<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 10.39.06.14" title_num="10" subtitle_num="39" chapter_num="06" heading="Delegation of Nursing Functions.">
  <paragraph num="A.">
    <text>The following nursing functions require nursing knowledge, judgment, and skill and may not be delegated:</text>
    <paragraph num="(1)">
      <text>The nursing assessment including, but not limited to, the admission, shift, transfer, or discharge assessment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Development of the nursing diagnosis;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The establishment of the nursing care goal;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Development of the nursing care plan;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Evaluation of the patient's progress, or lack of progress, toward goal achievement; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Any nursing task which requires nursing knowledge, judgment, and skill.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The nurse may delegate treatments of a routine nature if:</text>
    <paragraph num="(1)">
      <text>The licensed nursing staff of the specific dialysis setting has identified the function as being routinely performed;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The specific treatments are performed at a high frequency necessary to retain competency;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The treatment has an inherently low risk to the patient, as determined by weighing the following factors:</text>
      <paragraph num="(a)">
        <text>Type of equipment utilized to perform the function;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Nurse staffing ratio that allows for close supervision;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Basic educational preparation of the certified dialysis technician performing the delegated function; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Knowledge and skill set of the nurse delegating and supervising the delegated function; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>There is a quality assurance mechanism in place to ensure the function is performed safely and patient outcomes meet accepted professional nursing standards, including, but not limited to:</text>
      <paragraph num="(a)">
        <text>An ongoing formalized documented performance appraisal mechanism designed to ensure that the certified dialysis technician’s revalidation of continued competency is a component of the quality assurance mechanism; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Patient outcomes meeting accepted professional standards, as reflected by:</text>
        <paragraph num="(i)">
          <text>Infection rates;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Rates of adverse events;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Error rates; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Patient satisfaction surveys.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The nurse may delegate the obtaining of specific information to a certified dialysis technician.</text>
  </paragraph>
  <paragraph num="D.">
    <text>When implementing the interdisciplinary plan of care, the nurse may delegate a nursing task to a certified dialysis technician when the delegation of that task does not jeopardize the patient's welfare.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Administration of medication is a nursing function. As such, the nurse retains full responsibility for medication administration.</text>
  </paragraph>
  <paragraph num="F.">
    <text>The following activities related to medication administration may not be delegated except as provided in Regulation .11A(1) of this chapter:</text>
    <paragraph num="(1)">
      <text>Calculation of any medication dose;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Administration of medications by injection route;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Administration of medications by way of a tube inserted in a cavity of the body; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Administration of medication by intravenous route.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Delegation of Medication Administration.</text>
    <paragraph num="(1)">
      <text>The administration of medication may be delegated to certified dialysis technicians only in structured settings.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A nurse may delegate the administration of only the medications set forth in Regulation .11A(1) of this chapter to a certified dialysis technician.</text>
    </paragraph>
  </paragraph>
</regulation>