Legislature(2005 - 2006)BUTROVICH 205
05/01/2006 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB426 | |
| HB467 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 426 | TELECONFERENCED | |
| + | HB 467 | TELECONFERENCED | |
| + | HB 482 | TELECONFERENCED | |
| + | TELECONFERENCED |
CSHB 467(HES) am -ADMINISTRATION OF MEDICATION BY A NURSE
3:01:13 PM
CHAIR DYSON announced CSHB 467(HES) am to be up for
consideration.
REPRESENTATIVE MIKE KELLY, sponsor, explained that this bill
would work to improve patient health care and safety, while
improving efficiency. The Board of Nursing determined that it is
outside the scope of practice for a nurse to administer dietary
supplements to a patient; so the only way they can get these
supplements is through friends or family members.
3:04:47 PM
The passage of HB 467 would reduce the practice of friends or
family bringing in supplements that are not coordinated with
other medications and allow, but not require, the nurse to
administer those supplements and add them to the patient record.
He stated that any dietary supplement or remedy would have to be
prescribed by a physician, dentist, advanced nurse practitioner,
podiatrist or physician's assistant, and that, if the nurse
believes the supplement should not be administered, he or she
can refuse to do so.
He said that patients, doctors, nurses, pioneer homes and long-
term care facilities support the bill.
3:06:36 PM
SENATOR ELTON said he received email from some pharmacists who
are concerned, and asked Representative Kelly if he could
address their concerns.
REPRESENTATIVE KELLY said that the current situation does not
serve the needs of the patient and ignores the fact that the
supplements are prescribed. It also ignores the fact that the
supplements are already coming in, but in a manner that is not
safe or wise.
3:09:55 PM
SENATOR ELTON asked why the pharmacists are not in favor of the
bill.
REPRESENTATIVE KELLY said he would guess that they might
consider the supplements, some of which are not FDA approved and
are outside the scope of what the pharmacists deal with,
inappropriate; but that supplements are a fact, and should be
administered and monitored in the safest way for the patient.
3:10:43 PM
CHAIR DYSON introduced Catherine Giessel.
3:10:53 PM
CATHERINE GIESSEL, MSN, RN ANP, Chairperson of the Board Of
Nursing, informed members that she had forwarded the board's
position paper and a letter from the Board of Pharmacy to them.
She said that the Board Of Nursing, the Alaska Nurse
Practitioners Association, and the Board of Pharmacy oppose HB
467, on the grounds that it is outside the scope for a
registered nurse because of safety issues. The National
Association of School Nurses wrote a position statement that
reflects the nursing board's position.
She stated that the bill is not "just about fish oil and
glucosamine", but encompasses a broad range of unregulated
substances. In addition, it was offered at the request of a
single constituent.
In 1994 the Dietary Supplement and Health Education Act
classified these substances as foods, so the Food and Drug
Administration (FDA) has to determine only if they are unsafe,
not to prove that they are safe; and because they are not
regulated, the manufacturer is not required to disclose all of
the contents on the label.
Studies conducted by ConsumerLab.com LLC found that they contain
broad ranges of contents. She related the experience of a
licensed nurse who had chemical dependency problems at one time,
and who had entered into an agreement with the board that
required her to submit to regular drug screening. During routine
screening she was found to be positive for barbiturates. She was
taking an unregulated compound prescribed by a naturopath, which
was found to contain Phenobarbital. The licensee was unaware of
the contents.
3:15:34 PM
CHAIR DYSON said he was led to believe the board or another
nurses' group would be meeting further on this.
MS. GIESSEL responded that he was probably told about a meeting
of the Alaska Nurses Association, which is not affiliated with
the Board of Nursing.
CHAIR DYSON asked if it is the board's position that the
prescribing physician or nurse practitioner should not be
allowed to make the decision about what to administer.
MS. GIESSEL replied that the issue is not about who prescribes
the supplement, but who is allowed to administer it. Court cases
have found that a nurse can be held accountable for any negative
outcome resulting from administration of supplements, and that
accountability cannot be superseded by a prescription or the
policy of the facility.
CHAIR DYSON countered that the bill is permissive, in that the
nurse can decline to administer the supplement.
MS. GIESSEL agreed that is the language in the bill, but said
that nurses place their jobs in jeopardy when they disagree or
decline to administer something like this against the policy of
the facility. She stressed that it is a safety issue and asked
why the Pioneer Homes require a waiver for administration of
these substances if they are so safe.
CHAIR DYSON thanked Ms. Giessel for her testimony.
3:18:14 PM
ROD BETIT, President, Alaska State Hospital and Nursing Home
Association (ASHNHA), testified in support of the bill. He said
that ASHNHA believes it will be safer to have all medications
and supplements documented and controlled by the medical staff,
and that no hospital or care facility would prosecute a nurse
for declining to administer something that she is not
comfortable with.
3:20:26 PM
SENATOR OLSON commented that the nursing board's concern is its
scope of practice, and that hearing of concerns raised by
licensees does not allay his own concerns.
MR. BETIT asked if he was referring to concerns of a licensed
nurse.
SENATOR OLSON responded that he meant the pharmacists who were
weighing in on the matter.
MR. BETIT said he had not seen the pharmacists' letter; but if a
physician makes the determination that a product is appropriate
based on other medications being prescribed and the patient's,
condition, he thinks the decision should rest there.
SENATOR OLSON said that, as a physician, when he prescribes any
kind of medication, he has full knowledge that the medication is
held to a standard and he knows what it contains. That is not
the case with a dietary supplement, which is a special concern
when dealing with brittle elderly patients. He stated that his
concerns were not put at ease by the assurance that a licensee
would not place his or her license in jeopardy by refusing to
administer the supplements.
MR. BETIT responded that he understood Senator Olson's point,
but questioned where the greater risk lies, in including
physicians in the decision about what supplements to administer,
or letting others administer them without the physician's
knowledge. In addition, the bill affords nurses the right to
decline to administer supplements for any reason.
SENATOR OLSON said that he is concerned that a nurse could be
caught in the middle and her license jeopardized for not
following the physician's orders, even if she has information
indicating that compliance is contrary to the best interest of
the patient.
3:23:45 PM
SENATOR OLSON asked whether the sponsor had heard anything from
Alaska State Medical Board.
REPRESENTATIVE KELLY said no, that he had one physician lined up
to join them, but he could not make it due to a scheduling
conflict.
SENATOR OLSON asked if he was referring to the medical board or
the medical association.
REPRESENTATIVE KELLY replied that he did not have a letter from
either of them.
3:24:24 PM
CHAIR DYSON said the committee was out of time and apologized to
those who did not have an opportunity to testify. He mentioned
that he had written messages from Rick Shakura (ph) and the
Alaska State Hospital and Nursing Home Association.
Virginia Smiley was present on behalf of the Division of Pioneer
Homes. She agreed to provide written testimony and be available
to testify later in the week.
SENATOR WILKEN asked if there were further referrals for this
bill.
Unidentified speakers: Just HES
CHAIR DYSON said that no one from the nurses association was
signed up to testify. He also wanted to hear from the medical
association and/or the state board between this meeting and the
next.
[HB 467 was held over.]
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