Legislature(2005 - 2006)BUTROVICH 205
05/05/2006 02:00 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HJR36 | |
| HB467 | |
| HB482 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HJR 36 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | HB 467 | ||
| = | HB 482 | ||
CSHB 467(HES) am -ADMINISTRATION OF MEDICATION BY A NURSE 2:05:46 PM CHAIR FRED DYSON announced HB 467 to be up for consideration. Before the committee was CSHB 467(HES) am. DEREK MILLER, Staff to Representative Mike Kelly, said he presented HB 467 at the previous hearing and now he would answer questions. CHAIR DYSON reminded Mr. Miller that he was asked to get more information at the previous hearing and questioned whether he had been successful. MR. MILLER reported that Senator Olson was given the information he requested and the State Medical Board was asked to issue a formal letter or opinion on the bill. Board members were polled and made the decision to maintain a neutral position on the bill. SENATOR DONNY OLSON said he assumes that was the chair, Dr. Head. MR. MILLER replied he wasn't sure; he contacted the legislative liaison with the Department of Commerce, Community & Economic Development. CHAIR DYSON opened public testimony. 2:08:12 PM PATRICIA SENNER, Chair, Alaska Nurses Association (ANA), Fairbanks, said HB 467 brings up two issues that require discussion. The first, which is the basis for the ANA opposition, relates to whether or not policies set by the Board of Nursing can be overruled by legislative process. The second issue relates to the safety of administering herbal remedies. She advised that the ANA Professional Practices Committee researched the issue and would present its recommendations to the Board of Nursing during the June 2006 meeting. She clarified she was not speaking to those findings today. MS. SENNER said the grounds for ANA opposition to the bill relate to the issue of how decisions are made about providing health care and the best practices for providing health care. She said the nursing community works very hard and conscientiously to base its practice on what has basis in medical research. Therefore it is dismaying that research and careful thought can be overruled by a legislative process that doesn't appear to be based on research of any kind of medical fact. The big issue of the safety of dietary supplements is based on quality control over production. As quality control improves the issue will go away, but currently there is a question of whether or not knowledgeable adults are making the decision to take supplements. Also there is the question of contaminates and whether the quantities on the label match the quantities in the bottle. If a nurse is required to administer medication to a patient it often means that the patient isn't capable of making the decision of whether or not to take the risk of taking the supplement. SENATOR WILKEN arrived at 2:11:53 PM. MS. SENNER expressed the hope that the committee would not pass the bill such that the Board of Nursing would be allowed to address the issue at its June meeting. 2:12:30 PM CHAIR DYSON said the current version of HB 467 provides a registered nurse with the option so he questioned whether she was speaking to a different version. MS. SENNER said no, but the difficulty arises for nurses working inside facilities. In some instances, particularly at the Pioneer Homes, nurses have been forced to quit because they did not agree with agency policies. CHAIR DYSON asked if it's fair to infer that the nurses cannot trust the prescribing physician's judgment. MS. SENNER responded, "the subscribing physician may write a prescription for a certain dietary substance at a certain quantity and he might do that in good faith. The nurse always has the obligation to independently evaluate the safety of that order." If the nurse is concerned about where the product came from or whether it was safely produced, then the nurse ought to have the right to raise the question. 2:14:42 PM MARY WEYMILLER, Licensed Practical Nurse (LPN), Board of Nursing, Fairbanks, said Ms. Senner did a good job of articulating the nurses' concern. She noted that there has been emphasis on the fact that the substances are being prescribed, but she would add that there is no guarantee that the particular substance is really safe. For that reason she said it doesn't add a level of safety. Safety is not increased when a physician prescribes an unknown and has a nurse administer that unknown. She related a hypothetical situation that might occur during a busy nurse's shift to demonstrate her point. 2:16:50 PM SENATOR WILKEN asked if the proposed amendment would address the concerns Ms. Weymiller articulated. MR. MILLER responded the amendment has not been distributed. CHAIR DYSON asked for confirmation that the amendment removes the fiscal note. MR. MILLER said that is correct. CHAIR DYSON asked if that would take it to regulation instead of policy. MR. MILLER said the amendment removes the requirement for the board to adopt regulations and inserts the permissive language about administering a prescribed dietary supplement. It allows the Board of Nursing to decide how to permit administration of prescribed dietary supplements. SENATOR WILKEN asked if the amendment is to address the issues just articulated or is it for other reason. MR. MILLER replied the amendment is for some other reason. 2:18:24 PM SCOTT LUPER, Naturopathic Physician, Fairbanks, spoke in favor of HB 467 because it adds a level of safety to the administration of supplements. It is appropriate that a nurse is able to administer supplements because it's better to have another educated, health-care trained person involved. This increases safety and convenience, he said. SENATOR ELTON said he is assuming that he can prescribe. DR. LUPER replied he cannot prescribe drugs, but he can prescribe supplements. SENATOR ELTON remarked the nurse could be the control point in that he or she might be the only person who understands what other medicines are being administered. Given that, it seems as though the bar is being lowered for that medical professional, he said. DR. LUPER said the way the system should work is that the physician elicits a medical history and takes that into consideration before prescribing. If someone doesn't reveal that they are using supplements, this legislation would increase safety because another health-care practitioner would be involved and could voice the concern to the physician. 2:22:04 PM CHAIR DYSON asked if he listened to the earlier testimony. DR. LUPER said yes. CHAIR DYSON said it's clear that some nontraditional medicines are of value, but it's also clear that some "hucksterism" has been around as well. The nurses' concerns related to quality control and whether the supplement that was supposed to be administered actually was. He asked if quality control is a real issue now in this country. DR. LUPER said yes it is of concern, but generally speaking quality is going up. There isn't a need to be overprotective, he said. It's a balancing act, and in this situation the pros outweigh the cons. 2:24:13 PM GENA EDMISTON, Registered Nurse (RN), Associate Administrator, Denali Long-term Care Center, Fairbanks, stated support for HB 467. She said that although she has tremendous respect for the Alaska Board of Nursing, she does not believe that HB 467 compromises the protection that the board works to ensure for patients and nurses. CHAIR DYSON said he assumes her belief is that nurses ought to be able to trust the prescribing physician's judgment. MS EDMISTON said she would not word in that way. She would agree with the board and ANA that nurses have the responsibility to make independent judgments regarding prescriptions for any supplements or drugs. The benefit of that is tremendous, especially in long-term-care setting where nurses are serving as the "family" for residents. CHAIR DYSON apologized that the committee is pressed for time. MS. EDMISTON summarized she supports HB 467. At the Denali Long- term Care Center, supplements come from the pharmacy and the nurses retain the judgment to administer or not. 2:27:29 PM RICK SCHIKORA reported that he sent a supporting statement to Mr. Miller for distribution. HB 467 mandates that the Board of Nursing adopt regulations such that nurses would not be required to administer non-FDA approved, but prescribed, dietary supplements. Although the board takes the position that patient safety is paramount, the stance it has taken on this legislation is contraindicative. He expressed the hope that the committee pass HB 467 and that the board adopt meaningful regulations so further legislative involvement is not necessary. In conclusion he expressed the view that older residents need nurses to administer these prescribed non-FDA-approved remedies. He urged the committee to give the Board of Nursing the opportunity to address the issue properly. 2:30:09 PM VIRGINIA SMILEY, Director, Division of Pioneer Homes, Department of Health and Social Services (DHSS), paraphrased from a written statement outlining the division policy relating to RN involvement in administering dietary supplements. [A copy may be found in the bill file.] MS. SMILEY described the process for administering supplements, which includes a written order from the prescribing practitioner. When the supplements are privately purchased, a release form is signed and the Pioneer Home pharmacy is informed so that residents' medication profiles can be monitored. Additionally the division policy includes voluntary agreement by an RN to administer supplements on a case-by-case basis. If a nurse is unsure about an order, he or she has an obligation to contact the prescribing physician. Nurses are expected to know the residents and the risk/benefit of each medication that is administered. The division expects nurses to treat supplements in the same manner. MS. SMILEY said if this legislation does not pass, Pioneer Home residents will continue to take supplements in an unsupervised manner. She emphasized that it is in the residents' best interest to have RN involvement. She urged the committee to pass HB 467. 2:33:54 PM SENATOR ELTON asked if he could assume that no one with less than RN training would distribute prescribed supplements. MS. SMILEY replied some certified nursing assistants complete a medication-administration training course so they are certified to administer medications, including supplements, under RN oversight. SENATOR ELTON asked if supplements are held and stored like other medications. MS. SMILEY said yes. 2:34:52 PM CHAIR DYSON said it sounds as though the process is responsible and he appreciates that. 2:35:11 PM MERRITT ANDRUSS, Gerontology Nurse Practitioner, Juneau, said she strongly supports HB 467 for several reasons. First, she emphasized, this legislation is about glucosamine, cranberry chews, and viacitiv. These supplements are taken to address arthritis pain, painful urinary tract infections, and osteoporosis. Without these supplements older people would need more and stronger FDA-approved drugs that their systems can't always tolerate and expecting family members to visit and administer these supplements several times a day is a hardship and a burden. Second, she said, nurses should advocate for patients. Just as they must have some understanding of the drugs they administer, they should have a similar understanding of the supplements they are asked to administer. If a nurse doesn't know about a supplement, information can be found in the natural medicines comprehensive database found online or in hard copy. In conclusion she said nurses owe it to their patients and their patients' families to know the pros and cons of each supplement they administer and for a nurse to rigidly refuse to administer any supplement is wrong and irresponsible. She said she supports the bill because it allows nurses who feel differently to simply refrain from administering the supplement. The argument that they will be fired for refusing is not correct because all nurses have the ability to refuse to administer any treatment to a patient that they believe is harmful. CHAIR DYSON called an at-ease from 2:40:57 PM to 2:42:08 PM. SENATOR LYDA GREEN referenced the amendment, which removes the requirement that the board adopt regulations, and asked if making regulations would default to the department. MR. MILLER said the amendment removes the requirement that the board adopt regulations because the sponsor doesn't feel that a joint session of the medical, pharmaceutical, and nursing boards is required and that requirement has a $30,000 fiscal note attached to it. The sponsor believes it can be done with the ANA providing recommendations and working collaboratively with the Board of Nursing. SENATOR ELTON said he is more comfortable zeroing the fiscal note than removing the requirement. The amendment removes a recipe for guidance and he would prefer the alternative of zeroing the fiscal note. MR. MILLER said he doesn't believe the sponsor would have a problem with that. 2:44:16 PM CHAIR DYSON questioned whether the work could be done without some fiscal impact. SENATOR ELTON said it sounds as though the work is already being done. MR. MILLER said HB 467, in combination with the collaborative efforts of the ANA and BON, is the goal. CHAIR DYSON asked whether the sponsor would prefer to zero the fiscal note or adopt the amendment. MR. MILLER expressed a preference for zeroing the fiscal note. SENATOR ELTON moved to zero out the fiscal note. There being no objection, it was so ordered. 2:47:17 PM CHAIR DYSON announced that without objection CSHB 467(HES) am moves from the Senate Health, Education and Social Services Standing Committee.
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