PURPOSE: Individuals who administer medications in residential care facilities I and II are required by 13 CSR 15-15.042(49) to be either a physician, a licensed nurse, a certified medication technician or a level I medication aide. This rule sets forth the requirements for approval of a Level I Medication Aide Training Program designating the required course curriculum content, outlining the qualifications required of students and instructors, designating approved training facilities and outlining the testing and certification requirements. (1) The purpose of the level I Medication Aide Training Program shall be to prepare individuals for employment as level I medication aides in residential care facilities (RCFs) I and II. The program shall be designed to teach skills in medication administration of nonparenteral medications in order to qualify students to perform this procedure only in RCFs I and II in Missouri.

1. (2) All aspects of the level I Medication Aide Training Program included in this rule shall be met in order for a program to be considered approved.
2. (3) The objective of the level I Medication Aide Training Program shall be to ensure that the medication aide will be able to—define the role of a level I medication aide; prepare, administer and chart medications by nonparenteral routes; observe, report and record unusual responses to medications; identify responsibilities associated with control and storage of medications; and utilize appropriate drug reference materials.
3. (4) The course shall be an independent selfstudy course with a minimum of sixteen (16) hours of integrated formal instruction and practice sessions supervised by an approved instructor which shall include a final written and practicum examination.
4. (5) The curriculum content shall include procedures and instructions in the following areas: basic human needs and relationships; drug classifications and their implications; assessing drug reactions; techniques of drug administration; medication storage and control; drug reference resources; and infection control.
5. (6) The course developed by the Missouri Department of Elementary and Secondary Education and the Division of Aging as outlined in the manual entitled Level I Medication Aide (IE 64-1) produced by the Instructional Materials Laboratory, University of Missouri-Columbia shall be the approved course curriculum. Students and instructors each shall have a copy of this manual.
6. (7) A student shall not administer medications without the instructor present until s/he successfully completes the course and obtains a certificate.

7. (8) Student Qualifications.

   1. (A) Any individual employable in an RCF I or II to be involved in direct resident care shall be eligible to enroll as a student in this course or to challenge the final examination. Employable shall mean an individual who is at least eighteen (18) years of age; not listed on the Missouri Division of Aging Employee Disqualification List or any other state’s disqualification list; and has not been found guilty of, pled guilty to, been convicted of, or nolo contendere to a class A or B felony under Chapters 565, 566, and 569, RSMo; a class D felony under section 568.020, RSMo 1994 or any violation of section 198.070.3, RSMo 1994.
   2. (B) The following individuals may qualify as level I medication aides by successfully challenging the final examination: Individuals either enrolled in or who have been enrolled in a professional nursing school or in a practical nursing program who have completed the medication administration or pharmacology course and who have letters of endorsement from the directors of their respective programs;
8. (9) Those persons wanting to challenge the final examination shall submit a request in writing to the Missouri Division of Aging enclosing applicable documentation. If approved to challenge the examination, a letter so stating will be sent from the division to present to an approved instructor so that arrangements can be made for testing.

9. (10) Instructor Qualifications.

   1. (A) An instructor shall be currently licensed to practice as either a registered nurse or practical nurse in Missouri or shall hold a current temporary permit from the Missouri State Board of Nursing. The licensee shall not be subject to current disciplinary action such as censure probation, suspension or revocation. If the individual is a licensed practical nurse, the following additional requirements shall be met:

      1. 1. Shall not be waived; and
      2. 2. Shall be a graduate of an accredited

program which has pharmacology in the curriculum.

1. (B) In order to be qualified as an instructor, the individual shall have had one (1) year’s experience working in a long-term care

1. (LTC) facility licensed by the Division of Aging or the Department of Mental Health within the past five (5) years; or shall be currently employed in an LTC facility licensed by the Division of Aging or the Department of Mental Health and shall have been employed by that facility for at least six (6) months; or shall be an instructor in a Health Occupations Education program; and shall have attended a “Train the Trainer” workshop to implement the level I Medication Aide Program conducted by a Missouri registered nurse presenter approved by the Missouri Division of Aging.

   1. (C) Upon completion of the workshop and receipt of all credentials validating qualifications, the presenter shall issue a certificate indicating that an instructor is approved to teach the level I medication aide course and shall submit the names of the approved instructors to the approved LTC association.

   2. (D) A person who has been approved as an instructor shall have that status revoked if, after an investigation by the division, it is found that the instructor:

      1. 1. Accepted money from a student and

did not follow through with the class or upon successful completion of the class did not follow through with certification;

1. 2. Falsified information on the final

score sheet or any other required documentation; or

1. 3. Administered the final examination

incorrectly and not in accordance with section (12) of this rule.

1. (E) Once an instructor’s status is revoked only the director of the division or his/her designee may reinstate the individual after the individual requests reinstatement documenting new circumstances. If the instructor’s status is revoked or reinstated, the division shall immediately notify all certifying agencies of the action.

1. (11) Sponsoring Agencies.

   1. (A) The level I Medication Aide Training Program may be sponsored by an area vocational-technical school, a comprehensive high school, a community junior college, a college or university approved by the Department of Elementary and Secondary Education, a currently licensed RCF I or II or an LTC association.
   2. (B) The sponsoring agency is responsible for obtaining an approved instructor, determining the number of manuals needed for a given program, ordering the manuals for the students and presenting a class schedule for approval by an approved LTC association. The required information will include: the name of the approved instructor; the instructor’s Social Security number, current address and telephone number; the number of students enrolled; the name, address, telephone number, Social Security number and age of each student; the name and address of the facility that employs the student, if applicable; the date and location of each class to be held; and the date and location of the final examination. The LTC association which approved the course shall be notified in advance if there are any changes in dates or locations.
   3. (C) Classrooms used for training shall contain sufficient space, equipment and teaching aids to meet the course objectives as determined by an approved LTC association.
   4. (D) If the instructor is not directly employed by the agency, there shall be a signed written agreement between the sponsoring agency and the instructor which shall specify the role, responsibilities and liabilities of each party.

2. (12) Testing.

   1. (A) The final examination shall consist of a written and a practicum examination administered by the instructor.

      1. 1. The written examination shall include

twenty-five (25) questions based on the course objectives.

1. 2. The practicum examination shall be

done in an LTC facility which shall include the preparation and administration by nonparenteral routes and recording of medications administered to residents under the direct supervision of the instructor and the person responsible for medication administration in the long-term care facility. Testing on medications not available in the LTC facility shall be done in a simulated classroom situation.

1. (B) A score of eighty percent (80%) is required for passing the final written examination and one hundred percent (100%) accuracy in the performance of the steps of procedure in the practicum examination.
2. (C) The final examination, if not successfully passed, may be retaken within ninety

1. (90) days one (1) time without repeating the course, however, those challenging the final examination must complete the course if the examination is not passed in the challenge process.

   1. (D) The instructor shall complete final records and shall submit these and all test booklets to the sponsoring agency.

2. (13) Records and Certification.

   1. (A) Records.

      1. 1. The sponsoring agency shall maintain

records of all individuals who have been enrolled in the level I Medication Aide Program and shall submit to the LTC association which approved the course all test booklets, a copy of the score sheets and a complete class roster.

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

provided to any individual enrolled in the course.

1. 3. A final record may be released only

with written permission from the student in 13 CSR 15-13

accordance with the provisions of the Privacy Act (PL 90-247).

1. (B) Certification.

   1. 1. The LTC association which approved

the course shall award a level I medication aide certificate to any individual successfully completing the course upon receiving the required final records and test booklets from the sponsoring agency.

1. 2. The LTC association which approved

the course shall submit to the Missouri Division of Aging the names of all individuals receiving certificates.

1. (14) The division shall maintain a list of LTC associations approved to handle the level I Medication Aide Training Program. In order for an LTC association to be approved by the division the association shall enter into an agreement of cooperation with the division which shall be renewable annually and shall effectively carry out the following responsibilities:

   1. (A) Maintain a roster of approved instructors;
   2. (B) Approve sponsoring agencies, class schedules and classroom space;
   3. (C) Distribute final examinations, review test booklets, score sheets and class rosters;
   4. (D) Award certificates to individuals who successfully complete the course, provide the Division of Aging with the names of those receiving certificates; and
   5. (E) Maintain records.

2. (15) Maintaining Certification.

   1. (A) If the division, upon completion of an investigation, finds that the Level I Medication Aide has stolen or diverted drugs from a resident or facility or has had his/her name added to the employee disqualification list, the division shall delete such person’s name from the division’s Level I Medication Aide listing. Such deletion shall render the Medication Aide’s certificate invalid.

AUTHORITY: section 198.076, RSMo 1994.* Original rule filed May 14, 1985, effective Sept. 1, 1985. Amended: Filed Oct. 16, 1985, effective Jan. 12, 1986. Amended: Filed May 26, 1998, effective Jan. 30, 1999. *Original authority 1979.