In order to provide delegation in the State of Washington, a patient must be “stable and predictable” prior to receiving nurse delegation services. When a nurse arrives to perform delegation, they will do a brief head to toe assessment of the client. If the client has had any significant changes from their last full comprehensive nursing assessment on file, they will require a new nursing assessment prior to delegation. You will need to have signed physician orders for the medications and tasks you would like to be delegated.

What is medication delegation?

Nurse Delegation helps to ensure patients who require nursing care to remain living in an AFH, ALF, or at home instead of being placed in a nursing home. Upon hospital discharge a patient without Nurse delegation and in need of care from a registered nurse (RN) daily, such as assistance with medications and/or medication management, wound care, tube feedings or insulin injections would need placement in a nursing home. By obtaining Nurse Delegation via a Registered Nurse delegator, the required tasks are to be able to be taught to caregivers in an AFH, ALF or families who take care of the patient. This enables increased patient independence and livability in the AFH or home setting. Currently Stardig Nursing Services, PLLC accepts patients on Medicaid for nurse delegation. If the patient is not part of any of these programs, then the service is a private pay service.

Why obtain Nursing delegation : 

Nurse delegation is required when a patient needs a licensed caregiver to put medication in or on the patient’s body. In accordance with Washington State rule (WAC 246-840-910 to 920) delegation is required when a patient can put the medication in or on their own body, but they do not understand they are taking medication, including both over the counter and prescription medications. Additional circumstances where nurse delegation is needed includes when a person is suffering from cognitive impairment or is frail such that medication administration must occur. Washington law aims to protect older adults who may not have the mental awareness or functionality to know what medications they are taking. Written orders from the primary care provider for medication administration.

Delegation alleviates the need for extended stays in nursing homes or hospitals and can significantly reduce ones care costs

Delegation Requirements:

In order to provide nursing delegation, the caregiver must be licensed with the state as a nursing assistant or home health aides certified under chapter 18.88B RCW. Once teaching and delegation have been competently understood and return demonstrated to the nurse delegator the caregiver can then provide the necessary care for the delegated patient. This then alleviates the need for extended stays at a nursing home and can significantly reducing one’s care costs. It is important to note that not all nursing skills can be delegated.

Only a Registered Nurse can delegate a qualified caregiver. Furthermore, the nurse must be a delegating nurse and assume formal delegation responsibility for the client. For instance, a home health nurse who is an RN cannot delegate a caregiver if not the RN delegator. An LPN CANNOT delegate. Nursing delegation means an RN transfers the performance of a specific task for an individual client to a qualified Nursing Assistant working in a community setting.

Registered nurses delegating tasks are accountable to the Washington State Nursing Care Quality Assurance Commission. The registered nurse delegator and nursing assistant are accountable for their own individual actions in the delegation process. No person may coerce a registered nurse into compromising patient safety by requiring the registered nurse to delegate. Not all licensed caregivers qualify to be delegated to assist with these tasks. A caregiver must be a CNA, HCA, HCA-C, or NAR and have a current unrestricted license.

Diabetic Delegation:

Diabetic delegation will require a nurse to perform an initial comprehensive visit. If a client is getting caregivers delegated for insulin the visits will be a minimum of 4 supervised weekly visits for the first 4 weeks. Non diabetic delegation will require an initial visit and every 90 days reassessment or sooner as needed for change in status. If there are any changes in medications or client condition, then a visit will be made. If a new caregiver begins to work with the patient a visit will be made.