1. (1) Home health aides and Certified Nursing Assistants (CNA) must receive training prior to providing services and each calendar year thereafter as required. Home health aides and CNAs performing tasks delegated by a registered nurse (RN), including medication administration, may require additional training and validation to be qualified to perform the tasks in the home setting. Training may be provided as in-service training unless otherwise specified in statute. Medicare and Medicaid agencies should check federal regulations for additional in-service training requirements.

2. (2) Definitions

   1. (a) A medication administration route is the path through which medication is delivered to a patient. For the proposes this rule, routes of administration are defined as follows:

      1. “Buccal” means medication is placed in the mouth between the cheek and gum.

      2. “Enteral” means medication is delivered by oral route, sublingual or buccal route, or rectal route.

      3. “Inhaled” means medication is administered as nose drops or nose spray, or medication is inhaled by mouth, such as with an inhaler or nebulizer.

      4. “Ophthalmic” means solution or ointment medication is instilled into the eye or applied on or around the eyelid.

      5. “Oral” means medication including, but not limited to, tablet, capsule, liquid, or powder form is introduced into the gastrointestinal tract by mouth.

      6. “Otic” means solutions or ointment medication is placed in the outer ear canal or applied around the outer ear.

      7. “Parenteral” means medication is injected into the body through some route other than the digestive tract, such as subcutaneous, intra-dermal, intra-muscular, or intravenous administration.

      8. “Rectal” means any medication including, but not limited to, capsule, enema, gel, or suppository administered via the rectum.

      9. “Sublingual” means medication is placed in the mouth under the tongue.

      10. “Topical” means medication including, but not limited to, salve, lotion, ointment, cream, spray, shampoo, or solution applied locally to a body part.

      11. “Transdermal” means a patch containing a pre-measured or measured amount of topical medication that is absorbed into the body via the epidermis (outer layer of skin).

      12. “Vaginal” means any medication including, but not limited to, capsule, cream, or ointment that is administered via the internal vagina. This route does not include medications applied to the epidermis external to the vagina.

3. (3) Medication Training Course Curriculum.

   1. (a) Home health aides and CNAs administering medication pursuant to Sections 400.489, 400.490 and 464.2035, F.S. must complete an initial 6-hour basic medication administration training course prior to assuming this responsibility and a 2-hour in-service medication training course annually thereafter.
   2. (b) Basic medication administration training must be provided by an RN licensed under Chapter 464, F.S. or a physician licensed under Chapter 458 or 459, F.S. who has been in practice for at least 2 years.

   3. (c) The training curriculum must require the home health aide or CNA to demonstrate the following in person, which must include, at minimum the ability to:

      1. Read and understand a prescription label;

      2. Administer oral, transdermal, ophthalmic, otic, inhaled, and/or topical medication routes;

      3. Measure liquid medications, break scored tablets, and crush tablets in accordance with prescription directions;

      4. Recognize the need to obtain clarification of an “as needed” prescription order;

      5. Recognize a medication order which requires the judgment or discretion of an RN, and to advise the patient and the supervising RN of the inability to assist in the administration of such orders;

      6. Complete a medication administration record (MAR) and fulfill related record keeping requirements;

      7. Recognize the general signs of adverse reactions to medications and report such reactions;

      8. Promote safety, sanitation and hand hygiene while administering medication; and

      9. Medication error prevention and error reporting.

4. (4) Validation for Routes of Medication Administration.

   1. (a) A home health aide or CNA must be assessed and validated as competent to administer medication by an RN after succsessfully completing required medication training.
   2. (b) Successful validation requires the home health aide or CNA to demonstrate their capability to administer medication in a safe, sanitary and responsible manner in an on-site, patient-setting using the patient’s prescribed medications.
   3. (c) The home health aide or CNA must achieve a score of 100% proficiency in the validation prior to administering medication.
   4. (d) Validation must take place within 90 days of completing required medication training.

   5. (e) Validation for medication administration includes a demonstration of the following:

      1. The ability to comprehend and follow medication instructions on a prescription label, physician’s order, and properly complete a medication administration record form;

      2. The ability to administer medication by oral, transdermal, ophthalmic, otic, inhaled, or topical administration routes, including prefilled insulin syringes if applicable;

      3. The ability to obtain pertinent medication information, including the purpose of the medication, its common side effects, and symptoms of adverse reactions to the medication, either from the package insert that comes from the pharmacy, or other professionally recognized medication resource, and to maintain this information for easy access and future reference;

      4. The ability to fulfill medication record keeping requirements; and

      5. The ability to effectively communicate in a manner that permits health care providers and emergency responders to adequately and quickly respond to emergencies.

5. (5) Validations expire 1 year from the effective date of the validation. A home health aide or CNA must be revalidated within 60 days prior to the expiration of their validation to continue to administer medications as delegated by an RN.
6. (6) Documentation demonstrating completion of required training and validations by home health aides and CNAs must be kept on file by the home health agency.

Rulemaking Authority 400.489, 464.0156, 464.2035 FS. Law Implemented 400.489, 400.490, 464.0156, 464.2035 FS. History–New 5-24-23.