Skip Maine state header navigation
-----Original Message-----
From: Kathleen Bernard [mailto:voodoosgirl@midmaine.com]
Sent: Monday, December 13, 2004 10:19 PM
To: Mauro, Peter; 'Darlene'; Beas-crma@lists.state.me.us
Subject: Re: beas-crma Fw: sub-cutaneous injections
[Mauro, Peter]
As the Director of Assisted Living Licensing, CRMAs, who are governed by the
former DHS, are allowed by regulation to be taught procedures by RNs. This
is covered in Section 7 of the regulations. Coordination and oversight is
also covered under the BON chapter 6 which was designed for Assisted Living
and Residential Care. I stand on my answer from before that we are not
requiring that all RNs teach CRMAs these procedures. There are RNs out
there who feel this is acceptable and some do not. If the provider wants to
pay the home health agency or an outside RN or employ an RN, that is up to
the provider.
This discussion needs to end as it is going no where. I believe I have made
my position clear.
Hello Everyone-how come we're all alarmed by this, but Peter and Carol think
it's ok. Just wondering....[Mauro, Peter] One should not assume what alarms
Carol or myself.
Peter, when you say "we have allowed the epi to not only cover bee stings
but other issues requiring that med." are you talking about the Lovenox?
[Mauro, Peter] No
Lovenox is a low molecular weight heparin, given for its anticoagulation
effect on blood pre and post surgury. It has extensive contraindications and
precautions and its life-threatening side effect is hemorrhage.
Epinephrine is in the Epi-pen, it is used as a bronchodilator managing
severe allergic reactions. Contraindications and precautions are fewer and
there are no life-threatening side effects from the med.
Insulin is a hormone used to treat diabetes. There are very few
contraindications, precautions and adverse side effects. The
life-threatening side effect is hypoglycemia.
So, all 3 meds are given subcutaneously and that is about the only thing
they have in common. The method of injection is not the issue. Patient
safety is the issue. A monkey can give a SC injection, but the monkey can't
keep the patient safe afterwards. (no offense to the CRMA's)
This is the email I received at work from the director of the home health
division that was denied payment:
"I just heard back from Lorraine LaChappelle at BEAS re: the meeting last
week that looked at CRMA curriculum. In that meeting Lorraine brought up the
Lovenox issue and the licensing regs governing level IV group homes. They
acknowledged that section 7.1.2 and 7.1.3 allow for unlicensed personnel to
administer insulin and bee sting kits only. They feel however, that because
Lovenox is a SQ medication and administered by the same technique that it
could be administered by a CRMA with proper training per sections 7.16 and
7.17 of those same regs. Also, they looked at Chapter 6 of the BON regs
re:teaching an unlicensed person. She said if the group home continued to
have concerns they should call Peter Mauro."
What ever happened to the delegation decision tree? If the task is within
the RN's scope of practice and NOT within the scope of practice of the UAP
then we can not delegate the task. So if one RN decides to delegate and
another RN decides to protect her patient and her license and NOT delegate,
the agency is punished financially if we choose patient safety.
The payment issue for MaineCare is NOT the same issue as the CRMA doing this
type of task. It is one thing to say the fee is "built into" the rate so the
home takes the hit when a nurse is needed. It is another thing to say we can
teach unlicensed people tasks that are beyond their training. If they want
to be nurses, let them go to school and get the degree, license and debt,
like the rest of us.
I realize the BON participated to some extent in the regs but I would like
to present the specifics of how the regs are being interpreted to see what
they think. Anyone have a best friend on the Board?
I keep wondering if the private-pay assisted living homes are delegating
nursing tasks.
Kathleen
----- Original Message -----
From: Mauro, <mailto:Peter.Mauro@maine.gov> Peter
To: 'Darlene' <mailto:Dgrass@gwi.net> ; 'Kathleen Bernard'
<mailto:voodoosgirl@midmaine.com> ; Beas-crma@lists.state.me.us
<mailto:Beas-crma@lists.state.me.us>
Sent: Monday, December 13, 2004 3:11 PM
Subject: RE: beas-crma Fw: sub-cutaneous injections
Even though the regs are specific about insulin and bee sting, we have
allowed the epi to not only cover bee stings but other issues requiring that
med. Also, at the end of section 7 there is a section which was designed
from the BON in their chapter 6 on coordination and oversight, to take care
of other issues that might come up that would allow RNs to teach unlicensed
personnel. DHHS/BEAS does not dictate that all RNs do this teaching, but if
they feel that the person is competent to learn and competent to carry
through, then they can. Also, DHHS/MaineCare is not going to double pay the
services of homehealth when there is a portion built into the rate for Nurse
services. Those facilities that want to train CRMAs to do some of those
procedures, can, those who want to hire a nurse and pay them out of the
daily rate to do some of those other services can do that. As licensing
moves towards being merge red into one unit, perhaps some of this can and
will be looked at. Carol and I have looked at all inquiries that providers
have had and we deal with over 800 freestanding facilities, to help
alleviate some of these issues.
-----Original Message-----
From: owner-beas-crma@lists.state.me.us
[mailto:owner-beas-crma@lists.state.me.us]On Behalf Of Darlene
Sent: Monday, December 13, 2004 10:40 AM
To: 'Kathleen Bernard'; Beas-crma@lists.state.me.us
Subject: RE: beas-crma Fw: sub-cutaneous injections
Kathleen, I also read the regs as specific to allowing CRMA's to administer
sc insulin and bee sting kits after RN instruction. Anything further in my
opinion, is asking too much from our CRMA's. What does Peter say about this
matter?
Darlene Grass RN
Granite Hill Estates
-----Original Message-----
From: owner-beas-crma@lists.state.me.us
[mailto:owner-beas-crma@lists.state.me.us]On Behalf Of Kathleen Bernard
Sent: Friday, December 10, 2004 11:59 PM
To: Beas-crma@lists.state.me.us
Subject: beas-crma Fw: sub-cutaneous injections
----- Original Message -----
From: Kathleen Bernard <mailto:voodoosgirl@midmaine.com>
To: Beas-crma@lists.st.me.us <mailto:Beas-crma@lists.st.me.us>
Sent: Friday, December 10, 2004 7:50 AM
Subject: sub-cutaneous injections
Hi Everyone,
I would like to get your feedback on a recent dilemma. I cover 6 group homes
under the assisted living regs, PNMI and BDS. One home is a level IV
assisted living home but serves adults with mental illness. We have CRMA's,
one LPN that coordinates appointments and works M-F days.
We needed home health to provide evening SC lovenox which they did but
Medicaid denied their payments. The Medicaid folks feel that CRMA's can
administer this SC medication because the assisted living regs state SC
insulin is ok so the assumption is that SC anything is ok.
Is anyone aware of CRMA's giving anything but bee sting and insulin
injections? The CRMA course seems specific, as do the regulations....bee
sting and insulin with instruction from an RN and not part of the CRMA
course itself.
Through the many levels of conversations about this subject Peter Mauro's
name was mentioned. It is unclear to me at this point what details were
presented to him.
Thanks for any help and guidance.
Kathleen Bernard RN,BC
Community Health and Counseling/Bangor
947-0366 x452
the email is my home, I don't have work email
To unsubscribe from beas-crma, send a message to
beas-crma-request@lists.state.me.us with "unsubscribe" in the
body of the message
This archive was generated by hypermail 2b29 : Fri Dec 31 2004 - 23:53:00 EST