Rule 111-8-100-.05 - Training and Other Requirements for Proxy Caregivers(1)Training Curricula. A licensed facility utilizing proxy caregivers must employ a written training curricula developed by appropriately licensed healthcare professionals which ensures that the proxy caregiver accurately demonstrates how to do the required health maintenance activities correctly and safely. At a minimum, the training curricula used for proxy caregivers must include the following: (a) Learning objectives which relate specifically to the health maintenance activities to be performed;(b) Content knowledge and skills that are required to accomplish the learning objectives;(c) Learning activities that will be utilized to provide instruction on knowledge and skills required;(d) The results of the Test of Functional Health Literacy (TOFHLA) used as an assessment tool to individualize necessary training for the specific skills if the caregiver does not have a high school diploma or a general equivalency degree (G.E.D.);(e) Satisfactory and independent completion of the required skills competency checklists relating to the specific health maintenance activities to be performed before an appropriately licensed healthcare professional;(f) The use of skills competency checklist forms when made available by the department for the specific health maintenance activities to be performed or other skills checklist forms that include all of the competencies in the correct order as contained on the forms made available by the department and as required for the specific client; and(g) Satisfactory evidence of routine evaluations of continued skills competencies by an appropriately licensed healthcare professional, at least annually if not assessed more frequently as specified on the written plan of care.(2)Licensed Facilities Providing Medication Administration. A licensed facility may use proxy caregivers to administer medications to an individual with a disability unless the use of proxy caregivers is subsequently prohibited or modified by regulations applicable to a specific type of licensed facility adopted after the effective date of these rules. In the absence of more specific requirements, the licensed facility using proxy caregivers for medication administration must meet the following conditions: (a) The individual with a disability or the legally authorized representative has provided a written informed consent which meets the requirement of these rules;(b) The medications and administration being provided have been determined by an appropriately licensed healthcare professional to be health maintenance activities that may be safely performed by properly trained proxy caregivers; and(c) The proxy caregiver has been trained in accordance with these rules and determined through completion of a skills competency checklist before an appropriately licensed healthcare professional to have the knowledge and skills necessary to perform the specific health maintenance activities in accordance with the written plan of care.(3)Medication Administration Curriculum. Licensed facilities that employ or contract with proxy caregivers to provide medication administration must maintain documentation reflecting that the facility has trained these proxy caregivers in accordance with the medication administration training curriculum established by DCH.(4) The training on medication administration must be provided by an appropriately licensed healthcare professional, e.g. registered professional nurse, advance practice registered nurse, physician's assistant, pharmacist or physician and must be individualized and supplemented as appropriate to meet the unique needs of the individual with a disability being served.(5) Where a new medication is ordered, a licensed healthcare professional must be contacted to ensure that no additional training is required prior to the caregiver providing assistance with the new medication. The date, time and the outcome of the contact with the licensed healthcare professional must be documented in the individual's record. Where additional training is required prior to the caregiver providing assistance, such training will be provided and documented by a licensed healthcare professional.(6) Proxy caregivers providing medication assistance must be proficient in reading and following detailed written instructions in English, recording understandable written entries in the client's records, communicating effectively with the client and have achieved at least a minimum score of 75 on the Test of Functional Health Literacy for Adults (TOFHLA).(7)Prohibited Assistance. The licensed facility providing medication management services must not train or permit proxy caregivers to provide the following assistance with medications:(a) Mixing, compounding, converting, or calculating medication doses, except for measuring a prescribed amount of liquid medication, breaking a scored tablet, crushing a tablet or adding water or other liquid to laxatives and nutritional supplements when such substance preparations are being done in accordance with a specific written prescription;(b) Preparing syringes for intravenous injection or the administration of medications intravenously;(c) Administering any intravenous medications and the first dose of any subcutaneous or intramuscular injection;(d) Interpreting a "PRN" (as needed) medication order when the order does not identify the resident behaviors or symptoms which would trigger the need for the medication and/or does not identify the appropriate dosing and is not specifically authorized on the written plan of care;(e) Irrigating or debriding agents used in the treatment of skin conditions;(f) Assisting in the administration of sample or over the counter medications where there is no written doctor's order providing amount and dosing instructions; and(g) Assisting in the administration of any medication to a client without appropriate evidence of a written order signed by an appropriately licensed healthcare professional; and(h) Performing any health maintenance activities where the licensed health care professional has determined that either the care required no longer meets the definition of health maintenance activities or the proxy caregiver has not demonstrated the knowledge and skill necessary to perform the health maintenance activities safely.(8)Maintaining Records on Medication Administration. Where the licensed facility manages medications for an individual with a disability, the licensed facility must maintain a daily Medication Assistance Record (MAR) for each person who receives assistance. At a minimum, the MAR must include the name of the specific person receiving assistance, any known allergies, the name and telephone number of the individual's health care provider, the name, strength and specific directions for the medications being managed, and a chart for staff who provide assistance to record initials, time and date when medications are taken, refused or a medication error is identified (e.g. missed dosage). The staff providing the assistance must immediately update the MAR for each individual each time the medication is offered or taken. (a) The licensed facility must make medication information concerning the descriptions of medication, dosing, side effects, adverse reactions and contraindications for each medication being administered to the individual with a disability immediately available for reference by proxy caregivers providing medication assistance. The licensed facility must utilize a properly indexed medication information notebook or folder which contains information about only the medications for which the caregivers are providing assistance.(b) Proxy caregivers provided by the licensed facility who provide assistance with medications must document in the client's record any unusual reactions to the medications and provide such information to the individual with a disability, legally authorized representative, if any, and healthcare provider as appropriate.(9)Competency Evaluations for Specialized Health Maintenance Activities. Where the health maintenance activity to be performed has multiple discrete tasks that must be performed in proper sequence to deliver safe care, the licensed healthcare professional must ensure that the skills competency checklist properly sequences all necessary tasks. The licensed healthcare professional must verify by direct observations and sign documentation that the proxy caregiver can complete all tasks required satisfactorily in proper sequence from memory without prompting or assistance of any kind. Competency to perform specialized health maintenance activities must be reevaluated whenever the health maintenance activities change, and on a regularly recurring schedule as determined appropriate by the licensed healthcare professional on the written plan of care. The schedule for such re-evaluations must take into consideration the nature of the health maintenance activities to be performed and the condition of the client. At a minimum, such reevaluations by the licensed healthcare professional must occur no less frequently than annually.Ga. Comp. R. & Regs. R. 111-8-100-.05
O.C.G.A. §§ 31-7-2.2, 43-26-12(a)(9).
Original Rule entitled "Training and Other Requirements for Proxy Caregivers" adopted. F. Jul. 18, 2011; eff. Aug. 7, 2011.Amended: F. Apr. 16, 2018; eff. May 6, 2018.