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Attendant Training Program - Specialized Procedures
This information is in response to multiple questions from the field. Providers are required, under the amended Title 22 draft regulations, Section 73874, to provide all non-licensed direct care staff an "Attendant Training Program" that has been approved by the Department of Developmental Services (DDS). Under Section 73874.1, you are also required to seek approval from DDS for, and provide training to non-licensed direct care staff in, specific specialized procedures prior to their implementing and performing the procedure.
Draft ICF/DD-N regulations that relate to specialized procedures under Section 73874.1 (e) (1-6) and (f) (1-4) are included for your reference.
- (e) An attendant may perform a specific procedure for a specific client subject to the following:
- The procedure is specifically ordered by the attending physician.
- Prior to performing the procedure, the attendant shall be trained by the facility registered nurse to perform the procedure and shall demonstrate proficiency in performing the procedure while under the immediate supervision of the registered nurse. The attendant shall also be trained to recognize complications which could arise as a result of the procedure and to be knowledgeable in how to respond if a complication arises.
- A signed written statement shall be prepared by the registered nurse which includes a certification of the attendant's competency to perform the procedure and which identifies the client for whom the certification is applicable. This certification shall be placed and maintained in the attendant's training record and a copy shall be placed in the client's record.
- The certification is procedure and client specific, and shall not be transferred between clients and facilities.
- The registered nurse shall be responsible for the monitoring and staff implementation of the procedure. At least once every three months, the registered nurse shall observe and confirm the attendant's proficiency in performing the approved procedure and shall update the certification.
- Training protocols for each procedure performed by an attendant shall be reviewed and approved as part of the facility program plan pursuant to 73859 (a) (12).
- (f ) Attendants shall not insert or remove the following:
- Nasogastric and gastrostomy tubes.
- Tracheostomy appliances.
- Indwelling catheters.
- Any intravenous apparatus.
Resource materials are provided that explore and define the role of the non-licensed direct care staff and the registered nurse. Resources include:
- Board of Registered Nursing, Position Paper on "Unlicensed Assistive Personnel."
- Board of Registered Nursing, Position Paper on "The RN as Supervisor."
- The Role of the Registered Nurse matrix
- Suggested Considerations for the Assignment and Performance of Specialized Procedures.
- Requirements for Nurses to Train Staff to Administer Blood Glucose Testing
The following list provides examples of commonly approved specialized procedures.
- Apnea monitoring.
- Colostomy care.
- Gastrostomy feeding and care.
- Medication administration via a gastrostomy tube.
- Tracheostomy care and light suctioning.
- Oxygen therapy
- Intermittent positive-pressure breathing.
- Catheterization - clean technique.
- Wound care - simple dressing changes.
To ensure that all components of a protocol are addressed, and to facilitate the approval process, please use the sample when submitting a request to DDS for the approval of the performance of a specific procedure. Suggested sample materials are below:
If corrections or additional information are required, the protocol must be returned for further development before approval is granted.
If you should have any questions or need assistance, please contact the Community Living Section at (916) 654-1965, or e-mail the Community Living Section.