Section 117.63 - Competency Evaluation(a) The governing body shall ensure that the core staff members of the facility review the training records of each trainee, including tests and skills checklists, hear comments from the training instructor(s) and preceptor(s), and validate that the trainee has successfully completed the training program.(b) An individual who completed the facility's orientation program and was determined by the facility to be qualified to deliver dialysis patient care may qualify as a dialysis technician by passing the written examination described in § 117.62(f) of this title (relating to Training Curricula and Instructors) and demonstrating competency by completion of the skills checklist described in subsection (c) of this section.(c) The supervising nurse or a registered nurse who qualifies as an instructor under § 117.62(g)(2) of this title shall complete a competency skills checklist to document each dialysis technician trainee's knowledge and skills for the following allowed acts: (1) assembling necessary supplies;(2) preparing dialysate according to procedure and dialysis prescription;(3) assembling and preparing the dialysis extracorporeal circuit correctly;(4) securing the correct dialyzer for the specific patient;(5) installing and rinsing dialyzer and all necessary tubing;(6) testing monitors and alarms, conductivity, and (if applicable) presence and absence of residual sterilants;(7) setting monitors and alarms according to facility and manufacturer protocols;(8) obtaining predialysis vital signs, weight, and temperature according to facility protocol and informing the registered nurse of unusual findings;(9) inspecting access for patency and, after cannulation is performed and heparin administered, initiating dialysis according to the patient's prescription, observing universal precautions, and reporting unusual findings to the registered nurse;(10) adjusting blood flow rates according to established protocols and the patient's prescription;(11) calculating and setting the dialysis machine to allow fluid removal rates according to established protocols and the patient's prescription;(12) monitoring the patient and equipment during treatment, responding appropriately to patient needs and machine alarms, and reporting unusual occurrences to the registered nurse;(13) changing fluid removal rate, placing patient in Trendelenburg position, and administering replacement normal saline as directed by the registered nurse, physician order, or facility protocol;(14) documenting findings and actions per facility protocol;(15) describing appropriate response to dialysis-related emergencies such as cardiac or respiratory arrest, needle displacement or infiltration, clotting, blood leaks, or air emboli and to nonmedical emergencies such as power outages or equipment failure;(16) discontinuing dialysis and establishing hemostasis:(A) inspecting, cleaning, and dressing access according to facility protocol; and(B) reporting unusual findings and occurrences to the registered nurse;(17) obtaining and recording postdialysis vital signs, temperature, and weight and reporting unusual findings to the registered nurse;(18) discarding supplies and sanitizing equipment and treatment chair according to facility protocol;(19) communicating the patient's emotional, medical, psychological, and nutritional concerns to the registered nurse;(20) obtaining current certification in cardiopulmonary resuscitation; and(21) maintaining professional conduct, good communication skills, and confidentiality in the care of patients.(d) For dialysis technician trainees who will be assisting with training or treatment of peritoneal dialysis patients, the following checklist shall be completed satisfactorily: (1) assisting patients in ordering supplies;(2) making a dialysate exchange (draining and refilling the peritoneal space with dialysate) to include continuous ambulatory peritoneal dialysis exchange procedures, and initiation or discontinuation of continuous cycling peritoneal dialysis;(3) observing peritoneal effluent;(4) knowing what observations to report;(5) collecting dialysate specimen;(6) performing a transfer tubing change; and(7) setting up and operating continuous cycling peritoneal dialysis equipment.(e) For dialysis technician trainees who will be cannulating dialysis access, administering heparin, normal saline, lidocaine, or oxygen the following checklist shall also be completed satisfactorily: (1) cannulation to include: (A) inspecting the access for patency;(C) using aseptic technique;(D) placing needles correctly;(E) establishing blood access;(G) knowing when to call for assistance; and(2) administration of heparin to include:(A) checking the patient's individual prescription;(C) labeling the prepared syringe;(D) administering the dose; and(E) observing for complications;(3) administration of normal saline to include:(A) understanding unit protocol;(B) checking the patient's prescription;(C) recognizing signs of hypotension;(D) notifying the registered nurse;(E) administering normal saline; and(F) rechecking vital signs;(4) administration of lidocaine to include:(A) checking the patient's prescription;(B) identifying the correct vial of medication;(D) administering the dose; and(E) observing for complications; and(5) administration of oxygen to include:(A) verifying the ordered flow rate from the nurse functioning in the charge role;(B) setting up the equipment; and(C) connecting the tubing for the patient.(f) If a dialysis technician other than a licensed vocational nurse is to cannulate a dialysis access, administer normal saline, heparin, lidocaine, or oxygen, the medical director shall verify and document competency of the dialysis technician to perform these tasks and delegate authority to the technician in accordance with Occupations Code, Chapter 157.25 Tex. Admin. Code § 117.63
The provisions of this §117.63 adopted to be effective July 6, 2010, 35 TexReg 5835