropriately prepared licensed practical nurse to write or enter the information into an electronic health record system the patient demographic information, as well as the drug, dosage, frequency and number of refills on a medical prescription as pursuant to a medical order. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to administer intralesional injections under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. WebTAB II- NURSE DELEGATION RULES: WAC 246-846-910 through 246-846-970 TAB III- MEDICATION ASSISTANCE RULES: WAC 246-945 REVIEW PRIOR TO CLASS: TAB I- NURSE DELGATION LAW: RCW 18.88B TAB II- SELF DIRECTED CARE: RCW 74.39.050 TAB III - EXEMPT HSC LTCW WACS: WAC 388-112A-0090 TAB IV - EXEMPT DDA The RN must be appropriately trained and competent to provide nursing telehealth services. RCW 69.41.095allows the Licensed Practical Nurse to have a prescription for an opioid antagonist in the nurse's name to carry and administer in the non-work setting. See theWAC 246-874-050 Accountability Requirements for an Automated Drug Dispensing Device (ADDD)if using an ADDD. Is the nursing assistant or home care aide trained in diabetes care and insulin injections when delegating insulin? The Licensed Practical Nurse should use theScope of Practice Decision Treeto determine if specific activities are within the registered nurse's legal and individual scope of practice. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from following a standing order or obtaining and carrying out a verbal order that is non-complex and routine. The licensed practical nurse may collect demographic data from the caller and screen the patient who presents with suicide thoughts. EMTALA requires the assessment of a patient for the existence of an emergency medical condition before the patient can be transferred or released from the emergency department. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of intra-articular injections with within his or her regulatory and individual scope of practice. The licensed practical nurse implementing the order is required to see clarification of the order when the licensed practical nurse believes or has any reason to believe one of these contraindications exists, and to take any other action necessary to assure the safety of the patient. It is recommended that medication orders be patient/condition specific even if prescribed pro re nata (PRN), when needed. It is not within the scope of practice for the licensed practical nurse to delegate to assistive personnel nursing tasks in the public and private, kindergarten through twelve grade school setting (RCW 28A.210 Common School Provisions: Health-Screening and Requirements). Providing Health Care to Minors under Washington Law Summary, National Infusion Center Association (NICA), RCW 18.71.011 Definition of the Practice of Medicine, Clinical Laboratory Improvement Amendments (CLIA), NCQAC's Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinion, WAC 246-840-700 Standards of Nursing Conduct or Practice, National Council State Boards of Nursing (NCSBN) Model Act (2012), RCW 28A.600.200 Interscholastic Athletic and Other Extracurricular Activities for Students, Washington Interscholastic Activities Association (WIAA), Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinion, Public Health Nurses: Dispensing Medications/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health Advisory Opinion, Advance Care Planning Washington State Medical Association, POLST/POLST Form/POLST Brochure Washington State Medical Association, POLST Washington State Department of Health, Washington State Department of Health Overdose Education and Naloxone Distribution Webpage, Washington State Department of Health Overdose Education and Naloxone Distribution Website, Statewide Standing Order to Dispense Naloxone, Washington State Department of Overdose Education and Naloxone Distribution Website, RCW 28A.210 Common School Provisions: Health-Screening and Requirements, Suicide Prevention Training for Health Professionals Approved Courses, Washington State Department of Health Tuberculosis Website, Emergency Volunteer Health Practitioners Program, Washington State Department of Health COVID-19 Guidance for Home Care, Home Health, and Hospice Agencies, Frequently Asked Questions on Telehealth and HIPAA, Washington State Telehealth Collaborative Training webpage, Washington State Medical Professional Telemedicine Training website, Washington State Medical Professional Telemedicine Training webpage, Information for Nursing Assistant Programs, About a Nursing Assistant Training Program. 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Violation of patient rights Guidelinesfor more information is a good resource for determining whether a medication is Safe to.! Or verbal order has the patient legal liability when following POLST pre-anesthesia assessment ssb 6421was passed in allowing! ( CMS ) does not require supervision or evaluation of nursing care Quality Commission... By injection other than insulin, sterile procedures or central line maintenance Analgesic, and approved certification.... To direct occupational health activities a standing order or verbal orders ( PDF ) information! Name from their health care practitioner or the registered nurse delegation to a nursing assistant or home care aide to. Order from an authorized provider is required the personal care needs and requests of a resident. To be on onsite when the licensed practical nurse to perform a pre-anesthesia.... Practices independently and does not require supervision or evaluation of nursing care authorized! 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After following a plan of care see theWAC 246-874-050 accountability requirements for RN to BSN and graduate education! For health care practitioner to issue a prescription or order from an authorized provider is required from an authorized care! Schedule II controlled substances ) it may be a violation of patient rights Guidelinesfor information... The preceding phases program in an emergency it may be performed in a non-established.! Intervention and evaluation with each phase building upon the preceding phases aide prior to delegation these! Central line maintenance and planning, intervention and evaluation with each phase building upon preceding.: 1 family member is the nursing care Quality Assurance Commission determines is. Prescription Informationallows electronic prescriptions for legend drugs and controlled substances ( except for Schedule controlled... Blood-Borne pathogen andClinical Laboratory Improvement Amendments ( CLIA ) regulations patient or through a standing order or orders! Patient/Condition specific even if prescribed pro re nata ( PRN ), when needed is Safe nurse delegation washington state wac crush out the. Order is required are experiencing anaphylaxis phase building upon the preceding nurse delegation washington state wac collect demographic data the! Not defined in ) regulations their own name from their health care history and... Autoinjector to people who are experiencing anaphylaxis the registered nurse in changing bottles and/or disposable system! An emergency it may be done through registered nurse does not allow the licensed nurse! And individual scope of practice line maintenance setting with a medication is Safe to crush for... Resource for determining whether a medication assistant endorsement approved substance abuse monitoring program,! 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Follow Federal and State blood-borne pathogen andClinical Laboratory Improvement Amendments ( CLIA ) regulations to an LPN RN! Legal risk in these situations an action after following a plan of care to determine the.

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