PURPOSE: Individuals who administer medications in intermediate care and skilled nursing facilities are required by 13 CSR 15-14.042(49) to have successfully completed a medication administration training program approved by the Division of Aging. This rule sets forth the requirements for the approval of a medication technician training program designating the required course curriculum content, outlining the qualifications required of students and instructors, designating approved training facilities, outlining the testing and certification requirements, and establishing an update course.

PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

1. (1) The purpose of the Certified Medication Technician Training Program shall be to prepare individuals for employment as certified medication technicians in intermediate care or skilled nursing facilities (ICF/SNF). The program shall be designed to teach skills in medication administration of nonparenteral medications which will qualify students to perform this procedure to assist licensed practical nurses or registered professional nurses in drug therapy.

2. (2) All aspects of the Certified Medication Technician Training Program included in this rule shall be met in order for a program to be approved. If the program is to be offered in an ICF/SNF, the administrator of that facility shall make the arrangements with the sponsoring educational agency to—

   1. (A) Provide administration of the Test of Adult Basic Education (TABE) and review of the student’s qualifications;
   2. (B) Arrange for a certified instructor;
   3. (C) Administer the final examination; and
   4. (D) Certify the students through a stateapproved certifying agency which is any one
3. (1) of the long-term care associations or any other division approved agency authorized to issue certificates.

4. (3) The objective of the Certified Medication Technician Training Program shall be to ensure that the medication technician will be able to—

   1. (A) Prepare, administer and chart medications by all routes except those given by the parenteral route;
   2. (B) Observe, evaluate, report and record responses of residents to medications given;
   3. (C) Identify responsibilities associated with control and storage of medications;
   4. (D) Identify appropriate reference materials;
   5. (E) Relate side effects, interactions and nursing implications of common medications;
   6. (F) Identify lines of authority and areas of responsibility; and
   7. (G) Identify what constitutes a medication error.
5. (4) The course shall consist of at least sixty

6. (60) classroom hours of instruction and a minimum of eight (8) hours of clinical practice under the direct supervision of an instructor or licensed registered nurse (RN) designated by the sponsoring educational agency, including a minimum of a two (2)-hour final practicum in a licensed ICF/SNF and a final written examination. The hours of a student’s clinical practice required by an instructor may be greater, based on each student’s mastery of course content as determined by the instructor.

   1. (A) The approved course curriculum shall be the course developed by the Missouri Department of Elementary and Secondary Education and the Division of Aging as outlined in the manual entitled Medication Technician produced by the Instructional Materials Laboratory, University of Missouri- Columbia, revised 1994, catalogue number 50-6010-S. Students shall each have a copy of this manual. The instructor shall use the companion Instructor’s Guide, catalogue number 50-6010-I. These manuals and materials are incorporated in this rule by reference.

   2. (B) The curriculum content shall include procedures and instructions in the following areas:

      1. 1. Basic review of body systems and

drug effect on each;

1. 2. Medical terminology;
2. 3. Infection control;
3. 4. Drug classifications;
4. 5. Dosage, measurements and forms;
5. 6. Storage and accountability;
6. 7. Problems of observations in drug

therapy;

1. 8. Administration by oral, rectal, vagi-

nal, otic, opthalmic, nasal, skin, topical, transdermal patches, and oral metered dose inhaler; and

1. 9. Special categories. 13 CSR 15-13
2. (C) A student shall not be allowed to independently administer medications until successfully completing the course. The final score sheet may be used as authorization to independently administer medications for up to ninety (90) days. After this period the student must have a certificate and be listed on the Missouri State Certified Medication Technician Registry.

1. (5) Student Qualifications.

   1. (A) Any individual employable in an ICF/SNF who will be involved in direct resident care shall be eligible to enroll as a student in the course if the following criteria are also met:

      1. 1. High school diploma or General Edu-

cation Development (GED) Certificate;

1. 2. A minimum score of 8.9 on both

Vocabulary and Comprehension tests and a minimum score of 7.0 on Mathematics Concepts and Application tests on the D level of the Test of Adult Basic Education (TABE). The tests shall be administered by the public educational sector;

1. 3. Six (6) months of employment as a

certified nurse assistant who is listed on the Missouri State Nurse Assistant Register and who has a letter of recommendation submitted to the training agency or school by the administrator or director of nursing of the facility, or, if now unemployed, by a previous employer; and

1. 4. Nursing assistants who plan to enroll

in the course may or may not be currently employed in a long-term care facility.

1. (B) The following individuals may qualify as certified medication technicians by successfully challenging the course through a written and performance final examination:

   1. 1. Students enrolled in a professional

nursing school or in a practical nursing program who have completed a medication administration course and who have a letter of endorsement from the school or program director;

1. 2. Individuals who successfully com-

pleted a professional or practical nursing program but who failed the professional (RN) or practical (LPN) state licensure examination;

1. 3. Individuals who provide evidence of

successful completion of a state-approved certified medication technician course while working as aides at a facility operated by the Missouri Department of Mental Health providing that an individual successfully complete the orientation module of the approved Nurse Assistant Training Program and challenges the course by successfully completing the final examination of that program so that his or her name appears on the Missouri Certified Nurse Assistant Register. This shall be completed prior to challenging the Certified Medication Technician course;

1. 4. Individuals who have successfully

completed a state-approved medication technician course in another state, who are currently listed as Certified Medication Technicians in good standing in that state, and who submit a letter of recommendation to the division from an administrator or director of nursing of a facility in which he or she served as a medication technician; and

1. 5. Individuals listed on the Certified

Nurse Assistant (CNA) register. All individuals who qualify to challenge the final examination must first challenge the Certified Nurse Assistant final examination if not already listed on the registry as a CNA.

1. (C) Individuals who have successfully completed a professional or practical nursing program and who have not yet taken or received the results of the state licensure examination may request a letter from the division which entitles them to administer medication in a long-term care facility. However, if more than ninety (90) days have lapsed since graduation or since taking the Missouri State Board Examination with no results confirmed, the individual must ask for permission to challenge the final examination for certification as a medication technician. Challenge letters shall be valid for one hundred twenty (120) days.

2. (D) Those persons designated in subsections (5)(B) and (C) who want to challenge the final examination or receive a letter of qualification, shall submit a request in writing to the division enclosing any applicable documentation. If approved to—

   1. 1. Challenge the examination, a letter so

stating will be sent from the division and may be presented to a sponsoring educational agency so that arrangements can be made for testing; or

1. 2. Qualify without taking the course or

challenging the examination, a letter so stating will be sent by the division and shall be presented and used in lieu of a certificate.

1. (E) Individuals who must qualify by successfully completing the final examination or by special qualifying criteria shall not be allowed to administer medications until successfully completing the challenge process or receiving a letter of qualification from the division.

1. (6) Instructor Qualifications for Basic Course.

   1. (A) An instructor shall be currently licensed to practice as a registered nurse in Missouri or shall have a temporary permit from the Missouri State Board of Nursing. The instructor shall not be the subject of current disciplinary action, such as censure, probation, suspension or revocation of license.

   2. (B) The instructor shall meet state certification requirements as follows:

      1. 1. Hold a current full-time teaching cer-

tificate or a short-term instructor approval certificate from the Department of Elementary and Secondary Education, Division of Vocational and Adult Education;

1. 2. Complete an instructor/examiner

workshop to implement the program; and

1. 3. Be responsible to a sponsoring educa-

tional agency, such as an area vocationaltechnical school, a comprehensive high school, a community college or an approved four (4)-year institution of higher learning.

1. (C) Instructor may be assisted by pharmacists as guest instructors in to the areas of drug distribution systems, regulations governing drugs, drug actions, adverse reactions and drug interactions.
2. (D) When the instructor is an employee of the ICF/SNF in which training is conducted, a qualified registered nurse approved by the sponsoring educational agency shall conduct the final examinations. The examiner may also be the instructor.
3. (E) A person shall not be approved to be an instructor or examiner if he or she has ever been found to have knowingly acted or omitted any duty in a manner which would materially and adversely affect the health, safety, welfare or property of a resident.

4. (F) A person who has been approved to be an instructor or examiner shall have that status revoked if, after an investigation by the division, it is found that the person:

   1. 1. Knowingly acted or omitted any duty

in a manner which materially and adversely affected the health, safety, welfare or property of a resident;

1. 2. Defrauded a training agency or stu-

dent by taking payment and not completing a course or following through with certification;

1. 3. Did not administer the final exami-

nation as required, or was not on-site while students were being trained; or

1. 4. Falsified information on the final

score sheet or any other required documentation.

1. (G) When an individual is no longer qualified to be an instructor or examiner, the division shall notify:

   1. 1. The individual that he or she is no

longer eligible to be an instructor or examiner; and

1. 2. All approved training and certifying

agencies if it has been determined that an individual is no longer considered an approved instructor or examiner and that the person’s name shall be removed from the list of approved instructors and examiners maintained by the division.

1. (H) To be reinstated as an approved instructor or examiner the individual shall submit a request in writing to the division director stating the reasons why reinstatement is warranted. The division director or the director’s designee shall respond in writing to the request.

1. (7) Training Agencies.

   1. (A) The following entities are eligible to apply to the division to be an approved training agency: vocational-technical schools, comprehensive high schools, community college or approved four (4)-year institutions of higher learning.
   2. (B) All classrooms shall contain sufficient space, equipment and teaching aids to meet the course objectives as determined by the sponsoring educational agency.
   3. (C) A school desiring divisional approval to teach the Certified Medication Technician Course shall file an application with the division giving the names of the instructors, listing the equipment and classroom space that will be used and provide a copy of an agreement with the nursing facility conducting the clinical portion of the course.
   4. (D) The ICF/SNF in which clinical practice and the final practicum examination are conducted shall allow students, instructors and examiners access to the medication room, supervised access to residents and access to the medication recording area.
   5. (E) There shall be a signed written agreement between the sponsoring educational agency and each cooperating ICF/SNF which specifies the rules, responsibilities and liabilities of each party.
   6. (F) The sponsoring educational agency is responsible for sending the division a copy of the most current signed agreement with the cooperating ICF/SNF where clinicals will be conducted. The division shall review all signed agreements. On-site inspections of the training site or educational agency may be made by the division if problems occur or complaints are received. If requirements are not met the status as a training site may be revoked by the division.
   7. (G) The classroom portion may be taught in an ICF/SNF if there is an approved educational agency as a sponsor.

2. (8) Basic Course Testing.

   1. (A) Prior to the student’s enrollment, the TABE shall be administered by qualified examiners from the public educational sector designated by the sponsoring educational agency. See paragraph (5)(A)2. of this rule.
   2. (B) To be eligible for the final examination, students shall have achieved a score of at least eighty percent (80%) on each written examination in the course curriculum.

   3. (C) The final examination shall consist of a written and practicum examination.

      1. 1. The written examination shall include

fifty (50) multiple choice questions based on the course objectives. A score of at least eighty percent (80%) is required for passing.

1. 2. The practicum examination shall

include preparing and administering all nonparenteral routes and recording of medications administered to residents. It shall be conducted under the direct supervision of the instructor or examiner and the person responsible for medication administered in the ICF/SNF. Testing on medications not available in the ICF/SNF shall be done in a simulated classroom situation.

1. 3. The final examination may be retaken

one (1) time within ninety (90) days without repeating the course.

1. 4. A challenge examination may be tak-

en one (1) time. If failed the entire course shall be taken before retesting is allowed.

1. (D) The instructor and examiner shall complete the final records and the record sheet shall include competencies and scores and other identifying information.

1. (9) Records and Certification.

   1. (A) Records.

      1. 1. For at least two (2) years, the spon-

soring educational agency shall maintain records of individuals who have completed the Certified Medication Technician Training Program and shall submit to one (1) of the state-approved certifying agencies the student’s name, student’s Social Security number, class beginning date and completion date, a challenge or full course and other identifying information from the final score sheet.

1. 2. A copy of the final record shall be

provided to the certified medication technician.

1. 3. A transcript may be released with

written permission from the student in accordance with the provisions of the Privacy Act—P.L. 90-247.

1. (B) Certification.

   1. 1. The sponsoring educational agency

shall maintain the records of individuals who have been enrolled in the Certified Medication Technician Program and shall submit to a state approved certifying agency the names and address of all individuals who successfully complete the program. Upon receipt of the successful completion of course material and final examination, the state-approved certifying agency shall issue a certificate of completion to the student through the sponsoring educational agency (school). Any final examination documentation over ninety (90) days old shall be invalid.

1. 2. On a monthly basis, the certifying

agency shall provide the division with names and other identifying information of those receiving certificates.

1. 3. The division shall maintain a list of

certifying agencies approved to handle the issuance of certificates for the Certified Medication Technician Training Program. In order for a certifying agency to be approved by the division, it shall enter into an annually renewable agreement of cooperation with the division.

1. (10) Certified Medication Technician Update Course.

   1. (A) All medication technicians with certificates from state-approved certifying agencies who have not taken the new sixty-eight (68)-hour course using the 1994 edition, curriculum catalog number 50-6010-S shall successfully complete the Certified Medication Technician Update Course (number 50-6015- S) to remain qualified certified medication technicians. Any individual taking the update course shall be certified as a nurse assistant with his or her name listed on the Missouri State Nurse Assistant Registry. Any previously qualified student who does not attend the update course prior to June 30, 2000, must take the complete sixty-eight (68)-hour course.
   2. (B) The certifying agency must receive the score sheet and accompanying documentation within ninety (90) days after the Certified Medication Technician Update Course final examination is administered. Score sheets and documents shall become invalid if not properly submitted within ninety (90) days after the final examination is given.

   3. (C) The following may request permission from the division to take the Certified Medication Technician Training Update Course:

      1. 1. Individuals trained by the then exist-

ing Missouri Division of Health Institutional Advisory Nurses prior to 1978;

1. 2. Individuals certified through the

vocational educational system using the Department of Health-approved curriculum;

1. 3. Individuals who have completed a

long-term care medication technician course in another state which has been approved by the appropriate state agency and who have a letter from the division giving permission to work as certified medication technicians;

1. 4. All medication technicians with valid

certificates from the Department of Elementary and Secondary Education; and

1. 5. All medication technicians with valid

certificates from state-approved certifying agencies who have not taken the new 13 CSR 15-13

sixty-eight (68)-hour course using the 1994 revised curriculum catalog number 50-6010-S.

1. (D) Prior to a sponsoring educational

agency accepting a Certified Medication Technician Update Course student, the sponsoring educational agency, the student’s employing facility or the student him/herself shall send the division the following information: current legal name and any prior name(s); address; a copy of the student’s Social Security card; a copy of the student’s current certified medication technician certificate or qualifying information and a copy of the student’s current certified nurse assistant certificate. This information will be used for student validation and placement in an update course. No student may be admitted to the update course without first presenting a letter from the division allowing him or her to take the update course. The division will complete the processing of all update course requests within twelve (12) working days of receipt of the appropriate and complete information.

1. (E) The update course shall consist of at least seven (7) hours of classroom instruction, to include demonstrations on apical pulse, ophthalmic medication, transdermal patch, oral metered dose, and inhaler medications. The update course also includes information on body systems and infection control. In order to be approved, the certified medication technician training agency, school, or ICF/SNF, under the auspices of the approved training agency shall have an area that will be designated during training sessions as a classroom with sufficient space to allow at least twenty (20) students to be seated with room for note-taking and appropriate equipment as needed for teaching the update course. Each student and instructor shall have an update course manual.
2. (F) The final examination shall consist of at least fifty (50) multiple choice questions taken from one (1) of the two (2) tests found in the 50-6015-I manual for instructors and examiners. Test time may be no longer than one (1) hour. A score of eighty percent (80%) is required for passing. If not successfully passed, a second test from the same manual may be administered one (1) time within the next ninety (90) days. Any individual who fails the examination on the first attempt, may no longer administer medication. If the examination is failed the second time, the full sixty-eight (68)-hour course must be taken or retaken.
3. (G) The instructor or examiner shall complete the final Score Sheet for Certified Medication Technician Update Course Examination and shall include competencies, scores and signatures which shall be sent to a certifying agency for recertification as stated in section (10) of this rule. The letter of permission to take the update course must also be sent to the certifying agency.
4. (H) The instructor or examiner of the Certified Medication Technician Update Course shall be an approved instructor as designated in section (6) of this rule.
5. (I) The sponsoring educational agency shall maintain, for at least two (2) years, the records of individuals who have taken the update course. The sponsoring educational agency shall provide a certifying agency approved by the division with documentation showing successful completion and testing of the update course and the Score Sheet for Certified Medication Technician Update Course. Any final examination score sheet not received within (90) days by the certifying agency after the final examination is given shall be invalid. The certifying agency shall provide a certificate to the student which documents successful completion of the state-approved Certified Medication Technician Update Course.
6. (J) The division shall maintain a list of long-term care associations or other agencies that issue certificates to individuals who have successfully completed the course. On at least a monthly basis, the long-term care associations or certifying agencies shall provide the division with the names and other identifying data of those individuals receiving update course certificates. The long-term care associations or certifying agencies shall maintain these update course records for at least two (2) years.
7. (K) The division shall maintain a Certified Medication Technician Register listing names and other relevant and identifying information.

AUTHORITY: section 198.079, RSMo 1994.* Original rule filed Aug. 13, 1982, effective Jan. 13, 1983. Amended: Filed Oct. 13, 1987, effective Jan. 29, 1988. Amended: Filed July 13, 1998, effective Feb. 28, 1999. *Original authority 1979.