49 Pa. Code § 21.145 - Functions of the LPN
(a) The LPN is
prepared to function as a member of the health-care team by exercising sound
nursing judgment based on preparation, knowledge, experience in nursing and
competency. The LPN participates in the planning, implementation and evaluation
of nursing care using focused assessment in settings where nursing takes place.
(1) An LPN shall communicate with a licensed
professional nurse and the patient's health care team members to seek guidance
when:
(i) The patient's care needs exceed the
licensed practical nursing scope of practice.
(ii) The patient's care needs surpass the
LPN's knowledge, skill or ability.
(iii) The patient's condition deteriorates or
there is a significant change in condition, the patient is not responding to
therapy, the patient becomes unstable or the patient needs immediate
assistance.
(2) An LPN
shall obtain instruction and supervision if implementing new or unfamiliar
nursing practices or procedures.
(3) An LPN shall follow the written,
established policies and procedures of the facility that are consistent with
the act.
(b) The LPN
administers medication and carries out the therapeutic treatment ordered for
the patient in accordance with the following:
(1) The LPN may accept a written order for
medication and therapeutic treatment from a practitioner authorized by law and
by facility policy to issue orders for medical and therapeutic
measures.
(2) The LPN may accept an
oral order if the following conditions are met:
(i) The practitioner issuing the oral order
is authorized by law and by facility policy to issue oral orders for medical
and therapeutic measures.
(ii) The
LPN has received instruction and training in accepting an oral order in an
approved nursing education program or has received instruction and training in
accepting an oral order in accordance with the established policies and
protocols of the facility.
(iii)
The policy of the facility permits an LPN to accept an oral order.
(iv) The regulations governing the facility
permit an LPN to accept an oral order.
(3) The LPN shall question any order which is
perceived as unsafe or contraindicated for the patient or which is not clear
and shall raise the issue with the ordering practitioner. If the ordering
practitioner is not available, the LPN shall raise the issue with a registered
nurse or other responsible person in a manner consistent with the protocols or
policies of the facility.
(4) The
LPN may not accept an oral order which is not within the scope of functions
permitted by this section or which the LPN does not understand.
(5) An oral order accepted by the LPN shall
be immediately transcribed by the LPN in the proper place on the medical record
of the patient. The transcription shall include the prescriber's name, the
date, the time of acceptance of the oral order and the full signature of the
LPN accepting the oral order. The countersignature of the ordering practitioner
shall be obtained in accordance with applicable regulations of the Department
of Health governing the licensed facility.
(c) The LPN participates in the development,
revision and implementation of policies and procedures designed to insure
comfort and safety of patients in collaboration with other health care
personnel.
(d) The Board recognizes
codes of behavior as developed by appropriate practical nursing associations as
the criteria for assuring safe and effective practice.
(e) The LPN may administer immunizing agents
and do skin testing only if the following conditions are met:
(1) The LPN has received and satisfactorily
completed a Board approved educational program which requires study and
supervised clinical practice intended to provide training necessary for
administering immunizing agents and for performing skin testings.
(2) A written order has been issued by a
licensed physician pertaining to an individual patient or group of
patients.
(3) Written policies and
procedures under which the LPN may administer immunizing agents and do skin
testing have been established by a committee representing the nurses, the
physicians and the administration of the agency or institution employing or
having jurisdiction over the LPN. A current copy of the policies and procedures
shall be provided to the LPN at least once every 12 months. The policies and
procedures shall provide for:
(i)
Identification of the immunizing and skin testing agents which the LPN may
administer.
(ii) Determination of
contraindications for the administration of specific immunizing and skin
testing agents.
(iii) The listing,
identification, description and explanation of principles, including technical
and clinical indications, necessary for the identification and treatment of
possible adverse reactions.
(iv)
Instruction and supervised practice required to insure competency in
administering immunizing and skin testing agents.
(f) An LPN may perform only the IV
therapy functions for which the LPN possesses the knowledge, skill and ability
to perform in a safe manner, except as limited under §
21.145a (relating to prohibited
acts), and only under supervision as required under paragraph (1).
(1) An LPN may initiate and maintain IV
therapy only under the direction and supervision of a licensed professional
nurse or health care provider authorized to issue orders for medical
therapeutic or corrective measures (such as a CRNP, physician, physician
assistant, podiatrist or dentist).
(2) Prior to the initiation of IV therapy, an
LPN shall:
(i) Verify the order and identity
of the patient.
(ii) Identify
allergies, fluid and medication compatibilities.
(iii) Monitor the patient's circulatory
system and infusion site.
(iv)
Inspect all equipment.
(v) Instruct
the patient regarding the risk and complication of therapy.
(3) Maintenance of IV therapy by
an LPN shall include ongoing observation and focused assessment of the patient,
monitoring the IV site and maintaining the equipment.
(4) For a patient whose condition is
determined by the LPN's supervisor to be stable and predictable, and rapid
change is not anticipated, the supervisor may supervise the LPN's provision of
IV therapy by physical presence or electronic communication. If supervision is
provided by electronic communication, the LPN shall have access to assistance
readily available.
(5) In the
following cases, an LPN may provide IV therapy only when the LPN's supervisor
is physically present in the immediate vicinity of the LPN and immediately
available to intervene in the care of the patient:
(i) When a patient's condition is critical,
fluctuating, unstable or unpredictable.
(ii) When a patient has developed signs and
symptoms of an IV catheter-related infection, venous thrombosis or central line
catheter occlusion.
(iii) When a
patient is receiving hemodialysis.
(g) An LPN who has met the education and
training requirements of §
21.145b (relating to IV therapy
curriculum requirements) may perform the following IV therapy functions, except
as limited under §
21.145a and only under supervision
as required under subsection (f):
(1)
Adjustment of the flow rate on IV infusions.
(2) Observation and reporting of subjective
and objective signs of adverse reactions to any IV administration and
initiation of appropriate interventions.
(3) Administration of IV fluids and
medications.
(4) Observation of the
IV insertion site and performance of insertion site care.
(5) Performance of maintenance. Maintenance
includes dressing changes, IV tubing changes, and saline or heparin
flushes.
(6) Discontinuance of a
medication or fluid infusion, including infusion devices.
(7) Conversion of a continuous infusion to an
intermittent infusion.
(8)
Insertion or removal of a peripheral short catheter.
(9) Maintenance, monitoring and
discontinuance of blood, blood components and plasma volume
expanders.
(10) Administration of
solutions to maintain patency of an IV access device via direct push or bolus
route.
(11) Maintenance and
discontinuance of IV medications and fluids given via a patient-controlled
administration system.
(12)
Administration, maintenance and discontinuance of parenteral nutrition and fat
emulsion solutions.
(13) Collection
of blood specimens from an IV access device.
Notes
The provisions of this § 21.145 amended under section 506 of The Administrative Code of 1929 (71 P.S. § 186); sections 8 and 17.6 of the Practical Nurse Law (63 P.S. §§ 658 and 667.6); and section 2.1(k) of The Professional Nursing Law (63 P.S. § 212.1(k)).
This section cited in 49 Pa. Code § 21.414 (relating to interpretations regarding the functions of Licensed Practical Nurses (LPN)-statement of policy).
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.