CHAPTER 20:48:04

THE PRACTICE OF NURSING

Section

20:48:04:01        Standards of nursing practice -- Registered nurse and licensed practical nurse.

20:48:04:01.01    Scope of nursing practice -- Registered nurse.

20:48:04:01.02    Scope of nursing practice -- Licensed practical nurse.

20:48:04:01.03    Supervision of a licensed practical nurse.

20:48:04:02        Repealed.

20:48:04:02.01    Repealed.

20:48:04:02.02    Repealed.

20:48:04:02.03    Authorization to perform kidney dialysis functions.

20:48:04:02.04    Training program required for a licensed practical nurse to perform kidney dialysis functions, Repealed.

20:48:04:03        Repealed.

20:48:04:04        Repealed.

20:48:04:05        Repealed.

20:48:04:06        Intravenous therapy tasks that may be performed by licensed practical nurses.

20:48:04:06.01    Administration of blood components by a licensed practical nurse.

20:48:04:07        Tasks that may not be performed by licensed practical nurses.

20:48:04:08        Scope and standards of nurse anesthetist practice -- Prescriptive authority.

20:48:04:09        Scope and standards of nurse anesthetist practice -- Controlled substance prescribing.

20:48:04:10        Scope and standards of nurse anesthetist practice -- Use and supervision of radiography.

20:48:04:11        Scope and standards of nurse anesthetist practice -- Procedures for pain management.

    20:48:04:01.  Standards of nursing practice -- Registered nurse and licensed practical nurse. The standards of practice for a registered nurse and a licensed practical nurse are to:

    (1)  Practice within the legal boundaries for nursing practice authorized in SDCL chapter 36-9 and this article;

    (2)  Accept personal responsibility and be accountable for actions, competence, decisions, and behavior in the course of nursing practice. A nurse does not avoid this responsibility by accepting the orders or directions of another person;

    (3)  Perform only those activities, tasks, or responsibilities that another reasonable and prudent nurse with similar educational preparation and demonstrated clinical competence would perform and that one has determined can be accomplished safely;

    (4)  Perform activities, tasks, or responsibilities only after considering the complexity and frequency of nursing care needed by the client population served;

    (5)  Perform activities, tasks, or responsibilities only after considering if a practice setting allows a nurse to perform the activities, tasks, or responsibilities in the practice setting, provides a sufficient number of qualified personnel within the practice setting, and provides adequate channels of communication that lend support to the types of nursing services offered in the practice setting;

    (6)  Maintain competence through ongoing learning and application of knowledge in current nursing practice;

    (7)  Obtain instruction and supervision when needed in implementing new or unfamiliar nursing techniques or practices;

    (8)  Document nursing care provided, changes in a client’s condition, or relevant information, in an accurate and timely manner;

    (9)  Maintain professional boundaries and therapeutic relationships with clients;

    (10)  Collaborate and consult with, or refer clients to, other health care providers to resolve situations beyond one’s expertise;

    (11)  Practice without discrimination on the basis of age, race, religion, gender, national origin, sexual orientation, patient diagnosis, or disability;

    (12)  Advocate for the respect, dignity, rights, and property of clients;

    (13)  Take preventive measures to promote an environment that is conducive to health and safety; and

    (14)  Report illegal, substandard, unethical, unsafe, or incompetent nursing practice.

    Source: SL 1975, ch 16, § 1; 3 SDR 35, effective November 11, 1976; 12 SDR 109, effective January 9, 1986; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 22 SDR 23, effective August 29, 1995; 26 SDR 174, effective July 4, 2000; 33 SDR 43, effective September 12, 2006; 41 SDR 12, effective July 31, 2014; 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(2).

    Law Implemented: SDCL 36-9-1.1, 36-9-3(4)(5)(8)(9)(10)(11), 36-9-4(3)(4)(5)(6)(7).

    Declaratory Rulings:

    Instructing a patient on routine measures for taking care of a condition does not constitute the practice of medicine and is not grounds for disciplinary action even if the information and recommendations provided are in excess of, or different from, the information and recommendations given by the patient's physician, so long as the nurse did not, on the nurse's own, treat the symptoms or disease. South Dakota Board of Nursing Declaratory Ruling No. 80-1.

    A nurse must exercise professional judgment when accepting orders through a third party, who may or may not be unlicensed, via telephone or otherwise. If an order is transmitted through a third party, all persons, including the third party, must be identified by name and title before the order may be implemented. South Dakota Board of Nursing Declaratory Ruling 87-1.

    Although registered nurses may administer narcotics, analgesics, sedatives, and tranquilizing medications to patients, registered nurses may not administer any medication for the purpose of inducing general anesthesia. It is not within the authority of the board to determine how or for what purpose a specific drug with multiple uses is being administered at any given time. Institutional or agency protocol must address this. South Dakota Board of Nursing Declaratory Ruling 89-1.

    Homemakers employed by the Department of Social Services or its contractors may provide assistance with the self-administration of medications to clients who are mentally capable of self-directing their care and who reside in their own home or reside in adult foster care or an assisted living center if the homemakers are trained as homemakers, are placed by an agency, and are under the supervision of a professional social worker or nurse as appropriate and if the assistance is limited to reminding the client to take a medication at a prescribed time, opening and closing a medication container, and returning a medication container to the proper storage area. Services provided under the conditions described are not dependent upon licensure in nursing. South Dakota Board of Nursing Declaratory Ruling 92-1.

    20:48:04:01.01.  Scope of nursing practice -- Registered nurse. A registered nurse in accordance with § 20:48:04:01 shall use the nursing process in the execution of nursing responsibilities, activities, or tasks authorized in SDCL 36-9-3 and this article for the promotion or maintenance of client health and the prevention of illness or injury. A registered nurse may:

    (1)  Conduct ongoing assessments to anticipate and recognize changes or potential changes in client status, including assimilation of data gathered from a licensed practical nurse and other members of the health care team;

    (2)  Identify client problems and use clinical judgment in accordance with § 20:48:04:01 to make independent nursing decisions or a nursing diagnosis;

    (3)  Develop a nursing plan of care that may include interventions for health maintenance, patient teaching, counseling, prevention of illness, rehabilitation, or discharge planning;

    (4)  Administer independent nursing interventions;

    (5)  Administer medications and treatments prescribed or ordered by a legally authorized prescriber, including:

        (a)  Determining which medication to administer when a prescriber orders more than one medication for the same therapeutic indication; and

        (b)  Determining the dose to administer when a prescriber orders an as-needed medication with a range of doses;

    (6)  Execute a delegated medical treatment, therapy, or regimen according to an approved medical protocol, standardized procedure, or standing order, including the performance of conservative sharp wound debridement to remove necrotic tissue above the level of viable tissue if the removal is not expected to cause significant blood loss and if the registered nurse holds current wound care certification from a national certification body approved by the board;

    (7)  Determine and place durable medical equipment or therapeutic devices when providing preventive, restorative, and supportive care, to implement the overall plan of care;

    (8)  Evaluate client response to nursing interventions and modify the nursing plan of care consistent with intended outcomes;

    (9)  Monitor changes in a client’s health status and take appropriate action, including preventive measures to protect the client, self, and others;

    (10)  Assess client learning needs, develop a teaching plan to meet the client’s needs, implement the plan, and evaluate the outcome;

    (11)  Delegate only tasks or activities that one can perform safely and in accordance with § 20:48:04.01:01; and

    (12)  Supervise licensed and unlicensed providers in accordance with this article.

    Source: 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(3).

    Law Implemented: SDCL 36-9-1.1, 36-9-3(1)(2)(3)(4)(5)(6)(7)(11).

    20:48:04:01.02.  Scope of nursing practice -- Licensed practical nurse. A licensed practical nurse, in accordance with § 20:48:04:01, may:

    (1)  Assist in the identification and administration of nursing interventions, including:

        (a)  Determining which medication to administer when an authorized prescriber orders more than one medication for the same therapeutic indication;

        (b)  Determining the dose to administer when an authorized prescriber orders an as-needed medication with a range of doses; and

        (c)  Administering intravenous therapy, authorized in § 20:48:04:06 or as delegated by a registered nurse pursuant to § 20:48:04:06.01, that is prescribed by a legally authorized prescriber;

    (2)  Assist in the administration of a delegated medical treatment or regimen according to an approved medical protocol, standardized procedure, or standing order;

    (3)  Contribute to the evaluation of client care and the adjustment of the plan of care by monitoring client outcomes, collecting data, and communicating findings in a timely manner;

    (4)  Assist with the identification of client learning needs, teaching, and counseling in accordance with the plan of care;

    (5)  Delegate only tasks or activities that one can perform safely and in accordance with  § 20:48:04.01:01; and

    (6)  Supervise a nursing assistant in accordance with § 20:48:04.01:02.

    Source: 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(3).

    Law Implemented: SDCL 36-9-1.1, 36-9-4(2)(3)(4)(8)(9)(10), 36-9-4.1(2).

    20:48:04:01.03.  Supervision of a licensed practical nurse. A registered nurse or advanced practice registered nurse who supervises the practice of a licensed practical nurse shall determine if direct or minimal supervision is required after considering:

    (1)  The educational preparation of the licensed practical nurse, including the basic educational program and the knowledge and skills subsequently acquired by the nurse through continuing education and practice;

    (2)  The depth of knowledge needed to perform the task and the potential threat to the client's well-being. If the provider determines a task is complex, direct supervision must be provided;

    (3)  The stability of the nursing situation:

        (a)  In a stable nursing situation, the licensed practical nurse may practice with minimal supervision. The supervisor is physically on the premises where the client is being cared for or readily available by electronic communication;

        (b)  In a complex nursing situation, the licensed practical nurse must practice under direct supervision;

    (4)  The qualifications and number of personnel in the facility where the licensed practical nurse practices and the proximity of the clients to personnel;

    (5)  Accessible resources in the facility; and

    (6)  Established policies, procedures, practices, and channels of communication that lend support to the types of nursing services offered.

    Source: 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(2).

    Law Implemented: SDCL 36-9-3(11), 36-9-4.

          20:48:04:02.  Additional functions which may be performed by licensed practical nurses.Repealed.

          Source: SL 1975, ch 16, § 1;  3 SDR 35, effective November 11, 1976; 6 SDR 88, effective March 3, 1980; 12 SDR 109, effective January 9, 1986; 12 SDR 151, 12 SDR 155, effective July 1, 1986; 20 SDR 159, effective April 5, 1994; 22 SDR 23, effective August 29, 1995; repealed, 26 SDR 174, effective July 4, 2000.

    20:48:04:02.04.  Training program required for a licensed practical nurse to perform kidney dialysis functions. Repealed.

    Source: 26 SDR 174, effective July 4, 2000; 49 SDR 1, effective July 6, 2022.

          20:48:04:03.  Recommendations of South Dakota joint practice commission.Repealed.

          Source: 3 SDR 35, effective November 11, 1976; repealed, 6 SDR 88, effective March 3, 1980.

          20:48:04:04.  Settings permitted for performance of overlapping functions.Repealed.

          Source: 3 SDR 35, effective November 11, 1976; repealed, 6 SDR 88, effective March 3, 1980.

          20:48:04:05.  Intravenous therapy functions which may not be performed by licensed practical nurses.Repealed.

          Source: 20 SDR 159, effective April 5, 1994; repealed, 26 SDR 174, effective July 4, 2000.

    20:48:04:06.  Intravenous therapy tasks that may be performed by licensed practical nurses. A licensed practical nurse who has completed a program of study that included supervised clinical practice acquired through a pre-licensure nursing education program or a continuing education program and who has demonstrated clinical competence may perform the following intravenous therapy tasks for clients who are twelve years of age or older, as ordered by a legally authorized medical prescriber, and as supervised in accordance with § 20:48:04:01.03:

    (1)  Insert peripheral venous access devices, using a needle or a catheter not to exceed three inches in length;

    (2)  Administer local anesthetics by the intradermal, subcutaneous, or topical routes for the purpose of pain control when inserting a peripheral catheter;

    (3)  Obtain blood samples through a peripheral or a central line;

    (4)  Assemble and maintain peripheral line and central line infusion equipment;

    (5)  Administer intravenous fluids, with or without added medication, that have been prepared and labeled by a pharmacist, registered nurse, physician, dentist, or manufacturer, via a peripheral or a central line, excluding the medications listed in § 20:48:04:07;

    (6)  Calculate and adjust infusion rates using standard formulas for peripheral and central lines;

    (7)  Reconstitute medications by activation of a manufacturer’s prepared bag and vial system;

    (8)  Administer peripheral intravenous push medications, if:

        (a)  Direct supervision is provided by a registered nurse, advanced practice registered nurse, physician, or other board-approved licensed health care provider;

        (b)  The medication is not listed in § 20:48:04:07; and

        (c)  Administration occurs in a health care facility licensed pursuant to SDCL chapter 34-12;

    (9)  Flush peripheral or central catheter lines with heparin or saline solutions;

    (10)  Administer total parenteral nutrition and fat emulsion solutions via a central line;

    (11)  Assemble and maintain patient-controlled analgesia infusion equipment, program the pump pursuant to an authorized provider’s order that prescribes a specific dosage, and assist a client with self-bolus when needed;

    (12)  Monitor the administration of blood products and plasma volume expanders after a registered nurse or physician has administered the blood product and monitored the client for the initial fifteen minutes of the infusion;

    (13)  Discontinue intravenous therapy infusion, blood products, and plasma volume expanders;

    (14)  Perform routine peripheral and central line intravenous site dressing changes;

    (15)  Remove peripheral intravenous therapy catheters that do not exceed three inches in length; and

    (16)  Remove implanted venous access device needles.

    Source: 26 SDR 174, effective July 4, 2000; 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(3).

    Law Implemented: SDCL 36-9-4(3)(4)(10), 36-9-4.1(1).

    20:48:04:06.01.  Administration of blood components by a licensed practical nurse. A registered nurse may assign the administration of blood products to a licensed practical nurse if:

    (1)  The licensed practical nurse has completed a program of study on the transfusion of blood products that included supervised clinical practice acquired through a pre-licensure nursing education program or a continuing education program;

    (2)  The licensed practical nurse demonstrates clinical competence in the administration of the specific type of blood product to be administered;

    (3)  The client to be administered the blood product is twelve years of age or older;

    (4)  The blood product will be administered to a client in a hospital licensed pursuant to SDCL chapter 34-12; and

    (5)  The licensed practical nurse is directly supervised during the administration of the blood product, according to § 20:48:04:01.03.

    Source: 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(3).

    Law Implemented: SDCL 36-9-3(7), 36-9-4.1(1).

    20:48:04:07.  Tasks that may not be performed by licensed practical nurses. A licensed practical nurse may not:

    (1)  Administer the following intravenous therapy fluids, medications, agents, or drug classifications:

        (a)  Antiarrhythmics;

        (b)  Antineoplastic chemotherapy;

        (c)  Biologics, including immunotherapy;

        (d)  Fibrinolytics;

        (e)  Immunoglobulins;

        (f)  Investigative or experimental;

        (g)  Oxytocics;

        (h)  Paralytics;

        (i)  Thrombolytics;

        (j)  Tocolytics; or

        (k)  Vasoactives;

    (2)  Titrate medications that require continuous assessments to determine the dosage of medication or agent;

    (3)  Administer medications for the purpose of inducing moderate sedation, a drug-induced depression of consciousness during which a client is capable of responding to verbal commands;

    (4)  Administer medications for the purpose of inducing deep sedation, a drug-induced loss of consciousness where the client may not be easily aroused and interventions to maintain a patent airway may be needed;

    (5)  Administer medications for the purpose of inducing general anesthesia, a drug-induced loss of consciousness where the client is not arousable, and interventions are required to maintain a patent airway;

    (6)  Administer fluids, medication, or agents via an epidural, intrathecal, intraosseous, umbilical, or ventricular reservoir; or

    (7)  Insert or remove a midline intravenous catheter, peripherally inserted central line catheter, or other type of central line catheter.

    Source: 26 SDR 174, effective July 4, 2000; 50 SDR 69, effective December 10, 2023.

    General Authority: SDCL 36-9-21(3).

    Law Implemented: SDCL 36-9-1.1.

CHAPTER 20:48:04.01

DELEGATION OF NURSING TASKS

Section

20:48:04.01:01        General criteria for delegation.

20:48:04.01:02        Supervision.

20:48:04.01:03        Repealed.

20:48:04.01:04        Repealed.

20:48:04.01:05        Repealed.

20:48:04.01:06        Repealed.

20:48:04.01:07        Nursing tasks that may not be delegated.

20:48:04.01:08        Repealed.

20:48:04.01:09        Requirements for delegated medication administration to a nursing assistant.

20:48:04.01:09.01    Delegation of medication administration tasks to a nursing assistant.

20:48:04.01:10        Delegation of additional medication administration tasks to a medical assistant.

20:48:04.01:11        Medication administration tasks that require a written protocol.

20:48:04.01:12        Medication administration tasks that may not be delegated.

20:48:04.01:13        Approval of training program required for delegated medication administration.

20:48:04.01:14        Requirements for approval of medication administration training programs.

20:48:04.01:14.01    Standards for medication administration training programs.

20:48:04.01:15        Medication administration curriculum.

20:48:04.01:16        Written protocol required for the delegation of insulin administration by the subcutaneous route to a nursing assistant.

20:48:04.01:17        Qualifications of the registered nurse for delegation of insulin administration by the subcutaneous route to a nursing assistant.

20:48:04.01:18        Delegation of specific medication administration.

20:48:04.01:19        Training required for the delegation of specific medication administration.

    20:48:04.01:01.  General criteria for delegation. A licensed registered nurse is responsible for the nature and quality of nursing care that a client receives under the nurse's direction. A licensed nurse may delegate selected nursing tasks to a nursing assistant. A nursing assistant may not substitute for the licensed nurse in the performance of nursing functions. A nursing assistant may not redelegate a delegated task.

    A licensed nurse shall assess a situation and determine whether delegating nursing tasks to a nursing assistant is appropriate. The delegation of nursing tasks to a nursing assistant must comply with the following criteria:

    (1)  The nursing task is one that a reasonable and prudent licensed nurse would find within the scope of sound nursing judgment to delegate;

    (2)  The nursing task is one that, in the opinion of the delegating nurse, can be properly and safely performed by a nursing assistant without jeopardizing the client's welfare;

    (3)  The nursing task does not require a nursing assistant to exercise nursing judgment;

    (4)  The licensed nurse evaluates the client's nursing care needs before delegating the nursing task;

    (5)  The licensed nurse verifies that the nursing assistant is competent to perform the nursing task; and

    (6)  The licensed nurse supervises the performance of the delegated nursing task in accordance with the requirements of § 20:48:04.01:02.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:02.  Supervision. The licensed nurse shall supervise all nursing tasks delegated to a nursing assistant in accordance with the following conditions:

    (1)  The licensed nurse determines the degree of supervision required after considering:

        (a)  The stability of the client's condition;

        (b)  The competency of the nursing assistant to whom the nursing task is delegated;

        (c)  The nature of the nursing task being delegated; and

        (d)  The proximity and availability of the licensed nurse to the nursing assistant when the nursing task is performed;

    (2)  The delegating nurse or another licensed nurse is readily available either in person or by electronic communication; and

    (3)  If the nursing assistant is providing care in the client's home, the time interval between supervisory visits and whether the visit is conducted in person or via electronic communication is determined by the licensed nurse in accordance with § 20:48:04.01:01. The visit must occur no less than once every 60 days.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

          20:48:04.01:03.  Definition of assistance with self-administration of medications.Repealed.

          Source: 21 SDR 13, effective August 7, 1994; repealed, 26 SDR 174, effective July 4, 2000.

          20:48:04.01:04.  Nursing tasks that may routinely be delegated.Repealed.

          Source: 21 SDR 13, effective August 7, 1994; repealed, 26 SDR 174, effective July 4, 2000.

          20:48:04.01:05.  Criteria for the delegation of nursing tasks that may not be routinely delegated.Repealed.

          Source: 21 SDR 13, effective August 7, 1994; repealed, 26 SDR 174, effective July 4, 2000.

          20:48:04.01:06.  Nursing tasks that may not be routinely delegated.Repealed.

          Source: 21 SDR 13, effective August 7, 1994; repealed, 26 SDR 174, effective July 4, 2000.

    20:48:04.01:07.  Nursing tasks that may not be delegated. A licensed nurse may not delegate to a nursing assistant:

    (1)  Assessments that require professional nursing judgment, intervention, referral, or follow-up;

    (2)  Formulation of the plan of nursing care and evaluation of the client's response to the care rendered;

    (3)  Tasks involved in the implementation of the plan of care that require nursing judgment or intervention, including:

            (a)  Sterile procedures involving a wound or anatomical site that could become infected, except urinary catheterization;

            (b)  Nasogastric tube feeding;

            (c)  Nasogastric, jejunostomy, and gastrostomy tube insertion or removal; and

            (d)  Tracheostomy care and suctioning;

    (4)  Administration of medications, except as permitted by §§ 20:48:04.01:09 to 20:48:04.01:11, inclusive, and § 20:48:04.01:18;

    (5)  Acceptance of medical orders; and

    (6)  Health counseling and health teaching.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

          20:48:04.01:08.  Client education.Repealed.

          Source: 21 SDR 13, effective August 7, 1994; repealed, 26 SDR 174, effective July 4, 2000.

    20:48:04.01:09.  Requirements for delegated medication administration to a nursing assistant. A licensed nurse may delegate the administration of medications authorized under §§ 20:48:04.01:09.01 and 20:48:04.01:11, inclusive, to a nursing assistant who:

    (1)  Has a minimum of a high school education or the equivalent;

    (2)  Completed a board-approved medication administration training program in accordance with § 20:48:04.01:13 or completed a program that the board determines is equivalent; and;

    (3)  If administering medications in a skilled nursing facility, assisted living center, or a hospital, licensed under SDCL chapter 34-12, are registered with the board in accordance with chapter 20:48:16.

    Source: 21 SDR 13, effective August 7, 1994; 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:09.01.  Delegation of medication administration tasks to a nursing assistant. A licensed nurse may delegate the following medication administration tasks to a nursing assistant if the delegation complies with the general criteria for delegation and supervision set forth in §§ 20:48:04.01:01 and 20:48:04.01:02, respectively:

    (1)  Administration of scheduled medications by oral, sublingual, eye, ear, nasal, rectal, topical, transdermal, vaginal, or inhalation route;

    (2)  Measurement of a prescribed amount of liquid medication or crushing a tablet for administration if a licensed nurse, physician, or pharmacist has calculated the dose; and

    (3)  Administration of schedule II controlled substances listed in SDCL 34-20B-16 and 34-20B-17 that are prescribed and labeled in a container for a specific client.

    If the nursing assistant is administering medications in a hospital setting, a registered nurse must provide direct supervision as defined in § 20:48:01:01.

    Source: 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:10.  Delegation of additional medication administration tasks to a medical assistant. In addition to the tasks listed in § 20:48:04.01:09.01, a licensed nurse may delegate the following medication administration tasks to a medical assistant, who holds current certification with a national certification body approved by the board, in a stable nursing situation as defined in § 20:48:01:01:

    (1)  Administration of scheduled medications by intradermal, subcutaneous, or intramuscular route; and

    (2)  Calculation of the dose of a prescribed amount of medication.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:11.  Medication administration tasks that require a written protocol. A registered nurse must develop, and maintain on file, a written protocol that includes specific medication administration instructions and training requirements, before delegating the following medication administration tasks to a nursing assistant:

    (1)  Administration of the initial dose of a medication that has not been previously administered to the client;

    (2)  Administration of medications on an as-needed basis, including schedule II controlled substances listed in SDCL 34-20B-16 and 34-20B-17 that are prescribed and labeled in a container for a specific client; and

    (3)  Administration of insulin by the subcutaneous route, when a licensed nurse is not available to administer the insulin, in accordance with §§ 20:48:04.01:16 and 20:48:04.01:17.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:12.  Medication administration tasks that may not be delegated. A licensed nurse may not delegate the following tasks of medication administration:

    (1)  Administration of schedule II controlled substances listed in SDCL 34-20B-16 and 34-20B-17 from a locked stock supply;

    (2)  Administration of medications by subcutaneous, intramuscular, intradermal, or intravenous route except as authorized in § 20:48:04.01:10 and 20:48:04.01:16 to 20:48:04.01:18, inclusive;

    (3)  Administration of medications by way of a tube inserted in a cavity of the body, except as authorized in § 20:48:04.01:18;

    (4)  Administration of medications via inhalation route in a complex nursing situation as defined in § 20:48:01:01; and

    (5)  Calculation of any medication dose, except as authorized in § 20:48:04.01:10.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 28 SDR 36, effective September 18, 2001; 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21(4).

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:13.  Approval of training program required for delegated medication administration. Medication administration as outlined in § 20:48:04.01:09.01 to 20:48:04.01:11, inclusive, may be delegated to individuals who have successfully completed a training program approved by the board pursuant to §§ 20:48:04.01:14 to 20:48:04.01:15, inclusive. A training program must apply for renewal every two years.

    Source: 21 SDR 13, effective August 7, 1994; 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:14.  Requirements for approval of medication administration training programs. An institution or individual must submit an application for a training program for delegated medication administration for approval to the board. The board shall grant approval to an applicant upon proof that the training program:

    (1)  Is based on the training curriculum in § 20:48:04.01:15;

    (2)  Includes no less than 16 hours of theoretical instruction;

    (3)  Is taught by a registered nurse who has a minimum of two years of clinical nursing experience and who holds a registered nurse license from the board or privilege to practice;

    (4)  Includes no less than four hours of clinical or laboratory instruction that is taught by a registered nurse or licensed practical nurse who has a minimum of two years of clinical nursing experience and who holds a registered nurse or licensed practical nurse license from the board or privilege to practice.

    The training program must submit an evaluation to the board every two years to demonstrate compliance with program standards in § 20:48:04.01:14.01 to maintain approval.

    Source: 21 SDR 13, effective August 7, 1994; 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:14.01.  Standards for medication administration training programs. An individual or institution approved by the board to offer a medication administration training program must ensure the training program meets the following standards:

    (1)  Maintains a faculty-to-student ratio that does not exceed 1:8 in the clinical setting and a faculty-to-student ratio that does not exceed 1:1 for skills performance evaluation;

    (2)  Requires the student to complete a skills performance evaluation administered by a registered nurse instructor utilizing a board-approved competency checklist;

    (3)  Requires the student to pass a written examination on the curriculum content in § 20:48:04.01:15. A passing score of 85 percent is required on the examination. If the student fails the examination, the student may retake the test one time. If the student fails the retake, additional instruction is required before further testing is allowed;

    (4)  Awards a completion certificate to a student who successfully completes the training program. The certificate must include the name and location of the institution, the length of the program, the date of completion, the full name of the student who completed the program, the signature of the faculty member in charge of the course, and the date the certificate was awarded; and

    (5)  Maintains documentation of:

            (a)  Each student enrolled in the program, including documentation of successful completion or the date and reason the student withdrew or failed;

            (b)  Each faculty member teaching the program, including the qualifications and nursing experience of each faculty; and

            (c)  All tests administered.

    Source: 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:15.  Medication administration curriculum. The training curriculum for delegated medication administration must include:

    (1)  General information relevant to the administration of medications, including:

        (a)  Governmental regulations related to the practice of nursing, the administration of medication, and the storage, administration, and recording of controlled substances;

        (b)  Ethical issues;

        (c)  Terminology, abbreviations, and symbols;

        (d)  Medication administration systems;

        (e)  Forms of medication;

        (f)  Procedures and routes of medication administration;

        (g)  Medication references available;

        (h)  The role of nursing assistive personnel in administering medications;

        (i)  The rights of medication administration including the right patient, right medication, right dose, right time, right route, and right documentation;

        (j)  Infection control policies and procedures;

        (k)  Documentation;

        (l)  Medication errors;

        (m)  Safe medication storage and disposal; and

        (n)  Circumstances to consult with or report to the delegating nurse, including the administration of an as-needed medication, a deviation from the delegated instruction of the nurse, or a concerning observation;

    (2)  An overview of the major categories of medications related to the body systems, including:

        (a)  Cardiovascular;

        (b)  Endocrine;

        (c)  Gastrointestinal;

        (d)  Integumentary and mucous membranes;

        (e)  Musculoskeletal;

        (f)  Nervous;

        (g)  Reproductive;

        (h)  Respiratory;

        (i)  Sensory;

        (j)  Urinary and renal; and

        (k)  Immune;

    (3)  Instruction on categories of medications relevant to the health care setting where the nursing assistant will be administering medications; and

    (4)  Clinical or laboratory instruction demonstrating medication administration and evaluation of individual competence.

    Source: 21 SDR 13, effective August 7, 1994; 26 SDR 174, effective July 4, 2000; 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:16.  Written protocol required for the delegation of insulin administration by the subcutaneous route to a nursing assistant. Before a registered nurse may delegate insulin administration by the subcutaneous route to a nursing assistant, the registered nurse must develop a written protocol. The written protocol must include the following requirements:

    (1) The nursing assistant shall complete a five hour board-approved training in the following areas:

        (a)  Diabetes basics;

        (b)  Hypoglycemia;

        (c)  Hyperglycemia;

        (d)  Blood glucose monitoring;

        (e)  Glucagon administration;

        (f)  Insulin types and methods of administration;

        (g)  Nutrition and physical activity;

        (h)  Documentation; and

        (i)  Standard precautions;

    (2)  The nursing assistant shall pass a written examination on the areas listed in subdivision (1). A passing score of 85 percent is required on the test. If the nursing assistant fails the test, the nursing assistant may retake the test one time. If the nursing assistant fails the retake, additional instruction is required before further testing is allowed;

    (3)  The nursing assistant shall complete a minimum of five hours of clinical or laboratory instruction, including the demonstration of individual competence utilizing a board-approved competency checklist, in the following areas:

        (a)  Blood glucose monitoring;

        (b)  Insulin administration;

        (c)  Glucagon administration;

        (d)  Carbohydrate counting and diet management; and

        (e)  Standard precautions;

    (4)  The registered nurse shall meet in-person with the nursing assistant, after completion of the requirements in subdivisions (1), (2), and (3), during a client’s mealtime at least two times per week in the first four weeks to consult with the nursing assistant and to evaluate competence;

    (5)  The registered nurse must be available by electronic communication at all mealtimes; and

    (6)  The registered nurse shall complete an annual review of the nursing assistant’s competence in each area identified in subdivision (3).

    Source: 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-21.

    20:48:04.01:17.  Qualifications of the registered nurse for delegation of insulin administration by the subcutaneous route to a nursing assistant. A registered nurse must meet the following qualifications to delegate insulin administration by the subcutaneous route to a nursing assistant in accordance with §§ 20:48:04.01:11, 20:48:04.01:16, and 20:48:04.01:18:

    (1)  Hold an active registered nurse license or privilege to practice in this state;

    (2)  Have two years of clinical nursing experience; and

    (3)  Have written evidence of demonstrated competence in the area of diabetes management in the past five years, or completion of a diabetes trainer program approved by the board; or

    (4)  Hold current specialty certification as a Certified Diabetes Educator (CDE).

    Source: 41 SDR 12, effective July 31, 2014; 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-21.

    20:48:04.01:18.  Delegation of specific medication administration. A registered nurse or licensed practical nurse may delegate the administration of one specific medication to be administered to one specific client by a specific nursing assistant, who has not met the requirements in § 20:48:04.01:09, if:

    (1)  A registered nurse has determined that the administration of that one medication by the nursing assistant will allow the client to remain in the client’s usual place of residence;

    (2)  The client does not reside in a nursing facility or assisted living center licensed under SDCL chapter 34-12;

    (3)  A licensed nurse is not available to administer the medication;

    (4)  The delegation complies with the general criteria for delegation and supervision set forth in §§ 20:48:04.01:01 and 20:48:04.01:02, respectively;

    (5)  The licensed nurse fulfills with the nursing assistant the training requirements in § 20:48:04.01:19; and

    (6)  The delegation is not prohibited by any other state statute, rule, federal statute, rule, or guidance.

    Source: 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.01:19.  Training required for the delegation of specific medication administration. A licensed nurse must meet the following requirements before delegating the administration of a specific medication as provided in § 20:48:04.01:18:

    (1)  Provide instruction to the nursing assistant on the specific medication to be administered, including:

            (a)  The trade name and generic name;

            (b)  The purpose of the medication;

            (c)  Signs and symptoms of common side effects, warnings, and precautions;

            (d)  Route of administration; and

            (e)  When to contact the licensed nurse;

    (2)  Verify, through the administration of a test or observation, that the nursing assistant knows:

            (a)  The six rights of medication administration, including the right client, right medication, right dose, right route, right time, and right documentation;

            (b)  The name of the medication and common dosage:

            (c)  The signs and symptoms of side effects for the medication;

            (d)  Circumstances when the licensed nurse should be contacted;

            (e)  How to administer the medication to the client; and

            (f)  How to document the medication administration;

    (3)  Observe the nursing assistant administering the medication to the client until the nursing assistant demonstrates competency;

    (4)  Document the training provided to the nursing assistant; and

    (5)  Evaluate the client when medication orders change to determine if further instruction of the nursing assistant is needed.

    A licensed nurse who delegates the administration of insulin under this section shall follow the requirements of §§ 20:48:04.01:16 and 20:48:04.01:17.

    Source: 49 SDR 51, effective November 27, 2022.

    General Authority: SDCL 13-33A-2, 36-9-21.

    Law Implemented: SDCL 13-33A-1, 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

CHAPTER 20:48:04.02

DELEGATION OF NURSING TASKS TO DIALYSIS TECHNICIANS

Section

20:48:04.02:01    Definition of dialysis technician.

20:48:04.02:02    Definition of end stage renal disease, Repealed.

20:48:04.02:03    Additional functions performed by licensed practical nurse in kidney dialysis.

20:48:04.02:04    Dialysis technician requirements.

20:48:04.02:05    Hemodialysis tasks that may be delegated to dialysis technician.

20:48:04.02:06    Nursing tasks that may not be delegated to dialysis technician.

20:48:04.02:07    Approval of training program required for delegated nursing dialysis tasks.

20:48:04.02:08    Standards for approval of training programs for dialysis technicians.

20:48:04.02:09    Dialysis technician training curriculum.

20:48:04.02:10    Central line dialysis tasks that may be delegated -- Delegation requirements.

20:48:04.02:11    Central line dialysis technician training.

    20:48:04.02:01.  Definition of dialysis technician. A dialysis technician is an individual who is not licensed as a nurse under SDCL chapter 36-9 but is trained to assist a nurse with the provision of hemodialysis tasks, as delegated by the nurse and authorized by this chapter.

    Source: 24 SDR 165, effective June 1, 1998; 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:02.  Definition of end stage renal disease. Repealed.

    Source: 24 SDR 165, effective June 1, 1998; 49 SDR 1, effective July 6, 2022.

          20:48:04.02:03.  Additional functions performed by licensed practical nurse in kidney dialysis. Nothing in this chapter may be construed to affect the practice of the licensed practical nurse performing additional specialized nursing functions in kidney dialysis pursuant to § 20:48:04:02.03.

          Source: 24 SDR 165, effective June 1, 1998; 26 SDR 174, effective July 4, 2000.

          General Authority:SDCL 36-9-21.

          Law Implemented:SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:04.  Dialysis technician requirements. A licensed nurse may delegate hemodialysis tasks as authorized under this chapter to a dialysis technician who:

    (1)  Has a minimum of a high school diploma or the equivalent;

    (2)  Has completed a board-approved training program for dialysis technicians; and

    (3)  Has passed a nationally recognized, board-approved dialysis technician certification examination and holds current certification, or completed a board-approved training program within the last eighteen months.

    Source: 24 SDR 165, effective June 1, 1998; 41 SDR 12, effective July 31, 2014; 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:05.  Hemodialysis tasks that may be delegated to dialysis technician. The following hemodialysis tasks may be delegated to a dialysis technician in a stable nursing situation with direct supervision, as those terms are defined in § 20:48:01:01, and if the delegation complies with the general criteria for delegation and supervision set forth in §§ 20:48:04.01:01 and 20:48:04.01:02, respectively:

    (1)  Assemble any necessary supplies;

    (2)  Rinse and prime dialyzer and attach and install all required tubing according to dialysis prescription and protocol. Test and set monitors and alarms according to protocol;

    (3)  Obtain pre-dialysis vital signs, weight, and temperature and inform registered nurse of abnormal or unusual findings;

    (4)  Inspect access site and report condition to registered nurse;

    (5)  Perform venipuncture to initiate dialysis including the administration of local anesthetics by the intradermal, subcutaneous, or topical routes;

    (6)  Obtain blood samples and blood cultures from extracorporeal circuit, fistula, or graft;

    (7)  Administer heparin and normal saline in the course of a routine hemodialysis treatment according to prescribed protocol;

    (8)  Measure and adjust blood flow rates according to prescribed protocol;

    (9)  Calculate, determine, and adjust fluid removal rates according to prescribed protocol;

    (10)  Monitor and record dialysis treatment parameters and make treatment adjustments including dialysis equipment settings, client positioning, and the administration of normal saline, as directed by the registered nurse. Report all changes to the registered nurse;

    (11)  Monitor equipment for safe and proper functioning, respond to alarms, and make appropriate adjustments;

    (12)  Initiate cardiopulmonary resuscitation measures in the event of a cardiac and/or pulmonary emergency. Respond to dialysis-related emergencies immediately seeking assistance from the registered nurse;

    (13)  Discontinue dialysis and establish hemostasis upon direction of the registered nurse;

    (14)  Inspect, clean, and dress access according to protocol, reporting any unusual finding or occurrence to the registered nurse; and

    (15)  Prepare, test, and monitor water treatment and dialysate.

    Source: 24 SDR 165, effective June 1, 1998; 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:06.  Nursing tasks that may not be delegated to dialysis technician. The following nursing tasks may not be delegated to a dialysis technician:

    (1)  Initiation or discontinuation of dialysis via a central catheter except as authorized in § 20:48:04.02:10;

    (2)  Administration of medications, except as authorized in § 20:48:04.02:05 or as delegated in accordance with §§ 20:48:04.01:09 to 20:48:04.01:13, inclusive;

    (3)  Administration of blood or blood products;

    (4)  Acceptance of medical orders.

    (5)  Assessments that require professional nursing judgment, intervention, referral, or follow-up;

    (6)  Formulation of a plan of nursing care and evaluation of the client's response to the care rendered;

    (7)  Specific tasks involved in the implementation of a plan of nursing care that require nursing judgment or intervention; and

    (8)  Health counseling or teaching.

    Source: 24 SDR 165, effective June 1, 1998; 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

          20:48:04.02:07.  Approval of training program required for delegated nursing dialysis tasks. Selected tasks of hemodialysis therapy may be delegated only to a dialysis technician who has successfully completed a training program approved by the board pursuant to § 20:48:04.02:08. Approval of the training program must be renewed every two years.

          Source: 24 SDR 165, effective June 1, 1998.

          General Authority:SDCL 36-9-21.

          Law Implemented:SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:08.  Standards for approval of training programs for dialysis technicians. An institution or individual desiring to offer a training program for dialysis technicians must submit an application for approval to the board. The board shall approve a training program application if the board determines the applicant has provided proof that the program:

    (1)  Is based on the curriculum outlined in § 20:48:04.02:09 and includes no less than 80 hours of classroom instruction and an additional 200 hours of clinical or laboratory instruction;

    (2)  Is taught by a registered nurse who is licensed or has a privilege to practice in South Dakota and has at least two years of clinical nursing experience and at least one year of experience in hemodialysis. A person who is licensed or has a privilege to practice as a practical nurse in South Dakota with at least two years of clinical nursing experience and at least one year experience in hemodialysis may assist in classroom instruction and serve as a preceptor in the clinical portion of the training program;

    (3)  Has a faculty-to-student ratio that does not exceed 1:2 in the clinical setting. A 1:1 ratio is required for a skills performance evaluation;

    (4)  Has tests for each unit in the curriculum, including a final test. A skills performance evaluation must be conducted;

    (5)  Requires a score of 85 percent or greater on each unit test with an opportunity to retake each unit test one time without additional instruction. If the student fails a unit test a second time, additional instruction is required before further testing is allowed;

    (6)  Awards a completion certificate to a student who has successfully completed the program. The certificate must include the name and location of the program, the length of the program, the date of completion, the full name of the student who completed the program, the signature of the registered nurse who taught the program, and the date the certificate was awarded; and

    (7)  Maintains documentation of the following:

        (a)  Each student enrolled in the program, including documentation of performance, and the date and reason the student withdrew or the date the student failed or completed the program;

        (b)  Each individual teaching the program, including qualifications and nursing experience;

        (c)  The curriculum plan and revisions;

        (d)  Any test administered; and

        (e)  A list of graduates of the program who were awarded certificates and the date of the award.

    The institution or individual offering the training program shall submit an evaluation of the curriculum and program standards for compliance with this section to the board every two years in order to maintain approval.

    Source: 24 SDR 165, effective June 1, 1998; 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:09.  Dialysis technician training curriculum. A training program curriculum for dialysis technicians must include:

    (1)  General information relevant to the performance of selected hemodialysis tasks including:

        (a)  Governmental regulations related to hemodialysis, the practice of nursing, and delegation;

        (b)  The role of the dialysis technician in hemodialysis;

        (c)  Ethical issues;

        (d)  Client rights and responsibilities;

        (e)  Terminology, abbreviations, and symbols;

        (f)  Basic client care skills including the collection of vital signs, weight, intake, and output;

        (g)  Standard precautions and aseptic technique;

        (h)  Quality assurance and continuous quality improvement;

        (i)  Documentation; and

        (j)  Communication and interpersonal skills;

    (2)  Renal anatomy and physiology;

    (3)  Renal disease and treatments;

    (4)  Principles of hemodialysis;

    (5)  Hemodialysis equipment and machines, including water treatment and dialysate preparation;

    (6)  Access procedures;

    (7)  Laboratory procedures;

    (8)  Administration of local anesthetics, normal saline, and heparin;

    (9)  Initiating hemodialysis;

    (10)  Monitoring hemodialysis treatments, troubleshooting, and when to report to the registered nurse;

    (11)  Identification of complications and response to hemodialysis-related emergencies;

    (12)  Discontinuing hemodialysis;

    (13)  Reprocessing and reuse; and

    (14)  Clinical or laboratory instruction for the purpose of demonstration of selected tasks of hemodialysis and evaluation of individual competence.

    Source: 24 SDR 165, effective June 1, 1998; 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-4, 36-9-4.1, 36-9-21.

    20:48:04.02:10.  Central line dialysis tasks that may be delegated -- Delegation requirements. A registered nurse who has at least one year of dialysis experience may delegate central line dialysis tasks in a stable nursing situation with direct supervision, as those terms are defined in § 20:48:01:01, if the delegation complies with the general criteria for delegation and supervision set forth in §§ 20:48:04.01:01 and 20:48:04.01:02, respectively, to a dialysis technician who holds current national certification as a dialysis technician and who has completed a training program that meets the requirements of § 20:48:04.02:11. Consistent with the requirements of this section, a registered nurse may delegate:

    (1)  Initiating and monitoring routine dialysis treatment for stable patients according to institution policy, including:

        (a)  Making adjustments to equipment settings, patient positioning, blood flow rates, and fluid removal rates;

        (b)  Obtaining blood samples and blood cultures; and

        (c)  Administering normal saline, heparin, and low concentration citrate;

    (2)  Discontinuing dialysis treatment; and

    (3)  Performing aseptic dressing change.

    Source: 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-21.

    20:48:04.02:11.  Central line dialysis technician training. An institution or individual desiring to offer a training program for the delegation of central line tasks listed in § 20:48:04.02:10 must submit an application for approval to the board. The board shall approve a training program application if the board determines the applicant has provided proof that the program:

    (1)  Is taught by a registered nurse who is licensed or has a privilege to practice in South Dakota and has at least two years of dialysis experience;

    (2)  Provides a four-hour theoretical course that includes content on:

            (a)  The roles and responsibilities of the dialysis technician and the nurse;

            (b)  Infection control;

            (c)  Documentation;

            (d)  The basic principles of central line catheter placement and functions;

            (e)  The initiation and discontinuation of dialysis through a central line catheter;

            (f)  Monitoring hemodialysis treatment, troubleshooting, and when to report to the registered nurse;

            (g)  The locking of central catheter devices;

            (h)  The administration of normal saline, heparin, or low concentration citrate during the routine course of dialysis treatment and discontinuation of treatment;

            (i)  Aseptic central line dressing changes; and

            (j)  Identifying and responding to complications;

    (3)  Provides a skills lab for the purpose of demonstrating central line dialysis tasks. A skills performance evaluation must be conducted utilizing a board-approved competency checklist to evaluate individual competence. A 1:1 faculty-to-student ratio is required for skills performance evaluation;

    (4)  Administers a test. A passing score of 85% is required on the test with an opportunity to retake the test one time. If a student fails on retake, additional instruction is required before further testing is allowed; and

    (5)  Requires the dialysis technician to observe a registered nurse perform each central line dialysis task a minimum of three times in the clinical setting. Following observation, the dialysis technician must perform each delegated task successfully a minimum of ten times under the direct observation of a registered nurse before performing the central line task without direct observation.

    A registered nurse shall conduct an annual review of the dialysis technician’s competence to perform the central line tasks using a board-approved checklist.

    Source: 49 SDR 1, effective July 6, 2022.

    General Authority: SDCL 36-9-21.

    Law Implemented: SDCL 36-9-3, 36-9-21.