WAC 246-840-940. Washington state board of nursing community-based and in-home care setting delegation decision tree

In community-based and in-home care settings, before delegating a nursing task, the registered nurse delegator shall decide if a task is appropriate to delegate based on the decision tree: (1) Does the patient reside in one of the following settings? A community-based care setting as defined by RCW 18.79.260 (3)(e)(i) or an in-home care setting as defined by RCW 18.79.260 (3)(e)(ii). No → Do not delegate Yes ↓ (2) Has the patient or authorized representative given consent to the delegation? No → Obtain the written, informed consent Yes ↓ No → (3) Is RN assessment of patient's nursing care needs completed? No → Do assessment, then proceed with a consideration of delegation Yes ↓ (4) Does the patient have a stable and predictable condition? No → Do not delegate Yes ↓ (5) Is the task within the registered nurse's scope of practice? No → Do not delegate Yes ↓ (6) Is the nursing assistant or home care aide, registered or certified and properly trained in the nurse delegation for nursing assistants or home care aides? Is the nursing assistant or home care aide trained in diabetes care and insulin injections when delegating insulin? No → Do not delegate Yes ↓ (7) Does the delegation exclude the administration of medications by injection other than insulin, sterile procedures or central line maintenance? No → Do not delegate Yes ↓ (8) Can the task be performed without requiring judgment based on nursing knowledge? No → Do not delegate Yes ↓ (9) Are the results of the task reasonably predictable? No → Do not delegate Yes ↓ (10) Can the task be safely performed according to exact, unchanging directions? No → Do not delegate Yes ↓ (11) Can the task be performed without a need for complex observations or critical decisions? No → Do not delegate Yes ↓ (12) Can the task be performed without repeated nursing assessments? No → Do not delegate Yes ↓ (13) Can the task be performed properly? No → Do not delegate Yes ↓ (14) Is appropriate supervision available? With insulin injections, the supervision occurs at least every two weeks for the first four weeks. No → Do not delegate Yes ↓ (15) There are no specific laws or rules prohibiting the delegation? No → Do not delegate Yes ↓ (16) Task is delegable (1) Does the patient reside in one of the following settings? A community-based care setting as defined by RCW 18.79.260 (3)(e)(i) or an in-home care setting as defined by RCW 18.79.260 (3)(e)(ii). No → Do not delegate Yes ↓ (2) Has the patient or authorized representative given consent to the delegation? No → Obtain the written, informed consent Yes ↓ No → (3) Is RN assessment of patient's nursing care needs completed? No → Do assessment, then proceed with a consideration of delegation Yes ↓ (4) Does the patient have a stable and predictable condition? No → Do not delegate Yes ↓ (5) Is the task within the registered nurse's scope of practice? No → Do not delegate Yes ↓ (6) Is the nursing assistant or home care aide, registered or certified and properly trained in the nurse delegation for nursing assistants or home care aides? Is the nursing assistant or home care aide trained in diabetes care and insulin injections when delegating insulin? No → Do not delegate Yes ↓ (7) Does the delegation exclude the administration of medications by injection other than insulin, sterile procedures or central line maintenance? No → Do not delegate Yes ↓ (8) Can the task be performed without requiring judgment based on nursing knowledge? No → Do not delegate Yes ↓ (9) Are the results of the task reasonably predictable? No → Do not delegate Yes ↓ (10) Can the task be safely performed according to exact, unchanging directions? No → Do not delegate Yes ↓ (11) Can the task be performed without a need for complex observations or critical decisions? No → Do not delegate Yes ↓ (12) Can the task be performed without repeated nursing assessments? No → Do not delegate Yes ↓ (13) Can the task be performed properly? No → Do not delegate Yes ↓ (14) Is appropriate supervision available? With insulin injections, the supervision occurs at least every two weeks for the first four weeks. No → Do not delegate Yes ↓ (15) There are no specific laws or rules prohibiting the delegation? No → Do not delegate Yes ↓ (16) Task is delegable