.11 Scope of Practice.

A. Medication Administration.

(1) A certified dialysis technician shall administer only the following medications:

(a) Intradermal lidocaine or another single therapeutically equivalent local anesthetic for the purpose of initiating dialysis treatment;

(b) Intravenous heparin or other single therapeutically equivalent anti-coagulant for the purpose of initiating and maintaining dialysis treatment;

(c) Intravenous normal saline; and

(d) Oxygen, when the administration of the oxygen has been delegated to the certified dialysis technician by a registered nurse.

(2) When administering the medications set forth in §A(1) of this regulation, the certified dialysis technician shall:

(a) Ensure that the right dose of the right medication is given to the right individual through the right route of administration at the right time;

(b) Accurately and timely document the administration of the medication and notify a physician or licensed nurse of the patient’s response to the medication as appropriate;

(c) Consult with an appropriate licensed practitioner when the certified dialysis technician believes or has reason to believe that a prescribed medication is inaccurate, not properly authorized, harmful or potentially harmful to a patient, or contraindicated by other documented information; and

(d) Take any other action needed to ensure the safety of the patient.

(3) A certified dialysis technician shall administer the medications authorized under §A(1) of this regulation only if the task has been delegated to the dialysis technician by a registered nurse or licensed practical nurse in accordance with Regulations .11—.13 of this chapter.

(4) The certified dialysis technician shall be under the direct supervision of a registered nurse or licensed practical nurse when administering medications.

B. Practice Standards.

(1) A certified dialysis technician shall provide dialysis care only when the performance of the care is delegated to the certified dialysis technician by a registered nurse or licensed practical nurse.

(2) A certified dialysis technician shall demonstrate competence and accountability in all areas of dialysis care in which the technician is engaged, including, but not limited to, the following:

(a) Consistent performance of all aspects of dialysis care according to acceptable standards; and

(b) Appropriate recognition, referral, consultation, or intervention when a complication arises in conjunction with dialysis or when a change in patient status occurs.

(3) A certified dialysis technician shall timely:

(a) Implement the prescribed dialysis care order for a patient unless the technician believes or should have reason to believe that the prescribed order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by other documented information; and

(b) Clarify any prescribed dialysis care order for a patient when the technician believes or should have reason to believe that the order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by other documented information.

(4) When clarifying the prescribed dialysis care order, the certified dialysis technician shall timely:

(a) Consult with an appropriate licensed practitioner;

(b) Notify the delegating nurse when the technician believes that it would not be appropriate to follow the prescribed dialysis care order;

(c) Document:

(i) That the delegating nurse was notified;

(ii) The outcome of the consultation with the delegating nurse; and

(iii) The treatment plan for the patient; and

(d) Take any other action needed to ensure the safety of the patient.

(5) A dialysis technician shall timely report to and consult as necessary with other members of the dialysis care team, including, but not limited to, the licensed nurse or physician when a patient refuses to follow the prescribed dialysis care order.

(6) A dialysis technician shall comply with the code of ethics for certificate holders set forth in COMAR 10.39.07.

(7) A dialysis technician shall do the following to promote patient safety:

(a) Display the applicable CDT title or initials at all times when providing dialysis care;

(b) Completely, accurately, and timely document and report all patient data obtained while providing dialysis care and the patient’s response to the care;

(c) Completely, accurately, and timely document and report to the appropriate practitioner all errors in or deviations from the prescribed dialysis care regimen;

(d) Not falsify any patient record or any other documents prepared in the course of or in conjunction with the provision of dialysis care. This includes, but is not limited to, case management documents or reports, time records or reports, and other documents related to billing for dialysis services; and

(e) Implement measures to provide a safe environment for the patient.

(8) A dialysis technician shall only work in a structured setting.