The Florida Legislature recently revised Section 400.488, F.S which details what constitutes ‘Assistance with Self-Administration of Medications’ (ASAM) as it applies to home care organizations. The definition has expanded the tasks an unlicensed person in a home health setting may perform to assist a patient with the same kinds of self-administration of medication tasks that are allowed in an assisted living facility (ALF). The law became effective on July 1, 2022.
Prior to July 1, 2022, Section 400.488, F.S., allowed home health aides (HHAs) and certified nursing assistants (CNAs) to assist a patient with the self-administration of his or her medications, which included:
- Taking the medication, in its previously dispensed, properly labeled container, from where it is stored and bringing it to the patient.
- In the presence of the patient, confirming that the medication is intended for that patient, orally advising the patient of the medication name and purpose, opening the container, removing a prescribed amount of medication from the container, and closing the container.
- Placing an oral dosage in the patient’s hand or placing the dosage in another container and helping the patient by lifting the container to his or her mouth.
- Applying topical medications, including routine preventive skin care and applying and replacing bandages for minor cuts and abrasions as provided by the AHCA rule.
- Returning the medication container to proper storage.
- For nebulizer treatments, assisting with setting up and cleaning the device in the presence of the patient, confirming that the medication is intended for that patient, orally advising the patient of the medication name and purpose, opening the container, removing the prescribed amount for a single treatment dose from a properly labeled container, and assisting the patient with placing the dose into the medicine receptacle or mouthpiece. (This paragraph was substantially modified and will be discussed below.)
- Keeping a record of when a patient receives assistance with self-administration under this section.
The definition of ASAM remains substantially the same, but the revision adds new tasks with which an HHA or CNA may provide assistance in a home care setting, including:
- Assisting with transdermal patches.
- Using a glucometer to perform blood-glucose level checks.
- Assisting with putting on and taking off antiembolism stockings.
- Assisting with applying and removing an oxygen cannula but not with titrating the prescribed oxygen settings.
- Assisting with the use of a continuous positive airway pressure (CPAP) device but not with titrating the prescribed setting of the device.
- Assisting with measuring vital signs.
- Assisting with colostomy bags.
The statute revised and simplified the manner in which ASAM via nebulizer may be performed in a home health setting to mirror how such assistance is provided in an ALF. Specifically, the revised statute says that assisting with the use of a nebulizer includes, “removing the cap of a nebulizer, opening the unit dose of nebulizer solutions, and pouring the prescribed premeasured dose of medication into the dispensing cup of the nebulizer.”
As before the amendment, Section 400.488, the ASAM by an HHA or CNA is conditioned upon a documented request by, and the written informed consent of, a patient or the patient’s surrogate, guardian, or attorney in fact.
Further, the requirement as set out in Rule 59A-8.0095, F.A.C., continues to require CNAs and HHAs to receive two hours of training prior to assisting with the self-administration of medication.
From an administrative standpoint, remember to update your agency’s ASAM policy & procedure to reflect the statutory changes, and for those licensees subject to staff member competency evaluation prior to the performance of a new task, remember to add the new duties to your competency verification program.