<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".10" citation="COMAR 10.39.06.10" title_num="10" subtitle_num="39" chapter_num="06" heading="Training Program Requirements.">
  <paragraph num="A.">
    <text>Faculty.</text>
    <paragraph num="(1)">
      <text>The training program shall be administered by a registered nurse approved by the Board who meets the following qualifications:</text>
      <paragraph num="(a)">
        <text>An active license to practice as a registered nurse in good standing in the State or a multistate licensure privilege to practice registered nursing in the State;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A minimum of 2 years of experience practicing as a registered nurse, of which at least 1 year was in the care of renal patients; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Education or experience in adult education in the form of:</text>
        <paragraph num="(i)">
          <text>Experience as a staff development instructor for a minimum of 1 year;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Completion of at least 6 credit hours of an adult education program at a college or university; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Completion of an adult education course approved by the Board.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The registered nurse who is responsible for administering the training program may utilize other licensed practitioners to assist in conducting classroom and clinical portions of the program in accordance with the professional’s educational background and applicable scope of practice.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>CDT Assistance.</text>
      <paragraph num="(a)">
        <text>A certified dialysis technician may assist in aspects of supervised clinical training in a clinical facility, under the direct supervision of the registered nurse.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A certified dialysis technician assisting in aspects of the training program shall:</text>
        <paragraph num="(i)">
          <text>Hold a Certified Dialysis Technician certificate from the Board;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Possess a current national certification; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Have at least 2 years' experience in hemodialysis services.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The course instructor is responsible for:</text>
      <paragraph num="(a)">
        <text>Participating in development and evaluation of the training program, including the acquisition of learning resources and instructional materials;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Implementing the approved training program;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Supervising classroom laboratory experiences;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Evaluating student performance during didactic and laboratory training; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Providing direct supervision and clinical evaluation of each student at the clinical facility.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Facilities and Resources.</text>
    <paragraph num="(1)">
      <text>Classroom, laboratory, and clinical facilities shall be approved by the Board.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>All instructional learning resources and materials shall:</text>
      <paragraph num="(a)">
        <text>Be accessible and relevant to the role of a dialysis technician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Be written at a level appropriate for a dialysis technician; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Have a publication date not older than 5 years from the current year.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Clinical Facilities.</text>
      <paragraph num="(a)">
        <text>Clinical facilities shall:</text>
        <paragraph num="(i)">
          <text>Have a sufficient number and variety of patients to provide training experiences for all students to achieve the stated course objectives;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Have a sufficient number of RNs and other nursing personnel to ensure safe and continuous care of patients; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Conform with accepted standards of nursing care and practice.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>There shall be a minimum of one course instructor for each eight students in the clinical area.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Except for facility-based programs, the training program shall have a written agreement with a clinical facility that shall:</text>
        <paragraph num="(i)">
          <text>Be developed jointly with the clinical facility and the training program;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Be reviewed periodically by the clinical facility and the training program;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Include a provision for adequate notice of termination;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Specify the responsibility of the training program to the clinical facility and the responsibility of the clinical facility to the training program; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Identify the functions and responsibilities of the parties involved.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Curriculum.</text>
    <paragraph num="(1)">
      <text>A dialysis technician training program shall provide a minimum of 220 hours of instruction, of which a minimum of:</text>
      <paragraph num="(a)">
        <text>80 hours shall be devoted to didactic instruction and classroom laboratory training; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>140 hours shall be devoted to supervised clinical training in a clinical facility.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A dialysis training program shall include curriculum content that ensures sufficient preparation for national certification and for safe and effective practice as a dialysis technician.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Didactic instruction shall include the following content:</text>
      <paragraph num="(a)">
        <text>Content required under 42 CFR §494.140E(3);</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A review of the relevant laws and regulations regarding the practice of a dialysis technician and appropriate program policies;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Data collection;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Environment;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Renal anatomy and physiology;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Infection control and universal precautions;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Basic chemistry of body fluids and electrolytes;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Manifestations of renal failure;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Blood work and laboratory values related to dialysis;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Principles of dialysis;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Pharmacology of the drugs commonly used during dialysis;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Medication administration techniques specific to the drugs used in dialysis, including lidocaine, heparin, and normal saline;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Management of the complications of dialysis and renal failure;</text>
      </paragraph>
      <paragraph num="(n)">
        <text>The role of the dialysis technician in a dialysis setting including, but not limited to, legal and ethical considerations and concepts of delegation;</text>
      </paragraph>
      <paragraph num="(o)">
        <text>Water treatment relevant to dialysis;</text>
      </paragraph>
      <paragraph num="(p)">
        <text>Principles of patient education related to renal failure;</text>
      </paragraph>
      <paragraph num="(q)">
        <text>Principles of and requirements for documentation;</text>
      </paragraph>
      <paragraph num="(r)">
        <text>Communication and teamwork skills, including:</text>
        <paragraph num="(i)">
          <text>Observing, recording, and reporting;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Interpersonal skills; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Listening;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(s)">
        <text>Operation of dialysis delivery systems that includes the machines, dialysate, and dialyzer;</text>
      </paragraph>
      <paragraph num="(t)">
        <text>Principles of safe effective dialysis care;</text>
      </paragraph>
      <paragraph num="(u)">
        <text>Principles related to the nutritional considerations for patients receiving dialysis;</text>
      </paragraph>
      <paragraph num="(v)">
        <text>Psychosocial aspects of renal disease;</text>
      </paragraph>
      <paragraph num="(w)">
        <text>Principles of dialyzer reprocessing;</text>
      </paragraph>
      <paragraph num="(x)">
        <text>Principles for initiating, monitoring, and discontinuing dialysis;</text>
      </paragraph>
      <paragraph num="(y)">
        <text>Principles related to the adequacy of dialysis; and</text>
      </paragraph>
      <paragraph num="(z)">
        <text>Establishing and maintaining professional boundaries with a patient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Clinical instruction shall:</text>
      <paragraph num="(a)">
        <text>Provide the student with the opportunity to practice the cognitive, psychomotor, and affective skills required for the safe performance of dialysis care by the dialysis technician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Meet the learning needs of each student;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Meet the established program objectives or outcomes; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Be provided concurrently with the related classroom theory instruction.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Each training program shall identify the unit objectives and performance indicators for each of the areas in §C(3) of this regulation in its training criteria.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>A training program shall provide at least 16 hours of didactic and classroom laboratory training before a trainee’s direct assignment to patient care. This instruction shall include the following topics:</text>
      <paragraph num="(a)">
        <text>The role of the dialysis technician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Infection control;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Safety and environment;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Data collection;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Treatments; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Laboratory procedures.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Evaluation.</text>
    <paragraph num="(1)">
      <text>Each training program shall have an objective final written examination that measures achievement of the performance indicators.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To successfully complete the program, each student shall:</text>
      <paragraph num="(a)">
        <text>Complete the required minimum hours provided in §C(1) of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Achieve a passing score of at least 75 percent on the written final examination; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Demonstrate competence in meeting the objectives and performance indicators during didactic, laboratory, and clinical instruction.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The training program shall provide a certificate of completion, using the form required by the Board, to students upon program completion.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>An administrator or faculty of a training program:</text>
      <paragraph num="(a)">
        <text>May sign a student’s application for certification as a dialysis technician before graduation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Shall submit to the Board written verification, as required by the Board, of each student’s program completion within 5 business days of program completion.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>