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Nurse Delegation 101. Why, What, Who, How and When of the Nurse Delegation Program. OBJECTIVES. Upon completion, participants will know: Why DMH developed NDP What NDP requires Who is impacted by NDP How to get more information When agencies must be in compliance. WHY???.

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Nurse Delegation 101

Why, What, Who, How and When of the Nurse Delegation Program


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OBJECTIVES

Upon completion, participants will know:

  • Why DMH developed NDP

  • What NDP requires

  • Who is impacted by NDP

  • How to get more information

  • When agencies must be in compliance

Vanessa B. Prater, BSN, RN


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WHY???

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Federal Law requires that State Agencies,

such as the Department of Mental Health

(DMH), that receive Federal funds MUST be in compliance with all State Laws.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

The Alabama Board of Pharmacy (ABOP) and the

Alabama Board of Nursing (ABON) direct and

control the provision, storage and administration of

medications.

Programs regulated by DMH must comply with not only

DMH regulations, but also those of the ABOP and ABON

with respect to their specific guidelines for the handling

and administration of medications by individuals

other than the consumers who receive the medications.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Alabama Board of Nursing (ABON) Regulation

Code of Alabama (1975) Section 34-21-20

(Statutory Law)

Any person practicing or offering to practice professional/practical nursing in Alabama for compensation shall be required to submit evidence that he/she is qualified so to practice and shall be licensed. It shall be unlawful for any person not licensed to practice or offer to practice professional/practical nursing for compensation in this State.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Alabama Board of Nursing Regulation

Code of Alabama (1975) Section 34-21-26

The Practice of professional/practical nursing by any person who has not been issued a license or whose license has been suspended, revoked or has expired, is hereby declared to be inimical to the public welfare and to constitute a public nuisance. The ABON may apply to any court of competent jurisdiction for any injunction to enjoin any person from practicing professional/practical nursing who has not been issued a license.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Alabama Board of Nursing Regulation

Administrative Code 610-X-6-.02(10)

The RN/LPN shall accept responsibility and accountability for timely reporting of illegal, substandard, unethical, unsafe or incompetent nursing practice directly to the Board of Nursing

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

SB 428

Under existing law, the ABON employs investigators who investigate alleged violations involving drugs or controlled substances. This bill grants investigators of the ABON the authority to exercise the powers of peace officers in investigating alleged violations of the Nurse Practice Act by persons licensed by the ABON.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Alabama Board of Nursing Regulation

Administrative Code 610-X-6-.15(1)

The RN/LPN who provides care in residential community mental health programs certified by the ADMH is accountable and responsible for the nursing care delivered to patients in those settings

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Alabama Board of Nursing Regulation

Administrative Code 610-X-6-.15(2)

RN/LPNs who provide nursing in the residential community mental health setting and the community extensions including day habilitation programs, may delegate specific limited tasks to designated unlicensed assistive personnel.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

Department of Mental Health Administrative Code Regulations

Intellectual Disabilities 580-5-32-.16

Mental Illness 580-2-12(6)

Substance Disorders 580-9-46(14)

All require 24/7 nursing coverage

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

ABOP and NDP

NAKED PILL SYNDROME

Carter English, R. Ph.

Vanessa B. Prater, BSN, RN


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DMH AND NDP, WHY?

ABOP and NDP

Pillboxes

Blister Packs – type (labeled at top; each blister labeled

Stock medications

OTCs

Controlled Substances

Current Pharmaceutical Companies assisting with NDP Requirements

Vanessa B. Prater, BSN, RN


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New DMH NDP Administrative Code Regulations

Anticipated completion: 2009

Will address at a minimum the 4 components of NDP:

Administrative Requirements

Education/Training

Quality Assurance

Compliance

DMH AND NDP, WHY?

Vanessa B. Prater, BSN, RN


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WHAT???

Vanessa B. Prater, BSN, RN


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ACRONYMS

NDP – Nurse Delegation Program

DMH – Department of Mental Health

MAC – Medication Assistant Certified

Unlicensed Nursing Individuals

MAS – Medication Assistance Supervisor

(RN/LPN)

MATT – Medication Assistance Train-

The-Trainer (RN ONLY)

Vanessa B. Prater, BSN, RN


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ACRONYMS

MAR – Medication Administration Record

Vanessa B. Prater, BSN, RN


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Definitions

Delegation

The act of authorizing a competent

individual to perform acts supportive to

RN/LPNs in selected situations.

ABON Administrative Code

Vanessa B. Prater, BSN, RN


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Definitions

Competency

Outcomes assessed through academic

standing, clinical performance and

certification examination that demonstrates

the ability to perform a particular task.

Vanessa B. Prater, BSN, RN


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Definitions

Supervision

Periodic monitoring by direct observation on

site, by the MAS Nurse to visualize MAC

Workers’ skill and ability to perform

delegated task(s).

Vanessa B. Prater, BSN, RN


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LPN Supervision

610-X-6-.04 Practice of Practical Nursing

(1) The practice of practical nursing includes, but is not limited to:

  • (a) Acts designed to promote and maintain health;

  • (b) Prevention of illness and injury;

  • (c) Provision of care using standardized procedures including administering medications and treatments under the direction of a licensed professional nurse or a licensed or otherwise legally authorized prescriber; and

  • (d) Exercise of appropriate nursing judgment.

Vanessa B. Prater, BSN, RN


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Supervision

Physically present or accessible within a reasonable time to the immediate area and is available to intervene if necessary

Vanessa B. Prater, BSN, RN


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Definitions

Self Administration

A consumer can self administer if he/she is

able to:

  • Recognize medication(s)

  • Understands purpose/reason for taking the of medication(s)

  • Ability to report major side effects and knows when to notify nurse, doctor, etc.

    (RN MUST PERFORM ASSESSMENT)

Vanessa B. Prater, BSN, RN


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Consumer Assessment

Self Administration

Limited Self Administration

Unable to Self Administer

Vanessa B. Prater, BSN, RN


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Definitions

Drug/Medication

Substances recognized as drugs in the

official US pharmacopoeia….

Substances intended for use in the

diagnosis, cure, mitigation, treatment or

prevention of disease in man or animals

Vanessa B. Prater, BSN, RN


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Definitions

Drug/Medication

Substances other than food intended to affect the structure or any function of the body of man or animals

Code of AL Section 20-2-2

Vanessa B. Prater, BSN, RN


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Definitions

Medication Administration

Removal of an individual dose of

medication, from a previously dispensed,

properly labeled container, verifying it with

the M.D./CRNP’s order, giving the individual

dose to the proper consumer at the proper

time by the proper route and promptly

recording the time and dose given.

Vanessa B. Prater, BSN, RN


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Definitions

Administer

The direct application of a controlled

substance, whether by injection, inhalation,

ingestion or any other means to the body of

a recipient.

Administrative Code Section 20-2-2

Vanessa B. Prater, BSN, RN


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Definitions

Assisting with Medication Administration

Helping the consumer

with one or more steps in the process of administering medication

Vanessa B. Prater, BSN, RN


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What is NDP?

The Nurse Delegation Program (NDP) was

developed by the Department of Mental Health

(DMH), with guidance from the Alabama Board

of Nursing (ABON), in response to changes

made to the Alabama Nurse Practice Act, which

allows non-licensed persons to assist with

medication administration in residential

programs, day programs and other community

extensions in programs regulated by DMH.

Vanessa B. Prater, BSN, RN


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What is NDP?

The NDP defines the respective authority and responsibility for agencies and nurses related to delegation of medication administration in DMH certified programs.

Vanessa B. Prater, BSN, RN


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What is NDP?

NDP is managed by the DMH in conjunction with the ABON to assure that all individuals who receive services from programs certified by the DMH receive appropriate care.

Vanessa B. Prater, BSN, RN


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What is NDP?

“Consumers have a right to health care that

meets legal standards of care regardless of

the setting. The Safety and well-being of the

consumer must be the central focus of all

decisions regarding delegation of nursing

tasks to MAC Workers (unlicensed

personnel)”

NCSBN, 1997

Vanessa B. Prater, BSN, RN


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What is NDP?

“Let whoever is in charge keep this simple question in her head, not, how can I always do this right thing myself, but how can I provide for this right thing to be always done”?

Florence Nightingale

Vanessa B. Prater, BSN, RN


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What is NDP?

  • Four Components of the NDP

  • 1. Administrative Requirements

  • 2. Education/Training

  • 3. Quality Assurance

  • 4. Compliance

Vanessa B. Prater, BSN, RN


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Administrative Requirements

There is both individual accountability and organizational accountability for delegation.

Organizational accountability relates to providing sufficient resources, staffing, appropriate staff mix, implementation of policies and position descriptions, opportunity for continuing education and creating an environment conducive to teamwork, collaboration and client-centered care.

Vanessa B. Prater, BSN, RN


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Administrative Requirements

The organization is accountable for assuring that documentation of competencies for ALL personnel is maintained

The organization is responsible for the development and enforcement of policies on delegation with active participation from nurses

Vanessa B. Prater, BSN, RN


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Administrative Requirements

Organizations are responsible for assuring that educational needs/requirements are met through the implementation of the NDP

Organizations are responsible for assuring compliance with all DMH Regulations

Vanessa B. Prater, BSN, RN


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Personnel Issues

MAC Workers Must :

  • Have a HS Diploma/GED

  • Be responsible

  • Be able to read with understanding

  • Be knowledgeable of agency operations

  • Be respectful

  • Be able to work independently

  • Be able to monitor consumers

Vanessa B. Prater, BSN, RN


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Personnel Issues

MAS Nurse Must:

  • Be an LPN/RN in good standing

  • Attend MAS Training and pass competency test

  • Understand disease and symptoms management related to MI/MR/SA

  • Be able to teach and supervise others

  • Practice according to the Nursing Standards of Practice

  • Practice within the NDP guidelines

Vanessa B. Prater, BSN, RN


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Documentation

Job Descriptions

Training – MAC, MAS, MATT

Supervision – MAC, LPN

MAR

Communications

Observations/Actions

Self Administration Assessment

Vanessa B. Prater, BSN, RN


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Documentation

IF IT IS NOT DOCUMENTED;

IT WAS NOT DONE!

Vanessa B. Prater, BSN, RN


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Policies and Procedures

  • Compliance with ABON Regulations

  • Compliance with NDP

  • Documentation – MAR, communications, observation, actions

  • MAC Supervision – quarterly

  • LPN Supervision

  • Training and Updates – MAC, MAS

  • Self Administration Assessment - annually

Vanessa B. Prater, BSN, RN


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Policies and Procedures

  • How to handle medications when on home visits, MD visits, trips

  • How to handle telephone orders

  • Reporting a Nurse to the NDP Director/ABON

  • Medication Errors – documentation, reporting

  • Medication security/disposal

Vanessa B. Prater, BSN, RN


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Administrative Requirements

The DMH Certification Process includes NDP Regulations. Certification Surveyors will assess compliance with NDP Regulations.

Vanessa B. Prater, BSN, RN


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Education and Training

MAC Worker

24 hours of training

12 hours Level I – classroom education

Take a written test and pass with 90%

Three attempts

12 hours Level ll – assessment of competencies

4 hours update/refresher annually

Vanessa B. Prater, BSN, RN


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Education and Training

MAS RN/LPN

Any RN/LPN licensed in Alabama, employed or contracted by an Agency certified by DMH is eligible for training and certification as a MAS Nurse

Vanessa B. Prater, BSN, RN


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Education and Training

MAS RN/LPN

A four (4) hour training program, taught by a MATT

RN is required

The RN/LPN must pass a written test with a score

of 90 or better

Three (3) attempts to pass written test

Certification updated every two (2) years

Vanessa B. Prater, BSN, RN


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Education and Training

MATT RN

RN ONLY

At least one (1) year residential/community experience

Specific trainers certified by the DMH to train MAS

Nurses

Must complete a self study module and take a written test

passing with a score of 90 or better

Vanessa B. Prater, BSN, RN


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Education and Training

MATT RN

Two attempt to pass test

Update every two (2) years

Appointed to DMH NDP Advisory Council

Vanessa B. Prater, BSN, RN


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Education and Training

NEXT SCHEDULED MAS TRAINING

JANUARY 2009

(Watch for announcement of date and location)

NEXT SCHEDULED MAS UPDATE TRAINING

DECEMBER 5, 2008 – Montgomery

DECEMBER 17, 2008 – Tuscaloosa

JANUARY 14, 2009 - Mobile

Vanessa B. Prater, BSN, RN


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Education and Training

2nd Annual Update for MAC Workers due

prior to April 1, 2009

Vanessa B. Prater, BSN, RN


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Quality Assurance

Medication Errors

A medication error occurs when the correct/incorrect recipient receives an incorrect drug, dose, form, quantity, route, at the incorrect time.

Failure to administer a drug (missed dose) at the scheduled time constitutes a medication error

Vanessa B. Prater, BSN, RN


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Quality Assurance

Medication Errors

Medications may be given one (1) hour before OR one (1) hour after the scheduled/ordered time. Administration within this acceptable range does not constitute a medication error.

Medication errors by licensed and unlicensed personnel must be reported to the DMH.

Vanessa B. Prater, BSN, RN


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Quality Assurance

Severity of Medication Errors

Level I – incidents in which the recipient experienced NO or MINIMAL adverse consequences AND NO TREATMENT or INTERVENTION other than monitoring or observation was required.

Vanessa B. Prater, BSN, RN


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Quality Assurance

Severity of Medication Errors

Level II – incidents in which the recipient experienced SHORT TERM, REVERSIBLE adverse consequences AND TREATMENT(S)/INTERVENTION(S) in addition to monitoring and observation was required.

Vanessa B. Prater, BSN, RN


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Quality Assurance

Severity of Medication Errors

Level III – incidents in which the recipient experienced LIFE THREATENING and/or PERMANENT adverse consequences

Vanessa B. Prater, BSN, RN


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Quality Assurance

ABON DATA REQUIREMENTS

# of programs with 24/7 on call coverage

Programs that participate in NDP

Programs that do not participate in NDP

Programs with Nurses 24/7

Programs with Nurses on call

Vanessa B. Prater, BSN, RN


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Quality Assurance

ABON DATA REQUIREMENTS

Method used to comply with 24/7 coverage

Turnover

Training

Medication Errors

Areas of non-compliance

How non-compliance was addressed

Vanessa B. Prater, BSN, RN


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Data Collection Suggestions

Nurse Case Load (#MAC/MAS)

#Calls received after 5P

#Calls received on weekends/holidays

Times of Calls

Location of calls

#Self Medication Assessments completed

Vanessa B. Prater, BSN, RN


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Compliance

ABON requires that the DMH provide an Annual Report addressing the required data

Failure to comply with all NDP Regulations may result in decertification

Vanessa B. Prater, BSN, RN


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MAR

  • All medications must be listed on the MAR

  • The MAR must be recopied by a licensed nurse if not pre printed by the pharmacy

  • MAC Workers CANNOT change, add or deleted any medications from the MAR

  • MAC Workers CANNOT take verbal orders

Vanessa B. Prater, BSN, RN


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PRNs

  • MAC Workers CAN give PRNs

  • MAC Workers MUST call the MAS Nurse prior to giving a PRN

  • Effectiveness of the PRN MUST be documented

  • MAS Nurse MUST be notified of outcome

Vanessa B. Prater, BSN, RN


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WHO???

Vanessa B. Prater, BSN, RN


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Who is Impacted?

This regulation applies to any DMH certified residential program, day programs and/or other community extensions that provide services to minorsUNLESS ALL medications are administered by nurses licensed in the State of Alabama

Vanessa B. Prater, BSN, RN


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Who is Impacted?

This regulation applies to any DMH certified residential program, day programs and/or other community extensions that provide services to individuals who are unable to self medicate as defined and assessed by a RN according to NDP guidelines.

Vanessa B. Prater, BSN, RN


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Who is Impacted?

This regulation does not apply to programs where ALL INDIVIDUALS SELF MEDICATE as defined and assessed by an RN as required by NDP

Vanessa B. Prater, BSN, RN


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Who is Impacted?

This regulation does not apply to individuals residing at home and receiving CARE FROM FAMILY/SIGNIFICANT OTHER(S)

Vanessa B. Prater, BSN, RN


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HOW???

Vanessa B. Prater, BSN, RN


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How can I get a MAS Nurse?

Employ a RN/LPN licensed in Alabama

Discuss Delegation with the nurse and

review Position Description

Contact me for training dates and scheduling

(334)242-3217

Contact me with problems/questions

Vanessa.Prater@mh.alabama.gov

Vanessa B. Prater, BSN, RN


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How can I get more information?

DMH Website

www.mh.alabama.gov

Click on the NDP link

OR

CONTACT: Vanessa B. Prater, BSN, RN, Director, Nurse Delegation Program

RSA Union Building

100 S. Union Street

P. O. Box 301410

Montgomery, AL 36130-1410

(334)242-3217 Office

Vanessa.Prater@mh.alabama.gov

Vanessa B. Prater, BSN, RN


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How can I get Technical Assistance?

CONTACT:

Vanessa B. Prater, BSN, RN, Director, Nurse Delegation Program

RSA Union Building

100 S. Union Street

P. O. Box 301410

Montgomery, AL 36130-1410

(334)242-3217 Office

Vanessa.Prater@mh.alabama.gov

Vanessa B. Prater, BSN, RN


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ABON

Practice Consultant

  • Carolyn Morgan, MSN, RN

    cmorgan@abn.state.al.us

    Executive Officer

  • Genell Lee, MSN, RN, JD

    Genell.Lee@abn.alabama.gov

Vanessa B. Prater, BSN, RN


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WHEN???

Vanessa B. Prater, BSN, RN


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When do I have to comply?

NOW!

Vanessa B. Prater, BSN, RN


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Historical Overview

  • Regulation initially effective: December 05

  • Program Development/Training:

  • Jan 06-Apr 1, 07

  • Full Implementation began: April 1, 07

  • Certification Compliance: Nov 1, 07

Vanessa B. Prater, BSN, RN


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QUESTIONS

Vanessa B. Prater, BSN, RN